Paramyxoviruses

Dr. Muna M A Yousif

M.D Clinical Microbiology
General characterisitcs

 Paramyxoviruses are enveloped viruses with a helical symmetry

and a negative polarity RNA genome.
 There are four human pathogens: measles virus, mumps virus,
respiratory syncytial virus and parinfluenza virus.
 Some have envelope glycoproteins with neuraminidase,
haemagglutinins and fusion proteins; others have only
neuraminidase ,haemagglutinins or fusion proteins.
 Envelope glycoproteins

Virus
Virus HA NA FP
Measles + - +
Mumps + + +
RSV - - +
Parainfluenzavirus + + +
Difference between paramyxoviruses
and orthomyxoviruses

 Paramyxoviruses differ from orthomyxoviruses by the following:

1. The genome of paramyxoviruses is not segmented
2. Their genome is larger
3. Their surface spikes are different (contain NA, HA and fusion
proteins)
Measles virus

 Causes measles (rubeola)

 The virus resembles other paramyxoviruses in that it has a SS
RNA virus with a helical nucleocapsid and a negative polarity
genome. Its envelope contains haemagglutinins and fusion
proteins only.
 It is pathogenic only to humans.
 Measles is transmitted mainly via respiratory droplets. It is a
highly contagious disease especially during the prodromal period
and in overcrowded areas.
 It is more common during the winter season and has a very high
attack rate, most previously uninfected children and adults who
are exposed will get the disease.
Pathogenesis and immunity

 The virus is inhaled and infects the cells of the upper respiratory
tract. It then enters our blood and infects and replicates in the
reticuloendothelial system (liver, spleen and lymph nodes). A
second viraemia occurs and the virus infects the skin where it
causes the typical skin rash.
 The patient develops life-long immunity.
Clinical findings

 Incubation period (10-14 days) is followed by prodromal

symptoms of fever, conjunctivitis, coryza and cough. Koplick
spots (tiny bright red lesions in the buccal mucosa near the lower
molars) maybe seen.
 After a few days a maculopapular rash appears on the face and
then descends down the body to the lower limbs.
Complications:

1. Pneumonia
2. Otitis media
3. Stillbirth in pregnant ladies
4. Post infectious encephalitis
5. Subacute sclerosing panencephalitis
CNS complications of measles

1. Acute post-infectious encephalitis:

 Occurs in 0.1% of patients with a fatality rate of 20%
 Presents with fever, seizures, headache, ataxia and coma.
 No antibodies are detected.
CNS complications of measles
cont.’d
2. Subacute sclerosing panencephalitis (SSPE)
 Is very rare (2 per 100,000) and may occur 7-10 years after initial
infection.
 Is a chronic progressive degenerative disease with a fatality rte of
>80%
 More common in males and associated with early infection (<2
yrs)
 Thought to be due to abnormal immune response to persistent
measles or defective measles virus with ↑Antibody levels.
 Presents with bizarre behaviour, dementia, gradual behavioural
changes, school problems, seizures, abnormal gait and coma.
Lab diagnosis

 Is clinical
 Virus isolation
 Antibody level
Treatment

 No specific antiviral therapy exists

 Treatment is usually supportive
Prevention

 A live-attenuated vaccine is given subcutaneously to children at 9

months and a booster is given at 18 months.
 The vaccine is contraindicated in immunocompromised and
pregnant ladies
Mumps virus

 Infection by mumps virus presents mostly during childhood.

 The virus is similar to other paramyxoviruses.
 Haemagglutinins, neuraminidase and fusion proteins are found in
the envelope.
 The internal nucleocapsid contains the S antigen.
Transmission and pathogenesis

 The virus is mostly transmitted by respiratory droplets.

 1/3 of children develop inapparent infection.
 Once the virus enters our body it infects the upper respiratory
tract. The virus enters our blood and from there spreads to the
parotid gland.
 Other organs such as testes, ovaries, pancreas and meninges
maybe infected too.
 Life-long immunity occurs.
Clinical findings

 The virus has an incubation period of 2-3 weeks.

 The prodromal phase is characterized by fever, malaise, anorexia
and painful swelling of the parotid glands (unilateral or bilateral)
 Complications:
1. Orchitis in postpubertal males
2. Meningitis.
Lab diagnosis

 Is usually clinical
 Lab diagnosis:
1. Virus isolation (saliva, CSF and urine)
2. Anitibody detection by complement fixation test
S (soluble) Ag: indicates current infection
V (viral) Ag: indicates past infection
Treatment

 No specific antiviral therapy exists

 Treatment is usually supportive
Prevention

 A live-attenuated vaccine is given subcutaneously to children at

15 months and a booster is given at 4-6 years.
 The vaccine is contraindicated in immunocompromised and
pregnant ladies
Respiratory syncytial virus

 Is the most common cause of bronchiolitis and pneumonia in

infants.
 Is also responsible for otitis media in children and pneumonia in
elderly.
 The virus is similar in structure to other paramyxoviruses
 Its surface spikes consist of only fusion proteins.
 Pathogenesis and clinical features

 RSV is highly contagious and transmission is mainly by

respiratory droplets and through contact with contaminated
hands.
 Lower respiratory tract infections (pneumonia, bronchiolitis)
occur more commonly in infants
 Upper respiratory tract infections which present as a common
cold or bronchitis is more common in older children.
Lab diagnosis

 Virus isolation and detection of characteristic CPE.

 Detection of RSV antigens in respiratory secretions.
 Detection of antibody using ELISA.
 PCR
Treatment

 Ribavirin is used to treat severe infections in infants and is

administered as an aerosol.
Prevention

 No vaccine exists.
Parainfluenza viruses

 Parainfluenza viruses resemble other pramyxoviruses in their

structure.
 Their surface spikes consist of HA, NA and fusion proteins.
 There are four major serotypes of parainfluenza virus.
 Parainfluenza virus 1 and 2 infect infants and children and are a
major cause of croup (acute laryngotracheobronchitis)
 Parainfluenza virus 3 is the most common serotypes isolated
from children with bronchiolitis and pneumonia and causes a
more severe form of the disease than serotypes 1 and 2.
 Parainfluenza virus 4 causes mild disease like the common cold.
Transmission and pathogenesis

 Parainfluenza viruses spread by respiratory droplets.

 They infect both the upper and the lower parts of the respiratory
tract but no viraemia is known to occur.
Clinical picture

 Common cold: all parainfluenza viruses can cause common cold

 Laryngotracheobronchitis (croup) commonly associated with
serotype 1 and 2.
 Bronchitis and pneumonia usually caused by serotype 3.
Lab diagnosis

 Diagnosis is most based on clinical examination

 Lab diagnosis includes:
1. Virus isolation in cell culture
2. Serology
Treatment

 No specific therapy exists. Treatment is mainly supportive.

 No vaccine is present.