Myxovirus and rubella

myxovirus and rubella are very important topics for pg entrance.....everything important about it with images have been discussed....do make use of it.......

1. INFLUENZA VIRUS -DR.AKIF A.B

2. INFLUENZA VIRUS -Segmented RNA virus - Helical symmetry Types : 1) Influenza A : MC cause of epidemics - only cause of Pandemic 2) Influenza B 3) Influenza C : Not circulating currently

3. ANTIGENS OF INFLUENZA Haemagglutinin : Causes haemagglutination Neuraminidase : Causes reversal of haemagglutination k/a Elution

4. Currently Circulating INFLUENZA VIRUSES H1N1 = Swine Flu H2N2 H3N2 =Seasonal flu H5N1 = Bird Flu H7N9 H5N6 TYPE - B TYPE A

5. ANTIGENIC VARIATIONS ANTIGENIC SHIFT ANTIGENIC DRIFT Due to genetic Reassortment Due to point mutation Occur in Type A Type A as well as in Type B Pandemic and epidemics sporadic cases Sudden onset Gradual onset

6. AVIAN INFLUENZA -Caused by H5N1 (MC Type) H7N7 (Netherlands) H9N2 (Hong Kong) H7N9 Bird Flu DOC : Oseltamavir 75mg bd for 5 days (C.I in Infants)

7. CLINICAL FEATURES Incubation Period = 18-72hrs MC Presentation : Flu like symptoms MC complication : Bacterial Pneumonia ( S.aureus > Pneumococci ) Reye Syndrome : Common with Type B Influenza following Aspirin intake.

8. DIAGNOSIS Most sensitive test = ELISA Most specific test = Neutralisation Test

9. VACCINES Killed Vaccine : 2doses, I.M route, 70-90% efficacy, last for 6-12months Life nasal Spray vaccine(Trivalent vaccine) 1) Influenza A (H1N1) 2) Influenza A (H3N2) 3) Influenza B Influenza vaccine can lead to Guillian Barre Syndrome

10. SWINE FLU (H1N1) -Originated by genetic reassortment of four strains : 1 human 2 swine 1 avian Uncomplicated case presents with flu like symptoms (URTI) Complicated cases presents with pneumonia, dehydration, CNS involvement and multi-organ failure

11. SWINE FLU (H1N1) Risk factors for severe Disease Infants and children <2yrs Persons aged >65yrs Pregnant females COPD Immunosuppressive diseases Chronic cardiac disease

12. SWINE FLU (H1N1) DIAGNOSIS RT-PCR : Most sensitive Samples : Nasopharyngeal or throat swabs -Patient to be isolated for 7days.

13. SWINE FLU (H1N1) TREATMENT Oseltamavir 75mg bd for 5 days Zanamavir 2 inhalations bd for 5 days Prophylaxis : Oseltamavir 75mg once a day, duration depends on clinical settings.

14. PARAMYXOVIRUS - DR.AKIF A.B

15. PARA-INFLUENZA VIRUSES MC agent of Croup ( Acute Laryngo-Tracheo bronchitis) MC complication : Otitis media

16. EPIGLOTITIS THUMB SIGN

17. Steeple sign CROUP

18. MUMPS VIRUS MC cause of Parotid Gland enlargement in children MC manifestation = Bilateral parotiris > Epididymo orchitis MC complication : Aseptic meningitis MC Complication in adolescent : Orchitis , Oopheritis Atypical Mumps : P atient directly presents with Aseptic Meningitis and parotitis is absent Once infected gets life long immunity Period of communicability : 4-5 days before to 7days after onset of symptoms. - Vaccine : Live vaccine, Jeryll Lynn Strain

19. RUBELLA Caused by Togavirus Also known as German Measles Incubation period = 14days Vaccine = RA 27/3 strain , Live vaccine, Subcutaneous Rubella vaccine is C.I in Pregnancy and if female is vaccinated she should be advised to prevent pregnancy for next 3 months Priority for vaccination: 1) 15-49 yrs reproductive age females 2) 1-14yrs children

20. CONGENITAL RUBELLA SYNDROME Infection in 1 st trimester Heart Disease (MC: PDA ) + Eye defect (MC: Salt and Pepper Retinopathy>Cataract) + Sensorineural deafness (MC) - Blue berry muffin lesions Infection in early part of 2 nd trimester : Only deafness Infection after 16 th week : No abnormalities.

21. BLUE BERRY MUFFIN LESIONS Rubella Toxoplasmosis Cytomegalovirus Herpes simplex Coxsackie virus Parvovirus Epstein Barr virus Syphilis

22. Salt and Pepper Retinopathy - Seen in Syphilis Rubella NARP Syndrome

23. MEASLES - Rubeola Incubation period : 10-14 days No carriers Secondary attack rates : 80% MC complication : Otitis Media Koplik spots are present opposite 2 nd upper molar Rarest but severe complication : Subacute Sclerosing Panencephalitis Cytopathic effect : Multinucleated Giant cells( Warthin Finkeldey cells ) Containing both intra cytoplasmic and intranuclear inclusion bodies. Fever + 3 C’s C- Coryza C- Cough C- Conjunctivitis

24. Warthin Finkeldey cells

25. MEASLES Incubation period (10days) Fever(10days) Koplik’s spots(12 th day) Rash( 14 th day )

26. MEASLES

27. MEASLES VACCINES Edmonston Zagreb strain Lyophilised form Reconstituted with distilled water Live vaccine, Sub cutaneous Given at 9months since that time maternal antibodies disappears by that time. Side effects : Toxic shock syndrome Measles immunoglobulin or vaccine can be given after exposure within 72days but should not be given together.

28. MEASLES ERADICATION Catch up : one time effort to vaccinate all children from 9months-10years Keep up Follow up : done every 2-yrs following catch up campaigns to vaccinate children of age >9months who were born after catch-up campaign

29. RESPIRATORY SYNCYTIAL VIRUS MC cause of LRTI in Infants causing Bronchiolitis , Pneumonia and tracheobronchitis . Diagnosis : HeLa and Hep-2 are most sensitive cell lines used - Treatment : Ribavirin

30. EXANTHEMATOUS DISEASES Very Varicella Rash appears 1 day after fever Sick Scarlet fever 2days Patients Pox (smallpox0 3 days Must Measles 4days Take Typhus 5days No no No Double Diphtheria 7days Treatment Typhoid 7days Patient is infective from 24hrs prior to onset of fever.