Viral infection and pathogenesis Flashcards
Pathogenicity, Virulence -> Definitions
- As soon as a germ can lead to a disease, it is classified as a pathogen.
- Im deutschen Sprachgebrauch ist es nicht korrekt, Viren als „hoch pathogen“ oder „schwach pathogen“ zu bezeichnen.
Richtig ist, von „hoch virulent“ oder „schwach virulent“ zu sprechen.
Endemic (Enzooty)
Disease, which occurs within a definied area for an indefinite time periode and without having the tendence to spread (low morbidity, spatial but no temporal limitation).
Example: rabies
Epidemic (Epizooty)
Massed occurance of a dangerous infectious disease with a temporal and spatial limitation while having a high index of manifestation (high morbidity, temporally and spatially limited).
Example: FMDV Great Britain 2001
Pandemic (Panzooty)
Spreading of a epidemic across whole countries or continents (widespread disease without spatial limitation in a certain time period).
Example: Swine Influenza 2009
Morbidity
= [number of sick animals x 100] / number of animals at risk in %
Mortality
= [number of animals which died from the virus x 100] / number of animals at risk
Lethality
= [number of deaths x 100] / number of animals with symptoms
Incidence
= number of new cases of illness within a certain time period
Prevalence
= [number of all existing infection cases x 100] / size of the population
Seroprevalence
= [number of antibody positive individuals („historical infection cases“) x100] / size of the population
Virus entry into the organism
-> Infection = Disease?
To infect the host the virus needs to
- either infect a cell on the body surface
- or break through the protecting body surface
Parenteral inoculation: wounds, insect bites, injection needles, bite injuries
Body surfaces involved in virus entry excretion
- Infection through body surfaces or parental inoculation
- conjunctiva
- respiratory tract
- alimentary tract
- urogenital tract
- anus
- arthropod
- capillary
- scratch, injury
- skin
Infection
1. External skin
- cornificated cells as an almost insurmountable barrier
Exceptions:
Small surface wounds
Infection of epithelial or neural cells:
Pox-, Papillomaviruses (Replication only in fully differentiated keratinocytes)
Example: human papillomavirus (HPV) - deeper wounds, scratches, insect bites, injection needles, sexual contact (access to bloodstream)
- iatrogenic (caused by physician) by nonsterile injection needles: HIV, HBV, CMV, Epstein-Barr Virus,
- arthropods as vector: Alpha-, Flavi-, Reovirus, Bunyavirus and others
- bite by virus carrier (e.g. dog/rabies virus)
Replication cycle of HPV in der Haut
Stratum corneum: High virus production and release of infectious viruses
Stratum granulosum: Few viral particles, many viral genomes, increased transcription of early and late genes
Stratum spinous: Few viral genomes, Transcription of genes E1, E2, E6 and E7
Stratum basale: Very few viral genomes, Minor transcription of genes E1 and E2
Disease induced by Human Papilloma Virus (HPV)
- Transmission by skin contact, sexually
- Chronic-persistent infection of basal cells
- Development of warts through cell proliferation, which usually regress spontaneously
- Benign lesions in the genital area (nether regions) can degenerate into malign lesions. Condylomas can disappear spontaneously or persist (20%)
- Integration of the virus genome leads to transformation, not replication; development into cervical carcinoma after a latency of 20 - 40 years (in 3-6%).
Disease through HPV
- Cytological diagnosis of cervical smear test; classification by degree of severity of the neoplasia
- In most cases neoplasias are precursors of invasive carcinoma
- Can break through basal membrane and metastasize
- Therapy, no specific therapy, surgical removal, Imiquimod, IFNa/b locally and systemically
HPV vaccination
Nobel prize in Medicine 2008
Rabies -> Infection by bite
Transmission to humans: Bite by infected dogs
India: about 50 000 deaths by rabies per year
Germany:
- one fatal case in 1996 and 2004, one in 2007
- officially free of rabies since 2008
Countermeasures:
Extensive vaccination
- of dogs
- of foxes (vaccination bait)
- Vaccination in humans
also therapeutic after infection - passive (anti rabies IgG)
+ active (inactivated vaccine)
Neurotropism
Virus travels after short replication phase in muscle cells via neurons into the CNS, where it is protected from antibodies
Rabies -> transport to the brain
MAY TAKE SEVERAL MONTHS
- Virus inoculated
- Viral replication in muscle
- Virion enters peripheral nervous system
- Replication in dorsal ganglion
- Replication ascent in spinal cord
- Infection of spinal cord, brain stem, cerebellum, and other brain structures
- Descending infection via nervous system to eyes, salivary glands, skin and other organs
Rabies
Symptoms:
* Diagnosis
- hallucinations
- fear of water
- convulsions und paralysis - coma, death
– Clinics: in case of suspicion - involve epidemiology!
– Direct virus detection in the case of suspected rabies (patient alive): IFA or RT-PCR
e.g. saliva sample, skin samples (only positive results are convincing!)
– Direct virus detection in the case of suspected rabies (dead patient) Autopsy: tissue pieces from the brain – hippocampus, cerebellum, pons
* Negri-bodies (alone not sufficient!)
* Immunofluorescence (IFA), detection of rabies antigen in the brain
* Virus isolation
* REITEN-PCR
A Purkinje cell in the cerebellum: The eosinophilic inclusion bodies in the cytoplasm, called Negri bodies, contain viral particles
Negri bodies (NB)
Histopathological changes associated with rabies encephalitis:
Hematoxylin and Eosin stain
Negri bodies: Cellular inclusions in
- pyramidal cells of Ammon’s horn
- Purkinje cells of the cerebellum
- medulla and various other ganglia
- contain TLR3 (central part) and rabies nucleocapsid protein N (periphery)
- TLR3−/− mice show better survival rates and less viral replication
Toll-like Receptor 3 (TLR3) Plays a Major Role in the Formation of Rabies Virus Negri Bodies
Human neurons produce TLR3, a protein involved in early host defence mechanisms and the modulation of neuronal survival.
In this study, we showed that rabies virus exploits TLR3 function to store viral proteins and viral genomic material in particular areas of the cell where virus multiplication occurs. We found that, during the course of infection, large (1–3 μm) spherical inclusions were formed within the region around the nucleus. These inclusions were composed of an inner core of aggregated TLR3 surrounded by a coat of viral proteins and genomic material. These inclusions were revealed to be the previously described
Negri Bodies (NBs).
In absence of TLR3, NBs were no longer formed and virus multiplication rate decreased. Mice deficient in TLR3 were more resistant to rabies and had lower levels of infection in their brains. This study shows how neurotropic viruses, such as rabies virus, hijack normal functions of neuronal proteins and use cell compartmentalisation to promote
viral multiplication.
Direct immunofluorescence
Fluorochrom (FITC) + Akanti N -> Adsorption -> Penetration -> Uncoating -> Transkription -> Translation -> Replikation -> Morphogenese -> Freisetzung
Iatrogenic rabies transmission
- woman dies months after trip to India; serves as organ donor (cornea, kidneys, liver, pancreas): rabies infection had not been detected
- 3 of 6 organ recipients came down with rabies and died
USA: 6-jähriger Junge stirbt an Tollwut
Meldung vom: 16.01.2018
A 6-year-old boy has died of rabies in Florida. The boy was scratched by a sick bat that his father had found and kept. The boy then washed his hands, but a rabies vaccine was not administered - so there was no immediate treatment after exposure.
About a week after being scratched by the bat, the 6-year-old was admitted to the emergency room with hallucinations and convulsions. As he was already showing symptoms of rabies, his survival was virtually impossible at this point.
A subsequent rabies vaccination was no longer possible, so the doctors in charge applied an experimental treatment called the Milwaukee Protocol New Scientist as well as Cambridge.org - but without success. The boy died on Sunday in Orlando Hospital as a result of his rabies infection.
Wild animals account for the vast majority of rabies cases in the United States; in 2015, more than 5,500 rabid animals were identified in the US. Only one or two people die of rabies in the United States each year. Prior to this case in Florida, the last person to die from rabies in the US was a 65-year-old woman from Virginia who was bitten by a dog.
Vector transmission Arthropde borne (Arbo)
Tick-borne viruses
e.g. – pathogen
of Tick Borne Encephalitis Virus (TBEV)
- transmitted by ticks
- first appearance in the Vienna Woods
- many lumberman with paralysis
- full protection through vaccination
West Nile Virus (Genus Flavivirus)
Infection
2. Respiratory tract
Epithelial cells of the respiratory tract
- target cells of many viruses: important site of infection
Countermeasures:
- translocation of mucous layer by ciliated epithelium
- only particles < 5μm can pass to the alveoli (thus big drops can not pass)
- control by alveolar-macrophages
Aerosols
- within and beyond 1 meter
- can float in air for hours
- can be inhaled
- < 5 µm
- 5-100 µm
Droplets
- Can travel less than 1 meter
- Fall to the ground in under 5 seconds
- Cannot be inhaled
- > 100 µm
Infections of oropharynx and respiratory tract
- Rubella Virus
- Rhinovirus
- Coronavirus
- Parainfluenza virus
- Respiratory syncytial virus
- Influenza virus
- Adenovirus
- Herpes Simplex Virus
- Epstein Barr virus
Examples of virus infections via the respiratory tract
LOCALISED INFECTION OF THE UPPER RESPIRATORY TRACT
Rhinovirus, Coxsackievirus (Picornaviridae) Arenaviruses, Hantaanvirus (Buyaviridae) Parainfluenza virus (types 1-4) and RSV (Mononegavirales); Coronaviridae Influenza A and B virus (Orthomyxoviridae) Adenoviruses (types 1-7, 14, 21)
LOCALISED OF THE LOWER RESPIRATORY TRACT
RSV, Parainfluenzavirus (types 1-3), Influenza A und B viruses, Adenoviruses (types 1-7, 14, 21) Infectious bovine rhinotracheitis virus (Herpesviridae)
ENTRY OVER THE RESPIRATORY TRACT WITH SUBSEQUENT SYSTEMIC SPREADING
FMDV, Rubellavirus, Arenaviridae, Hantavirus, Mumps virus, Measles virus, Varizella Zoster Virus, Pox viruses
Infection of the respiratory tract by influenza viruses
Influenza hemagglutinin (HA) binds to terminal silica acid residues as receptor
Highly virulent avian influenza virus (H5N1): sialic acid alpha 2-3 Gal
human influenza viruses (H1N1) or (H3N2): silica acid alpha 2-6Gal
Transfer to humans has not occurred so far, since human to human transmission is inefficient
Receptor abundances as molecular basis?
Hypothesis
Mucosal epithelial cells of the upper and lower respiratory tract carry different sugar residues structures on their surface
- Bad reputation of H5N1 in upper respiratory tract (1918 virus very efficient)
- Inefficient infection and release
New primary culture experiments: Hypothesis wrong?
Sala 2-3Gal/Sala 2-6Gal distinction is not sufficient :
Sugar topology is crucial as well
Infection
3. Oropharynx and gastrointestinal tract
- oral virus uptake
- infection of mucosa in mouth and pharynx
- tonsils
-> Adenovirus, Pestiviruses - gastric and intestinal area: only when stable against acid pH!
- Enteroviruses (e.g. Hepatitis A)
- Calicivirus (Noroviruses)
- Reoviruses
->uncoated
coated:
- enteral Coronaviruses: protection by casein/associated proteins
Infection of the gastrointestinal tract
Intestinal mucosa is an effective barrier
- different pH-values
- mucus
- phagocytes und antibodies
- GALT “gut assoz. lymphoid tissue“
- e.g. Peyer‘s Patches
Lymph follicles in mucosa have specialized epithelia on luminal side, which contains M-(membranous epithelium) cells
M-cells take up antigens and present them to lymphocytes which are located beneath:
Trans-cytosis = Transfer through M-cell membranes without degradation
Infection of the gastrointestinal tract
-> Virus entry through M-cells
- Entry via M-cells followed by further spreading: Reovirus Poliovirus: only trans-cytosis – no replication in M-cells?
- Infection and replication in M-cells without further spreading Destruction of M-cells leads to inflammation/diarrhea:
Virus of transmissible gastroenteritis TGEV (corona virus of pigs) Rotavirus
Routes of viral infection (Entry)
DIGESTIVE TRACT
Local replication: Coronavirus, Rotavirus
Systemic replication: Enterovirus, Reovirus, Adenovirus
UROGENITAL SYSTEM
Local replication: Papillomavirus HPV (carcinoma)
Systemic replication: HIV-1, HBV, HSV
EYE
Local replication (normal case): Coxsackievirus, Echovirus, Adenovirus
Systemic replication (rarely): Enterovirus 70, HSV
Host specificity and tissue tropism
Definition:
Host – Species, race or age (infection, replication, excretion) which serves viral reproduction
Viruses with minor host specificity
- Alphaviruses: Hosts are birds, arthropods, mammals
- Genus Flavivirus: Hosts are birds, arthropods, mammals
- Rabies virus
Viruses with high host specificity
- Herpesviruses (exception Pseudorabies virus)
- Papillomaviruses
- Retroviruses
- Hepatitis Viruses: HCV, HBV
Viral tropism
Preferred locations of replication in the body
- Affinity of viruses to certain organs / cell types z.B. dermatotropic, epithelotropic, pneumotropic, hepatotropic, neurotropic, lymphotropic
Viruses with distinct tropism
Hepatotropic: Humans: hepatitis pathogens HAV, HBV, HCV + Rabbit: Caliciv. Rabbit Hämorrhagic Disease Virus (RHDV)
Neurotropic: Rabies virus; FSME virus; Herpes viruses (EBV, HSV, VZV)
Pneumotropic: Influenza virus
Epithelotropic: Papilloma viruses
Dermatotropic: Parapoxvirus: Molluscum contagiosum V., “Dellwarzenvirus”
Lymphotropic: Human T-cell-lymphotropic virus type I, HTLV I, Eppstein Barr Virus
Viruses without broad tropism
Pathogens causing systemic diseases
- Morbillivirus: distemper virus (“Staupevirus” in dogs, „Seehundsterben“)
- Filoviruses, Adenoviruses, Pestiviruses, Poliovirus, VSV