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Familia Picornaviridae
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Caractere generale
• virusuri mici (22-30 nm), nude, cu simetrie
icosaedrică, genom viral de tip ARN monocatenarcu polaritate pozitivă;
• capsida virală, reprezentată de 2 pentamere
!ormate din "0 su#unită$i (protomere) constituite
din % polipeptide (&'-&'%), cu rol n ataareavirusului la receptorii celulari i n di!eren$ierea
antigenică a speciilor i serotipurilor;
• replicare intracitoplasmatică, cu eli#erare prin lizacelulelor (e*cep$ie virusul +epatitei A);
• include 3 genuri de interes medical Enterovirus,
Rhinovirus i Hepatovirus
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ME - picornavirusuri
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Genul Enterovirus
Caractere generale
•include virusuri cu transmitere predominent !ecal-orală,rezistente la p. acid, enzime proteolitice sau săruri
#iliare;
• su#divizate n
- poliovirus (3 serotipuri);
- coxsakievirus A (23 serotipuri);- coxsakievirus B (" serptipuri);
- echovirus (2/ serotipuri); enteric c ythopatic humanorphan
- enterovirus 68-71;
• determină !recvent in!ec$ii asimptomatice imunizante, cecon!eră protec$ie !a$ă de in!ec$ia cu acelai tip de virus;
• sunt lipsite de Ag cu speci!icitate de grup;
• nu dispunem de agen$i terapeutici cu activitate pe
enterovirusuri
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Virusurile poliomielitei
• prezintă 3 serotipuri di!eren$iate prin testul deneutralizare, cu patogenitate e*clusivă pentru om;
• apro* 01 din in!ec$ii sunt asimptomatice;
• % tipuri de mani!estări clinice
- #oala minor;
- meningită lim!ocitară;
- !orma ma4oră, cu paralizii de tip !lasc;- !orma #ul#ară cu prognostic vital rezervat;
• diagnostic de la#orator
- direct izolarea virusului pe culturi de celule din pro#e dee*sudat !aringian sau materii !ecale;
- indirect serodiagnostic 5 Ac neutralizan$i;
• pro!ila*ie speci!ică prin vaccinare cu cele 3 serotipuri
- vaccin inactivat (6al7) pe cale in4ecta#ilă;
- vaccin viu atenuat (6a#in) cu administrare orală
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Caractere generale
• VP1 – VP3 – reactioneaza cu Ac specifici
• VP4 – asociata genomului.
• Pentonele varfului icosaerului !in numar e 1"#sunt incon$urate e o crevasa in profunzimeacareia sunt liganzii pentru receptorii celularispecifici !liganzii sunt inaccesi%ili Ac neutralizanti#.
• &u se pot selecta variante antigenice ale liganzilor-sta%ilitatea antigenica a picornavirusilor.
• Atasarea e tip 'creasta -canion(.
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Atasareamoelul
'creasta -canion(
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)eplicarea picornavirusurilor
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*ec+ele ale poliomielitei
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*taiul eraicarii poliomielitei – mai ",,"
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Argumente pentru eraicare
• &u eista rezervor animal.
• &u este transmis pe cale aeriana.
• Eista oar 3 serotipuri.
• Patrunerea virusului in celule este foarteineficienta.
• Vaccinul !oral# este ieftin si usor e aminstrat
• Virusul sal%atic a fost eliminat in multe zone aleglo%ului.
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Contra-argumente
• Poate inuce %oala la animale !eperimental#.• Ma$oritatea infectiilor sunt inaparente
!1-" paralizii#.
• /ificil e vaccinat 1,, intre persoanelereceptive !zone ca 0nia Pa2istan tari in Africaetc#. /e regula acoperirea vaccinala estesuficienta aca se asigura .
• 5ulgaria – aprilie ",,1 !" cazuri infectii cu tulpinisal%atice#.
• 5ots6ana – fe%ruarie ",,4 777
• Camerun – august ",,87
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)om9nia
• )om9nia – zona li%era e virus poliosal%atic – iunie ",,"
• :ltimele cazuri; cazuri e paralizie post-
vaccinala !",,1 ",,3#.• Controlul conform cerintelor <M* prinsupraveg+erea cazurilor e PA= !paralizieacuta flasca#.
• >inta; 1 caz la ,?,,, copii su% 1 ani !)o;
1." cazuri ,?,,,#. &-E tarii – 1.@.
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<ral polio vaccin – <PV
• 1954: Dr. Jonas Salk develops the first
vaccine against polio, an inactivated
(killed), injectable polio vaccine (IPV).
• Mass OPV campaigns are conducted in
!echoslovakia and "ungar#. $%&& '
$%&)
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onas *al2>eas *cottis+ )ite Bospital for C+ilren 0mage Arc+ive
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1
18
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18 /r. Barol =uerst /r. eona
5aumgartner si D
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0storic - VV<A
• 1961: Dr. Albert Sabin o%tine vaccinuloral viu atenuat !V.V.<.A#.
• /evine imeiat vaccinul utilizat pentruprevenirea poliomielitei.
• :tilizat in Cu%a si Europa e Est – virusulsal%atic poate fi eliminat e pe arii intinseargument al eraicarii posi%ile.
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Al%ert *a%in
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Enterovirusuri nepoliomielitice
• pot determina in!ec$ii suclinice sau cu mani!estări diverse
- neurologice meningite cu lic+id clar, ence!alite, ocazional
!orme paralitice;- car!iace "i musculare miocardite sau pancardite, pleurodinia (#olaa 8orn+olm);
- cutanate "i mucoase +erpangina, #oala m9nă-picior-gură,erup$ii cutanate;
-oculare con4unctivite +emoragice, 7eratite;
- respiratorii rino!aringite, #roneolite;
- !igestive #oală diareică;
• diagnostic de la#orator
- direct izolarea i identi!icarea virusului pe culturi de celulesau inoculare intracere#rală la oareci nou-născu$i;
- indirect con!irmarea diagnosticului direct prinautoserodiagnostic;
• nu dispunem de tratament i metode de pro!ila*iespeci!ică
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Berpangina – cosac2ie A!serotipuri; "-8 F 1,#
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5oala mana-gura-picior
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Genul Rhinovirus
• include virusuri cu structură i replicare asemănătoare cuenterovirusurile;
• spre deose#ire de acestea
- sunt sensi#ile la p. acid;
- temperatura optimă de cultivare este de 330:;
•sunt descrise 00 serotipuri;
• agen$i etiologici ai guturaiului, cu transmitere prinintermediul m9inilor contaminate sau prin aerosoli;
• diagnosticul de la#orator nu este utilizat curent;
• nu dispunem de tratament i metode de pro!ila*iespeci!ică
Genul Hepatovirus
• include virusul +epatitei A (vezi +epatitele virale)
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)inovirusuri
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Diagnostic de laborator
• Produse patologice;
• esuat nazal Gi faringian• aspirat nasofaringian
• lic+i sinusal
• sputH• *e prelevH In primele trei zile e %oalH.
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0zolarea
• Culturi e celule; e origine umanH !e.g.M)C J013F# la temp. e 33°C.
• Efectul citopatic apare e regulH upH 1-" sHpt.
• 0entificare; prin apariKia unui efectcitopatic tipic Gi emonstrarea sensi%ilitHKiifaKH e acizi.
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)inovirus tip 18 – ECP pe celule fi%ro%lastice umane sicelule neinfectate !stanga#
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/iagnostic serologic
• *erotiparea; rar este necesarH ar esteposi%ilH utiliz9n seruri specifice anti-serotip.
• /iagnosticul serologic nu este util atoritHmarii iversitHKi e serotipuri Gi a a%senKeiunui antigen comun.
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Familia Reoviridae
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Caractere generale
• virusuri cu aspect s!eric ("0-/0 nm), nude, cu du#lă
capsidă icosaedrică i genom de tip ARN #icatenarsegmentat, cu replicare intracitoplasmatică;
• % genuri includ virusuri izolate de la om
-Orthoreovirus care determină cel mai !recvent
in!ec$ii asimptomatice, !iind uneori asociate cuin!ec$ii respiratorii sau digestive;
-Coltivirus i Orbivirus care determină #oli !e#rileuneori complicate cu ence!alite, pericardite sau
+emoragii, transmise prin artropode +emato!age(ar#ovirusuri);
- Rotavirus, agen$i etiologici ai #olii diareice acute,n special la copii < 3 ani
<enul Rotavirus
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<enul Rotavirus
• denumirea este legată de aspectul caracteristic alvirusului la me(stratul intern al capsidei are
contur zim$at iar statul e*tern este neted);
• Ag capsidale (&'-&'=) au speci!icitate de grup,
su#grup i tip, din cele = grupe (A-<), 3 au !ost
izolate de la om, cele mai !recvente tulpini !iind
din grupa A;
• determină diaree apoasa cu des+idratare lacopilul de v9rsta mică, uneori cu evolu$ie
epidemică, n zona temperată !recven$a ma*imă
!iind in lunile de iarnă;
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<enul Rotavirus
• virusul se elimină masiv prin scaun n primele zile
de #oală (0/-0>g), put9nd !i eviden$iat la me;
• diagnosticul de la#orator se #azează pe
identi!icarea Ag virale n pro#ele de scaun prin
late*aglutinare sau ?@6A;
• tratamenmt prin reec+ili#rarea +idroelectrolitică;
• n studiu un vaccin anti-rotaviral viu atenuat
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Agen#i etiologici virali mici s$erici ai olii!iareice
• !ac parte din !amiliile Caliciviridae (virus NorBal7 i NorBal7-like) i Astroviridae;
• virusuri nude, ARN monocatenar de sens pozitiv, nu au
putut !i cultivate pe culturi de celule;• dimensiuni cuprinse ntre 2=-3C nm;
• determină !orme autolimitate de #oală, cu transmitere!ecal-orală;
• diagnostic prin imuneletronomicroscopie sau ?@6A,accesi#ile la#oratoarelor de cercetare;
• nu dispunem de tratament i metode de pro!ila*iespeci!ică
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Damilia Coronaviridae, genul
Coronavirus
• virusuri mari (20-"0 nm) cu genom ARN
monocatenar de sens pozitiv, capsida cu simetrie
+elicală, anvelopate;
• glicoproteine virale pedunculate, dispuse caracteristic
n coroană permit ataarea virusului la receptorii
celulari, cu epitopi recunoscu$i de Ac neutralizan$i;
• determină in!ec$ii la om (E:%3, 22?), la numeroasespecii de mami!ere i păsări, tulpinile animale ne!iind
transmise la om;
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Damilia Coronaviridae, genul
Coronavirus
• mani!estă tropism pentru tractusul respirator, dar
pot replica la nivelul mucoasei intestinului su#$ire,
!iind implicate n in!ec$ii respiratorii superioare i
pneumonii intersti$iale, posi#il n gastroenterite;• diagnostic etiologic #azat pe e*amen serologic
?@6A, .A', RD:;
•nu dispunem de un tratament etiotrop sau
pro!ila*ie speci!ică
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%A&% ' S evere Acute Respiratory S yndrome(
• reprezintă prima in!ec$ie emergentă a secolului FF, carea a!ectat peste /000 de persoane din 2" $ări i a cauzat
mai mult de =00 decese;
• determinat de o tulpină de coronavirus izolat de laanimale care a depăit #ariera de specie i a trecut la om;
• transmis prin aerosoli sau pe cale !ecal-orală, este
capa#il să determine in!ec$ii sistemice cu mani!estărisevere de pneumonie, asociate, mai ales la copii, cu!enomene digestive;
• virusul a !ost izolat pe culturi de celule din secre$ii
respiratorii, materii !ecale, s9nge, urină;• diagnosticul de la#orator poate !i direct, prin ':R sau
indirect, prin ?@6A, D;
• n studiu agen$i terapeutici antivirali i vaccin
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