Pharm D Program

(2023/2024)

3 December 2024 www.su.edu.eg 1

 Pharm
PharmDDProgram
Program
(2024/2025)
(2023/2024)

(PM 704)

Lecture No. (9)

RNA Viruses (1)

By
Professor
Yasser El Mohammadi
3 December 2024 www.su.edu.eg 2
 Pharm
PharmDDProgram
Program
(2024/2025)
(2023/2024)

Lecture’s Aim

To help the student to get a detailed knowledge about the most dangerous
and prevalent RNA viral families and their corresponding diseases all over the
world.

3 December 2024 www.su.edu.eg 3

 Pharm
PharmDDProgram
Program
(2024/2025)
(2023/2024)

Lecture’s Competencies

To enable the student to

1- Discover the most important RNA viruses families and to describe their main
characteristics.
2- Know the most dangerous & prevalent RNA viral diseases and how to treat
or prevent these diseases.

3 December 2024 www.su.edu.eg 4

 Pharm
PharmDDProgram
Program
(2024/2025)
(2023/2024)

Lecture’s Contents

RNA Viruses
1) Picornaviruses
2) Paramyxoviruses
3) Toga viruses
4) Orthomyxoviruses

3 December 2024 www.su.edu.eg 5

II- RNA Viruses
 II- RNA Viruses
1. Picorna: Poliomyelitis, Rhino virus
2. Orthomyxo: Influenza
3. Paramyxo: Parainfluenza, Measles, Mumps
4. Toga: German measles
Arboviruses (Flaviviruses): Yellow fever
5. Corona: SARS
6. Reo: Rota virus
7. Rhabdo: Rabies
8. Retro: HIV
Hepatitis: (RNA and DNA), A, B, C, D, E, G
 1) Picornaviruses
- Small icosahedral naked (non enveloped) RNA viruses.

- Classification
a) Enteroviruses
1- Poliovirus
2- Cosackie virus ‫الحمى القالعية‬
3- ECHO (entero cytopathogenic human orphan) virus.
4- Hepatitis A virus.
Stable in low pH of stomach, replicate in GIT, & are excreted in stool
(fecal-oral route).

b) Rhinoviruses: labile at acidic pH.

 A- Enteroviruses
I) Poliovirus ‫شلل األطفال‬
- Three serotypes.
- Transmission:
• Oral-fecal especially
water & milk in
children.

- Pathogenesis
Poliomyelitis is
mainly characterized
by flaccid paralysis mostly affecting the lower limbs due to
viral replication in the lower motor neurons in the anterior
of spinal cord.
The infection occurs most commonly in low socioeconomic areas.
- Prophylaxis:
1) Salk vaccine: Formalin killed poliovirus, taken as 3 S.C. injections 4-8
weeks apart.
- Disadvantages Does not prevent viral replication in the intestine.

2) Sabin vaccine: Live attenuated, taken in 3 oral doses 4-8 weeks apart.
- Advantages:
i) Prevent intestinal viral replication (induce secretory Abs)
ii) Pass in stool & led to spread of immunity in the community.
iii) Cheap
 B- Rhinoviruses

• Transmission: by droplets via respiratory tract.

• Pathogenesis:
- Most common cause of common cold & upper respiratory tract infections,
usually nose.

- The release of histamine & bradykinin by infected cells is the cause of runny
nose.

- Infections are self limiting & do not cause serious disease.

- Immunity is transient due to the large number of serotypes (more than 100).
 2) Paramyxoviruses
a) Parainfluenza
b) Respiratory syncytial
c) Mumps
d) Measles
 A- Mumps ‫النكاف‬
• A highly communicable disease infecting only humans.
• Transmission: by respiratory droplets.

• Pathogenesis
- Main cause of acute benign viral parotitis (bilateral or unilateral swelling of
salivary glands especially parotid glands).
- Systemic infection may occur in pancreas, CNS (meningitis & encephalitis)
& testes (orchitis) leading to sterility.

- Prophylaxis
- MMR vaccine: live attenuated mumps - measles - rubella vaccine.
- Immumity is life long following infection or vaccination.
 B- Measles (Rubeola) ‫الحصبة‬
• A highly communicable disease infecting
mainly children.
• Transmission: by respiratory droplets.

• Pathogenesis
• Koplik's spots appear on buccal cavity
mucosal membrane (mouth & throat).
• A generalized maculopapular rash extending
from head to the extremities.
• Prophylaxis
- MMR vaccine.
- Live attenuated single measles vaccine.
 3) Toga viruses
A- Rubella (German measles)
‫الحصبة األلمانية‬

Pathogenesis
- Postnatal rubella: resemble measles
in causing fever & skin rash, but milder
with no koplik’s spots & is self limiting.
• Congenital rubella: Infection is very serious in pregnant ladies as it crosses the
placenta. It results in congenital defects in the fetus (deafness, blindness,
spleenomegaly, heart defects & mental retardation), especially during the first
three months of pregnancy.
 Laboratorydiagnosis
Laboratory diagnosis
Serological tests: ELISA or hemagglutination inhibition
Serological tests: ELISA or hemagglutination inhibition.
Prophylaxis
- MMR vaccine.
- Live attenuated single rubella vaccine for girls before marriage.

Vaccination should be avoided during pregnancy &/or 3 months before

pregnancy.
• Immunity is life long following infection or vaccination.
Comparison between measles & German measles
Measles German measles
Rubeola Rubella
Paramyxovirus Togavirus
Helical Icosahedral
Severe course Mild course
Long duration Short duration
Koplik’s spots No Koplik’s spots
Less severe in pregnancy Severe in pregnancy
 Arbo (arthropod born) viruses
Toga viruses
B- Yellow fever ‫الحمي الصفراء‬

• Transmission: by the bite of female Aedes aegypti mosquito.

Usually infection is restricted to tropical forests.
• Pathogenesis
• Severe symptoms such as fever, heart & kidney damage, liver degeneration
(jaundice) & massive GI hemorrhage (black vomit), with mortality over 50%
in epidemics.

• Laboratory diagnosis
- Serological tests: ELISA or hemagglutination inhibition.

- Prophylaxis
- The 17D vaccine (living attenuated & lyophilized) is given I.D. & elicit life
long immunity.
 4) Orthomyxoviruses
Influenza A, B & C ‫األنفلونزا‬
• Pleomorphic (spherical or tubular) enveloped RNA virus.
• The envelope is composed of lipid bilayer with an inner matrix M protein
& outer surface 2 glycoprotein spikes: hemagglutinin (HA: 1-18) &
neuraminidase (NA: 1-11) (two important Ags).
• Classification into 3 serotypes A, B & C.

Antigenic variation
It is common in influenza virus due to changes in HA & NA. Types of
variation are:
1) Antigenic drift: minor changes due to point mutation in HA gene & affects
severity of disease.
2) Antigenic shift: major changes due to recombination between 2 different
strains that results in new antigenic type (new HA subtype +/- NA) which
 usually starts an epidemic or even pandemic. RNA is divided into 8 segments
(in case of influenza A & B), each coding for a single protein. Consenquently,
if two (or more) influenza viruses simultaneously infect the same individual,
then during replication, these viruses can exchange RNA segments with one
another, thereby creating viruses with entirely new combinations of genes.

- Pathogenesis
- Influenza A is the most severe & C is the least.
- Influenza (flu) is an infection of the upper respiratory tract & is transmitted
by respiratory droplets.
- After inhalation of influenza virus particles, respiratory epithelial cells are
destroyed by the immune response, especially cytotoxic T cells & also by the
virus itself.
 - HA: binds to receptors on host cells.
- NA: cleaves sialic acid residue of the mucus facilitating virus penetration
into both mucus secreting & ciliated epithelial cells & destroy them. This
action helps the release of virion particles from the cells & facilitates the
adhesion of bacteria such as pneumococci which then easily attacks the
respiratory epithelia.
- Symptoms:
Chills, high fever, myalgia (muscle aches), dry cough & severe drowsiness.
- The disease runs its course in 4 to 5 days, then it is usually self limiting.

- Short life immunity to influenza virus is due to:

1) Continuous variation (shift & drift) of the virus.
2) The virus mostly does not invade the blood.
3) Short incubation period & short disease time.
- Prophylaxis: Formalin killed vaccine with the suspected type A & B variants.
• The host produce antibodies against HA that can neutralize the virus.

• Treatment
- Amantadine & rimantadine prevent the influenza virus from uncoating.
Salicylates & antihistaminics.
- Vitamin C & rest in bed.

• Avian flu (Bird flu)

• A highly pathogenic strain of the subtype A/H5N1 that infect birds which in
their turn infect humans where the infection is often fatal (death rate is high
> 50%).

• Swine flu (A H1N1)

 Pharm
PharmDDProgram
Program
(2024/2025)
(2023/2024)

Lecture’s References

Review of Medical Microbiology and Immunology.

By Warren Levinson - 10th Edition (2008).
Publisher: McGraw Hill - Lange.

3 December 2024 www.su.edu.eg 38