Virus Diseases Facts Chickenpox (Varicella) and Shingles (Zoster) 1. Chickenpox a.

Caused by varicella-zoster virus (VZV), a member of Herpesviridae; is acquired by inhaling virus-laden aerosols or by touching pustules on others or on oneself. b. Incubation period is 10 to 23 days (commonly 18 days) after which small vesicles first appear on face and upper trunk and spread to extremities c. Crops of stages from vesicles to pustules form and subside as scabs d. Can be prevented with attenuated childhood vaccine (Varivax) or the drug acyclovir which prevents herpesvirus DNA synthesis e. Infection confers permanent immunity from chickenpox, but does not rid the individual of virus; instead, virus enters a latent disease stage in the sensory nerve ganglia, as a epistosomic virus genome; second cases have been reported f. VZV produces Type A Intranuclear inclusion bodies in infected cells g. The characteristic signs and symptoms of both VZV diseases usually rule out laboratory diagnosis but if required, PCR would be the test of choice 2. Shingles a. If an individual who harbors the VZV is under stress, the virus can emerge in later life and cause sensory nerve damage and painful vesicle formation, in a specific dermatome, a condition known as shingles b. The disease is treated with acyclovir, famciclovir, or gancyclovir c. An attenuated vaccine (Zovirax) is available for adults d. Immunocompromised patients are particularly susceptible to developing shingles by activation of latent e. Non-immune children will develop chickenpox following contact with a shingles patient Measles (Rubeola, Red measles) 1. A skin disease with respiratory spread caused by Rubeola Virus, a member of family Paramyxoviridae 2. Cold-like symptoms, perhaps a barking cough, develop, during 10-21 day incubation followed by a rash; on rare occasions, subacute sclerosing panencephalitis can develop a. The rash begins in the hair line, behind the ears, spreads to the face, trunk, and extremities b. Koplik Spots, a pharyngeal and buccal lesions are diagnostic 3. MMR (Measles, Mumps, and Rubella) attenuated vaccine is used for prevention routinely in childhood immunizations a. Monovalent and killed measles vaccines are available Mumps 1. Caused by Mumpsvirus, in the family Paramyxoviridae 2. Spread in saliva and aerosolized respiratory droplets; portal of entry is the respiratory tract 3. Causes swelling of salivary glands; a. Meningitis and inflammation of testes are complications, especially in postpubescent male b. The disease has been associated with diabetes and ovary damage 4. Therapy is supportive and the MMR vaccine is used for routine childhood immunizations/prevention Respiratory Syndromes and Viral Pneumonias 1. Acute respiratory syndromes a. Caused by a variety of viruses (Adenoviruses, Coronaviruses, RSV, Paramyxoviruses) b. Associated with rhinitis, tonsillitis, laryngitis, and bronchitis; immunity resulting from infection is incomplete and reinfection is common (ie there are 33 adenovirus types, coronavirus is a poor immunogen, enveloped viruses lipids- are weak antigens) 2. Viral pneumonia is clinically nonspecific, and symptoms may be mild or severe (death is possible) a. Acute Respiratory Disease is seen in military b. Adenoviruses produce Type B Intranuclear inclusion bodies in infected cells and may also cause conjunctivitis during respiratory cases

Respiratory syncytial virus 1. (RSV) is the most dangerous cause of respiratory infection in neonates, children with other chronic diseases, birth earlier than 36 weeks a. Croup, barking cough, cyanosis, are serious signs 2. RSV is a member of the RNA virus family Paramyxoviridae a. RSV is the most feared pathogen in pediatric wards 3. Genetically engineered passive immunoglobulins may be required to decrease mortality; Synergis and Respigam Rubella (German measles, Three-day Measles) 1. Caused by Rubellavirus, a virus of family Togaviridae 2. in pregnant women it causes congenital rubella syndrome, which leads to fetal death, premature delivery, and congenital defects of brain, eyes, ears, circulatory system, developing organs, etc2. Virus is spread by respiratory droplets, and the resulting infection is mild in children (a rash), but serious for pregnant women in first trimester, lessens in the second trimester, and decreases after that time. 3. A vaccine (MMR) is available for routine immunization 4. Hyperimmune passively administered gamma globulin will prevent congenital damage if administered early enough to stop rubella from replicating in the fetus Arthropod-Borne Diseases 1. General features of arthropod-borne diseases 2. Viruses multiply in insect vectors without producing disease, and vector acquires a lifelong infection after being infected during a blood meal 3. Three clinical syndromes are common 1. Undifferentiated fevers, with or without a rash 2. Encephalitis-often with a high case fatality rate 3. Hemorrhagic fevers-frequently severe and fatal 4. Infection provides permanent immunity; for many of the diseases treatment is usually supportive Yellow Fever 1. Mosquito-borne; there are two patterns of transmission a. Urban cycle-human-to-human transmission b. Sylvan cycle-monkey-to-monkey and monkey-to-human transmission 2. Early symptoms include fever, chills, headache, backache; these are followed by nausea and vomiting; in severe cases jaundice, lesions and hemorrhaging occur 3. Prevention and control is by vaccination and vector control St Louis Encephalitis 1. Virus is a Flaviviridae - RNA Virus and is spread by mosquitoes and is endemic in Canada, the USA, the Caribbean, and South America. 2. The disease is most severe in elderly humans. West Nile Virus 1. The virus is a Flaviviridae - RNA Virus and is a major mosquito-borne infection of birds, horses, and humans 2. The virus has spread to the western hemisphere, including every contiguous USA state. 3. The disease produces encephalitis, muscle weakness, and possibly flaccid paralysis, 4. The disease is most serious in debilitated elderly humans. 5. It is detected by RT-PCR and prevented by mosquito control Togaviruses are enveloped RNA viruses members of the Togaviridae 1. Except for rubella, humans and equine animals are dead-end hosts, are birds are the reservoirs, and mosquitoes are the vectors.

2. A viremic state, during the infection, allows mosquitoes to transmit the viruses, and the viruses replicate in mosquito tissues following a blood meal. 3. The viruses share a common group antigen. 4. Alphaviruses There are 26 arthropod-borne viruses, which are transmitted to humans and domestic animals. 5. Three significant diseases are of importance to the USA. a. Western Equine Encephalitis b. Eastern Equine Encephalitis seen in New England c. Venezuelan Equine Encephalitis 6. Laboratory identification is generally made by demonstration of a rise in antibody titer,comparing acute and convalescent sera with ELISA 7. In cases of viral encephalitis, virus may be isolated from the CNS. 8. Virus can be isolated from mosquitoes. 9. Virus isolates can be identified by RT-PCR 10. Prevention is by mosquito control and there are killed vaccines for EEE and VEE. a. Vaccines are not routinely used in humans but are in equine animals

Acquired immune deficiency syndrome (AIDS) 1. AIDS is a syndrome where patients develop bacterial, viral, parasitic, fungal, and neoplastic diseases because of severe immunodeficiency a. Patients cannot maintain immuno-competence and, without therapy, die from these diseases 2. It is caused by Human Immunodeficiency Virus (HIV-1), a lentivirus within the family Retroviridae 3. AIDS occurs worldwide, but certain groups are more at risk; these include men having sex with men,/bisexual men, intravenous drug users, prostitutes, and newborn children of infected mothers a. individuals can be infected with HIV-1 and not present AIDS 4. HIV is acquired by direct exposure to body fluids containing the virus and is also transmitted via breast milk 5. Virus targets CD4+ cells such as T-helper cells, macrophages, dendritic cells, and monocytes 6. CD4+ viral receptors allow the virus to infect these cells a. These cells are killed by HIV replication b. The expression of HIV antigens on the surface of cells makes them susceptible to attack by cell-mediated immune mechanisms such as K-cells, ADCC, and natural killer cells 7. Pathological changes may then ensue a. AIDS-related complex (ARC)-mild fever, weight loss, lymph node enlargement, and production of antibodies to HIV (a mononucleosis-like illness) b. The virus establishes itself in CD4+ Helper T-cells, which leads to destruction of the humeral immune system; this leaves the person open to opportunistic and latent infections and cancers 8. Diagnosis is by viral genome detection (RT-PCR) or by viral antigen/antibody detection (ELISA) 9. Three types of antiviral agents are used to treat and control HIV disease a. Nucleoside analogues that inhibit HIV reverse transcriptase (RT) b. No nucleoside inhibitors of HIV RT c. Inhibitors of HIV protease d. The drugs do not eradicate HIV-1 10. Virus load testing can evaluate the effective use of antiviral drugs and design cocktails 11. Prevention and control involves screening of blood and blood products, education, and protected Sexual practices Herpes simplex Cold Sores, Fever Blisters, and Keratoconjunctivitis 1. The disease is caused by herpes simplex type 1 (HSV-1), a DNA virus a. It transmission is by direct contact or on fomites 2. The pustules at site of infection are due to viral- and host-mediated tissue destruction a. Infected cells have Type A intranuclear inclusion bodies 3. Lifetime latency is established when virus migrates to trigeminal nerve ganglion; is periodically reactivated in times of physical or emotional stress

4. Herpetic keratitis-recurring infections of the cornea; can result in blindness 5. Drugs are available which modify but do not eradicate oral Herpes simplex disease a. Gancyclovir Herpes simplex Genital Herpes Disease 1. The disease is caused by herpes simplex type 2 (HSV-2), a DNA virus a. It transmission is by direct sexual and oral contact and during birth in an infected mother b. Congenital (neonatal) herpes is spread to an infant during vaginal delivery; therefore, infected females should deliver children by caesarean section 2. The pustules at site of infection are due to viral- and host-mediated tissue destruction a. Infected cells have Type A intranuclear inclusion bodies 3. Lifetime latency is established when virus migrates to sacral nerve ganglion; is periodically reactivated in times of physical or emotional stress 4. Drugs are available which modify but do not eradicate genital Herpes simplex disease a. Gancyclovir Common colds 1. Common cold are caused by many different viruses and some of which do not confer durable immunity a. Rhinoviruses Rhinoviridae b. Adenoviruses Adenoviridae c. Coronaviruses Coronaviridae d. Parainfluenza viruses and RSV Paramyxoviridae e. Influenza viruses Orthomyxoviridae 2. Common colds are thought to be spread primarily by hand-to-hand contact; by inhalation of aerosols containing the virus, and by fomites 3. Treatment is supportive in most cases; with the disease presenting as rhinitis lasting only several days; however, depending on the virus species, serious respiratory disease may occur a. In young and elderly patients, the disease may become severe, presenting as pharygitis, bronchiolitis, and or pneumonia

Roseola 1. Human Herpesvirus 6 is the etiologic agent of exanthem subitum (rash) in infants a. Disease is seen about the time maternal immunity wanes2. Its a short-lived disease characterized by a high fever of 3 to 4 days duration, followed by a macular rash on the trunk; disease has few other symptoms 3. CD4 cells are the main sites of viral replication and the tropism of the virus is wide and includes CD8+ T cells, natural killer cells, and probably epithelial cells 4. Transmission is probably by way of saliva 5. Virus produces latent and chronic infections and has been implicated in a variety of other diseases, including chronic fatigue syndrome and lymphadenitis 6. Diagnosis is by immunofluorescence or ELISA or PCR, or the characteristic high fever 7. Treatment nor prevention is currently available Erythema Infectiosum Fifth Disease 1. Parvovirus B-19 is the causative agent of Fifth Disease 2. Mild symptoms (fever, headaches, chills, malaise) in most normal adults 3. Erythema infectiosum in children is seen as a slapped face or lacy rash on extremities a. It reappears following exercise 4. A transient arthritis or joint disease can occur in some adults 5. Autoimmune hemolytic anemia occurs in women and it can cause fetal abortion 6. Spread by a respiratory route 7. Antiviral antibodies are the principal means of defense, and treatment is by means of commercial

B19 immunoglobulins; infection is usually followed by lifelong immunity 8. Parvovirus B-19 is identified by PCR

Mononucleosis 1. Caused by Epstein-Barr virus (EBV), HH6, or Cytomegalovirus, which are Herpesviruses (DNA virus), 2. Each virus is spread by mouth-to-mouth contact ("kissing disease") or by shared bottles and glasses 3. CMV may be spread via transfusions and by tissue transplants 4. Viruses replicate in lymphatic tissue, eventually infecting B cells, and causing enlargement of lymph nodes and spleen, sore throat, headache, nausea, general weakness and tiredness, and a mild fever; the spleen may swell to critical size if supportive care recommendations are not followed 5. The Disease is self-limiting and its greatest morbidity is in 15-25 years of age group 6. Treatment is largely supportive and requires rest; diagnosis is made by microscopy, Monospot tests, or fluorescent antibody tests are used to ID infectious viruses 7. EBV is also associated with Burkitt's lymphoma and nasopharyngeal carcinoma in certain parts of the world Rabies 1. Caused by a virus of the family Rhabdoviridae (RNA viruses) 2. The virus is transmitted by bites of infected animals; and possibly by scratches, abrasions, open wounds, or mucous membranes which become contaminated with saliva of infected animals a. The rabies virus has been transmitted by organ donors who die from rabies disease 3. Virus multiplies in neural tract and migrates to central nervous system, causing a rapidly progressing encephalitis, with varying incubation periods, which correspond to the severity of the animal bites and CNS proximity 4. Diagnosis depended on fluorescent antibody tests, virus isolation, or the detection of Negri bodies 5. Symptoms progress and death results from destruction of the part of the brain that regulates breathing and respiratory function 6. Vaccines conferring immunity are available and must be given prophylactically (professions at risk) or soon after exposure (postexposure vaccination is effective because of the long incubation period of the virus) and the use of Hyperimmune gamma globulin 7. Prevention and control in humans involves vaccination of dogs and cats, and frequent preexposure vaccination of humans at special risk

Viral Hepatitis Hepatitis A Virus 1. HAV is caused by Hepatitis A virus (HAV), a Picornaviridae 2. It is spread by fecal contamination of water, food or drink, or by infected shellfish growing in sewage contaminated water 3. It is caused by the hepatitis A virus (HAV), an RNA virus of family Picornaviridae a. the incubation period is 15-45 days 4. Mild intestinal infections sometimes progress to liver involvement; most cases resolve in four to six weeks and produce strong immunity 5. Control is by hygienic measures, and cooking or sanitary preparation of fruits and vegetables

6. A killed vaccine (Havrix) is recommended for children and travelers to endemic areas 7. The enterovirus can be detected by RT-PCR testing Hepatitis B Virus 1. HBV is caused by Hepatitis B Virus (HBV), a DNA virus; Hepadnaviridae a. The incubation period varies between 50-160 days 2. The Virus is transmitted by blood, contaminated equipment, unsterile needles, venerally, or any by contaminated body secretions 3. Cases can be asymptomatic; sometimes theres fever, appetite loss, abdominal discomfort, and nausea, and fatigue develop; Death can result from liver cirrhosis or HBV-related liver cancer a. HBV DNA genome can be incorporated into hepatocyte nuclei as a chronic disease 4. Control measures involve excluding contact with contaminated materials, use of HBV vaccine and passive immunotherapy within seven days of exposure a. Vaccination of high-risk groups, routine vaccination of children, and education are required b. The disease can be controlled by vaccine usec. Education and childhood/risk group vaccination contribute to control 5. Diagnosis is made by detection of HBsAg, HBe, or Hbc and/ or antibodies directed at there viral antigens; PCR testing can detect the viral genome Hepatitis D Virus 1. Is caused by hepatitis D virus (HDV) which only causes disease if the individual is Coinfected or Superinfected with hepatitis B virus 2. Coinfection may lead to a more serious acute or chronic infection than that normally seen with HBV alone 3. Superinfection usually leads to a more serious acute or chronic infection than that normally seen with HBV alone because the patient is already presenting signs and symptoms of disease a. Diagnosis is made by serological tests or PCR b. Prevention and control is by the use of the hepatitis B vaccine and education Hepatitis C Virus 1. HCV is aused by Hepatitis C virus (HCV) an RNA virus within the family Flaviviridae 2. Virus is spread by intimate contact with virus-contaminated blood, in utero from mother to fetus, by the fecal-oral route, venerally, or through organ transplants 3. Diagnosis is by serological tests or RT-PCR 4. HCV as reached epidemic proportions; However, testing has prevented unlimited transmission 5. HCV is treated with interferon with limited success. Hepatitis E Virus 1. Implicated in many epidemics in developing countries in Asia, Africa, and Central and South America 2. Caused by hepatitis E virus (HEV), a Picornavirus-like RNA virus 3. Infection is associated with fecal-contaminated drinking water and uncooked foods

4. HEV enters the blood from the gastrointestinal tract, replicates in the liver, is released from hepatocytes into the bile, and is subsequently excreted in the feces 5. HEV, like HAV, usually runs a benign course and is self-limiting; can be fatal (10%) in pregnant women in their last trimester 5. There are no specific measures for prevention other than those aimed at improving the level of health and sanitation

Food- and Waterborne Diseases

Gastroenteritis and -Acute viral gastroenteritis 1. Caused by Norwalk viruses, Rotaviruses, Caliciviruses, and Adenoviruses 2. The transmission route for Norwalk, Caliciviridae, and Adenoviridae is the fecal-oral route, and through the ingestion of contaminated water, shellfish, and uncooked fruits and vegetables a. In recent years, they have produced explosive point-source epidemics on cruiseships and closed populations such as summer camps, etc 3. Rotavirus disease is leading cause of childhood death in developing countries 4. It is seen most frequently in the USA as nosocomial disease in infants; disease severity may range from asymptomatic infection, to mild diarrhea, to severe and occasionally fatal dehydration a. There are 2 vaccines that are used in the USA but they have been associated with bowel disorders 5. Viral gastroenteritis is usually self-limited; treatment is supportive 6. The detection of the viral agents is as follows: a. Rotaviruses Microscopy, ELISA and RT-PCR b. Norwalk and Caliciviridae RT-PCR and ELISA c. Adenoviridae PCR Poliomyelitis 1.Caused by poliovirus (Types 1-3), members of the family Picornaviridae; they are RNA viruses 2. They are fairly stable and remain infectious in food and water a. Virus transmission is by aerosols and fecal-oral routes 2. Once ingested, virus multiplies in throat, where it mimics a cold, and then in intestinal mucosa 3. It may enter the bloodstream and cause viremia (but 99% of viremia cases are transient with no clinical disease) 4. In less than 1% of cases it can enter central nervous system, leading to paralysis 5. Vaccines have been extremely effective (less than 10 cases per year in the USA) and those most likely due to vaccine strains; it has no endogenous reservoir 6. Killed and attenuated vaccines have been effective in preventing and controlling the disease; global eradication, in developing countries, may be possible in the next few years

Warts 1. Warts are caused by papillomaviruses; treatment involves removal of warts, physical destruction, or injection of interferon; some papillomaviruses play a major role in the pathogenesis of epithelial cancers of the male and female genital tracts 2. Two vaccines are commercially available and have been used for ~2 yrs.