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Human Immunodeficiency Virus (HIV

Family Retroviridae
Genus Lentiviridae
2 major strains: ➔ HIV-1 (US)
➔ HIV-2 (Africa)
Previous names: ➔ HTLV-III (Human T-cell Lymphotropic Virus)
➔ LAV (Lymphadenopathy Associated Virus
➔ ARV (AIDS-associated Retrovirus)
Mode of ➔ Sexual contact
transmission ➔ Injection/Drug use
➔ Pregnancy, Childbirth & Breast Feeding
➔ Occupational Exposure
➔ Blood Transfusion/Organ Transplant (rare)
NOT TRANSMITTED THROUGH
➔ Air or Water
➔ Saliva, Sweat, Tears or Closed-Mouth Kissing
➔ Insects or Pets
➔ Sharing Toilets, Food or Drinks
➔ HIV infects primarily T-cells by binding to CD4 and several co-receptors (CXCR4 , CCR5)
➔ The hallmark of HIV disease is a profound immunodeficiency resulting primarily from a
progressive quantitative and qualitative deficiency of the subset of T lymphocytes referred
to as helper T cells (CD4+)
72 knob-like spikes - gp 120

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HIV binding and fusion tat p14 Transactivates transcription

rev p19 Production of viral RNA
vif p23 Infectivity factor
nef p27 Unknown regulatory function
vpu p16 Maturation of viral particles
STRUCTURAL GENES
gene Structure
gag ➔ p24, p17, p15, p55
pol ➔ reverse transcriptase (p66/51), endonuclease integrase (p31)
env ➔ gp120, gp41, gp160

Virus Protein Location gene

HIV-1 ➔ gp41 ➔ envelope ➔ env
➔ gp160/120 ➔ envelope ➔ env
➔ p24 ➔ core ➔ gag
HIV-2 ➔ gp34 ➔ envelope ➔ env
➔ gp140 ➔ envelope ➔ env
➔ p26 ➔ core ➔ gag
3 MAIN STRUCTURAL GENES
GAG ➔ codes for p55 = precursor protein
Located in nucleocapsid
➔ p15 - Found in capsid
➔ p24 - Found in capsid
➔ P17 - nucleocapsid
ENV ➔ codes for gp160 = precursor protein
➔ gp120 = forms the 72 knoblike structure
➔ gp41 = spans the inner and outer membrane
POL ➔ codes for enzymes necessary for HIV replication
➔ P66
➔ P51
➔ P31
➔ P10
MAJOR HIV GENES AND THEIR PRODUCTS
GENE PROTEIN PRODUCTS FUNCTIONS
gag p17 Inner surface envelope
p24 Inner coat for nucleic acid
p9 Core-binding protein
p7 Binds to genomic RNA
env gp120 Binds to CD4 on T cells VIRAL REPLICATION(HIV)
gp41 Transmembrane protein Attachment ➔ gp120 binds to the CD4 antigen (receptor)
pol p66 Subunit of reverse transcriptase ➔ T helper cells are the main target
p51 Subunit of reverse transcriptase ◆They express high numbers of CD4
p31 Integrase

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➔ Once the RNA is released into the cytoplasm of the host cell
Entry or ➔ Mediated by binding of coreceptors ➔ The reverse transcriptase makes a DNA copy of the viral RNA
Penetration ➔ Chemokine receptors direct WBCs to the site of inflammation genome
Receptors: ➔ As the DNA is formed, reverse transcriptase degrades the RNA
➔ CXCR4 → required for entry of HIV into T lymph strand
➔ CCR5 → Entry to macrophages ➔ Complementary strand → added by the reverse transcriptase
➔ CCR2 → Entry to macrophages ➔ Ends of the resulting DNA segment are joined noncovalently
➔ Nucleoside analogues and reverse transcriptase inhibitors →
interferes w/ formation of viral DNA
➔ Resulting circular DNA → moved to the nucleus and inserted
to the host cell of chromosome (by viral integrase) th
➔ Pro-viral DNA → integrated viral DNA
Assembly phase ➔ All the newly formed protein will be gathered to form new capsid
➔ When viral production occurs, viral DNA within the nucleus is
transcribed into genomic RNA and mRNA which are transported to
the cytoplasm
➔ Translation of mRNA occurs, with production of viral proteins and
assembly of viral particles.
Additional notes from the video
➔ RNA can be synthesized from DNA (by RNA Polymerase) = Viral
Uncoating ➔ The viral nucleic acid escapes from the capsid genome RNA and mRNA
➔ Viral mRNA → translated (ribosome/cytoplasm) = viral
enzymes and structural proteins
➔ Some of the functional proteins are formed by the cleavage of the
long polyprotein by the protease
Release Phase ➔ As the virions bud from the cell membrane, host cells may be
destroyed by lysis
➔ Viral replication occurs to the greatest extent in antigen
activated T helper cells
➔ Gp 41 and gp 120 → inserted to the host cell membrane and
structural protein surround viral RNA → core → released through
budding
Clinical manifestations
Primary infection ➔ Rapid burst of viral replication (viremia)
Biosynthesis phase ➔ The pro-virus is integrated into the host's genome and is copied ➔ HIV disseminates in lymphoid organs
along with the cells DNA ➔ Acute retroviral syndrome may develop
➔ “flu-like” or IM-like symptoms
➔ 3 – 6 weeks after initial infection
Clinical latency ➔ Decrease viremia
➔ Absence of clinical symptoms
➔ Virus still in plasma (in little amount) where it causes a gradual
deterioration of immune system
AIDS ➔ Profound immunosuppression
➔ Resurgence of viremia

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➔ Life-threatening infection and malignancies

➔ About 10yrs after infection
➔ CD4 = <200/uL
TREATMENT
Nucleoside analog ➔ Interferes with the production of viral DNA for viral replication
RT inhibitor
➔ Ziduvudine (ZDV) ➔ Didanosine (ddI)
➔ Azidothymidine (AZT) ➔ Abacavir (ABC)
➔ Lamivudine (3TC) ➔ Stavudine (d4T)
Non-nucleoside ➔ Nevirapine (NVP) ➔ Efaverinz (EFV)/Efavirenz (EFV)
inhibitor ➔ Delavirdine (DLV)
Protease inhibitor ➔ Interferes with the cleavage of long polyprotein
➔ Saquinavir (SQV) ➔Nelfinavir (NFV)
➔ Indinavir (IDV) ➔Amprenavir (AMP)
➔ Ritonavir (RTV) ➔Lopinavir
HAART (Highly ➔ Multidrug regimen (2 or 3 drug classes)
Active
Antiretroviral
Therapy)
Laboratory Diagnosis of HIV Infection
Immunologic Manifestations
Methods utilized to Antibody
➔
➔ Early stage slight depression of CD4 count, few symptoms, temporary
detect Antigen
➔
➔ Window of up to 6 weeks before antibody is detected, by 6 months 95% positive
Viral nucleic acid
➔
➔ During window p24 antigen present, acute viremia and antigenemia
Virus in culture
➔
➔ Antibodies produced to all major antigens
CD4 T cell Enumeration
◆ First antibodies detected produced against gag proteins p24 and p55
➔ CD4 lymphopenia = hallmark feature of AIDS
◆ Followed by antibody to p51, gp 120 and gp41
➔ Determined every 3-6 months
◆ As disease progresses, antibody levels decreases
➔ Immune abnormalities associated with increased viral replication Methods: ➔ Manual bead assay
◆ Decrease in CD4 cells ➔ Enzyme immunoassay
◆ B cells have decreased response to antigen ➔ ELISA
◆ CD8 cells initially increase and may remain elevated ➔ Immunophenotyping (by Flow cytometry
◆ As HIV infection progresses, CD4 T cells drop resulting in immunosuppression and Immuno Specimen: Whole blood
susceptibility of patient to opportunistic infections phenotyping (Flow ➔ Incubated with a panel of fluorescent-labeled monoclonal Ab
◆ Death comes due to immunodeficiency Cytometry) ➔ RBC lysis and fixation of WBCs with paraformaldehyde
OPPORTUNISTIC INFECTIONS IN AIDS
Reporting of result:
➔ Pneumocystis jiroveci (carinii)
➔ Cryptosporidiosis
➔ Tuberculosis
➔ Kaposi’s sarcoma
REMEMBER! ➔ AIDS: CD4 = <200/uL

Ratio:
● CD4:CD8
● <1:1 → AIDS

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Detection of Ab ➔ Add antihuman-Ig with enzyme label

ELISA ➔ Standard screening method ➔ Wash
➔ antibodies detected include those directed against p24, gp120, ➔ Bound conjugate is detected after addition of substrate (colored
gp160 and gp41, detected first in infection and appear in most bands)
individuals ➔ p24 and p55 → appear first
1st generation ➔ Detects HIV-1 only ➔ Gp31, gp41, gp120, gp160 → remain throughout all disease
ELISA ➔ Color development is directly proportional to Px Ab stages

Interpretation of Result
Negative no colored bands
Positive at least 2 of the ff.: p24, gp41, gp120/gp160
(CDC)
at least 3 of the ff.: p24, p31, gp41, gp120/160

➔
2nd generation ➔ Genetically engineered (purified Ag from HIV-1 and HIV-2)
ELISA
3rd generation ➔ Sandwich technique
ELISA
4th generation ➔ EIA or IFA – detects HIV-1, HIV-2, p24 Ag
ELISA
Confirmatory Tests
Western Blot ➔ 1st method based on the principle of PAGE using HIV lysate
Procedure:
➔ Px serum → react with Antigen in nitrocellulose strip
➔ wash (remove unbound Ab)

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Indeterminate results are those samples that produce bands but not enough to be positive, Polymerase Chain Reaction (PCR)
may be due to the following: ➔looks for HIV DNA in the WBC’s of a person
1. prior blood transfusions, even with non-HIV-1 infected blood ➔amplifies tiny quantities of the HIV DNA present, each cycle of PCR results in doubling of
2. prior or current infection with syphilis the DNA sequences present
3. prior or current infection with malaria ➔the DNA is detected by using radioactive or biotinylated probes
4. autoimmune diseases ➔once DNA is amplified it is placed on nitrocellulose paper and allowed to react with a
5. infection with other human retroviruses radio-labeled probe, a single stranded DNA fragment unique to HIV, which will hybridize
6. second or subsequent pregnancies in women with the patient’s HIV DNA if present
● run an alternate HIV confirmatory assay ➔radioactivity is determined
Detection of p24 HIV antigen Virus isolation
➔ p24 antigen only present for short time, disappears when antibody to p24 appears ➔definitive diagnosis of HIV
➔ anti-HIV-1 bound to membrane, incubated with patient serum, second anti-HIV-1 antibody ➔best sample is peripheral blood, but can use CSF, saliva, cervical secretions, semen,
attached to enzyme label is added (sandwich technique), color change occurs tears or material from organ biopsy
➔ optical density measured, standard curve prepared to quantitate results ➔cell growth in culture is stimulated, amplifies number of cells releasing virus
➔ positive confirmed by neutralizing reaction, pre-incubate patient sample with anti-HIV, ➔cultures incubated one month, infection confirmed by detecting reverse transcriptase or
retest, if p24 present immune complexes form preventing binding to HIV antibody on p24 antigen in supernatant
membrane added Viral Load Tests
Neutralization Assay ➔ viral load or viral burden is the quantity of HIV-RNA that is in the blood
➔ measures the amount of HIV-RNA in one milliliter of blood
➔take 2 measurements 2-3 weeks apart to determine baseline
➔repeat every 3-6 months in conjunction with CD4 counts to monitor viral load and T-cell
count
➔repeat 4-6 weeks after starting or changing antiretroviral therapy to determine effect on
viral load
Testing of neonates
➔difficult due to presence of maternal IgG antibodies
➔use tests to detect IgM or IgA antibodies, IgM lacks sensitivity, IgA more promising
➔ measurement of p24 antigen
➔PCR testing maybe helpful but still not detecting antigen soon enough: 38 days to 6
Detection of p24 HIV antigen months to be positive
➔ test not recommended for routine screening as appearance and rate of rise are
unpredictable
➔ sensitivity lower than ELISA
➔ most useful for the following
◆ early infection suspected in seronegative patient
◆ Newborn
◆ CSF
◆ monitoring disease progress
Indirect Immunofluorescence Assay
➔ can be used to detect both virus and antibody to it
➔ antibody detected by testing patient serum against antigen applied to a slide, incubated,
washed and a fluorescent antibody added
➔ virus is detected by fixing patient cells to slide, incubating with antibody

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Agents of Respiratory Infections

Influenza virus Parainfluenza viruses Respiratory Syncytial Adeno viruses Rhino viruses Coronavirus
Virus (RSV)
family Orthomyxoviridae Paramyxoviridae Paramyxoviridae Adenoviridae Picornaviridae Coronaviridae
type ss-RNA ss-RNA ss-RNA ds-DNA ss-RNA ss-RNA
coating Enveloped Enveloped Enveloped Naked naked Enveloped
Replication nucleus cytoplasm cytoplasm nucleus cytoplasm cytoplasm
shape helical helical helical icosahedral helical helical
Distinct Most common cause of ordinary Major cause of respiratory ● Affects the cells lining Most common serotypes: ● Causes common colds Has distinctive
characteristic flu disease in young children the respiratory tract 1-8, 11, 21, 35, 37, 40 ● closely related to enteric club-shaped
● Upper and respiratory viruses projection on their
diseases in infants and ● Can activate surfaces
young children inflammatory mediators
●
Cell lines ● Primary monkey kidney ● pMK ● HEp2 cells (form large ● Human embryonic human diploid fibroblast
● MDCK cells with trypsin ● LLC-MK2 cells multinucleated cells) kidney
added ● pMK cells ● Continuous epithelial
● human diploid fetal cells cell lines
● Graham 293
transformed cell lines
surface Hemagglutinin (H) or (HA) H-N antigens (Hemagglutinin
antigens ➔Determines infectivity because Neuraminidase)
it can attach to host sialic ➔Gives the viruses specificity
acid receptors which are
present on the surfaces of F antigen (Fusion antigen)
RBCs. ➔.Responsible for the fusion
➔When this happens, it will of virus to cell and fusion
cause hemagglutination of infected cell to infected
reactions which agglutinates cell.
erythrocytes.
Neuraminidase (N) or (NA)
➔helps disperse the budding
viruses.
➔May activate the
hemagglutination
Clinical ➔Rarely cause viremia ➔Major cause of respiratory ➔Cause major ➔Adenoviruses types 1
Infection because they are mostly disease in young children nosocomial outbreaks in to 7 and type 21
respiratory pathogens Type I and II parainfluenza crowded nursery ◆Cause localized
virus respiratory outbreaks
➔ May cause the most ➔
serious illness in children
ages 2-4 years of age
Type III
➔Causes bronchitis and
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MOT ● Aerosols
● Inhalation of respiratory
droplets
● Contact with fomites
Signs and ➔body malaise (muscle
Symptoms weakness)
➔myalgia (muscle pain)
➔Fever
➔production of nonproductive
cough
Lab Dx ➔Nasopharyngeal swabs,
washes of aspirates
➔Specimen should be taken
early in the disease state
➔Specimen should never be
frozen
Methods of ➔EIA (Enzyme Immunoassay)
identification ➔Hemagglutination inhibition
➔Complement fixation
➔Direct immunofluorescent assay
➔Cell lines
◆Viruses also grow in
amniotic cavity of
embryonated chicken eggs
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viral pneumonia in infants
➔Croup = Parainfluenza
infection of the larynx and
other respiratory
structures that occur in
children
◆ characterize by stridor
(whizzing sound) due to
swelling of respiratory
structures that produces
narrow airways
◆there’s also a “barking
cough”
➔ aerosols by respiratory Direct or indirect contact ● aerosols, fomites, ➔ Hand contact ➔ Inhalation of droplets
secretions and by contact with nasal or oral fecal-oral route between persons or aerosols
➔ Coughing or sneezing secretions from infected ● Contact with respiratory ➔ Through fomites ➔ Contact with
➔ Close personal contact persons or common secretions from an ➔ Oral or aerosol contaminated
➔ Contact with a surface on which viruses infected person transmission (rare surfaces
contaminated object have been deposited ● Contact with a and dependent on ➔ Fecal-Oral
➔ contaminated object viral particles
➔ ● Inhalation of aerosols concentration in the
● Ingestion of droplets)
contaminated water
➔ Colds ➔profuse watery ➔resembles rhino virus
➔ Pharyngitis discharge infection but with more
➔ Tonsilitis ➔nasal congestion nasal
➔ Fever ➔Headache ➔discharges and malaise
➔ Cough ➔sore throat ➔
➔ tender lymph nodes ➔Cough
➔Bronchitis
➔asthma
➔Nasopharyngeal ➔ Nasopharyngeal swabs
secretions and washes
➔Specimens must be
kept on ice but not
frozen
➔IFA (immunoFluorescent ➔IFA (immunoFluorescent ➔ Hemagglutination with ➔ IFA (immune ➔Fragile and difficult to
Assay) Assay) monkey and rat RBCs Fluorescent Assay) culture
➔EIA (Enzyme ➔EIA (Enzyme ➔ Penton fiber length ➔ EIA (Enzyme ➔Serum neutralization
Immunoassay) Immunoassay) ➔ Content of their DNA Immunoassay) ➔Immunofluorescent Ab
➔Hemadsorption ➔ ➔ Oncogenicity ➔ Complement fixation Testing (IFAT)
➔Neutralization ➔ Incubate specimen at ➔ EIA
pH 3.0 with lipid solvent ➔ Complement fixation
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Target cells Ciliated epithelial cells
Complications primary
➔viral pneumonia
secondary
➔bacterial pneumonia
◆ Staphylococcus aureus
◆ Streptococcus
pneumoniae
Distribution ➔worldwide (pandemic)
➔Isolated during:
➔November to April in Northern
hemisphere countries
➔May to October in Southern
hemisphere
➔Endemic in the tropics
Other infos
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nasal epithelial cell
➔Rhinitis Swimming pool
➔Pharyngitis associated
➔Laryngotracheitis pharyngoconjunctivitis
➔Tracheobronchitis ➔Disease caused by type
➔Bronchiolitis 1 to 7 & 21
➔viral pneumonia ◆fever, pharyngitis,
headache, cervical
lymphadenopathy,
diarrhea, rash
➔ Conjunctivitis
➔pharyngitis
➔ worldwide (pandemic)
here are 10 structural
proteins, the most
important types are:
➔ Hexone
➔ Pentones
CPE detected: swollen
cells in grape-like
structures (clusters)
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SUMMARY OF RESPIRATORY VIRUSES

➔ Respiratory viruses cause illnesses that affect them. nose, throat and breathing ◆ Damage to your skin by the organism.
passages including the lungs ◆Reaction to a toxin the virus produces.
➔ These viruses commonly result in mild cold or flu-like symptoms in most people,
except in those with risk factors, the elderly and the very young.
➔ Common respiratory viruses include:

Virus Viral Nucleic Acid

Adenovirus dsDNA
Coronaviruses ssRNA
Influenza (Flu) ssRNA
Parainfluenza ssRNA
Parvovirus B19 ssDNA
Respiratory Syncytial Virus (RSV) ssRNA
Rhinovirus (Common Cold) ssRNA
Parvovirus B19 Mode of Transmission
➔ Respiratory secretions such as saliva, sputum, or nasal mucus
➔ Blood or blood products
➔ Vertical transmission

AGENTS OF EXANTHEMS
Exanthem ➔ is a medical term that describes a widespread rash.
➔ A viral exanthem rash accompanies a viral infection.
➔ Usually in the largest organ (skin)
➔ It causes spots, bumps or blotches on your skin.
➔ A person might experience additional viral symptoms such as
fever, fatigue and body aches.
➔ A rash that appears abruptly and affects several areas of the skin
simultaneously
➔ Greek origin "exanthema" which means "a breaking out"
➔ Commonly described as "morbilliform" which means "composed
of erythematous macules and papules that resemble a measles
rash
➔ MEASLES → 1 st disease (Rubeola virus)
➔ RUBELLA → 3 rd disease (German measles)
➔ PARVOVIRUS B19 → 5 th disease (Erythema infectiosum)
➔ HHV-6 → 6 th disease (Roseola infantum / exanthema subitum)
➔ VARICELLA → chickenpox → shingles (VZV)
Enanthem ➔ found within mucous membranes (mouth → cold sores or those
specific types of sores that are usually found within the mouth)
Morbilliform ➔ flat pink or red spots that may merge or become raised as the
rash spreads
causes viral ➔ A virus can cause a viral exanthem rash in one of three ways:
exanthem rash? ◆The rash is your body’s immune response to the virus
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AGENTS OF EXANTHEMS
Mumps or Parotitis Measles Rubella Hand, Foot, and Mouth Human Parvovirus B19 Varicella
Disease (HFMD) (B19V)
Important ➔Related to parainfluenza ➔ “Measles” or “Hard Measles” ➔ “German Measles” or “3-day ➔ Can also be caused by Causes fifth disease ➔is an acute
informations viruses ➔most common viral disease of Measles” Enterovirus Type 71 infectious disease
children
➔ highly contagious
Virus Rubeola virus Coxsackie virus type A5, Parvo virus varicella-zoster virus
10, and 16 Erythroparvovirus Herpes virus group
Parvoviridae
type ss-RNA ss-RNA ss-RNA ss-RNA ss-DNA ds-DNA
coating Enveloped Enveloped Naked Naked
Mode of ➔droplet spread of infected ➔ aerosols ➔droplet spread ➔spread by fomites and ➔respiratory secretions, ➔person-to-person
Transmission saliva ➔capable of passing/crossing fecal-oral route ◆Saliva by direct contact
the placenta ◆Sputum or through the air.
◆nasal mucus
➔infected person coughs or
sneezes
Distribution ➔worldwide ➔ worldwide
Other ➔ Prevented using vaccine ➔Measles infection causes ➔c ➔Signs and Symptoms: ➔Resistant to lipid solvents
information ➔MMR = Measles Mumps generalized type of infection ◆Malaise but sensitive to extreme pH
Rubella characterized by ◆Headache and heat
➔ Acute, self-limiting maculopapular rash ◆abdominal pain ➔composed of a group of
systemic illness that is (differentiate Measles from ➔Parts of the body small DNA viruses with a
characterized by unilateral other infections) affected: linear single-stranded
and bilateral swelling of ◆2-3 days ◆Tongue DNA genome
salivary glands (parotid ◆Remains bright red for about ◆buccal cavity ➔ Mild, febrile illness with
glands) 4 days ◆soft palate lymphopenia and
➔ Other organs affected: ◆For another 3 days it ◆characterized by the transient rash that lasts
◆ Testes becomes brownish appearance of only a couple of days
◆ Ovaries ➔ The virus circulate maculopapular rash on ➔Aplastic anemia (in cases
◆ pancreas. ◆B and T cells the hands, feet of hemolytic anemia)
➔ The primary infection of ◆monocytes ◆and buttocks of patient ➔During period of
the ductal epithelial cells ➔Target cells: initial target cells infection:
found in the salivary glands are the mucosal cells of ◆erythropoiesis stops
result in cell death and respiratory tract, later on, it can which leads to aplastic
inflammation. replicate in the local lymph anemia in patients that
➔ Cell death can lead to nodes may require transfusion
permanent impairment of ➔ ➔ There is high risk of fetal
testes and ovaries. death if B19 infects
➔Influenza virus and pregnant women
enteroviruses may also ➔Portal of entry: through the

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cause this syndrome. respiratory tract

H-N antigens (Hemagglutinin
Neuraminidase)
➔Gives the viruses specificity
F antigen (Fusion antigen)
➔.Responsible for the fusion
of virus to cell and fusion
of infected cell to infected
cell.
Complications ➔Orchitis = inflammation of ➔ otitis, pneumonia, ➔ spontaneous abortions
testis encephalitis, if it recurs
➔Oophoritis = inflammation produces progressive highly
of ovaries fatal encephalitis

Specimen infected saliva and swabs secretion from nasopharynx o Nasopharyngeal secretions virus can be isolated from
or recovered from urine and conjunctiva o Nasopharyngeal tissues of mouth swabs and swabs
(severe cases) infected infants of bullae
Clinical ➔Must be handled carefully ➔The disease is a mild febrile ➔ In cases of verimic phase
Manifestation (virus is fragile) illness accompanied by an erythroid precursors are
erythematous lost and then reticulocytes
maculopapular discrete disappear.
rash with post- auricular ➔ There is decrease in
and suboccipital lymphocytes, neutrophils,
lymphadenopathy and platelets
➔ There is no rash on the ➔ within about a week, the
palms and soles patients return to normal
Methods of ➔ Direct examination ➔ Direct examination ➔ Direct examination ➔serum neutralization ➔ Viral detection: DNA
Examination ◆IFA ◆IFA ◆IFA probes
◆IDA ◆IDA ◆EIA
➔ Viral isolation: amniotic ➔ Viral isolation:
fluid/cavity of embryonated ◆Serum neutralization,
chicken eggs ◆EI
➔Paired sera taken as little as ◆ IFA
4-5 days apart can be
diagnostically demonstrated
by four-fold rise in titer
when tested by EIA or
Hemagglutination
inhibition
Cell lines ➔ pMK cell ➔primary human kidney cells ➔ ➔pMK cells and human ➔
➔human embryonic causing formation of distinctive diploid fibroblast cells
➔kidney cells spindle-shaped cells or multi-
nucleated cells
Vaccine MMR = Measles Mumps children and young women
Rubella) (before they become sexually
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active)

Diagnosis Of Viral Exanthems According To Age Group And Diagnostic Tests

Age Group Diagnosis Diagnostic Tests
Children Roseola infantum None
Hand, Foot, and Mouth Disease Specimen from oropharynx, skin vesicles, stool or blood for viral culture

Laterothoracic exanthem None

Erythema infectiosum Parvovirus B19 serology
Gianotti-Crosti syndrome None, but take into account hepatitis B serology and liver function tests
Children and Varicella VZV PCR
adults Measles Measles serology and PCR
Rubella Rubella serology
Adults Pityriasis rosea Biopsy helpful in atypical cases
PPGSS Parvovirus serology
Shingles Herpes zoster PCR

Types of Specimens Used for Testing

Oropharyngeal swab Stool
Specimen from skin vesicles Blood
Skin swab Nasopharyngeal swab

SEXUALLT TRANSMITTED DISEASE

Types of Specimens Used for Testing
Frequent
Human papilloma virus circular dsDNA
Herpes simplex virus type 2 linear dsDNA
Hepatitis B virus circular dsDNA
linear dsDNA
Poxlike virus large dsDNA
Cytomegalo virus large dsDNA

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SEXUALLY TRANSMITTED DISEASES

HUMAN PAPILLOMA Epidermodysplasia
VIRUS (HPV) Verruciformis
➔It is considered one of
➔Usually rare
the most common ➔Chronic cutaneous
sexually transmitted infection that can start as
infections (STIs) flat warts
worldwide ➔skin cancer
Mode of ➔Sexual Contact ➔ SEXUAL CONTACT
Acquisition ◆Sexual contact,
including vaginal,
anal, and oral sex
➔ ➔contact with infected bodily fluids NON-SEXUAL CONTACT NON-SEXUAL CONTACT ➔Through bodily fluids such as
Pathophysiolog ➔Skin and genital warts ➔Infections on Mucous
y exhibit a tissue tropism membrane (Upper
for either cutaneous respiratory
or mucosal tissue tract)respiratory
➔Many are papillomatosis (voice
asymptomatic changes & high pitch
➔infections are more breath sounds if larynx is
likely for infected)
immunocompromised. ➔Anal & genital
infections (numerous
warts)
➔Condylomata
acuminata
◆Skin-colored
◆range in size & have a ➔Primary infection is often
cauliflower-like look
to their surface.
➔Can cause itching,
burning, local pain or
bleeding.
HERPES SIMPLEX VIRUS TYPE 2 HEPATITIS B VIRUS (HBV) POXLIKE VIRUS CYTOMEGALOVIRUS
(HSV-2)
➔causes genital herpes (no cure) ➔ ➔MOLLUSCUM ➔
CONTAGIOSUM
VIRUS (MCV)
SEXUAL CONTACT SEXUAL CONTACT SEXUAL CONTACT
➔Sexual contact, including vaginal, ➔Bodily fluids such as ➔Transmitted through ➔Through bodily fluids such as
anal, and oral sex. semen, and vaginal skin-to-skin during semen
NON-SEXUAL CONTACT secretion intercourse NON-SEXUAL CONTACT
or by transmission from mother to ➔Transmitted through ➔Through contact with blood and saliva
child during childbirth blood, and sharing of contaminated objects or ➔Transmitted from mother to
➔ needles or other injection surfaces child during pregnancy or
➔ equipment, and from childbirth
mother to child during ➔Through blood transfusions or
childbirth (Vertical) organ transplants
Blisters ➔ ➔Chronic, localized skin ➔Permanent in a person's body
➔Affects lower part of the body infection with ➔Most infections > no signs or
(below the waist: genitals). vesicular-shaped symptom
➔may have very mild symptoms papules caused by ➔Acquired Infection
or no symptoms. MCV. ➔Congenital Infection
➔Affects sensory neurons and ➔Incubation period: ACQUIRED INFECTION
travel up the axon to cell body to 2-6 weeks ➔usually ASYMPTOMATIC
start a latent cycle. Dome-shaped papules ➔self-limited
➔The neurons in genitalia have cell ➔Distribution: ➔persist as a chronic or latent
bodies found in the sacral ganglia Anywhere on the skin ➔infection
where the virus settles for life. except palms and ➔incubation period: 3 to 12
Recurrent episodes are less soles weeks
severe ➔It causes round, firm, ➔hepatitis can occur as well
Oral Herpes painless bumps ACQUIRED INFECTION
ranging in size from a SYMPTOMS:
asymptomatic. pinhead to a pencil ➔Sore throat
If symptomatic: eraser. If the bumps ➔Fever
➔usually affects children. are scratched or ➔Swollen glands
➔cause lesions ( clusters of small, injured, the infection ➔chills
painful, fluidfilled blisters), fever, can spread to nearby ➔profound malaise
enlarged lymph nodes skin. ➔myalgia
➔The lesions will ooze and ulcerate ➔ ➔lymphadenopathy
and heal after few weeks ➔ ➔Splenomegaly
CONGENITAL INFECTION
Pharyngitis: ➔high incidence of neurologic
➔older children and adults. symptoms
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Symptomatic ➔neuromuscular disorders

➔Reactivation causes blisters at ➔jaundice
vermillion border ➔hepatomegaly
Genital Herpes ➔splenomegaly
➔Primary infection causes uclers ➔Petechiae – the most
and pustules common
In females it infects: ➔clinical sign, seen in about
➔labia majora and minora 50% of CMV-infected infants
➔mons pubis CYTOMEGALIC INCLUSION
➔vaginal mucosa DISEASE (CID)
➔cervix ➔If severe, can cause
In males: permanent neurologic
➔in shaft of penis sequelae:
Symptomatic reactivation: ➔Intracranial calcifications
➔ fewer blisters that heals after a ➔Microencephaly
week. ➔Motor dysfunction
➔People who are severely ➔Mental retardation
immunocompromised ➔Psychomotor
➔such as those with advanced ➔Deafness
human immunodeficiency virus ➔Vision defects impairment
(HIV), HSV-2 can cause rare but
serious complications like aseptic
meningitis (inflammation of the
lining of the brain).
HPV Types 6 & 11 ➔ ➔ ➔ ➔
➔are responsible for the majority of laryngeal
papillomatosis & genital warts. (Considered low risk
because they don't tend to progress beyond warts.)
High risk HPV Types:
➔Type 16 & 18 (have high risk of transforming into
caancers of cervix, vagina, vulva, penis, anus, or
upper respiratory tract over one or two decades
Laboratory ➔ Detection of HPV DNA or RNA ➔Detection of HSV DNA or Viral ➔ ➔Detection of Viral DNA ➔Detection of CMV DNA or
Diagnosis Antigen or Viral Antigen Viral Antigen
Specimen type ➔ Genital Swab ➔Genital Swab ➔Serum ➔Lesion Swab ➔Blood
➔ Cervical Scrapes ➔Vesicular FluidsCerebrospinal ➔Plasma ➔Blood ➔Urine
➔ Biopsy Specimen Fluid ➔ ➔Saliva ➔Tissue Biopsy Specimens
➔ ➔Scabs
Laboratory ➔ Polymerase Chain Reaction (PCR) ➔Polymerase Chain Reaction ➔Polymerase Chain ➔Polymerase Chain ➔Polymerase Chain Reaction
Tests ➔ Nucleic Acid Neutralization (PCR) Reaction (PCR) Reaction (PCR) (PCR)
➔ DNA sequencing ➔Cell Culture ➔Enzyme Immunoassay ➔Cell Culture ➔Cell Culture
➔Immunoflourescence Assay (EIA) ➔Electron Microscopy ➔Immunofluorescence Assay
➔Liver function tests

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Additional notes
Specimen type ➔ Genital Swab
➔ Cervical Scrapes
➔ Biopsy Specimen

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