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IMPORTANT PATHOGENIC VIRUS

DURING CHILD GROWTH (2)

Microbiology Department

Medical Faculty,

University of Sumatera Utara

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Parainuenza virus

Causing a spectrum of respiratory illnessfrom upper respiratory tract symptomsin healthy children to severe pneumonia

in the immunosupressed Member paramyoviridae, genus

Paramyovirus, species parainuenza

virus !"# virus single stranded

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Parainuenza virus

Pathogenesis

 $ransmission is by droplet spread%

!eplication occurs in cells of therespiratory epithelium%

Clinically , illness most fre&uentlyinvolves larger air'ays of the lo'er

respiratory tract, causing croup(laryngotracheobronchitis)%

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Parainuenza virus

Pathogenesis (con*t)

!e+infection may occur and tends to causemilder upper air'ay disease, probably

representing 'aning of immunity% #ntigenic variation is not progressive

(unlie inuenza virus)

Mucosal immunity is most important forresisting infection% CD- $ cells areimportant in viral clearance%

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Parainuenza virus

Clinical Feature

Upper respiratory tract illness (Childrenunder . years )

/titis media

Croup

0ronchiolitis (infants undert 1 months)

Severe pneumonia in theimmunosupressed

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Parainuenza virus

Diagnosis

2iral isolation by tissue culture andimmunouorescence is the standard

PC! based tests are faster and candistinguish viral type

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!espiratory Syncytial 2irus

!S2 is a ma3or cause of lo'er respiratory tractinfection in young children (bronchiolitis)

#n important nosocomial infection

Member of the Paramyoviridae family, genuspneumovirus, species !espiratory Syncytial2irus

 ss!"# virus

May survives up to 45 hour in patient secretionsdepositing on non+porous surface and aroundan hour on porous surfaces (tissue, fabric, sin)

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!espiratory Syncytial 2irus

Pathogenesis

6ncubation bet'een 4 and - days%6noculation is by nose and eye, 'ith

infection con7ned to the respiratorytract%

8ymphocytic in7ltration of the areas

around the bronchioles 'ith 'all andtissue oedema is follo'ed byproliferation and necrosis of thebronchiolar epithelium 9 bronchiolitis

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!espiratory Syncytial 2irus

Clinical Feature

 :oung children 9 pneumonia andbronchiolitis

/lder children 9 a severe common cold

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!espiratory Syncytial 2irus

Diagnosis

Clinical diagnosis can be made 'ith somecon7dence in children during an outbrea

Serology is only useful epidemiologically

Cell culture 9 nasopharingeal aspirateprovides the best sample 'ith a high rate of

virus isolation% 6t should be inoculated intocell lines as soon as possible%

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!espiratory Syncytial 2irus

Diagnosis (con*t)

6nfection is characterized by the typicalsyncytial appearance , and the

cytopathic e;ect is visible at around day<+=

!apid test 9 immunouorescence

antibody test (6F#$), PC! and enzymeimmunoassays are all available%

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!espiratory Syncytial 2irus

Prevention

#ctive immunization is not available%

!S2 monoclonal antibody reducesmorbidity in infants at ris of severe !S2%

6nfection control in hospital%

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Mumps

#cute generalized viral infection ofchildren and adolescents causings'elling and tenderness of the salivaryglands

# member of the Paramyoviridaefamily, genus rubulavirus, species

mumps virus !"# virus, single stranded

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Mumps

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Mumps

Pathogenesis

 $ransmitted by droplet spread or direct contact

6ncubation is 4+5 'ees

During incubation the virus proliferates in theupper respiratory tract 'ith conse&uentviraemia and localization to glandular andneural tissue

Parotid glands sho' interstitial oedema andsero7brinous eudate 'ith mononuclear cellin7ltration

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Mumps

Clinical feature

Prodrome of fever, headache andanoreia

>arache and ipsilateral parotidtenderness% $he gland s'ells over 4+<days% S'elling can lift the ear lobe up

and out'ard $he other side follo's 'ithin a couple of

days in most cases

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Mumps

Diagnosis

8ab con7rmation is re&uired forepidemiological purposes or 'hen

disease is atypical 8eucocytosis may be seen particularly

'ith meningitis, orchitis, or pancreatitis

Serum amylase is elevated in parotitis orpancreatitis

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Mumps

Diagnosis (con*t)

Serology 9 most reliably determinedusing >86S# for 6gM

 2irus isolation 9 present in saliva from4 days before symptom onset to . daysafter onset

Prevention

2accination is more than ?.@ e;ective

and taes place at A4+A. months and

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!ubeola (Measles)

#n acute highly infectious disease of childrencharacterized by cough, coryza, fever andrash

# member of the family Paramyoviridae,genus Morbillivirus, species Measles virus

ss !"#

 $his virus sensitive to light and drying but

can remain infective in droplet form for somehours

6mmunity after infection is lifelong

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!ubeola (Measles)

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!ubeola (Measles)

Pathogenesis

#irborne, spread by contact 'ith aerosolizedrespiratory secretions and one of the most

communicable of the infectious diseases Patients are most infectious during the late

prodromal phase 'hen coughing is at itspea%

2irus invades the respiratory epithelium andlocal multiplication leads to viraemia andleucocyte infection%

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!ubeola (Measles)

Pathogenesis (con*t)

!eticulo+endothelial cells becomeinfected and their necrosis leads to asecondary viraemia

 $he ma3or infected blood cell is themonocyte

 $issue that become infected include thethymus, spleen, lymph node, liver, sinand lung

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!ubeola (Measles)

Pathogenesis (con*t)

Secondary viraemia leads to infection ofthe entire respiratory mucosa 'ith

conse&uent cough and coryza Bopli*s spots and rash appear a fe'

days after respiratory symptoms (may

represent host hypersensitivity to thevirus)

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!ubeola (Measles)

Clinical Features

# prodromal phase of malaise, fever,anoreia, con3unctivitis and cough isfollo'ed by Bopli*s spot then rash%

!ash begins on the face and proceeddo'n involving palms and soles last% 6tlast around . days and maydes&uamate as it heals

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!ubeola (Measles)

Diagnosis

Usually clinically

8ab con7rmation is useful in atypical cases

2irus isolation possible in renal cell lines,useful in the immunode7cient 'hereantibody responses may be minimal

Serology, a fourfold increase in measlesantibody titres bet'een acute andconvalescent specimens is diagnostic

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!ubeola (Measles)

Diagnosis (con*t)

>86S# is capable of detecting speci7c6gM on a single sample

6mmunouoresent microscopy of cells insecretions

PC!

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!ubeola (Measles)

Prevention

Measles vaccine is given as part ofmeasles, mumps, rubella (MM!), at A4

months and preschool% Passive immunization 'ith

immunoglobulin is recommended for thoseeposed susceptible people at ris ofsevere or fatal measles% 6t must be given'ithin 1 days of eposure to be e;ective%

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!ubeola (Measles)

Prevention ( con*t)

Such groups include 9

Children 'ith malignant disease,

particularly if receiving chemo orradiotherapy

Children 'ith 62 should be given

immunoglobulin after eposure even ifalready vaccinated

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6nuenza virus

/ne of the commonest infectious disease ofman, primarily causing epidemics of upperrespiratory tract infection

6nuenza is a moderate to severe illness mostoften caused by inuenza # or 0 viruses%

Members of family /rthomyoviridae

ss !"# viruses

ave haemagglutinin (#) orneuraminidase("#) activities as ey antigeniccomponents and may alter by mutation(antigenic drift)

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6nuenza virus $hree distinct inuenza viruses 9

6nuenza # (A1 # and ? "# variants havebeen identi7ed)% >ample of subtype9A"A, ."A, etc

 $ypical inuenza syndrome and can

precipitate pandemics% 6nuenza 0

causes the typical inuenza syndrome but

does not cause pandemic 6nuenza C (does not possess

neuraminidase structures)

causes afebrile common cold lie syndrome

and does not occur in epidemics%

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6nuenza virus

Pathogenesis

6t is highly infectious

6ts short incubation period (A+4 day) can

rapidly cause large epidemics andpandemics

2irus enters respiratory epithelial cells,replicates and progeny are released, the cell

dies% 2iral shedding may start 'ithin 45 hour of

infection + 6llness follo's 45 hour later

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6nuenza virus

Pathogenesis (con*t)

 $here is di;use infammation of the tracheaand bronchi 'ith an ulcerative, necrotizing

tracheobronchitis in severe cases% Primary viral pneumonia is uncommon but is

severe 'hen it occurs%

0acterial superinfection is common,

facilatated by damage to the mucociliaryescalator, and virus+induced defects inlymphocyte and leucocyte function%

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6nuenza virus

Pathogenesis (con*t)

2iral levels fall rapidly after 5- hour ofillness, becoming undetectable by .+A

days%

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6nuenza virus

Clinical features

A+4 day incubation is follo'ed by anabrupt onset of symtomps% Fever, chills,

headache, malaise, myalgia, eye pain,anoreia, dry cough, sore throat, andnasal discharge%

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6nuenza virus

Diagnosis

6n the contet of a community outbrea,the diagnosis of inuenza can be made

'ith some con7dence on clinical criteriaalone

2iral culture, virus is readily isolated

from sputum, throat, or nasal s'abs% 6t iscultured in cell lines and detected 'ithin<+. days by its cytophathic e;ect

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6nuenza virus

Diagnosis (con*t)

2iral antigen detection 9 rapid detection'ithin A+4 days is possible 'ith

immunouoresence or >86S#% PC! are inincreasing use%

Serology 9 acute and convalescent (A+

4days apart) samples sho'ing afourfold rise in antibody titre%

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6nuenza virus

Prevention

6nactivated vaccines are the maincontrol measure

 $hey are prepared each yearcontaining t'o type # and one type 0strain

 $'o doses are re&uired in childrenunder ? years

Protection is around =@ and last for A

year

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!ubella virus

#cute mild eanthematous viral infection ofchildren and adults resembling mild measles

Potential to cause fetal infection and birth

defects # member of $ogaviridae family, genus

!ubivirus, species rubella virus

!ubella is also called Eerman Measles andthird disease*, measles and scarlet feverbeing the 7rst and second eanthematousinfections in children

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!ubella virus

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!ubella virus

Pathogenesis

Spread is by droplets

Moderately contagious

6ncubation is A4+4< days

Patients are at their most contagious'hen the rash is erupting

2irus may be shed from A daysbefore to 4 'ees after itsappearance

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!ubella virus

Pathogenesis (con*t)

!ash appears as immunity develops andviral titres fall

Primary viraemia follo's infection of therespiratory epithelium, secondary viraemiaoccurs a fe' days later once the 7rst 'aveof infected leucocytes release virions

#fter infection or vaccination most peopledevelop lifelong protection

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!ubella virus

Clinical feature

Many cases are subclinical

 $he main symtomps are

lymphadenopathy and a maculopapularrash

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!ubella virus

Diagnosis

6ts mild nature maes clinical diagnosis diGcult

Serology , positive 6g M on a single sample or a

fourfold rise in 6gE in paired sera is diagnostic% Serological diagnosis of congenital rubella in

neonates need analysis of several samplesover time to determine 'hether antibody titres

are falling (maternal antibody) or rising (recentinfection)

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!ubella virus

Diagnosis ( Con*t)

Detection of rubella 6g M in ne'born*sserum indicates infection

6ntrauterine diagnosis has been made byplacental biopsy and by cordocentesis'ith detection by PC!

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!ubella virus

Prevention

2accination achives a seroconversionrate of ?.@

#ll 'omen of child bearing age should bevaccinated before pregnancy

Homen should not become pregnant in

the < months follo'ing vaccination

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Candida species

# yeast and the most common cause of fungalinfection

Candida albicans is responsible for ?@ ofinfection

Small ovoid cells that reproduce by budding

C. albicans may be found in soil, food andhospital environment% $hey are commensal ofhuman (sin, sputum, E6 tract, female genital

tract, etc

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Candida species

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Candida species

Pathogenesis

 $he rise of Candida sp% infection relatesto the increase in medical intervention 9

+ $he use of antibiotics (supressing normalbacterial ora and permittingproliferation of Candida organism

+ 6ntravenous catheters (providing route ofentry)

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Candida species

Pathogenesis (con*t)

6mmune supression mediated by disease(e%g%62) or therapy such as steroids are alsoassociated 'ith increase rates of infection

6mmune response to Candida infection ismediated by humoral and cellular mechanism

Candida sp. virulence factors include surface

molecules that permit organism adherence toother structures ( human cells), acid protease

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Candida species

Clinical features 9 /ral thrush

/ral candidiasis characterized by 'hite,creamy patches on the tongue and oral

mucosa%

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Candida species

Diagnosis

Can be con7rmed using a B/ smear or gramstain to demonstrate hyphae and yeast form

Culture 9 smooth 'hite colony

Presumtive identi7cation of C. albicans is

possible by inoculating organism from acolony into a small tube of serum, germ tubeshould form 'ithin ? minutes%

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