인간의 바이러스성 질병 (Viral Diseases of Humans) AIDS to Zoster( 대상포진 ) 18

Looking Ahead 인간의 바이러스성 질병은 천연두 (smallpox), 광견병 (rabies) 그리고 에이즈 (AIDS) 와 같은 심각한 질병뿐만 아니라 홍역 (measles), 볼거리 (mumps), 수두 (chickenpox) 와 같은 가벼운 질병까지 광범위하다. On completing this chapter, you should be able to: –Summarize the salient characteristics of some traditional viral diseases and be aware of the viral diseases of contemporary times; –Recognize some misconceptions regarding viral diseases and gain new insights about these public health problems; –Develop a vocabulary of terms relating to viral diseases and be able to discuss them confidently.

피부의 바이러스성 질병 (Viral Diseases of the Skin) Herpes simplex( 단순포진 ) –DNA virus –Signs Cold sores Fever blisters( 수포 ) Herpetic ulcers( 포진에 의한 종기 ) Herpetic whitlow( 표저 ) –Two different viruses HSV-1: labial herpes( 입술포진 ) HSV-2: genital herpes( 생식기포진 ) –Latency and reactivation( 잠복과 재활성화 ) –Transmission( 전염 ) 60-80% of people in developed world are HSV-1-positive HSV-2 transmission during pregnancy –Treatment Acyclovir (Zovirax) Valacyclovir (Valtrex) Fig The cold sores (fever blisters) of herpes simplex Courtesy of Dr. Hermann/CDC

Viral Diseases of the Skin Chicken pox( 수두 ) : 피부가 닭의 피부처럼 보여 이름을 수두라고 붙였다. 20 면체 DNA 바이러스에 의해 야기되는 전염성이 높은 질병. –Caused by varicella-zoster virus (VZV 수두 - 대상포진 바이러스 ) –Also a herpes virus –Primary infection –Usually recurs as shingles( 대상포진 ) –Vaccine available Varicella (chicken pox 수두 ) Zoster (shingles 대상포진 )

Viral Diseases of the Skin 홍역 (Measles ; rubeola) –RNA virus –Transmitted by respiratory droplets –Rarely seen in US any more –Signs ( 발진이 선홍색의 여드름같이 시작하여 얼굴, 몸 그리고 팔 다리로 퍼진다.) Hacking cough( 마른기침 ) Sneezing( 재채기 ) Nasal discharge( 콧물 ) Eye redness Sensitivity to light High fever Characteristic red rash( 발진 ) that eventually encompasses entire body –Extremely effective vaccine

Viral Diseases of the Skin: Measles Reduction in US Figure 18.2: Reported U.S. cases of Measles (Rubeola)

Viral Diseases of the Skin 풍진 (Rubella ;German measles) –Different from measles Slightly red rash( 발진 ) Caused by rubella virus(20 면체 RNA 바이러스 ), not measles virus –Signs Occasional fever Variable, pale-pink rash –Begins on face –Spreads to trunk and extremities –Congenital ( 선천적인 )rubella –Extremely effective vaccine

Viral Diseases of the Skin 홍진 (Fifth disease ; erythema infectiosum) –Caused by parvovirus B19 –DNA virus(20 면체 ) –5th disease marked by rash( 발진 ) I is measles( 홍역 ) II is scarlet fever( 성홍열 ) III is rubella( 독일홍역 ) IV is roseola( 장미진, 홍진 ) –Signs ( 볼과 귀의 염증성 붉은 발진이 특징이다.) Fiery red rash on cheeks and ears (slapped cheek appearance) Rash may spread to trunk and extremities Rash fades within several days Leaves lacy pattern of red on skin –No available treatments

Viral Diseases of the Skin Mumps( 이하선염 ) 특징적 증상은 팽창한 타액분비선, 특히 턱의 조직이 커진다. 나선형 RNA 바이러스가 원인이다. –Characteristic unilateral salivary gland enlargement –Obstruction of duct out of gland creates painful swelling –Orchitis( 고환염 ) –Extremely effective vaccine

Viral Diseases of the Skin Smallpox( 천연두 ) –Caused by variola major virus –Scourge of the world –Signs Pink-red spots (macules) Appearance of large fluid-filled vessels Vesicles become deep pustules( 농포 ) Pustules break open and emit infectious pus If person survives, pustules leave pitted scars (pocks) –Extremely lethal –Extremely effective vaccine Developed originally by Jenner in 1798 (first “vaccine”) –Eradicated worldwide Officially 1980 Last case observed 1977 in Somalia –Risk of smallpox as bioterrorism agent Fig. 18.3a Smallpox lesions Courtesy of World Health Organization; Diagnosis of Smallpox Slide Series/CDC

Viral Diseases of the Skin Warts( 사마귀 ) : 사마귀는 작고, 양성 피부 종양이고 일반적으로 바이러스 때문에 생긴다. –Caused by papilloma viruses –Small DNA viruses(20 면체 DNA 바이러스 ) –Many types of warts Cutaneous warts( 피부사마귀 ) Plantar warts( 발바닥사마귀 ) Genital warts –Linked to cervical cancer –Effective vaccine for genital warts

호흡계의 바이러스성 질병 (Viral Diseases of the Respiratory Tract) Influenza( 유행성 감기 ) and parainfluenza( 호흡기 감염병 ) –Influenza viruses A, B, C RNA viruses( 나선형 RNA 바이러스 ) All infect humans All cause “the flu” –Sudden chills –Fatigue –Headache –Pain that is most pronounced in chest, back, and legs –Very high fever (up to 40°C) –Severe cough Hemagluttinin and neuraminidase (HA/H and NA/N) Flu vaccines –Inactivated –Attenuated (FluMist)

Viral Diseases of the Respiratory Tract Influenza and parainfluenza –Influenza viruses A, B, C Antiviral drugs –Amantadine and rimantidine –Oseltamivir (trade name, Tamiflu) and zanamivir (Relenza) Bird flu –New variant –Spreading through wild migratory fowl –No human-to-human transmission –Parainfluenza Different RNA virus Signs similar to those caused by influenza viruses, but much less severe

Viral Diseases of the Respiratory Tract Adenovirus infections( 아데노바이러스 감염 ) –DNA viruses : 정이십면체 바이러스에 속한다. –Large family –Usually result in common cold

Viral Diseases of the Respiratory Tract Rhinovirus infections( 코감기 바이러스 감염 ) –RNA viruses( 정이십면체 RNA 바이러스 ) –Major cause of common cold (beyond adenoviruses) –Over 100 subtypes –Usual signs Headache Dry, scratchy throat Runny nose Variable cough Little to no fever –No vaccines –No antiviral drugs –Infection and signs usually short-lived and tolerable

신경계 바이러스성 질병 ( Viral Diseases of the Nervous System) Rabies( 광견병 ) : 초기증상은 물린부위에 따끔거림, 뜨거움 또는 차가움과 같은 비정상적 감각이 느껴진다. 그런 다음 근육팽창이 커지고 사람은 공격적으로 된다. 그리고 마비가 오고 특히 식도 근육이 마비되고 입에서 타액이 흐른다. –Carried in wild animals –RNA virus –Fatal to all animals, including humans –Transmission from infected animal into skin wound Saliva Urine Blood –Incubation period of days to years

Viral Diseases of the Nervous System Rabies( 광견병 ) –Signs Abnormal sensations at site of bite from infected animal –Tingling –Burning –Increased muscle tension Individual becomes alert and aggressive Paralysis, especially in swallowing muscles Saliva drips from mouth (frothing at the mouth) Hydrophobia Death from respiratory paralysis –Prevention and treatment with efficacious vaccine Fig A TEM of a Rabies virus (x35,000) © Phototake/Alamy Images

Viral Diseases of the Nervous System Polio( 소아마비 ) –RNA virus –Paralytic disease –Acquired from contaminated drinking water –Extremely effective vaccines Salk: inactivated virus Sabin: attenuated virus –Global eradication effort

Viral Diseases of the Nervous System Slow diseases( 지발형 바이러스 ) –Not viruses, but prions (infectious proteins) –Diseases caused by prions Bovine spongiform encephalopathy (BSE 광우병 ) –Also known as “mad cow disease” 광우병 Scrapie( 양이나 염소의 뇌를 침범하는 질병 ) Kuru ( 쿠루병 ) Creutzfeldt-Jakob syndrome Fatal familial hyperinsomnia –Not clearly understood yet Fig A bovine victim of Bovine Spongiform Encephalopathy. ( 소해면상 뇌증 ; 과우병 ) © Sinclair Stammers/SPL/Photo Researchers, Inc.

Viral Diseases of the Nervous System –Signs 고열, 심한두통, 마비, 경련을 이르킨다.) Sudden, very high fever Severe headache Stupor Coma Frequently fatal –Types of encephalitis St. Louis Japanese West Nile La Crosse California Venezuela equine Russian Looping ill Arboviral encephalitis( 아르보바이러스성 뇌염 ) Caused by many different viruses, typically of flavivirus family Transmitted by arthropods ( 절지동물 ; mosquitoes and ticks) Hence arthropod-borne viruses

내장기관의 바이러스성 질환 (Viral Diseases of the Visceral Organs) Yellow fever( 황열병 ) –RNA virus –Transmitted by bite of infected mosquito –Causes liver damage that leads to jaundice ( 황달 ; hence, “yellow”) –Signs : 모기가 혈류를 통하여 바이러스를 주입한다. 잇몸에서 피가 나고 대변에 피가 묻어 나오고 종종 환자들은 정신없이 피를 토한다. Death by rupture of capillaries: internal bleeding High mortality –Vaccine exists for high risk groups –Yellow fever shaped the course of history in the New World Louisiana Purchase Spanish-American War Panama Canal

Viral Diseases of the Visceral Organs Dengue fever( 댕기열 ) –Also called breakbone fever –RNA virus –Transmitted by infected mosquito bite –Signs High fever Severe prostration( 심한피로, 쇠약 ) Sharp pains in muscles and joints –Primary infection usually not fatal –Subsequent infection results in potentially fatal dengue hemorrhagic fever

Viral Diseases of the Visceral Organs Hepatitis A (A 형간염 ) –RNA virus –Signs : 증상은 식욕감퇴, 메스꺼움, 구토, 미열과 심각한 황달. –Transmitted through contaminated water –Concentrated in shellfish –Effective vaccine –Pooled gamma globulin Fig An electron micrograph of the Hepatitis A viruses Courtesy of Betty Partin/CDC

Viral Diseases of the Visceral Organs Hepatitis B –DNA virus –Transmitted by infected blood and/or bodily fluids –Extremely effective vaccine Fig Some methods for the transmission of Hepatitis B

Viral Diseases of the Visceral Organs Viral gastroenteritis ( 바이러스성 위장염 ) –DNA virus (noroviruses) or RNA virus (rotaviruses) –Signs : 유행병과 풍토병 형태로 발생하는 흔한 장 질병. 보통 설사, 메스꺼움, 미열, 경련, 두통 그리고 무기력 등 다양하게 결합되어 발병한다. – 두 번째 원인균은 정이십면체 RNA 바이러스인 Norwalk 바이러스 이다. Fig. 18.9A TEM of a Norwalk virus (x80,000) © Science VU/CDC/Visuals Unlimited

Viral Diseases of the Visceral Organs Viral hemorrhagic fevers ( 바이러스성 출혈열 ) –All caused by RNA viruses –Different diseases caused by different viruses Ebola and Marburg Sin Nombre hantavirus (hantavirus pulmonary syndrome) Dengue Yellow fever –Signs Complete breakdown of capillaries Uncontrollable hemorrhaging, usually ending in death

Viral Diseases of the Visceral Organs HIV infection( 인체 면역 결핍 바이러스 감염 ) and AIDS –RNA virus –Epidemic first recognized in 1981 Called Acquired Immune Deficiency Syndrome (AIDS) Loss of immune control, especially by CMI –Characterized by multiple opportunistic infections Pneumocystis carinii Histoplasmosis Thrush (Candida albicans) Kaposi’s sarcoma CMV retinitis( 망막염 ) Fig The Human Immunodeficiency virus (HIV)

Viral Diseases of the Visceral Organs HIV infection and AIDS –Infected blood and some bodily fluids –High transmission rates Those who practice unprotected intercourse Intravenous drug users who share dirty needles –Prevalence Over 1 million cases in US Over 35 million affected worldwide Highest concentration in sub-Saharan Africa Greatest increase of cases occurring in sub-Saharan Africa –Other manifestations of disease AIDS dementia( 치매 ) complex AIDS wasting syndrome

Viral Diseases of the Visceral Organs HIV infection and AIDS –Detection PCR test ELISA Western blot

Viral Diseases of the Visceral Organs: HIV Replication Cycle Figure 18.11: The replication cycle of the Human Immunodeficiency virus (HIV)

Viral Diseases of the Visceral Organs HIV infection and AIDS –Treatment Nucleoside analogues –AZT –3TC –Abacavir Non-nucleoside reverse transcriptase inhibitors (NNRTIs) –Delavirdine –Nevirapine Protease inhibitors –Ritonavir –Indinivar –Saquinavir Fusion inhibitor –Enfuvirtide Integrase inhibitor –Raltegrevir

Viral Diseases of the Visceral Organs HIV infection and AIDS –Treatment Highly active anti-retroviral therapy (HAART) –Combination therapy of at least three drugs –Consistently manipulated and tailored to patient –Problems with compliance Vaccine does not exist yet