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VIRAL INFECTIONS OF THE

RESPIRATORY TRACT
VIRAL INFECTIONS OF THE
RESPIRATORY TRACT

Influenza virus Parainfluenza viruses


Rhinovirus Respiratory Syncytial
Coronavirus viruses
Adenovirus
Coxsackievirus
INFLUENZA VIRUSES
INFLUENZA VIRUSES
Orthomyxovirus: myxo (viruses interact with mucin (glycoproteins))

ORTHOMYXOVIRUS PARAMYXOVIRUS

RNA genome Segmented Single piece

diameter Smaller (80-120 nm) Larger (150 nm)

Hemagglutinin (H) and


On different spikes On the same one
neuraminidase (N)

Giant cell formation No Yes


DISEASE
Influenza A virus cause
worldwide epidemics (pandemic)
major outbreaks of influenza
occurs virtually every year.

Influenza B virus cause


major outbreaks of influenza
VIRUS
Segmented (8 segments in types A & B, 7 in type C) ssRNA
genome

Helical nucleocapsid

Outer lipoprotein envelope


The envelope is covered with two different types of spikes,
hemagglutinin and a neuraminidase.
Hemagglutinin binds cell surface receptor, to initiate infection.
Neuraminidase releases progeny virus from infected cells.

The internal ribonucleoprotein is the group specific antigen that


distinguishes influenza A, B and C.
ORTHOMYXOVIRUSES
HA - hemagglutinin

NA - neuraminidase

helical nucleocapsid (RNA plus


NP protein)

lipid bilayer membrane

polymerase complex

M1 protein

Type A, B, C : NP, M1 protein


Sub-types: HA or NA protein
ANTIGENIC CHANGES
Influenza viruses especially type A show changes in
antigenicity of hemagglutinin (H) and neuraminidase (N)
proteins.

Antigenic shifts:
major changes based on the reassortment of RNA
segments. It occurs only with influenza A.
Other theories of antigenic shift includes:
Recirculation of existing subtypes
Gradual adaptation of animal viruses to human transmission

Antigenic drifts:
minor changes based on mutations in the RNA
genome.
Animal viruses (aquatic birds, chicken,
swine) are the source of RNA segments
that encode antigenic shift variants.

Because influenza B virus is only a human


virus, there is no animal source of new
RNA segments. Influenza B virus shows
only antigenic drift, but not shift.
Reassortment

Avian H3 Human H2

Human H3
A / PHILIPPINES / 82 (H3N2)

A group antigen of influenza A

Philippines / 82 location and year the virus isolated

H3N2 Hemagglutinin and Neuraminidase types

H1N1 and H3N2 strains of influenza A are the most


common types at this time and are the strains included in
the current vaccine.
Past Antigenic Shifts

1918 H1N1 Spanish Influenza 20-40 million deaths


1957 H2N2 Asian Flu 1-2 million deaths
1968 H3N2 Hong Kong Flu 700,000 deaths
1977 H1N1 Re-emergence No pandemic

At least 15 HA subtypes and 9 NA subtypes occur in


nature. Up until 1997, only viruses of H1, H2, and H3
are known to infect and cause disease in humans.
TRANSMISSION
Airborne respiratory droplets

EPIDEMIOLOGY
Winter months
CLINICAL FINDINGS

Incubation period 24 48 hours

Fever, myalgias, headache, dry cough,


photophobia, shivering

Resolve spontaneously in 4 7 days. Influenza


B is similar to A, but influenza C is usually
subclinical or milder in nature.
COMPLICATIONS
Tracheobronchitis and bronchiolitis
Primary viral pneumonia
Secondary bacterial pneumonia
usually occurs late in the course of disease, after a period
of improvement has been observed for the acute disease.
S. aureus is most commonly involved although S.
pneumoniae and H. influenzae may be found.
Myositis and myoglobinuria
Reye's syndrome
Reye's syndrome is characterized by encephalopathy and
fatty liver degeneration. It occurs in children with viral
infection and are taken aspirin to reduce fever. The disease
had been associated with several viruses; such as
influenza A and B, Coxsackie B5, echovirus, HSV, VZV,
CMV and adenovirus.
LABORATORY DIAGNOSIS
Virus Isolation
Throat swabs, NPA and nasal washings may be used for
virus isolation. It is reported that nasal washings are the
best specimens for virus isolation. Influenza viruses
isolated from embryonated eggs or tissue culture can be
identified by serological or molecular methods.

Rapid Diagnosis by Immunoflurescence


cells from pathological specimens may be examined for the
presence of influenza A and B antigens by indirect
immunofluorescence.

Serology
Demonstration of a rise in serum antibody to the infecting
virus
TREATMENT
Amantidine
The only effective against influenza A.
Act at the level of virus uncoating.
Both therapeutic and prophylactic effects.
Significantly reduces the duration of fever (51
hours as opposed to 74 hours) and illness.
70% protection against influenza A when given
prophylactically.
Rimantadine is an amantadine derivative but not
as effective as amantadine and less toxic.
PREVENTION
Vaccine
killed influenza A (HINI and H3N2 isolates) and B viruses
Protection lasts only 6 months
Yearly boosters are recommended
Should be given to people
Older than 65 years
With chronic respiratory diseases
With chronic cardiovascular diseases.
Immunity to Influenza
Antibody against hemagglutinin (H) is the most important
component in the protection against influenza viruses.
AVIAN INFLUENZA

Avian influenza A viruses usually do not infect humans

Rare cases of human infection with avian influenza viruses have


been reported since 1997 with avian influenza A (H5N1) viruses

All strains of the infecting virus were totally avian in origin and there
was no evidence of reassortment.

Infection in humans are thought to have resulted from direct


contact with infected poultry or contaminated surfaces.

To date, human infections with avian influenza A viruses have not


resulted in sustained human-to-human transmission.
PICORNAVIRUSES
PICORNAVIRUSES
Small (20 30 nm) nonenveloped viruses, with icosahedral
nucleocapsid and ssRNA genome with positive polarity.
Includes two groups:
Enteroviruses
Enteroviruses include poliovirus, coxsackieviruses, echovirus and
hepatitis A virus.
replicate optimally at 37 C
Enteroviruses are stable under acid conditions (pH 3 5)
Rhinoviruses
Rhinoviruses grow better at 33 C in accordance with the lower
temperature of the nose.
Rhinoviruses are acid labile.
RHINOVIRUSES
RHINOVIRUSES
Common cold accounts for 1/3 to 1/2 of all acute
respiratory infections in humans.
Rhinoviruses are responsible for 50% of
common colds, coronaviruses for 10%,
adenoviruses, enteroviruses, RSV, influenza,
parainfluenza can also cause common cold
symptoms indistinguishable form those caused
by rhinoviruses and coronaviruses.
Common cold is a self-limited illness.
More than 100 serologic types of rhinoviruses
(No vaccine)
TRANSMISSION
Directly from person to person via respiratory
droplets
Indirectly in which droplets are deposited on the
hands or on a surface such as table and then
transported by fingers to the nose or eyes.
An individual may suffer 2 to 5 episodes of colds
per year. The primary site of rhinovirus infection
is in the nasal epithelium. Rhinoviruses rarely
cause lower respiratory infection.
CLINICAL FINDINGS
Incubation period: 2 4 days

Sneezing
Nasal discharge
Nasal obstruction
Sore throat
Cough
Headache
Lasts for 1 week
COMPLICATIONS
Acute bacterial sinusitis
The major causes are Pneumococcus, Hemophilus
influenza, Moraxella, and Staphylococci.

Acute bacterial otitis media


mainly a problem in children

Asthma attacks in children

Exacerbation of chronic bronchitis


LABORATORY DIAGNOSIS

Usually, common cold does not require


laboratory investigation

Cell culture isolation from nasal secretion


TREATMENT

Cold treatments recommended include the


following:
Antihistamines
Nonsteroidal antinflammatory drugs
Decongestants (vasoconstrictors)
Cough suppressants (narcotics)
CORONAVIRUSES
CORONAVIRUSES
The group was so named because of the
crown-like projections on its surface.

At present, at least 10 species are


recognized, of which human coronavirus is
one. The other viruses are found in
animals.
PROPERTIES
ssRNA enveloped viruses of pleomorphic
morphology
60 to 220nm in diameter.
Positive stranded RNA; helical symmetry
Three antigenic molecules are found in the
virions i.e. nucleocapsid, surface projection and
transmembrane proteins. The main antigenic
determinants reside on the surface projections.
Human coronavirus strains fall into serological
groups, which are named OC43, and 229E.
EPIDEMIOLOGY
Human coronavirus infections occur during
the winter and early spring.
High infection rates during the year are
caused by either 229E or OC43 group
viruses. This pattern is observed
throughout the world.
Human coronaviruses are responsible for
10 - 30% of all common colds.
DIAGNOSIS AND TREATMENT
Laboratory diagnosis is not attempted.

Coronaviruses have fastidious growth


requirement in cell culture.

No antiviral drugs against coronaviruses


are available.
OTHER CAUSES OF COMMON
COLD SYNDROME
Coxsackievirus
Herpangina (severe sore throat with vesiculoulcerative
lesions)
Pleurisy
common cold syndrome
Adenovirus
Pharyngitis
common cold syndrome
Bronchitis
pneumonia (types 3, 4, 7 and 21)
Influenza C