Enterovirus & Poliomyelitis

ENTEROVIRUS & POLIOMYELITIS
LECTURE NO.3
CLASSIFICATION ENTEROVIRUS
23 serotypes =coxsackievirus A 6 serotypes =cosakievirus B 28 serotypes =echovirus 3 serotypes =poliovirus(1,2,3)
MICROBIOLOGY ENTEROVIRUS
Picornaviridae RNA virus non-enveloped Got 4 viral proteins Stable in stomach acid High resistance to disinfectant, alcohol etc.
EPIDEMIOLOGY
World wide, high rate of infection in younger children Most in northern hemisphere, in autumn and summer Persist in watery environment human as reservoir Transmission=airborne, fecal-oral, transplacental, direct contact Communicable=highly infectivity in acute phase of illness and maybe prolonged since virus in feces till 2 months Incubation=2hr-6days
PATHOGENESIS ENTEROVIRUS
After ingestion, affect the epithelium cell of GIT in mucosal layer Spread and replicate in submucosal lymphoid tissue of tonsil and payers patch Next virus spread to regional lymph nodes Then in viral phase, replication occurs in organs, brown fat tissues and reticuloendothelial system In 2nd phase, viremia occurs which lead to further replication in tissues and cause symptoms to appear Next virus reach to CNS and cause major illness in brain and spinal cord (Motor system in the anterior horn of spinal cord). Cervical and lumbar spines are the most affected. In brain, lesions are found in hypothalamus, thalamus, center motor cortex, part of cerebellum and brain stem. Can be isolated from blood 3-5 days after infection. Virus shed in oropharyngeal up to 3 months. In GIT= 12months.
CLINICAL MANIFESTATION
Non specific febrile illness (summer grippe) -incubation 3-6days -acute onset of fever -malaise, headache -nausea, vomiting -symptoms resolve for 3-4 days (or till 1 week) Generalized disease of newborn -develop during 1st week of life -resemble bacterial sepsis signs -fever, irritability, lethargy -can be complicated by myocarditis, severe hepatitis, DIC, meningitis, meningiocephalitis, pneumonia and others. Myocarditis and pericarditis -patient with upper respiratory tract infection -fever, chest pain, dyspnea, arrhythmias, heart failure, changes in ECG=elevation ST or T wave abnormalities.
Aseptic meningitis and encephalitis -acute fever, chills, headache, photophobia, pain in eye movement -nausea and vomiting -diarrhea, myalgia, pleurudynia, rash, hyperangina, myocarditis -in CSF=normal glucose, normal/increase protein -encephalitis is recognized in the basic of lethargy to deep coma and seizures. -paralytic disease due to enterovirus other than poliovirus occurs sporadically and less severe as in coxsakievirus A and B. Pleurodynia / Borhholm disease -acute onset of fever and spasm of pleuritic chest or upper abdominal pain -knifelike pain last for 15-30 minutes with diaphoresis and tachypnoe. -X-ray examination and blood test are normal -treatment using NSAID and heat on affected muscles Exanthemas -rashes morbiliform or rubiliform -start on face then trunk and extremities -not associate with lymphoadenopathy -rashes also can be multiform, vesicular, urticaria etc
Hand-foot-mouth disease -fever, anorexia, malaise, vesicles on buccal mucosa and tongue, sore throat -tender vesicular lesion on dorsum of hand, palate, buttock, and resolve in 1 week. Acute hemorrhagic conjuctivitis -severe eye pain -blurred vision, edema, chemosis -subconjuctival hemorrhage, photophobia, keratitis Hyperangina -fever, sore throat, dysphagia, grayish-white papulovesicular lesion -lesion persists for 1 week -acute lymphonodular pharyngitis present as white or yellow nodules surrounded by erythema in post oropharyngeal Other manifestation -pneumonia, common cold, bronchitis, bronchiolitis, croup,arthritis and nephritis.
DIAGNOSIS
Isolation from throat, stool, CSF, serum, fluid from body cavities and tissues. For coxsakievirus A need to cultivate in special cellculture lines or into suckling mice All stool, throat and serum samples need to take from patient with suspected poliomyelitis PCR=92% of serotype can be detected by this method Serological method cant be used due to a lot of serotypes and lack of serum antigen
TREATMENT AND PROPHYLAXIS

Most of infection=mild and resolve spontaneously Intensive care for CNS, cardiac and hepatic status IV, intrathecal and intraventricular Ig for chronic enterovirus meningioencephalitis and dermatomyositisin patient with hypo or agammaglobulinemia. Oral pleconaril, capsid bindingantiviral agent reduce symptom of enterovirus aseptic meningitis. Glucocorticoid is contraindicated. Wash hand, use glove, mask etc Enteric precaution for 7 days after onset No vaccination due to many serotypes Hospitalization and isolation.
POLIOMYELITIS
Causative agent= poliovirus From picornaviridae, RNA virus, nonenveloped Got 3 antigenic types:1, 2 and 3. Characterized by asymmetric paralysis and flaccid.
EPIDEMIOLOGY
Occurs in human only Virus survive in water up to 3 months Most in poor countries where bad immunization plan US free from polio in 1991, Russia in 2001. Transmission=fecal oral route, food, water and air borne, Infectivity of virus for severel weeks.
CLINICAL MANIFESTATION
Incubation period from 3-6 days and cause minor illness (abortive poliomyelitis) -fever, malaise, sore throat, anorexia -myalgia, headache, GIT discomfort, -resolve in 3 days Aseptic meningitis or nonparalytic poliomyelitis -occurs in 1%orf patient -phase begins with preparalytic signs - In infants= irritability, anorexia, vomiting, inconsolable crying, lethargy, seizure, focal neurological sign - In older children= headache, back pain, shift neck, photophobia. - Positive Kernigs and Brudzinski
Paralytic disease -incubation 7-21 days for mild case,7-28 days for vaccine associated case and 7-60 days in contact. -1-4days signs appear after aseptic period -severe back, neck and muscles pain -rapid or gradual development of motor weakness -paralysis occurs due to poliovirus attack of neuromotor cell in the spinal cord. -may attack single muscle group (usually in limbs) -paralysis develops in febrile phase of illness. -spinal form: weakness, fasciculation, decrease muscle tone, hypo or areflexia. -bulbar form: dysphagia, dysphonia, dysphasia and difficult to handle secretion. This affect IX, XI and XI cranial nerves and lead to respiratory disturbance. --respiratory insufficient if involve the respiratory center in the MO and phrenic nerve and intercostal nerve and lead to circulation collapse. -Pontile form= affect the facial nerve -most patient recover partially in weeks to months after infection. -about 2/3 of patients got residual neurological problem.
-Post polio syndrome as anew onset of weakness, fatigue, fasciculation, pain, atrophy muscles involved in 20-40 years earlier. -Poliomyelitis due to live vaccine in recipient of 1st or 2nd OPV (oral polio vaccine), the median interval from vaccination to the onset of symptoms usually 3 weeks but in some cases disease can develop up to 6 months. -the possibility of of poliomyelitis after OPV= 1 in 2.5million
DIAGNOSIS
From feces, throat, and rarely from CSF 2 specimens of stool are isolated in 7 days taken from patient with acute flaccid paralysis Culture from 2 specimens collected within 1st 15 days of illness Serological method =difficult
TREATMENT AND PROPHYLAXIS

No specific treatment only bed rest and supportive treatment Immunization by trivalent vaccine -live oral poliovirus vaccine (Sabin)-OPV -inactivated poliovirus vaccine (Salk)-IPV -in Russia, vaccination is given in 3rd, 4.5th, 6th, 18th, 20th months and 14th year.

Enterovirus & Poliomyelitis

Uploaded by

Copyright:

Available Formats

Enterovirus & Poliomyelitis

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Enterovirus & Poliomyelitis

Uploaded by

Copyright:

Available Formats

ENTEROVIRUS & POLIOMYELITIS

TREATMENT AND PROPHYLAXIS

TREATMENT AND PROPHYLAXIS

You might also like

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.