Homer A. Boushey MD
 https://www.ucsfhealth.org/homer.boushey Indications and Guidelines for Rifampin Chemoprophylaxis for Contacts of Index Cases of Invasive Haemophilus infuenzae Type b (Hib) Disease Chemoprophylaxis Recommended 4 medications purchase requip 2mg amex. Household with at least 1 contact younger than 4 years of age who is unimmunized or incompletely immunizedb? Household with a child younger than 12 months of age who has not completed the primary Hib series? For preschool and child care center contacts when 2 or more cases of Hib invasive disease have occurred within 60 days (see text) symptoms ruptured spleen purchase discount requip on line. For index patient medicines 604 billion memory miracle purchase requip with amex, if younger than 2 years of age or member of a household with a susceptible contact and treated with a regimen other than cefotaxime or ceftriaxone symptoms in early pregnancy cheap 0.5mg requip with mastercard, chemoprophylaxis usually is provided just before discharge from hospital Chemoprophylaxis Not Recommended. For occupants of households with no children younger than 4 years of age other than the index patient. For occupants of households when all household contacts 12 through 48 months of age have completed their Hib immunization series and when household contacts younger than 12 months of age have completed their primary series of Hib immunizations. For pregnant women a Defned as people residing with the index patient or nonresidents who spent 4 or more hours with the index patient for at least 5 of the 7 days preceding the day of hospital admission of the index case. Data are insuffcient on the risk of secondary transmission to recommend che moprophylaxis for attendees and child care providers when a single case of invasive Hib disease occurs; the decision to provide chemoprophylaxis in this situation is at the discretion of the local health department. Treatment of Hib disease with cefotaxime or ceftriaxone eradicates Hib colonization, eliminating the need for prophylaxis of the index patient. Patients who are treated with ampicillin, meropenem, or another antibiotic regimen and who are younger than 2 years of age should receive rifampin prophylaxis at the end of therapy for invasive infection. Rifampin should be given orally, once a day for 4 days (20 mg/kg; maxi mum dose, 600 mg). The dose for infants younger than 1 month of age is not estab lished; some experts recommend lowering the dose to 10 mg/kg. Two single antigen (monovalent) Hib conjugate vaccine products and 2 combination vaccine products that contain Hib conjugate are available in the United States (see Table 3. Conjugate vaccines vary in composition and immunogenicity, and as a result, recommendations for their use differ. Depending on the vaccine, the recommended primary series consists of 3 doses given at 2, 4, and 6 months of age or 2 doses given at 2 and 4 months of age (see Recommendations for Immunization, p 350, and Table 3. The HepB Hib combination vaccine is licensed for use at 2, 4, and 12 through 15 months of age and should not be given to infants younger than 6 weeks of age. The monovalent Hib conjugate vaccines available in the United States are considered interchangeable for primary and booster immunization. Licensure of a Haemophilus infuenzae type b [Hib] vaccine [Hiberix] and updated recommendations for use of Hib vaccines. Some children with immunologic impairment may beneft from more doses of conjugate vaccine than usually indicated (see Recommendations for Immunization, below). Pain, redness, and swelling at the injection site occur in approximately 25% of recipients, but these symptoms typically are mild and last fewer than 24 hours. All children should be immunized with an Hib conjugate vaccine beginning at approxi mately 2 months of age or as soon as possible thereafter (see Table 3. Other general recommendations are as follows: Immunization can be initiated as early as 6 weeks of age. When sequen tial doses of different vaccine products are given or uncertainty exists about which products previously were administered, 3 doses of a conjugate vaccine are considered suffcient to complete the primary series, regardless of the regimen used. For children who have completed a primary series, an additional dose of conjugate vaccine is recom mended at 12 through 15 months of age and at least 2 months after the last dose. For accelerated immunization in infants younger than 12 months of age, a minimum of a 4 week inter val between doses can be used. Recommendations for children who have had a lapse in the schedule of immunizations are based on limited data. For preterm infants, immunization should be based on chrono logic age and should be initiated at 2 months of age according to recommendations in Table 3. Children who have received a primary series and a booster dose and are undergoing scheduled splenectomy (eg, for Hodgkin disease, spherocytosis, immune thrombocytopenia, or hypersplenism) may beneft from an additional dose of any licensed conjugate vaccine. Whether these children will beneft from additional doses after completion of the primary series of immunizations and the booster dose at 12 months of age or later is unknown. For children 12 through 59 months of age with an underlying condition predispos ing to Hib disease who are not immunized or have received only 1 dose of conjugate vaccine before 12 months of age, 2 doses of any conjugate vaccine, separated by 2 months, are recommended. For children in this age group who received 2 doses before 12 months of age, 1 additional dose of conjugate vaccine is recommended. These children should be immunized according to the age appropriate schedule for unimmunized children and as if they had received no previous Hib vaccine doses (see Table 3. Immunization should be initiated 1 month after onset of disease or as soon as pos sible thereafter. Immunologic evaluation should be performed in children who experience invasive Hib disease despite 2 to 3 doses of vaccine and in children with recurrent invasive disease attributable to type b strains. All cases of H infuenzae invasive disease, including type b, nontype b, and nontypable, should be reported to the Centers for Disease Control and Prevention through the local or state public health department. Respiratory tract symptoms or signs usually do not occur for the frst 3 to 7 days, at which time pulmonary edema and severe hypoxemia appear abruptly after the onset of cough and dyspnea. In severe cases, persistent hypotension caused by myocardial dysfunction is present. Extensive bilateral interstitial and alveolar pulmonary edema and pleural effusions are the result of a diffuse pulmonary capillary leak and appear to be caused by immune response to hantavirus in endothelial cells of the microvasculature. Intubation and assisted ventilation usually are required for only 2 to 4 days, with resolution heralded by onset of diuresis and rapid clinical improvement. The severe myocardial depression is different from that of septic shock; cardiac indices and stroke volume index are low, pulmonary wedge pressure is normal, and systemic vascular resistance is increased. Poor prognostic indicators include persistent hypotension, marked hemoconcentration, a cardiac index of less than 2, and abrupt onset of lactic acidosis with a serum lactate concentration of >4 mmol/L (36 mg/dL). Limited information suggests that clinical manifestations and prognosis are similar in adults and children. Bayou virus, Black Creek Canal virus, Monongahela virus, and New York virus are responsible for sporadic cases in Louisiana, Texas, Florida, New York, and other areas of the eastern United States (Utah, Colorado, Arizona, and New Mexico). Humans acquire infection through direct contact with infected rodents, rodent drop pings, or nests or inhalation of aerosolized virus particles from rodent urine, droppings, or saliva. Rarely, infection may be acquired from rodent bites or contamination of bro ken skin with excreta. Person to person transmission of hantaviruses has not been dem onstrated in patients in the United States but has been reported in Chile and Argentina. At risk activities include handling or trapping rodents; cleaning or entering closed, rarely used rodent infested structures; cleaning feed storage or animal shelter areas; hand plow ing; and living in a home with an increased density of mice in or around the home. Weather conditions resulting in exceptionally heavy rainfall and improved rodent food supplies can result in a large increase in the rodent population. Increased rodent population results in more frequent contact between humans and infected mice and may account for increase human incidence. Most cases occur during spring and summer, and geographic location is determined by the habitat of the rodent carrier. The incubation period may be 1 to 6 weeks after exposure to infected rodents, their saliva, or excreta. Hantavirus specifc immunoglobulin (Ig) M and IgG antibodies are present at the onset of clinical disease. A rapid diagnostic test can facilitate immediate appropriate supportive therapy and early transfer to a ter tiary care facility. Enzyme immunoassay (available through many state health depart ments and the Centers for Disease Control and Prevention) and Western blot are assays that use recombinant antigens and have a high degree of specifcity for detection of IgG and IgM antibody. Diagnosis can be made retrospectively by immunohistochemistry in tissues obtained from autopsy. Supportive management of pulmonary edema, severe hypoxemia, and hypo tension during the frst 24 to 48 hours is critical for recovery. Serial clinical examinations should be used to monitor people assessed to be at high risk of infection after a high risk exposure (see Epidemiology, p 353). Hantavirus infections of humans occur primarily in adults and are associated with domestic, occupational, or leisure activities bringing humans into contact with infected rodents, usually in a rural setting. The best available approach for disease control and prevention is risk reduc tion through environmental hygiene practices that discourage rodents from colonizing the home and work environment and that minimize aerosolization and contact with virus in saliva and excreta. Measures to decrease exposure in the home and workplace include eliminating food sources available to rodents in structures used by humans, limiting pos sible nesting sites, sealing holes and other possible entrances for rodents, and using snap traps? and rodenticides. Before entering areas with potential rodent infestations, doors and windows should be opened to ventilate the enclosure. These Informational handouts should include all pertinent locating devices are worn on the wrist or ankle and information and be copied and carried with care locate the individual through radio frequency medications 2 cheap requip 0.5mg mastercard. If your child will not wear ation about safety and wandering can be found at: a bracelet or necklace symptoms uric acid purchase requip no prescription, consider a temporary tattoo awaare medicine website order requip 0.5 mg with visa. Teach Your Child to Swim the leading cause of death of individuals with autism who wander is drowning my medicine purchase requip paypal. It is critical to teach your child both to swim and to understand the importance of water safety. Remem ber that teaching your child how to swim does not mean your child is safe in water. It is important to remember that you are the Autism Speaks website to help you navigate this not alone. You will also begin (en Espanol 888 772 9050) or email to experience the world in a new way; your priorities familyservices@autismspeaks. Even if you are A section for therapy times, program start and very on top of this, it may take a while to be able to end dates, deadlines access additional evaluations and the services that your child needs. Diagnosis A section for medical documents and any prescriptions Start Now 56 W eek 1 W eek 2 Complete Evaluations Getting Support If your child has not had a complete work up, Find a support group or a parent mentor. If your schedule the remainder of necessary evaluations child is in school, you may also want to fnd out if (see Getting Services below). This can be a long and time consuming process, but may be useful in Start to read material, join online groups and further determining the services that are needed. Keep a Phone Log Try to set aside some time each day to make the phone calls necessary to set up the evaluations and to start the process of getting services. There may be a waiting list for services and evaluations, so make the calls as soon as possible and follow up as needed. Don?t hesitate to put your name on multiple lists so you can get the earliest appoint ment possible. Some of the professionals who pro vide services through Early Intervention or Special Education may take a specifed number of days to complete evaluations or begin services. Note both good and not so good behavior so that, in the future, you will be able to recognize where your child was at that point in time. Talk to other parents who may know of therapists with time available for your child. You don?t have to wait until Play with Your Child every member of the team is in place before begin Play with your child. Talking Plan Some Time Away about these times can help them remember that Plan some time away from your child. Ideas for purposeful play are included at the end of this section of your tool kit. If possible, Review Your Insurance go to a workshop or look for additional information Investigate your insurance coverage to see what, if online. You may need Go to a support group or spend some time with a to create a separate binder to keep track of insurance parent who can help you along your journey. Look into qualifed babysitting child is entitled to services you weren?t aware of or services and respite care. If you already have a great babysitter, invite her or him to spend some time with Do Something for You you and your child so he or she can adjust to the You?ve made it through a month, and it may have new techniques your family is using at home. You will fnd it helps Continue to follow up on services and research any you face the challenges ahead. If you?ve built a team of therapists, you may want to call a meeting to establish procedures and goals and open lines of communication. You?ll also want to continue observing therapy sessions and using what you learn at home. It will also help you plan for the other Your typically developing children will no doubt be members of your household. But maintain ing as much normalcy as possible will help them Continue Learning about reach their potential too. Treatments and Services Make Contact with Friends and Family Consult the Autism Speaks Resource Guide for contacts in your area. Keep Spend Some Time Organizing ing up your social life will help you safeguard against feelings of isolation. Stay involved with your team by continuing to attend as many sessions as possible. Spend time researching online Rally the Troops resources that will keep you up to date. Add useful websites to your favorites, register for e newsletters Encourage your team. Let them know you appre and join list servs where parents and professionals ciate everything they are doing for your child. Plan a Family Outing Continue to Connect with Other Parents Schedule an activity designed to include your Stay active with a support group or, if possible, child with autism and utilize strategies you?ve socialize with other parents of children with autism. Continue to use the strategies you?ve learned from parent training sessions and other resources. Books, seminars, Set aside time to do some research and reading on movies, websites all sorts of sources can help additional treatments and therapies. Make notes and you deepen your understanding of autism and copy useful information to include in your binder. If communication has been diffcult, consider scheduling time with a counselor to keep your relationship healthy. Parents are amaz ing resources and will help provide emotional and practical support. Look into additional groups in your area if you don?t feel like you?ve found the right one for you. Angelman Syndrome is a genetic disorder causing developmental delays and neurological problems, often accompanied by seizures. Children often display hyperactivity, small head size, sleep disorders and movement and balance disorders. Anticonvulsant is a type of drug used to prevent or stop seizures or convulsions; also called antiepileptic. Anxiety Disorder is a disorder that affects an estimated 30% of individuals with autism and includes social phobia, separation anxiety, panic disorder and specifc phobias. An individual suffering from anxiety may experience strong internal sensations of tension such as a racing heart, muscular tensions and stomachache. Skills are broken into small components and taught to child through a system of reinforcement. Asperger Syndrome is a developmental disorder on the Autism spectrum defned by impair ments in communication and social development and by repetitive interests and behaviors, without a signifcant delay in language and cognitive development. Symptoms include chronic problems with inattention, impulsivity and hyperactivity. Audiologist is a professional who diagnoses and treats individuals with hearing loss or balance problems. Auditory Integration Training, or sound therapy, is used to treat children with diffculties in auditory processing or sound sensitivity and involves the individual listening to electronically modifed music through headphones during multiple sessions. Autism Speaks Insurance Link is a tool to help families in the autism community determine whether an individual is entitled to coverage for the treatment of autism under their health insurance plan. Autism Spectrum Disorder and autism are both general terms for a group of complex disor ders of brain development. These disorders are characterized, in varying degrees, by diffcul ties in social interaction, verbal and nonverbal communication and repetitive behaviors. B C Casein is protein found in milk, used in forming the basis of cheese and as a food additive. Celiac Disease is a disease in which there is an immunological reaction within the inner lining of the small intestine to gluten, causing infammation that destroys the lining and reduces the absorption of dietary nutrients. Childhood Disintegrative Disorder is a disorder in which development begins normally in all areas, physical and mental.
Infuenza immunization should begin in September or as soon as the vaccine becomes available and continue into March or for as long as vaccine is available treatment ind order requip 2mg with amex. People with the following conditions are at increased risk of severe compli cations from infuenza medications 2355 generic 1 mg requip free shipping, and it especially is important they receive annual immunization: Immunosuppressive disorders or therapy (see Special Considerations symptoms at 6 weeks pregnant buy requip 2mg overnight delivery, p 448) 1 Centers for Disease Control and Prevention symptoms after embryo transfer order genuine requip on-line. Some children 2 through 4 years of age have a history of wheezing with respiratory tract illnesses but have not been diagnosed with asthma. Consideration should be given to the potential risks and benefts of administering infuenza vaccine to any child with known or suspected immu nodefciency. In children receiving immunosuppressive chemotherapy, infuenza immu nization may result in a less robust response than in immunocompetent children. The optimal time to immunize children with malignant neoplasms who must undergo che motherapy is more than 3 weeks after chemotherapy has been discontinued, when the peripheral granulocyte and lymphocyte counts are greater than 1000/? Children with hemodynamically unstable cardiac disease constitute a large group potentially at high risk of complications of infuenza. Corticosteroids administered for brief periods or every other day seem to have a minimal effect on antibody response to infuenza vaccine. Prolonged administration of high doses of corticosteroids (ie, a dose of prednisone of either 2 mg/kg or greater or a total of 20 mg/day or greater or an equivalent) may impair antibody response. Infuenza immunization can be deferred temporarily during the time of receipt of high dose corti costeroids, provided deferral does not compromise the likelihood of immunization before the start of infuenza season (see Vaccine Administration, p 20). Studies have shown that infants born to women who received infuenza vaccine have better infuenza related health outcomes. However, data suggest that no more than half of pregnant women receive seasonal infu enza vaccine, even though both pregnant women and their infants are at higher risk of complications. In addition, there is limited evidence that infuenza immunization in preg nancy may decrease the risk of preterm birth. Immunization of people who are in close contact with children with high risk conditions or with any child younger than 60 months (5 years) of age is an important means of protection for these children. In addition, immunization of pregnant women may beneft their unborn infants, because transplacentally acquired antibody and human milk may protect infants from infection with infuenza virus. Because 1 voluntary immunization programs have failed to raise coverage rates among health care personnel above an average of 40%, a mandate is necessary to achieve herd immunity, reach Healthy People 2020 objectives, and suffciently protect people who come in con tact with health care personnel. Infuenza causes signifcant morbidity and mortality for both patients and health care personnel. A mandate is expected to cut costs and increase effciency in health care settings. There is growing support for a mandate among medical organizations, and hospitals that already have implemented mandatory infuenza immu nization for health care personnel have had enormous success. The recommended time ranges from the beginning of September to the end of April and longer when vaccine is available and not expired. Infuenza vaccine administration throughout the entire season now is recommended, because the infuenza season extends into March and April. Immunization throughout the season may protect some people against late outbreaks of infuenza. In addition, there may be more than 1 peak of activity during an infuenza season, so later immuni zation still may help protect from a later peak caused by a different strain of infuenza virus that same season. The recommended vaccine dose and schedule for different age groups are given in Tables 3. Annual infuenza immunization is recommended, because immunity can decrease during the year after immunization and because in most years, at least one of the vaccine antigens is changed to match ongoing antigenic changes in circulating strains. Strategies to maximize immunization levels include using reminder/recall systems and programs for standing orders. If alternate venues are used, a system of patient record transfer is benefcial to ensuring maintenance of accurate immunization records. More conservative approaches, such as skin testing or a 2 step graded chal lenge, no longer are recommended. Policy statement: recommendation for mandatory infuenza immunization of all health care personnel. As a precaution, clinicians should determine whether the presumed egg allergy is based on a mild or severe reaction (eg, anaphylaxis). Mild reactions are defned as hives alone; severe reactions involve cardiovascular changes, respiratory tract and/or gastro intestinal tract symptoms, or reactions that required use of epinephrine. Clinicians should consult with an allergist for children with a history of severe reaction. Most vac cine administration to people with egg allergy can happen without the need for referral. Data indicate that approximately 1% of children have immunoglobulin E (IgE) mediated sensitivity to egg, and of those, a very small minority have a severe allergy. Standard immunization practice should include the ability to respond to acute hyper sensitivity reactions. Therefore, infuenza vaccine should be given to people with mild 1 egg allergy with the following preconditions: The decision not to immunize should be thoughtfully balanced against the potential morbidity and mortality associated with infuenza for that individual. Usually occurring 6 to 24 hours after immunization, fever affects approximately 10% to 35% of children younger than 2 years of age. In children 13 years of age or older, local reactions occur in approximately 10% of recipients. A retrospective analysis of a large pediatric trial in Northern California revealed a statistically signifcant increase in asthma events among children 12 1 American Academy of Pediatrics, Committee on Pediatric Emergency Medicine. Preparation for emergencies in the offces of pediatricians and pediatric primary care providers. However, similarly low rates of medically signifcant wheezing and hospitalizations were observed in children 24 through 59 months of age regardless of the infuenza vaccine given. The proposed explanation for the low incidence of transmission is that the vaccine virus is shed for a shorter duration and in a much smaller quantity than are wild type strains. Chemoprophylaxis should not be considered a substitute for immunization in most cases. However, infuenza antiviral drugs are important adjuncts to infuenza immunization for control and prevention of infuenza disease. Because of high rates of resistance of 2009 pandemic infuenza A (H1N1), infuenza A (H3N2), and infuenza B strains to amantadine or rimantadine, oseltamivir, or zanamivir are recommended. However, recommendations for use of these drugs for chemoprophy laxis may vary by location and season, depending on susceptibility patterns. Providers should inform recipients of antiviral chemoprophylaxis that the risk of infuenza is low ered but still remains while taking medication, and susceptibility to infuenza returns when medication is discontinued. Manifestations are similar to those caused by other enteric protozoa (eg, Cryptosporidium and Cyclospora species) and can include abdominal pain, cramping, anorexia, nausea, vomiting, weight loss, and low grade fever. Infection results from ingestion of sporulated oocysts (eg, in contaminated food and water). Humans are the only known host for C belli and shed noninfective oocysts in feces. Under favorable conditions, sporula tion can be completed in 1 to 2 days and perhaps more quickly. Oocysts probably are resistant to most disinfectants and can remain viable for prolonged periods in a cool, moist environment. The incubation period is uncertain but ranges from 7 to 12 days in reported cases. This constraint under scores the utility of repeated stool examinations, sensitive recovery methods (eg, concen tration methods), and detection methods that highlight the organism (eg, oocysts stain bright red with modifed acid fast techniques and autofuoresce when viewed by ultra violet fuorescent microscopy). Pyrimethamine (plus leucovorin, to prevent myelosuppression) is an alternative treatment for people who cannot toler ate trimethoprim sulfamethoxazole. If untreated, approximately 20% of children may develop coronary artery abnormalities, including aneurysms. Approximately 80% of cases of Kawasaki disease occur in children younger than 5 years of age. The illness is characterized by fever and the following clinical features: (1) bilateral bulbar conjunctival injection with limbic sparing and without exudate; (2) erythematous mouth and pharynx, strawberry tongue, and red, cracked lips; (3) a polymorphous, generalized, erythema tous rash that can be morbilliform, maculopapular, or scarlatiniform or may resemble erythema multiforme; (4) changes in the peripheral extremities consisting of induration of the hands and feet with erythematous palms and soles, often with later periungual desquamation; and (5) acute, nonsuppurative, usually unilateral, cervical lymphadenopa thy with at least one node 1. For diagnosis of classic Kawasaki disease, patients should have fever for at least 5 days (or fever until the date of treatment if given before the ffth day of illness) and at least 4 of the above 5 features without alternative explanation for the fndings. Irritability, abdominal pain, diarrhea, and vomiting commonly are associated features.
Fusion and attachment proteins are glycosylated by N linked carbohydrate side chains medications for schizophrenia generic 2mg requip amex. In the subfamily Pneumovirinae the attachment protein (G) is heavily glycosylated by O linked as well as N linked carbohydrate side chains treatment xanthelasma purchase requip 2 mg online. Genome organization and replication the genome organization is illustrated in Figure 2 for viruses representing the seven genera of the family symptoms ketosis purchase requip without prescription. After attachment to cell receptors symptoms 8 weeks purchase requip 0.5mg without a prescription, virus entry is achieved by fusion of the virus envelope with the cell surface membrane. Virus replication occurs in the cell cyto plasm and is thought to be independent of host nuclear functions. Transcription is guided by short (10?13 nt) conserved transcription start and termination/ polyadenylation signals fanking each transcriptional element. Intergenic regions are either highly conserved in sequence and length (Respirovirus, Henipavirus, Morbillivirus and all of the newly discovered viruses in the unassigned group; Figure 2 and list on p. Nucleocapsids are enveloped by budding at the cell surface plasma membrane at sites containing virus envelope proteins. Members of the subfamily Paramyxovirinae contain 6?7 transcriptional ele ments that encode 7?11 proteins. Other truncated, or chimeric, proteins (called I, W, or D, depending on the virus) can be produced by shifting into the third reading frame. Antibodies to N and, variably, to other viral proteins also are induced by infection. Various proteins of members of the subfamily Paramyxovirinae have been reported to be broken into specifc peptides that, when complexed to major histocompatibility glycoproteins, serve as recognition molecules for cytotoxic or helper T cells. Biological properties Paramyxoviruses have been conclusively identifed only in vertebrates and mostly in mammals and birds, although they have recently also been detected in reptiles and fsh. Most viruses have a nar row host range in nature, but in cultured cells they display a broad host range. Infection of cultured cells generally is lytic, but temperate or persistent infections in vitro are common. Other features of infection include the formation of inclusion bodies and syncytia. Viruses were selected from the seven established genera as well as a group of unassigned viruses, which signifcantly increased the genetic diversity of the fam ily. The lengths of the boxes are approximately to scale although the intervening or preceding sequences are not to scale. There are conserved trinucleotides that serve as intergenic sequences for the respiroviruses, henipaviruses and morbilliviruses. For rubulaviruses, avulaviruses, pneumoviruses and meta pneumoviruses, the intergenic sequences are variable (1?190 nt long). In the group of unassigned new viruses, all of them have a 3 nt intergenic region similar to those observed in the genera Morbillivirus, Respirovirus and Henipavirus. However, the genome sizes of these new viruses vary signifcantly from 15,378 nt to 19,212 nt. Nucleocapsids associate with viral membrane proteins at the plasma membrane and are enveloped by budding. Paramyxovirus infection typically begins in the respiratory tract and may remain at that site. In general, paramyxovirus infections are limited by, and eliminated by, host immunity. However, virus sometimes can be shed for periods of weeks or months in nor mal and, especially, immunocompromised individuals. The recurrence of neurological manifestations has also been noted in NiV patients more than 4 years after recovery from acute encephalitis. Amino acid sequence relatedness is much greater within the subfamily than between subfamilies. The division of this subfamily into the fve genera is consistent with phylogenetic grouping based on amino acid sequence relation ships. The genome length must be a multiple of 6 nt for effcient genome replication (the rule of six?), perhaps refecting the precise packing of nt by a nucleocapsid pro tein subunit. One genus (Morbillivirus) lacks a neuraminidase activity and some viruses (canine distemper virus, phocine distemper virus and rinderperst virus) lack a detectable hemagglutinating activity. Viruses from the genus Henipavirus lack both neuraminidase and hemag glutinating activities. The rubulavirus P protein is substantially smaller than that of the respiroviruses or morbilliviruses. They share greater sequence relatedness within the genus than with members of other genera but are closely related to the rubulaviruses. The avulavirus P protein is substantially smaller than that of the respiroviruses or morbilliviruses. The many other avian paramyxoviruses are antigenically related and are not well studied. Also, each serotype has a distinct pattern of electrophoretically separated polypeptides. List of other related viruses which may be members of the genus Avulavirus but have not been approved as species None reported. Amino acid sequence relatedness within the genus ranges from low to high, depending on the protein, and always is higher than in comparisons with other genera. They share low to high sequence relatedness among the various proteins (see above). With the exception of Simian virus 10, each species represents a signifcant pathogen in its respective host. List of other related viruses which may be members of the genus Respirovirus but have not been approved as species None reported. They share greater sequence relatedness within the genus than with members of other genera. Each species has been associated with limited outbreaks with high mortality in domesticated animals and humans. The identifcation of the highly conserved ephrin B2 as the main functional receptor for both HeV and NiV and the widespread occurrence of the molecule in vertebrates, particularly in arterial, but not venous, endothelial cells, in the smooth muscle of the tunica media and in neurons, provide an explanation for the wide host range of henipaviruses and the systemic nature of the infections they cause. Species demarcation criteria in the genus HeV and NiV are antigenically distinct and are distinct by genome sequence and geographic loca tion. HeV has been detected exclusively in Australian fying foxes whereas NiV or anti NiV anti bodies have been detected in fruit bats from Indonesia, Malaysia, Thailand, Cambodia, India and Bangladesh, to Madagascar and West Africa. List of other related viruses which may be members of the genus Henipavirus but have not been approved as species None reported. Member viruses exhibit greater amino acid sequence relatedness within the genus than with other genera. They have an identical gene order, number of transcriptional elements and size of intergenic sequences with members of the genus Respirovirus (Figure 2). All morbilliviruses produce both intracytoplasmic and intranuclear inclusion bodies containing nucleocapsid like structures. Narrow host range distribution of receptor defnes susceptibility of organisms to infection. Species demarcation criteria in the genus the morbilliviruses are distinguished by host range, genetic (sequence) and antigenic differences. Cross neutralization and cross protection also occurs between members of DaneshGroup. List of other related viruses which may be members of the genus Morbillivirus but have not been approved as species None reported. For example, both viruses grow effciently in cultured human or bovine cells, although some specifcity may be evident. The two viruses share consider able sequence and antigenic relatedness, but also can clearly be distinguished on either basis. Antiserum against one virus will cross neutralize the other with a 6 to 64 fold reduction in effciency. Purchase requip 0.25mg with amex. Bacteria 1A: Gram-positive Cocci- Staphylococcus Streptococcus (Diseases).
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