MICRO: Enteroviruses / CNS Disease

Question 1

Enteroviruses Microbiology

Answer 1

Single stranded RNA

Unenvoloped

Acid Stable (Differentiates from Rhinoviruses)

Question 2

Enterovirus Transmission

Answer 2

Virus is shed in the faeces and transmitted via the fecal-oral route (can survive gastric acid)

Following ingestion pass to terminal ileum and replicate in submucosal lymphoid tissue (Peyer’s patches)

Major symptoms occur following secondary viremia with
dissemination of infection to target organs=> cytopathic effect

Enteroviruses shed in the upper respiratory tract for 1-3 weeks and in the faeces for up to 8 weeks following primary infection

Question 3

Four main neurological syndromes that can be caused by viruses

Answer 3

1. Aseptic meningitis
2. Encephalitis
3. Acute flaccid paralysis
4. Post-infectious encephalomyelitis

Question 4

Commonest neurological viral syndrome

Answer 4

Aseptic meningitis

Question 5

Answer 5

Question 6

Viral replication occurs in the brain tissue itself, causing destructive lesions in the grey matter

Clinical Presentation?

Answer 6

Encephalitis

Question 7

Viruses that can cause Aseptic Meningitis?

Answer 7

Enteroviruses

Herpes simplex

Varicella zoster virus

Mumps

Question 8

Viruses that can cause Aseptic Meningitis?

Answer 8

Enteroviruses (Majority due to coxsackie B/echoviruses)

Herpes simplex

Rabies

Some Arboviruses

Question 9

Viral infection of motor neurones (grey matter) in the spinal cord by a virus

Answer 9

Acute Flaccid Paralysis

Question 10

Viruses tha cause Acute Flccid Paralysis

Answer 10

Polioviruses 1, 2 and 3 (Vaccine greatly reduced)

Non polio enteroviruses (EV D68) and adenoviruses are responsible for most cases.

Question 11

Clinical syndromes associated with EV?

Answer 11

• Non focal acute febrile illness
• Skin and mucous membranes hand, foot, & mouth disease, herpangina
• Respiratory disease (e.g. EV D68)
• Acute Flaccid Paralysis
• Ocular infections

Question 12

Hand, foot, and mouth disease cuasitive viruses?

Answer 12

EVA71

Group A Coxsackie viruses

Question 13

Hand, foot, and mouth disease causative viruses?

Answer 13

Question 14

Enterovirus A 71 Sequelae

Answer 14

Range of presentations:

• Hand Foot Mouth disease
• Brainstem Encephalitis
• Cardiopulmonary failure

Question 15

Enterovirus D68 Sequelae

Answer 15

Severe respiratory Disease

Acute Flaccid Paralysis

Question 16

What is Post-poliomyelitis Syndrome?

Answer 16

Question 17

Cornerstone of Polio Eradication programme?

Challenges?

Answer 17

Vaccination and acute flaccid paralysis surveillance are cornerstones

5 of the 6 WHO regions which represents >90% of the worlds population are polio free with 2 countries, Pakistan and Afghanistan, continuing to see cases

Most of poliovirus disease in the world today is related to oral vaccine use!! Need to expand use of Intramuscular polio vaccine (inactivated) and make it more affordable

Question 18

Cornerstone of Polio Eradication program?

Challenges?

Answer 18

Vaccination and acute flaccid paralysis surveillance are cornerstones

5 of the 6 WHO regions which represents >90% of the worlds population are polio free with 2 countries, Pakistan and Afghanistan, continuing to see cases

Most of poliovirus disease in the world today is related to oral vaccine use!! Need to expand use of Intramuscular polio vaccine (inactivated) and make it more affordable

Question 19

Antiviral Drug against Rhinoviruses and Enteroviruses?

Answer 19