COMPREHENSIVE MICROBIOL MBIM 720
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COURSE MEDICAL MICROBIOLOGY MBIM 650720 FALL 2001 TOPIC Zoonotic viruses ll viruses with vertebrate vectors LECTURE63 FACULTY Dr Margaret Hunt Tel 7333293 email mhuntmedscedu REFERENCE Murray et al Microbiology 3rd Ed Chapter 58 Rhabdoviruses appropriate parts of chapters 60 Bunya and Hanta viruses and 64 Filo and Arena viruses WEB SITES httn lwvvvv r rlr 39 39 39 39 39 39 39 39 39 39 39 htm rabies excellent httn39lwww r dr 39 ru008a1htm httn39lwww r dr quot 39 quot 39 39 39 39 tm L TEACHING OBJECTIVES Introduction to viral zoonoses Brief overview of general features of L 39 39 39 39 39 including L 39 arenaviruses and filoviruses Discussion of ecology epidemiology and public health Discussion of rabies rodent borne hemorrhagic fever and arenaviruses hemorrhagic fever with renal syndrome hantavirus pulmonary syndrome and hantaviruses filovirusassociated hemorrhagic fevers and Ebola and Marburg viruses RABIES f v 5 M protein lipid bilayer membrane helical nucleocapsid RNA plus N protein olymerase l2 proteins Rabies virus Singlestranded RNA virus negativesense nonsegmented genome Member of the Lyssavirus genus lyssa frenzy of the Rhabdovirus family Virus is enveloped the nucleocapsid has helical symmetry TRANSMISSION Usually obtained by a bite from an infected animal In rare cases has been transmitted by corneal transplant or through contact of infected saliva with mucosal membranes or an open w CDC Inhalation of aerosdized rabies virus is also a potential nonbite route of exposure but other than laboratory workers most people are unlikely to encounter an aerosol of rabies virus It has been suggested that people in infected bat caves may be exposed to aerosolized virus Most bats are not infected PATHOGENESIS AND DISEASE The VIYUS TepITesTes sT The sTTe eT TheeuIsTTeh she Theh ehTeTs a pehpheTsI quotENE IT Theh IIaveIS sIeh The quotENE YEUngadE ax p asmm aw Te The she eh HENDUSSySEm T esh SpVEad um Wa e HENES Te vsheus sTTes Th The Inn y T eTe Ts he VIYEmIa The armbudy YESpurISE Th sh unvaccma ad pEYSDn Ts heT seeh MIN sTTeT The dISeaSe deveIupS IT TheTe Ts dISeaSET TT shhesT InEVI ab y TesuITs Th death The TheuhsTTeh peTTee Ts VaHab EJYDm WEI WeekSIu EIgMEErI NEIMHS WTTh sh avevage eT abqu WEI ehT s The eTsTshe Tehh Th museIeTe The CNS she The amuum eTTTTus Th The Wuund May a TeIe Th eeTeThhThThg The IehgTh eTThe TheuhsTTeh peTTee sThee TT IakeS a eehsTeeTshIe peTTee eTTThhe Ten The VIYUS Te get Te The CNS TheTe Ts TThhe TeT pesT The VIYUS Ts Th quotanSNT ThTs esh pYEVEM The dISeaSe meme Mmmmw SympTehhs esh Vavy she eases may eTTeh he hhTsenghesee sT hTsT TheTe may he TTthThg m h h h hh T T h T T N nausea hhTTThh hh Tm Tshes eh T T h TTTT Th TT h ThTs Ts TeIIewee by eehhsT TespTTsTeTy TsTIuTe she death NuI aH psTTehTs shew aH eT These sympTehhs DIAGNOSIS uSuaHy sTe eth detectabIe IsTe Th dISeaSe A eeThesI ThhpTessTeh eT huehsI 5km qupSy eT hTsTh qupSy esh he EXENWEH TeT YabIES shTTgeh usmg a eTTeeTTIueTeseehT armbudy TesT Sahva may he F Th hhTIT ne expertenced wttn rabtes and tnere can be tatse oostttyes r so aH sucn resutts need to be conttrrned by anotner rnetnod Tnere ts a stngte serotyoe of rabtest however tnere are subtte dtfferences tn nucteottde sequence between stratns Tne ytms RNA ts tneretore arnotttted by RTVPCR and sequenced Tnts can gtye a ctue as to tne hkety ongtn ottne y m5 EPIDEMIOLOGY UsuaHy transrnttted by antrnat btte Wortdwtde rnost cases artse from a dog btte Cantne rabtes ts oreyatent tn tattn Arnertca Asta and Atrtca tn recent years 19902000 tn tne us tne rnatortty of cases 74 naye been assoctated wttn bat rabtest o ne rernatntng cases aH were from dogcoyote hkestratns of ytrus and 78 of tnose were acoutred outstde tne us Marty antrnats tn tne us are tnfected wttn rabtes ytruses tnctudtng raccoons espectatty atong tne r for susotctousty benaytng bats nus trnrnuntzatton of bets and rnats rnay exptam wny batrtransmtsston of a bedroorn e g a bat wntcn ts acttye by day ts eastty approacned ts una te to y ts tn a roorn tn nouse or on a tawn owever as rnen toned a oye a s r ouesttons tt may be dttttcutt to obtatn a ntstory of bat contact stnce tney may no found tne tnctdent remarkabte enougn to rnentton to anyone nurnan transrntsston nas occurred tn a few cases of corneat transotants wnen tt was a not reattzed that the encephahtts Was due to rabtes Thts has ted to Stncter crtterta tn Screemng of potenttat donors for encephahtts 50 that those Who mtght have rabtes or Creutzfetddakob disease are not accepted Apart from these cases no humanhuman spread of the disease has ever been documented PREVENTION AND TREATMENT OF A PERSON WHO MAY HAVE BEEN EXPOSED The wound is immediately and thoroughly washed with soap and water then treated with 4070 ethyl alcohol or an antiseptic such as benzyl ammonium chloride The State Health authorities should be promptly informed The risk of exposure to rabies and whether prophylactic treatment should be given are determined in consultation with the State Health Department If the animal is available the brain is examined for rabies virus antigen by fluorescent antibody In some cases if the bite was from a domesticated cat or dog the animal may be kept under close observation Postexposure prophylaxis Rabies vaccine This is an inactivated vaccine and is strongly immunogenic It is grown in human diploid cells or rhesus monkey lung cells and is more potent and has fewer side effects than the vaccine used in the early 1980 s A purified chick embryo cell grown vaccine is also available The vaccine is administered as a series of injections over a 4 week period Human rabies immunoglobulin HRIG HRIG is prepared from the plasma of hyperimmune donors Up to half of the recommended dose is infiltrated into the wound area if possible The remainder is given as an intramuscular injection A separate syringe and a separate site are used for the HRIG and the vaccine so that the HRIG does not neutralize the vaccine So far there has never been a case of someone who received postexposure prophylaxis in the US developing rabies Preexposure prophylaxis People at risk for rabies infection may be vaccinated as a preventive measure Such individuals include rabieslaboratory workers certain people in areas with enzootic rabies who are at risk for exposure to rabid animals veterinarians and their staff wildlife control workers spelunkers travelers who will be spending more than a month in areas with enzootic rabies People at high risk for exposure to rabid animals should have regular serologic testing and booster vaccinations when necessary If a vaccinated person is exposed to rabies they still need to get postexposure prophylaxis but the number of postexposure vaccination shots is reduced and HRIG is not used TREA11VENT There is no specific antiviral treatment once symptoms develop lntensive supportive care is given However there have only ever been three cases of documented recovery from rabies VIRAL DISEASES TRANSMITTED BY RODENTS SYMMETRY GENOME 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