Medical Virology

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Presentation contents
• Introduction
• General characteristics of viruses
• Classifications of Viruses
• Viral pathogenesis mechanism
• Medical important DNA viruses
• Medical important DNA viruses
• Lab diagnosis of viral disease

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Introduction
• Virology: study of virus
• A virus is an infectious agent that is minimally
constructed of two components:
1. A genome consisting of either ribonucleic acid (RNA)
or deoxyribonucleic acid (DNA), but not both, and
2. A protein-containing structure (capsid) designed to
protect the genome

– Virion: Complete and infective viral particle

– Composed of Nucleic acid, proteins, and sometimes

envelope 3
 Human Pathogens

Acellular Cellular

Prions Virus Bacteria Protozoa Fungi Worm

Increased in size

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Virus particle contain:

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 ▪ Not detected in light microscope
Virus Structure: ▪ Most can be seen only with an electron
microscope

Lipid Envelope Nucleic Acid

Protein
Capsid

Virion
Associated Spike
Polymerase Projections
Glycoprotein)

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 Why we study viruses
• Some viruses are major cause disease
– Viruses infect all major groups of organism. vertebrates,
invertebrates, plants, fungi, bacteria Viruses are important
agents of many human diseases
• ranging from the trivial (e.g. common colds) to the
lethal (e.g. rabies)
• viruses also play roles in the development of several
types of cancer
– There is therefore a requirement to understand the nature
of viruses, how they replicate and how they cause disease.
• Some viruses are useful
– Some viruses are studied because they have useful current
or potential applications
• Phage typing of bacteria
– Bacteria classified into strains on the basis of the
spectrum of phages to which they are susceptible
• Sources of enzymes
– Examples reverse transcriptase and RNA polymerases
• Pesticides
• Anti-bacterial agents
• Anti-cancer agents
• Gene vectors for treatment of genetic diseases
 General characteristics of viruses
1. Viruses infect every form of life.

– Viruses that infect humans are considered along with

the general class of animal viruses
– viruses that infect bacteria are referred to as
bacteriophages, or phage for short
– Plant virus = infect plant
– This is the host range virus

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2. Viruses are the smallest infectious agents / Sub microscopic entity

• Viruses are filterable agents:

• pass through filters that retain even the smallest bacteria.

• The units for measurement of virion size are nano meters (nm)
(Size ranges : 20 – 300 nm in diameter)

• Only be observed by electron microscope

• only the largest and complex viruses are seen under light
microscope with high resolution(Poxviridae)

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Different virus species are shown here to scale inside an E. coli bacterium
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3. Viruses are obligate intracellular parasites: They are totally
dependent on living cells

• since they
– Can not reproduce on their own

– Unable to generate energy/metabolically inert

– Lack cellular machinery for protein synthesis

• Therefore, Viruses exploit host cell machinery for protein
synthesis and cellular enzymes for energy
• Viruses redirect host cell metabolism to primarily synthesise viral
proteins

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4. Contain a single type of nucleic acid, either DNA or RNA but never both

5. They do not divide by binary fission, mitosis, or meiosis

– Viral components are assembled and do not replicate by "division.“

6. Unaffected by antibiotics

– difficult targets for chemotherapy, but many can be controlled by effective

vaccines

7. Exist as inert particles (virions) outside the cell

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Morphology of viruses
• Virion is the infectious particle
– composed of nucleic acid, protein capsid, +/- envelope
– Complete virus particle - entire infectious unit – Virion
– Virion contains DNA or RNA which is surrounded by
protein coat
• Protein coat = capsid
• Some viruses - capsid may be covered by a lipid envelope:
called enveloped viruses.
• Viruses are inert outside of cell (extra cellular).

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 Structure of virus
ALL viruses have three things in common.

1. A protein coat called Capsid that protects them.

2. An inner core that contains genetic material or nucleic acid

(DNA or RNA)

3. Surface proteins that allow it to attach to certain cells in the

host.
➢ Some viruses are also surrounded by an additional
outer membrane or envelope.

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• Nucleic Acid
– DNA or RNA, but not both.
• Protein Coat (capsid)
– Protects the nucleic acid from its environment.
• Envelope
– Only found in viruses that infect animals.
– Spike-like projections that recognize animal cells and bind to the cell
surface.
– Enveloped viruses are viruses which have a membrane coat surrounding
the protein coat or capsid. These viruses are common in animal viruses,
but are uncommon in plant viruses

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• Viruses are divided into three groups, based on the
morphology of the nucleocapsid and the arrangement
of capsomeres.
1. Cubic symmetry/ icosahedral in shape
2. helical symmetry / elongated in shape
3. complex symmetry/ asymmetry

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Cubic symmetry Helical symmetry
• Icosahedral protein Helical capsids are rod-like structures
shell containing with the RNA in the center of the
nucleic acid helix. A helix is made by stacking
repeating units in a spiral.

RNA

protein coat

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 Complex (binal ) viruses
• have neither helical nor polyhedral forms, are pleomorphic
(irregular shaped), or have complex structures.

A T-even bacteriophage consisting of

a head, sheath, and tail
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 Multiplication of Virus
• Viruses do not breathe.
• Viruses do not metabolize.
• Viruses do not grow.
• However, they do reproduce
• It reproduce by Replication
• Viruses cannot replicate on their own, they must need
host.

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 Viral Replication
• A virus can not reproduce by itself
• it must invade a host cell and take over the cell activities,
• eventually causing destruction of the cell and killing it.
• The virus enters a cell, makes copies of itself and causes the
cell to burst releasing more viruses.
How Viruses Multiply
• Once inside a cell, a viruses genetic material takes over many
of the cells functions.
• It instructs the cell to produce the virus’s proteins and
genetic material.
• These proteins and genetic material assemble into new
viruses which go on to infect more cells.
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Viral multiplication steps
1. Attachment: virus attach to host cell
2. Penetration: it enter to host cell
3. Uncoating: its nucleic acid released from protein coat.
4. Replication: It instructs the host cell to produce the virus’s
proteins and genetic material
5. Assembly: New virus genomes(DNA) and proteins are
assembled to form new virus particles.
6. Release: Enveloped viruses are released by budding from
the infected cells. Unenveloped viruses are released by
rupture of the infected cells.

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 Unconventional Agents
• There are also the 'unconventional agents' sometimes known as
'unconventional viruses' or 'atypical viruses
• Up to now, the main kinds that have been studied are viroids and
prions.
• Viroids
– Viroids contain RNA only.
– They are small (less than 400 nucleotides), single stranded,
circular RNAs.
– The RNAs are not packaged
– At present, the only known human disease agent to resemble
viroids is hepatitis delta virus (HDV).

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 Prions
• Prions contain protein only
• They are small, proteinaceous particles
• Affects nervous tissue and results in
– Bovine spongiform encephalitis (BSE) “mad cow disease

– Examples of prion-caused human diseases are Kuru, Creutzfeldt-

Jakob disease and Gerstmann-Straussler syndrome

– Prions also cause scrapie in sheep.

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Classification of viruses
Viruses can be classified in different ways as follows:
• Type of nucleic acid
– (DNA or RNA)
• Physical construction of nucleic acid
– (Single / Double stranded)
• Symmetry of nucleocapsid
– (Icosahedral, Helical and Complex)
• Presence / absence of a lipid envelope
– (Enveloped and Non- Enveloped)

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 Virus Classification according to the nature of their genome and
their structure
VIRAL CLASSIFICATION

RNA or DNA
single-stranded or double-stranded
non-segmented or segmented
linear or circular
Nucleic acid
if genome is single stranded RNA, can it
function as mRNA?
whether genome is diploid (such as in
retroviruse
Virion structure symmetry (icosahedral, helical, complex)
enveloped or not enveloped
number of capsomers
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 Mechanism of pathogenesis of viruses

• Interaction between viruses and host cells

• Presence of receptors on surface of host cell determines
whether virus can adsorb
• Temperature, biochemical activity of host cell also play
important role in initiating infection

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 Virus-host receptor interaction

Virus Receptor Cell Type Infected

CD4,
HIV CXCR4 and CCR5 TH cells

CR2 (complement receptor

Epstein-Barr virus B cells
type 2)

Influenza A Glycophorin A Many cell types

Rhino virus ICAM-1 Many cell types

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 Important events in pathogenesis
▪ To cause disease, the virus must invade the host
▪ Replicate in susceptible cells at site of inoculation
▪ Overcome local defenses for example
– Lymphocytes,
– Macrophages and
– Interferon
▪ Spread from site of inoculation to other areas, often via blood
stream
▪ Undergo further replication in its target areas, it may be localized
(e.g. Adenovirus conjunctivitis) or generalized (e.g. measles)
▪ Exit from the host in numbers large enough to infect other
susceptible hosts and to ensure its own survival
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 Some important target organs
• Skin: rash or exanthema e.g. Rubella, Measles, Herpes simplex
virus, Chicken pox virus
• Lung: Infection may occur after local spread or a part of general
infection e.g. Measles, varicella
• Liver: Target of Hepatitis viruses, yellow fever
• Kidney: cytomegalovirus, hantavirus.
• CNS: poliovirus, arbovirus encephalitis, Herpes simplex, rabies,
varicella-zoster

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Important Mechanisms Of Viral Cytopathogenesis

• Inhibition of cellular protein synthesis

– Poliovirus, Herpes simplex virus, Pox virus
• Inhibition & degradation of cell DNA
– Herpes viruses
• Alteration of cell membrane structure
– Enveloped viruses

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Medically important

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 1. Herpes Viruses
• Herpes viruses are a leading cause of human viral disease, second only to influenza
and cold viruses.
• They are capable of causing overt disease or remaining silent for many years only
to be reactivated, for example as shingles.

HERPES VIRUS TYPES THAT INFECT HUMANS

Herpes simplex virus Type 1 (HSV-1)
Herpes simplex virus Type 2 (HSV-2)
Epstein Barr virus (EBV)
Cytomegalovirus (CMV)
Varicella Zoster Virus (VZV)
Human herpes virus 6 (exanthum subitum or roseola infantum)
Human herpes virus 8 (Kaposi's sarcoma-associate herpes virus)
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• Diseases caused by Herpes Simplex Viruses
• HSV 1 infect the upper part of the body
- mouth and the face
• HSV 2 infect the lower part of the body
- genital infections.
– Oral herpes - Cold sores
• The infection, often initially on the lips spreads to all parts
of the mouth and pharynx.
• Reactivation from the trigeminal ganglia can result in what
are known as cold sores.
– Herpes keratitis
• This is an infection of the eye and is primarily caused by
HSV-1.
• It can be recurrent and may lead to blindness

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• Herpes whitlow
– manual contact with herpes-infected
body secretions
• Herpes gladiatorum,Eczema
herpeticum,Genital herpes
• HSV proctitis -This is an inflammation
of the rectum and the anus
• HSV Encephalitis,
• HSV Meningitis
• HSV infection of neonates

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Clinical figures

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Clinical figures of Herpes Simplex Viruses (HSV)

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Varicella-Zoster Virus (VZV)(human herpes virus-(HSV-3)
• Zoster means girdle from the characteristic rash that forms a belt
around the thorax in many patients.
• This virus causes two major diseases,
– Chicken-pox (Varicella), usually in childhood, and
– Shingles (Zoster), later in life.
• Shingles (Zoster) is a reactivation of an earlier varicella
infection.
• Chicken Pox
– This virus is highly infectious
– It is spread by respiratory aerosols or direct contact with skin
lesions

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 Epstein-Barr Virus (EBV)
• The causative agent of :
✓ Burkitt's lymphoma in Africa,
✓ Nasal pharyngeal carcinoma in the orient and
✓ Infectious mononucleosis in the west.
• The virus is spread by close contact (kissing disease).
• The virus can also be spread by blood transfusion.
Pathogenesis
– i) Transformation of B cells
– ii) Burkitt's lymphoma
• This is a tumor of the jaw and face found in children
– iii ) Nasopharyngeal cancer
– iv) Oral hairy leukoplakia

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Gingivostomatitis Burkitt’s Lymphoma

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 Cytomegalovirus (CMV)
• The virus is spread in most secretions particularly:
– Saliva, urine, vaginal secretions and
– Semen (which shows the highest titer of any body fluid).
– Sexually transmitted
– It can also spread to a fetus in a pregnant woman
– newborn via lactation
– blood transfusions and transplants
• Pathogenesis
– The virus first infects the upper respiratory tract and then
local lymphocytes.
– The virus can inhibit T cell responses.
– Reactivation in immunocompromised patients

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 Summary
Virus Subfamily Disease Site of Latency

Herpes Simplex Virus I a Orofacial lesions Sensory Nerve Ganglia

Herpes Simplex Virus II a Genital lesions Sensory Nerve Ganglia

Varicella Zoster Virus a Chicken Pox Sensory Nerve Ganglia

Recurs as Shingles

Cytomegalovirus b Microcephaly Lymphocytes

Human Herpesvirus 6 b Roseola Infantum CD4 T cells

Human Herpesvirus 7 b Roseola Infantum CD4T cells

Epstein-Barr Virus g Infectious Mono. B lymphocytes, salivary

Human Herpesvirus 8 g Kaposi’s Sarcoma Kaposi’s Sarcoma Tissue

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 Human Papilloma Virus (HPV)
• Transmitted via
– sexual contact (genital, oral warts) or
– skin-skin contact (plantar, hand warts)
– Transmission Not prevented by condom use
• Clinical features
– Common warts, genital warts, laryngeal warts (recurrence
common)
– Cervical dysplasia and cancer (types 16, 18),
– Anal dysplasia
– Oral Human Papilloma Virus causes genital wart and cervical
cancer in women

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 Laboratory Diagnosis

• PAP smear –Based on cytology, detects precancerous

lesions which can progress to cancer
– Recommended for women 21 years of age and older

It tests for the presence of

precancerous or cancerous cells on
the cervix, the opening of the uterus

➢Sweep the cervix with a brush or

cotton swab

➢Fix it in a clean glass slide using

fixative Cytological study
➢The collected cells are examined
under a microscope to look for
abnormalities.
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 Prevention
• Interruption of Transmission
• Pap smear screening can prevent most cervical cancers (the
most serious consequence of HPV infection).
• Decrease sexual promiscuity.
• Vaccines (to young adolescents who are not yet sexually
active and Even in sexually active individuals).
– Gardasil® - Quadrivalent vaccine = protects against HPV 16,
HPV18, HPV6 and HPV11
– Cervarix® -Bivalent vaccine = protects against HPV16 and
HPV18

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 Hepatitis viruses
Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E

Virus family Picornavirus Hepadnavirus Flavivirus Delta virus Hepeviridae

RNA (+ DNA RNA (+ RNA (+

Nucleic acid RNA (- sense)
sense) (partially ds) sense) sense)
Enteric non-
Disease Infectious Serum Non-A, non-B
A, non-B
caused hepatitis hepatitis hepatitis
hepatitis
Size ~ 28nm ~40nm 30 - 60nm ~ 40nm 30 - 35 nm

Envelope No Yes Yes Yes No

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Common Symptoms in Severe Hepatitis

▪ Jaundice (yellowing of the skin & the whites of the eyes)

▪ Muscle Aches
▪ Headaches
▪ Joint Pain (due to immune complexes)
▪ Fever
▪ Abdominal Pain
➢ Diminished Appetite
➢ Nausea
➢ Vomiting
➢ Diarrhea
▪ Dark “tea-colored” urine
▪ Pale “clay-colored” stools
▪ Edema (large amount of fluid collect in the abdomen beneath the skin) -
Ascites
▪ Bleeding easily (decrease in levels of coagulation factors made by liver)

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• HEPATITIS A & E (transmitted enterically)
• Infectious hepatitis - Hepatitis A virus

➢Transmitted via the oral-fecal route as a result of close contact

such as in day-care centers.

➢The virus is also spread by contaminated food

➢The symptoms of HAV and HBV are very similar.

➢The most obvious symptom is jaundice.

➢HAV also causes abdominal pain, nausea and diarrhea

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Hepatitis B, C, D and G
• Disease transmitted parenterally
• Serum hepatitis - Hepatitis B
– The virus is spread via contact with body fluids (usually blood
contamination but the virus is also in semen and various secretions such as
vaginal fluids, menstrual blood, saliva and milk).
– The virus can also be contracted via sexual intercourse (particularly male
to male) and perinataly
• Carcinogenesis
– HBV is a major cause of hepatocellular carcinoma worldwide.
• Transmission
– HBV is spread parenterally, sexually (hetero and homosexually) and
neonatally.
– The virus is high in the blood/serum and in wounds.
– Moderate levels are found in semen, saliva and vaginal secretions. Other
body secretions show low or non-detectable levels of virus.
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 Laboratory diagnosis:
Specific tests:
• HBV markers can be tested by serological tests : ELISA
• HBsAg - used as a general marker of infection.
• HBsAb - used to document recovery and/or immunity to HBV infection.
• HBcAg - It is core of HBV and not detectable in serum
• anti-HBc IgM - marker of acute infection.
• anti-HBcIgG - past or chronic infection.
• HBeAg - indicates active replication of virus and therefore infectiveness.
• Anti-Hbe - virus no longer replicating. However, the patient can still be
positive for HBsAg which is made by integrated HBV.
• HBV-DNA - indicates active replication of virus, more accurate than
HBeAg especially in cases of escape mutants. Used mainly for monitoring
response to therapy.
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 Test Results Interpretation
HBsAg Negative The patient is susceptible to an HBV infection and has not been
anti-HBcAg Negative exposed previously to the virus
anti-HBsAg Negative The patient has not been vaccinated
HBsAg Negative The patient is immune to HBV as a result of having been infected
anti-HBcAg Positive previously (indicated by the presence of anti-HBc antibodies which
anti-HBsAg Positive would not occur if the patient had been vaccinated)
HBsAg Negative
anti-HBcAg Negative • The patient is immune because of vaccination against HBV
anti-HBsAg Positive
HBsAg Positive • The patient has an acute HBV infection.
anti-HBcAg Positive • Any anti-HBsAg antibodies that have been made are complexed
anti-HBcAg Positive with the large amount of the antigen and are thus undetectable
IgM Negative
anti-HBsAg
HBsAg Positive
anti-HBcAg Positive • The patient has a chronic HBV infection.
anti-HBcAg Negative • The IgM anti-HBc has waned
IgM Negative
anti-HBsAg
HBsAg Negative • The patient may be in the recovery phase of an acute HBV
anti-HBcAg Positive infection. This patient could be infected and thus a carrier of
anti-HBsAg Negative HBV. The inability to detect HBsAg may result from it56being
complexed with anti-HBsAg antibodies in the "window" phase
Interpret Lab result

• HBsAg -------Negative
• anti-HBcAg---Negative A ________________
• anti-HBsAg---Positive

• HBsAg -------Negative
• anti-HBcAg---positive B ________________

• anti-HBsAg---Positive

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Medically important RNA viruses

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 Retroviruses
• By 1984 the Human Immunodeficiency Virus (HIV) was identified
as the causative agent for AIDS (Montagnier / Gallo)
– There are two types of HIV: HIV-1 and HIV-2.
– These cause clinically indistinguishable disease, although the
time to disease onset is longer for HIV-2.
– The worldwide epidemic of HIV and AIDS is caused by HIV-1
while HIV-2 is mostly restricted to west Africa.
• HIV Infection
– HIV is a sexually transmitted and blood-borne infection.
– HIV is transmitted when body fluids (semen, vaginal secretions,
blood) from an infected person enters the body of an uninfected
person.
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 Viral Structure
• HIV is a retrovirus, a class of gp120
RNA virus
gp41
◼ The outer envelope includes core
2 major glycoproteins
– gp120 and gp41 integrase viral
RNA

◼ Viral core has 2 copies of HIV protease

RNA and 3 enzymes essential

for viral replication
➢ Reverse transcriptase
➢ Integrase
➢ Protease
envelope

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 Clinical Manifestation of HIV

• HIV is a dynamic infection causing a chronic illness of many

years’ duration.
• HIV usually produces a pronounced and increasingly debilitating
decline in immune function.
• The persistent infection and depletion of CD4 T cells is central to
the pathogenesis of HIV infection.
• Mortality results from opportunistic infections that overwhelm the
weakened immune system.

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HIV Lab diagnosis
• HIV diagnosis (Antibody/Antigen testing)
– Enzyme Immunoassays (EIAs)
– Rapid tests
– Western blot (WB)
• Early diagnosis in infants
– P24
– RNA RT PCR
• Initiation and monitoring of ART
– CD4
– Viral Load
 Testing Algorithm
Conduct A1
One Step
Remark
• Reactive = R
• Non-Reactive =NR
• Algorithm = A
Result: A1 R Result: A1 NR
Report: Negative
Conduct A2
First Response

Result: A1 R; A2 Result: A1 NR; A2 NR

NR Report: Negative

Repeat: A1 & A2

Result: A1 R; A2 R Result: A1 R; A2 NR
Report: Negative

Conduct A3
Unigold

Result: A1 R; A2 R; A3 R Result: A1 R; A2 R; A3 NR
Report: Positive HIV Status Inconclusive
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 Paramyxovirus
(Measles and Mumps viruses)
• Measles (Rubeola)
– The word measles is derived from the German word for
blister.
• Pathogenesis and disease
– Infection is via an aerosol route and the virus is very
contagious.
– The disease develops 1 - 2 weeks after infection.
– Uncomplicated disease is characterized by the following:
➢ Fever,
➢ running nose (coryza) and cough,
➢ Conjunctivitis,
➢ Koplik's spots on mucosal membranes,
➢ Maculopapular rash which extends from face to the extremities. 64
Clinical features
Complications
• 3 Cs (Cough, Coryza & Conjunctivitis)
• Koplik spots • Diarrhea
• Four days fever (400c) • Pneumonia
• Generalized maculopapular erythematous rash. • Otitis media
• Convulsions

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 Laboratory diagnosis:

• Nasopharyngeal swabs, blood samples

• ELISA test can be used to detect Antibodies.
Prevention & control
• Measles is usually a disease of childhood, and is followed by life-
long immunity.
• A live, attenuated measles vaccine (MMR Vaccine),
• 2 doses of the vaccine:
✓ The first at twelve to eighteen months,
✓ The second at four to twelve years

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 Mumps
• The name comes from the British word "to mump", that is
grimace or grin.
• Clinically, mumps is usually defined as acute unilateral or bilateral
parotid gland swelling that lasts for more than two days with no
other apparent cause.
• Pathogenesis and disease
– very contagious and is probably usually acquired from
respiratory secretions and saliva via aerosols or fomites.
– The virus is secreted in urine and so urine is a possible
source of infection.
• The symptoms of mumps:
– Fever, Parotitis, Meningitis, Deafness, Orchitis
(testicular inflammation), Pancreatitis and Myocarditis.
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Mumps (ጆሮ ደግፍ)

Complications
• Orchitis
• Epididymitis
• Oophoritis
• Spontaneous abortion
• Sensory neural hearing loss, (uni- or
bilateral).
• Mild form of meningitis
• Encephalitis

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 Laboratory diagnosis:
• Saliva, CSF, urine
• ELISA can be used to detect antibodies.
Prevention & control
• A live, attenuated vaccine has been available for many years; this
has resulted in a dramatic drop in the number of cases of mumps
• Mumps vaccine is available in
– Monovalent form or
– In combinations with rubella (MR) or
– Measles & rubella (MMR) live virus vaccines
• Individuals who have had the disease develop lifelong immunity

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 Filoviridae:

• General Characteristics of Filoviridae

– Filoviridae is -ve sense ssRNA linear genome virus
– Enveloped, helical nucleocapsid
– Long Filamentous,
– Replication in cytoplasm of the host cell
– Has 7 gene structure
• Medical important Filoviridae
– Ebola virus &
– Marburg Virus
• Marburg virus infection was detected in lab workers in Marburg, Germany who
were exposed to infected African wild monkeys
• Ebola virus - isolated from patients with hemorrhagic fever in Zaire and the
Sudan.

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 Ebola 5 Subtypes

Zaire Ebola (ZEBOV) • Sudan Ebola • Reston Ebola • Ivory-Coast • Uganda Ebola (BEBOV) or
(SEBOV) (REBOV) Ebola • Bundibugyo ebolavirus (2007)
• highest case fatality rates
• 40—60%. (1976) • Airborne (ICEBOV) or • (27%).
• 60-90%
• Philipine- Asian spp. • Täi Forest
• First discovered (1976)
(1990) ebolavirus
(1994)

• Four subtypes are transmitted by • The virus is transmitted to people from

contact of any kind (fluids or wild animals and spreads in the human
skin) population through human-to-human
• Except REBOV by Airborne transmission

Professor - Peter Piot discovered Ebola virus

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Clinical Signs

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 Rhabdo viruses
• Rabies
– Worldwide, it is estimated that approximately 55,000 persons
die of rabies each year.
– Rabid animals become aggressive and harbor the virus in saliva
– Thus transmission is frequently via animal bites.
– In rare cases, rabies has been transmitted through contact of
infected saliva with mucosal membranes or an open wound in
the absence of a bite.

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• Disease
– pain or itching at the site of the wound, fever, headache and
gastrointestinal problems.
– CNS infection is apparent.
– In up to half of patients, hydrophobia is seen.
– This fear of water is the result of the pain associated with
drinking.
– There are also seizures and hallucinations.
• Prevention/treatment of a person who may have been exposed
-- The wound should be immediately and thoroughly washed with
soap and water, then treated with 40-70% ethyl alcohol or an antiseptic
such as benzyl ammonium chloride.
• in some cases, if the bite was from a domesticated cat or dog, the
animal may be kept under close observation.
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➢ Post-exposure prophylaxis
✓ Rabies vaccine. This is an inactivated vaccine and is
strongly immunogenic.
✓ Human rabies immunoglobulin (HRIG). It is prepared
from the plasma of hyperimmune donors.
➢ Pre-exposure prophylaxis
✓ People at risk for rabies infection may be vaccinated as a preventive
measure(rabies laboratory workers, high exposure for enzootic rabies).
✓ If a vaccinated person is exposed to rabies, they still need to get post-
exposure prophylaxis,

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Rotavirus
• Rotavirus – the most common cause of severe dehydrating diarrhea in infants
and children less than 3 years old.
– Rotaviruses are divided into 7 major groups (A-G ).
– Human strains belong to Groups A, B and C.
– Group A is the most important pathogen.
– Group B causes epidemics in China.
– Group C causes sporadic disease in children.
• oral-fecal transmission;
– Treatment with rehydration and electrolyte replacement
– Reovirus – cold-like upper respiratory infection, enteritis
• Oncolytic (cancer-killing) - Reovirus is now used as a therapeutic
agent in the treatment of various types of malignancy.

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Lab Diagnosis:
Rotavirus diagnosis
– Antigen detection (ELISA) or
– Electron microscopy.
Prevention
• Practice stringent hygiene
• Rotavirus vaccine
• Infants should get either of the two available rotavirus vaccines:
– RotaTeq® is given in 3 doses at ages 2 months, 4 months, and 6 months
– Rotarix® is given in 2 doses at ages 2 months and 4 months.
• Children should receive all doses of rotavirus vaccine before they turn
8 months old.
• Both vaccines are given by putting drops in the child’s mouth.

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