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a) red bumps on skin. b) a micrograph of human herpesvirus 3 is shown. The diameter is approximately 300 nanometers according to a scale bar on the bottom right of the micrograph.
(a) The characteristic appearance of the pustular chickenpox rash is concentrated on the trunk region. (b) This transmission electron micrograph shows a viroid of human herpesvirus 3, the virus that causes chickenpox in children and shingles when it is reactivated in adults. (credit b: modification of work by Centers for Disease Control and Prevention)

Like other herpesviruses, the varicella-zoster virus can become dormant in nerve cells. While the pustular vesicles are developing, the virus moves along sensory nerves to the dorsal ganglia in the spinal cord. Once there, the varicella-zoster virus can remain latent for decades. These dormant viruses may be reactivated later in life by a variety of stimuli, including stress, aging, and immunosuppression. Once reactivated, the virus moves along sensory nerves to the skin of the face or trunk. This results in the production of the painful lesions in a condition known as shingles ( [link] ). These symptoms generally last for 2–6 weeks, and may recur more than once. Postherpetic neuralgia, pain signals sent from damaged nerves long after the other symptoms have subsided, is also possible. In addition, the virus can spread to other organs in immunocompromised individuals. A person with shingles lesions can transmit the virus to a nonimmune contact, and the newly infected individual would develop chickenpox as the primary infection. Shingles cannot be transmitted from one person to another.

The primary diagnosis of chickenpox in children is mainly based on the presentation of a pustular rash of the trunk. Serological and PCR-based tests are available to confirm the initial diagnosis. Treatment for chickenpox infections in children is usually not required. In patients with shingles, acyclovir treatment can often reduce the severity and length of symptoms, and diminish the risk of postherpetic neuralgia. An effective vaccine is now available for chickenpox. A vaccine is also available for adults older than 60 years who were infected with chickenpox in their youth. This vaccine reduces the likelihood of a shingles outbreak by boosting the immune defenses that are keeping the latent infection in check and preventing reactivation.

a) Large red spots on an adult’s neck. B) Red bumps on skin.
(a) An individual suffering from shingles. (b) The rash is formed because of the reactivation of a varicella-zoster infection that was initially contracted in childhood. (credit a: modification of work by National Institute of Allergy and Infectious Diseases (NIAID); credit b: modification of work by Centers for Disease Control and Prevention)
  • Why does measles often lead to secondary infections?
  • What signs or symptoms would distinguish rubella and measles?
  • Why can chickenpox lead to shingles later in life?

Smallpox stockpiles

Smallpox has probably killed more humans than any other infectious disease, with the possible exception of tuberculosis. This disease, caused by the variola major virus, is transmitted by inhalation of viral particles shed from lesions in the throat. The smallpox virus spreads systemically in the bloodstream and produces a pustular skin rash. Historical epidemics of smallpox had fatality rates of 50% or greater in susceptible populations. Concerted worldwide vaccination efforts eradicated smallpox from the general population in 1977. This was the first microbial disease in history to be eradicated, a feat made possible by the fact that the only reservoir for the smallpox virus is infected humans.

Although the virus is no longer present in the wild, laboratory samples of the virus still exist in the United States and Russia. Centers for Disease Control and Prevention. “CDC Media Statement on Newly Discovered Smallpox Specimens.” July 8, 2014. http://www.cdc.gov/media/releases/2014/s0708-nih.html. Accessed on July 7, 2016. The question is, why do these samples still exist? Some claim that these stocks should be maintained for research purposes. Should the smallpox virus ever reappear, they say, we would need access to such stocks for development of vaccines and treatments. Concerns about a re-emergence of the virus are not totally unfounded. Although there are no living reservoirs of the virus, there is always the possibility that smallpox could re-emerge from mummified human bodies or human remains preserved in permafrost. It is also possible that there are as-yet undiscovered samples of the virus in other locations around the world. An example of such "lost" samples was discovered in a drawer in a Food and Drug Administration lab in Maryland. Ibid. If an outbreak from such a source were to occur, it could lead to uncontrolled epidemics, since the population is largely unvaccinated now.

Critics of this argument, including many research scientists and the World Health Organization, claim that there is no longer any rational argument for keeping the samples. They view the “re-emergence scenarios” as a thinly veiled pretense for harboring biological weapons. These scenarios, they say, are less probable than an intentional reintroduction of the virus from militarized stocks by humans. Furthermore, they point out that if we needed to research smallpox in the future, we could rebuild the virus from its DNA sequence.

What do you think? Are there legitimate arguments for maintaining stockpiles of smallpox, or should all forms of this deadly disease be eradicated?

Viral infections of the respiratory tract

Many viruses are capable of entering and causing disease in the respiratory system, and a number are able to spread beyond the respiratory system to cause systemic infections. Most of these infections are highly contagious and, with a few exceptions, antimicrobial drugs are not effective for treatment. Although some of these infections are self-limiting, others can have serious or fatal complications. Effective vaccines have been developed for several of these diseases, as summarized in [link] .

Table title: Viral Infections of the Respiratory Tract. Columns: Disease, Pathogen, Signs and Symptoms, Transmission, Vaccine. Chickenpox (varicella); Varicella-zoster virus; In children, fever, chills, pustular rash of lesions that burst and form crusty scabs; in adults, more severe symptoms and complications (e.g., pneumonia); Highly contagious via contact with aerosols, particles, or droplets from infected individual’s blisters or respiratory secretions; Chickenpox vaccine. Common cold; Rhinoviruses, adenoviruses, coronaviruses, others; Runny nose, congestion, sore throat, sneezing, headaches and muscle aches; may lead to otitis media, pharyngitis, laryngitis; Highly contagious via contact with respiratory secretions or inhalation of droplets or aerosols; None. Influenza Influenza viruses A, B, C; Fever, chills, headaches, body aches, fatigue; may lead to pneumonia or complications such as Reye syndrome. Highly virulent strains may cause lethal complications; Highly contagious between humans via contact with respiratory secretions or inhalation of droplets or aerosols. Influenza A virus can be transmitted from animal reservoirs. Vaccines developed yearly against most prevalent strains. Measles; Measles virus (MeV); High fever, conjunctivitis, sore throat, macular rash becoming confluent, Koplik’s spots on oral mucosa; in severe cases, can lead to fatal pneumonia or encephalitis, especially in children; Highly contagious via contact with respiratory secretions, skin rash, or eye secretions of infected individual; MMR. MERS; Middle East respiratory syndrome coronavirus (MERS-CoV); Fever, cough, shortness of breath; in some cases, complications such as pneumonia and kidney failure; can be fatal; Contact with respiratory secretions or inhalation of droplets or aerosols; None. Rubella (German measles); Rubella virus; Facial rash spreading to extremities, followed by low-grade fever, headache, conjunctivitis, cough, runny nose, swollen lymph nodes; congenital rubella may cause birth defects, miscarriage, or stillbirth; Contagious via inhalation of droplets or aerosols from infected person or asymptomatic carrier; ransplacental infection from mother to fetus; MMR. SARS; SARS-associated coronavrius (SARS-CoV); High fever, headache, body aches, dry cough, pneumonia; can be fatal; Contact with respiratory secretions or inhalation of droplets or aerosols; None. Shingles; Varicella-zoster virus; Painful lesions on face or trunk lasting several weeks; may cause postherpetic neuralgia (chronic pain) or spread to organs in severe cases; Nontransmissible; occurs when dormant virus is reactivated, generally many years after initial chickenpox infection; Shingles vaccine. Viral pneumonia; Adenoviruses, influenza viruses, parainfluenza viruses, respiratory syncytial viruses, others; From mild cold-like symptoms to severe pneumonia; in infants, RSV infections may be life-threatening; Highly contagious via contact with respiratory secretions or inhalation of droplets or aerosols; None.

Key concepts and summary

  • Viruses cause respiratory tract infections more frequently than bacteria, and most viral infections lead to mild symptoms.
  • The common cold can be caused by more than 200 viruses, typically rhinoviruses, coronaviruses, and adenoviruses, transmitted by direct contact, aerosols, or environmental surfaces.
  • Due to its ability to rapidly mutate through antigenic drift and antigenic shift , influenza remains an important threat to human health. Two new influenza vaccines are developed annually.
  • Several viral infections, including respiratory syncytial virus infections, which frequently occur in the very young, can begin with mild symptoms before progressing to viral pneumonia.
  • SARS and MERS are acute respiratory infections caused by coronaviruses, and both appear to originate in animals. SARS has not been seen in the human population since 2004 but had a high mortality rate during its outbreak. MERS also has a high mortality rate and continues to appear in human populations.
  • Measles , rubella , and chickenpox are highly contagious, systemic infections that gain entry through the respiratory system and cause rashes and fevers. Vaccines are available for all three. Measles is the most severe of the three and is responsible for significant mortality around the world. Chickenpox typically causes mild infections in children but the virus can reactivate to cause painful cases of shingles later in life.

Fill in the blank

The _______ virus is responsible for causing German measles.

rubella

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A(n) _______ is an uncontrolled positive feedback loop between cytokines and leucocytes.

cytokine storm

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In cases of shingles, the antiviral drug _______ may be prescribed.

acyclovir

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The slow accumulation of genetic changes to an influenza virus over time is referred to as _______.

antigenic drift

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The _______ vaccine is effective in controlling both measles and rubella.

MMR

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Short answer

Since we all have experienced many colds in our lifetime, why are we not resistant to future infections?

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Source:  OpenStax, Microbiology. OpenStax CNX. Nov 01, 2016 Download for free at http://cnx.org/content/col12087/1.4
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