RNA ENVELOPED VIRUS ORTHOMYXOVIRUS Are all influenza viruses which cause ordinary flu Spherical virion containing

ng 8 segmented negative stranded RNA put together with a protein (nucleocapsid protein NP) into a helical symmetric capsid Virulence Factors glycoprotein spikes which are anchored inside the virus by a membrane protein called Mprotein. The two types of glycoprotein spikes of influenza virus are: o Hemagglutinin activity (HA) attaches to hosts sialic acid receptors on the surface of RBC and upper respiratory tract cell membranes. HA is used for attachment and adsorption/fusion o Neuraminidase (NA) dissolves hosts neuraminic acid which is an important component of mucin, the substance that covers and protects mucosal epithelial cells especially in upper respiratory tract Genetic reassortment a property of segmented RNA viruses (like influenza virus) where in when two different viruses of a given type coinfect cell, the gene segments of the two viruses are reassembled into a progeny virion o Antigenic drift a minimal change in the antigenic nature of the viral glycoprotein spike (NA and HA) during viral replication o Antigenic shift complete change in the HA, NA or both MOT: airborne or droplet Influenza/Flu/Trangkaso s/sx: chills, fever, malaise, sore throat, cough, rhinorrhea (runny nose), myalgia (muscle pain), headache POC: until 5th day of illness Complications: sinusitis, otitis media, secondary bacterial pneumonia (S. aureus, S. pneumoniae) Diagnosis o CBC shows leukopenia o Throat swab o serology Treatment and control: o Amantadine (DOC) prevents uncoating of influenza virus; can decrease the severity of illness if given early in the course o Antipyretic/analgesic for fever and myalgia; choose paracetamol and iboporfen and avoid aspirin Aspirin administered in viral infection is associated with development of Reyes symdrome in children o Increase resistance Rest; increase fluid and Vit C intake o Respiratory isolation PARAMYXOVIRUS The structure of paramyxovirus is very similar to that of orthomyxovirus except: o Negative stranded DNA is in single strand, not segmented o HA and NA are part of the same glycoprotein spike, not different spikes o They possess a fusion protein (F protein) that causes infected host cells to fuse together into a multinucleated giant cells Significant viruses under this family are o Mumps virus o Measles virus o Respiratory Syncytial virus MUMPS VIRUS Infectious Parotitis/Mumps/Beke Nonpurulent inflammation of the parotid salivary glands MOT: direct contact (oropharyngeal secretion) IP: 18-21d POC: from 6 days before symptoms appear until swelling subsides S/sx: ante-auricular pain and swelling; dysphagia

 Complications: o Epididymo-orchitis (inflammation of epididymis and testicles) in postpubertal male (can lead to sterility) o Oophoritis (inflammation of ovaries) in postpubertal females o Transient high-frequency deafness o Meningitis, encephalitis, or pancreatitis (spread from initial site through viremia) Diagnosis o Isolation of virus in saliva o Hemagglutination test with known antiserum Treament: supportive o Increase resistance Rest, increase Vit C and fluid intake o Soft bland diet (to prevent stimulation of parotid gland secretion) o Administer ice pack or ice collars if necessary cold numbs nerve endings relieving pain o wear well-fitted supporters to relive pressure and prevent orchitis Prevention: MMR (measles, mumps, rubella) vaccine o a live attenuated vaccine which provide 6 years immunity to mumps o recommended for children 12-18mo (ave 15 mo) during outbreaks o administer only 24-48hrs ANST (after negative skin test); clients who have had asymptomatic/subclinical mumps infection may have positive reaction to skin test and should not receive the vaccine anymore MEASLES VIRUS Measles/Hard measles/ Little Red disease/ 7-day measles/Rubeola/Morbili/First Disease/Tigdas Has one strain only; recovery results to permanent immunity

MOT: direct contact to upper respiratory tract secretion or conjunctiva IP: 10-11d POC: 3 d before the rash appear to 5 days after rash disappear S/Sx: Pre-eruptive stage (Day1-3) Prodromal o high grade fever o 3 Cs: cough; colds or coryza; and conjunctivitis (formerly Stimsons sign) o Kopliks spot (Pathognomonic sign) red rash with elevated white center and bluish base found in gums and buccal mucosa Eruptive Stage (Day 4-5) - Disease o Morbiliform rash red blotchy large maculopapular rash appearing in cephalocaudal presentation covering the whole body in two days Post-Eruptive stage (day 6-7)Recovery o Fine desquamation (skin is flaking or scaling) o Fever subsides Complication: pneumonia and encephalitis Dx: clinical observation and isolation of virus from respiratory tract Treatment o Passive immunity using Human Anti-measles Gammaglobulin effective in preventing the disease if given within the first 3 days (72hrs) of exposure (NOTE: 3 days after exposure and not 3 days in the disease) o Prophylactic broad spectrum antibiotics to prevent secondary bacterial pneumonia o Increase resistance Rest, nutrition, fluid and vitamins o Prevent draft, keep client dry (prevent pneumonia) o Darken room for clients having photophobia associated with conjunctivitis Prevention: Active immunity

o AMV (Antimeasles vaccine) live attenuated vaccine; single dose at 9th month (or before 1 year) of age; SC; given with Vit A to prevent blindness o MMR see discussion in Mumps section ARBO VIRUS Arthropod-borne viruses are large group of viruses that are spread mainly by blood sucking insects (mosquito, ticks) More than 100 arboviruses can cause disease in humans including o Alphaviruses o Eastern Equine encephalitis o Werstern Equine encephalitis o St. Louise encephalitis o Japanese encephalitis o La Croseesencephalitis o Colorado Tick Fever Reservoir: birds, horses and other animals MOT: mosquito bite (Aedes Solicitans and Culex Tarsalis mosquitoes) and horse ticks Encephalitis/Brain fever Inflammation of the brain (rare because human is not part of the natural life cycle of arboviruses) IP: 4-21d S/Sx: drowsiness, stiff neck, dysphagia, dyspnea, aphasia, confusion, convulsion, tremors, and coma Diagnosis: o Lumbar puncture and CSF examination o EEG (electroencephalogram) to determine extent of brain injury o ELISA identify specific IgM Treatment: supportive o Mannitol osmotic diuretic to decrease brain edema o Corticosteroid antiinflammatory to decrease inflammation o Anticonvulsants to prevent seizure

o Antipyretic control fever to decrease oxygen demand o Monitor LOC Prevention: CLEAN program o Chemically-treated mosquito net o Larvivorous fish (tilapia) o Environmental sanitation o Antimosquito soap and/or lotion o Neem or Eucalyptus tree FLAVIVIRUS/DENGUE VIRUS Arbovirus transmitted to the blood stream by mosquito bite where they cause multiple lesions in capillaries and increase capillary permeability and fragility causing hemoconcentration and bleeding respectively resulting to shock MOT: mosquito bite o Aedes aegypti and Aedes Albopictus - biological transmitter (harbours and transmits the virus indefinitely) o Culex Fatigans mechanical transmitter (does not harbour the virus and transmit the virus once) Aedes aegypti characteristics o D (day biting), L (low flying), S (stagnant water), U (urban community) o Has white stripes in legs and gray wings Note: mosquito becomes infective 8-12 hours after a blood meal, person becomes infective a day before the febrile period to end of it Dengue Fever/Breakbone fever IP: 5-8 d Grades and S/sx: Grade I o high grade fever x3-5d o pain (behind the eye, in joints, in bones, abdominal, headache) o N/V o Petechiae (due to bleeding from small capillaries) o Hermans sign (general flushed appearance)

 Grade II(signs of bleeding ) o epitaxis and gum bleeding o GI bleeding manifested by hematemesis (vomiting of blood if bleeding in stomach), melena (dark tarry stool of bleeding is in stomach or small intestine) and/or hematochizia (feces with streak of fresh bright red blood if bleeding is in lower part of large intestine) Grade III (signs of circulatory failure because of bleeding) o cold clammy skin o altered VS decreased BP, increased RR, increased HR, weak pulse Grade IV circulatory collapse and shock; multiple organ failure (may result to death) Diagnosis: o Torniquet test/Rumpel-Lead test (screening/presumptive) application of tourniquet or BP cuff with the average pressure of systolic and diastolic pressure for 5 min in children and 10 min in adults; (+) TT means the appearance of >20 petechial rash in 1 in2 o Platelet count (confirmatory) decreased platelet (thrombocytopenia) because of consumption from clotting in multiple bleeding site o Hematocrit increased Hct (>54%) because of hemoconcentration from plasma loss because of increase capillary permeability Treatment: supportive o IVF to manage hemoconcentration and shock o Blood transfusion to manage bleeding and shock o Platelet transfusion to replace platelet consumed o Vit K to enhance blood clotting o Vit C to promote capillary strength and resistance o Promote fluid intake if capable to manage

hemoconcentration and prevent shock o Control bleeding Epistaxis tilt head forward; keep head elevate; apply cold compress; avoid forceful blowing of nose Gum bleeding take ice chips Hematemesis put client in NPO, position in upright or side lying, apply ice pack over epigastrium TOGAVIRUS RUBELLA VIRUS German Measles/Rubella/Rotela/3 day Disease A disease that primarily affect skin and lymph nodes MOT o direct contact with respiratory droplets o transplacental transmission IP: 14-18d POC: 1 week before to 1 week after rash appears S/Sx: Preeruptive phase (Day 1-2) o (+) or (-) fever o Catarrhal (URT) symptoms o Transient arthritis (because of viremia) o Forcheimers spot (pathognomonic spot) fine red spots in soft palate Eruptive phase (Day 2-3) o Dicrete (fine) red maculopapular rash; cephalocaudal presentation (covers the body in 24 hours) o Enlarged lymp nodes (postauricular, posterior cervical and suboccipitl lymph nodes Post-eruptive (Day 3) o Rashes desquamate and disappear Congenital rubella teratogenic; may be fatal or may cause congenital disease: o Cleft lip, cleft palate or both

o Patent ductus arteriosus (PDA); atrial septal defect (ASD) o Congenital glaucoma; retinopathy o Deafness o Microcepahaly; cerebral palsy; mental retardation Treatment/prevention: o Same with measles o Rubella immune globulin provide passive immunity to clients exposed to rubella when given within 3d (72hr) within the exposure (especially for pregnant women to prevent congenital rubella) o MMR provide active immunity (see previous MMR discussion) Do not give in pregnant women because it is live attenuated vaccine Women who receive MMR should be instructed not to get pregnant in the next 1-2 months at least, because of risk of congenital rubella RHABDOVIRUS/RHABDOVIRIDAE From the the genus Lyssavirus Bullet-shaped, single stranded RNA virus Negri bodies pathologic lesion in the brain of infected host; oval or globular in shape and around the size of RBC MOT: o tissue transplant from infected humans (rare) o bite or scratch (with saliva from licking the paws) of an infected animal (dog, cat, rats) chances of contracting the disease: 60% if bite is in face 15-40% if bite is on the upper extremities <10% if bite is on the lower extremities Other factors affecting chances of contracting the disease:

Richness of blood supply to the bite site Extensiveness of the bite Resistance of the host Rabies/Lyssa Acute, central nervous system infection characterized by CNS irritation, followed by paralysis and death IP: 10 d- 21 yrs (1-3 mo) Stages and S/Sx: Prodromal Stage 2-10 d o Catarrhal symptoms; Fever and chills; Malaise, headache o Persistent cough o Pain, burning sensation or tingling sensation in the inoculation bite Excitation phase (acute neurological) 2-7d o Insomnia, irritability, apprehension, perspiration (cholinergic effects) o Tachycardia, tachypnea o Hyperesthesia o Sensitivity to loud noises o Hydrophobia and excessive salivation (due to painful pharyngolaryngeal spasm when swallowing o Aerophobia (due to facial spasm when air brushes face) o Photophobia o Maniacal behaviour, rage Terminal phase (coma) o Spasm stops o Progressive paralysis o Peripheral vascular collapse o Coma and death in 24-72hr Dog o IP: 3-8 wks o Dumb stage suspiciously quiet, inactive o Furious stage agitated, vicious look, drooling saliva Diagnosis o Clinical observation o Brain biopsy and DFA confirmatory and definitive (can only be done post mortem)

o Observe animal for 10d for behaviour change or death (brain biopsy of dog if possible) Treatment o Passive immunization using animal or human antiserum (because active immunity develops only after 3d) ERIG (equine rabies immune globulin) administer ANST antiserum derived from infected horse ARS (anti-rabies serum) antiserum from infected human Single dose IM ventrogluteal 0.2 cc/kg of body weight for animal serum 0.133/kg of body weight for human serum o Active immunization (provide longer immunity) Maybe administered IM or ID IM vaccination schedule: Day 0, Day 7, Day 21 ID vaccination schedule: Day 0, Day 3, Day 7, Day 28, Day 90 o Antitenus prophylaxis Tetanus toxoid o Nursing care if rabies set in (esp in excitation stage) Dim the room, provide minimal stimulation Restrain client before maniacal behaviour sets in Place in a room away from utility room and with minimal human traffic Wear personal protective equipment (masks, gloves, eye wear) when providing care to client to avoid saliva Prevention: immunization of dogs; be responsible pet owners RETROVIRUS/RETROVIRIDAE HUMAN IMMUNODEFICIENCY VIRUS (HIV) Has two identical strands of RNA, the enzyme reverse transcriptase and an envelope of phospholipids

Fragile virus that is destroyed by 70% alcohol, chlorine, temperature of 56 degrees C, NaCl 1:10 solution when outside the body Factors used for viral replication: o GP120 glycoprotein spikes used for attachment to CD4 receptors of WBCs o Chemokines substance used for entry to target host cells (during attachment, fusion) o Reverse transcriptase used by HIV to convert its RNA to DNA o Integrase used to integrate HIV DNA into host cells DNA (during synthesis) o Protease used to cut virion chains into new HIV particles (during assembly) MOT: o Blood transfusion 90% chance in single transfusion o Sexual contact 0.1-1.0% in single transfusion o Transplacental transmission 30% chance if mother is without treatment and 5% chance if mother is with treatment o Inoculation through needle prick 0.1-0.5% chance in a single incident HIV/AIDS Course Well Window period asymptomatic for 6 wks to 6 mo HIV infection characterized by general signs and symptoms and positive antibodies o Minor s/sx Persistent cough x 1 mo Persistent general lymph adenopathy Persistent general pruritic dermatitis Oropharyngeal candidiasis Recurrent herpes zoster Progressive disseminated herpes simplex o Major s/sx

 10% weight loss or stunted growth Chronic diarrhea Persistent fever AIDS characterized by positive AIDS defining disease o P. carinii pneumonia o vaginal candidiasis o Kaphosis sarcoma o Non-Hodgkins lymphoma o Cervical cancer characterized by post-coital bleeding, metrorrhagia, blood tinged vaginal discharge o AIDS dementia characterized by cognitive dysfunction, motor paralysis and behavioural changes o HIV wasting syndrome profound involuntary weight loss (10% body weight) with either chronic diarrhea, weakness and fever Classification of infection o Category A asymptomatic to general manifestation o Category B symptomatic o Category C AIDS defining disease or syndromes Diagnosis o ELISA screening test o Western Blot test confirmatory; recommended after 2 positive ELISA o Viral load monitors the replication activity of virus o CD4 count monitor progress of disease or treatment o 200 HIV infection o < 200 - AIDS Antiretroviral agent o Fusion Inhibitor (FI) prevents HIV from entering healthy cells in the body (eg. enfuvirtide) o Non-nucleoside Reverse Transcriptase Inhibitor (NNRTI) prevent HIV RNA from converting to DNA (eg. Rescriptase) o Nucleoside Reverse Transcriptase Inhibitor (NRTI) blocks HIV replication in newly

infected cells (eg. Combivin, Epivir, Retrovir) o Protease Inhibitors (PI) attack infected cells and prevents the virus from maturing appropriately (eg. Fortovase, Invirase) Antiretroviral Therapy o Combination pill 2 NRTIs and 1 NNRTIs o Monotherapy one antiviral agent at a time o Goal: to lower viral load and increase CD4 count; test 3-4 wks after initiation of treatment, then q 3-4 mo to check for viral load and CD4 count Treatment o Treat secondary bacterial and fungal infection o Treat neoplasm/cancer o Provide safety for dementia o Provide nutrition for wasting syndrome