Virology 14- Respiratory and Cardiac Diseases

INFLUENZA – Clinical Presentation

High fever, headache, myalgias, malaise, cough; children may have croup/otitis/vomiting; risk of secondary bacterial pneumonia (S. aureus, S. pneumoniae, H. influenzae); Reye syndrome if aspirin given.

INFLUENZA – Diagnosis

Rapid antigen test; PCR of nasal swab (most sensitive).

INFLUENZA – Treatment

Oseltamivir or Zanamivir (neuraminidase inhibitors); Baloxavir (endonuclease inhibitor); supportive care.

INFLUENZA – Prevention

Annual vaccine (quadrivalent); live attenuated nasal spray for healthy 2–49 y/o; high‑dose vaccine for ≥65; hand hygiene.

Neuraminidase (NA) inhibitors MOA against Flu

Neuraminidase inhibitors work by preventing release of virions and further proliferation of disease in influenza. HA glycoprotein binds cell (spike) and NA glycoprotein cleaves receptor to release virus from cell. NA inhibitors stop this process

ADENOVIRUS – Clinical Presentation

Pharyngoconjunctival fever (“pool fever”), non‑purulent conjunctivitis, febrile pharyngitis, acute hemorrhagic cystitis (boys 5–15)=>bloody urine, pneumonia, myocarditis. (lemonADE at the pool)

ADENOVIRUS – Diagnosis

Antibody testing; PCR.

ADENOVIRUS – Treatment

Supportive; cidofovir for severe disease in immunocompromised.

ADENOVIRUS – Prevention

Military oral vaccine (serotypes 4 & 7); hygiene; chlorine‑treated pools.

Pathogens that cause lesion on palms and soles (CARS)

Coxsackievirus A, RMSF, Syphillis (CARS)

COXSACKIEVIRUS A – Clinical Presentation

Hand‑Foot‑Mouth disease (vesicles on hands, feet, mouth), herpangina (painful oral ulcers), acute hemorrhagic conjunctivitis, aseptic meningitis. (You can put a cox in your hands, feet and mouth)

COXSACKIEVIRUS A – Diagnosis

Clinical; PCR of swab or blood.

COXSACKIEVIRUS B – Clinical Presentation

Myocarditis, pericarditis, dilated cardiomyopathy, Bornholm Disease (“Devil’s grip”)=sharp pain in lower chest of one side and SOB;, hepatitis, aseptic meningitis. (B for Bornholm Disease and other organs gripped)

COXSACKIEVIRUS B – Diagnosis

PCR of blood or swab.

ECHOVIRUS – Clinical Presentation

Common cause of febrile illness in infants; rash; aseptic meningitis; neonatal sepsis with liver failure or myocarditis; myocarditis in older patients. (Hearts and little kids makes an ECHO)

ECHOVIRUS – Diagnosis

PCR of blood or swab.

RHINOVIRUS – Clinical Presentation==> COMMON COLD

#1 cause of common cold; sore throat, rhinorrhea, congestion, cough; mild fever; peaks summer/fall.

RHINOVIRUS – Diagnosis

Clinical; PCR if needed.

CORONAVIRUS (Endemic) – Clinical Presentation

#2 cause of common cold; winter/spring; mild URI; severe disease in immunocompromised.

CORONAVIRUS (Endemic) – Diagnosis

PCR of nasopharyngeal swab.

SARS‑CoV / MERS‑CoV – Clinical Presentation

Severe atypical pneumonia, fever, dry cough, dyspnea, hypoxia; TRAVELED to the far East; high mortality (MERS ~35%).

SARS‑CoV / MERS‑CoV – Diagnosis

PCR; serology.

COVID‑19 (SARS‑CoV‑2) – Clinical Presentation

Severe acute respiratory syndrome: Fever, cough, dyspnea, hypoxia, anosmia, fatigue; MIS‑C(Multi system inflammatory syndrome) in children; long COVID; atypical pneumonia.

COVID‑19 – Diagnosis

PCR; rapid antigen test.

COVID‑19 – Treatment

Outpatient: Paxlovid or Molnupiravir; Inpatient: Remdesivir, steroids, IL‑6 inhibitors; supportive oxygen.

COVID‑19 – Prevention

mRNA vaccines (Pfizer, Moderna), Novavax; boosters; masks; ventilation.

COVID-19 moa

COVID-19 binds ACE2 (and TMPRSS2)

RSV – Clinical Presentation

Infants: bronchiolitis, wheezing, tachypnea, apnea; adults: common cold; premature infants at highest risk.

RSV – Diagnosis

PCR of nasal secretions.

RSV – Prevention

Nirsevimab (monoclonal antibody) for infants; maternal vaccination (Abrysvo); RSV vaccines for adults ≥60.

HUMAN METAPNEUMOVIRUS – Clinical Presentation

RSV‑like illness: bronchiolitis, pneumonia, wheezing; common cold in adults; severe in infants and immunocompromised. (“This kid must have RSV but the test is negative”)

HUMAN METAPNEUMOVIRUS – Diagnosis

PCR of nasal secretions.

PARAINFLUENZA VIRUSES 1–4 – Clinical Presentation

Type 1: croup (barking cough, stridor); Type 3: bronchiolitis/pneumonia; Type 2: croup/URI; Type 4: mild URI. (RAIN is a good dog name)

PARAINFLUENZA – Diagnosis

PCR of nasal secretions.

PARAINFLUENZA – Treatment

Supportive; steroids + nebulized epinephrine for croup; ribavirin in severe immunocompromised cases.

HANTAVIRUS (Cardiopulmonary Syndrome) – Clinical Presentation

Fever, myalgias, abdominal pain → rapid pulmonary edema, respiratory failure, cardiogenic shock; rodent exposure history. (Acute respiratory distress with rodent exposure) (Hanta brought me rat poop)

HANTAVIRUS – Diagnosis

Serology; PCR.

HANTAVIRUS – Prevention

Rodent control; avoid aerosolized rodent droppings; no vaccine.