VIRUSES:

General Characteristics/Behavior
● Invasion
● Adhesion
● Penetration
● Uncoating
● Replication
● Assembly
● Lysogeny

o Invasion
▪ RNA needs to get in to the cell
▪ Contact is the #1 way to spread infection
▪ Best prevention is HAND WASHING
o Adhesion
▪ Viruses adhere themselves to the cell
▪ Viruses have receptors for certain cells → Tropism
o Penetration
▪ 99% will enter the cell via endocytosis
▪ Only HIV injects RNA into the cell
o Uncoat
▪ Virus takes it’s capsule off → removing envelope
▪ Drugs are helpful at this stage:
● Amantadine
o Treatment for ONLY Influenza A
o Inhibits uncoating of virus
o Also, promotes the release of dopamine
▪ Used in Parkinson’s
o Anticholinergic effects
● Rimantidine SE: Both will
o Indicated for prophylaxis affect rapidly
dividing cells
Both effective
if taken within 73
hours

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 Virus Type RNA DNA
Location of Replication Replicates in the cytoplasm Replicates in the nucleus
Exception: Retrovirus Exception: Poxvirus (too large)
Polymerase ● Needs RNA dependent ● Exception→
RNA polymerase ● Poxvirus requires DNA
● Exception: dependent RNA
Retrovirus → requires polymerase
RNA dependent DNA ● Hep B requires DNA
ploymerase dependent DNA
polymerase

Strand Type ● 90% are SS ● 90% DS

● Exceptions → ● Exceptions:
Orthomyxovirus (ds) Parvovirus
Reovirus (segmented) Hepadenovirus (Hep B)

Assembly Assembled on cell membrane

→ destroy cell membranes
(recall AST/ALT)
Negative or Positive Strand ● Negative Strand:
Needs to be translated
into + mRNA before
getting translated →
Takes 1-3 weeks to
get “sick”
● Positive Strand:
Gets translated
immediately → making
you sick immediately
(hemorrhagic viruses)
Envelope ● Assume an envelope Assume Naked
Except: Exception:
Coxsackie A Herpes (enveloped)
(non-enveloped)
Misc ● HIV is an retrovirus that
goes to the nucleus
● Hep. B uses a reverse
transcriptase
● Remember that if
there is nuclear
damage the cell dies
→ think about rapidly
dividing cells →
promotion of cancer

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3
 o Replication
▪ Insertion of RNA virus into your DNA genome and you do all the work
▪ Drugs are helpful at this stage
● 3TC, Pyrimidine
Used in HIV ● 4TC, Pyrimidine
Therapy ● DDI, Purine
When CD4
< 500 o SE: Painful neuropathy and pancreatitis
● DDC, Pyrimidine
o SE: Painful neuropathy and pancreatitis
● AZT
o Bone marrow suppression (aplastic anemia)
● Acyclovir
o 5x/day These are used to treat HSV I/II
Replace ↓ viral shedding
● Pencyclovir ↓ symptomatic days
Guanine
o 3x/day NO CURE
Purine ● Demcyclovir Outbreak within 2
Analogs o 3x/day weeks of delivery, need to
perform C-section
● Valcyclovir
o 2x/day
● Gancyclovir
o Cures CMV retinitis (AIDS patient with vision problems)
o Foscarnet is the backup drug for CMV retinitis
● Fancyclovir
o Used to treat Shingles (Herpes Zoster)
o Herpes Zoster
▪ Resurfacing of chickenpox → hide in the Dorsal Root Ganglia
(1 dermatome)
▪ MC locations
● T4 → level of the nipple
● Opthalmic Division of V1
▪ MC reason for outbreak = STRESS
▪ Must do ELISA Test for HIV/Cancer patient if >40 y.o. with shingles
▪ Patient can complain of “burning” on the chest
● Ribavarin
o RSV Treatment
o Teratogenic and given aerosol
▪ No pregnant nurses are allowed to give this medication
o Assembly
o Lysogeny
▪ Virus explodes out of the cell
▪ Destroys membrane
● RNA → destroy cell membrane
● DNA → destroy nuclear membrane
▪ Wrap themselves with cell membrane → autoimmune disease

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3 Stages: From Invasion → Penetration
● Viremic and asymptomatic
o There is not enough virus to cause illness
o While in blood still able to perform tests (ELISA)
▪ Invasion
▪ Adhesion
● Eclispe
o Virus is now hidden
o Virus is in the blood but can no longer be detected
o Need to run PCR, Southern Blot, or Northern Blot
▪ Penetration
▪ Uncoating
▪ Replication
● Viremic and symptomatic
o Patient begins to deteriorate
▪ Assembly
▪ Lysogeny

MCC Infections:

● Encephalitis = inflammation of the brain

o Togavirus
▪ All end in “equine”
▪ The more “e” in the name the more lethal
▪ Mosquito carrier
o Present with:
▪ Bad headache
▪ Ataxia
o Self-limiting → will go away by itself
o Herpes virus the #2 cause of encephalitis
▪ Location → Temporal Lobe = hemorrhagic
● Meningitis
o Protein (inflammatory cell) is elevated in every meningitis Bacteria:
↓ glucose
o If viral look for ↑ lymphocytes/monocytes ↑
▪ Will have normal sugar neutrophils
o Aseptic Meningitis → NO BACTERIA INVOLVED
▪ MCC: Enterovirus (any virus that causes diarrhea → GI)
● Adult → Adenovirus Fungus:
↓ sugar
● Pediatrics → Rotavirus ↑ lymphocytes
▪ Present with Headache & monocytes
● Common Cold → sinusitis, otitis, bronchitis, pneumonia
o Rhinovirus → only common cold symptoms = sniffles

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 o With any additional symptoms (cough, sore throat) = Adeno or Corona
o Adenovirus (fall/winter)
▪ #1 cause of conjunctivitis
▪ Associated with Cryoglobulinemia
▪ Described as necrotizing bronchiolotis in the lung
o Coronavirus (summer/spring)
o Influenza virus
▪ Cryoglobulinemia ( recall Strep. Salivarius)
o Parainfluenzae
o HSV-I
▪ Herpes Keratitis = inflamed cornea
● Steroids are contraindicated → will cause loss of vision because the dendrites
will rip throught the cornea
Childhood Illnesses
● Mumps
o Affects the parotids → Acute parotidis
o Inflammed parotid gland → swelling in the front of the ear
o Stenson’s duct appears red
o Painful when asked to taste something sour (saliva can’t be secreted to nullify acid)
o Complications:
▪ Orchidis → Males
▪ Oopheritis → Females
▪ Pancreatitis
● Rubeola → Measles
o Paramyxovirus
o Koplik spots
▪ Viral Prodrome → Shows up in the cheek, buccal mucosa 1 day before rash
● Appearance of a gray pearl on a red base
o 3 C’s
▪ Cough
▪ Coriza (thick nasal drainage)
▪ Conjunctivitis
o Rash
▪ Morbilliform → blotchy
▪ Appears on the head and neck → proceeds down the body
▪ Disappears in the same order
o Complications
▪ Otitis media
▪ Pneumonia
▪ Rapid Demyelinating disease = SSPE (rare)
● Subacute Sclerosing PanEncephilitis
● No treatment → will die
● Present as a child with a headache who can’t walk
● Must ask about PMH for Rubeolla

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● Rubella = German measles
o Togavirus
o No 3 C’s
o Only a morbilliform rash after a few days after fever (rash appears like rubeola)
o Warthin Finkeldey Cells → multinucleated giant cells with eosinophilic cytoplasmic and
nuclear inclusion bodies
o Swollen lymph nodes
▪ Behind ears and neck
▪ Post-auriccular and occipital

o Complications of Rubella
▪ Neonatal rubella (pregnant mom → child)
● If it happens in the 1st trimester one can offer an abortion b/c 70-90% of the
children will be deformed
● Catracts
● Deafness
● Autism
o Sameness
o Language problems
o Don’t bond
● PDA – associated because of prematurity
● Blueberry Muffin rash
▪ If affected after MMR vaccine → child will shed virus for 2 months

● Varicella
o Chicken pox
▪ Pox lesions come in 4 waves
● Red macule (red dot)
● Clear vesicle (dome)
● Pustule
● Scab → no longer infectious → 7 days to scar over
▪ Most infectious
● 2 days before rash breaks out
● 3 days after the rash breaks out
▪ Immuocompromised patients exposed to child with chicken pox must give varicella IgG
within 72 hours of exposure
▪ Complications:
● Skin infections
o S. aureus, strep. Pyogenes
o Pulmonary varicella pneumonia
▪ Highly lethal
▪ Happens in adults
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● Fifths Disease
o Parvovirus B19 → Erythema infectiosum (slapped face)
▪ #1 cause of Aplastic anemia
● Roseolla → HSV VI
o Sixth Disease → Exanthem subitum
▪ ONLY illness where rash comes 24 hrs after the fever disappears
▪ No treatment/complications
● HSV VII
o Pityriasis rosea
▪ Circular dry patches of ski all over the body
▪ Mimics Excema
▪ X-mas tree pattern → follows skin lines
▪ Herald Patch
▪ Self Limiting

● Molluscum contagiosum
o Poxvirus → Fleshy colored papules with central umbilicus
o Goes away on it’s own
o Can be sexually transmitted
● Kawasaki Disease = mucocutaneous lymph node disease
o Symptoms
▪ Strawberry tongue (only other is Scarlet Fever), red lips, red eyes (mucositis)
▪ Red rash all over including the Palms and Soles!!! (TRCKSSS)
▪ Swollen lymph nodes → follows down the cervical chain
▪ Fever > 1020 F for at 3-5 days
o Causes Vasculitis (systemic)
▪ Will cause Thrombocytoses (↑ platelet count)
● Use ASA to inhibit platelet aggregation
● Flu vaccine every year to prevent Reye’s Syndrome
▪ (+) Heart failure
o Biggest complication
▪ Will cause coronary aneurysm in 90% of cases within the 1st 6 months
▪ Do echo every month for 6 months and every 6-12 months after that
▪ If a coronary aneurysm is > 8 mm need to do bypass surgery on the child
o Treatment
▪ IgG immediately → block antibodies
▪ ↓ frequency of coronary aneurysm
● Hand and Foot – Mouth
o Coxsackie A
o Rash = little red dots on PALMS & SOLES
o Ulcers in the mouth and back of the throught
▪ Painful → so won’t drink and breast feed
▪ Common complication is dehydration

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Lung
● Croup
o Subepiglottic edema
o Symptoms
▪ Stridor
▪ Barking cough
▪ Steeple sign on neck film
o Treatment:
▪ Dexamethasone
o Common causes
▪ Parainfluenza (80%)
▪ RSV (15%)
● Severe symptoms → send to ER
▪ Influenza
▪ Adenovirus

● Bronchiolitis
o Behaves like asthma
▪ Is not called asthma until 2 y.o. because one can outgrow bronchiolitis
o Mucous collection in the small airways
▪ Recall → obstructive disease

o Common causes of Bronchiolitis:

▪ Parainfluenza (80%)
▪ RSV (15%)
● Severe symptoms → send to ER
▪ Influenza
▪ Adenovirus
Heart
● Acute Myocarditis/Pericarditis
o MCC Coxsackie B
o EKG Findings
▪ Myocarditis → diffuse ST wave depression
▪ Pericarditis → diffuse ST wave elevation (inflammation causes blood to be sent to that
area leaving other areas with minimal blood flow and oxygen → ISCHEMIA!!!)
● Recall: peri → myo → endo (Ishemia affects outside → in)
GI
● Gastroenteritis
o Adult → adenovirus
o Pediatrics → rotovirus
GU
● Viral cystitis (UTI)
o MCC is Adenovirus
● Pancreatitis

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o Etiology
▪ Coxsackie B
▪ Remember that the #1 cause is TRAUMA!!!

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HEPATITIS

Hepatitis Type A/E B C D

DNA Segmented

Incubation 2 – 6 weeks 2 – 6 months 20 – 30 years

Transmission Fecal/Oral 1. IV 1. Blood
2. Blood transfusion
3. Sexual 2. IV
4. Vertical 3. Sexual
(mom → baby No vertical Trans.
Chronic Active NO 10% Risk 60% Risk
Hepatitis
Cancer NO Highest Risk Lower than B
Misc Hep E = asian Dane Particle → DNA Only after one
version of A If mom is +Hb- gets B can
Known to surface antigen → they get D
attack pregnant Baby must get Look for a
women chart showing
vaccine and IgG at
an increase of
birth ( remember that
AST/ALT at 6
it takes 2 weeks for months after
IgM to peak → Full Hep B
Protection infection is
Higher incidence and getting better
prevalence than C
Symptoms Gastroenteritis
with Shell Fish

Chronic Hepatitis
● Defined by:
o Symptoms that are persistent
o Elevated enzymes beyond 6 mos.
o Persistent Hb surface antigen
● Deferentiate between chronic persistent and chronic active:
o Liver biopsy
▪ Chronic persistent → nothing wrong with the liver
▪ Chronic active → will have fibrosis → can lead to cancer

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Hepatitis B Infection Cycle:
● Must have core antibody to show prior infection
● Surface antibody will give immunity to Hep. B
● Profiles to Know
o + Core antibody and surface antigen
▪ Current Infection
o + Core antibody by itself
▪ Window Period
o + Core antibody and surface antibody
▪ Had past infection but now immune
o + Surface antigen alone
▪ Just been vaccinated less than 2 weeks ago
o + Surface antibody alone
▪ Vaccination

2
mos.
4
mos.
6
mos.
8 mos.

● Hb Core = Dane Particle

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● Hbs = Surface Antigen → usually positive when patient first comes in

● Anti-HbC = Core antibody → stays for life

● Anti – HbS = surface antibody → provides immunity

● Window Period → equivalence zone

o HbE → can be seen in this window → Can determine infectivity

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