1. Enteroviruses New Emerging Disease April 2010 HuthayfaMujahed

2. Outline Introduction Virus Properties Clinical Aspects Pathogenesis Vaccines & Treatment Epidemiology

3. Introduction Most common human pathogens. Distribution world wild. Usually cause mild fever. Rarely progress to severe and fatal disease.

4. Properties Classification : Family : Picornaviridae Genus : Enterovirus 10 species

5. Properties 2. Morphology : Small 30 nm. Icosahedral. Non-enveloped. 60 protomers forms the capsid - Variant VP = Different Ag serotypes.

6. Properties 3. Genome : +ssRNA 7500 b (De Palma, et. al 2008 )

7. Properties 4. Replication EndocytosisCytoplasm Cell lysis (Zoll, et. al 2009)

8. Clinical Aspects Symptoms : Often NO symptoms. Rash, Fever, Muscle aches, Common clod, flu-like. Transmission : Saliva, Blister fluid, stool, nasal mucus, and any thing contaminated with the virus.

9. Pathogenesis The University of Texas Medical Branch at Galveston, Pathogenesis of enterovirus infections 1996.

10. Pathogenesis Aseptic Meningitis Less severe than bacterial meningitis. Rarely fatal in people with normal immune systems. Symptoms last from 7 to 10 days. Completely recover within 2 weeks. H. Enterovirus B species

11. Pathogenesis Hand Foot and Mouth Disease causes fever, sores in the mouth, and a rash with blisters. children <10 yr. recover in 7–10 days. Coxsackievirus A16 When pretty baby gets HFMD

12. Lab Diagnosis RT-PCR. Recently Flow Cytometry .

13. Vaccines No vaccine, Good hygiene. Treatment No specific anti-viral agent.

14. Epidemiology Centers for Disease Control and Prevention :Aseptic meningitis in Baltimore-USA during June 1 – September 30, 1998–2001.

15. Epidemiology Centers for Disease Control and Prevention : Reported aseptic meningitis cases in Cuba, January through September 2000

16. Epidemiology Centers for Disease Control and Prevention : Monthly distribution of aseptic meningitis incidence in Cuba 2000.

17. Epidemiology Centers for Disease Control and Prevention : Total cases of HFMD and herpangina in Taiwan, March 19 to August 29, 1998.

18. Epidemiology Centers for Disease Control and Prevention : Number of hospitalizations and severe cases of hand, foot, and mouth disease and herpangina in Taiwan, June-August, 1998

19. Epidemiology Centers for Disease Control and Prevention : Clinical features of HFMD in children admitted to hospital in southern Vietnam during 2005.

20. Epidemiology Centers for Disease Control and Prevention : Monthly distribution of 387 cases of HFMD associated with isolation of either (CVA16) (214 cases) or (HEV71) (173 cases), southern Vietnam, 2005. March,2010 more than 77,000 cases of HFMD and 40 deaths were reported in China by CDC.

21. References Cordey. Samuel, Gerlach. Daniel, Junier. Thomas, Zdobnov. Evgeny M, Kaiser. Laurent, and Tapparel. Caroline. 2008. The cis-acting replecation elements define human enterovirus and rhinovirus species. RNA, 14:1568-1578. De Palma. Armando M, Vliegen. Inge, De Clercq. Erik, Neyts. Johan. 2008. Selective inhibitors of Picornavirus replication. Medicinal Reasearch Reviews, 28:823-884. Lin. Mong-Cheng, Chan. Yu-Jiun, Chen. Chun-Jen, Tang. Ren-Bin, and Wu. Keh-Gong. 2008. Epidemiology and diagnostic methodology for enterovirus infection, including cerebrospinal fluid analysis. MicrobioImmunol & infect, 41:450-455. She. Rosemary C, Preobrazhensky. Sergey N, Taggar Edward W, Petti Cathy A, and BahlerDevid W. 2009. Flow cytometric detection and serotyping of enterovirus for the clinical laboratory. Jviromet, 162:245-250. Zoll. Jan, Heus. Hans A, Kuppeveld. Frank J.M Van, and Melchers. Willem J.M. 2009. The structure-function relationship of the enterovirus 3’-UTR. Viruses, 139:209-216. Centers for Disease Control and Prevention./www.cdc..gov/

22. When pretty baby gets HFMD… Be a virus, see the world