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Pulm > Micro - Paramyxoviruses (RSV, hPIV, hMPV) > Flashcards

Micro - Paramyxoviruses (RSV, hPIV, hMPV) Flashcards

1
Q

RSV, hPIV, hMPV are (enveloped, nonenveloped) (segmented, nonsegmented) (RNA+, RNA-, DNA)

A

Enveloped nonsegmented RNA-

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2
Q

What distinguishes paramyxoviruses from influenza?

A

They are nonsegmented so antigenicity doesn’t change much unlike the segmented influenza virus

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3
Q

RSV is the leading cause of:

A

Viral LRI in infants

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4
Q

hMPV is the second leading cause of:

A

LRI in kids (behind RSV)

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5
Q

What can hMPV cause in older children and adults?

A

ARDS

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6
Q

Cause of croup? Another name for croup?

A

hPIV1-3

Laryngotracheobronchitis

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7
Q

What faction of the adult population is susceptible to hPIV infection?

A

Elderly

Immunocompromised

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8
Q

What are the two most important distinguishing factors of an RSV/hPIV/hMPV infection?

A

Age and seasonality

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9
Q

When is RSV most common in Memphis?

A

Oct-Mar

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10
Q

At what age is RSV infection most common?

A

2-8

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11
Q

When is hMPV most common?

A

Winter-spring

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12
Q

Most kids have been infected by hMPV by age ___ and seroconversion rates for hMPV ~ 100% by age ___

A

3

10

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13
Q

When is each strain of hPIV1-4 most common?

A 
hPIV1 = autumn of odd # years (biennial)
hPIV2 = follows hPIV1 outbreak
hPIV3 = spring and summer
hPIV4 = sporadic
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14
Q

Where do the paramyxoviruses replicate?

A

CYTOPLASM***

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15
Q

Describe the entry of paramyxoviruses

A

Receptor binding protein and fusion protein mediate fusion of viral envelope with membrane of host cell

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16
Q

What other function besides entry does fusion protein mediate?

A

Fusion of infected cell with adjacent cell = forms SYNCYTIUM*****

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17
Q

Tropism of paramyxoviruses?

A

URT and LRT only; do NOT cause systemic infection

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18
Q

Why don’t paramyxoviruses cause systemic infection?

A

hPIV and hMPV use their HN protein to bind to sialic acid, which is found in the mucus membrane layer lining respiratory epithelium.
Less is known about HSV binding protein, so it’s just called G (for glycoprotein) and it binds nucleolin, found on all cells, and GAGs of the respiratory epithelium

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19
Q

Attachment of hPIV/hMPV vs. RSV

A

RSV does NOT bind sialic acid

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20
Q

Two major envelope proteins of RSV

A

G & F (fusion protein)

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21
Q

Two major envelope proteins of hMPV and hPIV

A

F & HN (hemagglutinin, neuraminidase)

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22
Q

Characteristic feature of paramyxoviruses

A

Syncytia formation (due to F protein)

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23
Q

Two primary cell types targeted by RSV

A

Airway epithelial cells and dendritic cells

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24
Q

Progression of RSV,hPIV,hMPV pathogenesis

A

Infects URT epithelial cells then moves to the LRT via dendritic cells &/or cell-to-cell transfer

25
Q

6 key pathological findings of RSV,hPIV,hMPV infection

A 
Airway inflammation
Necrosis
Sloughing of airway epithelial cells
Edema
Excessive mucus production
Interstitial infiltrates
26
Q

What would you expect to see on CXR of pt with RSV infection?

A

Hyperinflation
Increased interstitial markings
Atelectasis (sometimes)
Pulmonary infiltrates (sometimes)

27
Q

What is croup? Characteristic sx?

A

Laryngotracheobronchitis = edema of the mucus layer and swelling due to hPIV1-4 infection
Barking cough with inspiratory stridor

28
Q

1 cause of bronciolitis and pneumonia in infants < 1 yo

A

RSV

29
Q

Where does RSV initially infect? Possible chronic complication?

A

Nasopharynx

Damage to lung can become permanent and result in chronic lung disease like asthma

30
Q

Sx progression in RSV infection

A

1-3 days after infection = cough, low-grade fever, wheezing (URI sx)
2 days later = tachypnea, polyphonic wheezing, retractions, rales, cyanosis, hypoxemia (LRI sx)

31
Q

RSV sx in adult

A 
Rhinorrhea
Cough
HA
Fever
Fatigue
32
Q

High risk factors for developing severe RSV infx

A 
Prematurity
Infected before 3 months of age
Chronic lung disease
Congenital heart problem
SCID
O2 sat < 95%
RR > 70
Atelectasis
Pneumonitis
Toxic appearance on presentation
Neuromuscular disease
33
Q

Most common presentation of hMPV infection

A

Bronchiolitis +/- pneumonia

34
Q

Who is most susceptible to a severe hMPV infection?

A

Infants < 1 yo
Elderly
Pt on immunosuppressants

35
Q

hPIV is second only to HSV as cause of:

A

Bronchiolitis and pneumonia in infants and young children

36
Q

What other infection is common with RSV and hMPV?

A

Otitis media (think S. pneumoniae)

37
Q

Sx of hMPV infection?

A 
HIGH fever
Rhinorrhea
Tachypnea
Dyspnea
Wheezing
38
Q

Sx of hPIV infection?

A 
Pharyngeal erythema
Nonproductive to minimally productive cough
Nasal congestion
Fever
Cough that develops into croup
Hoarseness (inflammation of vocal cords)
39
Q

How are the paramyxoviruses transmitted?

A

Person-to-person via large droplets

40
Q

What is special about the epidemiology of RSV?

A

It is the most predictable epidemic disease in the US

occurs Oct-Mar

41
Q

Which causes more widespread illness: RSV or influenza?

A

Influenza (RSV emerges only within a community)

42
Q

~100% seroconversion of RSV by age ___; ~100% seroconversion of hMPV by age ___

A

3

10

43
Q

RSV sx vs. common cold sx

A

RSV is more severe

44
Q

(T/F): Most people only get infected with a paramyxovirus once

A

False; reinfection occurs throughout life

45
Q

High risk factors for acquiring RSV

A 
Young kid in daycare
Older sibling in daycare
Crowding
Low SES
Multiple birth sets (especially triplets+)
Minimal breastfeeding
Exposure to pollutants (smoking)
46
Q

Primary RSV infection vs. recurrent RSV infection

A

Recurrent more likely to be confined to URT

also, RSV infection with increasing age likely to be restricted to URT

47
Q

When are you most likely to see croup?

A

Autumn of odd numbered years

48
Q

Diagnostic options for RSV

A
  1. Culture from nasal secretions
  2. ELISA for antigen
  3. RT-PCR
49
Q

Gold standard for diagnosing hMPV

A

RT-PCR (most sensitive test)

50
Q

Although diagnostic assays are generally not used for hPIV, what could be used?

A

High IgM/IgG titer
RT-PCR
Culture
Immunoassay

51
Q

Why isn’t serological testing commonly done is paramyxovirus suspected?

A

Seroconversion is almost universal

52
Q

Which paramyxovirus has a vaccine?

A

None

53
Q

Tx of paramyxovirus infection is mainly:

A

Supportive

54
Q

Goals of supportive tx for paramyxovirus infection?

A

Oxygenation, hydration, nutrition

55
Q

Give some examples of supportive tx used for paramyxovirus infection

A 
Bronchodilator
O2
Ventilation
Fluids
Aerosolized epi
56
Q

Two Rx used for RSV and their MOA

A
  1. Palvizumab - mab that neutralizes RSV

2. Ribavirin - nucleoside analog that prevents replication

57
Q

AE of ribavirin

A

Teratogen

58
Q

Indication for palvizumab vs. ribavirin

A

Palvizumab - premies, high risk pt < 6 months

Ribavirin - pts on immunosuppresant

Pulm (33 decks)

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