RNA VIRUSES Virus first multiply in the throat and intestine,

invade the lymph nodes and lymphatics then

Positive sense
finally reach the CNS via the blood circulation
Pico Infection range from mild to nonparalytic polio
Called (asceptic meningitis to paralytic poliomyelitis
Virus recovered from throat swab taken soon
Flavio
after onset of illness and from rectal swab or
To stool sample for long periods
Return? Uncommonly recovered from CSF

Reos o Coxsackie A: 24
Herpangia
Corona
Hand-foot-mouth dse
o Coxsackie B: 6
Double stranded = Reo
Pleurodynia
Pericarditis
Non enveloped (PICOs CALCIum REached Myocarditis
stars(astro)) o Echo: 34
Picorna o Enterovirus 70
Calci Acute hemorrhagic cystitis
o Many:
Reo
Aseptic meningitis
Astro
Fever
Malagia
Aedes aegypti Flu
Chinkungynya Maculopappilla skin rashes
Dengue o Human Hepatitis A virus (Human
Zika Enterovirus 72)
Yellow 2-6 wks IP
Anorexia, Malaisen, nausea, Diarrhea,
Helical
Abdominal discomfort, Fever, Chills,
Filoviridae Jaundice
Paramyxo NO CHRONIC
Ortho Serology
Acute Hep A infx = IgM
Spherical - BUNYA
anti HAV
o Appear 4
PICORNAVIRIDAE
weeks after the
Icosahedral
25-30 infection
o Disappears 3-4
Human Enteroviruses
o Fecal-oral months
o Polio: 3 sero IgG = immunity
Poliomyelitis Human Rhino viruses: 113 (common colds)
Acute infection in children (infantile paralysis) Foot and mouth (apthovirus) in cattle
that destroys the motor neurons in the Detection
spinalcord resulting in flaccid paralysis o Cell culture
 PMK kidney Treatment: Supportive
HDF human diploid Prevention: avoid, vaccination
PCR Immunity: Specific and permanent
o Serology
CALICIVIRIDAE
Icosahedral
Cup-like depression on capsid surface
35-40 nm
Human pathogens
o Norovirus/Norwalk agent
Fecal-oral
Epidemic viral gastroenteritis in
adults and older children
24-48 hr IP TOGAVIRIDAE
Vomiting & watery Icosahedral
diarrhea 60-70nm
Not cultivated G. Alphavirus (mosquito borne)
Detection o E., W., Venezuelan equine encephalitis
Reverse transcriptase virus
PCR o Chikungunya virus
Monkey reservoir
Electron microscopy
A. aegypti
Serology Fever same as classical dengue
o Hepatitis E virus (Hepeviridae) Fever, skin rashes,
Hepatitis similar to A arthralgia, arthritis
(calciviridae) Diagnosis

32-34 nm Virus isolation

Mortality rate 40-20% in Serology

G. Rubivirus
pregnant women
o Rubella virus German measles
Diagnosis: serology
Transmission
Difficult to cultivate
Respiratory
o Winter vomiting bug
Transplacental
ASTROVIRIDAE
Dse
icosahedral Rubella/GM
28-30 nm Congenital rubella
star-shaped o 35% if mother is infected during 1st
Human astrovirus: 8 trimester
o Classic triad
o Acute gastroenteritis
Deafness
o Diarrheal dse
Eye cataract
Infants
Heart defects
Young children
o Others
elderly
Groth retardation
o Detection: E/M, RT-PCR
Mental retardation
Hepatoslenomegaly
 Meningoencephalitis Detection:
Acquired post-natal rubella RT-PCR
3-day measles
Serology (HI)
o
o Milder
o Maculopapular skin rashes Treatment: Supportive
o Fever (3d) Prevention: Rubella vaccine
o Postauricular and suboccipital
lymphadenopathy
(contraindicated in pregnant)

FILOVIRIDAE Tret: Sup

Helical Prevention: vaccine
80x1000 nm o Mumps virus
Marburg virus Person to person contact,
Ebola virus respiratory droplets
o Zoonotic: African green monkets Mumps (Epidemic parotitis)
Reservoir bats
Painful inflammation and
o Detection
E/M swelling of one or both
ELISA detection of viral Ag & Ab parotid glands,
Cell culture (monkey kidney cells)
o Treatment Mild fever,
Maintaining renal function and electrolyte Pain on swallowing
balance and combating hemorrhage and Orchitis in males past
shock
puberty
PARAMYXOVIRIDAE Permanent immunity
Helical Detection:
150 nm Cell culture (PMK)
Pathogens Serology
o Measles virus / Rubeola (tipdal) Treatment: Supp
Contact with respiratory secretions, Prevention: Mumps vacc
extremely contagious o Parainfluenza viruses type 1-4
Measles (Rubeola) Conact with respiratory secretion
High fever, Adults
maculopapular skin rashes Upper respiratory infection
(face-trunk-extremeties), Pneumonia (rare)
Children
Koplik spots
Croup (Acute
Late complications:
laryngotracheobronchitis)
Subacute sclerosing
Bronchiolitis
panencephalitis (SSPE)
Pneumonia
Branny desquamation Detection
Permanent immunity
Cell culture (PMK)
Detect:
Shell cial culture
Cell culture (PMK)
FA
Serology Treatment: Supportive
Warthin Finkeldey giant
Prevention: Avoid contact
cells
 o Respiratory syncytial virus (RSV) Respiratory Secretions
Person to person by hand and Influenza A Virus
respiratory contact o Contact with respiratory secretions
1 in infants and children o Influenza
Infants Malaise
Bronchiliolitis Headache
Pneumonia Myalgia
Coup Cough
Children o Primary influenza pneumonia
Up respiratory infection Detection
Adults o Cell culture (PMK)
Life threatening pneumonia o EIA
Detection o FA
Cell culture (HEp-2) Epidemiology
EIA o Viral subtypes based on H and N
FA stain o Can infect humans and animals
Epidemiology o Antigenic shift results to local or
Nosocomial transmission worldwide outbreaks
occurs readily Prevention: vaccine
Treatment: Supportive
Prevention
Prevent nosocomial infx
ORTHOMYXOVIRIDAE
Helical
80-120
Influenza viruses A-C
o Avian flue (H5N1)
o Swine (H1N1) BUNYAVIRIDAE
Envelope glycoproteins Spherical
o Hemagglutinin (H) spikes (15) 80-120 nm
Allow virus to recognize and Human pathogens
attach to receptors on body o Arthropod borne (mosq, tick, sandfly)
Sandfly fever virus
cells
California and La Crosse virus
Antibodies against influenza is
(mosq)
generally directed against
Rift Valley fever virus
these spikes
o Hantavirus (Korean hemorraghic fever)
(Sin Nombre virus)
o Neuramidase (N) spikes (9) Rodent-borne
Enzymatically help the virus Aerosolized rodent
separate from infected cells excreta
during budding o Caused by Hantavirus
Less important antibodies
 Hemorrhagic fever with renal Hantavirus pulmonary
syndrome syndrome
Interstitial nephritis Acute respiratory
Generalized failure
hemorrhage and shock Deer mouse
Urban rats o Diagnosis
Ag-Ab detection
RT-PCR Hantavirus Ag
Increased vascular permeability with
FLAVIVIRIDAE plasma leakage into insterstitial
Enveloped icosahedral nucleocapsids spaces
45-55 nm o Zika Virus
Arthropod borne (mosquito) Zoonotic from monkeys
o Dengue virus Transmitted by Aedes aegypti mosquito
4 serotypes: 1-4 S/S
Transmission: bite of Fever
Aedes aegypti Skin rashes
Aedes albopictus mosquito Muscle and joint pains
Disease: Last for 2-7 days
Classical Dengue fever Infection of pregnant mothers can cause
Dengue hemorrhagic fever or Dengue congenital infection manifested as
shock syndrome (Immune-mediated) microcephaly
Detection: Serology and PCR Can trigger Guillaine-Barre syndrome
Prevention: Vector control o Japanese encephalitis virus
Dengue fever Leading cause of viral encephalitis in Asia
S/S Transmission: Bite of infected Culex
o Fever
mosquito
Subsides during the 3rd day Disease: Encephalitis
Rises again about 5-8 days Infection have high mortality rate of
o Chills
30%
o Pains in back, joints, muscles,
Survivors are usually left with
and eyeballs
neurologic sequela
o Last for 2-7 days
Detection: Serology
o Deep bone pain and skin rashes
Prevention: Vector control
(maculopapular) o Yellow Fever Virus
Monitor platelet and hematocrit Africa and South America
Dengue hemorrhagic fever or Dengue
Monkeys reservoir
shock syndrome Mosquito (Aedes aegypti) vector
Occur in individuals with preexisting Primarily infects liver resulting in
antibodies resulting to formation of Fever
virus-antibody complexes (immune Jaundice
enhanced disease) Hemorrhage
 Involve o Cough and shortness of
Spleen breath
Kidney Progress rapidly to severe acute
Heart respiratory disease
Detection High mortality rate especially among
Serology
the elderly
PCR
Detection:
o St. Louis Encephalitis Virus
E/M
Hepatitis C Virus (HCV)
Culture (Vero monkey kidney cells)
o Hepatitis C infection previously referred as non-
Serology (ELISA or FAT)
A, non-B hepatitis Epidemiology: Originated from
o Responsible for 90% of post-transfusion Pigs
hepatitis Domestic fowls
o Chronic infection Treatment:
o Consequence of liver cirrhosis and/or Supportive
hepatocellular carcinoma Prevention:
o Serology: Detection of anti-HCV Isolation of patient
Quarantine of those exposed
Travel restrictions
Wearing of protective gears
o Common colds
o Gastroenteritis
o MERS-CoV (Middle East Respiratory
Syndrome Corona Virus)
CORONAVIRIDAE Saudi Arabia 2012
Enveloped helical nucleocapsids Originates from baths and
Large, widely spaced-petal-shaped spikes producing camels
a crown-like structure REOVIRIDAE
SS genome, 120 nm, (+)sense Naked icosahedral nucleocapsid
Human Coronavirus 75 nm;
o SARS virus DS genome
Transmission: Close contact with infected Wheel-like appearance
persons (superspreaders) Human Rotavirus: A-E
Disease o Transmission:
Originated from China Fecal-oral
First outbreak in Nov 2002 Survives well in inanimate objects
IP average of 6 days Infects the villi of small intestine (Damage
Early symptoms
their transport mechanism)
o Fever o Disease:
o Malaise Major cause of gastroenteritis in infants and
o Chills
children 6 months to 2 years
o Headache
Nosocomial infection can occur only
o Dizziness
o Detection:
 EIA Heat at 50
Latex agglutination 30-90 range of PH
o Epidemiology: Lipid solvents
4 serotypes Ether
Nosocomial infections can occur easily Chloroform
o Treatment: Supportive especially fluid o Inhibited by
replacement 95% ethanol
o Prevention: Avoid contact with the virus Phenol
o Group A as the most frequent pathogen Chlorine
o Stable to
RHABDOVIRIDAE o Diseases: Rabies
Bullet-shaped enveloped helical nucleocapsid 3 phases
SS (-)sense IP 1-3 months
180 x 75 nm Short prodromal
Rabies virus o Last 2-10 days
o Transmission: Malaise
Bite of a rabid animal (most Anorexia
common) Headache
Inhalation Abnormal sensation
Corneal transplant at the site of bite
o Mechanism: Acute neurologic phase
Rabies virus multiplies in the o Last 2-7 days
muscle or CT at the site of the Nervousness
Apprehension
bite then enters the peripheral
Hallucination
nerve, spread to CNS
Bizarre behavior
Virus multiplies to CNS and
Inc salivation
cause progressive encephalitis Hydrophobia
Virus spreads through o Convulsion, coma, and
peripheral nerves to salivary death
glands and other tissues o Detection:
(including cornea) FA Staining using antirabies
Produce eosinophilic monoclonal Abs
cytoplasmic inclusion called Serology
Negri bodies Slow rise in specific Abs
o Inactivated by carbon dioxide Negri bodies
o Killed rapidly by exposure to Viral isolation
UV radiation or sunlight Intracerebral inoculation of
Heat (1 hour at 50 C) suspected tissues into
Lipid solvents suckling mice
Trypsin Detect Negri bodies and
Detergents rabies antigen
Extremes of pH o Treatment: Supportive
 o Prevention: HIV-1 and HIV-2
Avoid contact with saliva of HIV-1 has 3 groups
infected animal or person o M (predominant M type
Vaccinate Animals contains 10 subtypes or
Post exposure: clades, A-J)
Rabies vaccine o N
Hyperimmune antirabies o O
globulin HIV-2 has subtypes A-E (5)
Regulatory or Accessory proteins
ARENAVIRIDAE Enveloped RNA virus
o tat
Enveloped helical nucleocapsid 100-120 nm
o rev
110-130 nm Virus encodes its genetic
o nef
Human Pathogens o vif information in RNA and uses a
o Lymphocytic choriomeningitis virus HIV infection unique viral enzyme called
(LCM) Target cells reverse transcriptase to copy its
o Argentinian (Junin) and Bolician o CD4+ genome
T cells (delayed,
into helper)
DNA
(Machupo) viruses o Monocytes and macrophages
Latency: CD4+ cells
o Lassa virus o Dendritic and Langerhans cells
o Transformed B cells genes
HIV genome:
o Astrocytes Code for proteins directly
Oligodendrocytes
involved in viral replication
Microglial cells
(structural proteins)
Pathogenesis
o gag viral core
o CD4 receptors
proteins (p24, p17)
Needed for attachment to host cell
o pol reverse
o Co-receptor/second receptor
Needed for fusion transcriptase,
and entryprotease,
into
target cells integrase
CCR5 o pro encodes
o protease enzyme
Predominant co-receptor
RETROVIRIDAE env envelope
ofor macrophages
Enveloped particles containing a coiled
CXCR4 glycoproteins (gp 120,
nucleocapsid within a probably icosahedral core o Predominant
gp 41) co-receptor
shell for lymphocytes o p
Reverse transcriptase Transmission
80-100 nm o HIV can be isolated from all body fluids
Human Retroviruses
and infected cells but virus infected
o Human T cell Lymphotropic virus type I
cells appear to be major vehicle for
(HTLV-I)
transmission
Associated with adult human T
Highest conc in semen and blood
cell leukemia and lymphoma
o Sexual transmission
o Human Immunodeficiency virus 1 and 2
o Parenteral
(HIV) o Vertical transmission
Lentivirus o At risk
Homo/heterosexuals with multiple
partners
Intravenous drug abusers
Person receiving multiple blood
transfusion
Babies of infected mothers
Medical and paramedic workers
 o Early or Acute
High virus production
High viremia and widespread
seeding of lymphoid tissues
Nonspecific illness
Spontaneously resolve in 2-4
weeks
o Chronic or Latent
5-10 yrs
Latency and AIDS related
complex (ARC)
Relative containment of the virus
HIV antibody concentration at its
peak
Patients either asymptomatic of
develop persistent generalized
lymphadenopathy
ARC: unexplained weight loss,
fever, oral lesions
o Final or Crisis or Full blown AIDS
Breakdown of host defense
Dramatic increase in viremia
Disappearance of HIV Ab
CDC guideline
Any HIV-infected person with
fewer than 200 CD4+
cells/uL
Opportunistic infections
o Protozoa
Toxoplasma
Cryptosporidium
Isospora
o Fungi
Candida albicans
Cryptococcus
neoformans
Pneumocystis
o Viruses
Cytomegalovirus
Herpes virus
Varicella Zoster virus
Clinical manifestations o Bacteria
o IP 4-12 weeks
 Mycobacterium Hepatitis oB Virus
Blood(HBV)
for transduction is screened for
avium-intracellulare Hepadnaviridae
antibodies to HIV 1 and 2
Mycobacterium IP: 60-90 days
tuberculosis Insidious onset
Lysteria Chronic infection (PH: 10-16%)
SEROLOGY OF HEPATITIS
Chronic carrier
monocytogenesis
Consequence
Secondary
Hepatitis Viruses
o Liver cirrhosis and hepatocellular
neoplasms/Opportunistic
Hepatitis A-G carcinoma
malignancies Target ocellsFound
are liver cells or fluids
hepatocytes
in all body blood
o Kaposi sarcoma AllHBsAg
are RNA virusesatexcept
is stable pH 2.4Hepatitis
(up to 6 B
hr), but HBV
o Lymphomas
(hepaDNAviridae)
infectivity is lost
o Cervical cancer
AllSodium
are transmitted by parenteral
hypochlorite destroysroute except A
antigenicity
o Anogenital cancer
&E HBsAg
(fecal-oral
is notroute)
destroyed by UV
o Kaposis sarcoma
Morphologic forms
o Non-Hodgkins lymphoma
Spherical particles
o (HAV)
Hepatitis A Virus
o Hodgkins lymphoma
Most numerous
Neurologic disease Picornaviridae
22 nm in diameter made up of
Only 10% of HIV-infected IP: 2-6 week
S/S exclusively HBsAg
individuals will develop full
Tubular or filamentous also made up
o o Anorexia
blown AIDS after a chronic
exclusively of HBsAg may be over 200 nm
o Malaise
phase lasting for 7-10 years
o Nausealong-result from overproduction of HBsAg
Laboratory diagnosis
o o Diarrhea
Larger, 2-nm spherical virions (formally
o Culture
o Abdominal discomfort
Dane particles) are less frequently
o Antigen detection
o Fever observed
o Polymerase Chain Reaction
o Chills 27 nm inner nucleocapsid
o Serology
o Jaundice
Serologic Marker(some)
of HBV
Mean time of seroconversion is
o o NOHepatitis
CHRONIC FORM antigen (HBsAg)
B surface
3-4 weeks after HIV infection
Serology Protein on the surface of the
Most individuals have detectable
o HAV detected in stool from 2 wks prior
antibodies within 6-12 weeks hepatitis B virus (HBV)
to onset ofItjaundice up to 2 wks
can be detected afterlevels in
in high
after infection o Acute hepatitis A infection is diagnosed
HIV antibody detection serum during acute or chronic HBC
by detected of IgM anti-HAV
ELISA screening infection
o IgM anti-HAV appear 4 weeks after the
Western blot or IF The presence of HBsAg indicates
infection and disappear about 3-4
confirmatory that the person is infectious
months afterThe infection
body normally produces
Treatment
o Presence after infection
o AZT antibodies to HBsAg as part of the
o Presence of IgG indicated immunity
o Treat infections resulting from normal immune response to
Destroyed by
immunosuppression
o Autoclavinginfection
(121 C x 20 min)
Prevention Antigen used to make HepaB
o Boiling x 5 min
o Avoid contact with infected blood and vaccine
o Dry heat (18 C x 1 hr)
blood products and other secretions o o UVHepatitis
irradiationB surface antibody (anti-HBs)
The presence of anti-HBs is
generally interpreted as indicating
recovery and immunity from HBV
infection
Anti-HBs also develops in a person
who has been successfully
vaccinated against hepatitis B
 o Formalin for 3 days (37 C)
o Chlorine treatment
Inactivated by
o heating food to >85 C for 1 min
o Total hepatitis B core antibody (anti-
HBc)
Appears at the onset of
symptoms in acute hepatitis B
infection and persists for life
The presence of anti-HBc
indicates previous or ongoing
infection with HBV in an
undefined time frame
o IgM antibody to hepatitis B core
antigen (IgM anti-HBc)
Positively indicates recent
infection with HBV (<6 mo)
Its presence usually indicates
acute infection
o Hepatitis B e antigen (HBeAg)
A secreted product of the
nucleocapsid gene of the
hepatitis B that is found in the
serum during acute and chronic
hepatitis B infection
Its presence indicates that the
virus is replicating and the
infected person has high levels
of HBV
o Hepatitis B e antibody (HBeAb or
anti HBe)
Produced by the immune
system temporarily during
acute HBV infection or
consistently during or after a
burst in viral infection
Spontaneous conversion from
e antigen to e antibody
(seroconversion) is a
predictor of long-term
o Disinfecting surfaces with sodium
hypochlorite (1:100)
clearance of HBV in patients
undergoing antiviral therapy
and indicates lower levels of
HBV
o HBV DBA
Indicates an active HBV
infection
HEPATITIS C VIRUS (HCV)
Flaviviridae
Hepatitis C infection previously referred as non-
A, non-B hepatitis
Responsible for 90% of post-transfusion
hepatitis
Most new infection with HCV are subclinical
70-90% develop
o Chronic hepatitis
o At risk of pregressing to chronic active
hepatitis or cirrhosis (10-22%)
Chronic infection: >50%
Consequence of liver cirrhosis or hepatocellular
carcinoma
Serology
o Anti-HCV by ELISA
o Confirmation by Western blotting
PCR
o Confirmatory
o Identify specifi serotype
HEPATITIS D (HDV)
Delta agent
o Defective RNA virus that requires an
external HBV envelope (helper virus) to
become infectious
Occurs as either
 o Acute form or coinfection: <5%
chronicity
o Chronic or superinfection: 80%
chronicity
Infection with HCV
o Anti HD (+), HBs Ag (+)
Coinfection HDV and HBV
o Anti HD (+), andti HBc IgM (+)
Superinfection
o Anti HD (+), andti HBc IgM (-)

HEPATITIS E VIRUS (HEV)

Hepeviridae
No chronic disease
Similar to HAV in structure, transmission and
clinical infection
Responsible for 20% mortality rate in infected
pregnant women

B HBsAg HBsAb IgM Ig Hep Hep HBV

Ab G B B DNA
ab ag Ab
Acute + _ + - + - +
Resolved - + - + - + -
acute
Chronic + _ - +- - + -
carrier state
Chronic + _ - +- + - +
active hepa
Chronic acute + _ - +- - + +
pre
Vaccinated _ + - - - - -
 PICORN Non Ss Ico 25-30
A
CALCI Non

A B C D E G
Picornavirida Hepadnavir Flaviviri Delta agent Hepeviridae
e idae dae ssRNA
Unenveloped Enveloped Enveloped ssRNA Unenveloped ssRNA
Icosahedral dsDNA ssRNA
ssRNA
Fecal-oral Parenteral, close contact Fecal-oral Parenteral
Feces Blood, blood-derived feces
2-6 wk 12 wk
Chronic None 5-10 of AI >50% <5% coinfx None None
80%
superinfx
Hepatocellul No Yes Yes No increase n/a none
ar carcinoma above HBV