RNA enveloped viruses

Virus family Medically important virus

Orthomyxoviruses Influenza viruses
Paramyxoviruses Measles, mumps, RSV and
parainfluenza virus
Togaviruses Rubella
Rhabdoviruses Rabies virus
Retroviruses HIV
Coronaviruses Coronavirus, MERS-virus and
SARS
Filoviruses Ebola virus
Flaviviruses Yellow Fever virus, dengue virus
and HCV.
Deltaviruses HDV
 Orthomyxoviruses

Dr. Muna. M. A. Yousif

M.D clinical Microbiology
 Structure
• Orthomyxoviruses are enveloped viruses with
a helical nucleocapsid and a single-stranded,
segmented genome (usually 8 pieces) of
negative polarity.
• The envelope contains haemagglutinin (HA)
and neuraminidase (NA) spikes.
• Matrix proteins are found and are important
for structural integrity and as an ion channel.
• The most important member in this family is
the influenza virus.
Structure
• Orthomyxoviruses include different
influenza viruses (types A, B and C).
• They are a group of highly contagious
human pathogens and outbreaks of
influenza are a major cause of
morbidity and mortality to humans
each year.
• Influenza pandemics have killed
thousands of people through out the
centuries.
 Classification
• Antigenic differences in the nucleocapsid proteins
and matrix proteins are used to divide influenza
viruses into types A, B and C.
• Influenza type A has different subtypes, based on
antigenic variation in the surface proteins (HA and
NA)
• There are 16 types of HA and 9 types of NA.
• Influenza A virus contains both human and animal
strains.
• Influenza B contains only human strains.
• Influenza C contains human and swine strains.
 History of influenza
• 1889 (Asiatic or Russian pandemic): killed 1
million.
• 1918 (Spanish flu pandemic) (H1N1): killed 20
million.
• 1957 Asian flu (H2N2) killed 1.5 million
• 1968 Hong Kong flu (H3N2)killed 1 million
• 1977 Russian flu(H1N1) killed
• 2009 flu pandemic (H1N1)killed 18,000-
280,000
• 2013 avian flu (H7N9) killed more than 24
 Epidemiology
• Antigenic changes occur continuously in
influenza A virus and to a lesser extent in
influenza B. Influenza C virus is a stable virus
and no change in it’s antigenicity is known to
occur.
• Aquatic birds, chickens, ducks, pigs, horses
are affected by animal influenza virus type A.
• Changes in the antigenicity of HA and NA of
influenza viruses (type A) is responsible for
causing devastating world-wide epidemics.
 Types of antigenic changes
1. Antigenic shift: is due to major changes that
result from reassortment of the eight RNA
genome segments. These reassortments result
in the formation of a new viral strain that infects
a susceptible population giving a pandemic.
Aquatic birds act as a source of new genes but
the reassortment which leads to the
appearance of the new strain occurs in pigs.
2. Antigenic drift: results from only minor
antigenic changes resulting from point
mutations in the viral HA and NA glycoproteins
• Because influenza B virus is only infects humans,
there is no animal source of new RNA segments
and therefore, antigenic shift does NOT occur in
influenza B.
 Pathogenesis
• The virus is transmitted from person to
person by respiratory secretions. Patients
secrete the virus 24 hours before becoming
symptomatic and 48 hours after.
• Attachment of the virus occurs in the mucosal
epithelial cells of the upper respiratory tract
by HA and infection is initiated.
• Neuraminidase breaks down neuraminic acid
(sialic acid) before the release of progeny
virus from the infected cell.
 Clinical disease
• After an incubation period of 1-3 days
the patient develops sudden fever,
headache, chills, myalgia, sore throat
and a dry cough.
• These symptoms last for 10 days up to
2 weeks.
• Secondary bacterial infection by
Staphylococcus aureus is common.
 Diagnosis
• Infection maybe diagnosed clinically or in the
lab by:
1. Virus isolation
2. Fluorescent antibody staining can be used to
demonstrate the virus in nasal or throat
washings, swabs or sputum
3. PCR
4. Rapid tests (used by physicians and detect
viral antigens)
5. Antibody detection in patients serum.
 Treatment
• Neuraminidase inhibitors:Oseltamivir (Tamiflu) and
zanamivir (Relenza) can be used for both treating
and preventing infection. Are effective against both
influenza A and B.
• Amantadine stops viral replication by preventing
entry or uncoating of the virus. It can be used to
prevent and treat influenza A virus ONLY.
• Most strains of influenza have now become resistant
to amantadine and it has CNS side-effects.
• Rimantadine is a derivative of amantadine with
fewer side-effects.
 Prevention
• Vaccine against influenza A and B
viruses is available .It is composed of the
two most recent A strains (H1N1 and
H3N2) and the most recent B strain.
• There are two types of vaccines present;
1. Killed vaccine. Given intramuscularly.
2. Live vaccine containing temperature
sensitive mutants of influenza A and B
virus. Given by nasal spray ‘nasal mist’
 Avian influenza virus
• Avian influenza virus in humans is caused by
influenza A virus (H5N1).
• Avian influenza infects primarily chickens but in
1997 an aggressive human type appeared in
Hong Kong.
• In 2003 an outbreak of avian influenza virus
appeared in Asia and killed thousands of birds.
• In March 2013 an outbreak, the World Health
Organization (WHO) reported 132 human
H7N9 infections, with 44 deaths
• Avian influenza virus rarely spreads among
humans because human mucous membranes
do not have the specific receptor required for
binding of the virus to occur. This receptor is
only present in the alveoli of humans, therefore,
although infection is uncommon in human,
when it does happen infection is severe.
• Avian flu is sensitive only to neuraminidase
inhibitors and not to amantidine.
• There is no human vaccine.
 Swine flu
• Is caused by S-OIV (swine-origin influenza virus) H1N1 virus.
• S-OIV first appeared in Mexico, then the United States and a
few months later a pandemic occurred.
• Is caused by a quadruple reassortment (with genes from N.
American and Eurasian swine viruses and from avian and
human influenza viruses)
• Swine flu is readily transmitted among humans and presents
with symptoms of the seasonal flu.
• Is diagnosed using PCR.
• Treatment is by using Oseltamivir and zanamivir.
• Two types of vaccines are present (killed and live-attenuated
vaccine).