Final Viruses Flashcards

1
Q

Most DNA viruses are ___sDNA, ____ symmetry, and replicated in the ____

There are 3 enveloped groups that include ___, ___, and ___ and 3 naked groups that include ___, ___, and ____

Exceptions include ____, which is ssDNA instead of dsDNA

Another exception is ____, which is not icoshedral and instead surrounded by a complex structural protein that looks like a box

Also ___ replicates in the cytoplasm rather than the nucleus

All the RNA viruses are ____sRNA, ___ symmetry, replicated in the ___, and ___ (do or do not?) have an envelope

Exceptions include ____ which has dsRNA

____s are naked instead of encapsulated

____s have icosahedral shape instead of helical

___ is shaped like a bullet

____ and ____ have nuclear replication instead of cytoplasm

A

dsDNA, Icoshedral, nucleus

Envelope = Herpes, Hepadana, and Pox

Naked = PAP -> Papova, Adeno, Parvo

Parvo (One PAR in golf)

Pox (Pox in a BOX)

Pox

SsDNA, helical, cytoplasm, do

Reoviridae

Reoviridae, Picorna, and Calici

Reoviridae, Picorna, Calici, Toga, and Flavi

Rhabdo

Retro and Orthomyxo

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2
Q

Unlike + stranded or - stranded RNA viral replication which uses a ___ dependent ___ polymerase, a retrovirus uses a ___ dependent ___ polymerase to transcribe the RNA back into DNA so it can be incorporated into the host’s genome

A

RNA dependent RNA polymerase, RNA dependent DNA polymerase

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3
Q

Influenza virus A, B, and C is part of the ____ viruses and causes the ____ characterized by fever, runny nose, cough, myalgias arthralgias (muscle aches), etc

Secondary ___ infections can often occur in high risk group patients like the elderly or immunosuppressed (like staph aureus or strep pneumonia)

If a child is given aspirin while they have the flu (Influenza) then they can develop brain and liver disease called ____ syndrome

Hemagglutinin (HA) and Neuraminidase (NA) are part of the influenza’s virulence factors

___ is needed to cleave the mucin barrier that covers cells to protect them in order to expose sialic acid binding sites beneath

Once exposed, ___ is needed to bind to sialic acid on the RBCs surface and surface of cells in the upper respiratory tract so that they can be adsorped into the host cells

^** In other words, HA and NA work together for infection

Antigenic ___ is when minor changes in HA or NA occur, resulting in ____ of the common flu

Antigenic ___ is when major changes in HA or NA occur, resulting in ____ of influenza and this ONLY occurs in influenzae type ___

H5N1 aka Bird flu which is an avian influenza A virus caused a pandemic threat resulting in a clinical pneumonia with diffuse patchy infiltrates on chest radiograms progressing to consolidation in the lungs and a secondary bacterial infection progressing to RDS

A

Orthomyxo, ORdinary flu (OR for ORthomyxo)

Bacterial

Reyes

NA

HA

Drift, epidemic

Shift, pandemics, A

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4
Q

Mumps and measles are part of the ____ viruses

Although many similar features to Orthomyxoviridae, these viruses have an ___ protein that causes the infected host cell to fuse together forming multinucleated giant cells (aka syncytial cells)

Although most of these contain HA and NA, which Paramyxoviridae contain no NA or HA glycoproteins and which contains only an HA?

A

Paramyxo

F protein (fusions)

Respiratory Syncytial virus (RSV), Measles

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5
Q

Parainfluenza, RSV, and Metapneumovirus all cause lower respiratory infections in ____ (aka pneumonia), and upper respiratory infections in ___ (bad colds characterized by rhinitis, pharyngitis, and sinus congestion)

____, which occurs in children and characterized by a stridor and a barking cough due to infection and swelling (narrowing) of the larynx occurs in ____ infections

___ is the NUMBER ONE cause of pneumonia in young children less than 6 months of age and metapneumovirus is the second most common cause on pneumonia in young children but a slightly older age group like 1yr olds

____ gland swelling, testicular inflammation (leading to orchitis), and meningitis and sometimes encephalitis would all be due to ___ virus

Measles aka ___ is first characterized by its prodrome of a VERY high fever, hacking cough, rhinitis, conjunctivitis, photophobia, and malasie

After 3-4 days, if you see small red based blue-white lesions in the mouth called ___, your’e about a day away from developing a rash due to the measles virus and this rash starts at the ___ and goes to the neck and torso and ends at the ____ (**Like dumping paint on someone)

The measels virus disseminates to many organs and the most feared complication is ____ and ____ is a slow form of this caused by the virus that occurs years later

A

Kids, adults

Coupe, Parainfluenza

RSV

Parotid (parotitis), Mumps

Rubeola

Kopliks, head, feets

Encephalitis, SSPE (Subactue sclerosing panencephalitis)

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6
Q

5 Hep viruses are RNA and the 1 Hep virus that is a DNA virus is Hep ____

ABCDE -> A and E at the ends of the spectrum are transmitted via A (anal) and E (enteric) and BCD and via Blood transmission

ABCDE can ALL have acute viral hepatitis manifestations (which normally include the patient being ____ in color, painful enlarged ___, and high levels of liver enzymes), but ONLY ____ can have chronic viral hepatitis

Hep A is part of the ____ viruses, Hep B is part of the ___ viruses, Hep C is a Flavivirus, and Hep E is a ____ virus

___ has increased AST and ALT and only MILD elevated alkaline phosphatase and GGT

___ has increased alkaline phosphatase and GGT and only MILD elevated AST and ALT

A

Hep B

Jaundiced, liver, BCD

Picrona, Hepadna, Callci (aka Hepeviridae)

Viral hepatitis

Gallstone (blocking of the bile duct)

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7
Q

Anti-HAV IgM means the Hep A is ___ and Anti-HAV IgG means it is ___

A

Active, Inactive (aka old)

^** Think G = Gone (no more infection)

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8
Q

The intact HepB virus is called the ____ and it can be broken down to tell us more about the infection

Hep B has ___ antigens if there is a LIVE virus and infection (can be either acute/chronic/carrier),

If there is a LIVE virus, we can use ____ antigens to determine if it is acute (we would see Ig__ anti-HBcAgs) or chronic (we would see Ig___ anti-HBcAgs

If the disease is LIVE, along with being either acute or chronic, it can be VERY infectious or Slightly infectious and ___ antigens if the disease is highly active (high infectivity) and anti-___ antigens the disease has low infectivity

Finally, if a patient has ___, they either have NO active disease, immunity, or cured

Hep B has acute viral hepatitis like all the other Heps, ____ hepatitis which is a sever form of acute hepatitis with destruction of the liver (often seen in patients who have Hep B and then become infected with Hep D as a superinfection, or chronic hepatitis (asymptomatic, persistent, or active forms)

Hep B patients can develop primary hepatocellular ____ or liver ____ (Also Hep ___ Genotype 1 often have these complications since 85% of the time patients with acute viral hepatitis C develop chronic hepatitis C ) due to liver injury from the cell mediated immune system

A

Dane particle

HBsAg (Hep B Surface Antigens),

HBcAg (Hep B Core Antigen), IgM, IgG

HBeAg, Anti-HBeAg

Anti-HBsAg

Fulminant

Primary hepatocellular carcinomas, cirrhosis, Hep C

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9
Q

Hepatitis ___ can NOT infect unless it has the envelope of hepatitis ___, specifically the HB___Ag

^** If they do infect, a coinfection causes acute hepatitis and if a patient already has chronic Hep B and gets infected with Hep D, it is called a superinfection leading to fulminant hepatitis and cirrhosis

The leading cause of Chronic Hepatitis with 85% of those who have an acute infection developing chronic hepatitis is Hep ___

Hep E is often called Non-HepA since they have the same manifestations and mainly occurs in Asia

A

D, B, HBsAg

C

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10
Q

Retroviridae include Rous sarcoma virus, HTLV-1, and HIV-1

Rous Sarcoma virus is an ____ transforming virus since it carries intact oncogenes (the src oncogene) within the genome and is integrated into the host DNA via integrase (the sticky ends) to cause malignant transformation

ALL the other retroviridae are Non-acute transforming since they activate host cell proto-oncogenes by integrating viral DNA into a key regulatory area

____ is linked to a paralytic disease that occurs in the tropics (Caribbean islands) called tropical spastic paraparesis

AIDS is caused by the retrovirus HIV (Human immunodeficiency virus) as is characterized by immunosuppression leading to increased opportunistic infections, secondary neoplasms, and neurological manifestations

The main routs of transmission include sexual contact (mainly man to man), parenteral inoculation (intravenous drug abusers, hemophiliacs, or recipients of blood transfusions), and transmission from mother to newborns (during intrapartum from an infected birth canal or peripartum from ingestion of breast milk are the most common)

^** Viral transmission occurs via either

1) Direct inoculation into the blood vessels breached by trauma
2) Infection of dendritic cells or CD4+ cells within the mucosa

Also note that HIV is enhanced via coexisting STDs (especially those associated with genital ulcerations)

^** Include Treponema pallidum, herpes simplex virus, Chlamydia trachomatis, and Neisseria gonorrhoeae

A

Acute transforming

HTLV-1

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11
Q

HIV is a non-acute transforming human retrovirus that belongs to the lentivirus family

There are two forms (HIV-1 and HIV-2) with HIV-1 being the most common

The HIV structure contains a viral core consisting of the major capsid (virus shell) protein ___, a nucleocapsid protein p7/p9, ___ copies of single stranded viral genomic ___NA, and 3 viral enzymes including ___, ___, and ___

The viral core ^ (What we just talked about above) is surrounded by a matrix protein called ___, which is under the virion envelope that has two glycoproteins called ___ and ___ studded into the viral envelope

The HIV-1 RNA genome has Long terminal repeats (LTRs) involved with sticky ends and promotor/enhancer functions, ___ which codes for the viral core proteins P24/MA/NC, ___ encodes for the 3 enzymes, and ___ genes that code for the glycosylated gp120 and gp41 proteins which are all typical of retroviruses

A

P24, 2 copies, RNA, protease and reverse transcriptase and integrase

P17, gp120 and gp41

Gag, pol, env (env for envelope)

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12
Q

HIV can infect many tissues but the two major tissues are the immune system and CNS

Profound immune deficiency, primariliy effecting ___-mediated immunity is the hallmark of AIDS and the main mechanism for the HIV infection is from a ___ amount of ____ cells (with moncytes/macrophages and dendritic cells also being targets of the HIV infection since they also contain the CD4 receptor)

As an overview, HIV enters through the mucosal tissues and blood and first infects T cells, along with dendritic cells and macrophages, and then it becomes established in the lymphoid tissues where it can remain latent

The HIV life cycle occurs in multiple steps including

1) Infection of the cells

^** This occurs from the ___ and ___ binding first, followed by a conformational change and then ____ co-receptors ___ or ___ binding to the CD4-gp120 complex

^** Note that CCR5 chemokine co-receptor is a R5 strain of the HIV and is called ___-tropic since it preferentially Infects cells of the monocyte/macrophage lineage

CXCR4 is an X4 strain of HIV and called ___-tropic because it preferentially infects T cells

^** R5 strain dominates in acute infection but overtime X4 accumulates and then becomes dominant

Once the gp120-CD4-Chemokine complex is formed, another conformation change occurs in ___ which exposes a fusion peptide which inserts into the cell membrane of the target cells (monocytes/macrophages or T cells) leading to fusion of the virus with the host cell

A

Cell-mediated, decreased, CD4+ T helper cells

CD4 and gp120, chemokine CCR5 or CXCR4

M-tropic

T-tropic

Gp41

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13
Q

The HIV life cycle occurs in multiple steps including

1) Infection of the cells (talked about on last notecard)
2) Integration of the provirus into the host cell genome

^** After fusion, the virus core containing the HIV genome enters the cytoplasm of the cell and the HIV RNA genome undergoes ____ leading to synthesis of cDNA aka proviral DNA (double stranded complementary DNA) and in dividing T cells the cDNA circularizes, enters the nucleus, and then integrated into the host genome

HIV is able to infect memory and activated T cells, but has a hard time infecting ___ cells because naive T cells have the enzyme APOBEC3G that causes mutations in the HIV genome once it undergoes reverse transcription… However, once the naive T cells become activated, they lose the enzyme and this is why activated or memory T cells can be infected

3) Activation of viral replication

Now remember, the viral life cycle can only be completed after cell activation, so if a cell was already actively replicating, then it just continues along its path…. However most of the time after the provirus is integrated into the host cell’s genome, it stays there in a latent phase where it is silent for months or years

So in this case above ^ once the cell become activated in most CD4+ T cells, the virus activation results in cell ___

Remember, when a T cell is activated by antigens or cytokines it phosphorylates IKB in the cytoplasm, releasing the inhibition it had on NF-KB and therefore NF-KB is up-regulated and translocates to the nucleus where it sends signals for increased transcription of IL-2 and its receptor occur so that the T cells can proliferate and differentiate…. HOWEVER, when the HIV has infected the nucleus and the infected cell becomes activated by an antigen or cytokine (either from the HIV itself or some other infecting microbe), the NF-KB up regulates and translocates to the nucleus but instead of binding on normal promoter regions in the nucleus, it actually binds to the HIV genome that has NF-KB binding sites (the HIV LTR sticky regions) and this causes the ___ of HIV proviral DNA (HIV DNA provirus -> HIV RNA provirus moves to cytoplasm) and leads to the production of virons and lysis of the cell

^** So in other words, if you have HIV you are at an increased risk for recurrent infections -> recurrent infections cause increased lymphocyte activation and production of pro-inflammatory cytokines -> More cytokines and antigens from microbes stimulates more HIV production from the mechanism we explained above ^ -> More CD4+ T cells undergo lysis and die -> More infection since less T cells -> never ending cycle

4) Production and release of infectious agents

A

2) Reverse transcription

Naive T cells

3) Lysis

transcription

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14
Q

Like we’ve already talked about, T cell depletion occurs mainly from direct cytopathic effects (lysis) of the replicating virus however some other mechanisms can also cause the loss of T cells including

1) Activation induced cell death where chronic activation of uninfected cells responding to HIV itself or an associated infection that cause the cells to undergo apoptosis
2) Pyroptosis
3) Destruction of lymphoid tissues
4) Loss of immature CD4+ T cells
5) Loss of TH1 responses

Since CD4+ T cells are important for both adaptive and humoral immunity, loss of this effects almost every component of the immune system including lymphopenia (low WBCs), decreased T cell function, altered T cell function, polyclonal B cell activation, and altered monocyte and macrophage functions

We’ve mainly talked about infection of T cells by HIV, but remember macrophages and dendritic cells are also infected

1) Macrophages infected by HIV occurs mainly in the tissues

^** Remember, cell division is needed for nuclear entry and replication for most retroviruses, but HIV can infect and multiply in terminally differentiated non-dividing macrophages due to the viral ___ gene (Aka plays a role in regulating nuclear import of HIV-1 and required for virus replication in non-dividing cells like macrophages)

Also unlike CD4+ T cells, macrophages are resistant to the cytopathic effects of HIV and therefore they can harbor the infection since they don’t lyse like T-cells do and are important for the late stages of HIV infection

2) Dendritic cells (Mucosal and follicular)

^** The ___ dendritic cells become infected by the virus and transport it to the regional lymph nodes where it can then be transferred to CD4+ T cells

____ dendritic cells in the germinal centers of the lymph nodes are potential reservoirs of HIV where they trap the HIV virions due to the dendritic cells FC receptor binding to anti-HIV Abs coated around the virions

A

1) vpr
2) Mucosal

Follicular

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15
Q

Even though we have been focusing mainly on cell-mediated defects from HIV, B cells also undergo changes….

There is polyclonal ___ (Inhibition or activation?) of B cells leading to B-cell hyperplasia in the germinal centers, hypergammaglobulinemia, bone marrow plasmacytosis, and formation of circulating immune complexes

^** But even though there are a lot of activated B cells, patients with AIDS still cant mount an Ab response to new antigens due to the fact that T-helper cells are decreased and can’t help them become activated, and some other factors…

Along with the immune system, remember we said that the CNS is also affected and here the HIV infects macrophages and microglial cells (M-tropic lineage)

A

Activation

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16
Q

Once the virus enters through the mucosal epithelia (where it normally comes through), a few subsequent phases occur including

1) ___ syndrome is the clinical presentation of the initial spread of the virus and host response and occurs 3-6 weeks after infection and resolves spontaneously after 2-4 weeks

Symptoms are fever like (soar throat, fever, weight loss, fatigue, possible rash, possible diarrhea, possible vomiting)

^** The primary infection occurs when ___ cells with the CCR-5 chemokine in the mucosal lymphoid tissue becomes infected and large amounts of T cells die

At the same time, dissemination (spreading) of the virus occurs via mucosal dendritic cells taking in the virus and bringing them to the lymph nodes and passing them on the CD4+ T cells via direct contact

^** Here, the HIV undergoes viral replication leading to ___ (viruses in the blood that is measured as ____ levels aka viral load) where it continues its dissemination to the peripheral lymphoid tissues infecting macrophages mainly at first, along with dendritic cells and Helper-T cells

As dissemination occurs, development of host immune responses also happens (anti-viral humoral and cell-mediated along with CD8+ CTLs) and evident by 3-7 weeks after the infection

^** The appearance of CTLs are responsible for the initial containment of the HIV infection

After initial viremia, infected people reach a stead state called the ____ and this can be used as a predictor for the rate of decline of CD4+ T cells and therefore progression of the HIV disease

^** Therefore CD4+ Cell counts and not viral load are the primary clinical measurement used to determine when to start antiretroviral therapy

***So in other words, Viral load tells you the speed that a train is heading towards a cliff and CD4 count tells you where the train is compared to the cliff edge

A

1) Acute retroviral syndrome

Memory CD4+ T cells

Viremia, HIV-1 RNA levels

Viral set point

17
Q

Once the virus enters through the mucosal epithelia (where it normally comes through), a few subsequent phases occur including

2) Middle, Chronic phase (most patients are asymptomatic)

^** Here, the virus is now concentrated in lymphoid tissues (mainly the lymph nodes and spleen) where continues HIV replication and CD4-T cell destruction occurs gradually

** Remember, this replication and destruction is occurring in the tissues, not the peripheral blood at the moment, however since CD4 T cells in the tissue are declining, there is less and less going out into the peripheral blood**

Along with a slow decline in the number of CD4+ T cells in both the lymphoid organs (from being destroyed) and the blood (from not enough T cells able to get into circulation), the immune defense system starts to decline as well and therefore the number of HIV infected cells begins to increase

^** The immune system declining is due to the HIV beginning to evade immune detection via destroying CD4+ T cells, antigenic variation, down-regulating class ___ MHCs on infected cells (so that the viral antigens are not recognized by CTLs), and switch from CCR5 to some other chemokine

Since no clinical manifestations of HIV occur during this period, it is called the ____ period and usually lasts about 8 years

Even though most patients are asymptomatic, candidiasis (oral thrush), herpes zoster, mycobacterial tuberculosis, athletes foot, some bacterial infections (H influenzae, S. Pneumoniae, Salmonella, S. Aureus, S. Epidermidis, etc) and some other small opportunistic infections might occur

^***** But these are just constitutional symptoms and do not represent AIDS

A

Class 1

Clinical latency

18
Q

Once the virus enters through the mucosal epithelia (where it normally comes through), a few subsequent phases occur including

3) Clinical AIDS

Typically occurs in about 7-10 years and clinical features include long lasting fever (over a month) and weight loss, diarrhea, generalized lymphadenopathy

Also, AIDS indicator diseases including

1) Neurologic diseases and constitutional illness (night sweats, fevers, enlarged lymph nodes, severe weight loss, wasting syndrome)
2) Diseases secondary to the immunodeficiency state such as secondary infection by pathogens and normal flora (opportunistic infections)

Opportunistic infections include

A) The most common opportunistic infection in the US is ___ characterized by cough and hypoxia

B) A common yeast infection with oral thrush and esophagitis is ____

C) Chorioretinitis and blindness, along with esophagitis and diarrhea can be due to the __ virus

D) Mycobacterium tuberculosis and MAC can occur with ___ being the most common cause of Fever of Unknown Origin (FUO) in AIDS patients will a CD4 count less than 50

E) Fever, nausea, vomiting, and meningitis is from ____ and if one sees a mass lesion in the brain with fever, headache, and focal neurological defects it is most likely from ____

F) High risk of developing encapsulated organism infections like ____

G) Severe genital or oral outbreaks can be from ___

H) Chronic diarrhea can be from ____, microsporidia, or Isospora belli

I) Herpes zoseters can develop and EBV can cause ___ characterized by white hair like projections arising from the side of the tongue

A

A) P. Jiroveci (causes PCP)

B) Candida albicans

C) Cytomegalovirus (CMV)

D) MAC

E) Cryptococcus neoformans, Toxoplasma gondii

F) Streptococcus pneumoniae

G) Herpes simplex virus

H) Cryptosporidium

I) OHL (Oral hairy leukoplakia)

19
Q

Neoplasms due to AIDS are also common and caused by oncogenic DNA viruses mainly….

****A) ____ is a vascular tumor with red to purple lesions and plaques and nodules that arise all over the body and the most common neoplasm associated with AIDS

^** It is characterized by spindle shaped cells that express markers for both endothelial cells (vascular or lymphatic) and smooth muscle cells; along with chronic inflammatory cell infiltrates

KS is caused by ___ and establishes a latent infection during which spindle cell proliferation and activation, along with prevention of apoptosis occurs… And the activated spindle cells produce proinflammatory and angiogenic factors that recruit inflammatory and neovascular components that lead to the tumor

B) Primary ___-cell ___s (commonly occur in the CNS and therefore present as a brain mass) are caused by tumor cells infected with oncogenic viruses, most commonly ____

^** Unchecked proliferation of B cells infected with oncogenic herpesviruses in the setting of profound T cell depletion can lead to lymphomas such as EBV+ large cell lymphomas or EBV+ Hodgkin lymphomas (associated with a large tissue inflammatory response and Reed-Sternberg cells) or KSHV+ primary effusion lymphoma

^**In a patient with AIDS, they obviously have low T cell counts… Since T cell immunity is required to restrain proliferation of B cells infected with oncogenic viruses like EBV (or KSHV), since it is low, this control is lost

THERE IS A SECOND mechanism that can cause B-cell lymphomas not related to EBV and this can occur in patients who might be receiving HAART and therefore have preserved CD4 T cell counts… This mechanism is due to germinal center B-cell hyperplasia in the setting of early HIV infection due to defective AID enzyme can occur

C) Invasive cancer of the uterine cervix, which can be caused by ___

^** This can also be caused by ___ cancer

A

A) Kaposi sarcoma (KS)

HHV8 (aka Human Herpes virus 8 aka KSHV aka KS herpesvirus….ALL THE SAME THING)

B) B-cell lymphomas, EBV

C) HPV

Anal (Anal intraepithelial neoplasms)

20
Q

So if one sees hyperplasia of B cell follicles, it is the ___ stages of HIV infection due to polyclonal B-cell activation and hypergammaglobulinemia seen in HIV patients

As the disease progresses, B-cell proliferation subsides and gives way to severe lymphoid involution (inactivation/shrinkage)… The lymph nodes become atrophic and small and can carry opportunistic infections and eventually the spleen and thymus also become involuted

A

Early

21
Q

Multinucleated giant syncytial cells with intranuclear inclusion bodies are seen in members of the ____viridae family (and also seen in the Paramyxoviridae family and retroviridae infections)

The herpes virus migrates up the nerves to the ____ where it resides until it is reactivated

There is a HUGE amount of manifestations that can occur depending on the site of inoculation including

1) ___ (aka ___ sores which are vesicles on the lips and mouth that ulcerate)
2) The number 1 cause of viral ____ in the US causing cell death, brain tissue swelling with fever, headache, and neurological abnormalities
3) Genital herpes
4) Neonatal herpes often occurs when mother has a primary genital herpes infection
5) Herpetic ____ which is an infection of the finger that causes it to become red, hot, painful, and swollen

A

Herpes

Sensory ganglia

1) Gingivostomatitis, Cold sores
2) Encephalitis
5) Herpetic whitlow

22
Q

Fever, malaise, and headache followed by a skin rash described as “dew on a rose petal” aka a red base with a fluid filled vesicle on top is seen in ____ that starts on the face and trunk and spreads to the entire body (including the mucous membranes like vagina, pharynx, etc)

This rash can sometimes be confused with small pox however the differences include

1) Chickenpox has ___ lesions that ___ (are or are not?) umbilicated, the lesions are in ____ (different or the same?) stages of development, and lesions on the ___ are more common
2) In contrast, small pox which is a member of the ___ viruses has ___ lesions that ___ (are or are not?) umbilicated, the lesions are in ____ (different or the same?) stages of development, and lesions on the ___ are more common

Once this subsides after about a week, if the patient becomes stressed or has a lowered cell-mediated immunity for some reason, the latent virus that now resides in the dorsal root sensory ganglion (where it will be replicated), moves to the peripheral nerves and this is now the beginning of a ___ virus characterized by a painful skin rash that overlays a SPECIFIC sensory dermatome (dermatome distribution is almost always unilateral)

^** Someone with the shingles can give someone chickenpox since they are the same disease

A

Varicella (chicken pox)

1) Superficial, are not, different, trunk
2) Pox, Deep hard, are, same, extremities

Zosters (shingles)

23
Q

Cytomegalovirus has 4 clinical states

1) Asymptomatic, which most patients are (80%)
2) Congenital disease which can cross the BBB and is the most common viral cause of ____, and it can also lead to microcephaly, deafness, seizures, etc
3) CMV Mononucleosis (similar to EBV) characterized by a Monospot ___ Mono which tells us that the mono is due to CMV and NOT EBV
4) Reactivation in immunosuppressed patients

^**In patients that have the reactivation of CMV (Cytomegalovirus) if they have ___ they can get retinitis, colitis, viremia, but NEVER pneumonitis (inflammation of the alveoli)

If they have ____ they can get colitis, viremia, pneumonitis but NEVER retinitis

AKA Marrow transplant = CMV ___nitis and AIDS = CMV ____nitis

A

2) Mental retardation
3) Monospot negative mono

AIDS

Bone marrow transplant

Pneumonitis, Retinitis

24
Q

If a patient has fever, chills, sweats, headache, and a very painful pharyngitis; along with an enlarged spleen and lymph nodes, think ____ due to ___

Blood work will reveal high WBC count with ___ lymphocytes and ____ antibodies

The Mono-spot test will be + (if Mono is due to CMV, the mono-spot test will be -)

EBV can also be involved in Burkitt’s lymphoma and nasopharyngeal cancers since it transforms B cells

A

Infectious mononucleosis, EBV

Atypical, heterophile

25
Q

Small 1-2mm in diameter white bumps that have a central dimple (like a wart) that is often found in the genital region is seen in ____ which is a ___ virus

90% of ___ is caused by type 6 and 11 of HPV and 70% of ___ is caused by 16 and 18 types of HPV and HPV is part of the ___ viruses

^** Warts are benign hyperproliferations of the keratinized squamous epithelium

BK polyomavirus causes asymptomatic infections in children, but causes symptomatic diseases in immunocompromised patients like ___ diseases in renal transplant patients (nephritis or ureteral stenosis) and _____ in bone marrow transplant patients

Immunocompromised patients with JC polyomavirus get ____ characterized by degeneration of the CNS and white matter leading to memory loss, poor speech, and incoordination

BK and JC polyomavirus are both part of the ___ viruses

A

Molluscum Contagiosum, Pox

Genitals warts, cervical cancer, Papova

Kidney, Hemorrhagic cystitis (hematuria combined with bladder pain)

PML (Progressive multifocal leukoencephalopathy)

Papova

26
Q

Upper respiratory tract infections in kids characterized by rhinitis, conjunctivitis, sore throat, and cough can be due to adenoviridae (Other common causes of children upper respiratory tract infections include RSV, metapneumovirus, parainflenza, rhinovirus, and adenovirus)

Epidemic keratoconjunctivitis aka ___ is another adeno virus

___ (aka ___ disease) affects children (4-12 year olds) and is characterized by a fever and slapped cheek rash which is due to the ____ virus strain ___

^** This is also the ___ DNA virus in size

A

Pink eye

Erythema infectiosum, Fifth, Slapped cheek, Parvo , Strain B-19

Smallest

27
Q

The ___S (which include Bunyaviridae, Togaviridae, and Flaviviridae) are all transmitted by ____ (blood sucking) and cause fever and ____

A

Arboviruses, arthropods, encephalitis

28
Q

Rubivirus is included in the ___ viruses and the other virus in this category is ___ viruses

There are three alpha virus disease transmitted via a ___ that all cause ____ characterized by fever, headache, altered levels of consciousness, and focal neurologic deficits… and they are named based on their location including ____ (seen in the western US and Canada), ___ (seen in eastern US), and ___ (seen in South and Central America and Southern US)

There is a 4th alpha virus disease that does NOT have encephalitis and instead has fever, rash, and ___ pain/swelling and this is called ____ virus transmitted via a ____ that is seen in tropical Africa and Asia

Sometimes, Measles (also called rubeola) due to the measles virus can be confused with rubella caused by the Rubivirus

The differences are that Measles virus (rubeola) has ____ spots, a rash that goes from the head -> neck and torso -> feet and lasts for ___ days, and _____ can develop which is a slow form of encephalitis that occurs many years after the infection

In contrast, Rubivirus does not have Koplik spots, rash goes from forehead -> face -> torso -> extremities and lasts for ___ days (this is why it is also called the 3 day measles), and encephalitis does NOT occur

Realize both have a prodrome characterized by fever, lymphadenopathy, and flu-like symptoms but the flu in ___ is MUCH more severe (high fever, hacking cough, and conjunctivits) rather than a MILD-flu seen in rubivirus

Even though Togaviridae is part of the even larger category of Arboviruses (arthropod born viruses that include Toga, Flavi, and Bunya), Rubivirus is an exception and is not classified as a Arbovirus since it only affects humans

If children are infected with rubivirus, the hear, eyes, and CNS are effected

A

Toga, Alpha viruses

Mosquito, Encephalitis, WEE (Western Equine Encephalitis), EEE (Eastern Equine Encephalitis), VEE (Venezuelan Equine Encephalitis)

Joint, Chikungunya, mosquito

Kopliks, 6, SSPE (Subacute Sclerosing Panencephalitis)

3

Rubeola (aka measles)

29
Q

Hepatitis with jaundice (yellow appearance), fever, backache, nausea, and vomiting seen in an African setting is most likely ____ due to a ____ transmission which is part of the ___ viruses

A painful fever that causes backaches, muscle and joint pain, and severe headaches seen in SW USA or Mexico is most likely ____ (sometimes called ____ fever), and transmitted via a ___ and is part of the ___ viruses

Repeat infections of dengue fever with serotype 2 leads to an increased risk of developing dengue ___ fever characterized by hemorrhage, thrombocytopenia, and septic shock

There are a few other species under the Flavi viruses and these cause ____ and named for their geographic location such as St. Louis encephalitis, Japanese encephalitis, and ____ encephalitis (only seen in north america) which is characterized by encephalitis, fever, meningitis, and muscle weakness (flaccid paralysis)

Also remember, ___ is the other Flavi virus considered to be in this group

A

Yellow fever, mosquito, Flavi

Dengue fever, break bone fever, Flavi

Hemorrhagic

West nile

Hep C

30
Q

In a young adult patient from New mexico, Arizona, Colorado, or Utah; with influenza like symptoms (high fever, muscle aches, cough, nausea, and vomiting) AND a pulmonary edema, ___ should be considered

In Asia and Europe, hantavirus is associated with ____ fever with ___ failure

Hantavirus is part of the ____ viruses and the other viruses in this category include Rift valley fever virus, California encephalitis virus, and Sandfly fever virus which all cause fever and encephalitis

^** If IgM and IgG Abs to Sin Nombre Virus is confirmed, then Hantavirus is the disease

A

Hantavirus (HPS aka Hantavirus Pulmonary Syndrome)

Hemorrhagic, renal

Bunya

31
Q

____viruses infect intestinal epithelial and lymphoid cells (tonsils, peyers pathces, etc) and ____ viruses is the main category for these viruses which can be remembered by the Mneumonic ____ + ____

Patients from india, pakistan, or nigeria can still get ___ virus which infects ____ and ____ cells

The virus can either be mild, ____ meningitis with fever and stiff neck and recovery in a week, or ____ which is the active and feared infection causing asymmetric ____ due to necrosis of the large motor neurons in the ___ horn of the spinal cord and meningismus/fever is also seen

The enteroviruses are the most common causes of non-bacterial (aka Aseptic) ____ which is characterized by a fever and stiff neck

These picrona virsues are the ___ (largest or smallest?) RNA viruses

A

Enterovirus, Picorna, PERCC (Polio, Echo, Rhino, CoxA, CoxB) + Hep A

Poliovirus, Motor and Peyer patch cells

Aseptic, Paralytic poliomyelitis, Flaccid paralysis, anterior

Meningitis

Picornaviridae

Smallest

32
Q

Coxsackie A, B and echoviruses are all subgroups of Enteroviruses, which remember are also grouped as picronaviridae

Cox A, B, and echoviruse ALL cause asymptomatic infections, respiratory infections, “cold” rashes aka exanthems, and aseptic ___ aka not due to bacteria…

^** You can tell them apart due to the fact that ONLY Cox A has ____, which is a mild self-limiting illness characterized by fever, soar throat, and small red-based vesicles over the back of the throat

^** Cox A also causes hand, foot, and mouth syndrome (vesicles in children under 5)

ONLY Cox B causes ___, ___, and ____

^** ___ is characterized by fever, headache, and sharp pleuritic chest pain aka severe lower thoracic pain on breathing

^** So realize ONLY Cox B causes myocarditis (inflammation of heart muscle), pericarditis (inflammation of pericardial membrane), and pleurodynia (fever, headache, and severe lower thoracic pain on breathing)

The only thing one will see in echoviruses and new enteroviruses are ____

So realize if you see pleuritic chest pain, it MUST be due to ___

A

Meningitis

Herpangina

Myocarditis, pericarditis, and pleurodynia

Pericarditis

Cox B

33
Q

___ and ___ cause the common cold and they are pretty much indistinguishable

^** Common cold symptoms include rhinorrhea (runny nose) and sore throat

Rhinoviruses are part of the ___ viruses and Coronaviridae are part of the ____ viruses

The coronavirus also caused ____ characterized by fever, myalgias, chills, dry cough, chest pain, dyspnea, and CT scan showing alveolar consolidation that was originally an outbreak of an atypical pneumonia in China

A

Rhinovirus and Coronaviridae

Picorna, Corona

SARS (Severe Acute Respiratory Syndrome aka SARS-CoV)

34
Q

Calicivirus, Reovirus, Adenovirus, and Astrovirus all cause ____

Fever, abdominal pain, vomiting, and diarrhea (with no blood or pus) are signs of viral gastroenteritis and can be caused by either ____viridae or ___viridae and both are pretty much indistinguishable

Calcivirus is also called ___ virus (sometimes called norovirus) and the other virus classified under the calcivirus is ___

^** Norwalk virus and Norovirus are commonly associated with acute infectious diarrheal outbreaks such as those seen on a cruise ship or after a hurricane

Reovirus is also called ____ virus and is also a leading cause of acute infectious diarrheal outbreaks

So one more time, if you see a patient with viral gastroenteritis characterized by fever, abdominal pain, vomiting, and diarrhea with no blood or pus (often occurs in children) and morphology shows it’s a viral cause then think norovirus/norwalk virus (from Calci) or rotovirus (from Reo)

A

Diarrhea

Calci or Reo

Norwalk virus, Hep E

Rotovirus

35
Q

___s have a bullet-shaped envelope and helical symmetry nucleocapsids

This virus causes ____ and upon examination of the CNS, one will see ____

Prodrome for rabies is nonspecific, and eventually acute ____ occurs with hyperactivity and agitation, eventually leading to classic brain step encephailitis that causes CN dysfunction and foaming of the mouth due to painful contraction of the pharyngeal muscles when swallowing liquid aka ___

A

Rhabdoviruses

Rabies, Negri bodies

Encephalitis, hydrophobia

36
Q

A patient from Africa (Zaire, Sudan, Uganda, Kenya) with fever, diarrhea, weakness, dysphagia, hiccups, and bleeding from the mucous membranes like the GI tract, Vagina, or skin has something called ____ fever and is due to the virus family ____ which can be from either the ___ virus or ___ virus

Lassa virus, LCM (Lymphocytic choriomeningitis virus), and South American hemorrhagic fever viruses all have similar manifestations to Filoviruses, but the disease occurs slower and all 3 of these are part of the ___ virus family

Also realize Rift valley fever (from the family ____ viruses) and yellow fever (from the family ____viruses) can cause hemorrhagic fever

A

Acute Viral hemorrhagic fever, Filo, Ebola or Marburg

Arena

Bunya, Flavi