1. Paramyxoviruses Stanley I. Martin, MD Associate Professor Division of Infectious Diseases

2. Primary objectives 1.Recognize the structure and microbial physiology of Paramyxoviruses and integrate this information with the human pathophysiologic correlates a. Describe physical and chemical properties of Paramyxoviruses b. Describe the replication of Paramyxoviruses c. Describe the underlying genetic mechanisms of Paramyxoviruses d. Recognize the molecular basis of pathogenesis of infections due to Paramyxoviruses e. Describe the physiology of infections due to Paramyxoviruses

3. Primary objectives 2.Identify the normal human immune response to infections due to Paramyxoviruses 3.Recognize the epidemiology and ecology of infections due to Paramyxoviruses 4.Describe and differentiate the principles of laboratory diagnosis of infections due to Paramyxoviruses 5.Describe the treatment, prevention and control of infections due to Paramyxoviruses 6.Apply principles of immunology in select clinical settings: Vaccines a. Describe the mechanisms for which Measles and Mumps vaccines are used to induce a protective adaptive immune response without overt infection

4. Paramyxoviridae* Morbiliviruses Paramyxoviruses Pneumoviruses Measles Mumps Parainfluenza Respiratory syncytial virus (RSV) Human metapneumovirus *Plus a few other arboviruses we’re not going to talk about today…

5.  Negative sense, single-stranded RNA genome  Enveloped helical nucleocapsid  F protein (fusion protein)  Viral attachment protein 1. HN - Mumps and Parainfluenza 2. H - Measles 3. G – RSV, h-MPV

7. Uninfected cells in an in vitro culture Infection of cells results in formation of large syncytia with multinucleated giant cells

10. The Three “C’s”:  Cough  Coryza  Conjunctivitis

11. Koplik spots

12. Measles exanthema

14. Mumps

17. Swollen salivary glands associated with mumps

18. Respiratory syncytial virus (RSV)  Most common cause of fatal respiratory infection in infants  Huge morbidity and mortality among children worldwide  Rivals influenza in terms of morbidity and mortality among the elderly

19. Seasonality of RSV

20. Clinical presentation

22. Diagnosis

23. Treatment and prevention Palivizumab

24. Parainfluenza  Four different serotypes  Limited to respiratory tract  URI  Bronchitis  Laryngotracheo- bronchitis (croup)

25. Seasonality of parainfluenza depends on the serotype

26. Croup in a child Pneumonia due to Parainfluenza-3 in a bone marrow transplant patient

27. Diagnosis and treatment  Culture or RT-PCR  Careful airway monitoring in children with croup  Ribavirin?  No vaccine

28. Human metapneumovirus (h-MPV)

31. Primary reference  Medical Microbiology, 7 th Ed. Murray, Rosenthal & Pfaller; Chapter 56, pages 512 – 523.

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