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Family: Paramyxoviridae Ss RNA genome, helical nucleocapsid, nucleocapsid, 150150-200 nm diameter, membrane
Pathogenesis
Droplet spread Primary replication in respiratory tract Viraemic spread Generalised infection Virus infects most epithelial surfaces of the body Incubation period 1010-14 days
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Pathogenesis continue
Rash due to cytoxic T cells against antigen as well as antibodyantibody-antigen complexes Circulating antibody appears simultaneously with onset of the rash Virus is shed in body fluids, including respiratory secretions and also replicates in leucocytes causing leukopenia
Clinical
Incubation period: 1010-14 days Prodromal illness: 22-3 days with fever and Koplik spots on the buccal mucosa. Rash starts on the face and then spreads to the trunk and limbs within the next 2 days. Rash fades over the next 44-5 days with desquamation
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Measles: Complications
Site
Respiratory
Complications
Croup, bronchitis, pneumonia Conjunctivitis, corneal ulceration, blindness Otitis media Stomatitis, enteritis with diarrhoea Convulsions, encephalitis, SSPE
Eye
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CNS
Epidemiology
Highly infectious, almost 100% of susceptible contacts Occurs worldwide: elimination in certain areas through vaccination programs In developing countries: early infection < 2 years is common associated with high case fatality rate 33-6% Infective up till 7 days after rash appears
Laboratory diagnosis
Detection:
Direct fluorescence antibody (DFA) assay PCR
Isolation:
pharyngeal swab, urine Intracytoplasmic and intranuclear inclusions, syncytia Shell vial culture with immunofluorescence
Serology:
IgG: IgG: previous infection - immunity IgM: IgM: current infection (some false positive or negative tests)
Prevention
Live attenuated vaccine Developed countries: At 15 months as part of MMR Developing countries at 9 and 18 months. In high risk areas (hospitals) may vaccinate at 6 months. Mass vaccination and case reporting are parts of measles elimination strategies.
Rubella
Family: Togaviridae Genus: Rubivirus + SS RNA Membrane icosahedral capsid
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Pathogenesis:
Respiratory transmission Viraemic spread Generalised infection: mucosal membranes, skin, joints, transplacental
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Epidemiology
Occurs worldwide Droplet spread, respiratory transmission Prior to vaccination 80% of women of child bearing potential were immune Incubation period: 1010-21 days Infective until 5 days after rash appears
Clinical
Milder than measles 1/3 infections asymptomatic Prodrome: Prodrome: low grade fewer <38.5 Fine maculopapular rash starts on face and neck spreads to body, fades 11-4 days and does not desquamate Lymphadenopathy: Lymphadenopathy: post auricular and occipital Complications: Arthritis, encephalitis, thrombocytopenia Congenital rubella syndrome: maternal infection first 16 weeks of pregnancy
Developmental
Permanent
Sensorineural deafness, Mental retardation, Language defects, Severe myopia Peripheral pulmonary stenosis, Patent ductus arteriosus, Ventricular septal defect, Cataract, Retinopathy, Microcephaly, Microphthlalmia Diabetes mellitus, Progressive rubella panencephalitis (PRP)
Late
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Laboratory diagnosis
Isolation: throat swab, urine sample Serology:
Acute infection: IgM IgG avidity: high avidity > 50% past/ rere-infection; low avidity <30% recent infectioninfection- indication for termination of pregnancy
Prevention
Live attenuated vaccine as part of MMR at 15 months (not part of EPI in SA) Immunise all nonnon-immune adult females Vaccination contracontra-indicated during pregnancy
Mumps
Family: Paramyxoviridae Subfamily: Paramyxovirinae Genus: Rubulavirus
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Pathogenesis
Spread in saliva and secretions in respiratory tract Incubation: 1414-21 days Infection: respiratory route, big droplets, hand contact Viraemia Generalised spread: including parotid gland Virus shed for several days before and after symptoms: respiratory tract and urine
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Epidemiology
Worldwide distribution, infects mainly children 55-14 years. Highest incidence in winter, 80% of adults immune Infective until 9 days after onset of parotitis
Clinical
Unapparent infections common. Typical symptoms: fever, painful enlargement of one or both parotid glands
Complications:
Aseptic meningitis (and encephalitis) Deafness Orchitis (sterility rare) Oophoritis Pancreatitis Mastitis Thyroiditis
Laboratory diagnosis
Isolation
Throat swabs or urine samples Syncytia and Intracytoplasmic inclusions in monkey cells Shell vial culture with IMF detection
Serology
Acute infection: IgM
Prevention
Live attenuated vaccine: Jeryl Lynn/ Urabe strain. Vaccinate children at 15 months: MMR
Enteroviruses
Family: Picornaviridae RNA viruses 1818-30 nm in diameter Icosahedral capsid No membrane
Group
Number serotypes
Disease/ symptoms
Poliovirus
Coxsackie A
23
Meningitis, encephalitis, myocarditis, pleurodinia, acute haemorrhagic conjunctivitis, herpangina, hand-foot-and-mouth disease, rash, paralysis, respiratory tract infection
Coxsackie B
Meningitis, encephalitis, myocarditis, pleurodinia, rash, pancreatitis, orchitis, respiratory tract infection
Echovirus
30
Encephalitis, meningitis, myocarditis, pleurodynia, herpangina, rash, paralysis, conjunctivitis, respiratory tract infection
Enterovirus
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Pathogenesis: Polio
Acquired via the faecal oral and respiratory routes After primary replication virus spread via blood stream to CNS Lytic infecion of the anterior horn cells of the spinal cord - lower motor neuron paralysis Infection is asymptomatic in 90% of cases
Epidemiology
Enteroviruses: Enteroviruses: majority of viral meningitis cases Children 3 months to 14 years Peak incidence in summer months
Laboratory diagnosis
Detection: PCR - on stool samples or throat swabs, nonnon-polio enterovirus on CSF Isolation: Stool samples. Isolation in monkey cells (polio, Coxsackie B, ECHO, Enterovirus) Enterovirus) and baby mice (Coxsackie A and B) Serology:
Polio 11-3, Coxsackie B 11-6 Neutralising antibody assay. For acute infection show a 4 fold rise in antibody titre on two specimens taken 1010-21 days apart
Prevention
Vaccines only available for polio Worldwide eradication campaign underway date was 2005 but largely due to outbreak originating in Kano Nigeria it was delayed. Eradication strategies: interrupt transmission
Routine infant vaccination Supplementary vaccination: National immunisation days Acute flaccid paralysis surveillancesurveillance- detect polio MopMop-up campaigns
Inactivated (Salk)
Used
Administered Cost Temperature Immunity Back mutation Secondary spread Breast feeding
Oral Cheaper 4C IgG and IgA Yes Yes Not contra-indicated, possible effect on vaccine success
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Parvovirus
Family: Parvoviridae Genus: Erythrovirus Virus: Human parvovirus B19 Morphology: ss DNA, 22 nm diameter, icosahedral capsid, capsid, no membrane
Pathogenesis
Primary infection of the upper respiratory tract Viraemia Virus replicates in rapidly dividing cells (foetal cells and red blood cell precursors)
Epidemiology
Worldwide Spread is by respiratory route Occasionally via blood transfusion Majority of infections are subsub-clinical
Clinical
Erythema infectiosum: infectiosum: fifth disease. Fever and maculopapular rash in children. Rash starts on face slapped cheeks cheeks. 80% of adult women with rash suffer from arthropathy
Aplastic crisis:
Patients with chronic haemolytic anaemias (sickle cell, thalassaemia, thalassaemia, spherocytosis, spherocytosis, etc.)
Congenital infection
Infection in early pregnancypregnancy- foetal loss laterlater- severe anaemiaanaemia- hydrops foetalis
Laboratory diagnosis
Detection:
Viral DNA blood or foetal material Electron Microscopy
Serology: IgM
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