GRAM-POSITIVE RODS



DNA VIRUSES:

|ORGANISM |PATHOGENESIS / CLINICAL FEATURES |DIAGNOSIS / TREATMENT |

|Parvovirus (B19 virus) |(erythema infectiousum (Fifth disease): affects children between 4-12( fever, “slapped face” rash |(self-limited illness |

|(naked icosahedral |(transient aplastic anemia: virus stops production of RBC |(IV immunoglobulin during aplastic crisis |

|(ss linear DNA | | |

|Papovavirus |(Human papilloma virus penetrates basal epithelial cells |(koilocytosis: dark-stained nuclei surrounded by halo |

|(naked icosahedral |common warts (1, 2, 4): most resolve in 1-2 years | |

|(ds circular, supercoiled DNA |genital warts (6,11): condylomata acuminata |(light nitrogen (freeze) |

| |cervical carcinoma (16, 18, 31, 33): intraepithelial neoplasia |(surgery/ laser ablation |

| |(E6: p53 (E7: Rb ( uncontrolled DNA synthesis | |

| |(BK Polyomavirus: mild infection in children |(podophylin or alpha-interferon: genital warts |

| |(JC Polyomavirus: progressive multifocal leukoencephalopathy (PML) | |

| |( in immunocompromised pts.: memory loss, poor speech, incoordination | |

|Adenovirus |(upper respiratory tract infections in children (4, 7): coughing, sneezing, rhinitis, sore throat, conjuctivitis( |(live, nonattenuated vaccines against some serotypes |

|(naked icosahedral |can progress to lower respiratory tract pneumonia |(4,7) used in military |

|(ds linear DNA |(epidemic keratoconjunctivitis (Pink Eye), gastroenteritis, hemorrhagic cystitis |(enteric-coated: no pathogenesis |

|Poxvirus |(only DNA virus to replicate in cytoplasm (own viral RNA polymerase) |(live, attenuated vaccinia vaccine |

|(BIG complex envelope |(molluscum contagiosum: small, 1-2mm diameter, white bumps w/ central dimple |(eradication in 1977: no carrier state, easy recognition,|

|(ds linear DNA |(respiratory aerosol or direct contact from skin lesions or fomites such as bedding |single serotype |

|Herpesvirus |(HSV-1: >90% of adults in 40’s exposed( saliva (most are asymptomatic |(Tzanck smear: Giemsa stain( multinucleated giant cells(|

|(enveloped icosahedral |(gingivostomatitis: painful swollen gums, mucous membranes w/ vesicles |Herpes |

|(ds linear DNA |(resolves in about 2 weeks; may have fever and other systemic symptoms |(acyclovir: encephalitis and systemic disease caused by |

|(binds FGF receptor |(herpes labialis (cold sores): milder, recurrent form( vesicles on lips or nose |HSV-1; also treatment for genital herpes( acts on viral |

|(cell-mediated immune response( |(keratoconjunctivitis: most common infectious cause of corneal blindness in US (stain of eye shows dendritic |thymidine kinase, DNA polymerase |

|multi-nucleated giant cells w/ |branching pattern of cornea) |( shortens duration of lesions and |

|intranuclear inclusion bodies |(encephalitis: most common cause of viral encephalitis in US (temporal lobe): |reduces extent of shedding of virus |

|(alpha subgroup: HSV-1, HSV-2, VZV |(sudden onset fever and focal neurologic abnormalities( treatable |HSV-1: latent in trigeminal ganglia |

| |(HSV-2: STD( vesicles on vagina, cervix, vulva, penis |HSV-2: latent in lumbar and sacral ganglia |

| |(painful with burning and itching( fever and inguinal adenopathy | |

| |(neonatal herpes: transplacental transfer( congenital defects/ encephalitis | |

|(Herpes Virus 6 |(roseola: high fever, truncal rash in children | |

|(Herpes Virus 8 |(Kaposi’s sarcoma, multiple myeloma | |

|(Varicella-Zoster Virus(VZV) |(Varicella (chickenpox): very contagious; often during winter and spring |(live, attenuated VZV vaccine |

|( infects respiratory tract w/ 2-week|( fever, malaise, headache w/ rash (starts on face and trunk) |(VZ immunoglobulin as prophylaxis for immunocompromised |

|incubation( viremia |(( red base w/ fluid-filled vesicle (papules(vesicles(pustules(crusts) |patients |

| |( may progress to pneumonia and encephalitis in adults (rare though) |(acyclovir (acting through TK) |

| | |(Reye’s syndrome: encephalopathy and liver degeneration |

| |(Zoster (shingles): reactivation of latent VZV (stress or ( cell-mediated immunity) |(assoc. w/ VZV and influenza B, esp. if with aspirin) |

| |(post-zoster neuralgia: burning, painful vesicles along course of sensory nerves (unilateral dermatome |(VZV: latent in dorsal root ganglia |

| |distribution) | |

|(Cytomegalovirus |(cytomegalic inclusion disease (transplacental or through mom’s milk): congenital abnormalities (mental |(ganciclovir: treat CMV retinitis and pneumonia for AIDS|

|(CMV) |retardation, microcephaly, deafness, seizures, jaundice, etc..) |patients |

|(saliva, blood, semen, |(kidney histology w/ multinucleated cells w/ intranuclear inclusion bodies |(foscarnet: more side effects |

|transplacental,peripartum |(reactivate in immunocompromised: CMV retinitis, pnemonia, hepatitis |(resistant to acyclovir (no TK) |

| | |(latent in WBC’s and kidney |

|(Epstein-Barr Virus |(mononucleosis: saliva (kissing)( > 90% of adults have Ab (recovery in 2-3 wks) |(atypical CTL’s |

|(EBV) |( fever, very painful pharyngitis, lymphadenopathy, splenomegaly |(heterophile antibody: cross-reacts w/ and agglutinates |

|( infects B cells via C3 receptor |( anorexia, lethargy prominent; hepatits and encephalitis in some patients |sheep RBC’s |

| |( early infection = milder disease |(IgM to viral capsid antigen (VCA): used in diagnostic |

| |(Burkitt’s lymphoma: transforms B cells( children in Africa (large mass on face) |test |

| |(nasopharyngeal carcinoma (China and other parts of Asia) | |

| |(oral, hairy leukoplakia (seen in AIDS patients) | |

| | | |

|Hepadnavirus (Hep B) |(RNA-dependent DNA synthesis: mRNA made used as template for genome DNA |(”window period” of no HBsAg or HBsAb; only HBcAb |

|(enveloped icosahedral |(necrosis and inflammation of hepatocytes: cytotoxic Tcells | |

|(ds incomplete circular DNA |(( risk of hepatocellular carcinoma |(active immunization: HBsAg protein |

|(fragments) |(long incubation (10-12 weeks) |(infant at birth, 2, 4, 15 months |

|(blood, sex, perinatally |(HBsAg: envelope protein indicating live virus and infection |(3 shots: teens and health workers |

|(enveloped: more prone to environment|(anti-HBcAg: acute( IgM chronic( IgG (anti-HBsAg: for immunity | |

| |(HBeAg: indicator of transmissibility | |

RNA VIRUSES:

|ORTHOMYXOVIRUS |(hemagglutinin interacts w/ sialic acid receptors on cell( endocytosis |(amantadine (inhibits uncoating): treat/ prevent only |

|Influenza virus |( uncoating( acidification via M2 protein |influenza A (not B) |

|(segmented (-) ssRNA |(neuraminidase cleaves neuraminic acid on cell surface( release of RNP |(mainly elderly, unimmunized pts. |

|(RNA-dependent RNA polymerase( |(EPIDEMICS: |(also, derivative: rimantadine |

|progeny RNA made in nucleus |(antigenic drift: viral replication mutations in proteins (every year) |(vaccine: killed influenza A and B |

|(enveloped helical |(antigenic shift: rearrangement of segments( major changes (every 10 years) |(Reye’s syndrome: encephalitis and liver disease in |

|(respiratory droplets |(24-48 hr incubation: fever, myalgias, headache, cough; vomiting, diarrhea rare |children w/ influenza or chicken pox given aspirin |

| |(secondary bacterial pneumonia: S. aureus, S. pneumoniae | |

|PARAMYXO-VIRUSES: |(one piece of ss (-) RNA( only (+) RNA have infectious geome (enveloped | |

| |(RNA-dependent RNA polymerase (fusion protein: ( multinucleated giant cells | |

|Parainfluenza virus |(Croup: acute laryngotracheobronchitis (larynx, trachea, bronchus) in children < 5 | |

|(HA (+) (NA (+) |(airway narrowing( stridor (wheeze), barking cough, hoarseness | |

|Respiratory Syncytial Virus (RSV) |(fusion protein: produces multinucleated giant cells (syncytial cells) |(limited (from IgA and IgG) immunity from previous |

|(HA (-) (NA (-) |(#1 cause of pneumonia in young children (esp. infants < 6 months of age) |infections |

| |(outbreaks every winter in hospitals and communities |(ribavirin (effectiveness uncertain) |

|Measles |(prior to rash, prodromal illness: after 2 week incubation( fever, conjuctivitis (photophobia), rhinitis, coryza, |(live, attenuated vaccine part of MMR vaccine |

|(HA (+) (NA (-) |hacking cough, malaise (feeling cruddy) |(not give before 15 months of age since maternal Ab can |

| |(Koplik’s spots: bright red lesions with blue-white centers on buccal mucosa |neutralize virus |

| |(rash: 2 days later( maculopapular (bumpy) from face down to lower limbs | |

| |(complications: pneumonia, bacterial otitis media, encephalitis (subacute sclerosing panencephalitis(fatal CNS | |

| |disease), myocarditis | |

|Mumps |(infects upper respiratory infect( disseminate to parotid glands (pain), ovaries, testes (orchitis( sterility if |(live, attenuated vaccine part of MMR vaccine at 15 |

|(HA (+) (NA (+) |bilateral), pancreas, and in some cases, meninges |months of age |

| | | |

|TOGAVIRUSES: |(alpha virus: mosquito-borne( fever, headache, encephalitis (EEE, WEE) |(posterior auricular lymphadenopathy |

|Rubella virus |(rubivirus: rubella(incubate 2-3 wks( mild febrile illness with rash (3d measles) |(adults (esp. women): polyarthritis |

|(ss (+) RNA ((+) HA |(congenital rubella syndrome: infect during 1st trimester( teratogenic effects |(IgM: recent infection IgG: immunity |

|(enveloped icosahedral |((heart (patent ductus arteriosus), eyes (cataracts), brain (deafness, retardation) |(live, attenuated vaccine (MMR) |

|RHABDOVIRUSES: |(attaches to acetylcholine receptor on cell surface( infects sensory neurons and moves by axonal transport to CNS( |(Negri body (eosinophilic cytoplasmic inclusions inside |

|Rabies virus |rapid progression to death over 1-2 weeks |infected neurons) |

|(ss (-) RNA | |(vaccination of dogs, cats |

|(lipoprotein envelope |(prodrome: nonspecific symptoms( fever, headache, sore throat, fatigue, nausea, anorexia, painfully sensitive |(confine animals X 10 days( signs? |

|(bullet-shaped capsid |nerves around healed wound site |(kill animal( Negri body in brain? |

|(infects all mammals |(encephalitis: hyperactivity, agitation( confusion, lethargy, seizures, madness |(preexposure vaccine and human rabies immunoglobulin |

|(raccoons, skunks, bats) |(hydrophobia (painful spasm of throat muscles upon swallowing), foaming |(RIG) |

| | | |

|REOVIRUSES: |(viral gastroenteritis: profound dehydration, esp. in infants |(IV fluid replacement |

|Rotavirus |( fever, abdominal pain, vomiting, diarrhea (no blood, no pus) | |

|(ds segmented RNA |( > 50% of infant diarrhea requiring hospitalization in U.S. | |

|(naked helical capsid | | |

|PICORNAVIRUSES: |(ss (+) RNA (naked icosahedral nucleocapsid |((Naked: stronger, less vulnerable! |

|Enteroviruses: |(3 serologic (antigenic) types (little cross rxn: need Ab against all 3 types) |(inactivated polio vaccine (Salk) w/ formalin-killed |

|(infect enteric tract |(infects Peyer’s patch in small intestine and motor neurons in anterior horn |viruses: IV injected |

|Poliovirus |(1) mild febrile illness( headche, nausea/vomiting, sore throat( resolves in most |(live attenuated poliovirus (Sabine): oral vaccine |

|(”infectious RNA” |(2) aseptic meningitis 5-10 days later (fever, stiff neck, headache) |(preferred in US) |

|(limited to primates |(3) paralytic poliomyelitis (flaccid asymmetric paralysis w/ painful muscle spasms) |(induces secretory IgA to protect |

|(fecal-oral: oropharynx |(possible respiratory paralysis in older patients( death |(reversion( virulence possible!! |

|Coxsackieviruses |(group A: herpangina( vesicular pharyngitis w/ fever, vomiting, malaise |(no treatment or vaccine |

|(fecal-oral route |hand-foot-and-mouth disease (fever and vesicular rash) | |

|(respiratory aerosol |(group B: pleurodynia (epidemic myalgia)( fever, pleuritic chest pain |((enteroviruses are most common cause of non-bacterial |

|(both can cause aseptic meningitis, |myocarditis/pericarditis( chest pain, arrhythmias, cardiomyopathy, |(aseptic) meningitis in U.S. |

|mild paresis, and transient paralysis|and heart failure (> 50% of viral causes) | |

| |diabetes (possible role in juvenile diabetes in humans) | |

|Echoviruses |(one of the leading causes of aseptic (viral) meningitis | |

|(fecal-oral route |(enteric cytopathic human orphan (also, “cold” rashes | |

|Hepatitis A virus |(young children most frequently infected |(Ig M antibody or 4X ( in IgG |

|(fecal-oral route |(common outbreaks: fecally contaminated water or food (ie. raw oyster) |(active immunity: inactivated HAV |

|(rarely via blood |(nasuea/vomiting, fever, anorexia, jaundice (dark urine, pale feces, ( AST/ALT |(passive immunity: preformed Ig |

| |(most cases resolve spontaneously in 2-4 weeks w/ short incubation (3-4 wks) | |

|Rhinoviruses: |(> 100 serologic types (acid-labile |(common cold: Coronaviruses, Adenoviruses, Influenza C |

|(common cold) |(respiratory (finger(nose/eye |virus, Coxsackieviruses |

|(best at 33( C |(incubation of 2-4 days( sneezing, nasal discharge, sore throat, cough, headache | |

|ARBOVIRUSES: |(transmitted by blood-sucking arthopods( fever, encephalitis | |

|Togavirus |(alpha virus (western/eastern equine encephalitis: WEE, EEE( rural U.S.) | |

|(ss (+) RNA |EEE more sever than WEE( sever headche, nausea/vomiting, seziures, coma | |

|(enveloped icosahedral |(rubivirus (rubella) (PLEASE SEE ABOVE | |

|Flavivirus |(hepatitic C: milder form of hepatitis B |(treat w/ alpha interferon |

|(ss (+) RNA |(Yellow fever (Panama canal workers): hepatitis, fever, backache | |

|(enveloped icosahedral |(Dengue fever (“breakbone fever”): muscle/joint aches, headache, hemorrhage, thrombocytopenia, septic shock( endemic|(live attenuated viral vaccine for Yellow Fever |

| |in Caribbean |(mosquito Aedes aegypti |

| |(St. Louis encephalitis (Japanese encephalitis (most common epidemic enc.) | |

|Bunyavirus |(California encephalitis (Rift Valley fever |(ribavirin for hantavirus pulmonary syndrome patients |

|(ss (-) segmented RNA |(Hanta virus (Korean hemorrhagic fever): hemorrhagic fever with renal failure | |

|(enveloped helical |( also, hantavirus pulmonary sydrome: high fevers, myalgias, cough, nausea/vomit | |

| | | |

|Calciviruses |(Hepatitis E: enterically-transmitted (fecally contaminated water); like Hep A |(Hepatitis E: no prolonged carrier state |

|(ss (+) RNA |(monsoon flooding (endemic to Asia, India, Africa, Central America |(Norwalk resolves spontaneously in 12-24 hours |

|(naked icosahedral |(Norwalk virus: outbreaks of gastroenteritis in schools, camps, cramped quarters | |

|Deltavirus |(Hepatitid D (ss (-) RNA (enveloped helical capsid (co-infection w/ Hep B |(fulminant hepatitis, liver cirrhosis |

|Arenaviruses |(lymphocytic choriomeningitis virus: aseptic meningitis |(ribavirin to treat Lassa fever |

|(ss circ. (-) RNA (2 seg) |(Lassa fever virus: severe, often fatal hemorrhagic fever w/ multi-organ involvement (lungs, heart, kidneys, and | |

|(enveloped helical |brain) | |

|Filoviruses |(Ebola and Marburg viruses: hemorrhagic fever (ie. Zaire outbreak) | |

|(ss (-) RNA filaments |( fever, headache, vomiting, diarrhea( bleeding into GI intract( shock and DIC | |

|(highly pleomorphic |(high infectious: health care workers, family members (bodily fluids) | |

|Coronavirus |(upper respiratory tract infections( common colds (20%) | |

|(ss (+) RNA |( similar to Rhinovirus | |

|(enveloped club-shaped | | |

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