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121 Cards in this Set
- Front
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Capsid
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Protein coat surrounding viral genome consisting of repeating protein aggregates (capsomeres)
RESISTANT to environmental factors such as drying, detergent, etc = very stable |
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Envelope
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Lipid envelope typically derived from host cellular membranes during exit (Exception = Pox where envelope forms in cytoplasm PRIOR to exit)
SUSCEPTIBLE to inactivation by environmental factors (heat, acid, drying, detergents, organic solvents) (Exception = Hepatitis B which has a stable envelope) Require moisture for survival outside of the host |
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Asymptomatic Viremia, spreads to bone marrow and spleen
Secondary Viremia with high fever, headache, malaise, backache and toxic appearance (flu-like symptoms) Virus in leukocytes localizes to blood vessels in dermis Rash (macular lesions) on buccal/pharyngeal mucosa, spreads to face and extremities, then spreads to trunk (centripetal) Vomiting and diarrhea follows Lesions progress to vesicles and pustules, then scabs. Mucosal lesions ulcerate and release virus into secretions |
Orthopoxvirus Variola aka Smallpox
Dx via PCR at CDC |
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Indigenous in ***WEST CENTRAL AFRICA***
Fever w/ a localized infection/rash or can be disseminated ***Extremely Enlarged Lymph Nodes*** Acquired from ***Prairie Dogs*** |
Orthopoxvirus Monkeypox
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Pustular lesions at site of inoculation (usually hands, arms, face) with spontaneous resolution
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Orthopoxvirus Cowpox
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Reddish, weeping, nodular lesions (usually on fingers) with spontaneous resolution
Commonly from sheep, goats and reindeer |
Parapoxvirus Orf
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Reddish, weeping, nodular lesions (usually on fingers) with spontaneous resolution
OCCUPATIONAL DISEASE of those that handle CATTLE (farmers, butchers, vets) |
Parapoxvirus Milker's Nodule
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Small, nodular, painless, ***PEARLY LESIONS*** with a central pit (umbilicated) containing a ***CASEOUS PLUG*** (can be squeezed out).
Occurs at site of inoculation (arms, legs, face, trunk, genitals) No systemic symptoms Spontaneous Resolution |
Molluscipoxvirus Disease caused by Molluscum contagiosum
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Impairment of Speech, Vision, Coordination, Mentation, followed by Paralysis of Arms and Legs, then Death.
Causes Progressive Multifocal Leukoencephalopathy (PML) = lesions in brain white matter --> a fatal CNS demyelinating disease caused by viral damage to Oligodendroglial Cells Found in Urinary Tracts of Immunosuppressed Adults |
Polyomavirus JC Virus
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Associated with Ureteral Stenosis (Renal Transplants) and Hemorrhagic Cystitis (Bone Marrow Transplants)
Found in Urinary Tracts of Immunocompromised Patients |
Polyomavirus BK Virus
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HPV Types:
1) HPV 1-5, 8, 10, 17 2) HPV 6, 11 3) HPV 16, 18, 31, 45 |
1) HPV 1-5, 8, 10, 17 = Common, Planter, or Flat Warts on Skin
2) HPV 6, 11 = Laryngeal Papillomas, Anogenital Warts (Condylomata Acuminata), Benign Cervical 3) HPV 16, 18, 31, 45 = Malignant Cervical (Squamous Cell Carcinomas) |
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HPV Vaccines:
1) Quadravalent (Gardasil) = 2) Bivalent (Cervarix) = |
1) Quadravalent (Gardasil) = HPV 6, 11, 16, 18 (anogenital and cervical)
2) Bivalent (Cervarix) = HPV 16, 18 (cervical) |
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How are Pox Viruses an Exception to the characteristics governing all other Enveloped DS DNA Viruses?
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In Pox Viruses:
1) Replication takes place in CYTOPLASM (NOT in Nucleus) 2) Envelope is formed in Cytoplasm PRIOR to exiting the cell (NOT during the exit) |
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Herpes Subfamily Alphaherpesviridae
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1,2,3
1) HSV-1 (above waste) 2) HSV-2 (below waste) 3) HHV-3, Varicella-Zoster Virus (VZV) Site of Latency = Neurons |
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Herpes Subfamily Betaherpesviridae
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5,6,7
1) HHV-5, Cytomegalovirus (CMV) 2) HHV-6, Roseola 3) HHV-7 Site of Latency = T Cells (6/7) or Monocytes/Lymphocytes (5) |
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Herpes Subfamily Gammaherpesviridae (Lymphocryptovirus)
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4,8
1) HHV-4, Epstein-Barr Virus (EBV) 2) HHV-8, Kaposi's Sarcoma Associated Site of Latency = B Cell |
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Vesicle formation on an erythematous base (***DEW ON A ROSE PETAL***)
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Herpes Simplex Virus 1 or 2
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Primary infection often asymptomatic or can cause Fever, then sore throat and mouth, submandibular lymphadenopathy
Recurrent infection characterized by Prodrome (pain, burning, itching) followed by erythematous papules that progress to tiny, thin walled vesicles that become pustular and ulcerate, then crust over. Resolves in about a week. Cold Sores, Fever Blisters |
Orolabial Herpes caused by HSV-1
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Most common in children 6-months to 5-years old. Less severe in adults.
Abrupt onset of high fever, irritability, ***GINGIVITIS (remarkably swollen, friable, erythematous GUMS)***, Painful Vesicular Lesions on Buccal Mucosa, Tongue, Gums, Throat 1-2 Week Duration Transmitted via Saliva |
Primary (Acute) Gingivostomatitis caused by HSV-1
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***STOMATITIS (inflammation of mucous membranes) OF MOUTH AND THROAT***, fever, headache, sore throat.
Vesicles rupture into ulcerative lesions with exudates on tonsils and pharynx. More common in adults. |
Herpetic Pharyngotonsillitis caused by HSV-1
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RED EYE, pain, tearing, sensitivity to light, decreased vision, rash on eyelid.
Primary infection consists of Vesicles on lids, follicular conjunctivitis, ***PREAURICULAR ADENOPATHY***. Recurrent infection involves any and/or all layer of ***CORNEA***. Ocular lesions can lead to permanent corneal scarring. Usually limited to ***ONE EYE*** Transmitted via touching site of infection, then rubbing eye or placing contact lens in eye. |
Herpetic Keratitis (Ocular Herpes) caused by HSV-1
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Fever, headache, mental status abnormalities, seizures, vomiting
Most common in Older Children (3 months) and Adults Encephalitis limited to ONE hemisphere of brain. |
HSV-1 Encephalitis
Usually due to previous infection (Orolabial), others due to primary infection Virus transmitted DIRECTLY to brain via Trigeminal or Olfactory Nerve from peripheral site of infection/latency |
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Infection of FINGERS due to Occupational Exposure (***DENTISTS***) or ***NAIL BITERS***
Virus infects breaks in skin and forms vesicles on fingers. Vesicles rupture and crust over. |
Herpetic Whitlow caused by HSV-1 (HSV-2 seen in sexually active adults)
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Vesicle formations that crust over due to viral infection of arms, legs torso.
Common in WRESTLERS/ATHLETES |
Herpes Gladiatorum caused by HSV-1
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Fever, headache, malaise, myalgia, with local pain, itching, dysuria, VAGINAL OR URETHRAL DISCHARGE, tender lymphadenopathy.
Infected tissue can be external genital area, or internal. Papules form, progress to vesicles and pustules, lymphadenopathy and tenderness |
Perianal/Genital Herpes caused by HSV-2
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Newborn with disseminated vesicular lesions with internal organ involvement, typically acquired during delivery from an infected mother
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Neonatal Herpes caused by HSV-2
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Vesicles that rupture and crust over on skin, often on buttocks, thighs, groin and occasionally fingers
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HHV-2 Skin Infections
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What is the most definitive Dx for HSV-1 and/or HSV-2?
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Vesicular Fluid Cell Culture (takes approx 48 hours)
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Tzanck Smear
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Detects Herpes Viruses
However, does NOT distinguish between them! |
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Fever and itchy maculopapular rash which develops after approx 2-3 week incubation period. ***Successive "CROPS" of Lesions***, thus vesicles present in differing stages from Vesicles to Crusted Over. Lesions are generalized, and MORE PREVALENT ON TRUNK than extremities (centrifugal spread)
Generally occurs in children before the age of 10 |
Chickenpox due to acute/primary form of Varicella-Zoster Virus (VZV) = Varicella = HHV-3
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Prodrome consisting of ***SEVERE PAIN*** in an affected Dermatome, typically on ONE SIDE of Trunk, but may be on face/soles of feet/palms.
Vesicles are close together on a reddened base (***DEW DROPS ON PETALS***) Can lead to chronic pain in older individuals (post-herpetic neuralgia) |
Shingles due to recurrent form arising from latency (from chickenpox) of Varicella-Zoster Virus (VZV) = Herpes Zoster = HHV-3
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Pain, redness, and vesicles at site of infection which progress to encephalopathy.
Often fatal or lead to serious brain damage. Transmitted from ***ASIAN MONKEYS*** |
Herpesvirus simiae (B Virus)
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Asymptomatic infection common, may have mild flu-like symptoms.
Shed in bodily secretions. |
Cytomegalovirus (CMV), HHV-5
Most common presentation |
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Virus causing polyneuritis and myelitis
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Cytomegalovirus (CMV), HHV-5 effecting the Nervous System
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Clinical illness resembling Infectious Mononucleosis, but less severe and NO heterophile antibody
Mononucleosis Syndrome Post-Transfusion Syndrome |
Cytomegalovirus (CMV), HHV-5 effecting the Lymphoid System
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10% of infected newborns show MICROCEPHALY, Intracerebral CALCIFICATION, Hepatosplenomegaly, Rash
Unilateral or bilateral Hearing Loss and/or mental retardation common |
Congenital Infection with Cytomegalovirus (CMV), HHV-5
Most prevalent VIRAL cause of congenital disease |
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Healthy neonates with no clinically evident disease. However, they secrete virus.
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Perinatal Infection with Cytomegalovirus (CMV), HHV-5
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Common cause of Kidney Transplant Rejection
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Cytomegalovirus (CMV) HHV-5 Infection in transplant that is REACTIVATED
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Fever, lymphocytosis in RES, pharyngitis, enlarged tonsils, fatigue (long lasting, maybe months), nausea (w/o vomiting), anorexia
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Symptomatic Mononucleosis (10%) caused by Epstein-Barr Virus (EBV), HHV-4
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Which virus immortalizes B Cells and is associated with atypical lymphocytes called Downey Cells?
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Epstein-Barr Virus (EBV), HHV-4
Spread via Saliva - Kissing, Sharing Toothbrush, Cups/Glasses |
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B-cell lymphoma of JAW and FACE, occurs in children in Malarial Regions of Africa
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African Burkitt's Lymphoma (Endemic Lymphoma) caused by Epstein-Barr Virus (EBV), HHV-4
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Lymphoproliferative disease common in ASIA which is associated with SALTED FISH and NITROSAMINES IN FOOD
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Nasopharyngeal Carcinoma caused by Epstein-Barr Virus (EBV), HHV-4
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Lymphoproliferative disease characterized by Lesions in MOUTH of AIDS patients
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Oral Hairy Leukoplakia (productive EBV infection) caused by Epstein-Barr Virus, HHV-4
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Virus associated with pathogenesis of Kaposi's Sarcoma
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HHV-8 aka Kaposi's Sarcoma-Associated Herpesvirus (KSHV)
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Parotitis: Prodrome followed by enlargement of one or both PAROTID GLANDS (most begin as unilateral and progress to bilateral): edema over parotid, pain with pressure, angle of mandible obscured.
Fever (persists about 1 week), Headache, Malaise, Anorexia, Abdominal pain, ACIDIC FOOD PAINFUL, Earache or facial pain, Swelling of salivary glands, esp. parotid(s), persist 7-10 days. Intraoral examination may reveal erythema and edema of ***STENSENS DUCT*** Viruria (virus in urine) is common Peak in Late Winter and Spring, Most common in School Aged Children (5-15) Lemon Juice causes increased salivation and pain! |
Mumps Virus (Paramyxoviridae Rubulavirus)
Can lead to: 1) Meningoencephalitis 2) Orchitis and/or Epididymitis 3) Deafness 4) Facial Nerve Neuritis 5) Oophoritis (rare) 6) Pancreatitis (rare) |
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Mumps Differential Diagnosis:
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1) Parotitis (from other viral or bacterial sources)
2) Diphtherie (bull neck) 3) Dental Abscess 4) Lymphadenopathy |
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Fever
The 3 “C’s”: 1) Cough 2) Coryza (Head Cold) 3) Conjunctivitis Enanthem: 1-3 days later, Koplik spots (pinpoint, gray-white spots with surrounding erythema) on mucous membranes Exanthem: 14 days after exposure. Erythematous blanching maculopapular eruption that appears 1st on the hairline and face, then spreads to the palms and soles (centrifugal) Desquamation, Lymphadenopathy, Hepatomegaly, Appendicitis due to generalized involvement of lymphoid tissue Peak in Late Winter and Spring |
Measles Virus (Paramyxoviridae Morbillivirus) AKA Rubeola AKA 5-Day Measles AKA Hard Measles
Can lead to: 1) Otitis Media 2) Pneumonia 3) Bacterial Superinfections 4) Encephalitis 5) SSPE (Subacute Sclerosing Panencephalitis) - a rare progressive neurologic disease beginning 2-10 years after infection 6) Pregnancy Complications (miscarriage, premature birth, low birth-weight) 7) Blindness (leading cause in African Children) 8) Death among children worldwide |
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How do the envelopes of Mumps Virus (Paramyxoviridae Rubulavirus) and Measles Virus (Paramyxoviridae Morbillivirus) differ???
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Both have Hemagglutinin and Fusion Protein
Only Mumps has Neuraminidase! |
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Measles Differential Diagnosis:
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1) Drug Induced Exanthem
2)Thrush 3) Secondary Syphilis 4) Rocky Mountain Spotted Fever 5) Acrodynia caused by Mercury |
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Prodrome: Listless & Irritable. Rapid onset of high fever, Children may appear toxic, Diarrhea and cough are common, Few abnormal findings on clinical exam (FWLS)
Coincident with resolution of fever is onset of exanthem: discrete irregular macules, rose-pink in color, first on neck and trunk, spreading to face and extremities (centrifugal). Rash persists from 2 to 48 hours then resolves. Most common in late fall and early spring, most common in infants and children (below 4) |
Roseola Virus (Herpesviridae Roseolovirus) AKA HHV-6 AKA Roseola infantum AKA Exanthem Subitum AKA Sixth Disease
Can lead to: 1) Febrile Seizures 2) Neurotropic sequelae |
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STAR Complex
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Sore Throat - Arthritis - Rash, all presenting together
Can be caused by: 1) Parvovirus B19 ***** 2) Rubella ***** 3) Hep B 4) Adenovirus 5) Echovirus 6) Coxsacieviruses 7) Epstein-Barr Virus |
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Year round, but Most common in ***LATE WINTER & SPRING***
4-12 day incubation period, subsequent viremia with spreading to bone marrow and elsewhere followed by biphasic disease: Phase 1: Febrile infectious stage = Initial mild illness with fever, malaise, headache, myalgia, sore throat, sometimes itching. May be accompanied by lymphadenopathy, splenomegaly. Mild decrease in WBC and RBC (leukopenia, anemia). Arthralgias/arthritis may develop (particularly SYMMETRICAL POLYARTHRITIS IN FEMALE ADULTS). Phase 2: Immune Mediated Symptomatic Stage = Manifestations of skin including ***SLAPPED CHEEK*** Syndrome (bright red, confluent, indurate rash on face) and/or ***GLOVES & SOCKS*** Syndrome (papular-purpuric erythema spreads to proximal extremities (acral distribution), fades to lacy pink-red exanthem. Palms and soles usually SPARED. May have enathem. Rash resolves in 5-7 days. IgG on rise when rash appears! |
Fifth Disease aka Parvovirus B19 aka Erythema Infectiosum (Family Parvoviridae)
Complications: 1) Fetus: Hydrops Fetalis and Death 2) Patients with Hemoglobinopathy: Anemia and Aplastic Crisis 3) Immunocompromised Patients: Persistent Infection with Persistent Anemia 4) Implicated in Etiology of KAWASAKI Disease |
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History:
1st Disease- 2nd Disease- 3rd Disease- 4th Disease- 5th Disease- 6th Disease– |
History:
1st Disease- Rubella 2nd Disease- Measles 3rd Disease- Scarlett Fever 4th Disease- Filatov-Dukes Disease (Atypical Scarlet Fever) 5th Disease- Parvovirus B19 6th Disease– Roseola (HHV6) |
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Peak incidence in ***LATE WINTER & EARLY SPRING***
More severe in adolescents and adults (complications include arthralgia, arthritis and thrombocytopenic purpura) Major concern is damage to fetus in pregnant woman/congenital infection. Symptoms include low grade fever, chills, headache, sore throat, ***EYE PAIN ON LATERAL & UPWARD MOVEMENT***, conjunctivitis, general body aches, anorexia, nausea, ***TENDER LYMPHADENOPATHY*** (especially posterior auricular and suboccipital lymph nodes)***, ***FORCHHEIMER SPOTS*** (pinpoint or larger petechiae usually occurring on Soft Palate) Exanthem: a discrete pinkish-red fine maculopapular eruption, which like measles, typically begins on the face and neck, spreading CENTRIFUGALLY to trunk and extremities in 24 hours. On second day, rash begins to fade centrifugally, beginning on the face. Resolved by end of ***DAY 3***! ***TERATOGENIC EFFECTS*** |
Rubella (Little Red) aka German Measles aka 3-Day Measles (Togaviridae Rubivirus)
Complications: 1) Arthralgia/Arthritis - more common in WOMEN 2) Meningoencephalitis (rare) 3) Congenital Rubella Syndrome |
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Infection transplacentally during maternal viremic phase
***SENSORINEURAL HEARING LOSS*** is most common symptom Other Symptoms: Ocular Abnormalitis, Cardiac Defects, Liver and Spleen Enlargement, Growth Retardation ***BLUEBERRY MUFFIN BABY*** |
Congenital Rubella Syndrome
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Differential Dx of Fifth Disease:
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1) Popsickle Panniculitis
2) Cutis Marmorata |
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Antigenic Drift vs Antigenic Shift
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Antigenic Drift = MINOR changes in Neuraminisase and/or hemagglutinin (changes strain but NOT subtype) = Influenza A,B,C
Antigenic Shift = MAJOR changes in neuraminidase and/or hemagglutinin (changes subtype) due to reassortment of segmented genome = Influenza A ONLY |
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Common epidemics in ***MIDWINTER***
***PLEOMORPHIC SHAPE*** (tubular or spherical), segmented (8) genome Fever, chills, nonproductive cough, headache, sore throat, malaise, myalgia, nasal congestion/rhinitis, dizziness, conjunctivitis, cervical adenopathy, pulmonary findings (rales, rhonchi, wheezing) In children, they can also have high fever, GI tract symptoms (abdominal pain/vomiting), otitis media, frequent ***CROUP*** (sounds like a barking seal) Complications include: 1) Viral pneumonia (primary and secondary) 2) Bacterial pneumonia (secondary) 3) Myositis (inflammation of muscle tissue) 4) Cardiac Involvement 5) Neurologic: -***GUILLAIN-BARRE'*** Syndrome -Encephalopathy -Encephalitis -***REYE SYNDROME*** (avoid treating with Aspirin) |
Influenza Virus Infection
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Non-segmented genome, enveloped with 3 glycoprotein spike: Neuraminidase, Hemagglutinin, and FUSION PROTEIN
NO Antigenic Shifts NOR Drifts Typically causes Upper Respiratory illness such as pharyngitis, acute otitis media, and "common cold" symptoms Can also cause lower respiratory tract illnesses |
Parainfluenza Virus Infection (Four Serotypes: 1-4 (4A and 4B))
1 and 3 more severe than 2 |
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Non-segmented, enveloped virus with GLYCOPROTEIN SPIKES: G Glycoprotein (attachment) and F Glycoprotein (fusion)
Common midwinter to early spring with outbreaks in temperate climates Neonates and Premature Infants: Upper respiratory symptoms may be minimal, poor feeding, lethargy, irritability, and apnea. Infants and Young Children: 1)Upper respiratory symptoms 2)Bronchiolitis and pneumonia Older Children and Adults: 1) Upper Respiratory Symptoms 2) Exacerbation of Asthma Conjunctivitis may occur. Fever usually minimal. Otitis media is common in infancy . Pharyngitis. Rash RARELY seen |
Respiratory Syncytial Virus (RSV)
Two Subtypes: Type A and Type B |
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Spring to Early Fall in Temperate Climates ("Summer Cold")
Nonenveloped, ***ACID LABILE, GROWS AT 33 DEGREES CELCIUS*** Typical "Common Cold" Symptoms Young infants: febrile illness associated with upper respiratory symptoms Children and adults: Afebrile upper respiratory illness (coryza, cough, and nasal congestion) Complications or Sequela: 1) Exacerbation of Asthma 2) Purulent otitis media or sinusitus |
Rhinovirus
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Envelope with distinct spikes (peplomers) for structural stability (withstand GI tract conditions)
Three major antigens: 1 Nucleocapsid 2 Envelope Proteins Upper and lower respiratory disease: 1) Common cold, sore throat and fever 2) Pneumonia in young infants 3) Precipitate an asthma attack Gastrointestinal: 1) Watery, non-bloody diarrhea in young infants 2) Possible association with Necrotizing Enterocolitis (NEC) in infants ***SARS*** - Severe Acute Respiratory Syndrome: Atypical pneumonia characterized by high fever, chills, rigors, headache, dizziness, diarrhea |
Coronavirus
Two strains cause human disease: 1) 229E 2) OC43 |
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Large naked (non-enveloped) double-stranded DNA virus
Icosohedral symmetry Respiratory Disease - ARD, "Super Cold", Non-Bordetella Whooping Cough Gastrointestinal Disease Genitourinary Disease Central Nervous System Disease Cardiac Disease Disseminated Disease Congenital/Neonatal Disease |
Adenovirus
At least 47 serotypes known to infect humans |
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Virus spreads from blood to spinal cord (anterior horn cells) and motor cortex of brain.
Biphasic - initial minor illness symptoms subside, then 3-4 days later onset of major illness Asymmetric flaccid paralysis, but NO sensory loss! May involve a few muscle groups, multiple, or all. Can spread and have outcome of full recovery, residual paralysis, or death. |
Paralytic Polio (Major Illness associated w/ Poliovirus)
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Most sever form of Polio infection.
Involves oropharynx, vocal cord, and respiratory muscles. Often results in death. "IRON LUNGS" used during 1950's |
Paralytic Polio w/ Bulbar Involvement
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Salk Vaccine
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Inactivated Poliovirus Vaccine (IPV)
Requires booster, 99-100% protection after 3 doses. Used in children and high risk adults. |
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Sabine Vaccine
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Live-Attenuated Oral Poliovirus Vaccine (OPV)
Provides local GI tract immunity and circulating antibodies NOT used for Immunocomprimised NOR in USA due to vaccine-associated paralytic poliomyelitis (VAPP) |
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***FLACCID PARALYSIS***, GENERALIZED myositis, infect skin and mucous membranes causing:
1) ***HERPANGINA*** - Oropharyngeal lesions with fever 2) ***ACUTE HEMORRHAGIC CONJUNCTIVITIS (AHC)*** - Catarrhal inflammation, conjunctival petechiae that coalesce, subconjunctivitis hemorrhages, painful progressive conjunctivitis, swollen eyelids, resolves in approx 1 week 3) ***HAND-FOOT-AND-MOUTH-DISEASE***- sore throat and mouth, low grade fever, macular lesions on buccal mucosa, tongue, hard palate. Lesions turn into vesicles which erode and surrounded by a red erythematous ***HALO***. 75% develop skin lesions. |
Group A Coxsackieviruses Infection
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***SPASTIC PARALYSIS***, FOCAL muscle injury, degeneration of neuronal tissue, causing:
1) Myocarditis 2) Epidemic Pleurodynia (BORNHOLM DISEASE) - Devils Grip, Abrupt onset of fever, sharp spasms of pain in chest and abdominal muscles 3) Aseptic Meningitis - major cause of community acquired meningitis |
Group B Coxsackieviruses
DDX: Echovirus - Very similar presentation! |
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Non-specific febrile illness
Acute Hemorrhagic Conjunctivitis (AHC) - Virus is Primary cause of AHC epidemics Aseptic Meningitis Non-Polio Paralytic Disease (outbreaks in Russia, Eastern Europe, Thailand, Taiwan) |
Enteroviruses 60-71 Illnesses
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Viral vs Bacterial Gastroenteritis
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Viral NOT usually bloody (dysentery)
Viral Gastroenteritis MORE PREVALENT than bacterial |
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Typically a Winter Epidemic
***HUBBED WHEEL APPEARANCE*** on EM 1-3 day incubation period, abrupt onset on ***FEVER*** and vomiting followed by explosive watery, non-bloody diarrhea. Results in MILD DEHYDRATION, ***METABOLIC ACIDOSIS*** = ***SEVERE***, and ELECTROLYTE ABNORMALITIES Duration of illness = 3-9 days. Re-infection occurs throughout life, but most subsequent reinfections are asymptomatic |
Gastroenteritis caused by ROTAVIRUS Infection
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1-2 day incubation period, abrupt onset on ***FEVER*** and vomiting followed by explosive watery, non-bloody diarrhea. Results in mild dehydration, metabolic acidosis, and electrolyte abnormalities. Also, ***FLU-LIKE SYMPTOMS***- fever, headache, anorexia, malaise, myalgia, and abdominal cramping
Duration of illness = 3-7 days (slightly shorter than Rotavirus). Re-infection occurs throughout life, but most subsequent reinfections are asymptomatic |
Calicivirus Infection (very similar to Rotavirus, only shorter duration and additional Flu-Like Symptoms)
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***STAR SHAPED*** w/ 5-6 Points
Gastroenteritis less severe than that caused by Rotavirus, otherwise indistinguishable! |
Astrovirus
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DS DNA Naked Virus w/ 12 Pentons (***ANTENNA-LIKE STRUCTURES***) projecting from vertices.
8-10 day incubation period, followed by symptoms indistinguishable from other enteric viruses (gastroenteritis) EXCEPT Mild ***RESPIRATORY SYMPTOMS*** - presents w/ low grade fever, vomiting and diarrhea. Diarrhea lasts 5-12 days, vomiting 2-3 days. NOT Detected by routine tissue culture techniques |
Enteric Adenovirus: Serotypes 40 and 41
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***SHELLFISH***, due to Polluted Water
PRODROME: Patients may have mild Flu-Like symptoms of Anorexia, Nausea and Vomiting, Fatigue, Malaise, Low-grade Fever (usually < 39.5°C), Myalgia, and Mild Headache. Smokers often lose their taste for tobacco, similar to those presenting with appendicitis. ICTERIC PHASE: ***DARK URINE*** appears first (bilirubinuria). ***PALE STOOL*** soon follows, although this is not universal. Jaundice occurs in most (70-85%) adults with infection. Jaundice is less likely in children and is uncommon in infants. The degree of icterus also increases with age. Abdominal pain occurs in approximately 40% of patients. Itch (pruritus), although less common than jaundice, is generally accompanied by jaundice. Arthralgias and skin rash, although associated, are less frequent than the above symptoms. Rash more often occurs on the lower limbs and may have a vasculitic appearance. High rates in ***ALASKA NATIVES*** and AMERICAN INDIANS*** |
Hepatitis A Virus (HAV)
Fecal-Oral Spread |
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Hepatocellular Carcinoma
***"GROUND GLASS"*** Cytoplasm in Hepatocytes Most common in Asia, Pacific Islands and Middle East Non-Specific Changes: Hepatocellular Necrosis, Portal Inflammation, Lobular Inflammation, Fibrosis and Cirrhosis |
Hepatitis B Virus (HBV)
Parenteral Spread Hepatitis F (HFV) was misnamed, it is most likely HBV. |
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Acute infection is mild and Anicteric (without Jaundice)
Also present with Cryoglobulinemia, Porphiria Cutanea Tarda, Aplasic Anemia 80% are Chronic Carriers, 20% have Cirrhosis (Scarring of Liver) Portal Dense Lymphocytic Infiltrate with Follicle Formation, Lobar Inflammation, Patchy Lobar Stenosis, Kuppfer Cell Hyperplasia, Cholestasis, Fibrosis, Cirrhosis Risk Factors: ***INTRANASAL COCAINE USE***, Injected Drug Use, Received clotting factors made before 1987, received blood/organs before July 1992, ever on Chronic Hemodialysis, Evidence of Liver Disease Progression increased in Alcoholics, people over 40, HIV co-infection, Males, other coinfections. |
Hepatitis C Virus (HCV)
Parenteral Spread |
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Defective Virus, requires coinfection (or superinfection) with Hepatitis B (HBV) for Replication
Worsening of HBV leading to ***FULMINANT*** Cirrhosis - more quickly and more intense/progressive! Common in individuals with frequent illegal IV drug use and promiscuous sexual contact |
Hepatitis D Virus (HDV)
Parenteral Spread |
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1) HBV-HDV Coinfection (infected at SAME time)
2) HBV-HDV Superinfection (infected with one AFTER the other) |
1) HBV-HDV Coinfection (infected at SAME time):
-Severe ACUTE Disease -LOW risk of CHRONIC Infection 2) HBV-HDV Superinfection (infected with one AFTER the other): -Usually develop CHRONIC HDV Infection -High Risk of Severe CHRONIC Liver Disease |
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Enteric outbreaks in Developing Countries including India, Asia, Africa, and Mexico
Exposure to contaminated water (usually fecally contaminated drinking water) Contracted via drinking water (and beverages with ice) of unknown purity, uncooked shellfish, uncooked fruit/vegetables not peeled or prepared by traveler. Clinically similar to Hepatitis A infection, with High Mortality (20%) among ***PREGNANT WOMEN*** and NO chronic cases. |
Hepatitis E Virus (HEV)
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First Retrovirus isolated from a human
Vacuolated "Foamy" Cytopathology |
Human Foamy Virus (Complex)
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Retrovirus which infects ***CHICKENS***
Contains Proto-Oncogenes and causes a Rapid Onset of DIRECT Cellular Transformation (Over-Production of Growth Stimulating ONCOGENIC Product) Important Oncovirus/Oncogene Research Tool |
Rous Sarcoma Virus aka Acute Transforming Virus (Complex)
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Retrovirus which causes a SLOW (up to 30 years of latency) and INDIRECT Cell Transformation.
Produces ***TAX***, a Transcriptional Regulator --> promotes outgrowth of host cell Tropism for CD4 Cells and Neurons (associated with malignancy and neurological disease) Endemic to Japan, the Caribbean, and parts of Central America |
Humane T-Cell Leukemia Viruses (HTLV) aka NON-Acute Transforming Virus (Complex)
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HTLV-1 Infection causing:
Neoplasia of CD4 Cells that is usually Monoclonal. Often Fatal despite treatment. |
Adult Acute T-Cell Lymphocytic Leukemia (ATLL)
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HTLV-1 Infection causing:
Myelopathy (Pathology of Spinal Cord) |
Tropical Spastic Paraparesis (TSP)
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HTLV-1 Infection causing:
Chronic and severe form of Childhood Dermatitis Endemic to ***JAMAICA*** |
Infectious Dermatitis HTLV (IDH)
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What disease(s) has HTLV-2 been associated with?
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Atypical forms of Hairy Cell Leukemia
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Due to cross-species transfers from Chimpanzees in Central Africa
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HIV-1
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Due to viruses infecting Sooty Mangabeys in Western Africa (however, does NOT cause disease in them)
NOT common in Industrialized/Developed Countries |
HIV-2
Compared to HIV-1, HIV-2 has: -Lower risk of transmission -Lower viral load -Slower progression to AIDS |
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Symptoms manifest 2-6 weeks post infection and last 1-2 weeks, including:
Fever, NIGHT SWEATS, Myalgia/Arthralgia, Headache, Diarrhea, Pharyngitis, Lymphadenopathy, Rash |
Acute Phase/Seroconversion of an HIV Infection
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Screening/Confirmation of HIV Infection
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Screening = ELISA (detects Ab in Blood, can give false positives as it does NOT detect recent infection)
Confirmation: Western Blot (detects Ab in Serum) |
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Definition of AIDS
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CD4 <200 OR 14%
Indicator Diseases: 1) PULMONARY TB 2) INVASIVE CERVICAL CANCER 3) RECURRENT PNEUMONIA ADDED Viral Load is NOT part of definition!!! |
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Recurrence of Poliomyelitis symptoms after approximately 30 years of good health.
Fatigue, muscle weakness, muscle pain, respiratory problems, swallowing problems, gait disturbance, ***FLAT-BACK SYNDROME*** (unable to stand erect due to lower back and leg pain) and sleep apnea. Rarely life threatening but decreases quality of life. NOT infectious. |
Post Polio Syndrome
In initial poliomyelitis, growth of affected leg is often affected. Years (approx 30) of compensation "Wears Out" surviving Motor Neurons (which have been innervating WAY MORE muscle cells than normal) |
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Acute vs Chronic Gastroenteritis
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Acute Gastroenteritis = LESS than 2 week duration
Chronic Gastroenteritis = GREATER than 2 week duration |
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Encephalitis common in ***RURAL US, NE to FLORIDA, GREAT LAKES AREA, CENTRAL AND SOUTH AMERICA***
Severe illness with high mortality in children Mainly affects children and adults over 55 Severe neurological sequelae in half that survive Host = ***Birds*** Vector = Culex Mosquitoes |
Togaviridae Alphavirus causing EASTERN EQUINE ENCEPHALITIS (EEE)
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Encephalitis common in ***RURAL WESTERN US***
Affects infants and children. Complete recovery. Host = ***Birds*** Vector = Culex Mosquitoes |
Togaviridae Alphavirus causing WESTERN EQUINE ENCEPHALITIS (WEE)
More frequent but less severe than EEE |
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Encephalitis common in ***CENTRAL AND SOUTH AMERICA***
Mainly infects Horses. Mild systemic disease. Severe encephalitis is rare. Host = Rodent Vector = Culex, Aedes Mosquitoes |
Togaviridae Alphavirus causing VENEZUELAN EQUINE ENCEPHALITIS
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Fever, headache, fatigue, rash, nausea, vomiting, muscle pain, severe joint pain
Fatality Rare "that which bends up" Vector: Aedes Mosquitoes |
Togaviridae Alphavirus causing CHIKUNGUNYA
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Encephalitis common in Texas, Florida and Mississippi
Moderately severe encephalitis Fatality rate = 3-30% High incidence in people >40 Reservoirs = Wild Birds (Sparrows) Vector = Culex Mosquitoes |
Flavivirus causing ST LOUIS ENCEPHALITIS (SLE)
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Sudden onset of mild or high fever, FRONTAL HEADACHE, back pain, myalgias, anorexia, sometimes rash.
Can be Neuroinvasive: Meningitis and/or Encephalitis - 1/150 have Focal Necrotic Neurons and Inflammatory Changes. Can cause Flaccid Paralysis, Seizures, and Optic Neuritis. Member of Japanese Encephalitis serogroup. Reservoirs: Wild Birds Vectors: Culex Mosquitoes Dead End Hosts: Humans and Horses Risk Factors: Older than 50, hypertension, immunosuppression. |
Flavivirus WEST NILE VIRUS (WNV)
Dx via Serology Detection of IgM Antibodies: AT LEAST 4-FOLD OR HIGHER! |
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Mild Systemic Disease
Fever Malaise, Muscle and Joints Pain, RETRO-ORBITAL PAIN, Nausea and Vomiting, Rash on Elbows, Knees and Chest that spreads to extremities. "Scarlatiniform Rash" Vector: Aedes Mosquito |
Flavivirus causing CLASSIC DENGUE
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Small dermal vessel injuries, petechiae, hepatic necrosis and disseminated intravascular coagulation (DIC)
Antibodies against a specific serotype play a pathogenic role. A SECOND attack with a DIFFERENT serotype makes Antibodies UNABLE to neutralize the virus Vector: Aedes Mosquito Reservoir: Monkeys |
Flavivirus causing HEMORRHAGIC DENGUE
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Fever, headache, myalgias and photophobia
Liver - jaundice (yellow skin), coagulation defects Kidney - proteinuria Hemorrhage of stomach mucosa (***BLACK VOMIT***) Mortality 50%; no sequelae in survivors Vector: Aedes Mosquito Reservoir: Monkeys Endemic in Africa and South America 2 Transmission Cycles: Urban and Jungle |
Flavivirus causing YELLOW FEVER
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Common in ***HIKERS or CAMPERS*** in "COLORADO, OREGON, UTAH, MONTANA, WYOMING***
Mild or subclinical disease Resembles Dengue Fever: Fever, chills, myalgia, arthralgia, retro-orbital pain, and lethargy. Children can have a more severe illness. Usually NO rash. When present, must be differentiated from Rocky Mountain Spotted Fever. Vector = ***TICK*** Reservoir = ***SQUIRRELS AND CHIPMUNKS*** |
Reoviridae Coltivirus causing COLORADO TICK FEVER (MOUNTAIN FEVER)
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Common in people living or playing in Woodland Areas.
No matrix protein unlike other (-)RNA viruses Originally found in California. Now found in many other north central states Abrupt syndrome with fever Highest attack rates in 5-18 yr olds Abrupt onset of encephalitis associated with seizures (50%) Lasts 7 days Good prognosis with rare mortality Vector: Aedes Mosquito Reservoir: Squirrel or Chipmunk |
Bunyaviridae causing CALIFORNIA ENCEPHALITIS COMPLEX
Includes LA CROSSE ENCEPHALITIS |
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Can lead to Adult Respiratory Distress Syndrome (ARDS)
Prodrome febrile phase. Damage to the capillaries occur predominantly in the lungs, rather than the kidney. Shock and cardiac complications may lead to death. Reservoir: Deer Mouse |
Bunyaviridae Hantavirus Infection producing a SIN NOMBRE VIRUS (Muerto Canyon, Four Corners, Navajo)
Can also be caused by Hantavirus Bayou Virus (reservoir = Rice Rat) |
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***SUBACUTE CHORIOMENINGITIS*** --> CSF shows many lymphocytes
Incubation period: 10-14 days Non-specific illness with fever, headache, myalgias, vomiting, stiff neck, changes in mental status Illness may persist for 3 months Diagnosis suggested by contact history Reservoir= House Mice, Mus musculus ***SANDY*** Appearance due to Host Cell Ribosomes being seen inside the outer membrane. |
Arenaviridae causing LYMPHOCYTIC CHORIOMENINGITIS (LCM)
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Endemic in West Africa, in particular Nigeria, Sierra Leone and Liberia
Humans get infected through contact with infected ***RAT URINE/FECES*** Human-human transmission can occur Insidious onset of non-specific symptoms such as fever, petechiae, malaise, myalgia and a sore throat Hemorrhagic manifestations, liver and spleen necrosis, shock, coagulopathy Diarrhea, vomiting, exudative pharyngitis and acute deafness Mortality rate is 10-50%; higher in PREGNANT WOMEN No damage to CNS Reservoir: African Bush Rat ***SANDY*** Appearance due to Host Cell Ribosomes being seen inside the outer membrane. |
Arenaviridae causing LASSA VIRUS Hemorrhagic Fever
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HIV-1 Structural or Enzymatic Genes:
1) gag: 2) pol: 3) env: 4) tat: |
HIV-1 Structural or Enzymatic Genes:
1) gag: -Capsid Protein (p24) -Matrix Protein -Nucleic Acid Binding Protein 2) pol: -Reverse Transcriptase (RT) -Integrase -Protease 3) env: -Surface Glycoprotein (gp120) -Transmembrane Glycoprotein (gp41) 4) tat: -Transactivator of Transcription (similar to Tax in HTLV-1) |
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***BULLET SHAPED***
Raccoons (Eastern States), Bats, Skunks (Central and Western States), Foxes (Central and SW States), Coyotes (Texas and SW) CNS involvement causing furious symptoms including hyperactivity, bizarre behavior, anxiety, depression, hallucinations interspersed with periods of calm and lucidity. Can also be paralytic with hydrophobia, pharyngeal spasms, nuchal rigidity, paresis, paralysis Can lead to Coma after hypotension, hypoventilation, secondary infections, cardiac arrest. ***NEGRI BODIES*** found in Neurons |
Rabies infection caused by Rhabdovirus
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Endemic to Africa
Causes severe or fatal ***HEMORRHAGIC FEVER*** May be endemic in BATS and WILD MONKEYS Sudden onset of fever, chills, headache, myalgia. Maculopapular Rash (prominent on Chest, Back and Stomach) Complications after recovery include Orchitis, Recurrent or Prolonged Hepatitis, Transverse Myelitis/Evetis, Inflammation of Testes, Spinal Cord, Parotid Gland |
Filoviridae Marburgvirus Infection
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Viral Hemorrhagic Fever which is MORE SEVERE than Marburgvirus
Endemic to Sub-Saharan Africa (disease/death in humans) and Philippines (disease/death in monkey, NOT humans) Abrupt onset of Severe Headache, Arthralgias and Myalgias, Fever, Sore Throat, Anorexia, Weakness Followed by Diarrhea, Vomiting, Stomach Pain, Conjunctivitis, Dysphagia, Hemorrhaging from GI Tract, Mucus Membranes, Puncture sites, Cutaneous Rash In fatal cases (90%), Obtunded (reduced consciousness, near comatose), Tachypnea (rapid respiration), Normal Body Temp, Hiccups, Shock |
Filoviridae Ebolavirus Infection
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Infects Mammals including Horses, Sheep and Humans. Recently found in Birds/Parrots.
Primarily in Central Europe, but also in North America and Asia Human infections associated with outbreaks in HORSES In animals, subtle loss of learning and memory, fatal immune-mediated meningoencephalitis. Resembles human neuropsychiatric disorders such as: depression, bipolar disorder, schizophrenia, autism. In humans with SCHIZOPHRENIA, AUTISM, or other Neuropsychiatric Diseases: prescence of Viral Abs and/or infected PMNs |
Bornavirus Infection
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Variable presentation:
33% = Initial complaints of Fatigue, Disordered Sleep, and Decreased Appetite 33% = Behavioral or Cognitive Changes 33% = Focal signs such as Vision Loss, Cerebellar Ataxia, Aphasia or Motor Deficits Prominent cognitive decline and myoclonus and death within one year. ***Periodic Sharp Waves on EEG*** Median Age of Death = 68 |
Sporadic CJD (Classic CJD)
Dx Confirmed via detection of PrPsc in Brain Biopsies or Autopsies |
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Caused by ingestion of infected BEEF
Median Age of Death = 28 Prominent psychiatric/behavioral symptoms, painful dyesthesiasis, delayed neurologic signs ***"PULVINAR SIGN" on MRI*** |
Variant CJD
Dx Confirmed via detection of PrPsc in TONSIL Biopsies |
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Infectious Prion Diseases (6)
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Account for less than 1% of Prion Diseases!
Humans: 1) vCJD 2) iCJD (Iatrogenic CJD = CJD resulting from a medical procedure) 3) Kuru Other Mammals (BCS) 4) BSE (Bovine Spongiform Encephalopathy aka MAD COW DISEASE) - Cattle 5) CWD (Chronic Wasting Disease)- Deer and Elk 6) Scrapie - Sheep and Goats |
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Clinical presentation similar to CJD. Difference is the age of onset:
Onset from 20s-40s (CJD onset is usually older than 60s) Duration is around 7 years (4 months for CJD) Autosomal DOMINANT Inheritance with HIGH Penetrance |
Gerstmann-Strausler-Scheinker (GSS) Syndrome
1 of 2 Inherited Prion Diseases |
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Progressive ***INSOMNIA***, ***AUTONOMIC*** dysfunction and dementia.
Neuronal degeneration limited to selected ***THALAMIC NUCLEI***. Average Duration = 13 Months Autosomal DOMINANT Inheritance with HIGH Penetrance |
Fatal Familial Insomnia (FFI)
1 of 2 Inherited Prion Diseases |
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LATEX AGGLUTINATION as a Diagnostic Test for Diarrhea Virus:
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Rotavirus!
Rapid Test |
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Rhabdovirus Treatment Pre/Post-Exposure
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PRE-Exposure:
A) Continuous/Frequent Risk Category Individuals: 1) Primary Course Immunization 2) Serologic Testing 3) Booster Vaccine if Antibody titer is below acceptable level B) Infrequent Risk Category Individuals: 1) Primary Course Immunization POST-Exposure: 1) Wound Cleansing - Begin with immediate cleaning w/ soap + water or a virucidal agent 2) RIG - Full dose infiltrating around any wound with remaining volume administered at a distant site from Vaccine Administration (partially suppresses active production of Abs) 3) Vaccine - HDCV or PCECV, one each on days 0,3,7,14,28 |
