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CNS Viral Infections Richard Johnson, MD Johns Hopkins University

Richard Johnson, MD Johns Hopkins Universityocw.jhsph.edu/courses/.../PDFs/EID_lec14_Johnson.pdf · 2 Richard Johnson, MD Professor of molecular micro-biology and immunology at the

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Page 1: Richard Johnson, MD Johns Hopkins Universityocw.jhsph.edu/courses/.../PDFs/EID_lec14_Johnson.pdf · 2 Richard Johnson, MD Professor of molecular micro-biology and immunology at the

CNS Viral Infections

Richard Johnson, MD Johns Hopkins University

Page 2: Richard Johnson, MD Johns Hopkins Universityocw.jhsph.edu/courses/.../PDFs/EID_lec14_Johnson.pdf · 2 Richard Johnson, MD Professor of molecular micro-biology and immunology at the

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Richard Johnson, MD

Professor of molecular micro-biology and immunology at the Johns Hopkins Bloomberg School of Public HealthEisenhower Professor of Neurology and Neuroscience at the Johns Hopkins University School of MedicineExpert on infectious and immune-mediated disorders of the nervous system, including multiple sclerosis

Page 3: Richard Johnson, MD Johns Hopkins Universityocw.jhsph.edu/courses/.../PDFs/EID_lec14_Johnson.pdf · 2 Richard Johnson, MD Professor of molecular micro-biology and immunology at the

Section A

Meningitis and Encephalitis

Page 4: Richard Johnson, MD Johns Hopkins Universityocw.jhsph.edu/courses/.../PDFs/EID_lec14_Johnson.pdf · 2 Richard Johnson, MD Professor of molecular micro-biology and immunology at the

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CNS Viral Infections

Syndromes of aseptic meningitis, encephalitis and flaccid paralysis (poliomyelitis)Most represent uncommon complications of common systemic infectionsOver 100 etiologic agents (some are not viruses)Spectrum of agents and syndromes overlapMost IMPORTANT: −

Rule out non-viral causes that require specific treatment

−

Do not miss herpes simplex encephalitis, which has highly effective treatment

Page 5: Richard Johnson, MD Johns Hopkins Universityocw.jhsph.edu/courses/.../PDFs/EID_lec14_Johnson.pdf · 2 Richard Johnson, MD Professor of molecular micro-biology and immunology at the

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Viruses

Enteroviruses 40%Mumps 15%Lymphocytic choriomeningitis 5%Other 10%Unknown 30%

Page 6: Richard Johnson, MD Johns Hopkins Universityocw.jhsph.edu/courses/.../PDFs/EID_lec14_Johnson.pdf · 2 Richard Johnson, MD Professor of molecular micro-biology and immunology at the

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Viruses and Severity of Disease

Page 7: Richard Johnson, MD Johns Hopkins Universityocw.jhsph.edu/courses/.../PDFs/EID_lec14_Johnson.pdf · 2 Richard Johnson, MD Professor of molecular micro-biology and immunology at the

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Seasonal Distribution

Page 8: Richard Johnson, MD Johns Hopkins Universityocw.jhsph.edu/courses/.../PDFs/EID_lec14_Johnson.pdf · 2 Richard Johnson, MD Professor of molecular micro-biology and immunology at the

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Mistakes about Poliomyelitis

Olfactory spread—mistake of translational researchFlies as vectorsSwimming pools

Page 9: Richard Johnson, MD Johns Hopkins Universityocw.jhsph.edu/courses/.../PDFs/EID_lec14_Johnson.pdf · 2 Richard Johnson, MD Professor of molecular micro-biology and immunology at the

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Epidemiology of Enteroviruses

Hand to mouth transmissionRole of children and familyCauses of “nonparalytic polio”

Page 10: Richard Johnson, MD Johns Hopkins Universityocw.jhsph.edu/courses/.../PDFs/EID_lec14_Johnson.pdf · 2 Richard Johnson, MD Professor of molecular micro-biology and immunology at the

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Severe and Fatal Encephalitis

Arthropod-borne virusesHerpes simplex viruses

Page 11: Richard Johnson, MD Johns Hopkins Universityocw.jhsph.edu/courses/.../PDFs/EID_lec14_Johnson.pdf · 2 Richard Johnson, MD Professor of molecular micro-biology and immunology at the

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Herpes simplex virus

Primary infection

Herpes Simplex Virus

Page 12: Richard Johnson, MD Johns Hopkins Universityocw.jhsph.edu/courses/.../PDFs/EID_lec14_Johnson.pdf · 2 Richard Johnson, MD Professor of molecular micro-biology and immunology at the

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Herpes simplex virus

Latency

Herpes Simplex Virus

Page 13: Richard Johnson, MD Johns Hopkins Universityocw.jhsph.edu/courses/.../PDFs/EID_lec14_Johnson.pdf · 2 Richard Johnson, MD Professor of molecular micro-biology and immunology at the

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Herpes simplex virus

Reactivated infection

Herpes Simplex Virus

Page 14: Richard Johnson, MD Johns Hopkins Universityocw.jhsph.edu/courses/.../PDFs/EID_lec14_Johnson.pdf · 2 Richard Johnson, MD Professor of molecular micro-biology and immunology at the

Section B

Arthropod-borne Viruses

Page 15: Richard Johnson, MD Johns Hopkins Universityocw.jhsph.edu/courses/.../PDFs/EID_lec14_Johnson.pdf · 2 Richard Johnson, MD Professor of molecular micro-biology and immunology at the

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Arthropod-borne Viruses = Arboviruses

Biological transmission with infectious cycle in arthropodvs.

Mechanical transmission with contaminated extremities or mouthparts

Page 16: Richard Johnson, MD Johns Hopkins Universityocw.jhsph.edu/courses/.../PDFs/EID_lec14_Johnson.pdf · 2 Richard Johnson, MD Professor of molecular micro-biology and immunology at the

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Occurrence of Arthropod-Borne Encephalitis

Page 17: Richard Johnson, MD Johns Hopkins Universityocw.jhsph.edu/courses/.../PDFs/EID_lec14_Johnson.pdf · 2 Richard Johnson, MD Professor of molecular micro-biology and immunology at the

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Colorado Tick Fever Virus

Page 18: Richard Johnson, MD Johns Hopkins Universityocw.jhsph.edu/courses/.../PDFs/EID_lec14_Johnson.pdf · 2 Richard Johnson, MD Professor of molecular micro-biology and immunology at the

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A. aegypti

Source: CDC PHIL

Page 19: Richard Johnson, MD Johns Hopkins Universityocw.jhsph.edu/courses/.../PDFs/EID_lec14_Johnson.pdf · 2 Richard Johnson, MD Professor of molecular micro-biology and immunology at the

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Geographic Distribution of Arbovirus Encephalitis

Page 20: Richard Johnson, MD Johns Hopkins Universityocw.jhsph.edu/courses/.../PDFs/EID_lec14_Johnson.pdf · 2 Richard Johnson, MD Professor of molecular micro-biology and immunology at the

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Eastern Encephalitis Virus

Page 21: Richard Johnson, MD Johns Hopkins Universityocw.jhsph.edu/courses/.../PDFs/EID_lec14_Johnson.pdf · 2 Richard Johnson, MD Professor of molecular micro-biology and immunology at the

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Sentinel Species

Source: CDC

Equine Death from Viral Encephalitis

Page 22: Richard Johnson, MD Johns Hopkins Universityocw.jhsph.edu/courses/.../PDFs/EID_lec14_Johnson.pdf · 2 Richard Johnson, MD Professor of molecular micro-biology and immunology at the

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St. Louis and Western Encephalitis

Page 23: Richard Johnson, MD Johns Hopkins Universityocw.jhsph.edu/courses/.../PDFs/EID_lec14_Johnson.pdf · 2 Richard Johnson, MD Professor of molecular micro-biology and immunology at the

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California Encephalitis

Page 24: Richard Johnson, MD Johns Hopkins Universityocw.jhsph.edu/courses/.../PDFs/EID_lec14_Johnson.pdf · 2 Richard Johnson, MD Professor of molecular micro-biology and immunology at the

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Tree Hole

Photo by Adam Benjamin. Some rights reserved.

http://www.flickr.com/photos/abr/
http://creativecommons.org/licenses/by-nc-nd/2.5/
Page 25: Richard Johnson, MD Johns Hopkins Universityocw.jhsph.edu/courses/.../PDFs/EID_lec14_Johnson.pdf · 2 Richard Johnson, MD Professor of molecular micro-biology and immunology at the

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Man-Made Breeding Places

Photo by bondidwhat. Some rights reserved.

http://www.flickr.com/photos/bondidwhat/
http://creativecommons.org/licenses/by-nc-nd/2.5/
Page 26: Richard Johnson, MD Johns Hopkins Universityocw.jhsph.edu/courses/.../PDFs/EID_lec14_Johnson.pdf · 2 Richard Johnson, MD Professor of molecular micro-biology and immunology at the

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Regions Reporting Japanese Encephalitis

Malaysia

Page 27: Richard Johnson, MD Johns Hopkins Universityocw.jhsph.edu/courses/.../PDFs/EID_lec14_Johnson.pdf · 2 Richard Johnson, MD Professor of molecular micro-biology and immunology at the

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Encephalitis Cases Reported Monthly: Thailand, 1970–83

Page 28: Richard Johnson, MD Johns Hopkins Universityocw.jhsph.edu/courses/.../PDFs/EID_lec14_Johnson.pdf · 2 Richard Johnson, MD Professor of molecular micro-biology and immunology at the

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Japanese Encephalitis Virus

Page 29: Richard Johnson, MD Johns Hopkins Universityocw.jhsph.edu/courses/.../PDFs/EID_lec14_Johnson.pdf · 2 Richard Johnson, MD Professor of molecular micro-biology and immunology at the

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Rice Fields

Photo by petes travels. Some rights reserved.

http://www.flickr.com/photos/petes_travels/
http://creativecommons.org/licenses/by-nc-nd/2.5/
Page 30: Richard Johnson, MD Johns Hopkins Universityocw.jhsph.edu/courses/.../PDFs/EID_lec14_Johnson.pdf · 2 Richard Johnson, MD Professor of molecular micro-biology and immunology at the

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Vaccine Trial

Page 31: Richard Johnson, MD Johns Hopkins Universityocw.jhsph.edu/courses/.../PDFs/EID_lec14_Johnson.pdf · 2 Richard Johnson, MD Professor of molecular micro-biology and immunology at the

Section C

West Nile Virus

Page 32: Richard Johnson, MD Johns Hopkins Universityocw.jhsph.edu/courses/.../PDFs/EID_lec14_Johnson.pdf · 2 Richard Johnson, MD Professor of molecular micro-biology and immunology at the

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West Nile Virus: History

Page 33: Richard Johnson, MD Johns Hopkins Universityocw.jhsph.edu/courses/.../PDFs/EID_lec14_Johnson.pdf · 2 Richard Johnson, MD Professor of molecular micro-biology and immunology at the

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European Distribution of West Nile Virus

Page 34: Richard Johnson, MD Johns Hopkins Universityocw.jhsph.edu/courses/.../PDFs/EID_lec14_Johnson.pdf · 2 Richard Johnson, MD Professor of molecular micro-biology and immunology at the

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West Nile Virus: 1999 New York City Epidemic

8/23−

ID physician called NYC DOH about two patients in Queens with suspected encephalitis

8/27−

Same physician called about two more cases

8/29−

DOH found eight cases in four-by-four-mile area of Queens— 58–87 years old, no common exposure, no illness in household; all spent time outdoors

9/2−

Tentative diagnosis of SLE; mosquito control begun

Before and concurrent—increased NYC bird deaths, particularly crowsBronx Zoo—death of cormorant, flamingos, Asian pheasant; WNV isolatedVirus closely related to Israeli isolate

Page 35: Richard Johnson, MD Johns Hopkins Universityocw.jhsph.edu/courses/.../PDFs/EID_lec14_Johnson.pdf · 2 Richard Johnson, MD Professor of molecular micro-biology and immunology at the

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How Did West Nile Virus Cross The Atlantic?

Man−

Viremic patient (unlikely due to brief viremia and low titer)

−

Intentional (unlikely choice as a weapon)Bird−

Migratory, windblown or hitchhiker

−

ContrabandMosquito−

On airplane

Page 36: Richard Johnson, MD Johns Hopkins Universityocw.jhsph.edu/courses/.../PDFs/EID_lec14_Johnson.pdf · 2 Richard Johnson, MD Professor of molecular micro-biology and immunology at the

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West Nile Virus: 1999 and 2000

1999

2000

Page 37: Richard Johnson, MD Johns Hopkins Universityocw.jhsph.edu/courses/.../PDFs/EID_lec14_Johnson.pdf · 2 Richard Johnson, MD Professor of molecular micro-biology and immunology at the

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West Nile Virus Activity, by State

Page 38: Richard Johnson, MD Johns Hopkins Universityocw.jhsph.edu/courses/.../PDFs/EID_lec14_Johnson.pdf · 2 Richard Johnson, MD Professor of molecular micro-biology and immunology at the

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West Nile Virus 2003

Page 39: Richard Johnson, MD Johns Hopkins Universityocw.jhsph.edu/courses/.../PDFs/EID_lec14_Johnson.pdf · 2 Richard Johnson, MD Professor of molecular micro-biology and immunology at the

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Cumulative 2004 Data as of 3 a.m., Oct. 26, 2004. USGS/CDC.

West Nile Virus 2004

Page 40: Richard Johnson, MD Johns Hopkins Universityocw.jhsph.edu/courses/.../PDFs/EID_lec14_Johnson.pdf · 2 Richard Johnson, MD Professor of molecular micro-biology and immunology at the

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Human cases of West Nile 2005 (November). USGS/CDC.

West Nile Virus 2005


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