VIRULOGY - HIV (AIDS) , POLIOMYELITIS VIRUS, RABIES VIRUS
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VIRULOGY - HIV (AIDS) , POLIOMYELITIS VIRUS, RABIES VIRUS

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This is a series of lectures on microbiology useful for undergraduate medical and paramedical students

This is a series of lectures on microbiology useful for undergraduate medical and paramedical students

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VIRULOGY - HIV (AIDS) , POLIOMYELITIS VIRUS, RABIES VIRUS VIRULOGY - HIV (AIDS) , POLIOMYELITIS VIRUS, RABIES VIRUS Presentation Transcript

  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 1 VIRULOGYVIRULOGY HIV, POLIOMYELITIS VIRUS,HIV, POLIOMYELITIS VIRUS, RABIES VIRUSRABIES VIRUS
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 2
  • HUMAN IMMUNODEFICIENCYHUMAN IMMUNODEFICIENCY VIRUSVIRUS (HIV)(HIV) Dr. Ashish JawarkarDr. Ashish Jawarkar M.D. (Pathology)M.D. (Pathology)
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 4 HistoryHistory  USA - 1981USA - 1981  Sudden emergence of large number of cases ofSudden emergence of large number of cases of Kaposci’s sarcoma and P. carinii pneumoniaKaposci’s sarcoma and P. carinii pneumonia among homosexualsamong homosexuals  Research showed they had low immunity thatResearch showed they had low immunity that made them vulnerable to infection andmade them vulnerable to infection and malignanciesmalignancies  This condition was given the name –This condition was given the name – ACQUIRED IMMUNO DEFICIENCYACQUIRED IMMUNO DEFICIENCY SYNDROME - AIDSSYNDROME - AIDS
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 5  This was found to be due to a virus –This was found to be due to a virus – Human immunodeficiency virus - HIVHuman immunodeficiency virus - HIV
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 6 Problem statementProblem statement  UNAIDS/WHO (2008)UNAIDS/WHO (2008)  33.4 million people infected with HIV33.4 million people infected with HIV  2.7 million new cases2.7 million new cases  2 million deaths2 million deaths  INDIAINDIA  2-3.1 million cases2-3.1 million cases  Males>femalesMales>females  Prevalence is high in sexually active age group – 15-Prevalence is high in sexually active age group – 15- 49 years49 years
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 7 EpidemiologyEpidemiology  Spread by ONLY three modesSpread by ONLY three modes  Sexual contact with infected personSexual contact with infected person  Blood and blood productsBlood and blood products  Infected mother to babyInfected mother to baby
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 8
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 9 RELATIVE RISKRELATIVE RISK  Blood and its productsBlood and its products 90%90%  Mother to babyMother to baby 30%30%  IntercourseIntercourse 0.1-1%0.1-1%  Sharp injuriesSharp injuries 0.5-1%0.5-1%
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 10
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 11 Health care workers (OccupationalHealth care workers (Occupational exposure)exposure)  Needle stick injuriesNeedle stick injuries  Disposable needlesDisposable needles  Donot recapDonot recap  Universal precautionsUniversal precautions
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 12 Structure of HIVStructure of HIV
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 13  GenesGenes functionfunction  gaggag p24p24  envenv gp160gp160  polpol p31, p51, p66p31, p51, p66
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 14 PathogenesisPathogenesis
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 15 Clinical featuresClinical features  Symptoms are due to failure of immuneSymptoms are due to failure of immune responseresponse  AIDS patient dies not due to AIDS but dueAIDS patient dies not due to AIDS but due to oppurtunistic infections andto oppurtunistic infections and malignanciesmalignancies
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 16
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 17 Acute HIV infection (0-3 weeks)Acute HIV infection (0-3 weeks)  FeverFever  MalaiseMalaise  HeadacheHeadache  LymphadenopthyLymphadenopthy
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 18  HIV p24 antigen – POSITIVEHIV p24 antigen – POSITIVE  HIV antibodies - NegativeHIV antibodies - Negative
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 19 Asymptomatic/Clinically latentAsymptomatic/Clinically latent stagestage  Around 10 yearsAround 10 years  HIV antibodies keep virus under checkHIV antibodies keep virus under check  CD4 cell count is >200CD4 cell count is >200  p24 antigen – Negativep24 antigen – Negative  HIV antibodies - PositiveHIV antibodies - Positive
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 20
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 21 AIDSAIDS  Irreversible break down of immune systemIrreversible break down of immune system  CD4 cell count <200CD4 cell count <200  p24 - positivep24 - positive  Antibodies - positiveAntibodies - positive
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 22
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 23  Presents with one or more of the followingPresents with one or more of the following infections / malignanciesinfections / malignancies  Respiratory systemRespiratory system  TuberculosisTuberculosis  P. carinii pneumoniaP. carinii pneumonia  GITGIT  CysypotsporoidosisCysypotsporoidosis  ThrushThrush  Herpetic stomatitisHerpetic stomatitis  CNSCNS  ToxoplasmosisToxoplasmosis  CryptococcosisCryptococcosis  MalignanciesMalignancies  Kaposci’s sarcomaKaposci’s sarcoma  DementiaDementia
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 24 AIDS related complex (ARC)AIDS related complex (ARC)  Weight loss of >10% of body weightWeight loss of >10% of body weight  Generalised lymphadenopathy andGeneralised lymphadenopathy and splenomegalysplenomegaly
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 25 Lab diagnosisLab diagnosis  Antigen detectionAntigen detection  As early as 2-3 weeks following infectionAs early as 2-3 weeks following infection  For testing needle stick injury patientsFor testing needle stick injury patients  For testing blood donorsFor testing blood donors  Can be done by ELISA, PCRCan be done by ELISA, PCR
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 26  Antibody detectionAntibody detection  At around 6 weeksAt around 6 weeks  Highly infectious in window periodHighly infectious in window period  Cannot be used for blood donor screeningCannot be used for blood donor screening  Screening test – ELISA (antibody detection)Screening test – ELISA (antibody detection)  Confirmatory test – western blot (antigenConfirmatory test – western blot (antigen isolation)isolation)
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 27
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 28
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 29
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 30 Why no vaccineWhy no vaccine  Diverse antigenic types and subtypesDiverse antigenic types and subtypes  Long latencyLong latency  Persistence in infected cells as provirusesPersistence in infected cells as proviruses
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 31 Structure of HIVStructure of HIV
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 32 PreventionPrevention  Health educationHealth education  Identification of sourcesIdentification of sources  Elimination of high risk activitiesElimination of high risk activities
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 33 TreatmentTreatment  Treatment should be started on anyTreatment should be started on any symptoms with CD4 count <350symptoms with CD4 count <350 cells/mm3cells/mm3  Anti retroviral drugsAnti retroviral drugs  ZidovudineZidovudine  LamivudineLamivudine  NevirapineNevirapine  EfavirenzEfavirenz
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 34 POLIO VIRUSPOLIO VIRUS
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 35 POLIO VIRUSPOLIO VIRUS  Polio – grayPolio – gray  Myelitis – inflammation of spinal cordMyelitis – inflammation of spinal cord
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 36  Gray matter – motor neuronsGray matter – motor neurons  White matter – sensory neuronsWhite matter – sensory neurons  Polio affects gray motor neurons – causesPolio affects gray motor neurons – causes paralysisparalysis
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 37 EpidemiologyEpidemiology  Exclusively human diseaseExclusively human disease  Symptomless carrier shed virus in fecesSymptomless carrier shed virus in feces  Spreads via contaminated food and waterSpreads via contaminated food and water  Infection is asymptomaticInfection is asymptomatic  Patient presents with paralysisPatient presents with paralysis
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 38 PathogenesisPathogenesis
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 39 Clinical featuresClinical features  Earliest – fever, headache, sore throat –Earliest – fever, headache, sore throat – abortive poliomyelitisabortive poliomyelitis  Later – biphasic fever, stiff neck – nonLater – biphasic fever, stiff neck – non paralytic poliomyelitisparalytic poliomyelitis  Still later – paralysis – paralyticStill later – paralysis – paralytic poliomyelitispoliomyelitis
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 40
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 41 Lab diagnosisLab diagnosis  Sample – blood, CSFSample – blood, CSF  Isolation of polio virus in cell cultureIsolation of polio virus in cell culture
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 42 Serological testsSerological tests  Demonstration of four fold rise in antibodyDemonstration of four fold rise in antibody titre is diagnostictitre is diagnostic
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 43 ProphylaxisProphylaxis  VaccineVaccine
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 44 OPVOPV IPVIPV  Attenuated virusAttenuated virus  OralOral  CheaperCheaper  Herd immunityHerd immunity  Long lasting immunityLong lasting immunity  Stops epidemicStops epidemic  Easy to implementEasy to implement  Killed virusKilled virus  InjectableInjectable  ExpensiveExpensive  No herd immunityNo herd immunity  Short lastingShort lasting  Doesn’t stopDoesn’t stop  Not easy toNot easy to implementimplement
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 45
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 46
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 47  India overcame huge challenges, with a strongIndia overcame huge challenges, with a strong commitment that matched $ 2 billion allocation over thecommitment that matched $ 2 billion allocation over the years to stop polio. Implementing innovative strategies,years to stop polio. Implementing innovative strategies, the programme reaches an incredible 99 per centthe programme reaches an incredible 99 per cent coverage in polio campaigns, ensuring every child, evencoverage in polio campaigns, ensuring every child, even in the remotest corner of the country is protected againstin the remotest corner of the country is protected against polio. polio.   India introduced the oral polio vaccine in 1985 in theIndia introduced the oral polio vaccine in 1985 in the Universal Immunisation Programme in the backdrop ofUniversal Immunisation Programme in the backdrop of over 200,000 cases of polio annually (as per estimatesover 200,000 cases of polio annually (as per estimates of the Indian Academy of Pediatrics). In 1995, the firstof the Indian Academy of Pediatrics). In 1995, the first national polio immunization campaign was held; sincenational polio immunization campaign was held; since then two national and multiple sub-national campaignsthen two national and multiple sub-national campaigns are rolled out every year for children up to 5 years ofare rolled out every year for children up to 5 years of age.age.  In each national polio campaign, 2.3 million lakhIn each national polio campaign, 2.3 million lakh vaccinators, led by 155,000 upervisors, visit 209 millionvaccinators, led by 155,000 upervisors, visit 209 million households to immunize 170 million children up to thehouseholds to immunize 170 million children up to the age of 5 years. age of 5 years. 
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 48  To immunize children on the move, transit vaccinatorsTo immunize children on the move, transit vaccinators are positioned at bus stands, train stations, on trains,are positioned at bus stands, train stations, on trains, market places and important road intersections. Nearlymarket places and important road intersections. Nearly 10 million children are immunized by the transit teams in10 million children are immunized by the transit teams in each polio campaign, of them 100,000 on trains.each polio campaign, of them 100,000 on trains.  Focusing on the migrant population, the people on theFocusing on the migrant population, the people on the move in search of livelihood who miss poliomove in search of livelihood who miss polio immunization in view of their transient nature, theimmunization in view of their transient nature, the programme covers 70,000 brick kilns and 38,000programme covers 70,000 brick kilns and 38,000 construction sites. Nearly 4.5 million children areconstruction sites. Nearly 4.5 million children are immunized in the high-risk migrant settlements in eachimmunized in the high-risk migrant settlements in each polio campaign.polio campaign.  Since the start of the polio campaigns in 1995, as manySince the start of the polio campaigns in 1995, as many as 131 polio campaigns have been held in India till date,as 131 polio campaigns have been held in India till date, in which 12.1 billion doses of polio vaccines have beenin which 12.1 billion doses of polio vaccines have been administered.administered.
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 49 RABIES VIRUSRABIES VIRUS
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 50 RabiesRabies  Derived from sanskrit –Derived from sanskrit – rabhasrabhas - mad- mad
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 51
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 52 Pasteur and MeisterPasteur and Meister
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 53 EpidemiologyEpidemiology  Virus is present in all terrestrial animalsVirus is present in all terrestrial animals  India – 30,000 death due to rabies / yearIndia – 30,000 death due to rabies / year  Can be prevented by simple vaccination ofCan be prevented by simple vaccination of humanshumans  Dog/cat/bat population in India is non vaccinatedDog/cat/bat population in India is non vaccinated  Rabies has been eliminated from Britain andRabies has been eliminated from Britain and Japan by strict vaccination and quarantineJapan by strict vaccination and quarantine
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 54 PathogenesisPathogenesis
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 55 Clinical featuresClinical features  Acute encephalitisAcute encephalitis  HydrophobiaHydrophobia  Generalised convulsionsGeneralised convulsions  Death due to respiratory arrestDeath due to respiratory arrest
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 56
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 57
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 58 Lab diagnosisLab diagnosis  Ante mortemAnte mortem  Biopsy from cornea/skin (face)Biopsy from cornea/skin (face)  salivasaliva  Post mortemPost mortem  Brain biopsyBrain biopsy
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 59 Ante mortemAnte mortem  Demonstration of rabies virus byDemonstration of rabies virus by immunofluorescenceimmunofluorescence
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 60 Post mortemPost mortem  Brain biopsy – negri bodies inBrain biopsy – negri bodies in hippocampus and cerebellumhippocampus and cerebellum
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 61 ProphylaxisProphylaxis  Pre exposure prophylaxisPre exposure prophylaxis  Three doses on days 0,7,21 or 0,28,56Three doses on days 0,7,21 or 0,28,56  Booster after 1 year and then every 5 yearsBooster after 1 year and then every 5 years  Post exposure prophylaxis (humans)Post exposure prophylaxis (humans)  Wound cleaned with soap and waterWound cleaned with soap and water  Apply betadine, savlon, 70% alcoholApply betadine, savlon, 70% alcohol  Donot sutureDonot suture  Administer TTAdminister TT  Give anti rabies immunoglobulin – both locally intoGive anti rabies immunoglobulin – both locally into wound and systemicallywound and systemically  Anti rabies vaccineAnti rabies vaccine
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 62 Anti rabies vaccineAnti rabies vaccine  Neural vaccine – out dated – no longerNeural vaccine – out dated – no longer used – epileptogenicused – epileptogenic  Non neural (cell culture vacccines) –Non neural (cell culture vacccines) – routinely usedroutinely used
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 63 Vaccination scheduleVaccination schedule  Five to six dosesFive to six doses  Days 0,3,7,14,30 and optionally 90Days 0,3,7,14,30 and optionally 90  Gives protection for 5 yearsGives protection for 5 years  Given in deltoid regionGiven in deltoid region
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 64 TreatmentTreatment  Rabies is fatalRabies is fatal  No treatment availableNo treatment available
  • HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 65