VIRAL INFECTIONS

LABORATORY MEDICINE
OCTOBER 6, 2016

VIRAL structure

VIRAL GENETICS
RECOMBINATION
Exchange

of genes between 2 chromosomes by crossing

over within regions of significant base sequence homology

REASSORTMENT
Viruses

with segmented genomes exchange genetic

material
Has potential to cause antigenic shift

VIRAL GENETICS
COMPLEMENTATION
When

1 of 2 viruses that infect the cell has a mutation that

results in a nonfunctional protein, the nonmutated virus
complements the mutated one by making a nonfunctional
protein that serves both viruses.

PHENOTYPIC
Occurs

MIXING

with simultaneous infection of a cell with 2 virus

VIRAL VACCINES
LIVE

ATTENUATED VACCINES

Induce

humoral and cell-mediated immunity but have

reverted to virulence on rare occasions
No booster needed for live attenuated vaccines
Dangerous to give live vaccines to immunocompromised
patients

VIRAL VACCINES
LIVE

ATTENUATED VACCINES

Smallpox
Yellow fever
Rotavirus
Chickenpox
Sabin polio virus
MMR (Measles,
Mumps, Rubella)
Influenza

VIRAL VACCINES
KILLED/INACTIVATED
Killed/inactivated

but
are stable
Rabies
Influenza
Salk Polio
HAV vaccines

vaccines induce only humoral immunity

VIRAL VACCINES
SUBUNIT

VACCINES

HBV (antigen=HBsAg)
HPV (types 6,11,16
and 18)

VIRAL REPLICATION
DNA VIRUSES
All

replicate in the nucleus (except poxvirus)

RNA VIRUSES
All

replicate in the cytoplasm (except influenza virus and

retroviruses)

VIRAL ENVELOPES
NAKED

(NONENVELOPED) VIRUSES

Papillomavirus
Adenovirus
Parvovirus
Polyomavirus
Calicivirus
Picornavirus
Reovirus
Hepevirus

Give PAPP smears and

CPR to a naked hippie
(hepevirus)
DNA= PAPP
RNA= CPR
Hepevirus

VIRAL ENVELOPES
ENVELOPED VIRUSES
Acquire their envelopes from plasma membrane when they exit
from cell

DNA VIRUS

DNA VIRUS CHARACTERISTICS

HHAPPPPy viruses (Hepadna, Herpes, Adeno, Pox, Parvo,

Papilloma, Polyoma)

Double stranded (except parvo)

Have linear genomes (except papilloma, polyoma and

hepadna)

Icosahedral (except pox)

Replicate in the nucleus (except pox)

VIRAL FAMILY

ENVELOPE

DNA STRUCTURE

HERPESVIRUSES

Yes

DS and linear

Yes

DS and linear
(largest DNA virus)

POXVIRUS

HEPADNAVIRUS

Yes

Partially DS and circular

MEDICAL IMPORTANCE
(separate table)
Smallpox eradicated world wide by use of the live attenuated vaccine
Cowpox (milkmaid blisters)
Molluscum contagiosum
HBV:
Acute or chronic hepatitis
Not a retrovirus but has reverse transcriptase
Febrile pharyngitis
Acute hemorrhagic cystitis
Pneumonia
Conjunctivitis

ADENOVIRUS

No

DS and linear

PAPILLOMAVIRUS

No

DS and circular

HPV warts (serotypes 1, 2, 6, 11), CIN, cervical cancer (most

commonly 16, 18)

DS and circular

JC virus (progressive multifocal leukoencephalopathy)

BK virus (transplant patients, commonly targets kidney)
JC: Junky Cerebrum; BK: Bad Kidney

POLYOMAVIRUS

PARVOVIRUS

No

No

SS and linear
(smallest DNA virus)

B19virus: aplastic crises in sickle cell disease, erythema infectiosum

(slapped cheeks)
RBC destruction in fetus leads to hydrops fetalis and death, in adults
leads to pure RBC aplasia and rheumatoid arthritis-like symptoms

HERPES VIRUS
VIRUS

ROUTE OF
TRANSMISSION

HERPES SIMPLEX
VIRUS 1

Respiratory secretions
Saliva

HERPES SIMPLEX
VIRUS 2

Sexual contact
perinatal

VARICELLA-ZOSTER
VIRUS (HHV-3)

Respiratory secretions

EPSTEIN-BARR
VIRUS (HHV-4)

Respiratory secretions
Saliva
kissing disease

Mononucleosis
Associated with lymphoma, nasopharyngeal carcinoma

Infects B cells through CD21

(+) Monospot test
Atypical lymphocytes on peripheral
blood smear

CYTOMEGALOVIRUS
(HHV-5)

Congenital transfusion
Sexual contact
Saliva
Urine
transplant

Mononucleosis in immunocompetent patients, infection in

immunocompromised patients, AIDS retinitis
(sightomegalovirus)

Infected cells have characteristic

owl eye inclusion
Latent in mononuclear cells

CLINICAL SIGNIFICANCE

NOTES

Gingivostomatitis, keratoconjunctivitis, herpes labialis,

herpetic whitlow on finger, temporal lobe encephalitis

Most common cause of sporadic

encephalitis

Herpes genitalis, neonatal herpes

Latent in sacral ganglia

Viral meningitis more common with
HSV-2 than with HSV-1

Varicella-zoster, encephalitis, pneumonia

Most common complication of shingles is post-herpetic neuralgia

Latent in dorsal root or trigeminal

ganglia

HERPES VIRUS
VIRUS

ROUTE OF
TRANSMISSION

HUMAN HERPES
VIRUSES 6 AND 7

Saliva

HUMAN HERPES
VIRUS 8

Sexual contact

CLINICAL SIGNIFICANCE

NOTES

Roseola infantum
Kaposi sarcoma
Seen in HIV/AIDS patients. Dark violaceous plaques or
nodules representing vascular proliferations8

Latent in sacral ganglia

Viral meningitis more common with
HSV-2 than with HSV-1

RNA VIRUS

VIRAL
FAMILY
REOVIRUS

ENVELO
PE
No

RNA
STRUCTU
RE
DS linear

CAPSID
SYMMETRY

MEDICAL IMPORTANCE

Icosahedral

Coltivirus (Colorado tick fever)

Rotavirus (leading cause of fatal diarrhea in
children)

PICORNAVIR
US

No

SS linear

Icosahedral

PERCH
Poliovirus
Echovirus (aseptic meningitis)
Rhinovirus (common cold)
Coxsackievirus (aseptic meningitis, herpangina,
hand foot and mouth disease, myocarditis,
pericarditis)
HAV (acute viral hepatitis)

HEPEVIRUS

No

SS linear

Icosahedral

HEV

CALICIVIRUS

No

SS linear

Icosahedral

Norovirus (viral gastroenteritis)

FLAVIVIRUS

Yes

SS linear

Icosahedral

HCV, yellow fever, dengue, St. Louis

encephalitis, West Nile virus

Icosahedral

Rubella
Eastern equine encephalitis
Western equine encephalitis

TOGAVIRUS

RETROVIRUS

Yes

Yes

SS linear

SS linear

Icosahedral
(HTLV)
Complex and

Have reverse transcriptase

HTLV (T cell leukemia)
HIV (AIDS)

VIRAL
FAMILY

ENVELO
PE

RNA
STRUCTU
RE

CAPSID
SYMMETRY

CORONAVIR
US

Yes

SS linear

Helical

Common cold, SARS, MERS-CoV

ORTHOMYXO
-VIRUS

Yes

SS linear

Helical

Influenza virus

MEDICAL IMPORTANCE

PARAMYXOVIRUS

Yes

SS linear

Helical

PaRaMyxovirus
Parainfluenza (croup)
RSV (bronchiolitis in babies)
Measles, Mumps

RHABDOVIR
US

Yes

SS linear

Helical

Rabies

FILOVIRUS

Yes

SS linear

Helical

Ebola/Marburg Hemorrhagic Fever

ARENAVIRUS

Yes

SS circular

Helical

LCMV (Lymphocytic Choriomeningitis Virus)

Lassa fever encephalitis (spread by rodents)

BUNYAVIRUS

Yes

SS circular

Helical

California encephalitis, Hantavirus

DELTA VIRUS

Yes

SS circular

Uncertain

HDV is a defective virus that requires the

presence of HBV to replicate

HEPATITIS VIRUSES
VIRUS

HAV

HBV

HCV

HDV

HEV

FAMILY

RNA picornavirus

DNA hepadnavirus

RNA flavirus

RNA deltavirus

RNA hepevirus

Fecal-oral

Parenteral, sexual,
perinatal

Blood

Parenteral, sexual,
perinatal

Fecal-oral
(especially
waterborne)

Short

TRANSMISSION

Short

Long

Long

Superinfection
(HDV after HBV) =
short
Coninfection (HDV
with HBV) = long

Asymptomatic
Acute

Initially like serum

sickness (fever,
arthralgia, rash)
May progress to
carcinoma

May progress to
cirrhosis or
carcinoma

Similar to HBV

Fulminant hepatitis
in pregnant women

PROGNOSIS

Good

Most adults have

full resolution,
minority have
chronic infection

Majority develop
stable, chronic
hepatitis C

Superinfection =
worse prognosis

High mortality in
pregnant women

HCC RISK

No

Yes

Yes

Yes

No

Hepatocyte
swelling, monocyte
infiltration,
Councilman bodies

Granular
eosinophilic
ground glass
appearance,
cytotoxic T cells

Lymphoid
aggregates with
focal areas of
macrovesicular

Similar to HBV

Patchy necrosis

INCUBATION

CLINICAL
COURSE

LIVER BIOPSY