Enteroviruses

New Emerging DiseaseApril 2010

Huthayfa Mujahed

Outline

• Introduction• Virus Properties• Clinical Aspects• Pathogenesis• Vaccines & Treatment• Epidemiology

Introduction

• Most common human pathogens.• Distribution world wild.• Usually cause mild fever.• Rarely progress to severe and fatal disease.

Properties

1. Classification :Family : Picornaviridae

Genus : Enterovirus10 species

Properties

2. Morphology :• Small 30 nm.• Icosahedral.• Non-enveloped.• 60 protomers forms the

capsid

- Variant VP = Different Ag serotypes.

Properties

3. Genome :• +ssRNA• 7500 b

(De Palma, et. al 2008 )

Properties

4. ReplicationEndocytosis Cytoplasm Cell lysis

(Zoll, et. al 2009)

Clinical Aspects

• Symptoms :• Often NO symptoms.• Rash, Fever, Muscle aches, Common clod, flu-like.

• Transmission :• Saliva, Blister fluid, stool, nasal mucus, and any thing

contaminated with the virus.

Pathogenesis

The University of Texas Medical Branch at Galveston, Pathogenesis of enterovirus infections 1996.

Pathogenesis

• Aseptic Meningitis– Less severe than bacterial meningitis.– Rarely fatal in people with normal immune

systems.– Symptoms last from 7 to 10 days.– Completely recover within 2 weeks.

– H. Enterovirus B species

Pathogenesis

• Hand Foot and Mouth Disease– causes fever, sores in the

mouth, and a rash with blisters.

– children <10 yr.– recover in 7–10 days.

– Coxsackievirus A16

When pretty baby gets HFMD

Lab Diagnosis

• RT-PCR.• Recently Flow Cytometry .

Vaccines

– No vaccine, Good hygiene.

Treatment

– No specific anti-viral agent.

Epidemiology

Centers for Disease Control and Prevention :Aseptic meningitis in Baltimore-USA during June 1 – September 30, 1998–2001.

Epidemiology

Centers for Disease Control and Prevention : Reported aseptic meningitis cases in Cuba, January through September 2000

Epidemiology

Centers for Disease Control and Prevention : Monthly distribution of aseptic meningitis incidence in Cuba 2000.

Epidemiology

Centers for Disease Control and Prevention : Total cases of HFMD and herpangina in Taiwan, March 19 to August 29, 1998.

Epidemiology

Centers for Disease Control and Prevention : Number of hospitalizations and severe cases of hand, foot, and mouth disease and herpangina in Taiwan, June-August, 1998

Epidemiology

Centers for Disease Control and Prevention : Clinical features of HFMD in children admitted to hospital in southern Vietnam during 2005.

Epidemiology

March,2010 more than 77,000 cases of HFMD and 40 deaths were reported in China by CDC.

Centers for Disease Control and Prevention : Monthly distribution of 387 cases of HFMD associated with isolation of either (CVA16) (214 cases) or (HEV71) (173 cases), southern Vietnam, 2005.

References• Cordey. Samuel, Gerlach. Daniel, Junier. Thomas, Zdobnov. Evgeny M, Kaiser. Laurent, and

Tapparel. Caroline. 2008. The cis-acting replecation elements define human enterovirus and rhinovirus species. RNA, 14:1568-1578.

• De Palma. Armando M, Vliegen. Inge, De Clercq. Erik, Neyts. Johan. 2008. Selective inhibitors of Picornavirus replication. Medicinal Reasearch Reviews, 28:823-884.

• Lin. Mong-Cheng, Chan. Yu-Jiun, Chen. Chun-Jen, Tang. Ren-Bin, and Wu. Keh-Gong. 2008. Epidemiology and diagnostic methodology for enterovirus infection, including cerebrospinal fluid analysis. Microbio Immunol & infect, 41:450-455.

• She. Rosemary C, Preobrazhensky. Sergey N, Taggar Edward W, Petti Cathy A, and Bahler Devid W. 2009. Flow cytometric detection and serotyping of enterovirus for the clinical laboratory. Jviromet, 162:245-250.

• Zoll. Jan, Heus. Hans A, Kuppeveld. Frank J.M Van, and Melchers. Willem J.M. 2009. The structure-function relationship of the enterovirus 3’-UTR. Viruses, 139:209-216.

• Centers for Disease Control and Prevention./www.cdc..gov/

Be a virus, see the world

When pretty baby gets HFMD…