Objectives

• Describe the structural features of Paramyxoviriade

• Describe the clinical presentation of various

• conditions caused by this viral family

• Describe methods of preventions if such exist

• Describe the structural features of Toga and Flavivirade

• Describe the clinical presentation

• Describe methods of preventions if such exist

 Paramyxoviridae

Pathogens VAP Systemic Vaccine Lifelong immunity

Measles H protein Yes Yes Yes
Mumps HN protein Yes Yes Yes
RSV G protein No No No
Parainfluenza HN protein No No No
Unique properties for Paramyxoviridae
• Enveloped, non-segmented, negative-sense RNA
virus
• Easily inactivated by dryness and acid
• Transmitted by respiratory droplets and initiate
infection in the respiratory tract
• Enter by cell fusion (via F protein)
• Replicate in the cytoplasm (typical -RNA viral
replication)
• M protein enables assembly between genome and
viral transmembrane proteins
• Release
• May exit by budding
• May induce cell fusion, causing
multinucleated giant cells
• Cell mediated immunity causes symptoms but is
also essential for control of the infection
Measles
U.S. Measles Cases for 2015 Rise 18.6% Over Past Week
CDC Says 121 Measles Cases Reported this Year in U.S. The Wall Street Journal

The number of U.S. measles

cases so far this year rose 19%
in the past week, to 121 people
in 17 states, the Centers for
Disease Control and Prevention
said Monday, raising concerns
about how far the virus has
spread.
A week earlier, the CDC
reported 102 cases in 14 states.

Health officials in Arizona continue to see cases of the measles. PHOTO: TOM STATHIS/ASSOCIATED PRESS
By
BETSY MCKAY
Updated Feb. 9, 2015 4:29 p.m. ET
Human diseases caused by Paramyxoviruses:
1. Entry
Measles 4. Exit
3. Diseases
SSPE 2. Spread
encephalitis
rash
1 2 otitis media
pneumonia

Mechanisms of spread
of the measles virus
within the body
 MEASLES - rash

• Highly contagious disease spread by

respiratory droplets

Koplik spots
• Most serious childhood exanthem

• Infects epithelial cells of the respiratory

tract. Can infect conjunctiva, respiratory
tract, urinary tract, small blood vessels, and
CNS

Measles rash
• High fever, three C’s (cough, coryza,
conjunctivitis) and photophobia

• First rash appears in the mouth, it is called

Koplik’s spots (small while lesions,
surrounded by red halo)
Time course of measles
Complications of measles
• Pneumonia
• Encephalitis
• Subacute sclerosing panencephalitis
(SSPE, which is another slow conventional viral
disease, in addition to PML)

Prevention of measles

Vaccine: MMR  live-attenuated

 Mumps
• Begins with respiratory epithelia

• Continues with viremic spread and infects parotid glands

• Swelling of the parotid gland (saliva-producing glands) due

to inflammation is the principal symptom

• This virus may infect many organs and glands

• Can spread through the blood to testes, ovaries, thyroid and

CNS

• Orchitis (infection of the testes) may lead to sterility

• As many as 20% of people infected with mumps will get

meningitis

• Cell mediated response is essential for control of infection

and is the cause of some of the symptoms.
 3. Diseases
1 2 Encephalitis
Meningitis
1. Entry
Parotitis
4. Exit

2. Spread

Pancreatitis

Oophoritis or
orchitis
3

Mechanism of spread of mumps virus

Complications of mumps

Prevention of mumps

Vaccine: MMR  live-attenuated

Incidence of mumps
Mumps diagnosis
• Serologic assays
• IgM test using EIA and IFA
• Molecular techniques
• Real time RT-PCR to detect mumps viral RNA.
• Virus isolation and growth in tissue culture
• Urine, saliva, pharynx
• Syncytia will be observed
• Infected cells will be able to hemadsorb rbc (due to
viral hemagglutinin)
Parainfluenza
• 5 serotypes of viruses
• Infection is often limited to the upper
respiratory tract (cold-like symptoms)
• The virus colonizes the nose and the
nasopharynx; invades the epithelium,
resulting in cell damage, edema, and loss
of cilia
• Pathophysiology includes inflammation,
increased mucus production, and swelling
of the upper airways
• Laryngeal muscle spasms are common
• In children, between ages 6 mo and 3 yr it
causes laryngotracheobronchitis
(croup), bronchiolitis and pneumonia RSV and Parainfluenza
may occur
• Tachypnea may occur
• Immunity is short-lived
 Laryngotracheobronchitis (croup)
• Croup presents with a severe barking cough

• May cause the narrowing of the airway tubes, tachypnea and

tachycardia

• Stridor is a characteristic inspiratory sound heard in croup

http://www.youtube.com/watch?v=xBDb3ndkCDs
Steeple sign
 Respiratory Syncytial virus (RSV):
Blamed for 1 in 13 pediatrician’s visits
Most common cause of fatal acute respiratory tract infections of
infants

• RSV is most serious in infants from birth to

12 months of age, causing bronchiolitis and
pneumonia, also a major problem in preemies

• There is no viremia, i.e .limited to respiratory tract

• RSV can cause common cold (adults), pharyngitis

(in children)
• In infants the epithelial necrosis of bronchi and bronchioles leads
to dead cells forming plugs of mucus and fibrin in the airways
• The narrow airways in infants are readily obstructed by these plugs
• Spread of the virus down the respiratory tract occurs through cell-to-
cell transfer of the virus from the upper to the lower respiratory tract.
• This can lead to bronchiolitis and pneumonia
Symptoms:
o Fever (typically low-grade)
o Cough
o Tachypnea
o Cyanosis
o Retractions
o Wheezing
• Bronchiolitis is most likely mediated by host’s immune response
• Maternal antibody does not offer long protection if the newborn
• Natural infection does not prevent reinfection
 Wheezing
• Wheezing - inflammation at the level of bronchiole causes air
trapping that can lead to expiratory sound called wheezing

• This causes the most problems in premature babies who have

immature lungs

http://www.youtube.com/watch?v=YG0-ukhU1xE
 Disorder Age group affected
Bronchiolitis, pneumonia Children younger than 1 yr
(fever, cough, dyspnea, old
cyanosis)
Febrile rhinitis and Children
pharyngitis
Common cold Adults and older children
*Cyanosis is a bluish coloration of the skin due to the presence of
deoxygenated hemoglobin in blood vessels near the skin surface. It occurs
when the oxygen saturation of arterial blood falls below 85%.

Treatment for RSV

• Synagis (Palivizumab)
• Humanized IgG1 against F protein for high-risk babies
 Antibody therapy
Mouse Chimeric Humanized Human

Chimeric (-ximab) * Human (-umab)

Mouse (-omab) Humanized (-zumab)

Common infections in the respiratory tract

Parain-
Rhinovirus fluenza RSV Influenza B. pertussis H. influenzae
 Viremia

Mechanism of spread of mumps virus

 Measles vaccine

Mumps vaccine