Epidemic 8, 9, 11, 19, Any age

Virology keratoconjunctivitis 35, 37

DNA VIRUSES gastroenteritis 40, 41 Infants, young
children,
 Adenoviruses immune
compromised
o MOT: aerosols, direct-contact, px
fecal-oral, contaminated Hepatitis 1-5, 7, 31 Immuno
swimming pools compromised
px
o Morphology; nonenveloped Meningoencephalitis 2, 7 Children,
(naked) icosahedral capsid immuno
o Patho: compromised
px
▪ Infects mucoepithelial
 Parvoviruses
cells in the respiratory
o Smallest DNA virus
tract, GI tract, &
o Members: B19 & bocavirus (only
conjunctiva or cornea
infectious to humans)
▪ Persists in lymphoid tissue
o MOT: spreads by respiration &
o CM:
oral secretions (droplet
▪ Pharyngitis/pharyngoconju
transmission)
nctival fever
o Morphology
▪ Gastroenteritis
▪ Naked icosahedral capsid
▪ ARI
▪ Single-stranded (+ or –
▪ Conjunctivitis/
sense) DNA genome
keratoconjunctivitis (pink
o Patho:
eye)
▪ B19 targets & is cytolytic
o Dx: virus isolation from the site or
for erythroid precursor
secretion relevant to the disease
cells; can cross the
→ immunoassays/ genome
placenta
assays
▪ Bocavirus also initiates
o Prevention; handwashing &
infection in the respiratory
chlorination of swimming pools
tract, replicates in the
Disease Types Patient respiratory epithelium
Population
Respiratory Disease B19 Bocavirus
Febrile, 1, 3, 5, 7, 14, Infants, young -Erythema infectiosum -mild or severe acute
undifferentiated 21, etc. children (5th disease) respiratory disease
upper respi tract -children: slapped – -<2 yo; bronchiolitis
infection cheek appearance
Pharyngoconjunctival 1, 2, 3, 4, 5, Children, -polyarthritis (adults)
fever 7 adults -aplastic crisis (in
Acute respi disease 1, 2, 4, 5, 6, Infants, young
persons w/ chronin
7, 14, 21 children,
military
anemia)
recruits Hydrops fetalis
Pertussis-like 5 Infants, young Dx: clinical presentation;
o
syndrome children immunoassays, genomic assays
Pneumonia 3, 4, 7, 14, Infants, young
o Tx/ prevention; no specific
21, 30 children,
military antiviral treatment or means of
recruits, control is available
immune  Poxviruses
compromised
px o Largest, most complex viruses
Other Diseases o DNA viruses that replicate in the
Acute hemorrhagic 11, 21 Children, cytoplasm
cystitis / nephritis immune
compromised o Morphology:
px ▪ Complex, oval to brick-
shaped
 o MOT monkeypox Generalized Zoonosis: Africa
disease monkeys,
▪ Aerosols & contact:
squirrels
smallpox Bovine Localized Zoonosis: Worldwide
▪ Direct contact: the rest of popular lesion calves,
poxviruses stomatitis beef,
virus cattle
Genus Virus Primary Disease Tanapox Localized Rare Africa
lesion zoonosis:
host
monkeys
Orthopoxvirus Variola (major Humans Smallpox
& minor) (now Yabapox Localized Rare Africa
eliminated) lesion monkeys,
Vaccinia Humans Localized baboons
lesions; Molluscum Many skin Humans Worldwide
used for contagiosum lesions
smallpox
vaccine
Buffalopox Water Human Clinically important Poxviruses
buffalo infections
rare; Poxvirus Disease /Properties
localized
lesion
Orf virus -poxvirus of sheep &
Monkeypox Rodents, Human goat
monkeys infections -CM: contagious
rare; pustular dermatitis or
generalized
sore mouth infection
dse
cowpox cows Human Cowpox -similar to vaccinia /
infections variola immunologically
rare; & in host range
localized
-CM: deep red
ulcerating
lesion hemorrhagic lesions
Parapoxvirus Orf Sheep Human Molluscum -small, pink, wart-like
Pseudocowpox Cows infections contagiosum tumors on the face,
Bovine popular cows rare;
arms, back & buttocks
stomatitis localized
lesion -pearl-like umbilicated
Molluscipoxvirus Molluscum Humans Many nodules
contagiosum benign skin Variola -Eradicated, 1980
nodules
-CM: smallpox
Yatapoxvirus Tanapox Monkeys Human
infections  Herpesviruses
rare; o MOT: contact, bodily fluids,
localized
lesion aerosol (VZV)
Yabapox Monkeys Human o Considered as ubiquitous viruses
infections
very rare & o Can cause lytic, persistent,
accidental; latent, & (EBV) immortalizing
localized
skin tumors infections
o Morphology
Different Diseases associated with Poxviruses ▪ Large, enveloped,
icosadeltahedral capsids
Virus Disease Source Location containing double-
Variola Smallpox Humans Extinct
(now stranded DNA genomes
extinct)
Sub Biologic properties Genus Examples
Vaccinia Used for Laboratory ----- family Virus
Growth Latent (HH) Common
smallpox product Herpes cycle & infections Name
vaccination virinae cytopat
-hology
Orf Localized Zoonosis: Worldwide
α Short, neurons simplex 1 HSV 1
lesion sheep, cytolytic 2 HSV 2
goats Varicella 3 Varicella –
Cowpox Localized Zoonosis: Europe zoster
virus
lesion rodents,
ß Long, Glands Cyto 5 Cytomega
cats, cows cytomegalic kidneys megalo -lovirus
Pseudocowpox Milker’s Zoonosis: Worldwide Lymphoid Roseolo 6 HH8
nodule dairy cows tissue
7 HH7
y Variable, Lymphoid Lympho 4 Epstein - -CM
Lympho tissue -crypto Barr virus
-prolirative Rhadino 8 Kaposi -infectious
Sarcoma – mononucleosis (kissing
associated
Herpes
disease)
virus -nasopharyngeal
carcinoma
Prominent members of herpesviruses -Burkitt lymphoma
-Hogkin’s dse
Herpesvirus Properties / Disease Human Herpes virus -Associated w/
Herpes simplex virus -involves skin above (HHV) 8 HIV/AIDs infection
(HSV)-1 (direct the waist o Dx:
contact) -CM: gingivostomatitis; ▪ Tzanck smear (HSV)
pharyngotonsillitis, ▪ Culture
keratoconjunctivitis;
▪ Immunologic test (EBV
cold sores; keratitis;
herpetic encephalitis; serology)
eczema herpeticum; ▪ PCR genome analysis
herpetic whitlow o Tx:
Herpes simplex virus -involves skin about the Acyclovir: most of the
▪
(HSV)-2 (sexual waist herpesviruses
transmission) -CM: neonatal infection;
herpetic whitlow;
▪ Ganciclovir: CMV
genital herpes; ▪ None: EBV
herpetic meningitis ▪ Prevention: vaccine (VZV)
Varicella-zoster Virus Varicella  Papillomaviruses
-CM: chickenpox o MOT: direct contact, sexual
-maculopopular lesion contact (STD), fomites, passage
forms a thin-walled
vesicle on an through infected birth canal
erythematous base o Formerly part of the
(“dewdrop on a rose Papovaviridae family (w/c on
petal”) longer exist)
-more prevalent on the o Morphology
trunk & head than on
the extremities
▪ Small, naked, DNA
Zoster genome
-recurrence of a latent o Patho: infects the epithelial cells
varicella infection of the skin or mucous membranes
-CM: herpes zoster o CM: different types of warts &
-severe pain in the area
cancer
innervated by the nerve
(dermatones) Syndrome Human Papillomavirus Types
Cytomegalovirus (CMV) -most common viral Common Less
cause of congenital Common
defects Cutaneous Syndromes
-MOT: acquired from Skin Warts
blood, tissue, & most Plantar wart 1 2,4
body secretions Common Wart 2, 4 1, 7, 26, 29
-CM: Flat Wart 3, 10
- congenital infection; Epidermodysplasia 5, 8, 17, 20, 36 9, 12, 14 ,15,
perinatal infection verruciformis 19, 21-25, 38,
Human Herpes virus -CM: Roseola (infantem 46
(HHV) 6 & 7 subitem, 6th disease) Mucosal Syndromes
-rapid onset of high Benign Head & Neck Tumors
fevert of a few days’ Laryngeal 6, 11 -----
duration, which papilloma
followed by a rash Oral Papilloma 6, 11 2, 16
Conjuntival 11 ------
Epstein – Barr Virus -saliva initiates
papilloma
(EBV) infection of oral Anogenital warts
epithelia & tonsillar B Condyloma 6, 11 1, 2, 10, 16, 30,
cells acuminatum 44, 45
Cervical 16-18 31, 33, 35, 39, (4) vaccination of
intraepithelial 45, 51, 52, 56, 9-26 y/o to prevent
neoplasia, cancer 58, 59, 66, 68, anal cancer &
associated
(high-risk, types) 69, 73, 82
precancerous
lesions due to HPV
Association of Viruses w/ Human Cancers types 6, 11, 16 &
18
Virus Family Virus Human Cancer  Polyomaviruses
Papillomaviridae Human Genital tumors
Papillomaviruses Squamous cell
o MOT: inhalation or contact w/
carcinoma contaminated water or saliva
Oropharyngeal o Formerly part of the
carcinoma
Herpesviridae Epstein – Barr Nasopharyngeal Papovaviridae family (w/c no
Virus carcinoma longer exists)
Burkitt lymphoma
Hodgkin’s dse o Commonly associated w/ IC state
B-cell lymphoma ( HIV/AIDS)
Human Kaposi sarcoma
herpesvirus 8 Primary effusion o Infections are ubiquitous
lymphoma o Morphology
Hepadnaviridae Hepatitis B virus Hepatocellular
carcinoma ▪ Small naked capsid, DNA
Polyomaviridae Merkel cell virus Merkel Cell genome
carcinoma
Retroviridae Human T- Adult T-cell Polyomaviruses Diseases
lymphotropic virus leukemia
Human AIDS – related JC virus Progressive multifocal
immunodeficiency malignancies leukoencephalopathy
virus BK virus Hemorrhagic cystitis in
Flaviviridae Hepatitis C virus Hepatocellular
bone marrow
carcinoma
transplant recipients
o Dx: PCR genome analysis of
Ki & Wu virus Found in
cervical swabs & tissue nasopharyngeal
specimens aspirates from children
o Tx/Prevention: Vaccines for HPV w/ respiratory
types infections
Merkel Cell Merkel cell carcinomas
Bivalent Quadrivalent Nine-valent polyomavirus
(Cervarix) (Gardasil) (Gardasil-9) SV40 virus Progressive multifocal
-HPV types 16 & -HPV types 6, 11, -In 2014, the FDA leukoencephalopathy
18 16, & 18 approved a new
-Administered IM nine-valent L1 VLP Dx: confirmed by the presence of
o
-Administered by
at months 0, 2, & 6 vaccine that PCR amplified viral DNA in
IM inj at months 0,
Targets HPV types
1, & 6 -Approved for the 6, 11, 16 & 18 (the cerebrospinal fluid & MRI or CT
ff
-This vaccine is
(1) vaccination of
types also evidence of lesions
approved for targeted by the
females 9-25 y/o girls & women quadrivalent HPV o Tx: Cidofovir
ages 9-26 years of vaccine) as well as  Hepatitis viruses
age to prevent 5 additional
genital warts & oncogenic HPV o MOT:
cervical cancer types (31, 33, 45, ▪ HAV, HEV: fecal-oral
caused by HPV 52, & 58)
types 6, 11, 16 & -Administered IM
transmission
18 at mos 0, 2 & 6 ▪ HBV, HCV, HDV: spread in
(2) vaccination of
the same
-Approved for the blood, tissue, & semen;
same indications
population to as w/ the STDs (blood borne
prevent
precancerous or
quadrivalent hepatitis)
(Gradasil) vaccine
dysplastic lesions, o Patho: liver dse defines
including cervical
AIS, CIN 2/3, VIN
symptoms
2/3, VaIN 2/3, & o Dx: RT-PCR, ELISA
CIN 1;
o Tx/Prevention:
(3) vaccination of
boys & men 9-26 ▪ Antiviral drugs (refer to
y/o to prevent antiviral agents)
genital warts
caused by HPV ▪ Vaccination
types 6 & 11 ▪ Hygiene
 Feature
Common
Hepa A
Infectious
Hepa B
Serum
Hepa C
Non-A,
Hepa D
Delta
Hepa E
Enteric
o Prevention: handwashing &
name Non-B agent non-A, disinfection
posttrans non-B
fusion
Virus Picorna Hepadna Flavi Viroid-like; Calici - Picornaviruses Group Disease/
structure -virus; -virus; -virus; envelop virus –
capsid, envelope envelope circular like; Properties
(+) RNA DNA (+) RNA RNA capsid
(+) RNA
Poliovirus Enterovirus -CM: paralytic
Trans Fecal – Parenteral, Parenteral, Parenteral, Fecal – polio
-mission oral sexual sexual sexual oral -asymmetric
Onset Abrupt Insidious Insidious Abrupt Abrupt
Inucbation 15 – 50 45 – 160 14 – 180+ 15 – 64 15 – 50 flaccid paralysis
Period w/ no sensory
(days)
Severity Mild Occasion Usually Co – Normal loss
-ally subclinical infection px, mild; -prevention;
severe ; 70% w/ HBV pregnant
chronicity occasion women, vaccine (2)
-ally severe 1. inactivated
severe;
super polio vaccine
-infection (IPV)/ Salk
w/ HBV
often vaccine
severe 2. Live
Mortality <0.5% 1 – 2% ≈4% High to Normal
very high px, 1-2%; attenuated oral
pregnant polio vaccine
women,
20% (OPV)/sabin
Chronicity No Yes Yes Yes No vaccine
/ carrier
state Coxsackie A Enterovirus -vesicular
Other dse None 1° hepato 1° hepato Cirrhosis, None lesions
Assoc -cellular -cellular Fulminant
-iations carcinoma carcinoma hepatitis
-CM:
, cirrhosis , cirrhosis 1. herpangina
Lab Dx SSx & SSx & SSx & anti- Anti – HDV -------
anti-HAV serum lvls HCV ELISA
2. HFMD (A16)
IgM of HBsAg, ELISA, 3. Hemorrhagic
HBeAg, & genome
anti-HBc testing1°
conjunctivitis
IgM hepato (A24)
-cellular
carcinoma
Coxsackie B Enteroviruses -Myocarditis
, cirrhosis (body) -pleurodynia
(Bornholm
Interpretation of Serologic Markers of HBV disease)
Infection Rhinovirus Rhinovirus Most important
cause of the
Serologic Disease State Healthy common cold &
Reactivity State upper respi
Early (Pre Early Acute Chronic Late Reso Vaccin
-symptomatic) acute acute -lved -ated tract infections
Anti-HBc - - + + +/- + -
Anti-HBe - - - - +/- +/- -  Coronaviruses
Anti-HBs
HBeAg
-
-
-
+
-
+
-
+
-
-
+
-
+
-
o MOT: droplet transmission,
HBsAG
Infectious
+
+
+
+
+
+
+
+
+
+
-
-
-
-
aerosols, direct contact
virus o Solar/club/petal-shaped/corona-
like appearance
o Patho:
RNA VIRUSES ▪ Infects epithelial cells of
POSITIVE SENSE upper respiratory tract
▪ Reinfection occurs in the
 Picornaviruses presence of serum
o Small (pico) RNA viruses, naked antibodies
capsid structure ▪ Glycoprotein “corona”
o Members helps this enveloped virus
▪ Enteroviruses (major survive the GIT
group, fecal-oral route) ▪ Severe ARI is exacerbated
▪ Rhinovirus (major group, by inflammatory
aerosol/ direct contact) responses
▪ Cardioviruses o Human coronaviruses
▪ Aphthoviruses ▪ 229E (alpha coronavirus)
▪ Hepatoviruses (Hepa A) ▪ NL63 (alpha coronavirus)
o Tx: no antiviral drugs are ▪ OC43 (beta coronavirus)
effective
 ▪ MERS-CoV (beta ✓ Cataracts & other ocular defects
coronavirus, causing ✓ Heart defects
MERS) ✓ Intrauterine growth retardation
▪ SARS-CoV (beta ✓ Failure to thrive
coronavirus, causing ✓ Mortality w/in the 1st year
SARS) ✓ Microcephaly
▪ SARS-Cov-2 (beta ✓ Mental retardation
coronavirus, causing
COVID-19)
o Cm:  Noroviruses
Common colds
▪ o Norwalk virus
Gastroenteritis
▪ o MOT: fecal-oral route
Respiratory infections:
▪ (contaminated food & water)
SARS, MERS, COVID-19 o Resistant to environmental
o Dx: RT-PCR (respiratory & stool pressure: detergents, drying &
samples) acid
o Tx: No vaccine or specific o CM: outbreaks of gastroenteritis (
antiviral therapy is available resolves after 48 hours, without
 Togaviruses serious consequences)
o Arboviruses (arthropod-borne o Dx: RT-PCR
viruses, except rubella) o Tx: No specific treatment
o Humans are usually “dead-end  Flaviviruses
hosts” o Arboviruses (arthropod-borne
o Major genera: alphavirus, viruses, except Hepa C)
rubivirus (rubella), & Arterivirus o Humans are usually “dead-end”
(non-pathogenic) hosts
o Dx: RT-PCR o Broad hoast range (vertebrate,
o Tx: No treatment exist for invertebrates)
arbovirus disease & rubella, o Dx: RT-PCR
other than supportive o Tx: No treatments exist for
o Prevention: arbovirus diseases & rubella,
▪ Elimination of its vector & other than supportive
breeding grounds o Prevention
(arboviruses) ▪ Elimination of its vector &
▪ Vaccination (MMR breeding grounds
vaccine) (arboviruses)
▪ Vaccines (Japanese
Virus Vector Host Distribution Dse encephalitis virus, yellow
Alphaviruses
Sindbis Aedes & Birds Africa, Subclinical
fever virus, dengue virus)
other Australia,
mosquitos India Virus Vector Host Distribution Dse
Semliki Aedes & Birds East & West Subclinical Flaviviruses
forest other Africa Dengue Aedes Human, Worldwide, Mild
mosquitos monkeys esp tropics systemic;
Venezuelan Aedes, Rodents, North, South Mild breakbone
Equine culex horses & Central systemic; fever,
encephalitis America severe dengue
encephalitis hemorrhagic
Easter Aedes, Birds N&S Mild fever, &
equine culiseta America, systemic, dengue
encephalitis Caribbean encephalitis shock
Western Culex, Birds North & Mild syndrome
equine culiseta South systemic, Yellow fever Aedes Human, Africa, south Hepatitis,
encephalitis America encephalitis monkeys america hemorrhagic
Chikungunya Aedes Human, Africa, Asia Fever, fever
monkeys arthralgia, Japanese Culex Pigs, Asia Encephalitis
arthritis encephalitis birds
Prominent Clinical Findings in Congenital West Nile Culex Birds Africa, Fever
encephalitis Europe, ,encephalitis,
Rubella Syndrome Central Asia, hepatitis
 north
america
o Tx: ARV agents
St. Louis Culex Birds North Encephalitis
encephalitis America Subfamily Characteristics Examples
Russian Ixodes & Birds Russia Encephalitis Oncovirinae Are associated w/ -----
spring- Derma
summer centor
cancer & neurologic
encephalitis ticks disorders
Powassan Ixodes Small North Encephalitis B Have eccentric Mouse
encephalitis ticks mammals America nucleocapsids core mammary
*Dengue warning signs in mature virion tumor virus
C Have centrally Human T-cell
✓ Abdominal pain or tenderness located lymphotropic
✓ Persistent vomiting nucleocapsid core in virus (HTLV-1,
mature virion HTLV-2,
✓ Clinical fluid accumulation HTLV-5), Rous
✓ Mucosal bleed Sarcoma
✓ Lethargy, restlessness Virus
(chickens)
✓ Liver enlargement > 2cm
D Have nucleocapsid Mason-pfizer
✓ Laboratory: inc in HCT concurrent w/ core w/ cylindrical monkey virus
rapid decrease in platelet count form
Lentivirinae Have onset of dse, Human
*Clinical Stages of Dengue cause neurologic immune
disorders & deficiency
immunosuppression, virus* (HIV-1,
are viruses w/ D- HIV-2), visna
type cylindrical virus (sheep),
nucleocapsid core caprine
arthritis/
encephalitis
virus (goats)
Spumavirinae Cause no known Human foamy
clinical dse but virus
cause characteristic
vacculated *foamy*
cytopathology
Human Retrovirus Human
Endogenous sequences that are placental
Retroviruses integrated into virus
(HERVs) human genome
 Zika Virus  Reoviruses
o Cause microcephaly o Double: double virus
o MOT:
 Retroviruses ▪ Fecal-oral (rotavirus,
o Subfamilies: orthoreovirus)
▪ Oncovirinae (HTLV-1, ▪ Vector borne (coltivirus,
HTLV-2, HTVL-5) orbivirus)
▪ Lentivirinae (HIV-1, HIV-2) o MOT:
▪ Spumavirinae ▪ Double-layered capsid
(nonpathogenic) virion
o MOT: blood & semen (sexual ▪ Icosahedral symmetry
contact) ▪ Double-stranded genomic
o Morphology segments
▪ RNA-dependent DNA o Resistant to environmental & GI
polymerase (reverse conditions
transcritptase), 2 copies of o Dx: ELISA (stool); RT-PCR
tRNA, protease, and o Tx:
integrase enzymes ▪ No approved antiviral
▪ Replicates in nucleus agent
▪ PATHO: AIDS; leukemia o Prevention
o Dx: RT-PCR, ELISA (screening), ▪ Vaccine (rotavirus)
western blot (confirmatory)
 Virus Disease ▪Kolpik spots (grains of salt
Orthreovirus Mild upper respiratory surrounded by a red halo;
tract illness, GIT established the certainty
illness, biliary atresia
of measles)
Orbivirus/ coltivirus Febrile illness
w/headache & myalgia o Dx: symptomatology
(zoonosis) o Tx: symptomatic mgmt.
Rotavirus GIT illness, respiratory o Prevention:
tract illness (?) ▪ MMR vaccine
*Reovirus is the most common name of the family ▪ Measles vaccine can be
Reoviridae & for the specific genus Orthoreovirus
given as early as 6 mos of
age ( esp if there is an
RNA VIRUSES outbreak)
o Complications
N EGATIVE SENSE ▪ Viral pneumonia –
accounts for 60% of the
 Paramyxoviruses death caused by measles
o MOT: droplet transmission ▪ Otitis media
o Genera: Morbilivirus, ▪ Subacute sclerosing
Paramyxovirus, & Pneumovirus panenencephalitis (SSPE)
o Patho: induce cell-to-cell fusion, – extremely serious, ver
causing multinucleated giant late neurologic squeal of
cells (syncytia) measles
o Dx: symptomatology, RT-PCR  Paramyxoviruses (Mumps)
genome analysis of respi o MOT: direct person – to – person
secretions contact & respiratory droplets
o Tx: symptomatic tx (majority of o Only one serotype is known
paramyxovirus); aerosolized o Patho: infection of parotid gland,
ribavirin (RSV) testes & CNS
o Prevention: vaccines (MMR) o CM
Genus Human Pathogen ▪ Swelling of parotid gland
Morbilivirus Measles virus (infectious parotitis)
Paramyxovirus Parainfluenza viruses 1 ▪ Swelling of other glands
to 4 (epididymoorchitis,
Mumps virus oophoritis, mastitis,
Pneumovirus Respiratory syncytial
pancreatitis, & thyroiditis)
virus
Metapneumovirus ▪ Meningoencephalitis
 Paramyxoviruses (Measles) ▪ Orchitis (testes) may
o Aka rubeola result to sterility, but rare
o One of the 5 classic childhood o Dx: RT-PCR, immunoassays
exanthems, along w/ rubella, o Tx: symptomatic mgmt.
roseola, 5th disease & chicken o Prevention: vaccine (MMR)
pox  Paramyxoviruses (Parainfluenza virus)
o MOT: droplet transmission (highly o MOT: person to person contact &
contagious) respi droplets
o Prodrome: high fever & CCC & P o Ex: Parainfluenza 1, 2, 3 & 4
– cough, coryza, conjunctivitis, & o CM
photophobia ▪ Parainfluenza 1, 2, 3:
o CM: laryngotracheobronchitis
▪ Maculopopular rashes (croup)
(starts below the ears & • Subglottal swelling
spreads over the body) • “seal bark” cough
▪ Parainfluenza 4: mild URTI
 o Dx: RT-PCR Lassa virus
o Tx: South American Hemorrhagic Ferver viruses
▪ Nebulized cold  Junin Virus (Argentina HF)
 Machupo virus (Bolivian HF)
▪ Hot steam  Guanarito virus (Venezuelan HF)
 Paramyxoviruses (Respiratory Syncitial  Sabia virus (Brazilian HF)
Virus [RSV])  Chapare virus (Chapare HF)
o Prevalent in young  Lujo virus (Lujo HF)
children/infants (</=2 y/o) LCM virus (lymphocutic choriomeningitis)
o MOT: aerosols; direct contact  Bunyaviruses
o CM: o “supergroup” of at least 200
▪ Bronchiolitis – infants enveloped, segmented, negative-
▪ URTI w/ rhinorrhea – older strand RNA viruses
children and adults o Genus: Bunyavirus, Phlebovirus,
o DX: RT-PCR Nairovirus, & Hantavirus
o Tx o Most are arboviruses (mosquito,
▪ Ribavirin – approved for tx ticks, or flies), except
of infants Hantaviruses (rodents)
▪ Supportive (administered o Most are arboviruses except
of O2, IV fluids, & hantavirus (rodents)
nebulized cold steam) o CM: encephalitis; others cause
 Filoviruses hepatic necrosis or hemorrhagic
o Members: Marburg & Ebola dse
viruses o DX: RT-PCR
o Endemic in bats or wild monkeys o Tx: No specific therapy for
o MOT: contact with the animal infections
reservoir or direct contact with Genus Members Insect Pathologic Vertebrate
Vector Conditions Host
infected blood or secretions Bunyavirus Bunyamwera Mosquito Febrile Rodents,
o Morphology: filamentous, virus, Cali illness, small
-fornia ence encep mammals,
enveloped, negative-strand RNA -phalitis -halitis, primates,
virus, La rash marsupials,
viruses Crosse birds
o CM: severe or fatal hemorrhagic virus, Oro
-pouche
fevers (endemic in Africa) virus; 150
members
o Dx: RT-PCR Phlebovirus Rift Valley Fly, Tick Sandfly Sheep,
o Tx: No antiviral meds have fever virus,
sandfly fever
fever,
hemorrha
cattle,
domestic
proved effective virus, -gic fever, animals
Heartland encep
o Prevention: rVSV – ZEBOV virus; 38 -halitis,
vaccine (vaccine for Ebola virus) members conjunct
-ivitis,
 Arenaviruses myositis
Nairovirus Crimean – Tick Hemorrha Hares,
o Sandy appearance (arenosa, Congo -gic fever cattle,
meaning “sandy”) because of the hemorrhagic
fever virus; 6
goats,
seabirds
ribosomes in the virion members
Uukuvirus Uukuniemi Tick -------------- Birds
o Infect specific rodents & are virus; 7
endemic to the rodents’ habitat Hantavirus
members
Hantaan None Hemorrha Rodents
o MOT: inhalation of aerosols, virus -gic fever
w/ renal
consumption of contaminated syndrome,
food, or contact w/ fomites adult respi
distress
o Dx: RT-PCR syndrome
Sin nombre none Hantavirus Deer
o Tx: Ribavirin (Lassa fever); pulmonary mouse
syndrome,
supportive therapy (other shock,
arenaviruses) pulmonary
edema

Arenavirus
  Othomyxoviruses pain, vomiting) , otitis
media, myositis, & more
o MOT: inhalation of small aerosol
frequent croup
droplets Complications of Primary viral pneumonia
o Members influenza virus infection Secondary bacterial
▪ Influenza A (pathogenic pneumonia
Myositis & cardiac
zoonotic) involvement
▪ Influenza B (pathogenic) Neurologic syndromes:
▪ Influenza C (mild disease) Guillain – Barre syndrome
Encephalopathy
o Morphology: Encephalitis
▪ Enveloped, segmented Reye syndrome
negative – sense RNA
genome Lab Diagnosis of Influenza Virus infection
▪ 2 glycoproteins,
Test Detects
hemagglutinin (HA) &
Cell culture in 1° Presence of virus;
neuraminidase (NA) monkey kidney or limited cytopathologic
▪ Membranes (M2) protein & Madin – Darby canine effects
is internally lined by the kidney cells
matrix (M1) protein Hemadsorption to Presence of
o Segmented genome promotes infected cells hemagglutinin protein
on cell surface
genetic diversity caused by Hemagglutination Presence of virus in
mutation & reassortment secretions
▪ Antigenic drift Hemagglutination Type & strain of
• Minor antigenic inhibition influenza virus or
changes specificity of antibody
Antibody inhibition of Identification of
• Accumulation of
Hemadsorption influenza type & strain
point mutations in Immunofluorescence, Influenza virus &
the gene ELISA antigens in respiratory
▪ Antigenic shift secretion or tissue
• Major antigenic culture
changes Serology: Seroepidemiology
hemagglutination,
• Result in the inhibition,
appearance of a hemadsorption
new subtype inhibition, ELISA,
• Most likely to result immunofluorescence,
complement fixation
in an epidemic
Genomics: RT-PCR Identification of
• Genetic influenza type & strain
reassortment o Tx
between human, Neuraminidase inhibitors
▪
swine, & avian (influenza A & B)
influenza viruses Oseltamivir,
• Infuenza B & C Zanamivir
viruses do not ▪ Viral uncoating inhibitors
exhibit antigenic (influenza A)
shift Amantadine,
Disorder Symptoms Rimantadine
Acute influenza infection Rapid onset of fever,  Rhabdoviruses
in adults malaise, myalgia, sore o Genus
throat, & nonproductive ▪ Vesiculovirus
cough
Acute influenza infection Acute disease similar to ▪ Lyssavirus (rabies &
in children that in adults but w/ rabies – like viruses)
higher fever, GI tract
symptoms (abdominal
 ▪ Plant rhabdovirus group • Seizures/convulsion
(unnamed) • Major cause of
▪ Other ungrouped death: cardiorespi
rhabdoviruses of arrest
mammals, birds, fish, & o Dx
arthropods ▪ RT-PCR (preferred
o Most important pathogen: rabies method)
virus ▪ Intracytoplasmic
o MOT: transmitted in saliva & inclusions consisting of
acquired from the bite of a rabid aggregates of viral
animal nucleocapsids (Negri
o Morphology bodies)
▪ Bullet-shaped, enveloped, ▪ Animal observation:
negative-sense, single- changes in behavior for 10
stranded RNA days
o Patho
Disease Symptoms Time Viral Immunologic
▪ Replicates in the muscle at Phase (Days) Status status
Incubation Asymptomatic 60-365 Low titer, ------
the site of the bite Phase after bite virus in
muscle
▪ Length of the IP is Prodrome Fever, nausea, 2-10 Low titer, ------
phase vomiting, loss virus in
determined by the of appetite, CNS &
headache, brain
infection site to the CNS lethargy, pain
▪ IP: 1-3 months (may be as Neurologic
at site of bite
Hydrophobia, 2-7 High titer, Detectable
short as 1 week or more Phase pharyngeal
spasms,
virus in
brain &
antibody in
serum & CNS
than a year) hyperactivity,
anxiety,
other sites

o CM depression
CNS ssx: loss of
▪ Short prodromal phase coordination,
paralysis,
• 2-10 days confusion,
delirium
• Ssx: malaise, Coma Coma, HTN,
hypoventilation,
0-14 High titer,
virus in
------

anorexia, secondary
infections,
brain &
other sites
headache, Death
cardiac arrest
-------- -------- --------- -------
photophobia, N&V, o Tx
sore throat & fever ▪No proven antiviral agent
▪ Acute neurologic phase ▪Postexposure prophylaxis
• 2-7 days is the only hope for
• SSx: nervousness, preventing overt clinical
apprehension, illness in the affected
hallucinations, & person
bizarre behavior o Local tx of the wound-washed
• Inc SNS activity: immediately w/ soap & water
lacrimation, o Immunization / vaccination
pupillary dilatation, ▪ Rabies vaccine (w/in 2
& inc salivation & weeks)
perspiration ▪ Passive immunization
• Other neuro ssx: (HRIG)
• Hydrophobia (fear o Prevention: effective control of
of water) rabies in domestic & wild animals
• Aerophobia (fear through vaccination
when feeling a
breeze)
• Painful spasm of the
throat muscle
▪ Coma
 o Requires phosphorylation (viral
kinases)
o MOA:
▪ Competition w/ deoxyGTP
for the viral DNA
polymerase
▪ Chain termination
following incorporation
o Route: P.O. , I.V.
o Clinical use: DOC for the ff
▪ HSV encephalitis
▪ Neonatal HSV infection
▪ Serious HSV/VZV infection
o ADR:
▪ Reversible renal toxicity
(crystalline nephropathy
interstitial nephritis)
 Valacyclovir
o Chemistry: L-valyl ester of
acyclovir
o Rapidly converted to acyclovir
after oral admin. Via 1st pass
enzymatic hydrolysis in the liver
& intestine
o ADR: at high doses, confusion,
hallucinations, & seizures
 Famciclovir
o Chemistry: diacetyl ester prodrug
Antivirals of 6-deoxypenciclovir
o PK: rapidly deacetylated &
oxidized by 1st pass metabolism
to penciclovir
o Spectrum: active in vitro against
HSV-1, HSV-2, VZV, EBV, & HBV
o Requires phosphorylation (viral
kinases)
o Unlike acyclovir, however,
penciclovir dose not cause chain
termination
 Docosanol
o Chemistry: saturated 22 carbon
aliphatic alcohol
o MOA: inhibits fusion between the
NON RETROVIRAL host cell plasma membrane &
viral envelope
ANTIHERPES AGENTS o Dosage: 10% cream
 Trifuridine
 Acyclovir
o Chemistry: trifluorothymidine
o Chemistry: guanosine derivative
o MOA: intracellularly by host cell
o Spectrum: HSV-1, HSV-2, VZV
enzymes, & then competes w/
(10x more potent for HSV than
thymidine triphosphate
VZV)
 Ganciclovir
 o Chemistry: acyclic guanosine
analogue
o Requires triphosphorylation
o MOA: competitively inhibits viral
DNA polymerase & causes
termination of viral DNA
elongation
o Spectrum: CMV
o PK: Poor oral BA
o Route: IV only
o Clinical Use: CMV retinitis in
immunocompromised patients
o ADR: myelosuppression (most
common)
 Valganciclovir
o Chemistry: L-valyl ester prodrug
of ganciclovir
o PK: Should be taken w/ food
o Clinical use: CMV retinitis
 Foscarnet
o Chemistry: phosphonoformic
acid; inorganic pyrophosphate
analog
o MOA: inhibits herpesvirus DNA
polymerase, RNA polymerase, &
HIV reverse transcriptase
o Not requiring activation by
phosphorylation
o Route: IV only (poor oral BA)
o C/A:
▪ End-organ CMV
▪ Ganciclovir / Acyclovir
resistant CMV
o ADRs
▪ Renal impairment
▪ Hypo / hypercalcemia
▪ Hypo / hyperphosphatemia
▪ Hypokalemia
▪ Hypomagnesemia
o DI
▪ Pentamidine →
hypocalcemia
▪ Zidovudine → anemia
 Cidofovir
o Chemistry: cytosine nucleotide
analogue
o Phosphorylation is independent
of viral enzymes
o MOA: acts both as a potent
inhibitor of and as an alternative
substrate for viral DNA
polymerase
o C/A
▪ CMV retinitis
o Route: I.V
o CI: px w/ renal insufficiency
o ADR: dose dependent proximal
tubular nephrotoxicity,
▪ Mx: prehydration using
normal saline
ANTI INFLUENZA AGENTS
 Neuraminidase Inhibitors
o Oseltamivir (PO); Zanamivir (inh);
Peramivir (IV)
o Spectrum: Influenza A & B
o Chemistry: sialic acid
o MOA: interfere w/ release of
progeny influenza A & B virus
from infected host cells, thus
halting the spread of infected
host cells
 Adamantanes
o Amantadine, Rimantadine
o MOA: block the M2 proton ion
channel of the virus particle →
inhibit uncoating of the viral RNA
o PK
▪ Amantadine is excreted
unchanged in the urine
▪ Rimantadine undergoes
extensive metabolism
o C/A
▪ Prevention of clinical
illness when initiated
before exposure
▪ Limit the duration of
clinical illness by 1-2 days
when administered as
treatment
o ADRs
▪ GIT (nausea, anorexia)
▪ CNS ( nervousness, light
headedness, difficulty in
concentrating, insomnia)
▪ Livedo reticularis
(amantadine – induced)
ANTIHEPATITIS AGENTS
 Interferon alfa
o Ex.
▪ Interferon alfa-2b: chronic
HBV & HCV infection
 ▪ Interferon alfa-2a; alfacon tx of HCV
genotype 4
– 1: chronic HCV infection
Velpatasvir NS5A inhibitor 1st once-daily
o CI: single-tablet
▪ Hepatic decompensation regimen w/
▪ Autoimmune diseases pangenotypic
activity
▪ Cardiac arrhythmias Dasabuvir NS5B Fixed-dose combi
o DI: polymerase w/ ombitasvir,
▪ Didanosine: hepatic failure inhibitor paritaprevir, &
ritonavir for yx of
▪ Zidovudine: cytopenia HCV genotype 1
o ADR: Sofosbuvir NS5B Administered in
▪ Flu-like syndrome (6 hrs polymerase combi w/ several
inhibitor other anti-HCV
after admin) medications
▪ Transient elevation of Grazoprevir NS3 / 4A Combi w/ elbasvir
hepatic enzymes (8-12 protease for tx of HCV
weeks of therapy) inhibitor genotypes 1 & 4
Paritaprevir NS3 / 4A Fixed-dose combi
 TX for Hepatitis B Infection protease w/ ombitasvir &
inhibitor ritonavir for tx of
Agent Uses / Properties HCV genotype 4
Adefovir dipivoxil Slower to suppress HBV Simeprevir NS3 / 4A 2nd gen protease
DNA levels; least likely to protease inhibitor
induce HBeAg inhibitor
seroconversion Ribavirin Guanosine Spectrum:
Entecavir Completely inhibits all (3) analog influenza A & B,
functions of HBV DNA parainfluenza,
polymerase transcription RSV,
of the negative strand paramyxoviruses,
Lamivudine Inhibits HBV DNA HCV, HIV-1
polymerase & HIV reverse
transcriptase
Telbivudine Induced greater rates of RETROVIRAL
virologic response than
either lamivudine or
adefovir in comparative
AGENTS
trials
Tenofovir disoproxil Antiretroviral agent, has a NRTIs
potent activity against
HBV; activity against  MOA: competitive inhibiton of HIV-1
lamivudine - & enecavir – reverse transcriptase
resistant hepatitis virus  Results to: premature chain
isolates
termination due to inhibition of
 Tx for Hepatitis C Infections binding w/ the incoming nucleotide
 Intracytoplasmic activation via
Agent Classification Uses / Properties phosphorylation by cellular enzymes
Daclatasvir NS5A inhibitor Combi w/
sofosbuvir for tx to the triphosphate form
of HCV  ADRs: mitochondrial toxicity
genotypes 1, 2, & o Peripheral neuropathy
3
Elbasvir NS5A inhibitor In vitro activity o Lipoatrophy
against most o Hepatic steatosis
major HCV o Pancreatitis
genotypes
Ledipasvir NS5A inhibitor Fixed-dose combi Agent Uses / Properties
w/ sofosbuvir; not Abacavir Recommended for use of
recommended pregnancy; screening for
for tx of HCV HLA-B*5701 before
genotype 2 initiation of abacavir
infection or therapy is important
genotype 3 Didanosine (ddl) Associated w/ peripheral
Ombitasvir NS5A inhibitor Fixed-dose combi distal sensory neuropathy
w/ paritaprevir & & dose- dependent
ritonavir for the pancreatitis
Emtricitabine (FTC) Recommended for use of
pregnancy; tenofovir &
emtricitabine is
recommended as pre-
exposure prophylaxis;
active agains HBV & HIV
Lamivudine (3TC) Active against HBV & HIV;
recommended for use of
pregnancy
Stavudine (d4T) Major toxicities:
peripheral neuropathy,
lactic acidosis w/ hepatic
steatosis, lipodystrophy
Tenofovir disoproxil Activity against HIV&
fumarate HBV; recommended for
use of pregnancy; serum
creatinine should be me
monitored
Tenofovir alafenamide Activity against HIV &
HBV; appears to have less
renal & bone toxicity than
tenofovir disoproxil
fumarate
Zidovudine (AZT) 1st antiretroviral agent to
be approved & has been
well studied;
recommended for use of
pregnancy; most common
AE is macrocytic anemia
& neutropenia; other AE
includes lipoatrophy,
myopathy
NNRTIs
 MOA: bind directly to HIV-1 reverse
trancriptase → resulting in allosteric
inhibition of RNA & DNA-dependent
polymerase
 PK: All NNRTI agents are substrates for
CYP3A4 & can act as
o Inducers (Nevirapine)
o Inhibitors (Delavirdine)
o Mixed inducers & inhibitors
(Efavirenz, Etravirine)
 AE: GIT disturbances & skin rashes
(SJS)
Agent Uses / Properties
Delavirdine Known teratogen; skin
rashes occurs during 1-3
weeks of therapy
Efavirenz Long t ½ (40-55 hrs);
toxicity occurs when
taken w/ high fat meal
(taken NPO); principal
toxicity involves the CNS;
recommended for use in
pregnancy (initiated after
8 weeks AOG)
Etravirine Designed to be effective
against strains of HIV that
had developed resistance
to 1st gen NNRTIs
Nevirapine Excellent oral BA (>90%);
single dose of nevirapine
(200 mg) can prevent
transmission from mother
to newborn when
administered at the onset
of labor, then 2-mg/kg
dose to the neonate w/in 3
days of delivery
Rilpivirine Must be administered w/ a
meal ( preferably high fat
or >400 kcal); dependent
on gastric acid
environment for
absorption;
recommended for use in
pregnancy
PROTEASE INHIBITORS (PI)
 MOA: prevenying post-translational
cleavage of the Gag-Pol polyprotein →
prevent the processing of viral proteins
into functional conformations →
production of immature, noninfectious
viral particles
 Pls do not need intracellular activation
 PK: All of the PIs are extensively
metabolized by
 CYP3A4 (ritonavir having the most
pronounced inhibitory effect &
saquinavir the least)
Agent Use / Properties
Atazanavir Recommended for use in
pregnancy; requires
acidic medium for
absorption & exhibits pH-
dependent aqueous
solubility
Darunavir Recommended for use in
pregnancy; co-
administered w/ ritonavir
or cobistat; contains sulfa
moiety
Fosamprenavir Prodrug of amprenavir;
contains sulfa moiety
Indinavir Requires acidic medium
for absorption; most
common AE unconjugated
hyperbilirubinemia &
nephrolithiasis; insulin
resistance is noted
Lopinavir Available only in combi w/
low-dose ritonavir as a
pharmacologic “booster”;
recommended for use in
pregnancy;
Nelfinavir Most common AEs
associated are diarrhea &
flatulence
Ritonavir Pharmacologic “booster”;
Di w/ saquinavir → QT
 prolongation, PR interval Dolutegavir Should be taken 2 hrs
prolongation before or 6 hrs after
Saquinavir Should be taken w/in 2 hrs cation-containing
after a fatty meal for antacids or laxatives,
enhanced absorption sucralfate, oral iron
Tipranavir Use for tx-experienced px supplements, oral calcium
who harbor strains supplements or buffered
resistant to other PI medications; inhibits the
agents; DI w/ ritonavir → renal organic cation
IC hemorrhage transpoter OCT, → inc
serum conc of dofetilide &
FUSION INHIBITORS metformin
Elvitegravir Requires boosting w/ an
additional drug, such as
 Enfuvirtide well as certain intestinal
o HIV attachment: binding of the transport proteins or
viral envelope glycoprotein ritonavir
complex gp160 (consisting of Raltegravir Recommended for use in
pregnancy; does not
gp120 & gp41) to CD4 + cells → interact w/ CYP450
conformational changes in gp120 system; metabolized by
glucuronidation the
that enable access to the
CYP450 system but is
chemokine receptors CCR5 or metabolized by
CXCR4 → conformational glucuronidation,
particularly UGT1A1
changes in gp120, allowing
exposure to gp41 & leading to
fusion of the viral envelope w/ the OTHER ANTIVIRAL AGENTS
host cell membrane
o MOA: binds to the gp41 subunit of Agent Use / Properties
Palivizumab Prevention of RSV
the viral envelope glycoprotein → infection in high-risk
preventing fusion of the viral & infants & children
cell membrane Imiquimod Topical tx of external
genital & perianal;
o Route: SQ (the only parenteral effective for molluscum
ARV) contagiosum
o AE
▪ Injection site reaction
▪ Eosinophilia

ENTRY INHIBITORS
 Maraviroc
o MOA: binds to the host protein
CCR5, one of tow chemokine
receptors necessary for entrance
of HIV into CD4+ cells
o Clinical use: approved for use in
combination w/ other ARV in
adult px infected only w/ CCR5-
tropic HIV-1

INTEGREASE INHIBITORS
 MOA: integrase, a viral enzyme essential
to the replication of both HIV-1 & HIV-2
 Dolutegravir, Elvitegravir, Raltegravir
 ADRs: headache & GIT effects
Agent Uses / Properties