Papilloma, Pox, Ebola, Rare Viruses

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Symptoms of viral hemorrhagic fever

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Fever accompanied with impaired coagulation resulting in bleeding under skin, within organs, from orifices.

Caused by RNA viruses in 4 families.

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What is cause of death of viral hemorrhagic fever?

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Visceral organ necrosis due to viral infection of tissue parenchymal cells

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What family are Ebola and Marburg virus in?

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Filoviridae

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4 families of RNA viruses that cause hemorrhagic fever

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Filovidae
Bunyaviridae
Arenaviridae
Flaviviridae (covered in arbovirus lecture)

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How are the filoviruses (Ebola and Marburg) transmitted?

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appear to be zoonotic, reservoir unknown
transmission is person-to-person via close contact

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Signs of Ebola/Marburg

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rapid onset of fever, headache, joint/muscle pain, sore throat, weakness, diarrhea, vomiting, and stomach pain. Rash, red eyes, internal and external bleeding in some patients.

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In what species/population was Marburg first identified?

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simultaneous outbreaks in research laboratories working with green monkeys from Uganda

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What are Ebola and Marburg called "filo"viridae?

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Because of the FILamentous shape of the RNA viruses

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What is the most important route of transmission of Ebola/Marburg?

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Direct contact with blood, vomit, urine, stool ,or semen, from living or dead patient

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What is treatment of Ebola/Marburg (Filoviridae?)

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Supportive.

No anti-viral treatment available.

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3 disease causing viruses in family Bunyaviridae

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1) Hantavirus
2) Crimean Congo Fever Virus
3) Rift Valley Fever Virus

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Transmission of Hantavirus

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Rodents (exposure to aerosolized urine, droppings, saliva).

Human to human transmission is rare

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Diagnosis of Hantavirus

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Diagnosis by clinical history confirmed by serology for Hantavirus infection, evidence of viral antigens in tissues, or detection of hantavirus RNA

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Symptoms of Hantavirus

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Initial symptoms begin suddenly. Intense headaches, back and abdominal pain, fever, chills, nausea, blurred vision.

Later symptoms: low blood pressure, acute shock, vascular leakage, acute kidney failure, can cause severe fluid overload.

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T/F Ribovirin decreases severity of disease and risk of death from hantavirus

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T

Front 16

Hantaan, Puumala, Seoul, and Dobrava viruses are all associated with what?

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Hemorrhagic fever with renal syndrome (HFRS)

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Crimean-Congo hemorrhagic fever (CCHF): symptoms

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symptoms characterized by large areas of bruising, nosebleeds, and uncontrolled bleeding at injection sites

9-50% fatality rate

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Transmission of Crimean-Congo hemorrhagic fever (CCHF)

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Oxodid ticks are reservoir and vector. Other wild and domestic animals serve as amplifying hosts.

Transmission to humans: contact with infected animal (including human) blood or ticks

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Diagnosis and Treatment of Crimean-Congo hemorrhagic fever (CCHF)

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ELISA, PCR, Virus isolation.

Virus is sensitive in vitro to antiviral drug ribavarin.

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Rift Valley Fever: Where does it occur and what is it associated with weather-wise?

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Most sub saharan Africa.
epizootics observed during years with heavy rainfall

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Transmission of Rift Valley Fever

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Infected mosquito bites

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Symptoms and fatality of Rift Valley Fever

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No symptoms or mild illness associated with fever and liver abnormalities.

Some patients progress to hemorrhagic fever, encephalitis, ocular disease.

fatality is ~1% but up to 10% may have long term vision loss from retinitis

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Lassa fever virus in what family?

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Arenaviridae

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Reservoir and Transmission of Lassa fever virus

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Reservior is a species of rat endemic to the affected regions
Transmission through excretia via aerosol or direct contact with contaminated objects or food.
person-to-person contact can occur through contact with patient blood or secretions

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Symptoms of Lassa fever virus

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80% cases mild/asymptomatic

Onset gradual, malaise, fever, headache, sore throat, cough, nausea, vomiting, diarrhea, myalgia, chest and abdominal pain.

Severe cases: shock, pleural effusion, hemorrhage, seizures, encephalopathy and edema.

Morality is 1% for infected people.

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Diagnosis of Lassa fever virus

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IgM antibody, or viral antigen detection by ELISA or PCR, by isolation of virus from blood, urine, throat washings, IgG seroconversion by ELISA or IFA.

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T/F For Lassa fever virus, ribavirin is effective if given within 6 days

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T

Front 28

Adenoviridae primarily cause what type of infections?

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Upper Respiratory Tract. Visualize A DEN of coughing, sneezing kids.

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Adenoviruses are from family _____

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Adenoviridae

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How are adenoviridae transmitted?

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Close contact or fecal-oral.

Sites of infection: Eye, respiratory tract, GI tract, and urinary tract

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Diagnosis of adenoviridae

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Virions or viral antigens

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Treatment and Prevention of of adenoviridae

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No specific vaccine. Mostly self-limited.

Can be serious in immunosuppressed patients.

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Characteristics of papillomavirus (nucleic acid)

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non-enveloped, circular dsDNA, 5-8 kb

Front 34

Infections with HPV (family Papillomaviridae) generally restricted to what?

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Outer layers of skin or mucosal surfaces (keratinocyte stem cells)

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How do warts from HPV form?

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virus infects undifferentiated keratinocyte stem cells in basal layer
warts are formed by abnormal growth of these latently infected cells

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Characteristics of skin warts: which HPVs?

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Raised with rough surface. Type 2 or 4

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Characteristics of butcher's warts, and which HPVs?

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Type 7; Occupational hazard of meat handlers

Front 38

Characteristics of plane warts, and which HPVs?

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types 3 & 10
small, flat, smooth warts on arms, face, knees of children

Front 39

Characteristics of plantars warts and which HPVS?

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type 1
weight bearing regions of the foot
can be deep and painful

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Condyloma acuminatum: what are they?

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Soft raised papillomas found on perineum, vulva, penis, anus.

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Condyloma planum

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Flat papillomas, found on cervix.
Associated with high risk for cervical cancer.

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What HPV types associated with 70% of all cervical cancers?

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16 and 18

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Treatment of warts

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most resolve spontaneoulsy with time
salicylic acid (“compound W”)
cryotherapy
podophyllin (a plant resin)
diathermy (electrically induced heat)
laser

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Polyoma viruses: characteristics

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non-enveloped, circular dsDNA, ~5 kb
worldwide distribution

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What disease does the BK virus cause?

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Causes mild infection in children, but during immunosuppression can affect kidneys.

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What disease does the JC virus cause?

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Opportunistic infection in immunocompromised: Progressive Multifocal Leukoencephalopathy (PML)

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Progressive Multifocal Leukoencephalopathy (PML): symptoms and cause

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Cause: JC polyomavirus
Symptoms: Central nervous system white matter damage. Usually fatal.

Front 48

Merkel Cell carcinoma is caused by

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Merkel Cell polyoma virusw

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only DNA virus to replicate in the cytoplasm

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Pox virus

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Pox virus: genome/ nucleic acid characteristics

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large dsDNA genome, replicates in cytoplasm

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POX in a box: what does it mean?

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Poxiviridae is a brick-shaped box.

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T/F Poxiviridae cause chickenpox

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F. That is VZV

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Variola is aka

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Smallpox! Eradicated 1977

Front 54

How did smallpox spread?

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Respiratory droplets; direct skin contact

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Symptoms of smallpox

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flu-like symptoms
rash on face, arms, legs
lesions fill with pus, crust over, scabs fall off

Fatality ~30%

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Jenner showed that inoculation with _____ virus results in mild disease (localized pustular lesions) but long-term protection

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vaccinia

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Difference between chickenpox and smallpox symptoms

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Smallpox pustules develop at same time, appear most dense on face and palms, and ulcerate deeper into the skin.


Chickenpox appears in waves or crops, lesions start on face or torso, lateral spreading to entire body.

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Modern smallpox vaccine

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Live vaccinia virus. Deaths are 1/1,000,000

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What is CMX001?

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Derivative of cidofovir, potent against variola in vitro and animal models of pox viruses.

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CMX001 mechanism of action

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blocks viral DNA polymerase

Front 61

common viral infection of skin in children and AIDS patients
diagnostic lesions – firm papules and nodules with central depressions

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Molluscum Contagiosum

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Treatment of molluscum contagiosum

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Generally self-limited

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rare emerging infection seen mainly in western Africa
normally infects monkeys, squirrels, mice
can spread human-to-human
2003 outbreak in the US associated with an exotic pet show

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Monkeypox

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Fatality rate of monkey pox

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fatality 1 to 14%

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T/F Smallpox vaccine is protective against monkey pox

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T

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T/F Vaccinia is cowpox

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F, related but not same.

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Fever, uncontrolled internal and external bleeding, caused by specific RNA viruses

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viral hemorrhagic fever

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viral hemorrhagic fever caused by specific (DNA, RNA) viruses

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RNA

Front 69

Why are papilloma virus infections isolated from immune system?

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They're restricted to outer skin layers

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How many ppl killed by smallpox in 20th century?

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500 million