Virus
Herpes Simplex
Virus
(Herpesviridae)
Varicella Zoster
Virus
(Herpesviridae)
Cytomegalovirus
(Herpesviridae)
DNA VIRUSES
Characteristics
Icosahedral
Enveloped
Double stranded
linear
2 types: HSV-1 and
-2
Lifelong infection
Icosahedral
Enveloped
Double stranded
linear
Lifelong infection
Primary and
Recurring
disease
Icosahedral
Enveloped
Double stranded
linear
Recurrent infection
Congenital
infection
Epidemiology
Spread: direct
contact (orally or
sexually)
Location: neurons
and epithelia
(latency)
Risk Factors:
1. Contaminated
fingers
2. Birth canal
transmission
3. Kissing
At Risk:
1. Children and
sexually active
people
2. Health care
workers
3. Immune
compromised or
neonates
Spread: respiratory
droplets
Location: neurons
and epithelia
(latency)
At Risk:
1. Children (5-9yo)
2. Teens and adults
3. Immune
compromised or
neonates
Pathogenesis
1. Initial infection through blood
(monocytes and macrophages)
2. Establish latency in infected
macrophages
3. Primary infection is subclinical
(asymptomatic)
Virulence
1. Viremia
2. Latency
1
Diseases
1. Herpes gingivostomatitis: initial
primary infection
2. Herpes labialis or Cold sores:
painful shallow ulcers on lips
accompanied by fever, malaise and
myalgia; usually heal without scarring in
8 to 10 days
3. Herpetic whitlow: thumb lesion
4. Keratoconjunctivitis: corneal scarring
and blindness (2nd most common cause)
5. Encephalitis: if virus spreads to CNS
Lab Diagnosis
Visual
diagnosis
Tzanck
smear: multinuc giant cells
and cowdry A
inclusion
bodies
Cell culture
Serology: type
specific Ab
(HSV-1 vs -2)
Treatment
Acyclovir
Foscarnet
Same as HSV
VarizIg
neutralizing
Ab
Live
attenuated
vaccine:
children
Owls eye
inclusion
body
Serology: Ag
detection
PCR
Absence of
atypical
lymphocytes
and
heterophile Ab
Ganciclovir
Foscarnet
Screening
reduces
intrauterine
transmission
DNA VIRUSES
sl 2013
Epstein-Barr
Virus
(Herpesviridae)
Parvovirus
(Parvoviridae)
Adenovirus
(Adenoviridae)
Icosahedral
Enveloped
Double stranded
linear
Linked to
malignancy
Icosahedral
Non-enveloped
Single stranded
linear
Smallest virus
Icosahedral
Non-enveloped
Double stranded
linear
50 serotypes
Used as a vector
for gene therapy
At Risk:
1. Neonates
2. Sexually active
people
3. Immune
compromised
4. Burn victims
Spread: saliva, body
fluids
Location: memory
B cells (latency)
At Risk:
1. Teenagers
2. Children
3. Immune
compromised
Spread: respiratory
Location: erythroid
progenitor cells
Risk Factors:
1. Sickle cell disease
2. Pregnancy (first
trimester highest
risk)
At Risk:
1. Elementary
school students
2. Parents of
children with B19
Spread: respiratory
and feco-oral
Location: intestine,
eyes, respiratory
tract
Risk Factors:
1. Contaminated
hands
2. Ophthalmologic
instruments
3. Swimming water
At Risk:
1. Infants
Pathogenesis
1. Initial replication in oropharynx
2. Infect B cells via C3b receptor
3. Establishes latency
4. Virus replicates when B cells
replicate
5. T cells try to eradicate B cells
Virulence
1. Latency
2. Immortalization of B cells
3. Polyclonal B-cell proliferation
4. T cell activation leads to disease
manifestation (IM)
CBC:
lymphocytosis
Atypical
lymphocytes
Heterophile
Ab
Paul-Bunnell
Test
EBV specific Ag
1. EA first
Ab
2. VCA IgM
then IgG
3. EBNA
marker of
infection; last
to develop
Clinical
presentation
ELISA IgM
PCR
No vaccine
Acyclovir?
ELISA
PCR
culture
No antiviral
agent or
vaccine
IVIG for B19
virus in
immunocomp
DNA VIRUSES
sl 2013
2. Military
recruits low
resistance to virus &
exposure to new
strains
Human
Papilloma Virus
(HPV)
(Papovaviridae)
Human
Polyoma Virus
(Papovaviridae)
Variola Virus
(Poxviridae)
Icosahedral
Non-enveloped
Double stranded
circular
High risk for
cervical
carcinoma (HPV
16 and 18)
Spread: sexual
contact, fomites,
transplacental
Location:
differentiated
epithelial cells
Risk Factors:
1. Pregnancy
2. Unprotected sex
Icosahedral
Non-enveloped
Double stranded
circular
Three human
subtypes: JC, BK,
& MC
Spread: respiratory
and urine
Location: CNS,
urinary tract
Risk Factors:
1. Immune
compromised
At Risk:
1. Children
Complex
Enveloped
Double stranded
linear
Eradicated from
Earth
Spread: none
Risk Factors:
1. Mutations in
animal poxviruses
At Risk:
1. Unvaccinated
JC virus:
1. Viremia: spread to CNS
2. Reactivated in oligodendrocytes
3. Demylination
BK virus: UTI in immunocompromised
1. Replication in cytoplasm: rapid, shuts
off cell synthesis and leads to cell death
and viral release
3
sharing of towels, unsterilized ocular
instruments
7. Gastroenteritis: infantile diarrhea
with vomiting (5-15% of viral diarrhea
in children); serotypes 40-42
8. Acute hemorrhagic UTI: bone marrow
recipients
9. Hepatitis: liver transplant recipients
1. Skin warts (types 1-4): keratinized
surface, benign and self-limiting,
regresses with time; mainly on hands,
fingers and feet; could lead to
squamous cell carcinoma
2. Laryngeal papilloma (types 13 & 32):
benign; due to infection of oral and
nasopharyngeal mucosa
3. Anogenital warts/Condyloma
accuminata (mostly type 6 & 11): benign
growth on squamous epithelia
4. Cervical cancer (type 16, 18):
carcinoma in situ, integrate into host
chromosome; E6/E7: inactivate p53
and Rb; E5: enhances EGF
1. Progressive multifocal
leukoencephalopathy (JC): mental
and sensory abnormalities, paralysis and
impared speech
2. UTI (BK)
Secondary infections
Visual
inspection
PCR: determine
whether HPV
is high risk
Gardasil: vaccine
against HPV 6,
11, 16 and 18
Surgical removal
or destruction
of warts
Most people
have Ab to
viruses
DNA
hybridization
No preventive
measures
None
Smallpox
vaccine
**Post-vaccinal
encephalitis
can occur