POSITITIVE ARN VIRUSES

PICORNAVIRUS

ARN virus, positive. They lack of viral envelop, naked virus. Transmitted through fecal/oral,
exception rinovirus que se transmite por el sistema respiratorio. Inside the body the virus uses
the host ARN polimerasa to get translated.

In positive sense virus since the viral ARN is the same sense as the host cell ARNm, can be
translated to proteins directly by the host cell ARN polymerase, the virus can use the host to
translate to proteins.

Negative sense virus needs to use its own ARN polymerase to translate inside the host.

The viral ARN its translated into a long poliportein product with any function (uncleaved) but it
activates when it gets cleaved by viral proteases into smaller active subunits

Differentiate virus that replicate in the cytoplasm between the ones that replicate in the
nucleous. All ARN positive replicate outside of the nucleous, in the cytoplasm. All most all ARN
negative also replicate in the cytoplasm except for some.

Members: 3 main subgroups

Hepatitis A: 5 main hepatitis

A is a picornavirus, causes hepatosplegnomegalia

Enteroviruses: poliovirus, coxsackie A y B, echovirus. Number one cause of aseptic meningitis

(not cause by a bacterial agent)

CSF glucose is normal, shows no organisms (without bacteria), elevated protein

Children most affected by meningitis

Rhinoviruses: primary cause of common cold, it isn’t transmitted fecal-orally but respiratory
infection.

POLIOVIRUS

Positive sense ARN virus, member of picornavirus. Causes polio (casi totalmente erradicado
excepto en Asia-Africa)

Is a naked virus, lacks of viral envelop. Transmitted through fecal-oral route, after entering the
GI tract it stars replicating in linfoid tissue like tonsul or peyers patches (collection of linfoid
tissue in the submucosa of the gut). Takes 2-3 weeks to replicate. Acid stable virus. Then
spreads to the anterior horn of the lower motor neuron cell bodies, causes paralisis (2-3 weeks
following the infection)

Causes an asymmetric paralysis, usually concentrated in lower legs, myalgias, decrease deep
tendon reflexes, respiratory insufficiency (paralysis del diaphragm). Can cause aseptic
meningitis.

There is no treatment, buy you can avoid it by vaccinations. Salk (inactivated or kill vaccine
parenterally) and Sabin (live, attenuated vaccine) Salk only forms IgG not IgA (primary
immunity in mucosal surfaces) The oral (live) Sabin creates both IgG and IgA, can be shed in
feces and possible reverse in a form that can cause paralysis in some people.
COXSACKIEVIRUS

Picornavirus, ARN positive sense, is a naked virus. 2 types of virus: A and B.

Coxsackie virus A: associated with hand, foot and mouth disease, produces a red vesicular
rash. Causes aseptic meningitis. Infection occur during summer months

Coxsackie virus B: can cause a dilated cardiomiopatia, causes devils grip (bornholms
disease/pleurodynia) with extreme sharp pain in the lower chest often unilateral makes
difficult to breath.

Sifilis also causes a ret rash in hands and feet, also rickettsia rickettsi.

Treatment is just supportive.

RHINOVIRUS

Picornavirus, naked virus, ARN positive sense. Transmitted usually though inhalation, is acid
labile cannot go though GI tract and cant be transmitted fecal/orally. Transmitted through
fomites (wash hands). Attaching to host cells attaching to a molecule ICAM-1. Grows best in
cooler temperatures (33° C), grows in upper respiratory tract where the air is cooler. Causes
URI, only affects upper respiratory tract. There are 113 serotipos, its difficult to make a
vaccine, there aren’t any treatment.

HEPATITIS A

Picornavirus, naked virus, ARN positive sense. Affects the hepatic system, causes hepatitis. Is
acid stable, transmits fecal-orally. Can contaminate water supplies, agua no purificada. How to
inactive Hepatitis A in water: chlorinated, bleached, UV irradiated or boiled to 45°.
Contaminated water is a common source in developing countries. It can be transmitted in shell
fish from contaminated water, mainly raw.

Commonly seen in travelers to endemic areas. Often subclonical and can be anicterus (without
jaundice) but can also cause acute hepatitis (fever, jaundice, vomits) Jaundice specially in
adults, in young children is less likely to cause jaundice.

Smokers with Hepatitis A will develop an aversion to smoking tabacco. Treatment: one month
duration on illness, self-limiting, no carrier or chronic state.

Prevention: inactivated vaccine, give to patients in endemic areas, chronic liver injury, men
that have sex with men.

CALICIVIRUS

ARN positive sense, single stranded and naked virus. Produces one long polyprotein that need
to be cleaved by viral proteases into smaller active pieces. Replicates in the cytoplasm.

Norovirus (most common calicivirus): can happen in anywhere with lots of people in close
quarters specially in cruses. Has a strong association with children in day care centers and
school. Consumption on shellfish is associated with Norovirus.

Causes diarrhea illness, a viral gastroenteritis, explosive watery diarrhea.

FLAVIVIRUS

ARN positive sense virus. Enveloped virus. Hepatitis C is a flavivirus. Single segment on ARN,
not segmented.

Causes dengue fever by aedes egyptei. Infects the bone narrow, break bone fever, type 2 is the
most important. Patients can develop thrombocytopenia que increase the risk of bleeding,
type of hemorraghic fever, can lead to renal failure, septic shock and death. Treatment mainly
supportive but mainly hydrated.

Causes yellow fever, aedes egyptei, causes jaundice, backache, bloody stool and bloody
vomiting. There is a live attenuated vaccine.

West Nile virus, birds are reservoir, vector mosquito culex mosquitos. Major complication:
encephalitis, also meningitis, flaccid paralysis, seizures and coma. PCR in CSF. Treatment only
supportive.

Hepatitis C: causes hepatitis, liver inflammation.

HEPATITIS C VIRUS

Es un flavivirus, positive sense ARN enveloped virus. Transmitted by exposure of infected

blood (blood transfusions) most common. IV drug users, needle sharing or sticks, placenta, sex
and breastfeeding. More infectious than HIV. Its envelop protein often vary their antigenic
structure and our immune system can keep up. The virion encoded ARN polymerase lacks of
proofreading 3-5 exonuclease activity, leads to antigenic variation, prone to frequent
mutations.

Acute inflammation can lead to jaundice, right upper quadrant pain, discomfort, enlarge live,
increase liver enzymes. 60-80% of Hep C infections become chronic.

Linfocytes with infiltrate the portal tract, hepatocitos die, some bits of the liver develop
fibrosis y cirrhosis or can reproduce cells and become malignant (hepatocellular carcinoma).

In an acute infection you will find Hepatitis c ARN in serum during first 6 months, ALT will rise
and fall by 6 months.

ALT can be present in active or chronic infection, no protection against recurrent infections.

In chronic infection viral ARN persist in serum after 6 months, a lot of lymphocytes in portal
tract in liver biopsy.

Hep C associated with cryoglobulins (serum proteins containing aminoglublence mostly IgM)
that precipitate in cold temperature.

Treatment: ribavirina + interferon alpha, protease inhibitors (cifosphivir). Protease inhibitors

cut up proteins

TOGAVIRUS

ARN virus positive sense, 2 types of togavirus: arbovirus (arthropod vector) and rubella. There
are different types of arbovirus, western equine encephalitis, eastern equine encephalitis y
Venezuelan equine encephalitis.

Encephalitis: headache, fever, altered mental status, focused neuro deficit.

There is not treatment for arbovirus.

Rubella is a childhood exanthem. Togavirus has an envelope. Rubella has 3 different

presentation: congenital, in childhood and in adult.

In childhood causes postauricular and occipital lymphadenopathy, also named “German

measles” causes a rash, maculopalpular, begins in the face (forehead) and moves downward.
Mild fever, lymphadenopathy, fatigue. The rash of rubella moves faster than the german
measles and it doesn’t darken, the rash is present for 3 days. Can spread by respiratory doplets
by wind.

It can present in neonate, part of TORCHES (Toxoplasma gondii, rubella, CMV, HIV, HSV and
Syphilis. It can cross the placenta and affect the fetus.

Symptoms in neonate: microcephaly, deafness, blindness, mental retardation, cataracts,

jaundice, patent ductus arteriosus, pulmonic stenosis, purpuric blueberry muffin rash and
radiolucent bone lesions.

Main triad: congenital cataracts, sensory-neural deafness and patent ductus arteriosus.

Adult rubella, have lymphadenopathy and fever, arthralgia and arthritis. Rubella has no
treatment but there is a vaccine MMR (cause of autism) they prevent deathly illness, live
attenuated vaccine. Should not be given to pregnant or immunocompromised people (in HIV
patients you have to wait until the CD4 count is high enough, above 200)

Immigrant has more probability to obtain the disease,

CORONAVIRUS

ARN positive single stranded virus, is an encapsulated virus with helical shape. Can cause
common cold and SARS. Different strains cause SARS and middle East respiratory syndrome
(MERS) Can cause acute bronchitis that can lead to acute respiratory distress syndrome.
Diagnose with a test for antibodies for SARS. Confirm with PCR. Treatment broad spectrum
antibiotics, ribavirin or corticosteroids. It replicates in the cytoplasm.

HIV

Human immunodeficiency virus will lead to AIDS. Es un retrovirus, single stranded ARN positive
virus that gets converted to a DNA intermediate by reverse transcriptase, then it incorporates
to the host chromosomes and replicate forever. Is enveloped, diploid RNA positive virus, there
are 2 molecules of positive stranded ARN.

ENV (responsible for protein 41 and 120 that form viral envelope) GAG (gene that makes the
protein p24 that serves as a capsule por RNA strands) , POL (retrovirus don’t have a simple
polymerase, they have a reverse transcriptase to transform ARN into DNA).

GP41 is a transmembrane protein, gp120 is outer glycoprotein that comes in contact with host
receptors.

Transmission primary trough sexual contact, vertical transmission or through blood (needle
sticks or IV drug users) Considered a TORCHES infection. HIV iniatially infects macrophages and
helper T cells

Primary infection or prodrome consist of flu or mono like syndrome with cervical
lymphadenopathy, fever, can last for several weeks, CD4 cells are infected. Then the virus stays
latent for up to 10 years, it replicates in the lymph nodes. After 10 years, CD4 count goes
below 200 and it becomes into AIDS. AIDS diagnose even if CD4 counts are above 200 and
there is a AIDS defining illness. HIV can cause a B cell lymphoma, diffuse large b cell lymphoma.

In order to the virus enter the macrophages t cells there must be fusion of the virus via
receptors of the host cell (CCR5 in early stages or CXCR4 in late stages) once it binds, the virus
enters, encodes, undergoes reverse transcriptase, gets incorporated into host DNA and can
make new virions using the host.

Screening test must be done first by an ELISA test that searches for antibodies, multiple test
should be done at different times after 6 months of possible exposure, a possible ELISA test
calls for a confirmation test → western blot.

Is important to measure viral load and CD4 count using PCR. If an ELISA or Western blot is
done in a baby (mother worried about vertical transmission) is more likely to turn out positive
because mother passes down her antibodies while the baby begins to generate its own, the
mother will have anti HIV antibodies that she will pass down. HIV ARN and DNA nuclei
amplification test is used for babies.

TREATMENT: antiretroviral therapy. Combination therapy is always better because VIH is

prone to variation.

NRTIs are the backbone of antiretroviral therapy, it is a nucleotide analog that get incorporate
in the DNA by reverse transcriptase and haults prolongation. Zidovudina first antriretroviral,
best for pregnant patients, postpartum, mothers can take this drug at 14 weeks of gestation.

NNRTIs it doesn’t incorporate in the DNA but it inhibits reverse transcriptase.

Protease inhibitors, cleave proteins necessary for viral replication.

Maraviroc (CCR5 inhibitor) so that virus cant fuse with host cells.

ARN NEGATIVE SENSE VIRUS

ORTHOMYXOVIRUS

ARN virus, negative sense, they need to be transcribed into positive strand so all must bring
their own ARN polymerase. All are single stranded unless REOVIRUS. ALL ARN negative sense
virus replicate in cytoplasm (exception ORTHOMYXOVIRUS that does in nucleus) It is
enveloped.

Influenza virus, 3 types: A, B, C. It has 8 segments (one of 4 virus that are segmented) the other
segmented virus are: bunyavirus, arenavirus and reovirus (BOAR).

There are 2 categories of mutation, antigenic shift (when antigenic segment ARN are shared
between species and can make new species, causes pandemics) and antigenic drift (point
mutation, causes epidemics and seasonal flu)

Antigenic variation, most recent flu pandemic H1N1 in 2009, called swan flu, result of antigenic
shift between human, avian and swan influenza virus.

Influenza A is the most important, causes epidemics and pandemics, both antigenic drift and
shift. Influenza B causes endemics, associated with antigenic drift.
HA, hemaglutinina, a glycoprotein on surface of influenza virus that binds to sialic acid found
on cells of the upper respiratory tract or RB cells, it calls hemaglutinina because it makes RB
cells come together in test tube. H1, H2 and H3 are the ones that affects humans.

It defines cell tropism, cells that can be infected by the virus. The anti HA antibodies protects
you in the future of infection of the same strain.

Once HA binds to sialic acid on the cell membrane, the virus is endocytose into the cell, then
pH needs to be just right this is done by M2 protein, needed to create a proper pH for viral
uncoating. Amantadine and rimantadine inhibit M2 no uncoating, they are no longer
recommended, only for influenza A because Influenza B lacks of M2 protein.

Amantadine is used for parkinsons disease, to increase dopamine release from CNS by an
unknow mechanism.

The virus will replicate inside the cell, in the nucleus, this viruses become bind to the host cell
after replication by the same sialic acid residue. Neuroaminidase cleaves the sialic acid to
release the newly formed virions from the host cell.

NA inhibitors: oseltamivir, anamivir, they prevent the release of the newly virions. It must be
given earlier-

It spreads by respiratory droplets (December-February season) Vaccine should be given in

October to let the build an adequate response.

Kill form injectable vaccine, it comes in 2 forms trivalent (2A-1B) or quadrivalent (2A-2B) and a
live attenuated intranasal nasal spray vaccine. After 6 months children can receive this vaccine.

Woman 72, cough not productive for 7 days, mialgias, then starts to have a productive cough
and fever (major complication is Pneumonia by staph aureus. When a mother gives aspirin to
kids with flu can develop into Reye syndrome (fally liver, liver failure, encephalitis) In hepatic
mitochondria there is a big damaged.

Avoid aspirin in children with a viral infection or recovering for one.

Influenza infection associated with Guillen Barre, ascending paralisis (starting from the feet
and upwards. CSF high protein with low white blood cell count, albumino dissociation

PARAMYXOVIRUS

Single stranded, negative sense ARN virus. Replicates in the cytoplasm, are enveloped. They
transmit by respiratory droplet.

Vaccine to prevent measles; MMR (live attenuated vaccine) is contraindicated in pregnancy.

Measles goes by other name: rubeola, IS NOT THE SAME AS RUBELLA or RUSSEOLA (causes by
HHB6 exantum suvitum) Childhood rashes.

4 Cs: cough, coryza, conjunctivitis, kolpik spots: first symptoms/predoom stage. Coryza fancy
word for runny or stuffy nose caused by inflammation of the upper respiratory. Kolpik spots
are small, blueish, whit spots found inside the cheek near the second molar.

Fever can get over 40 ° C and can last for 4 days.

After you see the kolpik spots (about a day) the patient will develop a maculopapular rash near
the back of the ear, to the neck, face and moves downwards. Confluent rash, the rash starts as
a small spot and then blends together.

Complication: bacterial or viral pneumonia, subacute sclerosing pan encephalitis (SSPE). The
patient had a history of measles as a child or was never vaccinated then 5.15 years later the
patient develops seizures, myoclonus, personality changes, ataxia, coma or death. To diagnose
anti-measles antibodies id the CSF, there Is no treatment.

Viruses in these family can have some of this virulence factors hemagglutinin, neuroamindase
or fusion proteins. Fusion proteins participate in the formation of multinucleated giant cells or
syncytium. In measles it is called Warthin–Finkeldey cell.

Neuroaminidase is not present in measles.

There is a vitamin that is used to prevent measles: vitamin A, reduces measles morbidity and
mortality.

Other virus: parotitis, replicated in the parotid glands and also in the testes and produces
orquitis. Typically unilaterally, causes atrophy and impair fertility. Other complication:
meningitis. Covered by MMR vaccine. Virulence factor: hemagglutinin, fusion protein and
neuroaminidasa.

Respiratory sincitial virus (RSV) seen in infants menores a 5 months. The virus infects cells by
attaching to G protein to infect respiratory epithelial cells. Causes bronchiolitis, pneumonia,
rhinitis y faringitis, but the most important is that RSV is the number one cause of pneumonia
and bronchiolitis in infants. Virulence factor: they have fusion proteins.

Ribavirin can be used to treat RSV in adults but no to treat babies. Palivizumab a monoclonal
antibody is used to prevent RSH in babies with high risk.

Parainfluenza virus is the cause of croup characterized by seal bark cough and Inspiratory
stridor. It has 3 virulence factors. Characteristic X ray: steeple sign.

Croup mainly affects children, also known as laryngotracheobronchitis.

RHABDOVIRUS

Causes rabies. Single stranded negative sense ARN virus, it its enveloped (bullet shaped) Has a
helical capsid. Is a zoonotic virus, carried by animals and transmitted to humans, the most
common is bats, squirrel, foxes, skunks and other rodents. Has a glycoprotein that binds to
nicotinic acid acetylcholine receptors in the post synaptic membrane of the neuromuscular
junction /motor endplate.

After incubation of weeks and months, the symtomps appear, it depends on the distance of
the site of the inoculation to the CNS, it travels in a retrograde direction via peripheral nerves
into they get to the dorsal root ganglia. While it travels it causes tingling, muscle spasm but
when it spreads to salivary glands causes increase salivary production and spasm of muscles in
the throat and larynge causing disfagia. Then leads to high fever, encephalitis y neuronal
death. They replicate in motor neurons.

Diagnosis clinically and can be confirm on biopsy or autopsy by finding eosinophilic negri
bodies in the hippocampus cytoplasm (affects the pyramidal cells and purkinje cells)
Treatment is by passive immunization with human rabies immunoglobulin given to those
suspected to have rabies after being bitten (preform antibodies) and a kill vaccine to develop
an active immunization.

FILOVIRUS

Negative sense single standed ARN virus, helical capsid. Replicates in cytoplasm is enveloped.

Marburg and Ebola.

Signs of hemorrhagic fever, petechial rash, can start days after contracting the virus. Causes
end-organ failure, eventually fatal as a result of severe blood loss (hypovolemic shock).

It originates with direct contact with animals, monkeys or baths (fruit bath reservoir) in
endemic areas. Transmitted through body fluids.

BUNYAVIRUS

Family of single stranded, ARN negative sense virus. Enveloped virus, it obtains its envelop
from the golgi body complex of host cells. It is segmented (BOAR) 3 circular segments.

Most are arbovirus, arthropod born, an exception is hantavirus (most important) it reservoir is
deer mouse, transmitted through feces and urine.

Causes pulmonary edema via capillary leak and pre renal azotemia (due to loss of fluids). Can
also cause hemorrhagic fever. There are many different kinds, rift valley fever and California
encephalitis, spread by aedes mosquito causes seizures, encephalitis, neurologic symptoms.

ARENAVIRUS

Lowes yield. Single stranded negative sense ARN virus. Replicates in cytoplasm, enveloped. It
has a capacity to encode both positively and negatively (ambisense) Has a helical capsid (other
filovirus and rhabdovirus) Also a segment virus (BOAR) just 2 segments. Visualized by electron
microscopy looks like grain (that’s why its name is arenavirus). Rodent transmission.

Lymphocitic choriomeningitis virus (LCV) leads to febrile aseptic meningealencephalitis. Is

inactivated by heating, low pH, detergent, irradiation.

REOVIRUS

ARN, doble stranded, it doesn’t apply the positive or negative sense, replicates in the
cytoplasm, naked virus. Is segmented, part or BOAR (Bunyavirus, Ortomyxovirus, Arenavirus)
11 segments.

Rotavirus transmitted by fecal/oral route causes a toxin mediated secretory diarrhea, explosive
watery diarrhea. Toxin: NSP4 viral interotoxin that increases chloride permeability that leads to
secretory diarrhea. Seasonal virus, winter time. Population at risk: children, especially in
infants/day care. Number one cause of severe diarrhea in young children.

Treatment: oral rehydration, live attenuated oral vaccine, first dose should be given before 3
months of age, it increases the risk of intussusception (enlargement of Payers patches)

Colorado tick virus, causes fever, vomiting and mialgias, but no rash. Occurs in the Rocky
Mountain but the difference between Rocky Mountain spotter fever is that it doesn’t have a
rash.
 DNA VIRUS

Herpes virus

Herpes simplex, is enveloped, replicates in the nucleus is double stranded and linear.
Intranuclear inclusion bodies (Cowdry bodies) host cells (also in CMV o VZV). Poxvirus has
similar inclusion bodies but in the cytoplasm. Transmitted through sex, saliva, vertically
transmitted TORCH. There are 2 strains: Herpes simplex one, herpes simplex 2.

HSV 1 find in upper half of the body, presents as gingival stomatitis causes inflammation of
lips (called herpes labialis or cold sores) Also causes keratoconjunctivits (serpiginous corenal
ulcers seen on fluorescein slit lamp exam)

Is associated with temporal lobe encephalitis, causes hemorrhage and necrosis of temporal
lobe. Symptoms fever, headache, seizure, altered mental status, personality changes, bizarre
behavior, personality changes, confussion. First cause of sporadic encephalitis in USA.
Maintains latent in trigeminal ganglia (activated during stress)

Causes herpes rash has “dew drops on rose petal” appearance, herpes in finger is called
Herpetic whitlow (more common in dentists and is caused by HSV 1-2) Can cause erythema
multiform (hypersensitive reaction which causes small target lesions in hands and feet, appear
1-2 after infection)

HSV 2 happens down below, transmitted by any action down below sexual or obstetric. Causes
herpes genitalis, painful inguinal lymphadenopathy with clusters, painful, vesicular. HSV2 lies
dormant in the sacral ganglia, can cause aseptic meningitis in adolescents and adults.

PCR is the test of choice for diagnosis, old test is Tzank frotis showing multinucleated giant
cells, characteristic of herpes infections

Treatment, you cant cure it but prevent breakouts. Use acyclovir or valcyclovir.

EBV

Epstein Bar virus is a double stranded DNA, causes infectious mononucleosis. Known by the
name the kissing disease, shared through saliva. Symptoms: fever, tender lymphadenopathy,
patients can also get generalized lymphadenopathy. Reactive cytotoxic CD8+ t cells (also
known as downey or atypical cells) endocytosis seen on blood smear, they can also be natural
killer cells. Splenomegaly due to T-cell proliferation.

When the virus enters a new host it targets the b lymphocytes (can make antibodies or
maintain dormant) EBV remains latent in B cells. To infect the B cells the EBV envelop
glycoprotein bind to cd21. Causes pharyngitis and tonsillar exudates. Strep pharyngitis is seen
in children and adolescent, mono is usually asymptomatic in children, infection in adults is
more likely to be symptomatic.

Patients with mononucleosis treated with amoxicillin or ampicillin develop a maculopapular

rash (adverse reaction)

Associated with cancer, higher risk of developing a b cell cancer (B cell lymphoma). Can be
divided into 2: Hodking lymphoma, not Hodking lymphoma. Hodking lymphoma characterized
by Reed Sternberg cells that look like owls eyes in mixcelullary subtype.
No Hodking lymphoma, Endemic or African Burkitt lymphoma (large lesion in jaw and
swelling). No endemic lymphoma or sporadic lymphoma develops in ileocecum. Also
associated with nasopharyngeal carcinoma (higher in Asian EBV patients) and oral hairy
leukoplakia (most often seen in HIV patients) is non-cancerous, occurs in the lateral portion of
the tongue and look like Candida but you cant scrap it off the tongue.

During the acute infection, EBV activate B cells to secrete anti sheep red blood cells antibodies
(mono spot test/rapid diagnosis)

Treatment: mainly supportive, must avoid contact sports due to risk of splenic rupture.

CMV

Cytomegalovirus, DNA virus, replicates inside the nucleus, part of Herpes virus family. Ramins
latent in mononuclear cells (lymphocytes, monocytes and macrophages) B-T cells. Can be
reactivated when the person becomes immunosuppressed. Can be transmitted through blood,
sexual contact, saliva, breastfeeding, urine. Part of TORCHES (Toxoplasmosis, rubella, CMB,
HIV, Herpes, Sifilis, BCV, Parvo) Rash described as blueberry muffin rash (thrombocytopenia)
same rash as congenital rubella. Also causes jaundice, hepatosplenomegalia, sensorineural
deafness, also causes structural abnormality in the brain, intracranial calcification and
ventricularmegaly, periventricular calcifications (also toxoplasmosis). Can lead to mental
retardation and seizures. Congenital cytomegalovirus is asymptomatic (80-90%), those
affected can develop hearing loss. Second trimester has higher risk of congenital CMV, hydrops
fetalis (heart failure leading to severe edema and leads to abortion)

Number one cause of mental retardation, most common congenital viral infection and number
one cause of sensorineural hearing loss.

Can occur in transplant pacients and HIV patients. Causes pneumonia in transplant pacientes
(buffy coat culture) In AIDS patients are particularly at risk in CD4 are below 50, most common
manifestation is CMV retinitis (pizza pie) Symptoms: vision lost, blind spots, flashing lights. Also
CMV linear ulcerations in esophagus (esophagitis) Distinguish CMV esophagitis from Herpes
esophagitis (CMV is singular, deep and linear/Herpes is multiple and shallow). CMV causes
colitis with ulcerated walls. When it infects cells it causes owls eye inclusion bodies.

Treatment: ganciclovir, foscarnet (when virus has UL97 gene that makes it resistant to
ganciclovir)

People that are not immunosuppressed have CMV mononucleosis (sore throat,
lymphadenopathy and fatigue) Monospot test is negative.

VZV

Herpes virus, enveloped (all are), causes chicken pox (exantum) associated with fever and
headache. Transmitted through respiratory droplets. Rash described as a vesicular lesion with
surrounding erythema (dew drops on a rose petal) “Herpes virus”. Lesions are seen in
different stages of healing. Tzank smear shows multinucleated giant cells. Adults that get
chicken pox can develop pneumonia, encephalitis (especially in immunocompromised).
Varicela vaccine (live attenuated). There is a drug for treat it: acyclovir for children over 12,
adults and immunocompromised. The virus remains latent in the dorsal root ganglia. Under
stress, aging or are immunocompromised VZV can get reactivated, it goes as “herpes zoster or
shingles” has dew drop on a rose appearance with dermatomal distribution. When it
reactivates it travels until it reaches the skin and makes these vesicles, rarely crossed the
midline, if it cruses the midline it’s a signal that they are inmunodepressed. The rash is
extremely painful and after the rash goes away, they can still feel pain (postherpetic neuralgia-
pain after rash subsides) Normally affects the throracic dermatomas but it can affect the
trigeminal nerve known as “Herpes Zoster Opthalmicus” (vision loss possible if V1 affected)

So if a question starts someone immunocompromised with vesicles in the forehead and blind
of one eye → Herpes Zoster Opthalmicus

There is a live attenuated Zoster vaccine, recommended for adults over 60 and should not be
given to pregnant women, leukemia, linfoma. You can give it to HIV if their CD is at least 200.

Treatment: acyclovir and famciclovir, additionally valacyclovir. Congenital infections (vertical

transmission) forms part TORCH. If a pregnant woman gets infected with VZV during the first 2
trimesters the child can develop congenital varicella syndrome (limb hypoplasia, cutaneus and
dermatoma scaring, blindness)

HHV6

Human herpes virus, double stranded DNA virus, also called six disease. HHV6 infects CD4 cells
and has an ability to cause immunosuppression by killing this cells. Roseola or exantum
subitem, occurs in children between 6months and 2 years. High fever that can last 3-4 days,
diffuse macular rash, fever can be so high that produces febrile seizures. After fever has
subsided a rash appears (a diffuse lacy body rash that spares the face) There is not FDA
treatment, just supportive.

HHV8

Causes Kaposi sarcoma, one of HIV illness defining. Double stranded DNA virus. Characterized
by erythematous violaceous lesions from the nose, extremities, and mucous membrane. May
be present as black patch macule or nodule, high vascularity in these lesions cause the
violaceous color (proliferation of vasculature) because it causes angiogenesis by dysregulating
of vascular endothelium growth factor (VEG-F). Lesions can be found in the GI tract, most
common location in hard palate (arch ceiling of mouth) Can also infect b cells and cause a b
cell lymphoma “primary effusion lymphoma”. Transmission is by sexual contact, includes
kissing, increases risk in gay, elderly russian man or people in areas of Africa (endemic) The
diferential diagnosis, is commonly confused with bartonella hensilae (cat scratches) “bacillary
angiomatosis”. The lesions must be examined microscopely. Kaposi sarcoma is accompanied
by a lymphocytic infiltrate versus neutrophilic infiltrate in (bacillary angiomatosis)

Treatment: anti-retroviral if the patient is HIV positive.

POLYOMAVIRUS. JC AND BK.

Naked, double stranded circular DNA virus.

JC virus stands for John Cunningham virus, causes progressive multifocal

leukoencephalopathy. Over half the population has the virus but it doesn’t cause
problems if the immune system is healthy but in immunocompromised it reactivates and
cause PML, affects VIH patients with CD4 less than 200. Demyelinating disease, kill
oligodendrocytes that produces myelin for nervous system, causes non-enhancing
multifocal brain lesions in white matter, progressive. Leukoencephalopathy is a
demyelinating process.
BK virus causes nephropathy, hemorrhage cystitis (also caused by adenovirus in young boys).
Patientes who usually gets BK virus are transplant patients especially kidney and bone narrow.
BK is named after the transplant patients en el que encontraron el virus. 44 year old HIV patient
weakness, visual changes, difficulty to speak, CD4 is 158, You get a brain scam that shows
multiple non enhancing lesions through the brain (JC and PML) or 50 year old
immunocompromised patient with fever and gross hematuria.

PAPILLOMAVIRUS

Human papillomavirus, double stranded DNA virus, parvovirus is the only fully single stranded
DNA virus. Is naked, over a 100+ types but the important are:

HPV 1-4: Verruca vulgaris “cutaneous common verruga” on hands and feet, transmission
requires physical contact.

HPV 6, 11: Laryngeal papillomatosis (11, recurrent respiratory papillomatosis) adquired during
vaginal birth. Anogenital verrugas or condyloma acuminata “anogenital warts from HPV 6 and
11” (sifilis also associated with condyloma acuminate) via sexually transmission.

HPV 16: anogenital squamous cell carcinoma

HPV 18: anogenital cancers (vulvar, vaginal, peneal) infects squamous cells in skins, anus, cervix.
(carcinoma de celulas escamosas)

Also associated with anogenital cancers: HPV 16, 18, 31, 33. Spread through sexual transmission.
Protect with condons and HPV inactivated vaccine, covers 6-11-16-18 name “Guardasil” (9-26).
Doesn’t cover 1-4, 31, 33.

HPV most common STD, this virus is able to disrupt the regulating of the cell cycle. P53 and RB
inhibit the transition from G1 to emphases. HPV encodes 2 proteins: E6 and E7 which promote
the proteolysis of P53 and RB and increases the risk of cancer. P53 (cell cycle checkpoint at G1S
phase) RB stands for retinoblastoma protein (tumor suppressor cells). Inhibiting leads to
neoplasia.

Post coital bleeding (cervical cancer).

Papanicolao (cervical cancer screening) in transformation zone (investigar) this cells koilocytes
(large, dense binucleu)

Important risk factor: immunosuppression (HIV) enhances E6-E7 expression, invasive

cervical/anal/penile cancer.

PARVOVIRUS

Full name Parvovirus B19, naked virus, is the smallest DNA virus. Single stranded. Transmitted
via respiratory droplets, vertically from mother to baby (TORCHES) Causes slapped cheek
disease, fifth disease or erythema infectiosas (when a kid gets low grade fever for a week then
the kid develops slapped cheek rash and then progress into a lasy body rash. Starts on face and
moves downwards.

School teacher with arthritis, joint pain, edema in adults. Aplastic anemia in sickle cell patients,
bone is left with only adipocytes.

Hydrops fetalis in utero (severe fetal anemia, then leads to fetal demise) same as alpha
thalassemia.
ADENOVIRUS

AND virus. First isolated from adenoids (number one cause of tonsillitis and infection on
adenoids) Naked virus, transmitted through respiratory droplets, fecal-oral route. Most
commonly affects children, military barracks and those who frequent public pools. Causes
hemorrhagic cystitis that leads to gross hematuria. Causes viral conjunctivitis. A live attenuated
vaccine only for military recruits.

POXVIRUS

AND virus, make their own envelop instead of taking it from their host. Completely replicated in
the cytoplasm, packs a DNA dependent ARN polymerase (normally found in nucleus) process by
ribosomes into proteins. It doesn’t have to go into the nucleus. Forms intracytoplasmic
inclusions bodies in the cells they infect, type B inclusion or guarnierni bodies, site of replication
in the cytoplasm. Dumbbell shaped core, Is the largest known DNA virus. Causes small pox or
variola characterized by ray blisters on skin and mucosal superficies, the lesions are the same
age. Varicella have a mixture of new ulcers, older, and healing ones.

Cowpox: transmitted by infected cows, Edward Jenner, used to develop a vaccine contra small
pox, small pox only exists in laboratory.

Molluscum contagiosum (flesh-colored, dome-shaped, umbilicated skin lesions) Commonly seen

in children, found everywhere except for the palm and soles, more often trunk, axilla, fosa
poplitea. In healthy adults presents as a single umbilicated lesion (sexual transmission), if it
presents as a diffuse contagiosum infection in adults suggests HIV infection.

HEPATITIS B

Causes hepatitis. Most well known virus from the Hepadnavirus family. Is a DNA virus,
enveloped virus. Most DNA virus replicates in the nucleus but HEP B replicates inside and outside
the nucleus (intranuclear and cytoplasmic replication) Partially double stranded circular ADN, to
an intermediate single stranded ARN, then back to a double stranded DNA, due to reverse
transcriptase. Does not integrate into host chromosomes. Transmitted mainly through sex,
sharing needles, vertically transmission during child birth (blood), drugs. Does not cross
placenta, considered TORCH infection. Hepatitis: right upper quadrant pain, jaundice. Some may
be acute and some chronic, less likely to become a chronic infection in adults, younger kids are
more likely to develop a chronic infection (newborns have 90%)

Prodromal, rash, arthralgia, glomerular nephritis and polyarteritis nodosa (systemic vasculitis
affects median to small arteries) Purpuric rash with non blanching dark macules. Affects the
kidneys causes Hypertension. Causes other renal diseases unrelated to polyarteritis nodosa also
associated with Hep b (membranous glomerulonephritis and membranoproliferative
glomerulonephritis)

Diagnose which stage the patient is in. Viral hepatitis causes an elevation of liver enzymes so
does hepatitis from alcohol. ALT is higher in viral hepatitis. ALT is normal early in neonatal
hepatitis.

First marker of infection is HbSAG (active disease/ Hep B Surface antigen), HBeAg if its high the
person is highly infectious, both are antigens. Symptomatic for the beginning of infection. First
detectable antibody, Anti-HBc (Hep b core antibody) is positive during the window period. Anti-
HBe, there is low infectivety. Anti-HBs indicates recovery (seen in immunization/vaccination)
Causes: Cirrosis, hepatocellular carcinoma.

Hepatitis D cannot cause any disease without hepatitis b, is an ARN negative virus, enveloped,
has circular genome. Requires the HBsAg in order to cause infection. There are 2 types of
infection: co-infection is when both viruses are transmitted at the same time or superinfection
is when Hep D is transmitted on top of existing Hep B infection.

Treatment: acute cases will clear by themselves. It will not eradicate the disease but it will
prevent replication. Use antiboides like limivudine, interferon alfa therapy, NRTIs. If the mother
is Hep B positive you must give the baby anti-hep b immunoglobulin + hep b vaccine.