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Picornaviridae
Assistant Professor & Consultant Virologist
College of Medicine & KKUH
By: Dr.Malak El-Hazmi
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Picornaviruses
Nonenveloped , icosahedral , ss (+) RNA
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Enterovirus
Members of the Family Picornaviridae
Genus Species
Poliovirus
Coxsackieviruses
Echoviruses
Enteroviruses ( 68-71)Hepatovirus
Parechovirus
Rhinovirus
Kobuvirus
Cardiovirus
Aphthovirus
Erbovirus
Teschovirus
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Characteristics of Human Picornaviruses
Property RhinoVs Enteroviruses ParechoVs
Polio Coxsackie A B
Echo Entero
Serotypes >100 1-3 1-24 1-6 1-34 68 -71 1-4
Acid pH (3.0) Labile Stable
Temp 33oC 37oC
Site Nose GIT
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Usual Host range of human enteroviruses: animal and tissue culture spectruma
aMany enteroviral strains have been isolated that do not conform to these categoriesbNew types, beginning with type 68, are now assigned enterovirus type numbers instead of coxsackievirus or echovirus numbers. Types 68-71 have been identified.CType 23 has been found to be the same as echovirus 9.dEchovirus 8 was determined to be the same serotype as echovirus 1 ; echovirus 10 has been reclassified as a reovirus type 1, echoviruses 22 & 23 as parechoviruses types 1& 2, echovirus 28 as human rhinovirus 1 A, and echovirus 34 as coxsackievirus A24.
Cytopathic effect Illness & Pathology
Virus Antigenic typesb
Monkey Kidney tissue culture
Human Tissue culture
Suckling Monkey mouse
Polioviruses 1-3 + + - +
Coxsackieviruses, gp A 1-24c ± ± (+) flaccid -
Coxsackieviruses, gp B 1-6 + + (+) spastic -
Echoviruses 1-34d + ± - -
Enteroviruses 68-71 + + - -
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Reservoir : Human
Spread : Fecal - oral route (mainly) Inhalation of Infectious aerosols Direct & indirect contact of
eye secretions
(Crowded, Poor hygiene & Sanitation)
Age : children > adults Seasonal distribution:
summer & fall
Epidemiology Excreta from human
Hand Sewage Solid waste landfills
Water Supply
Shellfish
Man
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Pathogenesis
Echo,coxHFM
Most EVs are cytolytic, some cause immunopath mech
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Coxsackievirus
Syndrome Poliovirus Types 1-3
Group A Types 1-24
Group B Types 1-6
Echovirus Types 1-34
Enterovirus Types 68-71
Neurologic Aseptic meningitis Paralysis Encephalitis
1-31-3
Many7,9
2,5-7,9
1-62-51-5
Many2,4,6,9,11,30
2,6,9,19
7170,7170,71
Skin and mucosa Herpangina Hand-foot-and-mouth disease Exanthems
2-6,8,105,10,16Many 5 2,4,6,9,11,16,18
7171
Cardiac and muscular Pleurodynia (epidemic myalgia) Myocarditis, pericarditis
1-51-5
1,6,91,6,9,19
Ocular Acute hemorrhagic conjunctivitis 24 70
Respiratory Colds Pneumonia Pneumonitis of infants Pulmonary edema
21,24
9,16
1,3,4,54,5
4,9,11,20,2568
71
Gastrointestinal Diarrhea Hepatitis
18,20-22,242
4,9 5Many2
4,9
Other Undiff. Febrile illness Generalized disease of infants Diabetes mellitus
1-3
1-61-53,4
11
Human enteroviruses & commonly associated clinical syndromes.1
1Examples are not all-inclusive. Other enterovirus types may be associated with a given disease:2Causality not established
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Herpangina
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Hand , Foot & Mouth disease
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Coxsackievirus
Syndrome Poliovirus Types 1-3
Group A Types 1-24
Group B Types 1-6
Echovirus Types 1-34
Enterovirus Types 68-71
Neurologic Aseptic meningitis Paralysis Encephalitis
1-31-3
Many7,9
2,5-7,9
1-62-51-5
Many2,4,6,9,11,30
2,6,9,19
7170,7170,71
Skin and mucosa Herpangina Hand-foot-and-mouth disease Exanthems
2-6,8,105,10,16Many 5 2,4,6,9,11,16,18
7171
Cardiac and muscular Pleurodynia (epidemic myalgia) Myocarditis, pericarditis
1-51-5
1,6,91,6,9,19
Ocular Acute hemorrhagic conjunctivitis 24 70
Respiratory Colds Pneumonia Pneumonitis of infants Pulmonary edema
21,24
9,16
1,3,4,54,5
4,9,11,20,2568
71
Gastrointestinal Diarrhea Hepatitis
18,20-22,242
4,9 5Many2
4,9
Other Undiff. Febrile illness Generalized disease of infants Diabetes mellitus
1-3
1-61-53,4
11
Human enteroviruses & commonly associated clinical syndromes.1
1Examples are not all-inclusive. Other enterovirus types may be associated with a given disease:2Causality not established
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Pathway to CNS by: Blood Peripheral nerves
Causing destruction of
motor neurons of AHCs
Rarely affects brain stem
(bulber poliomyelitis)
Pathogenesis of polio:
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Pathogenesis of Polio :
Immunity: IgA & IgG = Lifelong type-specific immunity
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Poliovirus Infections
Minor Illness
No illness
Major Illness 1- Nonparalytic poliomyelitis (Aseptic meningitis)
2- Paralytic poliomyelitis: (Flaccid paralysis)
Abortive poliomyelitis (No CNS involvement)
90-95%
Asymptomatic 4-8%
1-2%
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Poliovirus Infections : Bulber poliomyelitis
( brain stem)
Post polio syndrome
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Lab Diagnosis of Enteroviruses Virus isolation:
• Samples: Stool (best) .Rectal, throat swabs ,
conjunctival swab, CSF• Inoculate in MKC & HDF
All EVs grown except some strains of Cox A viruses• Observe for CPE• Identify the type by Neutralization Test
CSF in aseptic meningitis; lymphocytosis
Glucose level N to slightly , Protein level N or slightly
Isolation rate is variable
EV RNA detected in CSF by RT-PCR Serology (limited value)
• IgM • ≥ 4 fold rise in AB titer b/t Acute & Convalescent sera
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Management Rx:
No antiviral Rx
Prevention: Sanitation & Hygienic measures Poliovirus vaccines
a- Inactivated polio vaccine
(IPV)
(Salk, Killed) (S/C or IM)
b- Live-attenuated polio vaccine
(OPV)
(Sabin, oral)
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Important Features of Polio VaccinesAttribute Killed (IPV) Live (OPV)
3 types (trivalent) Yes Yes Prevents disease Yes Yes
Route of administration Injection Oral
Induces humoral IgG Yes Yes
Induces intestinal IgA No Yes
Interrupts transmission No Yes
Affords 2o protection by spread to others
Causes disease in the immun ed No Yes
Reverts to virulance No Yes (rarely)
No Yes
No Yes Co-infection with other EVs
may impair immunization
Requires refrigeration No Yes
Duration of immunity Shorter Longer
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Poliovirus Vaccine
Adverse reactions ; local reactions (IPV) Vaccine -Associated Paralytic Poliomyelitis (OPV)
adult , immuno ed
4 doses of PV;
2, 4 , 6-18 ms
& 4 - 6 yrs
Pediarix contains IPV, DTaP & HB vaccines
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Polio Vaccination of Adults
Indications: Travelers to polio-endemic countries Selected laboratory workers HCWs
IPV; 0, 1-2 ms, 6-12 ms
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عنه تعالى الله رضي جبل بن معاذ عن
لله أن ا وسلم رسول عليه الله قالصلىالخير} { أبواب على أدلكم أال
: نعم قلت جنة:} ,قال الصوم
, برهان والصدقةالليل جوف في العبد وقيام
خطيئه كل يطفئ}