An acute viral infection is characterized by rapid onset of disease, a relatively brief period of

symptoms, and resolution within days. It is usually accompanied by early production of

infectious virions and elimination of infection by the host immune system. Acute viral
infections are typically observed with pathogens such as influenza virus and rhinovirus.
Ebola hemorrhagic fever is an acute viral infection, although the course of disease is
unusually severe.
Often an acute infection may cause little or no clinical symptoms the so-called inapparent
infection. A well-known example is poliovirus infection: over 90% are without symptoms.
During an inapparent infection, sufficient virus replication occurs in the host to induce
antiviral antibodies, but not enough to cause disease. Such infections are important for the
spread of infection, because they are not easily detected. During the height of the polio
epidemic in the US, the quarantine of paralyzed patients had no effect on the spread of the
disease, because 99% of the infected individuals had no symptoms and were leading normal
lives and spreading infection. Inapparent infections probably are important features of
pathogens that are well-adapted to their hosts. They replicate sufficiently to ensure spread to
new hosts, but not enough to damage the host and prevent transmission.
Acute infections begin with an incubation period, during which the genomes replicate and the
host innate responses are initiated. The cytokines produced early in infection lead to classical
symptoms of an acute infection: aches, pains, fever, malaise, and nausea. Some incubation
periods are as short as 1 day (influenza, rhinovirus), indicating that the symptoms are
produced by local viral multiplication near the site of entry. For some infections, incubation
periods can last many days (papilloma, 50-150 days) or even years (AIDS, 1-10 years). In
these infections, the symptoms are likely produced by virus- or immune-induced tissue
damage far from the site of entry.
An example of a classic acute infection is uncomplicated influenza. Virus particles are
inhaled in droplets produced by sneezing or coughing, and begin replicating in ciliated
columnar epithelial cells of the respiratory tract. As new infectious virions are produced, they
spread to neighboring cells. Virus can be isolated from throat swabs or nasal secretions from
day 1 to day 7 after infection. Within 48 hr after infection symptoms appear; these last 3 days
and then subside. The infection is usually cleared by the innate and adaptive responses in 7
days. However, the patient usually feels unwell for several weeks, a consequence of the
damage to the respiratory epithelium, and the cytokines produced during infection.
Acute viral infections are responsible for epidemics of disease involving millions of
individuals each year, such as influenza and measles. When vaccines are not available, acute
infections are difficult to control most are complete by the time the patient feels ill, and the
virus has already spread to another host. This characteristic makes it exceedingly difficult to
control acute infections in large populations and crowded areas (such as colleges, nursing
homes, military camps). The outbreaks of norovirus gastroenteritis this winter a classic
acute infection highlights the problem. Antiviral therapy cannot be used, because it must be
given early in infection to be effective. There is little hope of treating most acute viral
infections with antiviral drugs until rapid diagnostic tests are become available. But the point
is moot there are no antivirals for most common acute viral diseases.
The rapid clearance of acute viral infections is a consequence of robust host defenses. The
same virus may cause a long-term, or persistent infection, in immunocompromised hosts. An

example is norovirus infection, which is self-limiting in immunocompetent hosts, but causes

a chronic infection in immunosuppressed kidney transplant recipients. We will consider the
characteristics of persistent viral infections in another post.
Westhoff, T., Vergoulidou, M., Loddenkemper, C., Schwartz, S., Hofmann, J., Schneider, T.,
Zidek, W., & van der Giet, M. (2008). Chronic norovirus infection in renal transplant
recipientsNephrology Dialysis Transplantation, 24 (3), 1051-1053 DOI: 10.1093/ndt/gfn693