Sie sind auf Seite 1von 56

Class

Subclass

Subclass

Virus

Enveloped?

Poliovirus

Coxsackie A virus
Enterovirus
Picornavirus

Coxsackie
virus

Non-enveloped
Coxsackie B virus

ECHO vruses
Enterovirus 70
Numbered

Rhinoviruses

Reovirus

Enterovirus 71
Enterovirus 72
(HepA)
Rhinovirus

Rotavirus

Non-enveloped

Adenoviruses

Adenovirus

Enteric
adenoviruses

Non-enveloped

Norwalk virus
(norovirus)

Calcivirus

Non-enveloped

Influenza A
Orthomyxoviruses

Influenza viruses

Enveloped

Influenza B
Influenza C
Parainfluenza (14)

Respiratory
syncytial virus
(RSV)

Paramyxoviruses

Mumps

Measles

Enveloped

Coronaviruse
s

SARS-associated
coronavirus

Enveloped

Other
coronaviruses

Hepadnavirus

Hepatitis B

Hepacivirus

Enveloped

Hepatitis C

St. Louis
Encephalitis Virus

West Nile Virus


Flavivirus

Enveloped
Arboviruses

Yellow Fever Virus

Dengue virus

[Deltavirus]

Hepatitis D

[Hepevirus]

Hepatitis E

Non-enveloped

Lymphocytic
Choriomeningitis
(LCMV)
(zoonoses
)

Arenaviruses

Enveloped

Lassa fever virus

Marburg Virus
Filoviruses

African
Hemorrhagic (zoonoses
Fever
)
Viruses

Enveloped
Ebola Virus

Western Equine
Encephalitis Virus
Arboviruses

(zoonoses
)

Eastern Equine
Encephalitis Virus

Togavirus

Enveloped

Rubella

Parvovirus

Parvovirus B-19

Non-enveloped

HSV-1

HSV-2

VZV

CMV

Herpesviruses

Enveloped

EBV

HHV-6

HHV-7

HHV-8, KSHV

Papilloma virus
(HPV)

Papovaviruses

Non-enveloped
Polyomavirus (now its
own family apart from
Papovaviruses but this is
not in our notes)

JC Virus

Oncoviruses

Human T-cell
Leukemia Virus-1
and -2 (HTLV-1/2)

Retroviruses

Enveloped
Lentiviruses

HIV-1 (HIV-2 in
West Africa)

Smallpox virus

Poxviruses

Enveloped and
Non-enveloped
(can withstand
adverse
conditions
better)

Enveloped and
Non-enveloped
(can withstand
adverse
conditions
better)

Poxviruses

Molluscum
contagiosum virus
(MCV)

Rhabdovirus

Prions (not viruses)

Rabies virus

Enveloped

A-11 to A-12:
A7 for
AWESOME
characterization of
TABLE of
simple
characterization
(unenveloped
of viruses in
viruses)
course

Useful Pages

Viral Inclusion Bodies:


Rabies: cytoplasmic
Negri bodies

Pox viruses:
cytoplasmic
inclusions

Herpes
viruses:
nuclear
inclusions

Nucleic Acid/structure

Virion
Structure

icosahedral
(VP1/2/3,
CD155
binding sites)

+ssRNA, one segment

icosahedral

dsRNA, 10 segments

icosahedral

dsDNA, linear one


segment

icosahedral

ss+RNA

ss-RNA, 8 segments

helical

ss-RNA, one segment

helical

ss+RNA, one segment

helical

circular DNA, ds for most


of length (2 gapped single
stranded regions), one
segment

icosahedral

+ssRNA

icosahedral

circular -RNA

+RNA

-ssRNA

-ssRNA

Long cylinder
(longer than
rhabdoviruses
)

+ssRNA

icosahedral

linear ssDNA

icosahedral

linear dsDNA

icosahedral

circular dsDNA (10 genes


so relies greatly on host
proteins)

icosahedral
circular dsDNA

+ssRNA, two identical


copies

dsDNA, largest nucleic


acid content of all animal
viruses

No symmetry
(only virus
family like
this)

dsDNA, largest nucleic


acid content of all animal
viruses

No symmetry
(only virus
family like
this)

-ssRNA

Helical
nucleocapsid,
bullet-shaped

SEE PAGE F-1 for


Hepatitis!!!

How Virus Multiplies

Binds CD155 receptors

vRNA functions as template for synthesis of mRNA, uses RdRp (packed with virion; hence, RNA
alone not infectious)

Viruses assembled in nucleus, have early mRNA (replication proteins) and late mRNA (structural;
virions)

Packaged with RdRp, HA binds sialic acid recptors, NA cleaves off for viral budding, infects cells
of respiratory tract to cause infleunza

Packaged with RdRp in virion

Packaged with reverse transcriptase, viral DNA gaps filled in nucleocapsid on way to nucleus, late
in infection long RNA created (pregenomes) and packaged in nucleocapsid, are copied via RT into
DNA inside the nucleocapsid while RNA is degraded , virus buds thru plasma membrane

Virion contains host-cell ribosomes (unknown function)

Virus contains host-cell ribosomes (unknown function)

virion adsorbs to cell, fuses with PM, nucleocapsid goes to nucleus, synthesis of
proteins/DNA/mRNA, progeny nucleocapsids assembled in nucleus (nuclear inclusion bodies),
glycoproteins inserted into nuclear membrane that nucleocapsids bud through, glycoproteins in
PM can result in cell fusion (multinucleate giant cells like measles), also has tegument proteins
btw envelope and nucleocapsid

has early and late (capsid) genes early gene can bind promoter to recruit DNApol for genome
replication, all genes essential for virus growth,

RT makes DNA from RNA, DNA integrates into host genome

viral envelope glycoprotein gp120 binds host CD4, cellular CXCR4 or CCR5 (chemokine coreceptors) needed for absorption, gp41 mediates envelope fusion, HIV is a nondefective virus

Virus carries DdRp in virion to make mRNA (only DNA virus that encodes own RNApol), virus
multiplies in cytoplasm (forms inclusion body when histologically stained)

Virus carries DdRp in virion to make mRNA (only DNA virus that encodes own RNApol), virus
multiplies in cytoplasm (forms inclusion body when histologically stained)

Packaged with RdRp, cytoplasmic Negri bodies

L-4 polymerases, L-5 routes of infection, L-6 vaccines

Transmission Route

Disease(s) Caused

General Epidemiology

polio (paralytic or bulbar),


aseptic meningitis

fecal-oral

aseptic meningitis, rash,


colds, herpangina, handfoot-and-mouth disease
(children)

seasonal infection (fall highest),


leading cause of aseptic
meningitis, infects males more
often, rarely fatal

aseptic meningitis, rash,


colds, neonatal myocarditis,
epidemic pleurodynia
rash, leading cause of
aseptic meningitis
Acute hemorrhagic
conjunctivitis
HFMD, CNS infections
Hepatitis A
airborne

colds

MOST COMMON cause of


colds

fecal-oral

rotavirus gastroenteritis

peaks in winter, endemic


worldwide (poor countries)

airborne

colds, conjunctivitis

stable when dried

fecal-oral

gastroenteritis, diarrhea

fecal-oral

adolescent/infant
gastroenteritis

Seen on cruiselines, school,


nursing homes, camps rare
complications highly
infectious

airborne

Influenza (fever, chills,


aches), can lead to
pneumonia

most deaths in elderly and


infants, usually associated with
underlying respiratory
insufficiency (CPD, etc.)

non-systemic respiratory
disease, croup

non-systemic respiratory
disease, lower respiratory
infection, pneumonia,
induces giant cells

airborne

no major shifts in antigenicity


(single segment of RNA), cause
severe febrile lower respiratory
infection on initial infection,
infection does not result in
lifelong imunity, causes
hemagglutination

Mumps, orchitis, aseptic


meningitis

Lifelong immunity from


infection, IgG neutralizes, long
incubation period, antigenically
related to parainfluenza

Measles, encephalitis,
pneumonia, otitis media,
rare giant-cell pneumonia
(w/o rash when cellmediated immunity is
defective), subacute
sclerosing panencephalitis
(SSPE), photophobia

Lifelong immunity from


infection, IgG neutralizes, long
incubation period, not related to
parainfluenza, most contagious
disease known, almost never
causes subclinical infections

SARS
airborne, others?
common cold

Hepatitis B, hepatocellular
carcinoma

High incidence with IV drug


users, unsafe male homosexual
sex, 5% cases become chronic
(2-4% of chronic develop
primary hepatocellular
carcinoma), 90% perinatal
transmission results in chronic
HBV carriers where 25% of
carriers will die of liver
carcinoma or chronic hepatitis

Hepatitis C, hepatocellular
carcinoma

75% chronically infected, 20%


develop cirrhosis or
hepatocellular carcinoma 10-20
years after acture HCV
infection results in 10k dpy in
US, 4 mil Americans chronically
infected

arthropods (mosquitoes; urban/rural


habitat), wild/domestic birds

Encephalitis

requires multiplication in
arthropod host (usually 2
incubation periods; intrinsic 7
days in humans; extrinsic 14
days in arthropod), humans are
dead-end hosts b/c not high
enough viremia

humans, Aedes aegypti mosquito


(jungle yellow fever can infect tree
mosquito and monkeystree
mosquito infects human, which then is
bitten by Aedes aegypti)

Yellow fever

only in rural tropical Africa and


South America

Aedes aegypti mosquito, humans

Classical Dengue ("bonebreak fever"), dengue


hemorrhagic fever (fatal)

found in tropics/subtropics, esp


in S.E. Asia and Caribbean
islands, humans are not deadend hosts

Parenteral transfer of blood, sexual


transmission, perinatal infection of
neonates (more likely to result in
chronic disease and cause primary
liver carcinoma)

STD, needle-sharing, blood


transfusion, perinatal

only infectious in people infected with


HepB as well

Hepatitis D

Immunity to HepB induced


HepD immunity (does not
encode envelope proteins)

fecal-oral

Hepatitis E

fecal-oral

ingestion/inhalation of mouse excreta


(endemic in mice), transplacental

lymphocytic
choriomeningitis, aseptic
meningitis, fetal abortion,
congenital hydrocephaly

Many subclinical cases, few


deaths (infiltration of CNS),
endemic disease of mice

Lassa fever, pharyngitis

Natural reservoir is African rat,


1/3 of hospital cases fatal,
human-to-human transmission
common in hospitals with fatal
infections of medical personnel

Person-to-person, from African rat


excreta

Human contact between open skin


lesions/membranes and
blood/tissue/bodily secretions of
infected person from animals
(rodent?)

Marburg hemorrhagic fever


Many epidemics in medical
personnel, gloves/face masks
reduce transmission
Ebola hemorrhagic fever

mosquito habitat: rural


wild birds, mosquitoes (humans and
horses dead-end hosts)

Encephalitis

airborne

Rubella (German Measles),


congenital rubella

most deadly arbovirus


encephalitis in US, mostly
infects children in
swampy/wetland areas
(mosquito habitats)
after multiplies in respiratory
epithelium, viremia develops
less contagious than measles

airborne

Transient aplastic crisis,


erythema infectiosum
(childhood rash = slapped
cheek), hydrops fetalis if
infected in first or second
trimester

often subclinical infection, can


cause acute arthritis (most
common symptom), infection
during pregnancy can cause
fetal death via edema (hydrops
fetalis)

saliva

herpes, cold sores, herpes


simplex encephalitis/keratitis

primary infection often


subclinical often recurrent
infections

sex, perinatal infectiion

genital herpesm neonatal


herpes simplex (perinatal
infection, 6 days after birth)

most fatal perinatal infection is


acute primary infection around
time of delivery, hepato-adrenal
necrosis in neonates

airborne, cotact with lesions

chickenpox (primary
infection), zoster/shingles
(recurrent disease),
congenital varicella
syndrome

winter-spring epidemics every


few years, patients with
impaired immune response get
severe/fatal chickenpox

mononucleosis-like, most
frequent viral congenital
infection

infected cells large with nuclear


inclusion, primary infections
before puberty often
subclinical,infection of nursing
infants is asymptomatic, most
frequent viral congenital
infection

close contact, nasopharyngeal fluid,


semen, urine, vaginal secretions

mononucleosis, oral hairy


leukoplakia or tumor (in
most common cause of
immunocompromised),
infectious mononucleosis,
Burkitt's lymphoma (esp
disease of teenagers and young
first-basing (kissing, duh!), close oral
African boys),
adults, immortalizes B-cells,
contact, shared items
nasopharyngeal
virus found in saliva and
carcinoma,hepatitis, fatal
produced by lymphoid cells in
lymphoproliferative disease
oro-pharynx
in pts w/mutation that blocks
cell-mediated immunity

roseola infantum (system


infection w/rash in infants),
MS, CFS, epilepsy

none known

90% prevalence worldwide, 1%


have HHV-6 integration

Kaposi's sarcoma

direct contact, sexual contact,


perinatal

most frequent neoplasm in


persons with AIDS, 15-20%
AIDS patients develop KS

1/3 college women have HPV in


Papillomas (plantar genital,
cervix, 80-90% of cervical
and anogenital warts),
carcinomas have HPV
cervical carcinoma,
integrated into host genome,
condylomas, association
other cofactors like smoking can
w/H&N cancers
cause cervical carcinoma

aerosols

progressive multifocal
leukoencephalopathy (PML)

Occurs in
immunocompromised, slow
virus

sexual contact, blood, breast milk


(horizontal transmission)

adult T-cell leukemia (ATL;


from HTLV-1), cutaneous Tcell lymphoma

endemic in southern Japan,


central Africa, Caribbean
0.025% incidnece in US

HIV, AIDS

3 stages early stage with


mono-like symptoms + high
viremia, middle stage 3-10
years latency with decline in
CD4 cells, late stage is AIDS
and immunodeficiency HIV-1
infected women progress to
AIDS faster than men of same
viral load

Smallpox (papules, vesicles,


pustules)

Oral mucosa lesions likely


cause of spreading infection,
smallpox has been eradicated
by immunization (ring
vaccination around any cases
found), no non-human
reservoirs and no subclinical
infections

sexual contact, blood, tears, vaginal


secretions, breast milk,
transplacental, perinatal

airborne

Intimate cutaneous contact (Owowwww!!!) often among young


children, wrestlers, and lovers

Molluscum contagiosum

Self-limiting disease (may take


months/years to subside)

Bite from infected animal (virus in


saliva) - viremia not required

Rabies

Infections in humans and dogs


nearly always fatal, long
incubation allows successful
immunization after infection,
treatment will not work after
virus invades CNS, 30,000
people in US treated per year
for possible infection SINGLE
antigenic type

Consuming brains

Kuru

inherited mutations, spontaneous


mutations, corneal transplants + GH
preparations (iatrogenic)

Creutzfeld-Jacob Disease
(CJD)

Consuming beef from infected cows


(who were fed brains/bone marrow of
cows/sheep)

Variant CJD ("mad cow")

I9 for HSV primary vs. recurrent


infections

I-14 for chemotherapy of


viral diseases (not including
AIDS)

J-1 for tumor viruses and


cancers caused

Epidemiology

Pathogenesis

Incubation
Period

0.1-1% paralytic rate in older groups

Virus swallowed, multiplication in


tonsils/Peyer's patches/ lymph nodes of SI
and fecal-oral excretion of virus (route to
next person via environment or hands),
invasion of CNS (via viremia) in cases that
cause paralysis, circulating Ab too late to
prevent CNS invasion (paralysis occurs
despite Ab)

2-3 weeks

Acute onset

~ 30 days

stable in environment (daycare problem),


large titers shed in feces

stable in environment (daycare problem),


large titiers shed in feces
leading cause of aseptic meningitis, stable
in environment (daycare problem), large
titiers shed in feces

0.1% mortality
poor growth at body temperature and low
pH, 80+ antigenic types

Common cause of infectious diarrhea in


infants (most infected by 2yo), major cause
of infant mortality in developing countries

3-10 days

Seen in shellfish/salad (contamination),


increased susceptiblity in blood type O
individuals

droplets infect upper rispiratory tract,


infection may extend to lower respiratory
Epidemics 2-3 years, Pandemics 10-30
tract destroys ciliated epithellium in
years (from antigenic shift of recombination respiratory tract, viremia uncommon (no role
with other viral host)
in pathogenesis), systemic symptoms
caused by toxic components from sites of
growth to cause H/A and muscle pains...
complicated by pneumonia (sometimes
secondary to bacterial pneomonia;
pneumococcus most common;
staphylococcos most fatal)

3-6 days

Epidemics 3-6 years


Minor clinical significance
Most common cause of croup (acute
laryngo-tracheo-bronchitis), peak incidence
at 2 yo

most frequent cause of severe lower


respiratory infection in infants and
significant infection of elderly

30% infections subclinical, no antiviral


therapy, MMR vaccine (live-attenuated)

Viremia important primary infection in


respiratory epithelium/local lymph nodes that
results in viremia to infect other organs.
Mumps grows in parotid gland and is
excreted in saliva before/after swelling

Local epidemics every 3rd winter (before


vaccine), needs large population to survive,
Viremia important primary infection in
cell-mediated immunity important in
respiratory tract and multiplies in
clearing infection, 5-25% measles mortality
epithelium/local lymph nodes/conjunctiva
in developing countries SSPE results
results in viremia 3 days prior to rash, virus
from people with uncomplicated measles
excretion from respiratory tract and in tears
infections from 4-17 years previous and at
and urine for a few days before/after rash
early age (2yo)

18-21 days

14 days

in adults, severity increasses with age,


case-fatality rate of 9%, first appeared in
China then spread worldwide, but
quarantine may have stopped spread

2-10 days

CD8+ cells recognize HBV peptides


HBeAG correlated with presence of
presented by MHC I, kills hepatocytes (killing
infectious HBV and progression to hepatic
+ regeneration leads to
carcinoma in chronically infected patients,
mutations/transformation of cells), tumors
responsible for 500k cancer deaths
have integrated HepB DNA (but not required
annually
for replication)

~ 70 days
(insiduous
onset)

CD8+ cells recognize HCV peptides


presented by MHC I, kills hepatocytes (again
higher chance of mutations), virus does not
integrate into the genome

~60 days
(insiduous
onset)

Generally infects adults over 50yo, 10%


cases fatal (mostly in elderly), many
subclinical infections, St Louis from N
America, West Nile from N Africa and
Middle East

Encephalitis after 7 day incubation period,


viremia from multiplication in vascular
endothelium, prodromal febrile malaise
followed by encephalitis with
paralysis/coma/death
7 days

High mortality, some subclinical infections

Primary infection in vascular endothelial


cells, then viremia, then secondarily infects
liver and other organs (spleen, kidney)

severe but not usually life-threatening


disease, 4 antigenic types

dengue hemorrhagic fever from massive


macrophage infection --> cytokine storm
(after sequential infections w/2 diff
antigentically cross-reacting dengue viruses)

7 days

2-30% mortality, acute onset with severe


pathology

~50 days (acute


onset)

20% mortality in pregnant women of


developing countries

~ 30 days (acute
onset)

Immune response appears to be cause of


pathyology in lymphocytic choriomeningitis
(similar to measles virus)

consequence of the cell-mediated immune


response

Death of 50% of hospitalized patients

Disruption of vascular system, widespread


hemorrhages common

10% clinical cases fatal, many subclinical


infections, infects infants and adults over
50 yo

humans and horses are dead-end hosts,


virus maintained by birds and mosquitoes

75% clinical cases fatal, some subclinical


infections, generally infects children under
10 yo

humans and horses are dead-end hosts,


virus maintained by birds and mosquitoes

sometimes subclinical infection, can be


more severe in adults, can cause transient
arthritis all infections produce lifelong
immunity

multiplies in respiratory epithelium can


cross placenta during pregnancy to cause
congenital rubella (earlier infectied, more
likely to have defects -esp 1st trimester)

7 days

18 days

Patients with pre-existing RBC deficit


(anemia, sickle cell anemia) have more
severe infection = Transient Aplasic Crisis

infects RBC precursors (inhibits RBC


production during incubation)

7 days

latent infections activated by fever, UV


light, emotion (virions transported down
axon to site of initial infection, produce cold
sores) 80% seroprevalence in adults

primarily infect nose/eyes/fingers/mouth


travels into sensory ganglia for latent
infection

7-14 days

can cause recurrent infection, 20% of US


population seropositive, vaginal lesions
before delivery indication for C-section

primarily infect sensory ganglia in genital


region (sacral ganglia)

7-14 days

zoster risk increases after 50 yo (decline in


cell-mediated immunity),
immunosuppressed pts at risk for
disseminated zoster (spread by viremia)

infection in respiratory tract followed by


viremia, latency established in sensory
ganglia, monocyte infiltration of involved
ganglion

14-21 days

appears like mononucleosis with negative


heterophile test, transmission common in
virus can cross placenta to cause congenital
nursery schools, can be post blood
disease, latent infected cell type unknown
transfusion complication, recurrent disease
only in immunocompromised

3-12 weeks

Burkitt's lymphoma most frequent


childhood tumor in Africa, boys at greater
risk, if untreated will die in 6 months can
also cause nasopharyngeal carcinoma,
Hodgkin's disease, gastric carcinoma, AIDS
patients tumors

4-6 weeks

infects B-cells (attacked by CTLs) for


Burkitt's lymphoma, often involves
translocation placing c-myc protoncogene
under Ig promoter

tumor cells express high cellular VEGF (for


vascularization)

condylomas (from nononcogenic HPV 6b


and 11), >75% cervical carcinomas from
HPV16 and HPV18

in warts the viral genome is not integrated, in


cervical tumors, early genes are integrated.
early genes E6 binds p53 to inactivate it and
E7 binds Rb to inactivate it (both tumor
suppressors)
Demyelinating disease of brain that infects
oligodendeoglia, no inflammation,
reactivation of JC virus causes PML that
progresses to
blindness/dementia/coma/death within 6
months

ususally asymptomatic, 0.1% infected


individuals develop ATL after 10-30 year
latency

viral tax protein is transcription factor that


induces IL-2 and receptor for autocrine loop
for transformation

AIDS patients have increased susceptibility gradual depeltion of CD4+ cells, suppression
to opportunistic infections and tumors
of cell-mediated immunity (variable
(Kaposi's sacoma, B-cell lymphoma,
progression to AIDS), cytopathic effect, CTL
autoimmune thrombocytopenia, chronic
destruction of infected cells, apoptosis of
lymphadenopathy, dementia/diffuse brain CD4 cells, HIV also targets CD4 Th17 cells
disease in later stages of infection)
(imp for mucosal imm -- bacteria)

Respiratory infection leads to more severe


infection, vaccination halted in US in 1971
(vaccine protects for 10-20 years, partial
immunity for longer), weaponized by
Soviets (Yarr!), current policy to vaccinate
medical and other personnel, use ring
vaccination to prevent outbreak

Primary infection in upper respiratory tract


with growth in mucosa/lymph nodes, then
viremia allows to spread to
lungs/liver/spleen, secondary infection in
skin (via viremia) causes
papules/pustules/vesicles

Diagnosis difficult, virus grows poorly in


culture

2-8 weeks

Prophylactic immunization recommended


for residents where rabies is common and
Travels from bite site into nerve cells, travels
for vets bite wounds should be washed
to CNS, then can go from CNS to salivary
to remove virus transmission in US from
glands
wild animals, dogs required to be
vaccinated most rabies in US from bats

limited to stone-age tribe in New Guinea


(Fore tribe), caused 1/2 total mortality at
peak, transmissible via brain products, low
incidence now with reduced cannibalism

Progressive degenerative disorder of CNS


(especially cerebellum), causes spongiform
encephalopathy

Most common human spongiform


encephalopathy, transmitted to primates,
can be result of inherited mutation (most
spontaneous), some iatrogenic via corneal
transplants and GH preparations

Spongiform encephalopathy

Outbreak in England linked to eating beef


from infected cows

Spongiform encephalopathy of cows (mad


cow disease) from using brains/marrow of
cow/sheep for bovine food

Weeks to
months

J-23 for infecyions in AIDS patients

Signs & Symptoms

Lab Diagnostics

Killed (Salk) Vaccine:


formaldehyde-fixed vaccine of
3 serotypes, not originally
given much in US but now
preferred since low risk, IM
injection
Live Attenuated
(Sabin) Vaccine: viral mutants
that grow in gut but do not
invade CNS, oral, causes gut
proliferation/viremia

Aseptic meningitis: H/A. stiff neck,


fever, increased leukocytes in CSF
Spinal polio: destroys motor neurons
withered leg, equinus foot Bulbar polio:
attacks respiratory centers in
medulla/cranial nerves
Herpangina: sore throat, generalized
infection, characteristic ulcerating
vesicles in throat
Hand-foot-andmouth disease: in children, viremic
disease, vesicular lesions appear at
same time Generalized
Neonatal myocarditis:
infection in infants (and heart- often
fatal) Epidemic pleurodynia: thoracic
pain aggravated on deep breath
(Devil's grip)

Vaccines

isolation/cell culture, rising


antibody titers, PCR for RNA in
CSF (aseptic meningitis cases)

None

isolation/cell culture, rising


antibody titers, PCR for RNA in
CSF (aseptic meningitis cases)

None

None

anorexia, nausea, fever, jaundice

Diarrhea

LFTs, serological tests (anti-HAVIgG/M comparison)

Formaldehyde-killed vaccine

Trachea organ culture

Too many serotypes

Live-attenuated vaccines
available (Rotarix, RotaTeq)

fevers, chills aches

Trivalent seasonal killed


Lab diagnosis by virus isolation in
vaccine: 2 influenza A viruses,
eggs/tissue or by comparison of
1 B virus need IgA so
acute vs. convalescent sera
immunity only lasts 3-10
looking for rise in anti-HA Ab via HI
years FluMist (liveassay rapid diagnosis via
attenuated intranasal spray
fluorescent Ab on throat swab
vaccine) effective in children
specimen

fever, croup: dyspnea and stridor (high


pitched inspiration)

Hemagglutination
fever

Prodromal fever/malaise/anorexia
followed by uni/bilateral swelling of
parotid glands. Usual presenting
symptom is parotiditis.

No vaccines available

Hemagglutination

Prodromal: fever, cold-like symptoms,


Koplik spots (bright red lesions with
central white spot on buccal mucosa), Hemagglutination, multi-nucleaed
conjunctivitis, photophobia anergy of giant cells in lymph tissue (result of
cell-mediated immunity severe
virus-induced cell fusion), SSPE:
hemorrhagic rash in fatal cases (death
see inclusion bodies w/helical
from fatal synergism of measles and
nucleocapsids + high Ab titers to
malnutrition) SSPE symptoms
measles virus + CNS has measles
include insidious onset of intellectual
antigen
deterioration/psych disturbances/fatal
with terminal paralysis and blindness

Live-attenuated vaccine
(MMR; twice)

Live-attenuated vaccine
(MMR; twice)

dry cough, dyspnea

anorexia, nausea, fever, jaundice,


prodromal rash/arthritis

Serological tests for HB-Ags (core


and surface), PCR test

anorexia, nausea, fever, jaundice,


prodromal rash/arthritis

Serological and PCR tests

At birth from HBV infected


mother: neonate given
passive anti-HBV Abs AND
vaccine immediately after
birth inactivated subunit
vaccine against HBV surface
Ags

fever, malaise

fever, nausea, jaundice

fevere, severe headache, muscle and


joint pains, rash dengue hemorrhagic
fever causes patient to vomit
blood/hemorrhage/go into shock (most
often in native pop)

live-attenuated vaccine (17-D


vaccine) gives lifelong
protection

Serological or PCR test of unique


HepD protein

HBV vaccine protects

mild influenza-like disease

Widespread hemorrhages, bleeding


from the eyes

rash lasts 3 days with


fever/lymphadenopathy congenital
rubella can cause cataracts/heart
defects like patent ductus
arteriosus/deafness/retardation of child
(also spontaneous abortion)

live-attenuated vaccine (MMR;


2 doses)

normal people have asymptomatic


infection OR ///fever, malaise, rash
(erythema infectiosum caused by
immune complexes) keratitis
presents with red
eye/irritation/photophobia (can cause
blindness)

cold sores, stomatitis (with vesicles in


mouth), encephalitis (temporal lobe),
keratitis (red eyes)

PCR detection in CSF for herpes


simplex encephalitis

lesions on genitalia, primary infection bilateral lesions or asymptomatic,


recurrent disease - fewer lesions that
are unilateral
fever, rash, lesions congenital
varicella can result in limb
atrophy/scarring of skin post-herpetic
neuralgia (pain after zoster lesions
heal), zoster lesions have unilateral,
dermatomal distribution
congenital CMV can result in
microcephalic mental retardation with
intracerebral calcifications, neurosensory deafness, jaundice, enlarged
liver/spleen, anemia//
immunosuppressed get generalized
infections, AIDS pts have high
incidence of retinitis and gastroenteritis
caused by CMV

live-attenuated (reduces
clinical infecions by 85%,
reduces severe infections by
97%, elderly should receive
booster

mononucleosis with negative


heterophile test, owl's eye
inclusion bodies

heterophile test (antigenic crossfever, sore throat, lymphadenpathy


reactivity of Abs to EBV and sheep
oral hairy leukoplakia (white patches on
RBCs), Ab does not neutralize
tongue/buccal mucosa)
EBV

systemic infection with rash in infants,


high fever

experimental live virus vaccine

multiple, pigmented, highlyvascularized nodules on skin

Pap smears

Primary infection: mono-like or flu-like


with fever/enlarged lymph
nodes/tiredness/headache

Papules, vesicles, pustules

recombinant vaccine based


on viral capsid protein

ELISA (forv viral antigens gp41 or


p24), Western blot (less sensitive
but more specific than ELISA),
PCR for HIV RNA

Live-attenuated (use vaccinia


virus)

Pearly white papules

Initial symptoms: fever, anorexia,


hydrophobia late symptoms is
coma/paralysis/death., causes
encephalitis

Negri bodies (cytoplasmic


Killed vaccine (human diploid
inclusions) in nerve cells ,
cell vaccine, highly
fluorescent Ab to confirm inclusion
immunogenic and very safe)
bodies are rabies virus

Chemotherapy

Passive immunization

Rehydration therapy

Tamiflu and zanamivir: NA


inhibitors reduce symptomatic
period 1-2 days only effective if
given early, resistance against
these drugs increasing
Adamantanes (not recommended
in US since many A viruses have
resistance against it and do not
inhibit B viruses) effective in
combination with NA inhibitors
against H1N1 viruses, given before
infection, nontoxic.... amantadine
inhibits Influenza A uncoating

severe croup treated with


glucocorticoids
Ribovirin: aerosol to treat RSV
(efficacy unknown) in high-risk
patients and severe infections
Passive immunization of high-risk
infants (premature, pulmonary
displasia) with mAb against RSV
(prevents severe RSV pneumonia)

Vitamin A reduces mortality, but no


antiviral therapy available

alpha-IFN and lamivudine (RT


inhibitor)

alpha-IFN, Ribivirin, and


telaprevir/boceprevir (essential
HCV protease inhibitors)

HBV treatment protects

Passive immunization from serum


with patients who survived
infections

Passive immunization with pooled


IgG for people with immunological
defects that result in prolonged
anemia

trifluridine for recurrent keratitis,


adenine arabinoside for
encephalitis, acyclovir for systemic
infection and for encephalitis

acyclovir

Passive immunization with IgG


(VZIG), acyclovir (can reduce risk of
post-herpetic neuralgia too),
foscarnet

ganciclovir, Foscarnet (PPi


analogue)

HAART, nucleoside analog RT


inhibitors (AZT), non-nucleoside RT
inhibitors, protease inhibitors, entry
inhibitors (Fuzeon), integrase
inhibitors (isentress), CCR5
inhibitors (maraviroc)

Passive immunization with human


vaccinia-immune globulia for
severe infections

Passive immunization
(hyperimmune human serum; given
to delay symptoms)