Viral Infections: Laboratory Medicine OCTOBER 6, 2016

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)
EPSTEIN-BARR
VIRUS (HHV-4)
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

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VIRAL INFECTIONS

of genes between 2 chromosomes by crossing

with segmented genomes exchange genetic

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

with simultaneous infection of a cell with 2 virus

humoral and cell-mediated immunity but have

vaccines induce only humoral immunity

replicate in the nucleus (except poxvirus)

replicate in the cytoplasm (except influenza virus and

Give PAPP smears and

DNA VIRUS CHARACTERISTICS

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

Double stranded (except parvo)

Have linear genomes (except papilloma, polyoma and

Icosahedral (except pox)

Replicate in the nucleus (except pox)

Partially DS and circular

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

JC virus (progressive multifocal leukoencephalopathy)

B19virus: aplastic crises in sickle cell disease, erythema infectiosum

Infects B cells through CD21

Mononucleosis in immunocompetent patients, infection in

Infected cells have characteristic

Gingivostomatitis, keratoconjunctivitis, herpes labialis,

Most common cause of sporadic

Herpes genitalis, neonatal herpes

Latent in sacral ganglia

Varicella-zoster, encephalitis, pneumonia

Latent in dorsal root or trigeminal

Latent in sacral ganglia

Coltivirus (Colorado tick fever)

Norovirus (viral gastroenteritis)

HCV, yellow fever, dengue, St. Louis

Have reverse transcriptase

Common cold, SARS, MERS-CoV

Ebola/Marburg Hemorrhagic Fever

LCMV (Lymphocytic Choriomeningitis Virus)

California encephalitis, Hantavirus

HDV is a defective virus that requires the

Initially like serum

Most adults have

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