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or complex (Pox,filo,etc.)
(-) rnaviruses carry RNA polymerase Enveloped viruses are more sensitive
Adenoviruses
First isolated in 1953 in a human adenoid cell culture. Approximately 100 serotypes have been recognized, at least 47 of which infect humans. Have been classified into six subgroups (A through F).
Adenoviruses
The first human adenoviruses to be identified, numbered 1 to 7, are the most common. Respiratory tract infection, conjunctivitis (pinkeye), hemorrhagic cystitis, and gastroenteritis. Several adenoviruses have oncogenic potential in animals and for this reason have been extensively studied by molecular biologists.
Infect epithelial cells lining the oropharynx, the respiratory and enteric organs
Epidemiology
Resist drying, detergents, gastrointestinal tract secretions (acid, protease, and bile), and even mild chlorine treatment. Can be spread by the fecal-oral route, by fingers, by fomites (including towels and medical instruments), and in poorly chlorinated swimming pools.
Epidemiology
Are spread mainly by respiratory or fecal-oral contact from human to human. Close interaction among people, as occurs in classrooms and military barracks, promotes spread of the virus. Most infections are asymptomatic, a feature that greatly facilitates their spread in the community. Adenoviruses 1 through 7 are the most prevalent serotypes
Clinical Syndromes
Adenoviruses primarily infect children and less commonly infect adults. Disease from reactivated virus occurs in immunocompromised children and adults.
Causes pharyngitis, which is often accompanied by conjunctivitis (pinkeye) and pharyngoconjunctival fever. Pharyngitis alone occurs in young children, particularly those younger than 3 years, and may mimic streptococcal infection. Patients have mild, flulike symptoms (including nasal congestion, cough, malaise, fever, myalgia, and headache).
Laboratory Diagnosis
Should be obtained from a site or secretion relevant to the disease symptoms. The presence of adenovirus in the throat of a patient with pharyngitis is usually diagnostic if laboratory findings eliminate other common causes of pharyngitis, such as Streptococcus pyogenes. Fluorescent antibody assays and the polymerase chain reaction can be used to detect, type, and group the virus. Serologic testing is rarely used except for epidemiologic purposes.
Cell cultures
Cell cultures derived from epithelial cells (e.g., HeLa). Within 2 to 20 days, the virus causes a lytic infection with characteristic inclusion bodies.
Parvoviruses
The smallest of the deoxyribonucleic acid (DNA) viruses.
Only one member of the Parvoviridae, B19, is known to cause human disease.
B19
Causes erythema infectiosum, or fifth disease, a mild febrile exanthematous disease that occurs in children (it
was the fifth of the childhood exanthems; the first four being varicella, rubella, roseola, and measles).
Also responsible for episodes of aplastic crisis in patients with chronic hemolytic anemia and is associated with acute polyarthritis in adults. Intrauterine infection of a fetus may cause abortion.
First replicates in the nasopharynx or upper respiratory tract, then spreads by viremia to the bone marrow and elsewhere, where it replicates and kills erythroid precursor cells.
Epidemiology
Approximately 65% of the adult population have been infected with B19 by 40 years of age. Erythema infectiosum is most common in children and adolescents ages 4 to 15 years, who are a source of contagion. Arthralgia and arthritis are likely to occur in adults. Disease usually occurs in late winter and spring.
The rash then usually spreads, especially to exposed skin such as the arms and legs, and then subsides over 1 to 2 weeks. Relapse of the rash is common.
Clinical Syndromes
In adults causes polyarthritis. Arthritis of the hands, wrists, knees, and ankles predominates. Infection of immunocompromised people may result in chronic disease. The most serious complication: the aplastic crisis that occurs in patients with chronic hemolytic anemia (e.g., sickle cell anemia). The reduction results in a transient reticulocytopenia that lasts 7 to 10 days and a decrease in hemoglobin level.
Clinical Syndromes
B19 infection of a seronegative mother increases the risk for fetal death. Infect the fetus and kill erythrocyte precursors, causing anemia and congestive heart failure (hydrops fetalis). Infection of seropositive pregnant women often has no adverse effect on the fetus. There is no evidence that B19 causes congenital abnormalities.
Laboratory Diagnosis
Specific immunoglobulin M (IgM) or viral DNA must be detected (i.e., to distinguish the rash of B19 from that of rubella in a pregnant woman). Enzyme-linked immunosorbent assays for B19 IgM and IgG are available. The polymerase chain reaction test is a very sensitive method for detecting the B19 genome in clinical samples.
Human Papillomaviruses
At least 100 types have been identified and classified into 16 (A through P) groups. HPV can be distinguished further as cutaneous HPV or mucosal HPV, on the basis of the susceptible tissue.
PATHOGENESIS
Are very tissue specific
The wart develops as a result of virus stimulation of cell growth and thickening of the basal layer as well as the stratum granulosum. Koilocytes, characteristic of papillomavirus infection, are enlarged keratinocytes with clear haloes around shrunken nuclei.
PATHOGENESIS
The viral infection remains local and generally regresses spontaneously but can recur. Innate and cell-mediated immunity are important for control and resolution of HPV infections.
Franoise Barr-Sinoussi
Luc Montagnier
EPIDEMIOLOGY-HPV
Resists inactivation and can be transmitted on fomites, such as the surfaces of bathroom floors, and towels.
Is acquired (1) by direct contact through small breaks in the skin or mucosa, (2) during sexual intercourse, or (3) while an infant is passing through an infected birth canal.
EPIDEMIOLOGY
Common, plantar, and flat warts are most common in children and young adults. Laryngeal papillomas occur in young children and middle-aged adults.
EPIDEMIOLOGY
The most prevalent sexually transmitted infection in the world. Is present in 99.7% of all cervical cancers. HPV-16, HPV-18, HPV-31, and HPV-45 are high-risk types for cervical carcinoma, the second leading cause of cancer death in women. Approximately 10% of women infected with the high-risk HPV types will develop cervical dysplasia, a precancerous state. Multiple sexual partners, smoking, a family history of cervical cancer, and immunosuppresion are the major risk factors for infection and progression to cancer.
Progression of HPV-mediated cervical carcinoma. HPV infects and replicates in the epithelial cells of the cervix, maturing and releasing virus as the epithelial cells progress through terminal differentiation. Growth stimulation of the basal cells produces a wart. In some cells, the circular genome integrates into host chromosomes. Expression of the other genes without virus production stimulates growth of the cells and possible progression to neoplasia
Can be life threatening in children because the papillomas may obstruct the airway.
Anogenital Warts
Genital warts (condylomata acuminata) occur almost exclusively on the squamous epithelium of the external genitalia and perianal areas.
Approximately 90% are caused by HPV-6 and HPV-11. Rarely become malignant in healthy people.
LABORATORY DIAGNOSIS
A wart can be confirmed on the basis of its characteristic histologic appearance, which consists of hyperplasia of the prickle cells and an excess production of keratin (hyperkeratosis).
LABORATORY DIAGNOSIS
DNA molecular probes and the polymerase chain reaction (PCR) from cervical swabs and tissue specimens are the methods of choice for establishing the diagnosis and typing of the HPV infection. Do not grow in cell cultures, and tests for HPV antibodies are rarely used except in research surveys.
They are removed through the use of surgical cryotherapy, electrocautery, or chemical means (e.g., 10% to 25% solution of podophilin), although recurrences are common.
A tetravalent HPV vaccine (Gardasil) consisting of the L1 major capsid protein HPV 6, 11,16, 18 Three immunizations for girls Starting at age 11 prior to sexual activity Bivalent HPV vaccine (Cervarix) HPV 16, 18 Three immunizations
Polyomaviridae
The human polyomaviruses (BK and JC viruses) are ubiquitous but usually do not cause disease. They are difficult to grow in cell culture. SV40, a simian polyomavirus have been studied extensively as models of tumor-causing viruses but have not been associated with any human disease.
PATHOGENESIS
In immunocompromised patients, such as those with the acquired immune deficiency syndrome (AIDS), reactivation of the virus in the kidney leads to viral shedding in the urine and potentially severe urinary tract infections (BK virus) or
EPIDEMIOLOGY
Respiratory transmission is the probable mode of spread. Latent infections can be reactivated in people whose immune systems are suppressed as a result of AIDS, organ transplantation, or pregnancy. Approximately 10% of people with AIDS develop PML (progressive multifocal leukoencephalopathy), and the disease is fatal in approximately 90% of all cases.
CLINICAL SYNDROMES
The BK and JC viruses are activated in immunocompromised patients, as indicated by the presence of virus in the urine of as many as 40% of these patients. Are also reactivated during pregnancy, but no effects on the fetus have been noted.
CLINICAL SYNDROMES
The ureteral stenosis observed in renal transplant recipients appears to be associated with BK virus, as is the hemorrhagic cystitis observed in bone marrow transplant recipients. PML is a subacute demyelinating disease caused by the JC virus that occurs in immunocompromised patients, including those with AIDS.
LABORATORY DIAGNOSIS
The diagnosis of PML is confirmed by the presence of PCR-amplified viral DNA in cerebrospinal fluid. Histologic examination of brain tissue obtained by biopsy or at autopsy will show foci of demyelination. The term leukoencephalopathy refers to the presence of lesions in only the white matter.
LABORATORY DIAGNOSIS
Immunofluorescence, PCR analysis of cerebrospinal fluid, urine, or biopsy material for the particular genetic sequences can also be used to detect virus. Urine cytologic tests can reveal the presence of JC or BK virus infection by revealing the existence of enlarged cells with dense, basophilic intranuclear inclusions resembling those induced by cytomegalovirus. It is difficult to isolate BK and JC viruses in tissue cultures;
No specific treatment for polyomavirus infection is available, other than to decrease the immunosuppression responsible for allowing the polyomavirus to be reactivated and symptoms to occur.