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213 Cards in this Set

  • Front
  • Back
What are 3 types of viral structure and what does each contain
1. naked icosahedral
-just icosahedral capsid and nucleic acid

2. enveloped icosahedral
-surface protein, lipid bilayer, capsid, nucleic acid

3. enveloped helical
-surface protein, lipid bilayer, matrix/core protein, nucleic acid+capsule attached
Viral recombination
Exchange of 2 genes between 2 chromosomes by homologous crossing over
Viral reassortment

what do these cause
Viruses with segmented genomes exchange segments

high frequency, cause of worldwide influenza pandemics
viral complementation
when 2 viruses infect a cell

1 of the viruses has a mutation that makes a non-functional protein

the other virus 'complements' the first by making the protein to serve both viruses
phenotypic mixing
Infection with both type A and type B virus

Type A genome may be coated with surface proteins of coat B

infectivity determined by type B protein coat, but all progeny will have type A coat/genetic material
Viral vaccine

what do live attenuated vaccines induce

5 examples
induce humoral and cell-mediated immunity

smallpox, yellow fever, chicken pox, Sabin's polio, MMR

"Live! see SMALL, YELLOW, CHICKENS get vaccinated with SABIN'S and MMR!"
live attenuated vaccines

a. do you need a booster
b. who should you NOT give these to and why
a. no booster needed
b. don't give to immunocompromised or their close contacts because they can revert back to virulence
only live attenuated vaccine that can be given to HIV patients
MMR

measles, mumps, rubella
Killed vaccines induce what?

4 examples
induce only humoral immunity

Rabies, Influenza, salk Polio, hAv

RIP Always
2 examples of recombinant vaccines
1. HBV - antigen = recombinant HBsAg

2. HPV (types 6,11,16,18)
DNA viral genomes

all are dsDNA except ...?

all are linear except...?
parvovirus (ssDNA)

Papilloma, polyoma, hepadnavirus (circular)
All RNA viruses are ssRNA except...?
Reovirus (dsRNA)
- rota and coltivirus

"double stranded because it needs to REpeatO"
Positively stranded RNA viruses (7)
I went to a RETRO (RETROvirus) TOGA (TOGAvirus) party, where I drank FLAVored (FLAVivirus) CORONA (CORONAvirus) and ate HIPPY (HEPEvirus) CALIfornia (CALcIvirus) PICKLES (PICOrnavirus)

retrovirus, togavirus, flavivirus, coronavirus, hepevirus, calcivirus, picornavirus
naked viral genome activity

purified nucleic acids
a. are infectious
b. are not infectious
c. why aren't these infectious
a. viruses with dsDNA (except pox and HBV) and (+) strand RNA

b. (-) strand ssRNA and dsRNA are not infectious

c. need enzymes contained in complete virion
which viruses are diploid?

which are haploid?
diploid = retrovirus (2 ssRNA copies)

haploid = everything else (1 copy of DNA or RNA)
Where do DNA viruses replicate

exception
nucleus

poxvirus
where do RNA viruses replicate

exceptions
cytoplasm

influenza virus (orthymyxo) and retrovirus
Naked viruses (7)
Naked CPR and PAPP smear

Calcivirus
Picornavirus
Reovirus
Parvovirus
Adenovirus
Papilloma
Polyoma
Where do most viruses acquire their envelope

1 exception
Most viruses acquire envelopes from the plasma membrane when they exit a cell

Herpesvirus acquires envelope from the nuclear membrane
Herpesvirus (HSV 1 and 2, VZV, CMV, EBV), HBV, Smallpox virus

structure
DNA enveloped viruses
Adenovirus, papillomavirus, parvovirus

Structure?
DNA nucleocapsid virus
Influenza, parainfluenza, RSV, measles, mumps, rubella, rabies. HTLV, HIV

structure
RNA enveloped viruses
Enteroviruses (poliovirus, coxsackievirus, echovirus, HAV), rhinovirus, reovirus (rotavirus)

structure?
RNA nucleocapsid viruses
7 DNA viruses
DNA viruses are HHAPPPy

Hepadna
Herpes
Adeno
Pox
Parvo
Papilloma
Polyoma
How are parvoviruses different from other DNA viruses?
single stranded (most other DNA viruses are double stranded)

"the hole is PAR ONE"
Shape of most DNA viruses

exceptions
linear

Papilloma and polyoma (circular, supercoiled)

hepadna (circular, incomplete)
In what two ways is poxvirus different from other DNA viruses
Not icosahedral (POX in a BOX - complex capsid)

Does not replicate in nucleus (because it carries its own DNA-dependent RNA polymerase)
Herpesvirus

a. envelope?
b. DNA structure
a. yes
b. ds DNA, linear
Which Herpesvirus?
causes...

-Oral (some genital) lesions
-spontaneous temporal lobe encephalitis
-keratoconjunctivitis
HSV-1
Which Herpesvirus?
causes...

-mostly genital lesions, some oral
HSV-2
Which Herpesvirus?
causes...

Chickenpox, zoster (shingles)
VZV (HHV-3)
Which Herpesvirus?
causes...

Mononucleosis, Burkitt's lymphoma
EBV (HHV-4)
Which Herpesvirus?
causes...

-AIDS retinitis, infections in immunosuppressed, especially transplant
-congenital defects
CMV (HHV-5)
Which Herpesvirus?
causes...

Chickenpox, zoster (shingles)
VZV (HHV-3)
Which Herpesvirus?
causes...

roseola (exanthem subitum)
HHV-6
Which Herpesvirus?
causes...

Mononucleosis, Burkitt's lymphoma
EBV (HHV-4)
Which Herpesvirus?
causes...

Kaposi's sarcoma-associated herpesvirus
HHV-8
Which Herpesvirus?
causes...

-AIDS retinitis, infections in immunosuppressed, especially transplant
-congenital defects
CMV (HHV-5)
Most common cause of spontaneous encephalitis in US

where can it remain latent
HSV-1

trigeminal ganglia
Virus that can cause
-gingivostomatitis (swollen gums, mucous membranes)

-keratoconjunctivitis (corneal blindness)

-temporal lobe encephalitis

-herpes labialis

route of transmission?
HSV-1

respiratory secretions, saliva
Which Herpesvirus?
causes...

roseola (exanthem subitum)
HHV-6
Which Herpesvirus?
causes...

Kaposi's sarcoma-associated herpesvirus
HHV-8
most common cause of corneal blindness in USA
keratoconjunctivitis from HSV-1
Which Herpesvirus?
causes...

Chickenpox, zoster (shingles)
VZV (HHV-3)
Patient had sexual contact, now has
-fever
-headache
-vaginal/urethral discharge
-enlarged LNs
-ulcerating vesicles on genitals

on sample, you see multinucleated giant cells with intranuclear inclusion bodies

dx? where is this latent?
HSV-2

latent in sacral ganglia
Most common cause of spontaneous encephalitis in US

where can it remain latent
HSV-1

trigeminal ganglia
Adult patient has a rash over a specific dermatome area

a. what is the virus
b. where can this establish latency
c. when is this especially dangerous
a. VZV (member of herpesviruses)

b. trigeminal and dorsal root ganglia

c. dangerous if reactivation over V1 segment of trigeminal (eye and corneal involvement)
Virus that can cause
-gingivostomatitis (swollen gums, mucous membranes)

-keratoconjunctivitis (corneal blindness)

-temporal lobe encephalitis

-herpes labialis

route of transmission?
HSV-1

respiratory secretions, saliva
Which Herpesvirus?
causes...

Mononucleosis, Burkitt's lymphoma
EBV (HHV-4)
Which Herpesvirus?
causes...

-AIDS retinitis, infections in immunosuppressed, especially transplant
-congenital defects
CMV (HHV-5)
most common cause of corneal blindness in USA
keratoconjunctivitis from HSV-1
Patient had sexual contact, now has
-fever
-headache
-vaginal/urethral discharge
-enlarged LNs
-ulcerating vesicles on genitals

on sample, you see multinucleated giant cells with intranuclear inclusion bodies

dx? where is this latent?
HSV-2

latent in sacral ganglia
Which Herpesvirus?
causes...

roseola (exanthem subitum)
HHV-6
Which Herpesvirus?
causes...

Chickenpox, zoster (shingles)
VZV (HHV-3)
Adult patient has a rash over a specific dermatome area

a. what is the virus
b. where can this establish latency
c. when is this especially dangerous
a. VZV (member of herpesviruses)

b. trigeminal and dorsal root ganglia

c. dangerous if reactivation over V1 segment of trigeminal (eye and corneal involvement)
Which Herpesvirus?
causes...

Mononucleosis, Burkitt's lymphoma
EBV (HHV-4)
Which Herpesvirus?
causes...

Kaposi's sarcoma-associated herpesvirus
HHV-8
Most common cause of spontaneous encephalitis in US

where can it remain latent
HSV-1

trigeminal ganglia
Which Herpesvirus?
causes...

-AIDS retinitis, infections in immunosuppressed, especially transplant
-congenital defects
CMV (HHV-5)
Virus that can cause
-gingivostomatitis (swollen gums, mucous membranes)

-keratoconjunctivitis (corneal blindness)

-temporal lobe encephalitis

-herpes labialis

route of transmission?
HSV-1

respiratory secretions, saliva
Which Herpesvirus?
causes...

roseola (exanthem subitum)
HHV-6
most common cause of corneal blindness in USA
keratoconjunctivitis from HSV-1
Patient had sexual contact, now has
-fever
-headache
-vaginal/urethral discharge
-enlarged LNs
-ulcerating vesicles on genitals

on sample, you see multinucleated giant cells with intranuclear inclusion bodies

dx? where is this latent?
HSV-2

latent in sacral ganglia
Which Herpesvirus?
causes...

Kaposi's sarcoma-associated herpesvirus
HHV-8
Most common cause of spontaneous encephalitis in US

where can it remain latent
HSV-1

trigeminal ganglia
Adult patient has a rash over a specific dermatome area

a. what is the virus
b. where can this establish latency
c. when is this especially dangerous
a. VZV (member of herpesviruses)

b. trigeminal and dorsal root ganglia

c. dangerous if reactivation over V1 segment of trigeminal (eye and corneal involvement)
Virus that can cause
-gingivostomatitis (swollen gums, mucous membranes)

-keratoconjunctivitis (corneal blindness)

-temporal lobe encephalitis

-herpes labialis

route of transmission?
HSV-1

respiratory secretions, saliva
most common cause of corneal blindness in USA
keratoconjunctivitis from HSV-1
Patient had sexual contact, now has
-fever
-headache
-vaginal/urethral discharge
-enlarged LNs
-ulcerating vesicles on genitals

on sample, you see multinucleated giant cells with intranuclear inclusion bodies

dx? where is this latent?
HSV-2

latent in sacral ganglia
Adult patient has a rash over a specific dermatome area

a. what is the virus
b. where can this establish latency
c. when is this especially dangerous
a. VZV (member of herpesviruses)

b. trigeminal and dorsal root ganglia

c. dangerous if reactivation over V1 segment of trigeminal (eye and corneal involvement)
Teenager comes in with
-fever, chills, headache
-painful pharyngitis
-atypical lymphocytes in blood
-heterophile Abs agglutinate sheeps blood

virus?
EBV-infectious mononucleosis

AB-heterophile agglutination = monospot test
Virus that causes
-Infectious mononucleosis
-Burkitt's lymphoma
-nasopharyngeal carcinoma

how is it transmitted?

latency?
EBV

respiratory secretions or saliva

latent in B cells
Teenager comes in with
-fever, chills, headache
-painful pharyngitis
-atypical lymphocytes in blood
-heterophile Abs agglutinate sheeps blood

virus?
EBV-infectious mononucleosis

AB-heterophile agglutination = monospot test
Patient with AIDS with this infection can get

-retinitis
-coltitis
-veremia

see cowdry type A owl's eye inclusions in cells

infection?
latency?
transmission?
CMV

mononuclear cells

congenital, transfusion, sexual contact, saliva, urine, transplant
Patient with transplant suffers from pneumonia

see multinuclear giant cell with owl eye inclusions

virus?
CMV
Virus that causes
-Infectious mononucleosis
-Burkitt's lymphoma
-nasopharyngeal carcinoma

how is it transmitted?

latency?
EBV

respiratory secretions or saliva

latent in B cells
Virus that can cause

-congenital infection
-mononuclosis (neg. monspot)
-pneumonia

especially in immunocompromised
CMV
Patient with AIDS with this infection can get

-retinitis
-coltitis
-veremia

see cowdry type A owl's eye inclusions in cells

infection?
latency?
transmission?
CMV

mononuclear cells

congenital, transfusion, sexual contact, saliva, urine, transplant
Patient is a child with high fever for 3-5 days, followed by diffuse macular rash

dx?
HHV-6 roseola
Patient with transplant suffers from pneumonia

see multinuclear giant cell with owl eye inclusions

virus?
CMV
Patient with AIDS gets red papules all over

what virus can cause this?
HHV-8 Kaposi's sarcoma
Virus that can cause

-congenital infection
-mononuclosis (neg. monspot)
-pneumonia

especially in immunocompromised
CMV
Latency
a. HSV-1
b. HSV-2
c. VZV
d. EBV
e. CMV
a. trigeminal ganglia
b. sacral ganglia
c. trigeminal and dorsal root ganglia
d. B cells
e. mononuclear cells
Patient is a child with high fever for 3-5 days, followed by diffuse macular rash

dx?
HHV-6 roseola
Patient with AIDS gets red papules all over

what virus can cause this?
HHV-8 Kaposi's sarcoma
What is the Tzanck test
Test for HSV-1, HSV-2, VZV

Smear of open skin vesicle to detect multinucleated giant cells

also see intranuclear cowdry A inclusions
Virus that can cause acute or chronic hepatitis

virus is enveloped and has dsDNA that is partially circular

a. virus?
b. vaccine?
c. what does this virus have that allows it to function
a. HBV (Hepadnavirus family)
b. Vaccine has HBV surface antigen
c. has reverse transcriptase
Latency
a. HSV-1
b. HSV-2
c. VZV
d. EBV
e. CMV
a. trigeminal ganglia
b. sacral ganglia
c. trigeminal and dorsal root ganglia
d. B cells
e. mononuclear cells
What is the Tzanck test
Test for HSV-1, HSV-2, VZV

Smear of open skin vesicle to detect multinucleated giant cells

also see intranuclear cowdry A inclusions
Teenager comes in with
-fever, chills, headache
-painful pharyngitis
-atypical lymphocytes in blood
-heterophile Abs agglutinate sheeps blood

virus?
EBV-infectious mononucleosis

AB-heterophile agglutination = monospot test
Virus that can cause acute or chronic hepatitis

virus is enveloped and has dsDNA that is partially circular

a. virus?
b. vaccine?
c. what does this virus have that allows it to function
a. HBV (Hepadnavirus family)
b. Vaccine has HBV surface antigen
c. has reverse transcriptase
Virus that causes
-Infectious mononucleosis
-Burkitt's lymphoma
-nasopharyngeal carcinoma

how is it transmitted?

latency?
EBV

respiratory secretions or saliva

latent in B cells
Patient with AIDS with this infection can get

-retinitis
-coltitis
-veremia

see cowdry type A owl's eye inclusions in cells

infection?
latency?
transmission?
CMV

mononuclear cells

congenital, transfusion, sexual contact, saliva, urine, transplant
Teenager comes in with
-fever, chills, headache
-painful pharyngitis
-atypical lymphocytes in blood
-heterophile Abs agglutinate sheeps blood

virus?
EBV-infectious mononucleosis

AB-heterophile agglutination = monospot test
Patient with transplant suffers from pneumonia

see multinuclear giant cell with owl eye inclusions

virus?
CMV
Virus that can cause

-congenital infection
-mononuclosis (neg. monspot)
-pneumonia

especially in immunocompromised
CMV
Virus that causes
-Infectious mononucleosis
-Burkitt's lymphoma
-nasopharyngeal carcinoma

how is it transmitted?

latency?
EBV

respiratory secretions or saliva

latent in B cells
Patient is a child with high fever for 3-5 days, followed by diffuse macular rash

dx?
HHV-6 roseola
Patient with AIDS with this infection can get

-retinitis
-coltitis
-veremia

see cowdry type A owl's eye inclusions in cells

infection?
latency?
transmission?
CMV

mononuclear cells

congenital, transfusion, sexual contact, saliva, urine, transplant
Patient with AIDS gets red papules all over

what virus can cause this?
HHV-8 Kaposi's sarcoma
Patient with transplant suffers from pneumonia

see multinuclear giant cell with owl eye inclusions

virus?
CMV
Latency
a. HSV-1
b. HSV-2
c. VZV
d. EBV
e. CMV
a. trigeminal ganglia
b. sacral ganglia
c. trigeminal and dorsal root ganglia
d. B cells
e. mononuclear cells
What is the Tzanck test
Test for HSV-1, HSV-2, VZV

Smear of open skin vesicle to detect multinucleated giant cells

also see intranuclear cowdry A inclusions
Virus that can cause

-congenital infection
-mononuclosis (neg. monspot)
-pneumonia

especially in immunocompromised
CMV
Virus that can cause acute or chronic hepatitis

virus is enveloped and has dsDNA that is partially circular

a. virus?
b. vaccine?
c. what does this virus have that allows it to function
a. HBV (Hepadnavirus family)
b. Vaccine has HBV surface antigen
c. has reverse transcriptase
Patient is a child with high fever for 3-5 days, followed by diffuse macular rash

dx?
HHV-6 roseola
Patient with AIDS gets red papules all over

what virus can cause this?
HHV-8 Kaposi's sarcoma
Latency
a. HSV-1
b. HSV-2
c. VZV
d. EBV
e. CMV
a. trigeminal ganglia
b. sacral ganglia
c. trigeminal and dorsal root ganglia
d. B cells
e. mononuclear cells
What is the Tzanck test

what would you be looking for?
Test for HSV-1, HSV-2, VZV

Smear of open skin vesicle to detect multinucleated giant cells

also see intranuclear cowdry A inclusions
Virus that can cause acute or chronic hepatitis

virus is enveloped and has dsDNA that is partially circular

a. virus?
b. vaccine?
c. what does this virus have that allows it to function
a. HBV (Hepadnavirus family)
b. Vaccine has HBV surface antigen
c. has reverse transcriptase
Teenager comes in with
-fever, chills, headache
-painful pharyngitis
-atypical lymphocytes in blood
-heterophile Abs agglutinate sheeps blood

virus?
EBV-infectious mononucleosis

AB-heterophile agglutination = monospot test
Virus that causes
-Infectious mononucleosis
-Burkitt's lymphoma
-nasopharyngeal carcinoma

how is it transmitted?

latency?
EBV

respiratory secretions or saliva

latent in B cells
Patient with AIDS with this infection can get

-retinitis
-coltitis
-veremia

see cowdry type A owl's eye inclusions in cells

infection?
latency?
transmission?
CMV

mononuclear cells

congenital, transfusion, sexual contact, saliva, urine, transplant
Patient with transplant suffers from pneumonia

see multinuclear giant cell with owl eye inclusions

virus?
CMV
Virus that can cause

-congenital infection
-mononuclosis (neg. monspot)
-pneumonia

especially in immunocompromised
CMV
Patient is a child with high fever for 3-5 days, followed by diffuse macular rash

dx?
HHV-6 roseola
Patient with AIDS gets red papules all over

what virus can cause this?
HHV-8 Kaposi's sarcoma
Latency
a. HSV-1
b. HSV-2
c. VZV
d. EBV
e. CMV
a. trigeminal ganglia
b. sacral ganglia
c. trigeminal and dorsal root ganglia
d. B cells
e. mononuclear cells
What is the Tzanck test
Test for HSV-1, HSV-2, VZV

Smear of open skin vesicle to detect multinucleated giant cells

also see intranuclear cowdry A inclusions
Virus that can cause acute or chronic hepatitis

virus is enveloped and has dsDNA that is partially circular

a. virus?
b. vaccine?
c. what does this virus have that allows it to function
a. HBV (Hepadnavirus family)
b. Vaccine has HBV surface antigen
c. has reverse transcriptase
Unenveloped virus that causes
-febrile pharyngitis, acute hemorrhagic cystitis
-pneumonia
-conjunctivitis - pink eye

genome
adenovirus


naked ds DNA linear
virus that causes
-aplastic crises in sickle cell disease
-fever + slapped cheek rash in kids
-can cause RBC destruction in fetus --> hydrops fetalis
-RBC destruction in adults --> RBC aplasia, RA

genome
Parvovirus

SS DNA virus (smallest DNA virus)
Papillomavirus
a. envelope
b. DNA structure
c. which forms cause HPV warts
d. which forms cause Cervical cancer
a. no
b. ds-circular
c. HPV warts = 1,2,6,11
d. HPV cancer = 16, 18
Virus that causes
-PML progressive multifocal leukoencephalopathy in HIV

genome? envelope?
polyomavirus - JC

no envelope
ds circular
virus that can cause
-small pox
-cowpox (milkmaid's blisters)
-mulluscum contagiosum (flesh colored dome lesion with central dimple)

envelope?
DNA structure?
Poxvirus

Yes envelope
DS linear DNA (largest DNA virus)
6 negatively stranded RNA viruses

what must they bring to transcribe strand to positive
Always Bring Polymerase Or Fail Replication

Arenavirus
Bunyavirus
Paramyxovirus
Orthomyxovirus
Filovirus
Rhabdovirus

Must bring RNA-dependent RNA polymerase
4 segmented viruses (all RNA)

Implications of segmentation
BOAR

Bunyavirus
Orthomyxovirus
Arenavirus
Reovirus

Segments can recombine --> antigenic shift --> pandemics (influenza)
5 picornaviruses

genome?
picoRNAvirus = small RNA virus

PERCH on a peak (pic)
Poliovirus
Echovirus
Rhino
Coxsackie
HAV
Picornaviruses

genome?
how does it cause its effects?

Common mode of transmission?
Common disease association?
ss RNA linear

RNA --> 1 large polypeptide --> cleaved by proteases to functional viral proteins

fecal oral (except rhino)
aseptic meningitis (except rhino and HAV)
picornavirus that causes common cold, not spread by fecal oral
rhinovirus
picornavirus that causes acute viral hepatitis
HAV
Rhinovirus - what family
a. envelope?
b. genome?
c. disease?
Picornavirus
a. no
b. RNA
c. common cold
acid labile, so it cannot infect the GI tract like other picornavirus

"rhinos have runny noses"
Patient has high fever +
-black vomit
-jaundice

virus (family, genome)?
reservoir?
transmission?
Yellow fever virus -->
flavivirus -enveloped, ssRNA, pos sense, linear

b. monkey or human reservoir

c. transmitted by Aedes mosquitos

Flavi = yellow, jaundice
Most important cause of infantile gastroenteritis worldwide

genome?
Rotavirus

Reovirus - segmented dsRNA
Virus that causes acute diarrhea in US in winter, especially in day care centers or kindergartens

MOA
rotavirus

destroys villi + atrophy --> decreases Na and water resorption

ROTA = right out the anus
genome of orthomyxovirus
ss RNA, segmented

envelope
Influenza

how is it different from common cold
SEVERE high spking fever, painful headache, painful myalgias

more severe
2 virulence factors in orthomyxovirus (influenzae)

what do they do
Hemagglutinin - binds to sialic acid receptoors to promote viral entry into cells

Neuraminidase - ceaves neuramic acid in mucous to expose sialic acid receptors

cleaves sialic acid - hemagglutinin bonds to allow budding, virion release
what is responsible for influenza epidemics

what is responsible for influenza pandemics
genetic drift = minor changes to HA or NA based on random mutation

genetic shift = reassortment of segmented genome (exchange) --> new influenza A virus
protection for the population against influenza virus
killed viral vaccine
How should you NOT treat a child with the flu or chicken pox (VZV)

how should you treat them
Don't give aspirin --> Reye's syndrome (liver and brain disease)

give acetaminophen
Treatments for flu (2)

mechanisms and limitations
1. Amantadine/rimantidine
-act by inhibiting M2 ion channel, preventing acidification --> no virion uncoating
-only protects against influenza A

2. zanamavir/oseltamivir

neuroaminidase inhibitor
Patient comes in with
-fever
-post auricular tenderness
-lymphadenopathy
-arthralgia
-fine truncal rash

lasts for 3 days

dx?
virus?
when does it cause a serious disease?
German measles from rubella virus (toga virus, ssRNA, pos, linear)

serious congenital disease (TORCH)
Paramyxovirus

3 ways in which it is different than orthomyxovirus structurally
1. (-) ss RNA genome (not segmented)

2. HA and NA in same spike (not on different spikes)

3. Fusion protein present --> causes respiratory epithelial cells to fuse and form multinucleated giant cells
4 paramyxoviruses

where do they all infect?

who do they all infect?
parainfluenza
mumps
measles
RSV

all infect lungs
#1 cause of pneumonia in kids, especially < 6mo
RSV (paramyxovirus)
Child comes in with stridor and a seal-like barking cough

which virus?
what should you see if you biopsy respiratory epithelial cells?
parainfluenza virus (paramyxovirus) --> croup

see multinucleated giant cells due to fusion protein
Infant gets bronchiolitis and pneumonia

virus?

treat?
RSV (paramyxovirus)

palivizumab = monoclonal Ab to neutralize F protein
ribavirin
RSV and parainfluenza virus

effect in kids?

effect in adults?
kids = pneumonia

adults = URI (bad cold)
child comes in with
-cough
-coryza (head cold - congestion)
-Conjunctivitis

in his mouth, you see tiny white spots surrounded by red
-rash from head to toe

what are these spots called?
diagnosis?
koplik spots


Measles from rubeola virus (paramyxovirus)
Difference between rash in measles vs. rubella
measles = head to toe, includes hands and feet

rubella = truncal rash
You see a rash

how do you differentiate measles from roseola (HHV-6)
measles = associated with koplik spots, conjunctivitis

HHV-6 = associated with 3-5 day fever
What is the #2 cause of viral encephalitis in the US
St. Louis virus - flavivirus (RNA pos, linear)
2 possible sequela of toagvirus infection
1. Rubella --> german measles (fever, truncal rash, dangerous if congenital)

2. E or W equine encephalitis
Arthropod-borne viruses (caused by blood sucking ticks)

what conditions do these all cause
toga
flavi
bunya

all cause fever, encephalitis
2 viruses that cause common cold
coronavirus
rhinovirus
1 virus that causes rabies

special shape of capsid
rhabdovirus

bullet shaped
2 viruses that cause hemorrhagic fever, could be used as biological weapons
filovirus --> ebola or marburg

arenavirus --> lassa fever or lymphocytic choriomeningitis
patient has koplik spots and head to toe rash that includes the hands and feet

what are three unlikely (but possible) sequelae of this disease
a. comes on years later
b. in immunocompromised
c. rate of 1:2000
a. subacute sclerosing panencephalitis --> mental deterioration

b. giant cell pneumonia

c. encephalitis
Vaccine to protect against measles
MMR
Patient had cough and fever a few days ago
-now has giant parotid gland
-giant testicles
-asceptic meningitis

dx?
major negative effect on patients who are post-pubescent?

vaccine?
Mumps (paramyxovirus)

can cause sterility

MMR vaccine
Negri bodies in purkinje cells of cerebellum

dx?
Pathology
Rabies virus

Cytoplasmic inclusions in neurons after virus traveled retrograde up nerve axons
Patient was bitten by a bat

had fever/malaise --> agitation, photophobia, hydrophobia

course?
organism?

what should patient have done as soon as he got bit?
rabies (rhabdovirus - RNA, ss, neg, linear, bullet shaped capsule)

paralysis, coma, death

should have come in for prophylactic vaccination right after bite
Lots of spots

truncal rash following 3-5 day fever
rubella (togavirus) causing german measles
Lots of spots

rash spreads from head to toe
follows cough, coryza, conjunctivitis, with small white spots on buccal mucosa
rubeola, measles

paramyxovirus
Lots of spots


patient has a diffuse maculopapular rash following a bout of high fevers in kids
roseola caused by herpesvirus (HHV-6)
patient has rash following dermatomal area
varicella-zoster from herpesvirus
Patient lives in crowded area
-gets flu-like symptoms
-3 weeks later, gets elevated ALT, AST
-mild jaundice seen later

virus?
diagnosis?
how was it transmitted?
Hep A (RNA picornavirus)

Active infection = HAV capsule IgM
-if you see HAV capsule IgG, indicates previous exposure

transmitted fecal-oral, no carrier
IgM anti-HAV and IgG anti-HAV
a. acute infection
b. old infection
c. no infection
a. IgM +, IgG -

b. IgM - , IgG +

c. both neg
Heptatitis viral transmission

a. fecal oral
-why can they do this

b. blood blood
a. A, E
-naked, so not destroyed by gut because they have no envelope

b. B, C, D
which hepatitis viruses can cause chronic hepatitis
B, C, D
Incubation time for
a. HAV
b. HBV
a. 3 weeks
b. 3 months
Patient has fever, malaise

3 months later, has highly elevated ALT, AST

develops jaundice

you diagnose HBV

a. class of organism
b. 3 enzymes involved in organisms replication/action
c. how is it transmitted
a. HBV is a DNA hepadnavirus

b. Cellular RNA pol transcribes DNA --> RNA

Reverse transcriptase transcribes RNA --> DNA (for replication)

virus contains DNA-dependent DNA pol

c. parenteral, sexual, maternal-fetal transmission, has carriers
3 sequelae of HBV infection
acute hepatitis
fulminant hepatitis
chronic hepatitis
Seroogical markers

what do the following indicate if found in blood

a. HBsAg
b. anti HBsAg
c. HBcAg
d. Anti HBcAg (IgM)
e. Anti HBcAg (IgG)
f. HBeAg
g. Anti HBeAg
a. active hep B infection
b. immunity to hep B, no active infection
c. antigen associated with core of HBV (?)

d. Acute/recurent infection

e. chronic infection

f. highly transmissible infection

g. lowly transmissible reaction
What is HDV and how does it act
HDV = delta agent

carriers to body --> uses HBsAg as its envelope, coinfects (or superinfects) with HBV --> worse prognosis for hepatitis
HCV
a. class of virus
b. transmitted how
c. how do you detect
a. RNA flavivirus
b. blood borne, carriers
c. anti-HCV
patient is an IVDU (or post-transfusion)
has mild AST/ALT elevation, developing cirrhosis

viral infection
HCV is the leading cause of chronic hepatitis
Hepatitis-inducing virus that is transmitted enterically, causes water born epidemics, and has high mortality rate in pregnant women
HEV
viruses that predispose patient to
-chronic active hepatitis
-cirrhosis
-hepatocellular carcinoma
HBV, HCV
As far as liver enzymes, how is viral hepatitis different from alcoholic hepatitis
viral: ALT > AST

alcoholic: AST > ALT
On serology, you see

HBsAg
HBeAg
IgM for HBcAg

stage
acute HBV infection
On serology, you see
-HBsAg
-HBeAg
-IgG to HBcAg

stage
chronic active HBV infection (high infectivity)
On serology, you see
-HBsAg
-anti-HBeAb
-IgG to HBcAg

stage
chronic HBV infection (low infectivity)
On serology, you see only
anti-HBs Ab

stage
recovery/immunity from HBV infection
HIV
a. genome
b. capsid protein
c. envelope proteins and roles
a. ss RNA, diploid (retrovirus)
b. p24
c. gp41 (fusion and entry), gp120 attach to host T cell
HIV

3 necessary enzymes
reverse transcriptase
integrase
protease - cleaves gag and pol from larger precursor molecules (post-translational modification)
HIV

matrix protein that holds gp41 and gp120 in place
p17 matrix protein
HIV

3 structural genes - what do these encode for
a. env
b. pol
c. gag
a. env for gp120 and gp41 (envelope proteins)

b. pol for reverse transcriptase

c. gag for p24 (capsid)
HIV

how does it enter T cells?

How does it enter macrophages?

what mutation has been found to cause immunity to HIV infection
T cells = binds CD4 and CXCR4

macrophages = binds CD4 and CCR5

homozygous CCR5 mutation--> immunity, heterozygous --> slower course of disease
HIV diagnosis

test you use to RULE OUT

test you use to RULE IN
rule out = ELISA (has a high false pos, so if this comes up negative, you can rule out HIV)

rule in = Western blot (high false neg, so if positive, you can pretty much rule in HIV)
Elisa/Western blots for HIV

a. what do these tests look for
b. when are they especially falsely negative
c. when are they especially falsely positive
look for antibodies to viral proteins

b. false neg in first 1-2 months after infection

c. false pos in babies born to infected mothers (because anti-gp120 crosses placenta)
HIV
test that allows physicians to monitor the effect of drug therapy on a viral load
HIV PCR/viral load test
AIDS diagnosis (3 ways)
1. CD4 < 200

2. HIV pos + AIDS indicator condition (Pneumocystis jiroveci pneumonia)

3. CD4/CD8 ration < 1.5
4 stages of AIDS infection (4 f's)
1. flu-like (acute)
2. feeling fine (latent -- virus replicates in LN, avg 8 years)
3. falling count - more susceptible to infections, etc
4. final crisis - AIDS develops for 2 years, CD4<200 or AIDS defining infectoin
HIV infection

a. what would you find serologically in an acute attack

CD4
anti-p24 antibodies
anti-gp120 antibodies
virus p24 antigen
-small dip in CD4

-virus p24 antigen peaks

anti-p24 and anti-gp120 slowly rising
HIV infection

a. what would you find serologically in a latent stage

CD4
anti-p24 antibodies
anti-gp120 antibodies
virus p24 antigen
everything steady except low p24 antigen
HIV infection

a. what would you find serologically in a 3-10 years after initial attack

CD4
anti-p24 antibodies
anti-gp120 antibodies
virus p24 antigen
decline of CD4, antip24 Abs, anti-gp120 antibodies

increase in p24 viral antigen
patient has AIDS

5 possible infections in brain that patient is most susceptible to
Cryptoccal meningitis
Toxoplasmosis
CMV encephalopathy
AIDS dementia
PML (JC virus)
Patient with AIDS

1 complication in eyes
CMV retinitis
Patient with AIDS

4 complications in mouth/throat
candida thrush

HSV

CMV

Oral hairy leukoplakia (EBV)
Patient with AIDS

which lung infections is she most susceptible to (3)
pneumocystis jiroveci pneumonia

Tb

histoplasmosis
Patient with AIDS is most susceptible to which GI infections
Cryptosporidiosius

Mycobacterium avirum-intracellulare complex

CMV colitis

Non-Hodgkin's lymphoma (EBV)

Isospora belli
Patient has AIDS

what are 2 cutaneous infections I worry about
Shingles VZV

Kaposi sarcoma (HHV-8)
Patient has AIDS

susceptible to whcih genial infections
Genital herpes, warts

Cervical cancr (HPV)
HIV associated infections - risk for these increases when CD4 count goes below what level

-oral thrush
-tinea pedis
-VZV reactivation
-TB
-bact infections
CD4 < 400
HIV associated infections - risk for these increases when CD4 count goes below what level

-reactivation HSV
-cryptosporidiosis
-Isospora
-disseminated coccidiomycoisis
-Pneumocystis pneumonia
CD4 < 200
HIV associated infections - risk for these increases when CD4 count goes below what level

-Candidal esphagitis
-toxoplasmosis
-histoplasmosis
CD4 < 100
HIV associated infections - risk for these increases when CD4 count goes below what level

-CMV retinitis and esphagitis
-disseminated M. avium-intracellulare
-cryptococcal meningoencephalitis
CD4 < 50
Kaposi sarcoma (HHV-8)
Invasive cervical carcinoma (HPV)

Primary CNS lymphoma

non-Hodgkin's lymphoma

all associated with what condition
HIV
What causes prion disease

what are the symptoms
conversion of normal cellular prion protein PrPc into b-pleated form PrPsc

spongiform encephalopathy --> dementia, ataxia, death
special features of converted prion to cause prion disease
PrPsc is..
-transmissable
-resists degradation
-facilitates conversion of more PrPc to PrPsc
Prion diseases

a. sporadic
b. inherited
c. acquired
a. creutzfeldt-Jakob (rapidly progressing dementia)

b. Gerstmann-Straussler-Scheinker syndrome

c. Kuru