Viruses - DNA - NOT from Herpes Family

Question 1

Polyomavirus; JC and BK

lab tests

Answer 1

Et Tu, BK?

Circular DS DNA

Naked virus (No envelope!)

Question 2

Polyomavirus; JC and BK

2 main polyomavirus strains

Answer 2

Et Tu, BK?

1. JC virus (John Cunningham virus)
2. BK virus

Question 3

JC Virus (a Polyomavirus)

MOA

aka John Cunningham Virus

Answer 3

Et Tu, BK?

• JCV causes persistent asymptomatic infection in approximately one-third of the adult population.
• The virus causes disease only when the immune system has been severely weakened. (causes PML!)
• Immunocompromised people, or in AIDS pts with CD4 < 200.
• PML has a mortality rate of 30–50 percent in the first few months.

Question 4

JC Virus (a Polyomavirus)

signs and symptoms

aka John Cunningham Virus

Answer 4

Et Tu, BK?

• JCV causes progressive multifocal leukoencephalopathy (PML), a demyelination disease (by killing oligodendrocytes that produce myelin for the CNS)
• Multifocal non-enhancing brain lesions in white matter (dds vs Toxoplasmosis w/ ring enhancing lesions)
• buzzwords: AIDS pt. with motor neuropathy

Question 5

BK Virus (a Polyomavirus)

signs and symptoms

Answer 5

Et Tu, BK?

• Nephropathy & other urinary tract problems
• Hemorrhagic cystitis* (Sudden onset of hematuria w/ bladder pain and irritable bladder syndrome)
• Common in transplant pts* (Kidney nephropathy and bone marrow transplants)

* DDX Adenovirus which also has hemorrhagic cystitis, but is more common in boys and swimming in public pools.

Question 6

HPV

lab tests

Answer 6

Pilloma Bugs

DS DNA

Naked virus (No envelope!)

• Pap smear and cervical cancer screening.
• Koilocytes in squamous* cells (large, dense, wrinkled nucleus that may be binucleated).

* Detecting morphological changes; sampled from the transformation zone (where squamous eipthelium from outer ectocervix comes into contact with columnar epithelium in the inner endocervix).

Question 7

HPV

know the main HPVs strains

Answer 7

Pilloma Bugs

100’s of HPV strains!

• HPV 1 - 4
• HPV 6 & 11**
• HPV 16 & 18**
• HPV 31 & 33

Question 8

HPV

HPV 1 - 4

signs and symptoms

Answer 8

Pilloma Bugs

• Verruca** (wart) **vulgaris (common)
• aka “cutaneous common wart”
• transmission requires direct physical contact
• Children typically get on hands and feet

Question 9

HPV

HPV 6** and **11

signs and symptoms

Answer 9

Pilloma Bugs

• Laryngeal Papillomatosis (Recurrent respiratory papillomatosis): Tumors (papilloma’s) develop in airways. Typically seen in children, and often obtained during vaginal birth (but not considered an STD)
• Anal genital warts (Condyloma acuminata*): seen in sexually active pts.

* ddx from secondary syphilis w/ Condylomata lata

Question 10

HPV

HPV 16**, **18, 31, and 33

signs and symptoms

Sketchy Tip: Remember 16/18. add 15 to each to get 31/33

Answer 10

Pilloma Bugs

• most common STD
• Ano_genital_ carcinoma (Squamous Cell Carcinoma): Cervical, vulvar, vaginal, penile, anal
• Buzzwords = “bleeding after sex” or “cancer”
• In anal or penile cancer a major RF is immunosupression, especially in HIV* pts.

* HPV is an AIDS-defining illness)

Question 11

HPV

HPV 16**, **18, 31, and 33

MOA

Sketchy Tip: Remember 16/18. add 15 to each to get 31/33

Answer 11

Pilloma Bugs

• HPV upsets the cells normal cycle.
• Tumor supressor proteins p53 and RB (Retinoblastoma protein) normally stop the cell cycle advancement from G1→S.
• HPV encodes E6** and E7** to promote the proteolysis of p53 (E6) and **RB (E7**) → removal of tumor supressors ↑ risk of cancer!
• AIDS-defining illness. Its thought HIV helps to enhance the E6/7 expression.

Question 12

HPV

HPV Vaccine

Answer 12

Pilloma Bugs

• HPV vaccine is Gardasil
• Its an inactivated quadravalent vaccine
• Used for strains 6, 11, 16, and 18*

* These 4 strains cause ~70% of cervical cancers

Question 13

Parvovirus b19

lab tests

AKA: 5th disease, Slapped cheek disease, Erythema infectiosum

Answer 13

Bombs Away

SS* DNA

* (The only SS DNA on sketchy!!!)

Naked virus (No envelope!)

“parvo” = small (It’s the smallest virus in sketchy)

Question 14

Parvovirus b19

Source

AKA: 5th disease, Slapped cheek disease, Erythema infectiosum

Answer 14

Bombs Away

• Transmitted by respiratory droplets
• Transferred from mother to fetus (a TORCHeS Infection)

Question 15

Parvovirus b19

signs and symptoms

AKA: 5th disease, Slapped cheek disease, Erythema infectiosum

Answer 15

Bombs Away

1. Low grade fever that lasts a week → as fever breaks slapped cheek rash → Erythema (lacy) rash that begins on the face and goes down the body
2. Adults (Teachers!!!) can present with joint pain, arthritis, soreness, and edema
3. Transient aplastic anemia in sickle cell pts (due to depletion of bone marrow) looks like cobwebs in bone scans, and can fade out when virus clears.
4. Babies in utero exposed to Parvovirus in trimesters 1 or 2 (a TORCHeS Infection)→ hydrops fetalis (massive edema) → fatal

Question 16

Parvovirus b19

ddx vs. Roseola

AKA: 5th disease, Slapped cheek disease, Erythema infectiosum

Answer 16

Bombs Away

• Parvovirus b19 presents with a low grade fever that lasts a week → as fever breaks slapped cheek rash → Erythema (lacy) rash that begins on the face and goes down the body
• Roseola which presents with a high grade fever for 3-4 days, can include febrile seizures, and is followed by a diffuse lacy rash that spares the face.

Question 17

TORCHeS Infections

Answer 17

TORCHeS Infections:

Toxoplasmosis

Other (HIV, VZV, Parvovirus B19, enteroviruses, others)

Rubella

Cytomegalovirus

Herpes

Syphilis

Question 18

Adenovirus

lab tests

Answer 18

A Den-O lions

DS DNA

Naked virus (No envelope!)

Question 19

Adenovirus

Source

Answer 19

A Den-O lions

• Transmitted by respiratory droplets and fecal-orally.
• Most at risk are little children**, **military recruits, and public pools.

Question 20

Adenovirus

signs and symptoms

Answer 20

A Den-O lions

3 major disease processes:

1. Tonsillitis (most common cause of infection in adenoids and tonsils).
2. Hemorrhagic cystitis*
3. Viral conjuctivitis aka “Pink Eye“ (common cause)

* DDX BK Virus (a Polyomavirus) which also has hemorrhagic cystitis, but is more common in immunocompromised (transplant pts, or pts with AIDS)

Question 21

Adenovirus

Vaccine

Answer 21

A Den-O lions

Military** recuits get a **live vaccine

Question 22

Pox Virus

lab tests

Answer 22

Pox in a Box

• DS DNA
• Enveloped virus
• Dumbbell-shaped core
• Largest known DNA virus
• Guarneri inclusion bodies*

* (B-type intracytoplasmic bodies in infected cells, appear as blobs on stains) found on skin lesion / blister biopsy

Question 23

Pox Virus

MOA

Answer 23

Pox in a Box

• Pox Virus comes with everything it needs inside of it, including making their own envelopes.
• Replicates in the cytoplasm (only DNA virus in sketchy that does).
• Replication sites are seen on stains as Guarneri inclusion bodies
• Brings its own DNA dependent RNA polymerase (reads DNA, produces primary transcript RNA!) to produce all of the proteins that it needs (including DNA polymerase)

Question 24

Pox Virus

3 main Pox virus strains

Answer 24

Pox in a Box

1. Small pox virus
2. Cow pox virus
3. Molluscum contageosum virus

Question 25

_**Small pox** **virus**_ **( a _Pox_ Virus)** signs and symptoms

Answer 25

**_Pox in a Box_** * _**Small pox** **virus**_: **_Raised_ skin** on surfaces. **_Scattered_ ulcers** and **blisters** that are the **_same_ age\*** **\*** (**ddx _Variola_** aka **Chickenpox** which also has **_scattered_ ulcers** and **blisters** but of **_mixed_ ages** and stages of healing.) * _**Cow pox** **virus**_: causes symptoms **similar to small pox**. transmitted by contact with infected **cow udders**.

Question 26

_**Molluscum contageosum** **virus**_ **( a _Pox_ Virus)** signs and symptoms

Answer 26

**_Pox in a Box_** * **Flesh** colored, **dome** shaped, **umbilicated** (**_dimpled_**) **lesions**. Usually **painless.** * **Most common** in **_children_****.** Found **anywhere on body _except_ _palms**_ and _**soles_**. Most often seen on **_trunk_**, **axilla**, **anticubital fossa**, and **poplitial fossa**. * **In _adults**_ usually presents as a _**single_ lesion** from **sexual** transmission. If it **spreads diffusely** it is **due to** **immunosuppression** (likely **HIV**).

Question 27

**_Hepatitis B_ (a **_Hep_**a_dna_virus)** lab tests

Answer 27

**_Hep B Love_** * **_Circular_ Partially\* _D_****S **_D_**NA** (becomes **fully **_D_**S during _replication_**) * **Enveloped** virus * **_Ground glass_** appearance (from HB**s**A**g**) * **_ALT↑_** in **acute infections** then **↓** once symptoms **end**. * **In _neonates**_ initial phase of HBV, serum _**ALT_ levels** are **_normal_!** * **_S_**P**_EC_**I**_ES_ (mnemonic** to determine **phase** of **Hep B**)

Question 28

**_Hepatitis B_ (a **_Hep_**a_dna_virus)** MOA

Answer 28

**_Hep B Love_** * **_Circular_ _partially_ D****S DNA**becomes**_fully_ DS during _replication_** * **Replicates _both_** inside the **nucleus and** in the **cytoplasm!** (_unique_!!!) * **Hep B contains** its own **reverse transcriptase** (like HIV) and goes from **S**S **_D_**NA → **_S_**S **_R_**NA → **_D_**S **_D_**NA (but unlike HIV, Hep B does not integrate into hosts chromosomes)

Question 29

**_Hepatitis B_ (a **_Hep_**a_dna_virus)** Source

Answer 29

**_Hep B Love_** * Spread via **_Sex_** and **_Drugs_** (similar to Hep C vs. Hep A spread fecal orally) * **Vertical transmission** (a **T**_O_**RCHeS** infection!) through **_blood_****\*** **during** child **birth** **\*** (Hep B is to large to cross placental wall, transmitted via blood during delivery)

Question 30

**_Hepatitis B_ (a **_Hep_**a_dna_virus)** **Acute** Hep B signs and symptoms

Answer 30

**_Hep B Love_** 1. **Purpuric _rash_** → non-blanching dark macules 2. **Arthritis**, Arthralgia 3. ****_P_**oly**_a_**rteritis **_N_**odosa** (**PAN**) 4. ****_M_**embranous** ****_g_**lomerulo**_n_**ephritis** (**MGN**) 5. ****_M_**embrano**_p_**roliferative** ****_g_**lomerulo**_n_**ephritis** (**MPGN**)

Question 31

**_Hepatitis B_ (a **_Hep_**a_dna_virus)** **Chronic** Hep B signs and symptoms

Answer 31

**_Hep B Love_** * Only about **5-10%** develop into **chonic** infection in **adults**. (vs. Hep C which is ↑) * **Newborns** have a **90-95%** chance of **chronic** infection. * Long term Hep B → **liver _cancer_** (hepatocellular carcinoma)

Question 32

**_Hepatitis B_ (a **_Hep_**a_dna_virus)** ****_P_**oly**_a_**rteritis **_N_**odosa** (**PAN**)

Answer 32

**_Hep B Love_** * **Systemic _vasculitis_** that affects **medium** to **small arteries**. * **Small** **aneurysms** are strung along the artieries like the **beads of a rosary**. * **_Beads on a string_ appearance**. * Damages **kidneys** **→** **_↓ GFR_** and ****_Hyper_**tension**

Question 33

**_Hepatitis B_ (a **_Hep_**a_dna_virus)** ****_M_**embranous **_g_**lomerulo**_n_**ephritis (MGN)**

Answer 33

**_Hep B Love_** * A type of **glomerulonephritis caused by deposits** in the kidney **glomerular _basement membrane_\*** (GBM) **thickening**, and **activating complement** → **damaging** the **glomeruli.** **\*** (**vs. _MPGN**_ which is in _**both_** the glomerular _mesangium_\* AND _basement_ membrane.) * By light **microscopy**, the **basement membrane** is observed to be **_diffusely_ thickened**. * Using **Jones' stain**, the **GBM** appears to have a "**_spiked_**" or "**_holey_**" **appearance**.

Question 34

**_Hepatitis B_ (a **_Hep_**a_dna_virus)** ****_M_**embrano**_p_**roliferative **_g_**lomerulo**_n_**ephritis (MPGN)** **aka** mesangiocapillary glomerulonephritis

Answer 34

**_Hep B Love_** * A type of **glomerulonephritis caused by deposits** in the kidney **glomerular _mesangium_\* AND _basement membrane_** (GBM) **thickening**, and **activating complement** → **damaging** the **glomeruli.** **\*** (**vs. _MGN_** which is **_only_** in the _GBM_.) * **GBM** is **rebuilt on top** of the deposits, causing a **"_tram tracking_"** **appearance** under the **microscope**.

Question 35

**_Hepatitis B_ (a **_Hep_**a_dna_virus)** **S**P**EC**I**ES** (mnemonic to help determine phase of Hep B)

Answer 35

**_Hep B Love_** **S**P**EC**I**ES** * **_S_:** Hep B **_S_**urface **antigen** (HB**s**Ag) * **_E_:** Hep B **_E_** **antigen** (HB**e**Ag) * **_C_:** Anti-Hep B **_C_**ore **antibody** (anti-HBc or HB**c**Ab) * **_E_:** Anti-Hep B **_E_** **antibody** (anti-HBe or HB**e**Ab) * **_S_:** Anti-Hep B **_S_**urface **antibody** (anti-HBs or HB**s**Ab)

Question 36

**_Hepatitis B_ (a **_Hep_**a_dna_virus)** Hep B **_S_****urface antigen** (HB**_s_**Ag) **S**P**EC**I**ES** mnemonic (to help determine phase of Hep B)

Answer 36

**_Hep B Love_** * 1^st clinically measurable * **(+)** for **_active_ infection** (acute or chronic) * Leads to "**_ground glass_** **appearance**"

Question 37

**_Hepatitis B_ (a **_Hep_**a_dna_virus)** Hep B **_E_** **antigen** (HB**_e_**Ag) **S**P**EC**I**ES** mnemonic (to help determine phase of Hep B)

Answer 37

**_Hep B Love_** * Not enough time to create antibodies yet * **Highly** corelates with **_infectivity_**.

Question 38

**_Hepatitis B_ (a **_Hep_**a_dna_virus)** **Anti-**Hep B **_C_****ore** **antibody** (**anti**-HB**_c_** or HB**_c_**Ab) **S**P**EC**I**ES** mnemonic (to help determine phase of Hep B)

Answer 38

**_Hep B Love_** * **(+)** in the **_window period_**\* **\*** (where the body starts producing Anti-Hep B Surface antibodies to bind the Hep B surface antigen.) * Either **HNsAg or HBsAb** may be **also detected**.

Question 39

**_Hepatitis B_ (a **_Hep_**a_dna_virus)** **Anti-**Hep B **_E_** **antibody** (**anti**-HB**_e_** or HB**_e_**Ab) **S**P**EC**I**ES** mnemonic (to help determine phase of Hep B)

Answer 39

**_Hep B Love_** * **_Low_** **infectivity**

Question 40

**_Hepatitis B_ (a **_Hep_**a_dna_virus)** **Anti-**Hep B **_S_****urface** **antibody** (**anti**-HB**_s_** or HB**_s_**Ab) **S**P**EC**I**ES** mnemonic (to help determine phase of Hep B)

Answer 40

**_Hep B Love_** * Indicates **recovery** * Also used to **check** for **immunization\*** \* (HB**_s_**Ab will be the **only antibody** that is **(+)** in **immunization** pts, both HB**_c_**Ab and HB**_e_**Ab will be **_negative_!**)

Question 41

**_Hepatitis B_ (a **_Hep_**a_dna_virus)** Treatment

Answer 41

**_Hep B Love_** 1. ****_Lam_**ivudine** and **NRTI's** 2. **Interferon Alpha** * **Anti Hep B Ig** w/ Hep B **vaccine** to **_neonates_** at risk

Question 42

**_Hepatitis D_** Key info

Answer 42

**_Hep B Love_** * **_Circular_** **_NEG_** sense ****_R_**NA** * **_Enveloped_** virus * **_NEEDS_ Hep B Surface antigen** (**HB**_s_**Ag**) to cause infection! * Can cause **_co_-infection** at **same time** as Hep B, **or** a **_super_-infection\*** if transmitted **on top of existing** Hep B infection **\*** (**_Post_ infection** has **_worse_ outcomes**)