Micro - Influenza Flashcards

1
Q

What key thing distinguishes influenza from other RT viruses?

A

Antigenic diversity

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2
Q

Influenza is (enveloped, nonenveloped) (segmented, nonsegmented) (RNA+, RNA-, DNA)

A

Enveloped segmented (reassortment!) RNA-

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3
Q

What determines an influenza type (A vs. B vs. C)?

A

Nucelocaspid and matrix proteins

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4
Q

What determines the subtype of influenza A?

A

HA and NA

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5
Q

What is unique about influenza C vs. influenza A/B?

A

It is usually asymptomatic, only has 7 genome segments (lacks NA gene)

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6
Q

Most important way to reduce mortality/morbidity of influenza?

A

Yearly vaccination

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7
Q

What is the role of HA?

A

Binds sialic acid on mucus membrane layer of respiratory tract –> virion
ATTACHMENT and PENETRATION

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8
Q

Why the name “hemagglutinin”?

A

Sialic acid also on RBCs, so influenza causes clumping of RBCs

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9
Q

Two sections of HA?

A

Antigenic domain and receptor binding sites

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10
Q

What quality of HA contributes to rapid evolution of influenza?

A

Frequent amino acid substitution

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11
Q

What does NA do?

A

Cleaves neuraminic acid to uncover sialic acid so HA can bind to it; once released from host cell, NA cleaves HA-sialic acid bond so virus can spread

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12
Q

What role does M2 play in virulence?

A

Ion channel on influenza A only that allows H+ influx into endosome which lowers the pH and causes protein dissociation = UNCOATING

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13
Q

What role does NS1 play in virulence?

A

Interferon antagonist and inhibits host cell mRNA processing

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14
Q

Genome of influenza A&B vs. influenza C

A
A&B = 8 segments
C = 7 segments (lacks NA; maybe this is why it's not as virulent?)
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15
Q

Replication of influenza vs. paramyxoviruses

A

Influenza - nucleus

HSV, hPIV, hMPV - cytoplasm

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16
Q

What causes new pandemic strains of influenza?

A

Reassortment of influenza A genes in a cell co-infected with animal and human strains –> new strain infects human with no immunity

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17
Q

Main influenza A reservoir

A

Avian

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18
Q

What’s unique about avian influenza A?

A

It infects respiratory and GI tracts = can be passed in bird poo

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19
Q

What’s unique about swine influenza A?

A

Avian influenza can’t directly infect humans, but swine can be infected with avian and human strains –> reassortment –> new viruses

20
Q

2 consequences of influenza A populating human and animal species

A
  1. Reassortment –> new pandemic viruses

2. Animal reservoir –> keeps virus circulating even when humans aren’t infected

21
Q

2 reasons influenza is so contagious

A
  1. Viral shedding occurs about 1 day before illness onset

2. Viral titers are highest in first 48 hours, before you know you’re sick and take precautions

22
Q

What causes mortality associated with influenza?

A

LRT complication, i.e. pneumonia

23
Q

Three types of pneumonic complications that can result from influenza infection:

A
  1. Primary viral
  2. Combined viral-bacterial (both at same time)
  3. Post-influenza bacterial pneumonia (after healed)
24
Q

How can one distinguish primary viral from secondary pneumonia?

A
  1. Primary viral pneumonia comes on within 1-4 days; secondary pneumonia comes on 5 days later
  2. Secondary pneumonia will produce purulent sputum and a productive cough, elevated PMNs, and WBCs on PBS
25
What is Reye's syndrome?
Give ASA to reduce fever in kids --> noninflammatory cerebral edema, fatty infiltration of liver, elevated transaminases and ammonia
26
What should be given to reduce fever in kids?
Acetaminophen (children's tylenol)
27
High risk populations for developing complications from influenza illness
1. Preggers - fetal loss/congenital defects especially if infected during 2-3 trimesters 2. Elderly/immunocompromised - increased viral shedding and duration of illness 3. Infants/young children - immature immunity; increased risk of pneumonia, encephalitis, meningitis
28
Flu-like sx
``` Fever Chills Myalgia Cough Sore throat HA Fatigue Runny nose ```
29
Describe resolution of sx of flu
Systemic sx (chills, fever, etc) subside 3-5 days but respiratory sx (cough, runny nose) persist for weeks
30
Populations with unusual flu presentation
1. Infants/young children: higher fever/convulsions, N/V, abd pain 2. Elderly/immunocompromised - Fever may be absent or low-grade
31
Sx suggesting viral pneumonia has developed
Hemoptysis Tachypnea Worsened cough Dyspnea
32
Sx suggesting secondary pneumonia has developed
Purulent sputum, productive cough, recurrence of fever, dyspnea, increased respiratory sx
33
Seasonality of flu
Winter to early spring | unless pandemic - irrespective of season
34
Flu incubation period
2 days
35
WTF is antigenic drift?
Point mutations in HA & NA genes during viral replication due to selective pressures of increased immunity
36
WTF is antigenic shift?
Major reassortment of HA +/- reassortment of NA genes when cell is co-infected by animal and human strains
37
How to dx influenza
1. H&P, seasonality 2. Rapid antigen test 3. RT-PCR 4. Culture
38
Who gets inactivated influenza vaccine (Fluzone)?
Anyone over 6 months
39
Who gets live attenuated influenza vaccine (FluMist)?
Anyone not preggo and 2-49 yo
40
Composition of current influenza vaccines? How long do they provide protection?
Two A subtypes + a B virus | 2-3 years
41
Who gets antivirals?
Pt with severe flu or at high risk for developing complications
42
Two classes of antivirals for use against influenza?
Neuraminidase inhibitors | M2 inhibitors
43
List the neuraminidase inhibitors
Olsetamivir | Zanamivir
44
List the M2 inhibitors
Amantadine | Rimantidine
45
Olsetamivir and Zanamivir are effective against which types?
A&B (C doesn't have NA)
46
Amantadine and Rimantidine are effective against which types?
A - only A has M2 channel
47
Which antiviral is associated with >99% resistance thus not recommended?
Amantadine