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378 Cards in this Set

  • Front
  • Back

Is Adenovirus a DNA, RNA positive, or RNA negative virus?


Is Adenovirus enveloped or naked?


What is the most common cause of adenoids and tonsillitis?


How is Adenovirus transmitted?

1. Respiratory droplets
2. Fecal-oral route

What is the most common demographic for Adenovirus?

1. Little children
2. Military baracks
3. Swimming at public pools

Clinical presentations of Adenovirus? (3)

1. Hemorrhagic cystitis
2. Viral conjunctivitis (pink eye)
3. Adenoid/tonsillitis

How are military recruits protected from Adenovirus?

Live attenuated virus vaccine

What type of virus is Togavirus?

Positive RNA virus

Is Togavirus enveloped or naked?


Protein processing of Togavirus?

Long polypeptide cleaved by proteases

What two diseases are caused by Togavirus?

1. Arbovirus
2. Rubella

What are the three subdiseases of Togavirus' Arbovirus?

1. Western equine encephalitis
2. Easter equine encephalitis
3. Venezuelan equine encephalitis

How do you treat Togavirus' Arbovirus?

No treatment

What type of disease is Rubella?

Childhood exanthema

Another name for Rubella

German measles

How is Rubella spread?

Respiratory droplets

Symptoms of childhood Rubella (4)

1. Postauricular and occipital lymphadenopathy
2. Maculopapular rash starts at head and descends - only present for 3 days, moves fast, dosen't darken or coalesce
3. Fever
4. Fatigue

Is Rubella a torches infection?


Symptoms of Congenital Rubella (9)

1. Congenital cataracts

2. Patent ductus arteriosus

3. Sensory-neural deafness

4. Blueberry muffin rash
5. Jaundice
6. Blindness
7. Mental retardation
8. Microcephaly
9. Bone lesions

Adult Rubella symptoms (3)

1. Lymphadenopathy
2. Arthritis
3. Fever

What is the treatment for Rubella?

No treatment available

MMR vaccine

1. Vaccine?
2. Who's at risk

1. Live attenuated vaccine, humoral and cell mediated immunity

2. Avoid while pregnant and immunocompromised C4 count < 200

What is one particular group at risk for Rubella?

Immigrants because often not vaccinated

What type of virus is Picornavirus?

Positive RNA virus

Are Picornaviruses naked or enveloped?


How are Picornaviruses transmitted?

Fecal-oral, except Rhinovirus which is respiratory droplets

Do Picornaviruses have a large polyprotein product that viral proteases cleave?


Hepatits A's family


Enterovirus's family


Rhinovirus's family


Poliovirus's genus


Coxsackie virus's genus


Echovirus genus


What are the number one cause of aseptic meningitis?


What patient population is most commonly affected with aseptic meningitis?


Is Poliovirus acid stabile or labile?

Acid stable

Where does Poliovirus replicate? (2)

1. Lymphoid tissue of tonsils

2. Peyer's patches of sumucosa of ileum

How long does Poliovirus take to replicate in the lymphoid tissue?

2-3 weeks

Symptoms of Poliovirus (3)

1. Asymmetric flaccid paralysis concentrated in lower legs
2. Can ascend to diaphragm => respiratory insufficiency
3. Aspetic meningitis

SALK vaccine

Killed Polio parenteral vaccine that only forms IgG antibodies not IgA

SABIN vaccine

live attenuated Polio oral vaccine forms both IgA and IgG with potential to revert back to active form in feces

When is Coxsackie infection most common?


Coxsackie A symptoms (3)

1. Hand, foot, mouth disease
2. Red vesicular rash
3. Aseptic meningits

Coxsackie B virus symptoms (2)


Dilated cardiomyopathy


Devil's grip - Bornholm's disease/pleurodynia - extreme sharp unilateral pain in chest, difficult to breath

How is Rhinovirus spread (2)?

1. Transmitted through respiratory droplets

2. Transmitted through fomites (grubby hands)

Are Picornaviruses acid stable or labile?

Acid stabile, except Rhinovirus

What is the only Picornavirus that is acid labile?


How does Rhinovirus attach/enter host cells?


What temperature does Rhinovirus grow best at?

Slightly cooler than body temperature (33 degrees) which is why it prefers cooler URT

How is Hepatitis A transmitted in developing countries?

Contaminated water

How is Hepatitis A transmitted in developed countries?

Uncooked shellfish

How do young children present with Hepatitis A?

Often anicteric hepatitis (no jaundice)

Smokers with an aversion tobacco may have...

Hepatitis A

How do symptoms of hepatitis A last?

1 month

What type of vaccine is used for hepatitis A?

Inactivated vaccine

Calicivirus is what type of virus?

Positive RNA virus

Is Calicivirus naked or enveloped?


Does Calicivirus create one long polyprotein that is cleaved by viral proteases?


What is the most common Calicivirus?

Norovirus (Norwalk)

Norovirus (Norwalk)'s family


Who gets Norovirus (Norwalk)?

1. Lots of people in closed quarters

2. Cruises

3. Young children and day cares/schools

What type of food do you get Norovirus (Norwalk) from? (2)

1. Shellfish

2. Buffets

Symptom of Norovirus (Norwalk)

Diarrheal illness- viral gastroenteritis with Explosive watery diarrhea

What type of virus is Flavivirus?

Positive RNA virus

Is Flavivirus enveloped or naked?


Is Flavivirus segmented?


What virus causes Dengue fever?


What virus causes Yellow fever?


What virus causes West Nile?


What virus family causes Hepatitis C


What is the vector of Dengue fever

Aedes Egyptei mosquitos

Another name for Dengue fever

Break-bone fever

Dengue fever type II Features (5)

1. Bone marrow problems
2. Thrombocytopenia
3. Renal failure
4. Hemorrhagic fever
5. Septic shock/death

What is the vector for Yellow fever?

Aedes Egyptei mosquito

Symptoms of yellow fever (4)

1. Jaundice
2. Backache
3. Bloody diarrhea
4. Bloody vomiting

What type of vaccine is there for yellow fever?

Live attenuated vaccine

What is the vector for West Nile virus?


What is the reservoir for West Nile virus?


Symptoms of West Nile virus (5)

1. Encephalitis
2. Meningitis
3. Flaccid paralysis
4. Seizures
5. Coma

What is unique about the envelope of Hepatitis C?

Envelope proteins have antigenic variability making it difficult to make a vaccine

What leads to the antigenic variation in Hepatitis C?

Noproofreading 3'-5' exonuclease activity in virion encoded RNA polymerase

What is associated with Cryoglobulins and what are they?

1. Serum proteins containing IgM that precipitate in cooler temperatures

2. Hepatitis C

Liver enzymes in acute Hepatitis C?

ALT will rise and fall by 6 months in acute infection

Does anti-HCV antibodies indicate acute, chronic, both or neither infection?

Acute or chronic, since HCV mutates a lot

What indicates chronic Hepatitis C infection?

Hepatitis C RNA persisting longer than 6 months

How do you treat Hepatitis C?

1. Ribavirin with IFN-α

2. Protease inhibitors

Rubella is caused by what virus?


What type of virus is Coronavirus?

Positive RNA virus

Describe the coronavirus capsule?

Encapsulated with a helical shape

Coronavirus diseases (4)

1. Common cold


3. MERS (Middle east respiratory syndrome)

4. Acute bronchitis => ARDS

Is HIV enveloped?


What type of virus is HIV?

Diploid Positive RNA virus

What positive RNA virus is diploid?


Gag function

makes p24 for the HIV capsule

Env function (2)

makes glycoprotein 41 (transmembrane protein) and glycoprotein 120 (outer glycoprotein) for the HIV envelope

These are made initially from one polypeptide product

Glycoprotein 41

Transmembrane protein made from Env gene of HIV for envelope

Glycoprotein 120

Outer glycoprotein made from Env gene of HIV for envelope

Pol in HIV

Reverse transcriptase

What cells does HIV initially infect?

1. Macrophages

2. Helper T cells

Where does HIV replicate in the latent period?

Lymph nodes

How is AIDS defined (2)?


CD4 count < 200 OR


AIDS defining illness with any CD4 count

What type of cancer can HIV cause?

Diffuse large B cell lymphoma

How does HIV enter host cells in the early stages?

CCR5 receptor

How does HIV enter host cells in the later stages?

CXCR4 receptor

How do you screen for HIV?

ELISA screening test but could be negative in first 6 months of infection

How do you confirm HIV?

Western Blot

How do you test a neonate for HIV from vertical transmission? Why?

1. Test for HIV RNA and HIV DNA

2. Mother will have passed down antibodies to HIV down to neonate making a false positive since ELISA and Western Blot test for antibodies

What drug do you use for HIV during pregnancy, labor, and post-partum? What class is this?

Zidovudine - NRTI

Maraviroc is what class of drug and used for what disease?

CCR5 inhibitor for HIV

What is the only RNA virus to replicate in the nucleus?


What kind of virus is Orthomyxovirus?

Negative RNA virus

Do Negative RNA viruses bring their own RNA polymerase or use host machinary?

Bring their own RNA polymerase

Do Positive RNA viruses bring their own RNA polymerase or use host machinary?

Host machinary

Is Orthomyxovirus enveloped or naked?


Influenza A, B, C's family


How many segments does Orthomyxovirus have?

8 virus segments

Which RNA viruses are segmented? (4)






Antigenic shift vs antigenic drift

Antigenic shift - segments switch => pandemic

Antigenic drift - point mutations => epidemic (seasonal flu)

Does influenza A cause pandemics, epidemics, or both?

BOTH ie antigenic shift/drift

Does Influenza B cause pandemics, epidemics, or both?

Epidemics only ie antigenic drift only

Hemaglutitinin (HA)

glycoprotein that binds sialic acid on cells of Upper respiratory tract or causes agglutination of RBC

what type of antibodies are protective in orthomyxovirus?

Anti-HA antibodies

For orthomyxovirus what determines tropism (what cells the virus can bind to)?

Hemagluttinin (HA)

M2 protein

In influenza A, M2 protein creates proper pH for viral uncoating


1. Mechanism

2. Use

1. inhibits M2 => no uncoating

2. Treatment for Influenza A only


1. Mechanism

2. Use

1. inhibits M2 => no uncoating

2. Treatment for Influenza A only

Does Influenza A have M2 protein?


Does influenza B have M2 protein?


Neuraminidase (NA)

cleaves sialic acid to allow virus to escape from cell


1. Mechanism

2. Use

1. NA inhibitor => inhibit virion release

2. Treats Influenza


1. Mechanism

2. Use

1. NA inhibitor => inhibit virion release

2. Treats Influenza

What is a major complication of Influenza? What causes this complication?

Secondary pneumonia caused by Staph aureus, or possibly Strep pneumoniae

What happens if a parent gives their children aspirin if they have the flu or other viral illness?

Reyes syndrome - aspirin contraindicated

Reyes syndrome symptoms (5)

1. Uncoupling of electron transport chain in hepatocytes
2. Liver failure
3. Fatty liver
4. Encephalitis
5. Fever

What syndrome is associated with orthomyxovirus?

Guillan-Barre Syndrome - ascending paralysis

What type of virus is Paramyxovirus?

Negative RNA virus

Is Paramyxovirus enveloped or naked?


How is paramyxovirus spread?

Respiratory droplet transmission

Another name for measles


Measles's family


Mumps's family


RSV's family


Croup's family


Measles symptoms

1. Cough
2. Coryza (rhinorrhea)
3. Conjunctivitis
4. Koplik spots (small bluish white spots with surrounding erythema on buccal mucosa)
5. Fever
6. Descending rash starting on the face that is likely to form confluent rash (multiple spots melting together)

Descending rash starting on the face that is likely to form confluent rash


Koplik spots (define and what disease)

1. small bluish white spots with surrounding erythema on buccal mucosa

2. Measles

Complications of Measles (2)

1. Pneumonia
2. Subacute Sclerosing Pan encephalitis (SSPE)

Subacute Sclerosing Pan encephalitis (SSPE)

1. Define

2. Symptoms (4)

3. Diagnosis

1. Post measles infection complication occurring many years later

2. Personality changes

3. Myoclonus

4. Seizures

5. Death

6. Diagnosis: Anti-measles antibodies in CSF

What virulence factors does measles have?

1. HA
2. Fusion protein - forms multinucleated giant cells called Warthin-Finkeldey cells in lymphoid tissue with eosinophilic inclusion bodies

Warthin-Kinkeldey cells

Multinucleated giant cells in Measles formed by fusion protein in lymphoid tissue with eosinophilic inclusion bodies

Is Neuraminidase in Measles?


How do you reduce measles morbidity and mortality

Vitamin A

Where does mumps replicate?

Parotid gland

Mumps symptoms (5)

1. Parotitis

2. Unilateral orchitis (inflammation of the epididymis)

3. Testicular atrophy

4. Impaired fertility

5. Meningitis

What are the virulence factors of Mumps?

1. HA

2. Fusion protein

3. NA

Respiratory Syncytial Virus (RSV) demographic

Infants < 6 months

How does RSV attach to the respiratory epithelium?

G protein

What is the most common cause of pneumonia and bronchiolitis in infants?


Virulence factor of RSV

Fusion protein

How do you treat RSV?

Ribavirin treatment for adults only, but not in pregnant women

Palivizumab use

Prophylaxis for high risk children for RSV such as premature

Laryngotracheobronchitis other name


Parainfluenza virus symptoms (2)

1. Seal bark cough

2. Inspiratory stridor

Virulence factors of parainfluenza virus

1. HA

2. Fusion protein

3. NA

X-ray sign of parainfluenza virus

Steeple sign - narrowing of the subglottic region

Demographic of parainfluenza virus

Usually children, but adults may present as a bad cold

What type of virus is Rhadovirus?

Negative RNA virus

Is Rhabdovirus enveloped or naked?


What is the shape of the capsule of Rhadovirus?

Bullet shaped

What is the shape of the capsid of Rhadovirus?


How is Rhabdovirus transmitted?

Zoonotic virus - most commonly bats

Pathogenesis of Rhabdovirus (2)

1. Glycoprotein binds to nicotinic acetylcholine receptors –initially infects neurons at the post-synaptic motor endplate-replicates here

2. Retrograde from peripheral nerves to dorsal root ganglia-1-3 mm per day

Where does Rhadovirus replicate?

Motor neurons

Symptoms of Rhadovirus (5)

1. Tingling/muscle spasms

2. Increased salivary production

3. Excruciating spasm of throat/larynx muscles - dysphagia

4. High fever

5. Encephalitis

Eosinophilic Negri bodies


What cells do you seen eosinophilic negri bodies in Rhabdovirus? (2)

1. The cytoplasm of Hippocamus pyramidal cells

2. Purkinje cells

How do you treat Rhabdovirus? (2)

1. Passive immunization with human rabies immunoglobulin for post exposure prophylaxis
2. Killed vaccine for active immunization

When should you give the Rhabdovirus vaccine?

Before symptoms appear or else deadly

What type of virus is Filovirus?

Negative RNA virus

What is the shape of the Filovirus capsid?


Is Filovirus enveloped or naked?


When do symptoms appear in Filovirus?

Days to weeks after contracting virus

Symptoms of Filovirus (5)

1. Fever

2. Petechial rash

3. Hemorrhagic fever

4. End-organ failure

5. Hemorrhagic (hypovolemic) shock

How is Filovirus spread? (3)

1. Direct contact with an animal infected such as primates /bats - Africa

2. Health care works taking care of infected

3. Bodily fluids

Filoviruses include (2)

1. Marburg virus

2. Ebola virus

Marburg virus's family


Ebola virus's family


What type of virus is Bunyavirus?

Negative RNA virus

Is Bunyavirus enveloped or naked?


What is unique about the Bunyavirus envelope?

Obtains envelope from golgi body of host cells

Is Bunyavirus segmented?


How many segments is Bunyavirus

3 circular segments

Two major categories of Bunyavirus





Hantavirus's family


Hantavirus reservoir

deer mouse

How is Hantavirus transmitted?

Urine/feces of deer mouse

Symptoms of Hantavirus (3)

1. Pulmonary edema via capillary leak

2. pre-renal azotemiavia capillary leak

3. Hemorrhagic fever

Rift valley fever is similar to....

California encephalitis

Rift valley fever is caused by?

An arbovirus of Bunyavirus

California encephalitis is caused by?

An arbovirus of Bunyavirus

Rift valley fever and California encephalitis symptoms

1. Seizures
2. Encephalitis

How is Rift valley fever and California encephalitis transmitted

Aedes mosquito

Are Rift valley fever and California encephalitis fatal?

Generally not fatal

What type of virus is Arenavirus?

Negative RNA virus, but acts ambisense (can be both negative and positive sense)

Which RNA virus is ambisense?


What type of capsid does Arenavirus have?


Is Arenavirus segmented?


How many segments is Arenavirus?

2 segments

How does Arenavirus look on EM?

Sandy/grainy look

Is Arenavirus enveloped or naked?


How is Arenavirus transmitted?


Lymphocytic choriomeningitis virus (LCV)'s family


Lymphocytic choriomeningitis virus (LCV) symptoms (2)

1. Meningoencephalitis
2. Fever

How is arenavirus inactivated (4)?

1. Heating
2. Low pH
3. irradiation
4. Detergents

What is the only double stranded RNA virus?


Is Reovirus enveloped or naked?


Where does Reovirus replicate?


Is Reovirus segmented?


How many segments is Reovirus?


Rotavirus's family


How is rotavirus spread?


Symptom of Rotavirus

Watery diarrhea

How does Rotavirus cause watery diarrhea?

NSP4 toxin – secretory diarrhea (increase chloride permeability)

What time of year is most common for Rotavirus?


Who is at risk of rotavirus?

Children, daycare

What is the leading cause of severe diarrhea in young children?


Colorado tick virus's family


What separates Colorado tick virus from other diseases like Rocky Mountain Spotted Fever?


Colorado tick virus symptoms (4)


2. Myalgia

3. Fevers

4. Vomiting

Where is Colorado tick virus located?

Rocky Mountain states

How do you treat rotavirus?

oral rehydration

Is there a vaccine for rotavirus and if so what kind of vaccine?

Yes, live attenuated virus vaccine (oral)

When should you give the rotavirus vaccine?

First dose should be given before 3 months of age due todecreased efficacy and increased side effects later

What is the side effect of the rotavirus vaccine?

intussusception = telescoping of the bowel from enlarge ofPeyer’s patches

What type of virus is HSV1 and HSV2?

Linear DNA virus

Is HSV1/HSV2 enveloped or naked?


Are herpes viruses enveloped or naked?


Cowdry bodies

Intranuclear inclusion bodies contained in big red eosinophilic cells seen in HSV1 and HSV2

Initially presents as gingivostomatitis (infection of lipsand gums) – more often in infants


Herpes labialis

cold sore (HSV1)


Serpiginous(snake like) corneal ulcers on fluorescent slit lamp exam - HSV1

What is a significant complication of HSV1?

Temperal lobe encephalitis – hemorrhage and necrosis oftemporal lobes, including fever, seizures, personality changes and olfactoryhallucinations

What is the #1 cause of sporadic encephalitis in USA?


Where is latent HSV1?

Trigeminal ganglia

Describe the HSV1 rash

rashhas “dew drops on rose petal” appearance – clear vesicles sitting on anerythematous base

Herpetic whitlow

morecommon in dentists, vesicles on a finger (can be HSV1 or HSV2)

What hypersensitivity reaction is associated with HSV1?

Erythema multiform – hypersensitivity reaction => smalltarget lesions that move in centrally from the backs of hands and feets, 1-2 weeksafter initial infection

Herpes genitalis

HSV2 – painful vesicular, inguinal lymphadenopathywith red base

Where does HSV2 lie dormant?

Sacral ganglia

What is a significant complication of HSV2?

Aseptic meningitis in adolescents and adults

How do you diagnose HSV? (2)

1. Tzank smear showing multinucleated giant cells,characteristic of herpes infections

2. PCR diagnostic test

How do you prevent HSV breakouts? (2)

1. Acyclovir

2. Valcyclovir

What type of virus is Epstein-Barr virus?

DNA virus

Symptoms of EBV (5)

1. Fever

2. Tender lymphadenopathy (posterior cervical) / can also begeneralized lymphadenopathy

3. Splenomegaly due to T-cell proliferation

4. Pharyngitis

5. tonsillar exudates

What causes the Splenomegaly in EBV?

T-cell proliferation

What do you see on blood smear in EBV?

Reactive cytotoxic CD8+ T cells (Downey, or atypical cells)

What cells are the target of initial infection in EBV?

B lymphocytes

Where does EBV remain latent?

B cells

How does EBV infect B cells?

Envelope glycoprotein binds CD21 on B cells

How does EBV typically present in children?


What happens if someone who you think has Strep pharyngitis is given amoxicillin or ampicillin develops a maculopapular rash?

Actually EBV infection

What cancers does EBV predispose you to?

B cell lymphomas:

1. Hodgkin lymphoma-Reed-Sternberg cells that look like owl’seyes, usually the mixed cellular type

2. Non-Hodgkin’s lymphoma: Endemic or African Burkitt lymphoma–large jaw lesion and swelling

3. Nasopharyngeal carcinoma associated with Asian EBV patients

EBV Nasopharyngeal carinoma is associated with what race?


HIV patients with EBV can develop....

Oral hairy leukoplakia in HIV patients but is non-cancerouslesion (can’t scrape off tongue)

Monospot test mechanism

EBV activates B cells to secrete heterophile antisheep RBCantibodies that will agglutinate sheep or horse RBCs => basis of Monospottest – rapid diagnosis

Treatment for EBV

supportivetherapy but most avoid contact sports due to risk of splenic rupture

What type of virus is Cytomegalovirus?

DNA virus

Cytomygalovirus's family

Herpes virus

Where does CMV remain latent?

mononuclearcells (WBC with one nucleus) – B, T, and macrophages

Can CMV be transmitted cross-placenta?


Symptoms of congenital CMV (6+)

1. Blueberry muffin rash (thrombocytopenia withpurpura)
2. Jaundice and hepatosplenomegaly
3. Sensorineural deafness
4. Intracranial/Periventricular calcifications
5. Ventriculomegaly (large ventricles in brain)
6. Mental retardation or Seizures fromcalcifications/ventriculomegaly

What percent of congenital CMV is asymptomatic?


What is a possible complication of asymptomatic congenital CMV later in childhood?

Sensorineural deafness later in life

When is a pregnant woman most likely to transmit CMV across the placenta? Consequences?

1. second trimester

2. Risk of Hydrops fetalis - severe edema => spontaneous abotion

What is the #1 cause of sensorineural hearing loss in children?


What is the #1 cause of congenital viral mental retardation?


Who is at risk of CMV pneumonia? How do you detect?

1. Organ transplant patients

2. candetect with Buffy Coat Culture(part of blood with WBC and platelets) andincubate with anti-CMV antibodies to detect virus presence

What CD4 count puts AIDS patients at risk of CMV?

CD4 count < 50

Most common manifestation of CMV in AIDS patients

1. CMV retinitis with retinal necrosis described as “pizza pie retinopathy” –blind spots, flashing light, vision loss unilaterally

2. Linear ulcerations in esophagus (singular deep linearcompared to Herpes which is multiple and shallow) – esophagitis

3. CMV colitis with ulcerated walls

Pizza pie retinopathy

CMV retinitis with retinal necrosis - blind spots, flashing light, vision loss unilaterally

Compare linear ulcerations in esophagus in CMV vs Herpes?

Linear ulcerations in esophagus (singular deep linear compared to Herpes which is multiple and shallow) – esophagitis

CMV histology appearance

Owl’s eye inclusion bodies

How do you treat CMV? (2)

Ganciclovir, second line treatment Foscarnet when resistantto Ganciclovir due to mutations in UL97 gene

UL97 gene mutation

In CMV, requires use of Foscarnet instead of Ganciclovir

CMV mononucleosis in immunocompetent patients

fatigue,sore throat, lymphadenopathy with negative Monospot test

What type of virus is varicella zoster virus?

DNA virus

Varicella zoster virus's family


Is Varicella zoster virus enveloped or naked?


Descibe the chicken pox rash (2)

1. Vesicular “dew drop on a rose”rash – surrounding erythema

2. Lesions in different stages ofhealing (unlike small pox which is all the same stage)

Difference between small pox rash and chicken pox rash

Chicken pox- lesions are in different healing stages

Small pox - lesions all same stage

How do you diagnose Chicken pox?

-Tzank smear shows multinucleatedgiant cells (similar to HSV)

What are adults likely to present with as a major cause of morbidity in chicken pox?


What complication in chicken pox can occur in immunocompromised?


What kind of vacccine is available for Varicella zoster virus?

Live attenuated vaccine for children

How do you treat chicken pox?

Acyclovir (children must be 12+)

Where does chicken pox remain latent?

Dorsal root ganglia

How does shingles rash look?

1. “dewdrop on a rose” appearance with dermatomal distribution

2. extremely painful

Does Shingles cross the midline?

Rarely crosses the midline unlessimmunocompromised and is a sign of dissemination

What kind of vaccine is the Zoster vaccine?

Live attenuated virus

At what CD4 count can you give the Zoster vaccine?

CD4 count > 200

How do you treat shingles? (2)

1. Famicilovir OR

2. Valacyclovir

Is Herpes Zoster/Varicella Zoster a Torch infection?


Congenital Varicella syndrome

1. When infected?

2. Symptoms (3)

1. Pregnant with varicella within first 2 trimesters

2. limb hypoplasia

3. cutaneous dermatomal scarring

4. blindness

Human Herpes Virus 6 (HHV-6) causes what disease


What type of virus is Roseola?

DNA virus

Roseola's family


What cell does HHV-6 infect?

CD4 helper T cells => immunosuppression

What age group is at risk of Roseola?

Children 6 months - 2 years

Symptoms of Roseola (2)

1. High fever lasting 4 days, canlead to febrile seizures (>104 degrees)

2. Diffuse macular rash with lacyappearance that spares the face after fever stops (compared to measles whichhas rash that covers face + rash during fever)

Human Herpes Virus 8 (HHV-8) causes what disease?

Kaposi Sarcoma

Who gets Kaposi Sarcoma?

Immunocompromised and specifically AIDS

Symptoms/Location on body of Kaposi Sarcoma (3)

1. Erythematous violaceous lesions onnose, extremities and mucous membranes (plaque, macule, nodule, patch) – newlycreated blood vessels within lesion

2. Lesions can be found within GItract

3. Hard palate lesions

Pathogenesis of Kaposi Sarcoma (2)

1. Causes proliferation ofvasculature
2. Causes dysregulation of VEG-F=> angiogenesis

What cancer can Kaposi Sarcoma cause?

Infection of B cells can causePrimary Effusion Lymphoma (B-cell lymphoma)

How is Kaposi Sarcoma transmitted?

Sexual contact including kissing,especially men who have sex with men

Demographic/Location of Kaposi sarcoma (2)

1. Higher incidence in elderlyRussian men with lower extremity lesions

2. Endemic to Africa

What can Kaposi sarcoma be confused with?

BartonellaHenseleae –(Kaposi has a lymphocytic infiltrate given viral illness)

How do you treat Kaposi Sarcoma?

Anti-retroviral treatment of HIV will improve infection

What type of virus is Polyomavirus?

Circular double stranded DNA

Is Polyomavirus enveloped or naked?


JC virus's family


BK virus's family


The full name of JC virus

John Cunningham virus

What are the two circular DNA viruses?

1. Polyomavirus

2. Heptatis B

What does JC virus cause?

Progressive multifocal Leukoencephalopathy (PML) in immunocompromised?

What CD4 count puts a patient at risk of JC virus?

CD < 200

What does imaging show in a patient with PML?

Non-enhancing multifocal bain lesions in white matter

Pathogenesis of PML?

Demyelination of CNS

Who is at risk of BK virus?

transplantpatients, especially kidney and bone transplants

Symptoms of BK virus (2)

1. Nepropathy

2. Hemorrhagic cystitis

What type of virus is HPV?

DNA virus

Is HPV naked or enveloped?


Verruca vulgaris

1. Cause

2. Define

1. HPV 1-4

2. cutaneouscommon wart (hands and feet)


1. Cause

2. Define

1. HPV 6, 11

2. recurrentrespiratory papillomatosis – tumors develop in airway in children, acquiredduring vaginal birth

Anogenitalwarts – condyloma acuminata cause

HPV 6, 11

What diseases do HPV 16, 18, 31, 33 cause?

Anogenital cancers

Squamous cell carcinoma

Post-coital bleeding

Think Cervical cancer - HPV 16, 18, 31, 33

How do HPV 16, 18, 31, 33 increase risk of cancer? (2)

1. E6 protein responsible forproteolysis of p53 – cell cycle checkpoint at G1/S phase transition

2. E7 protein responsible forproteolysis of RB (retinoblastoma protein-tumor suppressor)

What does Pap Smear show if infection with HPV?

showsKoilocytes (cells infected with HPV) that look like dense bi-nuclei


HPV6, 11, 16, 18 in activatedsubunit vaccine (9-26 years old recommended)

Immusuppresion in HPV.....

Immunosuppression, particularlyHIV which increases E6/E7 activity, put patient at risk for invasive cervical,anal, penile cancer

What is the smallest DNA virus?

Parvovirus B19

What is the only single stranded DNA virus?

Parvovirus B19

Is Parvovirus B19 naked or enveloped?


How is Parvovirus B19 transmitted? (2)

1. Respiratory droplets

2. Vertical transmission (TORCH)

Slapped cheek fever other names (2)

Fifth disease

Erythema Infectiosum

Disease caused by Parvovirus B19

Slapped cheek fever = fifth disease = erythema infectiosum

Slapped cheek fever symptoms (2)

1. Low grade fever for a week =>post fever Rash starts on face and moves downward

2. May present with arthritis + edema in adults

Complication of Parvovirus B19 in sickle cell patients?

Aplastic anemia - cob web look of bone marrow (usually transient)

If Parvovirus B19 is contracted in first 2 trimesters in pregnancy?

Hydrops fetalis

What is the largest DNA virus?

Pox virus

What is unique about the envelopes of Pox virus?

Make their own envelopes instead of taking it from host

Is Pox virus enveloped or naked?


Guarniernibodies (3)

1. Intracytoplasmicinclusion bodies in host cells

2. Sites of viral replication in cytoplasm

3. Pox virus

Dumbbell shaped core is seen with

Pox virus

What diseases are caused by Pox virus? (3)

1. Variola (small pox)

2. Coxpox

3. Molluscum contagiosum virus

Variola other name

Small pox

Variola - symptoms

1. raised blisters on skin andmucosal surfaces

2. lesions are same age for smallpoxversus (all different age for varicella)

Molluscumcontagiosum virus symptom

Flesh colored, dome-shapedumbilicated skin lesions in children, usually on trunk and can occur inmultiple places except palms on soles

How is molluscum contagiosum virus transmitted?

Sexually transmitted

How does molluscum contagiosum virus present in an immunocompetent adult?

Single lesion

Diffuse molluscum contagiosum infection in adults suggests...

HIV infection

What type of virus is Hepatitis B?

Circular, partially double stranded DNA virus

What is a partially double stranded DNA virus?

Hepatitis B

What is the virus family of Hepatitis B?

Hepadnavirus family

Is Hepatitis B enveloped or naked?


What where does replication occur for Hepatitis B?

Intranuclear and cytoplasmicreplication

Mechanism of replication for Hepatitis B

Partially double-stranded DNA=> single stranded RNA => Reverse transcriptase => fully doublestranded DNA

Does Hepatitis B cross the placenta?

No, but still vertical transmission during delivery during mixing of blood

What is the chance newborns infected with hepatitis B will develop chronic infection?


What is the chance adults infected with hepatitis B will develop chronic infection


Hepatitis B features (5)

1. Polyarteritis Nodosa (medium/smallarteries “bead on a string appearance”)

2. Purpuric rash – nonblanching darkmacules

3. Arthralgias

4. GlomerulonephritisMembranous glomerulonephritis –thickened glomerular BM

5. Membranoproliferativeglomerulonephritis – tram track appearance


antigen associated with level of infectivity

What antibody is positive during the window period of Hepatitis B?


What type of virus is Hepatitis D?

Circular Negative RNA virus

Is Hepatitis D an enveloped or naked?


What is worse Hepatitis D superinfection or coinfection?

1. Superinfection = Hep D istransmitted on top of existing Hep B infection

2. Coinfection = Hep D is transmittedsimultaneously with Hep B infection
3. Superinfection is worse

How do you treat Hepatitis B infection?

1. Lamivudine and other nucleosidereverse transcriptase inhibitors and IFN-alpha used to treat chronic infectionand infection of pregnant women

2. Immunoglobulin given to at riskneonates