Virology 4

Question 1

Gastrointestinal/Enteric Viruses

• ___virus
• ___virus
• ___viruses
• ___virus: Virus that comes into play with outbreaks of diahhreal disease on cruise ships

____virus

• ___ ___virus
• ___viruses
• ___viruses

•

Answer 1

• rotavirus
• adenovirus
• caliciviruses
• Norovirus
• Sapporovirus
• hepatitis E virus
• astroviruses
• polioviruses

•

Question 2

Rotavirus Characteristics

• ___virus family; ___, ___ ____ capsid, ____ ___ genome; ___ segments
• ___ to environmental and GI conditions
• ___ groups, ____ serotypes
• most common cause of ___ ___ among ___
• virus ___ cells of the epithelium overlying the ___

Segmented genome

Genes are encoded by 11 segments of RNA
Naked Capsid Virus so resistant

Answer 2

• reovirus family; naked, double-layered capsid, segmented RNA genome; 11 segments
• resistant to environmental and GI conditions
• five groups, seven serotypes
• most common cause of severe diarrhea among children
• virus lyses cells of the epithelium overlying the villi

Segmented genome

Genes are encoded by 11 segments of RNA
Naked Capsid Virus so resistant

Question 3

Rotavirus Pathogenesis

It gets into ____l cells of the GI tract.

It enter ____

Virus ____ and produces a___

It makes its own toxin which contributes to the ___ ___ ass with the virus

Virus ____ these cells and infects ___ cells

___ cells begin to ___ and the ___ exit the body

Answer 3

It gets into epithelial cells of the GI tract.

It enters cytoplasm

Virus multiplies and produces a toxin

It makes its own toxin which contributes to the severe diahhrea ass with the virus

Virus leaves these cells and infects healthy cells

Epith cells begin to die and the fluids exit the body

Question 4

Rotavirus Facts and Figures

• transmitted by _____ route
• prior to vaccine, ___% infected by age 5
• may be as many as ____ viral particles/gram of stool
• some children hospitalized because of____
• infants younger than ___ ____most susceptible
• vaccination

–RotaTeq® licensed in 2006

–Rotarix® licensed in 2008

•very severe, possibly fatal infection in ____ people; may cause up to 500,000 deaths/year in ____ countries where ___ is unavailable

Vaccine is relatively new. A lot of kids are immune bc they actually had the infection.

Crowding in underdeveloped world also helps to spread the infection.

Don’t need to know names of vaccines for each virus unless she REALLY emphasized it

Answer 4

• transmitted by fecal-oral route
• prior to vaccine, >90% infected by age 5
• may be as many as 1010 viral particles/gram of stool
• some children hospitalized because of dehydration
• infants younger than 24 months most susceptible
• vaccination

–RotaTeq® licensed in 2006

–Rotarix® licensed in 2008

•very severe, possibly fatal infection in malnourished people; may cause up to 500,000 deaths/year in underdeveloped countries where vaccine is unavailable

Vaccine is relatively new. A lot of kids are immune bc they actually had the infection.

Crowding in underdeveloped world also helps to spread the infection.

Don’t need to know names of vaccines for each virus unless she REALLY emphasized it

Question 5

Enteric Adenoviruses

• types __ and ___
• most common ___ ____ in infants and children since the introduction of ___ ___

As we get protection against one virus, then other viruses emerge to create the same problems

•____day incubation period

Answer 5

• types 40 and 41
• most common diarrheal illness in infants and children since the introduction of rotavirus vaccine

As we get protection against one virus, then other viruses emerge to create the same problems

•8-10 day incubation period

Question 6

Noroviruses

• ___viruses–small, ___, ___ stranded _NA
• named for the original strain “___ ___”; caused a gastroenteritis outbreak in ___, __in 1968
• resistant to ___, ___, ____
• highly____ (___ particles can cause infection)
• fecal-oral transmission
• symptoms–___, ___, ___

Similar to ___ virus but in a different family

Answer 6

• caliciviruses–small, naked, ssRNA
• named for the original strain “Norwalk virus”; caused a gastroenteritis outbreak in Norwalk, OH in 1968
• resistant to detergents, drying, acid
• highly contagious (10 particles can cause infection)
• fecal-oral transmission
• symptoms–diarrhea, nausea, vomiting

Similar to polio virus but in a different family

Question 7

Norovirus Epidemiology

• leading cause of ___ ____ outbreaks in the U.S.
• 19-21 million cases of ____/yr
• 1.7-1.9 million ____visits/yr; 400,000 ___ visits/yr
• 56,000-71,000 ____/yr
• outbreaks common in __ ___ facilities, especially ___ ___care facilities
• causes 90% of diarrheal disease outbreaks on ___ ___
• leading cause of ___ _____ worldwide

Outbreaks common on cruise ships

Graph shows a couple of times there’s been a pandemic

No ___ or ____

For most of these GI: Just make sure that there is ___ ___ so patients don’t have any other problems ass with infection

Answer 7

Norovirus Epidemiology

• leading cause of foodborne disease outbreaks in the U.S.
• 19-21 million cases of gastroenteritis/yr
• 1.7-1.9 million outpatient visits/yr; 400,000 ER visits/yr
• 56,000-71,000 hospitalizations/yr
• outbreaks common in health care facilities, especially long-term care facilities
• causes 90% of diarrheal disease outbreaks on cruise ships
• leading cause of viral gastroenteritis worldwide

Outbreaks common on cruise ships

Graph shows a couple of times there’s been a pandemic

No trt or vaccines

For most of these GI: Just make sure that there is adequate hydration so patients don’t have any other problems ass with infection

Question 8

Poliovirus Infections

• mainly affects ___ under 5 yrs of age
• 1/___ infections leads to irreversible____
• cases have ____by 99% since 1988
• 1988—350,000 cases
• 2013—406 reported cases
• global effort to eradicate disease
• _____ vaccine used in U.S. since 2000; oral (____) vaccine used in many parts of the world

____ been eradiated in US. Last case in US was in ___. But its still out there.

Paralytic polio is not the typical presentation.

Attenuated vaccine: Given in form of a __ ___

Now we use an inactivated vaccine.

Advantages of attenuated vaccine are that you can ___ target tissue and illicit i___ ___without getting___

Answer 8

Poliovirus Infections

• mainly affects children under 5 yrs of age
• 1/200 infections leads to irreversible paralysis
• cases have decreased by 99% since 1988
• 1988—350,000 cases
• 2013—406 reported cases
• global effort to eradicate disease
• inactivated vaccine used in U.S. since 2000; oral (attenuated) vaccine used in many parts of the world

•

Basically been eradiated in US. Last case in US was in 1980. But its still out there.

Paralytic polio is not the typical presentation.

Attenuated vaccine: Given in form of a sugar cube

Now we use an inactivated vaccine.

Advantages of attenuated vaccine are that you can infect target tissue and illicit immune response without getting disease

Question 9

Cases of polio

Not ____eradicated

Answer 9

Not completely eradicated

Question 10

Coxsackievirus and Echovirus Infections

• Coxsackie A associated with diseases with ___ ___
• Coxsackie B associated with ___ and___
• most common results of infection

–____

–mild ___ ___, __-like illness

•___(aseptic) ____-echovirus __

Vesicular lesion that occur in the _____—> Coxsackie A virus

Coxsackie B virus is associated with infection of the myocardum and ___ of the lungs

Not ____ in kids

Named after___ ___

Answer 10

• Coxsackie A associated with diseases with vesicular lesions
• Coxsackie B associated with myocarditis and pleurodynia
• most common results of infection

–subclinical

–mild upper respiratory, flu-like illness

•viral (aseptic) meningitis-echovirus 11

Vesicular lesion that occur in the mouthà Coxsackie A virus

Coxsackie B virus is associated with infection of the myocardum and lining of the lungs

Not uncommon in kids

Named after coxsackie NY

Question 11

Hand, Foot, and Mouth Disease

• Coxsackie ___ is most common cause
• Enterovirus ___ associated with outbreaks
• vesicular lesions on ___, ___ and, in ___

AKA (____)

•mild, ____ illness

Coxsackie causes hand, foot and mouth disease

Serotype A16 is the most common cause

Disease is sometimes called herpangina

Febril (fever)

Answer 11

Hand, Foot, and Mouth Disease

• Coxsackie A16 is most common cause
• Enterovirus 71 associated with outbreaks
• vesicular lesions on hands, feet, in mouth (herpangina)
• mild, febrile illness

Coxsackie causes hand, foot and mouth disease

Serotype A16 is the most common cause

Disease is sometimes called herpangina

Febril (fever)

Question 12

Respiratory Tract Viruses

• ___virus
• ___virus
• _____virus
• ___virus
• ____ virus
• respiratory ____ virus
• enterovirus___
• ___
• ___
• ___
• parvovirus ___

Answer 12

• adenovirus
• coronavirus
• parainfluenzavirus
• rhinovirus
• influenza virus
• respiratory syncytial virus
• enterovirus 68
• measles
• mumps
• rubella
• parvovirus B19

Question 13

Adenovirus Characteristics

___, ____, ___ viruses

• fibers at ____; ___
• ___serotypes of human adenovirus
• ___, ___ and ___ infections

Naked so Stable in the environment

They have pentagon fibers that stick out. Fibers at vertices of pentagon are toxic to the cell

This is an important mechanism of pathogenesis of this virus

__ and __ cause enteric disease. ___ cause resp disease.

They can cause lytic infections, persistent infections and latent infections so they can hang around and cause problems

Answer 13

• naked, icosahedral, DNA viruses
• fibers at vertices; toxic
• 52 serotypes of human adenovirus
• lytic, persistent, and latent infections

Naked so Stable in the environment

They have pentagon fibers that stick out. Fibers at vertices of pentagon are toxic to the cell

This is an important mechanism of pathogenesis of this virus

40 and 41 cause enteric disease. Most cause resp disease.

They can cause lytic infections, persistent infections and latent infections so they can hang around and cause problems

Question 14

Common Adenovirus Illnesses

• endemic, ___ ___ ___–5-10% of pediatric respiratory disease
• ____
• ________
• ____ ___ ___
• _____–15% ofgastroenteritis in hospitalized patients
• acute ___ ____
• ______
• ___

Most common illnesses of adenovirus infection is acute resp disease

5-10% of pediatric resp diesease is caused by adenovirus

Adenovirus conjunctivitis: not that easy to distinguish what would be caused by bacteria. If you have bad sore throat and then get conjuntivitis, you can almost be sure it is from adenovirus

• gastroenteritis–15% of gastroenteritis in hospitalized patients
• Easy to spread
• acute hemorrhagic cystitis
• Bleeding from bladder
• meningoencephalitis
• hepatitis

Wide variety of clinical manifestations

Most significant ones are GI disease and resp disease

Problems in people who are __ ____

Answer 14

• endemic, acute respiratory disease–5-10% of pediatric respiratory disease
• pneumonia
• keratoconjunctivitis
• pharyngoconjunctival fever

•gastroenteritis–15% of
gastroenteritis in hospitalized patients

• acute hemorrhagic cystitis
• meningoencephalitis
• hepatitis

Most common illnesses of adenovirus infection is acute resp disease

5-10% of pediatric resp diesease is caused by adenovirus

Adenovirus conjunctivitis: not that easy to distinguish what would be caused by bacteria. If you have bad sore throat and then get conjuntivitis, you can almost be sure it is from adenovirus

• gastroenteritis–15% of gastroenteritis in hospitalized patients
• Easy to spread
• acute hemorrhagic cystitis
• Bleeding from bladder
• meningoencephalitis
• hepatitis

Wide variety of clinical manifestations

Most significant ones are GI disease and resp disease

Problems in people who are not immunocompetent

Question 15

Adenovirus Disease Mechanisms

• transmission
• ___
• __ __
• __ ___ for enteric ones
• ____ of___

____ objects

• ___ ____
• infection of mucoepithelial cells
• ___ tract
• ____l tract
• ____
• ____cell damage
• ___ important
• ___
• ___
• type of disease determined by tissue___ of group and ___

Virus in saliva can cause infection in the eyes

Swimming in contaminated pools

Virus can infect epithelial cells of resp tract, GI, and conjuctiva

Causes direct cell damage by the fibers that she talked about

Ab is important in protecting against reinfection and resolving the disease

Answer 15

• transmission
• aerosol
• close contact
• fecal-oral for enteric ones
• autoinoculation of eyes
• inanimate objects
• swimming pools
• infection of mucoepithelial cells
• respiratory tract
• gastrointestinal tract
• conjunctiva
• direct cell damage
• antibody important
• protection
• resolution
• type of disease determined by tissue tropism of group and serotype

Virus in saliva can cause infection in the eyes

Swimming in contaminated pools

Virus can infect epithelial cells of resp tract, GI, and conjuctiva

Causes direct cell damage by the fibers that she talked about

Ab is important in protecting against reinfection and resolving the disease

Question 16

Adenovirus Epidemiology/Treatment

• risk groups include those in ___ ___ centers, ___ ___ camps,____ clubs
• some people infected with adenoviruses can have ____ infections in their ___, ___s, and____ that __ __ ___ symptoms
• they can ___ the virus for ___ or ___

_____ infections lead to ___

•___, ___ vaccine against adenovirus types _ and _ was approved by the FDA in March 2011 for U.S. ___ personnel 17 through 50 years old

Can asymptomatically spread the virus

___ ____ vaccine for adenovirus

There was oral vaccine for types 4 and 7 used in military but not used for general popl.

Not worth a huge immunization program

Answer 16

Adenovirus Epidemiology/Treatment

• risk groups include those in day-care centers, military training camps, swimming clubs
• some people infected with adenoviruses can have ongoing infections in their tonsils, adenoids, and intestines that do not cause symptoms
• they can shed the virus for months or years
• asymptomatic infections lead to spread
• live, oral vaccine against adenovirus types 4 and 7 was approved by the FDA in March 2011 for U.S. military personnel 17 through 50 years old

Can asymptomatically spread the virus

No general vaccine for adenovirus

There was oral vaccine for types 4 and 7 used in military but not used for general popl.

Not worth a huge immunization program

Question 17

Rhinovirus Characteristics

• ____–__, ___, ___serotypes
• acid ____; do not replicate in ___ ___
• resistant to ___ and ___
• grow best at ____
• infection initiated by as little as __ viral particle
• peak illness ® ______ infectious virions/ml in nasal secretions

___ ___

Stable in the environment

100 serotypes, that’s why we get colds over and over again. Never develop good immunity to any of them

Don’t replicate in GI tract.

Grow best at 33 degrees which is the temperature of our ___ ___. That’s why cold symproms localized to upper respiratory tract

Highly infectious

Answer 17

• picornavirus–naked, RNA, 100 serotypes
• acid labile; do not replicate in gastrointestinal tract
• resistant to drying and detergents
• grow best at 33oC
• infection initiated by as little as 1 viral particle
• peak illness ® 500-1000 infectious virions/ml in nasal secretions

Common cold

Stable in the environment

100 serotypes, that’s why we get colds over and over again. Never develop good immunity to any of them

Don’t replicate in GI tract.

Grow best at 33 degrees which is the temperature of our nasal passages. That’s why cold symproms localized to upper respiratory tract

Highly infectious

Question 18

Rhinovirus Clinical Syndrome

• ___
• ____ (runny nose)–due to release of____ and____; ___ at first, then ___/___ (___ ___), and then ___ (not an indication for antibiotics; __ ___ are __ __)
• nasal obstruction
• sore throat
• headache
• ___
• occasionally __ and ____

These are the symptoms

Runny nose is clear at first and then turns white/yellow. That’s when everyone runs to to doctor. Simply reflection of immune response fighting off infection.

Answer 18

Rhinovirus Clinical Syndrome

• sneezing
• rhinorrhea (runny nose)–due to release of bradykinin and histamine; clear at first, then white/yellow (immune response), and then green (not an indication for antibiotics; normal flora are growing back)
• nasal obstruction
• sore throat
• headache
• malaise
• occasionally fever and chills

These are the symptoms

Runny nose is clear at first and then turns white/yellow. That’s when everyone runs to to doctor. Simply reflection of immune response fighting off infection.

Question 19

Rhinovirus Epidemiology/Treatment

• cause of___ of all___ ___ ___
• immunity is ___
• transmission

____

____

___ to ___–hands (virus can be recovered from the hands of 40-90% of persons with colds)

• half of all infections are ____
• disease more common in __ ___ and____ ___
• symptomatic control
• plenty of___
• ___medicines

Immunity is Transient. Bc they infect the nasal cavity you don’t get a huge immune response

___ viremia. The infection is localized. If anything there may be small ___ ___ to virus. But No ____ immunity bc of localization

Fomites: inamnimate objects

Most common way is person to person on the hands

Answer 19

• cause of 1/2 of all upper respiratory infections
• immunity is transient
• transmission
• aerosols
• fomites
• person-to-person–hands (virus can be recovered from the hands of 40-90% of persons with colds)
• half of all infections are subclinical
• disease more common in early fall and late spring
• symptomatic control
• plenty of liquids
• OTC medicines

Immunity is Transient. Bc they infect the nasal cavity you don’t get a huge immune response

No viremia. The infection is localized. If anything there may be small SIgA response to virus. But No systemic immunity bc of localization

Fomites: inamnimate objects

Most common way is person to person on the hands

Question 20

Coronavirus Characteristics

• ___, ___ virus
• ___, ___-like appearance
• grows best at____
• infects epithelial cells of the __ ___ __

Different from rhinovirus because these are enveloped

Answer 20

Coronavirus Characteristics

• enveloped, RNA virus
• solar, corona-like appearance
• grows best at 33-35oC
• infects epithelial cells of the upper respiratory tract

Different from rhinovirus because these are enveloped

Question 21

Coronavirus Epidemiology

• ___ most prevalent cause of the __ __
• cause ____% of ___ ___ tract infections and ___
• spread by ___ and in __ ___
• re-infection occurs __ ___

•

Occasionaly cause pneumonia but that is rare

re-infection occurs despite antibodies bc its just a__ ___ response in general

Answer 21

Coronavirus Epidemiology

• 2nd most prevalent cause of the common cold
• cause 5-10% of upper respiratory tract infections and pneumonia
• spread by aerosols and in large droplets
• re-infection occurs despite antibodies

•

Occasionaly cause pneumonia but that is rare

re-infection occurs despite antibodies bc its just a local immune response in general

Question 22

Severe Acute Respiratory Syndrome-SARS

• global attention in 2/2003
• caused by ___-__
• WHO notified of 305 cases of atypical pneumonia in __ ___
• SARS declared contained in 7/2003
• >8,000 cases
• 780 deaths
• 29 countries
• most recent human cases of SARS-reported in ___ in April 2004 in an outbreak resulting from ___ ___ ___

It was shown that SARS is caused by a ____

This is an example of a virus that Shows up, makes a bunch of people sick and then goes away

About __% mortality

Answer 22

Severe Acute Respiratory Syndrome-SARS

• global attention in 2/2003
• caused by SARS-CoV
• WHO notified of 305 cases of atypical pneumonia in Guangdong Province
• SARS declared contained in 7/2003
• >8,000 cases
• 780 deaths
• 29 countries
• most recent human cases of SARS-reported in China in April 2004 in an outbreak resulting from laboratory-acquired infections

It was shown that SARS is caused by a Coronavirus

This is an example of a virus that Shows up, makes a bunch of people sick and then goes away

About 10% mortality

Question 23

MERS-CoV

• first reported in___ ___ in 2012
• severe,__ ___ illness
• spread through ___ __
• ___, ___, ___ of ___
• ___% mortality
• likely origin is ___; transmitted by ___
• ___ cases in U.S. in 2014
• outbreak in ___ in 2015

Another one that popped up

Middle East Resp Syndrome

This was also a Coronavirus

Came from bats, transmitted it to camels and then people in contact with camels got infected

Cases in US were in people who had traveled to the middle east

Answer 23

MERS-CoV

• first reported in Saudi Arabia in 2012
• severe, acute respiratory illness
• spread through close contact
• fever, cough, shortness of breath
• 30% mortality
• likely origin is bats; transmitted by camels
• two cases in U.S. in 2014
• outbreak in Korea in 2015

Another one that popped up

Middle East Resp Syndrome

This was also a Coronavirus

Came from bats, transmitted it to camels and then people in contact with camels got infected

Cases in US were in people who had traveled to the middle east

Question 24

Current Status of MERS Outbreak

Still some hotspots of MERs in the__ __and __

Answer 24

Still some hotspots of MERs in the middle east and Korea.

Question 25

Respiratory Syncytial Virus (RSV)
Characteristics

• _____virus–___, __NA, ____ core; cause ___ ___
• causes____ infection of ___ tract
• highly ____
• causes ____, ___ in children < 1 yr
• causes ___ ___ and ____ in young kids
• causes __ ___ in older kids and adults

Similar to virus that causes measles and mumps

Severe in kids who are less than a year old

In young kids, it causes fever and sore throat and cold

Answer 25

Respiratory Syncytial Virus (RSV)
Characteristics

• paramyxovirus–enveloped, RNA, helical core; cause syncytia formation
• causes localized infection of respiratory tract
• highly contagious
• causes bronchiolitis, pneumonia in children < 1 yr
• causes febrile rhinitis and pharyngitis in young kids
• causes common cold in older kids and adults

Similar to virus that causes measles and mumps

Severe in kids who are less than a year old

In young kids, it causes fever and sore throat and cold

Question 26

RSV Epidemiology

• the most common cause of severe ___ ___ tract disease among ___ and __ ___worldwide
• can be devastating in ___ ___
• infects nearly ___ by age 2
• large-droplet ____; transmitted by ___, ____, contact with ___ ___
• treatment with ___ (___ analog) ____ in only most severe cases; palivizumab( ___ ___) for ____ infants
• outbreaks occur in communities __ ___, usually lasting __ months during the___ ____ and/or ___ months

We don’t think of these resp viruses very often causing pneumonia. Some of them do.

RSV can get into to lower resp tract and cause infants and young children

Treatment for children who are infected: For RSV, its ribavirin

Ribovirin also treat___ and ___

It’s a nucleoside analogà get into NA and prevents its replication

Its given as a ___ in babies and you can give an immune globin in severe cases or premature infants

Answer 26

RSV Epidemiology

• the most common cause of severe lower respiratory tract disease among infants and young children worldwide
• can be devastating in hospital nurseries
• infects nearly everyone by age 2
• large-droplet aerosols; transmitted by hands, fomites, contact with respiratory secretions
• treatment with ribavirin (nucleoside analog) nebulization in only most severe cases; palivizumab (immune globulin) for premature infants
• outbreaks occur in communities each year, usually lasting 4-5 months during the fall, winter, and/or spring months

We don’t think of these resp viruses very often causing pneumonia. Some of them do.

RSV can get into to lower resp tract and cause infants and young children

Treatment for children who are infected: For RSV, its ribavirin

Ribovirin also treats Hep B and C

It’s a nucleoside analogà get into NA and prevents its replication

Its given as a nebulizer in babies and you can give an immune globin in severe cases or premature infants

Question 27

Parainfluenza Virus Characteristics

• ____
• ___ serotypes cause human disease
• infects epithelial cells of ___ respiratory tract
• ___ __ ___ causes cell damage
• clinical diseases include___ , ___ and ___

Not influenza virus

Croup: really bad cough

Answer 27

Parainfluenza Virus Characteristics

• paramyxovirus
• four serotypes cause human disease
• infects epithelial cells of upper respiratory tract
• cell-mediated immunity causes cell damage
• clinical diseases include colds, bronchitis, croup

Not influenza virus

Croup: really bad cough

Question 28

Parainfluenza Virus Epidemiology

• transmitted by __ ___ and inhalation of __ __ ___
• can cause outbreaks in ___ and pediatric units
• 90% to 100% of children aged 5 years and older have antibodies to HPIV-_; about 75% have antibodies to HPIV-_ and -_.

Very rarely cause anything serious

Answer 28

Parainfluenza Virus Epidemiology

• transmitted by close contact and inhalation of large-droplet aerosols
• can cause outbreaks in nurseries and pediatric units
• 90% to 100% of children aged 5 years and older have antibodies to HPIV-3; about 75% have antibodies to HPIV-1 and -2.

Very rarely cause anything serious

Question 29

Metapneumovirus

• undiscovered until 2001 because it grows ___ in ___ ___
• nearly ___ ___ has been infected by age 5

___ in adults

• more ___ ___ ___ in kids
• severe __
• ____
• ___
• new research suggests that this virus is ___ only to ___ as a cause of severe___ respiratory infections in the young, occurring about ___ as often

Causes colds in adults and more severe infections in kids

Answer 29

Metapneumovirus

• undiscovered until 2001 because it grows poorly in cell cultures
• nearly every child has been infected by age 5
• colds in adults
• more severe respiratory infections in kids
• severe coughing
• wheezing
• congestion
• new research suggests that this virus is second only to RSV as a cause of severe lower respiratory infections in the young, occurring about 2/3 as often

Causes colds in adults and more severe infections in kids

Question 30

Metapneumovirus Epidemiology

___ to ___/ ___ ___ peak

Answer 30

Winter to spring/early summer peak

Question 31

Characteristics of Influenza Viruses

•____virus-___, _ _NA ____s;

___ types–_ _ _; only _ & _ cause significant human disease

• two envelope ____s–___ and ___
• cause one of the most prevalent and significant __ ___ ___

Like the rotavirus, it has a segmented genome

Segmented genome of this virus contributes to the fact that we have new emerging types of this virus very freq in the popl

If you look at what comprises the flu vaccine, it will give you an h number and an n number. This refers to the type of glycoproteins that the virus that is circulating has

Answer 31

Characteristics of Influenza Viruses

• orthomyxovirus-enveloped, 8 RNA segments; three types–A, B, & C; only A & B cause significant human disease
• two envelope glycoproteins–hemagglutinin and neuraminidase
• cause one of the most prevalent and significant viral infections worldwide

Like the rotavirus, it has a segmented genome

Segmented genome of this virus contributes to the fact that we have new emerging types of this virus very freq in the popl

If you look at what comprises the flu vaccine, it will give you an h number and an n number. This refers to the type of glycoproteins that the virus that is circulating has

Question 32

Influenza A & B Disease Mechanisms

• infect___ and ___ respiratory tract
• systemic symptoms due to ___ and ____; ___ and ___ important for ___ ___
• local symptoms due to ___ to __ __
• predisposition to ___ super-infection
• loss of __ __
• induction of __ ___ to epithelial cells

A and B cause human disease

Std flu is more of an ___ resp tract infection but that can develop into a more severe infection of the ___ resp tract

IF and lymphokines are important for resolution of the disease but they are also what makes you feel so crummy. Makes you feel ___, ___ etc

Local symptoms: __ __, __ __

People who have received IF for trt of viral diseases, feel like they have the flu

People with bad case of flu are predisposed to bacterial super-infection bc you have a loss of natural barriers in ___ resp tract and that can help bact adhere to the epithelial cells

Answer 32

Influenza A & B Disease Mechanisms

• infect upper and lower respiratory tract
• systemic symptoms due to interferon and lymphokines; CMI and interferon important for immune resolution
• local symptoms due to damage to respiratory epithelium
• predisposition to bacterial super-infection
• loss of natural barriers
• induction of bacterial adhesion to epithelial cells

A and B cause human disease

Std flu is more of an upper resp tract infection but that can develop into a more severe infection of the lower resp tract

IF and lymphokines are important for resolution of the disease but they are also what makes you feel so crummy. Makes you feel feverish, tired, etc

Local symptoms: runny nose, sore throat

People who have received IF for trt of viral diseases, feel like they have the flu

People with bad case of flu are predisposed to bacterial super-infection bc you have a loss of natural barriers in upper resp tract and that can help bact adhere to the epithelial cells

Question 33

Diseases Caused by Influenza Virus

• acute influenza in adults
• rapid onset of___
• ___
• ___
• __ __
• __-___ ___
• acute influenza in kids
• similar to adults but ___ fever

____ symptoms

• ___ media
• ___
• ___
• complications
• primary viral ___
• secondary ___ pneumonia
• Strep. pneumoniae
• H. influenzae
• Staph. aureus

____ and___ involvement

___ syndromes

•___-___ syndrome

___

____’s syndrome

Myalgia: muscles ache

Otitis Media: ear problems due to build up of fluid is upper resp tract and sinuses

Myositis: muscle aches

Complications if virus reaches lower resp tract

primary viral pneumonia would be unusual in someone with competent immune sys

Guillain-Barre syndrome and Reye’s syndrome are why you are advised to give kids Tylenol and never Asprin

Answer 33

Diseases Caused by Influenza Virus

• acute influenza in adults
• rapid onset of fever
• malaise
• myalgia
• sore throat
• non-productive cough
• acute influenza in kids
• similar to adults but higher fever
• gastrointestinal symptoms
• otitis media
• myositis
• croup

•

• complications
• primary viral pneumonia
• secondary bacterial pneumonia
• Strep. pneumoniae
• H. influenzae
• Staph. aureus
• myositis and cardiac involvement
• neurological syndromes
• Guillain-Barre syndrome
• encephalitis
• Reye’s syndrome

Myalgia: muscles ache

Otitis Media: ear problems due to build up of fluid is upper resp tract and sinuses

Myositis: muscle aches

Complications if virus reaches lower resp tract

primary viral pneumonia would be unusual in someone with competent immune sys

Guillain-Barre syndrome and Reye’s syndrome are why you are advised to give kids Tylenol and never Asprin

Question 34

Influenza Virus Epidemiology

• infects __ ___e species
• segmented genome facilitates major __ ___s by genetic ____ (type _ only); antigenic ___
• 3 known subtypes of human flu currently circulating
• ___ ___ ___ (H_ not around since 1968)
• minor genetic changes by ____ of __ and __; antigenic ___
• spread by inhalation of __ ___ ___
• transmission precedes ____
• prefers __, __ ___ atmosphere (i.e. ___)

•

•

Antigenic drift: when flu centers try to determine contents of flu vaccine this year, they look at antigenic drifts to see if any types of mutations have occurred

Spread by resp route

Get infected before get symptoms. Asymptomatic Spread

Virus prefers cool, less humid atmosphere to cause infection (i.e. So flu season is in the winter)

Answer 34

Influenza Virus Epidemiology

• infects many vertebrate species
• segmented genome facilitates major genetic changes by genetic reassortment (type A only); antigenic shift
• 3 known subtypes of human flu currently circulating
• H1N1, H1N2, H3N2 (H2 not around since 1968)
• minor genetic changes by mutation of HA and NA; antigenic drift
• spread by inhalation of small aerosol droplets
• transmission precedes symptoms
• prefers cool, less humid atmosphere (i.e. winter)

•

•

Antigenic drift: when flu centers try to determine contents of flu vaccine this year, they look at antigenic drifts to see if any types of mutations have occurred

Spread by resp route

Get infected before get symptoms. Asymptomatic Spread

Virus prefers cool, less humid atmosphere to cause infection (i.e. So flu season is in the winter)

Question 35

Antigenic Shift and Antigenic Drift

Shift:

Swine flu and human flu virus can both infect a single host.

8 segments of RNA replicating

Many types of RNA replicating in one cell

Some of the virus that comes out of that animal will be the original inputs (swine flu and human flu).

Some of them will be a new virus as a result of intermixing of genomic segments.

Get 3 viruses that come out. Original 2 plus intermixing of genomic segments.

That’s how new viruses emerge.

Drift: Responsible for the shifts we see every year

one virus infects the cell. Mutation occurs. New virus may come out. Old virus also comes out.

Smaller changes. Not substitution of an entire gene.

Answer 35

Antigenic Shift and Antigenic Drift

Shift:

Swine flu and human flu virus can both infect a single host.

8 segments of RNA replicating

Many types of RNA replicating in one cell

Some of the virus that comes out of that animal will be the original inputs (swine flu and human flu).

Some of them will be a new virus as a result of intermixing of genomic segments.

Get 3 viruses that come out. Original 2 plus intermixing of genomic segments.

That’s how new viruses emerge.

Drift: Responsible for the shifts we see every year

one virus infects the cell. Mutation occurs. New virus may come out. Old virus also comes out.

Smaller changes. Not substitution of an entire gene.

Question 36

Influenza Pandemics

• 1918-1919; H1N1—___ flu
• 20-40% of worldwide population got sick
• 50,000,000 died; 675,000 in U.S.
• 1957-1958; H2N2—____ flu
• not as devastating as 1918
• 70,000 died in U.S.
• 1968-1969; H3N2—__ __ flu
• 2009-2010; H1N1—___ flu
• 40,000,000-80,000,000 infected
• 8,800-18,000 deaths

•

•

•

Answer 36

• 1918-1919; H1N1—Spanish flu
• 20-40% of worldwide population got sick
• 50,000,000 died; 675,000 in U.S.
• 1957-1958; H2N2—Asian flu
• not as devastating as 1918
• 70,000 died in U.S.
• 1968-1969; H3N2—Hong Kong flu
• 2009-2010; H1N1—swine flu
• 40,000,000-80,000,000 infected
• 8,800-18,000 deaths

•

•

•

Question 37

New Flu Viruses

• H5N1 bird flu—2003
• highly pathogenic in domestic poultry
• 600 human cases; 60% mortality
• __ ___ ___ among ___
• small outbreak in 2011
• many widespread infections in poultry in Far East
• H7N9 bird flu—2013
• no sustained spread among people

•

Bird flu: millions of chickens had to be slaughtered bc of this.

Don’t cause sig mortality in people bc cells of the ___ ___ don’t have right ____ for these viruses

Answer 37

New Flu Viruses

• H5N1 bird flu—2003
• highly pathogenic in domestic poultry
• 600 human cases; 60% mortality
• no sustained spread among people
• small outbreak in 2011
• many widespread infections in poultry in Far East
• H7N9 bird flu—2013
• no sustained spread among people

•

Bird flu: millions of chickens had to be slaughtered bc of this.

Don’t cause sig mortality in people bc cells of the resp tract don’t have right receptors for these viruses

Question 38

Influenza Treatment

• _____ and ____ block ____ by targeting ___ protein of influenza ___
• zanamivir (___) and oseltamivir (___) inhibit ___ of influenza __ and ___
• ____ therapy

NA is what helps the virus ____ from the cell once it has replicated

Problem with drugs is that you need to get them before you get sick in order for them to shorten course of infection

Can’t give these drugs prophylactically

Answer 38

Influenza Treatment

• amantadine and rimantadine block uncoating by targeting M2 protein of influenza A
• zanamivir (Relenza) and oseltamivir (Tamiflu) inhibit NA of influenza A and B
• supportive therapy

NA is what helps the virus escape from the cell once it has replicated

Problem with drugs is that you need to get them before you get sick in order for them to shorten course of infection

Can’t give these drugs prophylactically

Question 39

Influenza Prevention and Control

• prevention
• _____
• 2015-16 vaccine; mixture of ___ and ___ strains
• control
• airborne spread almost ___ to ___•

Answer 39

Influenza Prevention and Control

• prevention
• immunization
• 2015-16 vaccine; mixture of H1N1 and H3N2 strains
• control
• airborne spread almost impossible to limit

•

Question 40

Enterovirus D68

• one of more than 100 __ ___ enteroviruses
• first identified in CA in 1962
• from mid-August 2014 to 1/15/15—1153 people in 49 states and D.C. confirmed to have EV-68
• mild to severe ___ illness mostly in ___, __ and ___
• ___ is risk factor for severe disease

This popped up last year in mid august

There were some reports that some of the infected kids had some paralysis as a result of the infection. Never proved that it was caused by E D68

Answer 40

Enterovirus D68

• one of more than 100 non-polio enteroviruses
• first identified in CA in 1962
• from mid-August 2014 to 1/15/15—1153 people in 49 states and D.C. confirmed to have EV-68
• mild to severe respiratory illness mostly in infants, children and teens
• asthma is risk factor for severe disease

This popped up last year in mid august

There were some reports that some of the infected kids had some paralysis as a result of the infection. Never proved that it was caused by E D68

Question 41

Measles Virus Characteristics

• _____virus
• causes one of the___ classic childhood rashes
• only ___serotype

___ only host

• infects ___ cells of the ___ tract
• highly ___s; ___ symptoms
• ___ immunity
• declared ___ in ___

Only one serotype so Once you’ve had infection you are immune to it Or get vaccine with boosters

Can spread virus before get symptoms

Declared eliminated but its not

Answer 41

Measles Virus Characteristics

• paramyxovirus
• causes one of the 5 classic childhood rashes
• only one serotype
• humans only host
• infects epithelial cells of the respiratory tract
• highly contagious; precedes symptoms
• lifelong immunity
• declared eliminated in 2000

Only one serotype so Once you’ve had infection you are immune to it Or get vaccine with boosters

Can spread virus before get symptoms

Declared eliminated but its not

Question 42

Measles Pathogenesis\

It gets into the resp tract where it replicates locally.

Spreads thru the___ and causes a ___

From the blood it gets into the___, ___ tract, ___ tract,small __ __s, ___ system, __

You get virus infected ____ cells

Virus tries to fight off the virus infected cells and because of that you get__ and ___ of measals

Most common is a ___ which most people recover from and have life long immunity.

However rarely you can get post-infectious ___ due to the __ __

You can get ___ due to ___e measels virus infecting the ___. If Virus gets into CNS and can’t replicate. Just stays in those cells and causes damage

Very rarely in person with ____ immune sys, if they get measels infection, it can be ___ bc virus is not controlled by CMI response.

Answer 42

Measles Pathogenesis\

It gets into the resp tract where it replicates locally.

Spreads thru the lymphatics and causes a viremia

From the blood it gets into the conjunctiva, respiratory tract, urinary tract,small blood vessels, lymphatic system, CNS

You get virus infected endothelial cellsc

Virus tries to fight off the virus infected cells and because of that you get signs and symptoms of measals

Most common is a rash which most people recover from and have life long immunity.

However rarely you can get post-infectious encephalitis due to the immune response

You can get SSP due to defective measels virus infecting the CNS. If Virus gets into CNS and can’t replicate. Just stays in those cells and causes damage

Very rarely in person with defective immune sys, if they get measels infection, it can be fatal bc virus is not controlled by CMI response.

Question 43

Measles Signs & Symptoms

• maculopapular rash
• ____spots
• ___
• ___
• ___
• ___
• complications
• otitis media
• ___
• broncho___

____

Rash occurs all over the body

Oral sign called Koplik’s spots. These spots generally occur 24 hours before the rash

If you see spots, within 24 hours will see the rash

Can get into the eyes and cause photophobia

Rhinitis: runny nose

Self limiting

Answer 43

Measles Signs & Symptoms

• maculopapular rash
• Koplik’s spots
• cough
• conjunctivitis
• photophobia
• rhinitis
• complications
• otitis media
• croup
• bronchopneumonia
• encephalitis

Rash occurs all over the body

Oral sign called Koplik’s spots. These spots generally occur 24 hours before the rash

If you see spots, within 24 hours will see the rash

Can get into the eyes and cause photophobia

Rhinitis: runny nose

Self limiting

Question 44

___—greatest number of cases since measles elimination documented in 2000

2014 outbreak originated in ___

Answer 44

2014—greatest number of cases since measles elimination documented in 2000

2014 outbreak originated in Disneyland

Question 45

Mumps Virus Characteristics

• ___virus
• only ___serotype
• ___ only host
• infects ___ cells of ___y tract
• can be ___
• spreads by ___
• infect ___ __, ___, ___ (10% symptoms)
• inflammation causes ___ of glands
• without immunization, 90% infected by age 15
• ___ immunity

A lot like measels but has different target tissues

Huge swelling of parotid glands

Before immunizations, most people have measels and mumps by the time they were teens

Can be bilateral or unilateral

Hurts pretty bad

Answer 45

Mumps Virus Characteristics

• paramyxovirus
• only one serotype
• humans only host
• infects epithelial cells of respiratory tract
• can be subclinical
• spreads by viremia
• infects parotid gland, testes, CNS (10% symptoms)
• inflammation causes swelling of glands
• without immunization, 90% infected by age 15
• lifelong immunity

A lot like measels but has different target tissues

Huge swelling of parotid glands

Before immunizations, most people have measels and mumps by the time they were teens

Can be bilateral or unilateral

Hurts pretty bad

Question 46

Mumps Pathogenesis

There has been a lot of work to see if mumps infection somehow contributes to onset of___ ___

There seems to be a correlation. But we think its more a genetic disorder. But maybe mumps in a kid that is predisposed to the disease can kick off the disease

Answer 46

There has been a lot of work to see if mumps infection somehow contributes to onset of juvenile diabetes?

There seems to be a correlation. But we think its more a genetic disorder. But maybe mumps in a kid that is predisposed to the disease can kick off the disease

Question 47

Mumps Epidemiology

• 2006—6,585 cases reported predominantly in college students living in dorms at midwestern schools
• 2009—another large outbreak; index case returned from UK where an ongoing outbreak involved 4,000 cases; 1,521 cases reported in NY and NJ
• 2014—outbreaks in 4 U.S. universities

•

Answer 47

• 2006—6,585 cases reported predominantly in college students living in dorms at midwestern schools
• 2009—another large outbreak; index case returned from UK where an ongoing outbreak involved 4,000 cases; 1,521 cases reported in NY and NJ
• 2014—outbreaks in 4 U.S. universities

•

Question 48

Rubella Virus Characteristics

• ___virus-____, __NA
• common name is __ __
• ___disease
• ___ transmission
• only ___ serotype

____ only known host

___ immunity

•problem in ____- ___ trimester; virus can cross ___a in __ ___women

common name is German measles or __ __ ___

More __ ___ than is rubeolla which is red measles (what we just talked about)

Now this is really only a problem in pregnant women who are not immune to the virus. Can cause congenital rubella syndrome

Answer 48

Rubella Virus Characteristics

• togavirus-enveloped, RNA
• common name is German measles
• mild disease
• respiratory transmission
• only one serotype
• humans only known host
• lifelong immunity
• problem in pregnancy-1st trimester; virus can cross placenta in non-immune women

common name is German measles or 3 day measles

More self limited than is rubeolla which is red measles (what we just talked about)

Now this is really only a problem in pregnant women who are not immune to the virus. Can cause congenital rubella syndrome

Question 49

Rubella Virus Diseases

• children–__ day rash and __ ___
• adults–__ and ___pain also; post-infectious ____s
• ___ ___ ___

____s; other ocular defects

___ defects

___

•intrauterine __ ___

____

•oral manifestation—____s spots

Children: Swollen parotid glands

In CRS: eyes can be affected, heart, deafness, and very small birth weight.

Kid with rubella Looks like measels on the palate.

These are called Forchheimer spots

Answer 49

Rubella Virus Diseases

• children–3-day rash and swollen glands
• adults–bone and joint pain also; post-infectious encephalitis
• congenital rubella syndrome
• cataracts; other ocular defects
• heart defects
• deafness
• intrauterine growth retardation
• microcephaly
• oral manifestation—Forchheimer’s spots

Children: Swollen parotid glands

In CRS: eyes can be affected, heart, deafness, and very small birth weight.

Kid with rubella Looks like measels on the palate.

These are called Forchheimer spots

Question 50

Parvovirus B19

• parvovirus-very __, ___, ___, _NA
• onl___ serotype
• replicates in ___ ___ cells
• causes one of the five childhood___ -___disease
• spread by ___ and __ ___
• causes ___ and can __ __

We immunize our pets against Parvo but there is a type that infects humans

Causes 5th disease

Causes rash and causes __ ___ appearance where cheeks are red

In adults and kids, there is biphasic disease where you have the initial signs of a ___ ___ feeling. And there is a post infectious (or immune) phase where this ___ occurs due to the __ ___ to the virus

Answer 50

Parvovirus B19

• parvovirus-very small, naked, icosahedral, DNA
• only one serotype
• replicates in mitotically active cells
• causes one of the five childhood rashes—Fifth disease
• spread by respiratory and oral secretions
• causes viremia and can cross placenta

We immunize our pets against Parvo but there is a type that infects humans

Causes 5th disease

Causes rash and causes Slapped cheek appearance where cheeks are red

In adults and kids, there is biphasic disease where you have the initial signs of a flu like feeling. And there is a post infectious (or immune) phase where this rash occurs due to the immune response to the virus

Question 51

Erythema Infectiosum—Fifth Disease

• ____ disease
• l____c, ___ phase–___-like symptoms
• __ ___, ___ phase
• ___
• ___

Non infectious phase has arthritic pain in joints for adults

One of the bad childhood diseases bc it persists so long

You often don’t know that you have it until you get the immune response

It’s a Problem in people with blood diseases or kids with sickle cell disease where their red blood cells are rapidly dividing bc virus infects those cells so it can cause ___ ___ in people with blood disorders

Answer 51

Erythema Infectiosum—Fifth Disease

• biphasic disease
• lytic, infectious phase–flu-like symptoms
• non-infectious, immunological phase
• rash
• arthralgia

Non infectious phase has arthritic pain in joints for adults

One of the bad childhood diseases bc it persists so long

You often don’t know that you have it until you get the immune response

It’s a Problem in people with blood diseases or kids with sickle cell disease where their red blood cells are rapidly dividing bc virus infects those cells so it can cause severe anemia in people with blood disorders

Question 52

Definition of Emerging Viruses

• a class of viruses that has ___ infected humans or animals but now has the ____y to attain ___ proportions due to human encroachment on __ ___s, increased ___ __, ____ populations in less developed countries, and, possibly, ___
• usually associated with one or more __ __ or ___
• humans are often ___ ___
• ___ to ___ transmission can result in __ __ __

Have been around for a long time but all of the sudden bc of human activity they have the opportunity to infect a larger popl

More and more people get infected and virus can mutate

usually associated with one or more nonhuman host or vectorà can be an insect or monkey

Once a human becomes infected you can get person to person transmisiion

Answer 52

Definition of Emerging Viruses

• a class of viruses that has long infected humans or animals but now has the opportunity to attain epidemic proportions due to human encroachment on tropical rainforests, increased international travel, burgeoning populations in less developed countries, and, possibly, mutation
• usually associated with one or more nonhuman host or vector
• humans are often accidental hosts
• person-to-person transmission can result in large human outbreaks

Have been around for a long time but all of the sudden bc of human activity they have the opportunity to infect a larger popl

More and more people get infected and virus can mutate

usually associated with one or more nonhuman host or vectorà can be an insect or monkey

Once a human becomes infected you can get person to person transmisiion

Question 53

West Nile Virus

• before ___, WNV never reported in the U.S.
• 62 cases in New York
• 7 deaths
• common in ___, western___ and the__ __
• transmitted to humans via ___

Airplane came back with these mosquitos in the cargo hold and it started to spread and now it is in every state in the US

Answer 53

West Nile Virus

• before 1999, WNV never reported in the U.S.
• 62 cases in New York
• 7 deaths
• common in Africa, western Asia, and the Middle East
• transmitted to humans via mosquitoes

Airplane came back with these mosquitos in the cargo hold and it started to spread and now it is in every state in the US

Question 54

Reservoir Host is ___s. Birds transmit to ___ and mosquitos can give it___ to birds

Then you have accidental hosts which are __ and ___

Answer 54

Reservoir Host is birds. Birds transmit to mosquitos and mosquitos can give it back to birds

Then you have accidental hosts which are people and animals

Question 55

Almost every state has had WN infections this year

Some just have__ ___ WNV activty

Answer 55

Almost every state has had WN infections this year

Some just have non human WNV activty

Question 56

West Nile Activity in Texas–2015

Not a __ __ for WNV

They ___mosquitos and test to see if they are __ ___

Answer 56

Not a bad year for WNV

They entrap mosquitos and test to see if they are spreading WNV

Question 57

West Nile Infection

• __- ___% of infected people do not develop__ __
• 20% develop ___, ___ __ aches, ___ pain, ___g, ___ea,___
• most recover___y, but fatigue and weakness can persist for ___
• 1% develop e___ or ___; __% will die

70-80% of infected people do not develop any symptoms

Know that they have it bc they go to donate blood and have Ab to WNV

Answer 57

West Nile Infection

• 70-80% of infected people do not develop any symptoms
• 20% develop fever, headache, body aches, joint pain, vomiting, diarrhea, rash
• most recover completely, but fatigue and weakness can persist for months
• 1% develop encephalitis or meningitis; 10% will die

70-80% of infected people do not develop any symptoms

Know that they have it bc they go to donate blood and have Ab to WNV

Question 58

Hantaviruses

• ___-borne; __ ___vector
• __ ____ diseases

•___ ___r with r__ ___ (not found in U.S.)

•___ ____ ___e (HPS)

Mosquito was arthopod vector in west nile

HPS is the disease that has been seen in the US

Answer 58

Hantaviruses

• rodent-borne; no arthropod vector
• two acute diseases
• hemorrhagic fever with renal syndrome (not found in U.S.)
• hantavirus pulmonary syndrome (HPS)

Mosquito was arthopod vector in west nile

HPS is the disease that has been seen in the US

Question 59

Hantavirus Pulmonary Syndrome

• first recognized in the __ ___area of __ ___ in 1993 due to unexplained deaths among __ ___
• ___ nfestation is the primary risk for exposure
• severe ___ disease with ___% mortality

•

This disease persists in this area today

Answer 59

Hantavirus Pulmonary Syndrome

• first recognized in the Four Corners area of New Mexico in 1993 due to unexplained deaths among Navajo Indians
• rodent infestation is the primary risk for exposure
• severe respiratory disease with 38% mortality

•

This disease persists in this area today

Question 60

These are cases per state

Still largest numbers in area where it was ___ ___

Not a __ __r of cases

Answer 60

These are cases per state

Still largest numbers in area where it was first discovered.

Not a huge number of cases

Question 61

Dengue Virus

• dengue fever ranked by WHO as the__ ___ ___ ___ viral disease in the world
• 30-fold increase in global incidence in last 50 years
• 40% of the world’s population live in areas where there is a risk for dengue transmission
• 50-100 million infections/yr

Most important bc it causes a __ __

Increase due to our __ __

Answer 61

• dengue fever ranked by WHO as the most important mosquito-borne viral disease in the world
• 30-fold increase in global incidence in last 50 years
• 40% of the world’s population live in areas where there is a risk for dengue transmission
• 50-100 million infections/yr

Most important bc it causes a nasty disease

Increase due to our travel patterns

Question 62

Dengue Virus Transmission

Transmited by aedes aegympti ___

Mosquito bites dengue __ ___

When Mosquitos bite us, they __t our blood.

D virus will replicate in __ __ of the ___

Mosquito will bit another person and about ___ days later that person will get __ __

____ type of transmission

Not ___ to ___ transmission. Need the mosquito

Answer 62

Transmited by aedes aegympti mosquito

Mosquito bites dengue infected person

When Mosquitos bite us, they injest our blood.

D virus will replicate in salivary glands of the mosquito

Mosquito will bit another person and about 4-13 days later that person will get D infection

Circular type of transmission

Not human to human transmission. Need the mosquito

Question 63

Disease Mechanisms of Dengue Virus

• _ serotypes of dengue
• infection with one type __ __ ___ against other types
• first infection is usually ___–> ___ ___
• sequential infections increase risk for __ __ ___ and __ __ __

dengue hemorrhagic fever and dengue shock syndrome

These are ___

Answer 63

Disease Mechanisms of Dengue Virus

• 4 serotypes of dengue
• infection with one type does not protect against other types
• first infection is usually mild—dengue fever
• sequential infections increase risk for dengue hemorrhagic fever and dengue shock syndrome

dengue hemorrhagic fever and dengue shock syndrome

These are fatal

Question 64

DHF and DSS

You get D infection and you make antibodies against __ ___

You get reinfected

First infection predisposes you to having a __ __ with __ ___

You get the problems ass with shock and you get reduced number of platelets, problems with coagulation, disseminated intravascular coagulation and severe bleeding. That can lead to death.

Answer 64

DHF and DSS

You get D infection and you make antibodies against that serotype

You get reinfected

First infection predisposes you to having a worse infection with second serotype

You get the problems ass with shock and you get reduced number of platelets, problems with coagulation, disseminated intravascular coagulation and severe bleeding. That can lead to death.

Question 65

Global Dengue

___ risk in US But present in our ___ with ___

Answer 65

Global Dengue

Low risk in US But present in our border with Mexico

Question 66

Chikungunya Virus

• transmitted by Aedes ____ (same as those that transmit dengue)
• often occurs as ___ ___ with high ___ rates
• symptoms

___ and __ ___

• join ___ and ___
• rarely ___ but symptoms can be___ and ___

All the mosquito borne illnesses have pretty much the same symptoms

Answer 66

Chikungunya Virus

• transmitted by Aedes mosquitoes (same as those that transmit dengue)
• often occurs as large outbreaks with high attack rates
• symptoms
• fever and joint pain
• join swelling and rash
• rarely fatal but symptoms can be severe and disabling

All the mosquito borne illnesses have pretty much the same symptoms

Question 67

Chikungunya Virus Cases as of 3/10/15

Answer 67

We have____ in US

Question 68

Ebola Virus

• ___ strains; ___ cause human disease
• discovered in 1976 near the Ebola River in Democratic Republic of the___
• natural reservoir is most likely ___; also infects other animals in____
• spreads human to human via contact with ___, ___s, ___s, and ___ __, etc.
• average fatality rate is around ___%

Can spread from these reservoirs to humans by __ ___ with vector

Answer 68

Ebola Virus

• five strains; four cause human disease
• discovered in 1976 near the Ebola River in Democratic Republic of the Congo
• natural reservoir is most likely bats; also infects other animals in rainforest
• spreads human to human via contact with blood, secretions, organs, and contaminated bedding, etc.
• average fatality rate is around 50%

Can spread from these reservoirs to humans by close contact with vector

Question 69

2014 Ebola Outbreak

____ in history and ___ Ebola ____ in the world

Answer 69

2014 Ebola Outbreak

•largest in history and first Ebola epidemic in the world

Question 70

Ebola Virus Disease

• fever > ___°F
• severe ___
• ___ pain
• ___
• diarrhea
• vomiting

___ or ___

•___ studies are very promising

Answer 70

Ebola Virus Disease

• fever > 101.5°F
• severe headache
• muscle pain
• weakness
• diarrhea
• vomiting
• bleeding or bruising
• vaccine studies are very promising