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99.

ADENOVIRUSES

ADENOVIRIDAE

Species

-

Adenovirus Type 1

-

Adenovirus Type 2

-

…Adenovirus Type 41 (…you get the drift)

Characteristics

-

linear double-stranded DNA genome

-

icosahedral capsid (multifaceted protein coat)

-

non-enveloped (“naked”, not surrounded by a cell membrane)

Reservoir s

-

humans (only reservoir, not normal flora - as are all other viruses)

Transmission

-

direct contact (“person-to-person”)

-

droplet nuclei (“respiratory spray”)

-

fecal-oral

-

contaminated fomites (indigestible objects)

Disease s

The Common Cold

 

-

fever, rhinitis leading to rhinorrhea and pharyngitis leading to sore throat

-

may complicate by progressing to laryngotracheobronchitis and viral interstitial pneumotitis

-

primarily occurs in children

-

caused by Adenovirus infection of the nasopharynx

 

Keratoconjunctivitis

 

-

“pink eye”

-

keratitis and conjunctivitis leading to conjunctival hyperemia and

 

preauricular lymphadenomegaly

 

-

caused by Adenovirus infection of the eye

Pharyngoconjunctival Fever

-

fever, rhinitis, pharyngitis, conjunctival hyperemia and preauricular lymphadenomegaly

-

caused by simultaneous Adenovirus infection of the pharynx and eye

 

Gastroente ritis

 

-

abdominal pain vomiting and watery diarrhea

-

caused by Adenovirus infection of the GI tract

Treatment

-

oral fluid and electrolyte replacement (if gastroenteritis)

-

1 -

100. HERPES SIMPLEX VIRUSES

HERPESVIRIDAE

Characteristics

-

linear double-stranded DNA genome

-

icosahedral capsid

-

enveloped (surrounded by a cell membrane originating from the previously infected host cell)

Her pes Si m pl ex V irus 1 (“ HSV- 1”, “ Hu man Her pes virus 1” )

Reservoir s

-

humans (only reservoir)

Transmission

-

direct contact

Disease s

Herpes Labialis

 

-

“cold sore”

-

painful ulcerating encrustating vesicles at the site of initial infection

-

primarily occurs on the lips and/or the bucca

-

spontaneously resolves in < 2 weeks

-

may complicate by reactivation of latent HSV-1 in the trigeminal ganglia ! reoccurrence of the painful ulcerating encrustating

 

vesicles at the site of initial infection

 

-

may also complicate by HSV-1 viremia ! meningoencephalitis

-

caused by HSV-1 infection of the oral cavity

 

Herpetic Keratitis

 

-

ulcerating coalescing vesicles on the cornea

-

may complicate by causing corneal scarring ! blindness

-

caused by HSV-1 infection of the eye

 

Herpetic Whitlow

 

-

painful ulcerating encrustating vesicles on the cuticles of the

 

fingernails

 

-

caused by HSV-1 infection of the skin

Treatment

-

indirect viral DNA polymerase inhibitors

- 2 -

Her pes Si m pl ex V irus 2 (“ HSV- 2”, “ Hu man Her pes virus 2” )

Reservoir s

-

humans (only reservoir)

Transmission

-

direct contact

-

sexual (“sexually transmitted disease”, “STD”, “venereal disease”)

-

perinatal (“mother-to-fetus”)

Disease s

Herpes Genitalis

 

-

painful ulcerating encrustating vesicles at the site of initial infection

-

primarily occurs on the external genitalia, periorally (if oral intercourse) or perirectally (if anal intercourse)

-

spontaneously resolves in < 2 weeks

-

may complicate by reactivation of latent HSV-2 in the lumbosacral paravertebral ganglia ! reoccurrence the of the painful ulcerating encrustating vesicles at the site of initial infection

-

may also complicate by HSV-2 viremia ! meningoencephalitis

-

caused by HSV-2 infection of the skin

 

Herpetic Keratitis

 

-

see above

 

Herpetic Whitlow

 

-

see above

TORCH Syndrome

-

spontaneous abortion, stillbirth, premature birth, birth defects, viral interstitial pneumonitis, acute viral hepatitis leading to jaundice, hepatosplenomegaly, generalized lymphadenomegaly and neonatal meningoencephalitis leading to mental retardation, seizures, deafness and blindness

-

caused by intrauterine HSV-2 infection ! HSV-2 viremia

Treatment

-

indirect viral DNA polymerase inhibitors

continued in 101…

- 3 -

101. CYTOMEGALOV IRUS

…continuation of 100

Cy to me gal ov irus (“ CMV ”, “Hu man Her pes virus 5 ”)

Reservoir s

-

humans (only reservoir)

Transmission

-

direct contact

-

perinatal

Disease s

Infectious Mononucleosis-Like Syndrome

-

analogous to infectious mononucleosis (see 102)

-

may complicate by reactivation of latent CMV in the paravertebral ganglia ! viral interstitial pneumonitis, acute viral hepatitis, and

 

retinitis leading to blindness (primarily occurs in immunocompromized)

 

-

caused by CMV infection of the nasopharynx ! CMV viremia

 

TORCH Syndrome

 

-

see 100

Treatment

-

indirect viral DNA polymerase inhibitors

-

direct viral DNA polymerase inhibitors

continued in 102…

- 4 -

102. EPSTEIN-BARR VIRUS

…continuation of 101

Epst ein -Barr V irus (“ EBV ”, “Hu m a n Herp es virus 4” )

Reservoir

s

-

humans (only reservoir)

Transmission

-

direct contact

Disease s

Infectious Mononucleosis

 

-

“kissing disea se”

-

fever, headache, severe pharyngitis, splenomegaly and generalized lymphadenomegaly

-

spontaneously resolves in < 6 weeks

-

primarily occurs in children and young adults

-

caused by EBV infection of the B lymphocytes in the nasopharynx

 

!

dissemination of EBV in virtually every lymphoid organ

 

-

may progress to burkitt lymphoma and/or nasopharyngeal

 

carcinoma (see below)

 

Burkitt Lymphoma

 
 

-

malignant neoplasm of B lymphocytes

-

primarily occurs in children

-

caused by persistent EBV infection of B lymphocytes

 

Nasopharyng eal Carcinoma

 

-

malignant neoplasm of the pharyngeal epithelium

-

primarily occurs in adults

-

caused by reactivation of latent EBV ! EBV infection of the pharyngeal epithelial cells

Treatment

-

none in particular

continued in 103…

- 5 -

103. VARICELLA-ZOSTER VI RU S AND HHV-6 (HUMAN

HERPESVIRUS-6)

…continuation of 102

Vari ce ll a- Zost er V irus (“V ZV ”, “Hu man Her pes virus 3 ”)

Reservoir s

-

humans (only reservoir)

Transmission

-

direct contact

-

droplet nuclei

-

contaminated fomites

Disease s

Varicella

-

“chickenpox”

-

fever and headache ! erythematous ulcerating encrustating vesicles beginning on the face and trunk and then progressing towards the extremities (as well as mucous membranes)

-

spontaneously resolves in < 1 week

-

may complicate by VZV viremia ! viral interstitial pneumonitis and meningoencephalitis (primarily occurs in immunocompromized)

-

caused by VZV infection of the nasopharynx ! VZV viremia

-

may progress to zoster (see below)

Zoster

-

“shingles”

-

reoccurrence of the erythematous ulcerating encrustating vesicles on 1 or more dermatomes

-

occurs years after initial infection

-

caused by reactivation of latent VZV in the paravertebral ganglia

Treatment

-

indirect viral DNA polymerase inhibitors

- 6 -

Rose ola Virus (“ Hu man H erpes virus 6”)

Reservoir s

-

humans (only reservoir)

Transmission

-

direct contact

Disease s

Roseola Infantum

 

-

“exanthema subitum”

-

high fever and cervical lympadenomegaly ! erythematous rash on the neck and trunk

-

spontaneously resolves in < 1 week

-

may complicate by reactivation of latent Roseola Virus in the paravertebral ganglia ! infectious mononucleosis-like syndrome (see 102), viral interstitial pneumonitis, acute viral hepatitis and meningoencephalitis (primarily occurs in immunocompromized)

-

primarily occurs in infants

-

caused by Roseola Virus infection of the nasopharynx ! Roseola Virus viremia

Treatment

-

indirect viral DNA polymerase inhibitors

- 7 -

104. POXVIRUSES (VARIOLA AN D THE ERADICATI ON OF SMALLPOX)

POXVIRIDAE

Characteristics

-

linear double-stranded DNA genome

-

complex capsid (uncharacterizable protein coat)

-

enveloped

Vari ola Virus

Serotypes

-

Variola Major

-

Variola Minor

Reservoir s

-

humans (only reservoir, now extinct due to vaccination (!))

Transmission

-

direct contact

-

droplet nuclei

Disease s

Variola

 

-

“smallpox”

-

high fever and maculopapular rash beginning on the pharynx, oral cavity, face and extremities and then progressing towards the trunk

-

> 25% mortality

-

caused by Variola Virus infection of the nasopharynx ! Variola Virus viremia

Treatment

-

none in particular

Vac ci nia Virus

Reservoir s

-

humans (only reservoir)

Transmission

-

parenteral (“injectional”)

Disease s

Vaccinia

 

-

ulcerating encrustating vesicles at the site of initial infection

-

may complicate by Vaccinia Virus viremia ! meningoencephalitis (primarily occurs in immunocompromized)

-

caused by inoculation of Vaccinia Virus into the skin (vaccination against Variola Virus, see above)

Treatment

-

none in particular

- 8 -

Mol luscu m C ont agi osu m Virus (“ M CV”)

Reservoir s

-

humans

-

animals (primarily primates and marsupials)

Transmission

-

direct contact

-

sexual

-

zoonotic

-

contaminated fomites

Disease s

Molluscum Contagiosum

-

multiple medium-sized nodules with central invagination (“umbilication”) at the site of initial infection

-

spontaneously resolves in < 2 years

-

caused MCV infection of the skin

Treatment

-

none in particular

- 9 -

105. HEPATITIS VIRUSES I (HAV AND HEV)

PICORNAVIRIDAE

Characteristics

-

linear positive-sense (does not need a viral RNA-dependent RNA polymerase to replicate) single-stranded RNA genome

-

icosahedral capsid

-

non-enveloped

He pa ti tis A V irus (“ HA V”)

Reservoir s

-

humans

-

animals (primarily primates)

Transmission

-

direct contact

-

fecal-oral

-

contaminated water

-

contaminated food (primarily seafood)

Disease s

Acute Viral Hepatitis

-

moderate hepatic damage ! fever, abdominal pain, vomiting,

 

hepatomegaly and jaundice

 

-

spontaneously resolves in < 3 months

Treatment

-

none in particular

CALICIVIRIDAE

Characteristics

-

linear positive-sense single-stranded RNA genome

-

icosahedral capsid

-

non-enveloped

He pa ti tis E V irus (“ HE V”)

Characteristics

-

same diseas es and treatment as HAV (see above)

Reservoir s

-

humans

-

animals (primarily primates, swine and rodents)

Transmission

-

fecal-oral

-

contaminated water

continued in 106…

- 10 -

106. HEPATITIS VIRUSES II (HBV, HDV, HCV AND HGV)

…continuation of 105

HEPEDNAVIRIDAE

Characteristics

-

circular double-stranded DNA genome

-

icosahedral capsid

-

enveloped

He pa ti tis B V irus (“ HB V”)

Reservoir s

-

humans (only reservoir)

Transmission

-

direct contact

-

sexual

-

perinatal

-

parenteral

Disease s

Acute Viral Hepatitis

-

see 105

-

may progress to hyperacute viral hepatitis (see below)

Hyperacute Viral Hepatitis

-

“fulminant hepatitis”

-

severe hepatic damage ! hepatic failure leading to generalized edema, ascites, coagulopathies and hepatic encephalopathy

-

primarily occurs in immunoreactive

Chronic Persistent Viral Hepatitis

-

moderate hepatic cirrhosis ! fever, abdominal pain, vomiting, hepatomegaly and jaundice

-

primarily occurs in moderately immunocompromized

-

may progress to chronic aggressive viral hepatitis (see below)

Chronic Aggressi ve Viral Hepatitis

-

severe hepatic cirrhosis ! hepatic failure (see above)

-

primarily occurs in severely immunocompromized

Chronic Carrier State

-

no hepatic damage and no hepatic cirrhosis (asymptomatic)

Hepatocellular Carcinoma

-

malignant neoplasm of the hepatocytes

Treatment

-

indirect viral DNA polymerase inhibitors

- 11 -

DELTAVIRIDAE

Characteristics

-

linear negative-sense (needs a viral RNA-dependent RNA polymerase to replicate) single-stranded RNA genome

-

icosahedral capsid

-

non-enveloped (needs HBV envelope to become infective (!))

He pa ti tis D V irus (“ HDV” )

Characteristics

-

same reservoirs, transmission and diseases as HBV (see above)

Treatment

-

none in particular

FLAVIVIRIDAE

Characteristics

-

linear positiv-sense single-stranded RNA genome

-

icosahedral capsid

-

enveloped

He pa ti tis C V irus (“ HC V”)

Characteristics

-

same reservoirs, transmission and diseases as HBV (see above)

Treatment

-

indirect viral DNA polymerase inhibitors (believe it or not (!))

He pa ti tis G V irus (“ HGV” )

Characteristics

-

same reservoirs and transmission as HBV (see above)

Disease s

-

none directly associated

Treatment

-

none in particular

- 12 -

107. INFLUENZA VIRUS A, B AND C

ORTHOMYXOVIRIDAE

Characteristics

-

linear segmented (8 segments) negative-sense single-stranded RNA genome

-

helical capsid (spirally-shaped protein coat)

-

enveloped

Influenz a Virus

Serotypes

-

Influenza Virus Type A

-

Influenza Virus Type B

-

Influenza Virus Type C

Reservoir s

-

humans

-

animals (primarily birds, only Influenza Virus Type A)

Transmission

-

direct contact

-

droplet nuclei

-

zoonotic (only Influenza Virus Type A)

Disease s

Influenza

 

-

“the flu”

-

high fever, headache, myalgias, rhinitis leading to rhinorrhea, pharyngitis leading to sore throat, and non-productive cough

-

may complicate by progressing to laryngotracheobronchitis and viral interstitial pneumonitis (primarily occurs in elderly and immunocompromized)

-

caused by Influenza Virus infection of the nasopharynx

Treatment

-

viral uncoating and assembly inhibitors

-

viral exit inhibitors

- 13 -

108. MUMPS VIRUS

PARAMYXOVIRIDAE

Characteristics

-

linear negative-sense single-stranded RNA genome

-

helical capsid

-

enveloped

Mum ps Virus

Reservoir s

-

humans (only reservoir)

Transmission

-

direct contact

-

droplet nuclei

Disease s

Mumps

-

fever, headache and parotitis leading to painful swollen jaws

-

may complicate by progressing to meningoencephalitis (primarily occurs in children)

-

may also complicate by progressing to orchidoepididymitis and/or oophoritis (primarily occurs in teenagers and adults)

-

primarily occurs in children

-

caused by Mumps Virus infection of the nasopharynx ! Mumps Virus viremia

Treatment

-

none in particular

continued in 109…

- 14 -

109. MEASLES VIRUS

…continuation of 108

Rube ol a Virus (“ Me asl es Virus” )

Reservoir s

-

humans (only reservoir)

Transmission

-

direct contact

-

droplet nuclei

Disease s

Rubeola

 

-

“measles ”

-

high fever, rhinitis, pharyngitis, conjunctivitis, non-productive cough and generalized lymphadenomegaly ! medium-sized erythematous rash with bluish-white centers on the bucca and tongue (“koplik’s spots”) ! erythematous maculopapular rash beginning on the face and then progressing descendingly to the feet

-

spontaneously resolves in < 2 weeks

-

may complicate by causing viral interstitial pneumonitis, infective myocarditis and meningoencephalitis

-

primarily occurs in children

-

caused by Rubeola Virus infection of the nasopharynx ! Rubeola Virus viremia

-

may progress to subacute sclerosing panencephalitis (see below)

Subacute Sclerosing Panencephalitis

-

“SSPE”

-

stupor and myclonic spasms in awaken state (spasms normally occurring in healthy as they fall asleep… you know what I’m talking about) ! deafness, blindness and seizures ! coma

-

> 25% mortality

-

occurs years after initial infection

-

caused by reactivation of latent Rubeola Virus

Treatment

-

none in particular

- 15 -

110. RUBELLA VIRUS

TOGAVIRIDAE

Characteristics

-

linear positive-sense single-stranded RNA genome

-

icosahedral capsid

-

enveloped

Rube ll a Virus

Reservoir s

-

humans (only reservoir)

Transmission

-

direct contact

-

droplet nuclei

Disease s

Rubella

 

-

“german measles”

-

low-grade fever, rhinitis, pharyngitis, conjunctivitis and painful postauricular and suboccipital lymphadenomegaly ! small erythematous rash on the soft palate (“forchheimer’s spots”) ! erythematous maculopapular rash beginning on the face and then progressing descendingly to the feet

-

spontaneously resolves in < 1 week

-

may complicate by progressing to infective arthritis

-

analogous to rubeola (see 109)

-

primarily occurs in children

-

caused by Rubella Virus infection of the nasopharynx ! Rubella Virus viremia

TORCH Syndrome

-

see 100

Treatment

-

none in particular

- 16 -

111. ROTAVIRUSES

REOVIRIDAE

Characteristics

-

linear segmented (11 segments) double-stranded RNA genome

-

icosahedral capsid

-

non-enveloped

Rot av irus

Reservoir s

-

humans (only reservoir)

Transmission

-

direct contact

-

fecal-oral

-

contaminated water

-

contaminated food

-

contaminated fomites

Disease s

Gastroente ritis

 

-

most common cause of gastroenteritis

-

abdominal pain, vomiting and severe watery diarrhea (> 20 liter

 

per day)

 

-

may complicate by leading to hypovolemia ! hypovolemic shock

 

!

death

 

-

may also complicate by Rotavirus viremia ! meningoencephalitis

-

primarily occurs in children

-

caused by Rotavirus infection of the GI tract

Treatment

-

oral fluid and electrolyte replacement

- 17 -

112. NORWALK VIR US AND OTHER VIRUSES OF HUMAN GASTROENTERITIS

CALICIVIRIDAE

Characteristics

-

see 105

Norwa lk V irus

Characteristics

-

same reservoirs, transmission and treatment as Rotavirus (see 111)

Disease s

Gastroente ritis

 

-

see 99

-

primarily occurs in teenagers and adults

-

caused by Norwalk Virus infection of the GI tract

- 18 -

113. POLIOVIRUSES

PICORNAVIRIDAE

Characteristics

-

see 105

Po lio v irus

Reservoir s

-

humans (only reservoir)

Transmission

-

direct contact

-

droplet nuclei

-

fecal-oral

Disease s

Inapparent Poliomyleitis

-

low-grade fever, headache and pharyngitis

-

spontaneously resolves in < 1 week

-

primarily occurs in children

-

caused by Poliovirus infection of the nasopharynx

-

may progress to non-paralytic poliomyelitis and/or paralytic poliomyelitis (see below)

Non-Paralytic Poliomyleitis

-

meningitis leading to high fever, vomiting and nuchal rigidity

-

spontaneously resolves in < 1 week

-

primarily occurs in children

-

caused by Poliovirus viremia ! Poliovirus infection of the meninges

Paralytic Poliomyleitis

-

asymmetric flaccid paralysis ! muscular atrophy and loss of myotatic reflexes (“stretch reflexes”)

-

may complicate by flaccid paralysis of the respiratory muscles ! death

-

primarily occurs in teenagers and adults

-

caused by Poliovirus infection of the peripheral motor neurons

Treatment

-

none in particular

continued in 114…

- 19 -

114. COXSACKIE AND EC HO VI RUSES

…continuation of 113

Coxsa ck ie A Virus (“ CA V”)

Reservoir s

-

humans (only reservoir)

Transmission

-

direct contact

-

droplet nuclei

-

fecal-oral

Disease s

The Common Cold

-

see 99

-

may complicate by CAV viremia ! meningoencephalitis

-

caused by CAV infection of the nasopharynx

-

may progress to herpangina (see below)

 

Herpangina

 

-

high fever and painful ulcerating erythematous vesicles on the pharynx

-

caused by progression of the common cold (see above)

-

may progress to hand-foot-and-mouth disease (see below)

Hand-Foot-and-Mouth Disease

-

high fever and painful ulcerating erythematous vesicles on the bucca and tongue as well as on the palms and soles

-

caused by progression of herpangina (see above)

Treatment

-

none in particular

- 20 -

Coxsa ck ie B Virus (“ CB V”)

Reservoir s

-

humans (only reservoir)

Transmission

-

direct contact

-

droplet nuclei

-

fecal-oral

Disease s

The Common Cold

-

see above

-

may complicate by CBV viremia ! meningoencephalitis, infective myocarditis and acute pericarditis

-

caused by CBV infection of the nasopharynx

-

may progress to pleurodynia (see below)

 

Pleurodynia

 

-

“bornholm disease”

-

high fever, headache and intercostal striated muscle necrosis leading to severe pain during inspiration (“pleuritic pain”)

-

caused by progression of the common cold (see above)

Treatment

-

none in particular

Echo v irus

Reservoir s

-

humans (only reservoir)

Transmission

-

direct contact

-

droplet nuclei

-

fecal-oral

Disease s

The Common Cold

-

see above

-

may complicate by Echovirus viremia ! meningoencephalitis, infective myocarditis and acute pericarditis

-

caused by Echovirus infection of the nasopharynx

Keratoconjunctivitis

-

see 99

-

caused by Echovirus infection of the eye

 

Gastroente ritis

 

-

see 99

-

primarily occurs in infants

-

caused by Echovirus infection of the GI tract

Treatment

-

none in particular

- 21 -

115. RABIES

RHABDOVIRIDAE

Characteristics

-

linear negative-sense single-stranded RNA genome

-

helical capsid

-

enveloped

Rab ies V irus

Reservoir s

-

humans

-

animals (primarily dogs, cats and bats)

Transmission

-

direct contact

-

zoonotic

Disease s

Furious Rabies

 

-

fever, headache and neuralgia at the site of initial infection ! encephalitis leading to delirium, psychosis and bursts of furious rage, and severe pharyngeal spasms upon drinking (“hydrophobia”) leading to foaming of the mouth ! symmetric flaccid paralysis and

 

seizures ! coma and respiratory center dysfunction

 

-

> 90% mortality rate (within 2 weeks (!))

-

most common

-

caused by Rabies Virus infection of wounds ! retrograde migration of Rabies Virus through sensory neurons into the CNS

 

Apathetic Rabies

 

-

fever, headache and neuralgia at the site of initial infection ! encephalitis leading to insomnia, stupor and apathy ! symmetric

 

flaccid paralysis and seizures ! coma and respiratory center dysfunction

 

-

> 90% mortality rate (within 2 weeks (!))

-

caused by Rabies Virus infection of wounds ! retrograde migration of Rabies Virus along sensory neurons into the CNS

Treatment

-

none in particular

- 22 -

116. “SLOW VIRUS INFECTIONS” AND PRION DISEASE

PRIONS

Characteristics

-

“proteinaceous infectious particles”

-

not viruses

-

consists solely of protein (“prion protein”, “PrP”)

Reservoir s

-

humans

-

animals (primarily cattle)

Transmission

-

zoonotic

-

contaminated food

-

contaminated fomites

-

inherited (!)

Disease s

Variant Creutzfeldt-Jakob Disease

-

“vCJD”

-

(“bovine spongiform encephalopathy”, “BSE”, “mad cow disease”, in cattle)

-

cerebral and cerebellar granulovacoular degeneration ! chronic progressive encephalopathy leading to insomnia, stupor, apathy, myclonic spasms in awaken state (see 109), and finally coma

-

100% mortality (in less than 2 years (!))

-

caused by Prion viremia ! Prion accumulation in the CNS

Treatment

-

none in particular

- 23 -

117. TUMOR VIRUSES

HERPESVIRIDAE

Characteristics

-

see 100

Kapos i Sarc o ma Herp esv irus (“ KS H V”, “Hu m an H erp esv irus 8”)

Reservoir s

-

humans (only reservoir)

Transmission

-

direct contact

-

sexual

-

perinatal

Disease s

Kaposi Sarcoma

 

-

malignant neoplasm of vascular smooth muscle

-

caused by KSHV viremia ! KSHV infection of vascular smooth muscle cells

Treatment

-

none in particular

- 24 -

PAPOVAVIRIDAE

Characteristics

-

circular double-stranded DNA genome

-

icosahedral capsid

-

non-enveloped

Hu man Pap il lo ma V irus (“ H PV” )

Reservoir s

-

humans (only reservoir)

Transmission

-

direct contact

-

sexual

-

perinatal

-

contaminated fomites

Disease s

Common Cutaneous Warts

-

“verrucae vulgaris”

-

painless superficial medium-sized rough hyperkeratinized nodules at the site of initial infection

-

primarily occurs on the hands and fingers (as well as on the feet)

-

caused by HPV infection of the skin

-

may progress to deep palmo-plantar warts (see below)

Deep Palmo-Plantar Warts

-

“myrmecias”

-

painful deep medium-sized rough hyperkeratinized pigmented nodules at the site of initial infection

-

primarily occurs on the feet and toes (as well as on the hands)

-

caused by progression of common cutaneous warts (see above) ! HPV invasion of the dermis

 

Anogenital Warts

 

-

“condyloma acuminata”

-

multiple small papules coalescing to form a large cauliflower-like lesion at the site of initial infection

-

primarily occurs on the external genitalia or perirectally (if anal intercourse)

-

caused by HPV infection of the skin

Cervical Intraepithelial Neoplasia

-

“CIN”

-

benign neoplasm of the cervix

-

caused by HPV infection of the cervix

-

may progress to cervical carcinoma (see below)

Cervical Car cinoma

-

malignant neoplasm of the cervix

-

caused by progression of cervical intraepithelial neoplasia (see

above)

- 25 -

Treatment

-

topical liquid nitrogen (if common cutaneous warts, deep palmo- plantar warts and/or anogenital warts)

RETROVIRIDAE

Characteristics

-

linear diploid (2 exact copies) positive-sense single-stranded RNA genome

-

complex capsid

-

enveloped

Hu man T-L y mph otro phi c V irus 1 (“ H TLV-1 ”)

Reservoir s

-

humans (only reservoir)

Transmission

-

sexual

-

perinatal

-

parenteral

Disease s

Tropical Spastic Paraparesis

-

“HTLV-1 associated myelopathy”

-

skeletal muscle spasm s and generalized striated muscle asthenia (including external urethral and external rectal sphincters) leading to incontinence

-

caused by HTLV-1 viremia ! HTLV-1 infection of the CNS

Acute T-Lymphocytic Leukemia

-

malignant neoploasm of T lymphocytes

-

caused by HTLV-1 viremia ! HTLV-1 infection of T lymphocytes

Treatment

-

none in particular

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118. ARBOVIRUSES (YELLOW F EVER VIRUS AND TICK-BORNE ENCEPHALITIS VIRUSES)

FLAVIVIRIDAE

Characteristics

-

see 106

Ye ll ow F ev er V irus (“Y FV ”)

Reservoir s

-

humans

-

animals (primarily primates and marsupials)

Transmission

-

zoonotic

-

vectorial (mosquitoes)

Disease s

Yellow Fever

 

-

fever, headache and myalgias (primarily of the lower back) ! toxic acute tubular necrosis leading to intrarenal acute renal failure and uremia, and acute viral hepatitis leading to jaundice and coagulopathies

-

> 40% mortality

-

caused by YFV viremia

Treatment

-

none in particular

TOGAVIRIDAE

Characteristics

-

see 110

West ern Equ in e Enc eph al it is Virus ( “WE EV”)

Reservoir s

-

humans

-

animals (primarily horses, rodents and birds)

Transmission

-

vectorial (mosquitoes)

Disease s

Western Equine Encephalitis

  • - “WEE”

  • - meningitis leading to high fever, vomiting and nuchal rigidity, and encephalitis leading to delirium, stupor and seizures ! coma

  • - < 10% mortality

  • - caused by WEEV viremia

- 27 -

Treatment

-

none in particular

Eeas tern Equi ne En ce pha li tis V irus (“EE EV ”)

Characteristics

-

same reservoirs, transmission and treatment as WEEV (see above)

Disease s

Eastern Equine Encephalitis

  • - “EEE”

  • - analogous to WEE (see above)

  • - > 60% mortality

  • - caused by EEEV viremia

Ven ezue li an Equ ine Enc eph al it is Virus (“VE EV” )

Characteristics

-

same transmission and treatment as WEEV (see above)

Reservoir s

-

humans

-

animals (primarily horses)

Disease s

Venezuelan Equine Encephalitis

-

“VEE”

-

analogous to WEE (see above)

-

< 20% mortality

-

caused by VEEV viremia

BUNYAVIRIDAE

Characteristics

-

linear segmented (3 segments) negative-sense single-stranded RNA genome

-

helical capsid

-

enveloped

Cal iforn ia En c epha li tis V irus (“ CEV ”)

Characteristics

-

same transmission and treatment as WEEV (see above)

Reservoir s

-

humans

-

animals (primarily rodents)

Disease s

California Encephalitis

-

analogous to WEE (see above)

-

< 1% mortality

-

caused by CEV viremia

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119. ROBOVIR USES (HANTAAN VIRUS, MARBURG AND EB OLA VIRUSES, LASSA AND LCM VIRUSES)

BUNYAVIRIDAE

Characteristics

-

see 118

Han ta virus (“ H anta an Virus ”)

Reservoir s

-

humans

-

animals (primarily rodents)

Transmission

-

direct contact

-

zoonotic

-

aerosolized

Disease s

Hantavirus Pulmonary Syndrome

-

“HPS”

-

fever, headache and myalgias (primarily of the lower back) ! alveolar capillary endothelial damage leading to adult respiratory

 

distress syndrome (“ARDS”)

 

-

> 80% mortality (in < 1 week (!))

-

caused by Hantavirus viremia (primarily of the pulmonary circulation)

Hantavirus Hemorrhagic Fever with Renal Syndrome

-

“HFRS”

-

fever, headache and myalgias (primarily of the lower back) !

 

disseminated capillary endothelial damage leading to hemorrhages in the skin and mucous membranes, and toxic acute tubular necrosis leading to intrarenal acute renal failure and uremia

 

-

< 10% mortality

-

caused by Hantavirus viremia (primarily of the systemic circulation)

Treatment

-

indirect viral DNA polymerase inhibitors (believe it or not (!))

- 29 -

FILOVIRIDAE

Characteristics

-

linear negative-sense single-stranded RNA genome

-

helical capsid

-

enveloped

Marburg V irus

Reservoir s

-

humans

-

animals (primarily primates)

Transmission

-

direct contact

-

zoonotic

Disease s

Marburg Hemorrhagic Fever

-

fever headache and myalgias (primarily of the lower back) ! disseminated capillary endothelial damage leading to hemorrhages in the skin, mucous membranes as well as other organs ! multiple

 

organ failure

 

-

> 25% mortality

-

caused by Marburg Virus viremia

Treatment

-

none in particular

Ebo la V irus

Characteristics

-

same reservoirs, transmission and treatment as Marburg Virus (see above)

Disease s

Ebola Hemorrhagic Fever

  • - analogous to marburg hemorrhagic fever (see above)

  • - > 90% mortality (!)

  • - caused by Ebola Virus viremia

- 30 -

ARENAVIRIDAE

Characteristics

-

linear segmented (2 segments) negative-sense single-stranded RNA genome

-

helical capsid

-

enveloped

Lassa V irus

Reservoir s

-

humans

-

animals (primarily rodents)

Transmission

-

direct contact

-

zoonotic

-

aerosolized

-

contaminated food

-

contaminated fomites

Disease s

Lassa Fever

 

-

analogous to marburg hemorrhagic fever (see above)

-

< 1% mortality

-

caused by Lassa Virus viremia

Treatment

-

indirect viral DNA polymerase inhibitors (believe it or not (!))

Ly mp hoc y ti c Chor io men ing it is V irus (“LC MV” )

Reservoir s

-

humans

-

animals (primarily primates, rodents, swine and dogs)

Transmission

-

direct contact

-

zoonotic

-

aerosolized

-

contaminated food

-

contaminated fomites

Disease s

Lymphocytic Choriomeningitis

-

“LCM”

-

fever, headache and myalgias ! meningoencephalitis (see 119)

-

< 1% mortality

-

caused by LCMV viremia

Treatment

-

none in particular

- 31 -

120. HUMAN PARVOVIR US B19

PARVOVIRIDAE

Characteristics

-

linear single-stranded DNA genome

-

icosahedral capsid

-

non-enveloped

Hu man Parv ov irus B1 9

Reservoir s

-

humans

Transmission

-

direct contact

-

perinatal

-

parenteral

Disease s

Erythema Infectiosum

-

“slapped-cheek disea se”

-

erythematous rashes of the cheeks as well as on the trunk and

 

extremities

 

-

may complicate by infection of the bone marrow ! aplastic anemia ! transient aplastic crisis (primarily occurs in infants, immunocompromized or if already anemic)

-

spontaneously resolves in < 1 week

-

primarily occurs in children

-

caused by Human Parvovirus B19 viremia

Treatment

-

none in particular

- 32 -

121. VIROLOGY AND LABORAT ORY DIAGN OSIS OF AIDS 122. EPIDEMIOLOGY AN D SPREAD OF AIDS

RETROVIRIDAE

Characteristics

-

see 117

Hu man I mm unod ef ic ien cy Virus (“ HIV ”)

Reservoir s

-

humans (only reservoir)

Transmission

-

direct contact

-

sexual

-

perinatal

-

parenteral

Disease s

Acquired Immunodeficiency Syndrome

-

“AIDS”

-

infectious mononucleosis-like syndrome (see 102) ! immunodeficiency leading to a torrent of opportunistic bacterial, viral, fungal protozoal and helmithic superinfections, as well as a torrent of malignant neoplasms

-

may complicate by HIV infection of both the central and peripheral nervous system ! encephalopathies, myelopathies and peripheral neuropathies (“AIDS dementia complex”)

-

100% mortality (eventually (!))

-

caused by HIV viremia ! HIV dissemination in virtually every lymphoid organ ! HIV infection of helper T lymphocytes

Treatment

-

indirect viral reverse transcriptase inhibitors

-

direct viral reverse transcriptase inhibitors

-

viral protease inhibitors

- 33 -

  • 123. CONGENITA L VIRAL INFE CTIONS (RUBELLA AND CM V, DIAGNOSIS AND PREVENTI ON)

  • 124. IMMUNOSUPPRESSIVE CONDITIONS, TRANSPLANTAT ION AND VIRAL INFECTIO NS, PREVENTION

  • 125. NOSOCOMIAL VIR AL INFECTIONS, EXAMPLES FOR TRANSMISSION OF RESPIRATORY, ENTERIC AND BLOOD- BORNE VIRUSES

- 34 -