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Medical Virology Part 2

classification by the WHO in terms of the type of diseases they cause

Medical Virology Part 2 1

 Anelloviridae

newly discovered virus

transmitted thru blood transfusion

no direct connection between the disease and the virus yet

DNA Virus
family names end in viridae (e.g. Parvoviridae)

genus names end in virus (e.g. Parvovirus)

Adenovirus
non-enveloped, icosahedral

dsDNA genome

Medical Virology Part 2 2

 the name is derived from where it was first discovered

source = adenoids

lymphatic tissues that are found between the back of the nose and the
throat

where the virus was first discovered and isolated

Family = Adenoviridae

Attacks the intestine, conjunctiva, pharynx

CM = gastroenteritis, conjunctivitis, pharyngitis

1st leading cause of URTI

commonly causing respiratory illnesses

4th leading cause of childhood viral gastroenteritis

the virus can attack the GIT

Pink eye conjunctivitis (epidemic)

Sore eyes etiology

virus

bacteria

course of the dx = 1-2 weeks

Sx

flu-like sx, URTI, difficulty of breathing, fever (analgesic, antipyretic),

gastroenteritis (address diarrhea = dehydration, electrolyte balance)

no vaccine yet

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 📌 Treatment

no specific treatment for viruses

limited antiviral drugs

symptomatic management and treatment of viral diseases

viruses are usually self-limiting

viruses usually go away w/o treatment because we have our immune

system to fight it

do not want complications in pediatrics or geriatrics →

hospitalization but still symptomatic tx

don’t give aspirin for viral infections

Reye’s Syndrome

causes damage to the CNS and kidney due to aspirin given

to a px w/ viral infection

Parvovirus
Family = Parvoviridae

Simplest DNA virus

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 CM = erythema infectiosum

aka 5th disease

📌 diseases that have characteristic rashes

1st disease = measles

Rubeola

2nd disease = Scarlet fever

3rd disease = German measles

Rubella

4th disease = Filatow-Duke’s Disease

aka SSSS — Scalded Skin Staphylococcal Syndrome

5th disease = Erythema infectiosum

6th disease = Roseola

S/Sx

Children — slapped-cheek appearance

virus is common in children

Adults — arthritis (joint pain)

Complications

Transient aplastic anemia → resulting from the activity of the virus on the
bone marrow

Mode of Transmission (MOT)

respiratory droplets → common

sneezes, saliva, mucus

blood → not common

the illness is contagious a week before rashes appear

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 if rashes appear = not contagious

specific viral CA = Parvovirus B19

Prophylaxis

Parvovirus B19 vaccine

no management, the disease usually goes away on its own

fever → antipyretic

Papovavirus
Family = Papovaviridae

affecting humans

Pa for papillomavirus

Po for polyomavirus

non-human pathogen (SV40)

Va for vacuolating

Simean Vacuolating 40 (SV40) → affects monkeys

Human Papilloma Virus

outgrowth of warts

can cause cervical cancer

Medical Virology Part 2 6

 Cervical Cancer

cauliflower-like skin growth

diagnose by PAP smear

check if there are abnormal cells

Tx:

Laser cauterization → if superficial warts

Silver nitrate (too much staining)

Podophyllin (podophyllum resin)

Liquid N

freeze para mabilis matanggal ung wart

Cashew ointment (Dewart cream®)

herbal preparation

from cashew extract

Medical Virology Part 2 7

 120 HPV types

highlighted are severe and cause warts

Epidermodysplasia verruciformis

an autosomal recessive genetic pattern of inheritance

outgrowth of warts throughout the whole body

if sa throat nagkaroon ng outgrowth of warts (e.g. Laryngeal papillomatosis) =

obstruction in the airway

tx = surgical removal

Genital cancer

HPV vaccine for teenagers

Prophylaxis = Gardasil® → prevent cervical cancer and genital warts

Medical Virology Part 2 8

 11-12 yrs old up to 26 yrs old

2 shots (6-12 mos. apart)

Poxvirus
Family = Poxviridae

3 categories

Orthopox

1° member = Monkey Pox

Sx = blisters, rashes

pimple-like blisters that can spread throughout the body

most common origination site is in Western Africa

from monkey breeding/testing facilities

no tx but currently available smallpox tx can be used against monkeypox

cuz they are similar

Smallpox

aka Variola (1970s) → eradicated using vaccine

the first disease that was declared as totally eradicated by the WHO

Cowpox

vaccinia

Parapox

Milker’s virus (cattle)

ORF virus (sheep) → occupational disease of sheep handlers

e.g. Contagious pustular dermatitis or sore mouth

normally sa animals but can infect humans

can be healed in 2-3 weeks w/o tx

symptomatic management

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 Miscellaneous (Unclassified)

1° member = Molluscum contagiosum (MC) viral infection

Common among children, seen in Px with AIDS

Sx — benign Pustular dermatitis

dimpled lesions found in the genitalia

affects diff breeds of monkeys (primates)

Yabapox

Tanapox

Herpes virus
Family = Herpesviridae

Characteristic

Latent phase → asymptomatic conditions (neurons and ganglia)

Medical Virology Part 2 10

 infected px → virus can be migrating in the neurons and neuroglia

Cytopathic effects

w symptoms

kills/destroys host cells

transform normal cells into giant cells known as syncytial cells

Controlled by the cellular portion of the Immune System

Cellular — T-cell mediated

CD4 → helper T-cell

Cytotoxic → killer T-cell

Humoral — B-cell mediated

can go away w/o tx

Classes:

Alpha-Herpes

HSV-1, HSV-2, VZV

Beta-Herpes

CMV (cytomegalovirus)

Gamma-Herpes

EBV (Epstein Barr virus), HSV-6

CM of HSV-1 and HSV-2

Gingivostomatitis

inflammation of the gums and mouth

Herpetic keratitis → blindness

conjunctiva

Encephalitis → treatable

inflammation of the brain

meningitis or encephalitis can be caused by either bacteria or virus

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 the moment this is discovered, px is given empiric Acyclovir

empiric

first medication given kahit di pa narurule out kung ano ang

cause

given via IV

dose = 10mg/kg

Tx = Acyclovir — guanosine-derivative

CM of Varicella Zoster Virus (VZV)

chicken pox

highly contagious especially pag pagaling na

Sx — Water-filled vesicles

Complication = Reye’s syndrome

don’t give aspirin when it is a viral infection cuz it will cause liver and brain
damage

Reinfection = Shingles → Herpes Zoster virus

Sx — isolated lesions, painful (affecting neurons)

2nd chickenpox infection if immunocompromised

normally we develop long-term immunity to chicken pox

no specific tx except for:

fever medications

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 cream for peklat

Prophylaxis

Chickenpox vaccine

CM of Cytomegalovirus (CMV)

CMV retinitis → blindness

mononucleosis

congenital condition

Congenital diseases (ToRCHeS) → can cross the placenta

To — Toxoplasmosis

R — Rubella

C — Cytomegalovirus

He — Herpes/HIV/Hepatitis B

S — Syphilis

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 the virus can infect people of all ages but pinakasevere ung manifestation
niya sa unborn baby

MOT = bodily fluids

saliva, mucus, tears, urine, breast milk, sexual contact

if the person is healthy, has no symptoms, and normally goes away on its own

if symptoms are present (especially in children)

Tx = Valganciclovir

pro-drug

metabolized in the body to Ganciclovir

CM of Epstein Barr Virus (EBV)

discovered by Michael Epstein & Yvonne Barr

Infectious mononucleosis

aka kissing disease

infection is spread via saliva

kissing/sharing of food

Common among the elite

teenagers and adults who go to the party

ID test = Monospot test

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 normally di na kasi nawawala naman sya

Sx = flu-like sx, tonsillitis (sore throat)

no specific tx

tx = drinking lots of fluids, rest

OTC analgesic and antipyretic if may fever

CM of HSV-6

6th disease

aka Infantum subitum or Roseola infantum

Rose rash of infants

non-pruritic rashes

no tx except for supportive care, rest, maintenance of fluid intake, antipyretic

(acetaminophen, ibuprofen) cuz di naman makati ung rashes

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 Hepatitis Virus
Hepa DNA virus or Hepa RNA virus

the main Sx is damage to the liver

Hepatitis D is the most severe

accounts for 15-25% of liver cancer

Hepatitis A > a picornavirus, a small ssRNA virus

Hepatitis B > a hepadnavirus family of dsDNA viruses

Hepatitis C > a flavivirus, a ssRNA virus

> aka Delta agent > a circular RNA that is more similar to a plant viroid
Hepatitis D
than a complete virus.

Hepatitis E > RNA virus, is similar to a calicivirus.

Hepatitis F > a togavirus, dsDNA virus

> a flavivirus — from mosquito > unclear connection to humans > “Orphan
Hepatitis G
Virus”

acute/chronic hepatitis

acute = short-term

Hepa A and E — food and water-borne

normally nawawala

chronic = long-term

blood-borne hepatitis

stays in the body, sometimes the rest of your life

rapid onset of jaundice

cuz of the increase in bilirubin, alanine transaminase (ALT), aspartate

aminotransferase (AST), alkaline phosphatase

liver enzymes go to the blood cuz the liver is damaged, making the blood
yellow in color

Hepa A and E (enteric form)

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 aka food and water-borne hepatitis

contaminated food and water

enteric = GIT

Sx = yellowish skin color → sign of liver damage

Infectious Hepatitis

aka blood-borne hepatitis

Hepa B, C, D

Hepa C — aka Non-A and Non-B hepatitis

Hepa B

Silent killer

no sx at early stages

sx appear at late stages

liver cancer

Px is asymptomatic at the early stages of the disease

but if px experiences sx (abdominal pain/distention), it is already late for the

management to be effective

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 “Bad hepatitis” → present in all body fluids

Dane particle = mature Hepa B virus

Diagnosis:

Liver Function test (ALT, AST, alkaline phosphatase, bilirubin)

check the presence of liver enzymes

Serological Tests vv

Serological Tests

important for Hepa B → early diagnosis to prevent complications

test involving serum involving antigen-antibody interaction (Ag-Ab)

vaccinated px (Hepa B vaccine) → #2 will be detected

Anti-Hepa B surface antigen

#3 — Hepa B core antigen

early stage of the disease = not detected or no implication

if detected = marami na virus in the blood

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 #4 — Anti-HBcAg IgM

early infection and the virus is actively dividing

#4 — Anti-HBcAg IgG

matagal na yung virus sa katawan ng px

Hepa D

only RNA-containing virus

Viroids — a virus-like organism that does not have a protein coat and contains
only NA

Can never cause a disease of its own → need a pre-requisite

It needs to form a complex with the Hepa B virus

Px must have Hepa B first before producing Hepa D

Complex B and D → more severe than B alone

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 Tx for Hepa = interferons (INF)

alpha, beta, gamma

RNA Virus

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 (+) sense = readily translated

(-) sense = has to be converted into its (+) form before translation

(+) Sense RNA Virus

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 Picornaviridae
a. Enterovirus

entry = mouth (oral cavity)

Settle in the intestine

1° target site = Payer’s patches

aggregates of lymphatic tissues in the small intestines — ileum

Poliovirus

Clinical manifestations:

Aseptic meningitis

aseptic → CNS is sterile

Mild febrile condition

mild fever

Paralytic poliomyelitis

The virus affects postganglionic and preganglionic fibers of the

sacral portion of the spinal cord

paralyzed body

MOT

oral

contaminated food/water

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 feces of infected px mixed with water → improper sewage →
spread infection

vaccine works by preventing the infected px to contribute to the

spread of the virus

Prophylaxis

Salk (IM)

component of the killed virus

aka IPV (Inactivated Polio Vaccine)

developed by Jonas Salk in 1952

IM → 3 doses

more expensive but more effective

ito nalang yung available na polio vaccine sa US (di na available

ang Sabin)

Sabin (po)

aka OPV (Oral Polio Vaccine)

po → 6 doses

live-attenuated virus

buhay but mahina

Patak Polio vaccine

the aim is to achieve herd immunity — especially in

developing countries like the Philippines

mass immunization

when enough people are immune to a disease, the disease

can’t spread, protecting those that are not
vaccinated/immune (mga di pa pede mavaccinate like
babies

less effective

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 b. Rhinovirus

one of the most common cold viruses — 113 serotypes

cough and colds that are viral in origin

no tx, but 1-2 days okay na

Coronaviridae
common colds

SARS (Severe Acute Respiratory Syndrome)

SARS-CoV-2 = COVID-19

tx = COVID-19 vaccine

may license lang and vaccine pag nasa state of emergency tayo

most severe so far

MERS-CoV (Middle East Respiratory Syndrome)

Novel Coronavirus 2012

not as severe as COVID-19

Gastroenteritis (infants)

Medical Virology Part 2 24

 Togaviridae
member of Arbovirus — arthropod borne

vector-transmitted virus (mosquito)

Alpha Virus Rubivirus

> non-vector-transmitted > air-borne —

respiratory droplets → respiratory illnesses > R in
vector-transmitted
ToRCHeS > no tx, except if the condition is
congenital

CM = Equine encephalitis (affects horses)

Rubella CM = German measles > aka soft
> Eastern EE > Western EE > Venezuelan
measles > tigdas
EE

Caliciviridae
Norwalk virus

Norwalk, Ohio elementary schools

Tx

prevent dehydration (oral rehydration sol’n) cuz sx includes diarrhea

CM = gastroenteritis (intestinal flu)

Medical Virology Part 2 25

 Flaviviridae
member of Arbovirus

a. Dengue Fever

CM

Break-bone fever

S&Sx

myalgia = muscle pain

arthralgia = joint pain

Dengue Hemorrhagic Fever

S&Sx

dec RBC and platelets

biglang mataas na fever (39-41°C) for 3-7 days

Platelet count

normal = 250-450

dengue px

decreased platelet if no fever na — Dengue Shock

Fever

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 Dopamine and Epinephrine are given to prevent shock

low BP that could lead to shock and death

bawal msaugatan cuz wala magclot ng blood (platelets)

Dengvaxia

shouldn’t be given to a zero positive px — di pa nagkadengue before (1st

infection)

dapat previously exposed na yung px sa dengue before receiving the

vaccine

2nd reinfection dapat

there are 4 strains of the Dengue virus

you can only be immune to the specific strain you were infected by

can lead to death

CA = female Aedes aegypti mosquito

female lang nagfefeed sa blood

vector agent

b. Yellow Fever Virus

During the construction of the Panama Canal

acute viral hemorrhagic disease

parang dengue ang manifestation

MOT

bite of a female Aedes aegypti and other strains of mosquito

S&Sx = jaundice, hemorrhagic disease

No tx

self-limiting — drink plenty of fluids and use pain relievers

c. St. Louis encephalitis virus

d. Japanese encephalitis virus

Medical Virology Part 2 27

 e. Russian encephalitis virus

Retroviridae
Retro → Reverse transcription

provides the virus the ability to convert its (+) sense RNA strand to DNA
strand

Abnormal growth of cells (oncogenes) → cancer

Blow cytopathic effect → CD4 cells or Helper T cells are eradicated

a. HIV → dec in CD4 levels

HIV types

HIV-1 = most common

HIV-2 = less common

b. HTLV (Human T-Lymphocyte virus) → leukemia

leukemia or cancer is secondary to HIV infection

HIV decreases CD4 T-cells → lowers the immune system → body is

prone to other types of illnesses including cancer

Antiretroviral Agents

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 CCR5 receptor antagonists = entry inhibitor

NRTIs and NNRTIs = prevention of uncoating

integrase inhibitor

prevents the integration of the DNA of the virus into the DNA of the host
cell for it to replicate

protease inhibitor

prevents the maturation, hence immature viruses, which are not virulent are
released

HIV groups

groups A-K

M is the major type of HIV

it consists of subtypes A-K

these can mutate and create a new subtype → so a combination of drugs is

used

Medical Virology Part 2 29

 Current Classes of Antiretroviral Drugs

3 main enzymatic targets

Reverse Transcriptase

Protease

Integrase

6 drug classes

Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)

Protease inhibitors (PIs)

Entry inhibitors

CCR5 receptor antagonists

Integrase inhibitors

Medical Virology Part 2 30

 HAART — a cocktail of drugs used to prevent resistance

HIV regimen = multiple agents are combined

iba combination if px developed resistance

common cocktail of antiretroviral drugs

2 NRTI, 1 NNRTI, 1 Protease Inhibitor, 1 CCR5

normally binibigay

Fixed-dose combination

if proven na effective sa px yung mga combination

if bago palang yung px sa regimen, di binibigay ng sama-sama (hiwa-hiwalay

muna)

kasi baka may drug as mga combinations na yan na allergic or resistant

yung px

(-) Sense RNA Virus

Paramyxoviridae
similar to orthomyxo-

a. Paramyxovirus

CM = URTI, LRTI in children

Sx = Stridor

difficulty and wheezing sounds in breathing

b. Mumps virus

CM = infectious parotitis

primarily affects the parotid gland

inflammation of the parotid gland

Medical Virology Part 2 31

 Males develop orchitis (prostate part — inflammation of the testes) →
infertility (20%)

if mumps develop during puberty

Prophylaxis

MMR vaccine = Mumps, Measles, Rubella

mumps generally go away on their own

c. Morbillivirus

CM = Measles (Rubeola)

Prodromal period = conjunctivitis, fever, cough, rhinitis, malaise

sx before lumabas characteristic sx of the disease — Koplik’s spots

A day before rashes come out:

(+) Koplik’s spots = red-based lesion with a bluish-white corner found

in the mouth

characteristic sx of Rubeola

1° Sx = Rashes

starts and ends from head to foot

Complications

SSPE (Sub Sclerosing Panencephalitis) → affects the CNS

persistent measles and then it goes to the CNS

Tx = OTC medications

Medical Virology Part 2 32

 acetaminophen if may fever but it generally goes away on its own

d. Myxovirus

flu-like but do not possess any of the H and N antigens

H and N antigens are glycoproteins evident in viruses

parang influenza

Respiratory Syncytial Virus (RSV)

the leading cause of URTI and LRTI among children (pneumonia,

bronchitis)

Tx = -mab

Medical Virology Part 2 33

 Filoviridae
Acute hemorrhagic conditions

Sx

bleeding profusely in ALL outlets of the body

90% fatal

one of the most severe

Examples:

Ebola virus

Africa

requires maximum containment facility

bats → natural hosts

MOT

Not air-borne

direct contact with contaminated blood as taong namatay or

nagkasakit ng Ebola

highly contagious

bodily fluids/secretions

ZMapp → under investigation vaccine for Ebola

Marburg virus

Germany

Medical Virology Part 2 34

 mokey breeding facility

Marburg hemorrhagic fever

Reston (REBOV)

affects monkeys

does not affect humans

only known source is the Philippines

Arenaviridae
rodent-borne

Lymphocytic Choriomeningitis virus (LCMV)

presents itself as aseptic meningitis

viral hemorrhagic fever

Lassa virus

Junin virus

Machupo virus

Bunyaviridae
Member of Arbovirus → Toga, Flavi, Bunya

vector-borne

mosquitos (common), ticks, flies

a. Phlebovirus

Medical Virology Part 2 35

 Named after the Phlebotomus fly (sand fly)

CM = Rift Valley Fever (RVFV)

b. California Encephalitis Virus

c. Norovirus

CM = Crimean Congo Hemorrhagic Fever

d. Hantavirus

CM = Korean Hemorrhagic Fever

Tx = mechanical ventilator and anti-convulsant (for seizures and convulsions)

Orthomyxoviridae
Influenza virus

Influenza A > epidemic > also present in birds (bird flu)

Influenza B > epidemic > no animal reservoir

> non-endemic > non-epidemic > sporadic

Influenza C
— occurring at irregular intervals

Antigens

H = hemaglutinin

Medical Virology Part 2 36

 N = neuraminidase

glycoproteins present in viruses

3 Common Types of Human Influenza

already caused a pandemic twice

H1N1

H2N2

H3N2

H5WN1 = swine influenza

H5N1 = Avian flu

Treatment

Oseltamivir (Tamiflu®)

-tamivir

Rhabdoviridae
Rabies virus

source = dogs, bats, skunks, squirrels, cats → bites or scratch

rodents usually anti-tetanus

Variable incubation period

(7-7-7-7) days → years of disease manifestation

hours, days, months, years

Attacks the CNS

CM = fatal encephalitis

100% fatal if it goes to the CNS

slow onset but depends largely on the site

pag sa ulo nakagat → emergency, category 3 → post-exposure

prophylaxis is given to the px

Medical Virology Part 2 37

 Helical-bullet shaped virus

Categories

Category 1 > lick through an intact skin

Category 2 > scratch

Category 3 > bite

Symptoms:

Hydrophobia

Photophobia

Painful swallowing

Stiff neck

Drooling effect

Rabies vaccine

expires in 3 years (depending on the brand) then booster nalang

post-exposure prophylaxis is given to px who are not animal handlers

schedule of treatment

1st shot Day 0 (infection)

2nd shot Day 3

3rd shot Day 7

4th shot Day 14

pre-exposure prophylaxis fo vets, animal handlers

meron na silang Rabies vaccine

Medical Virology Part 2 38

Medical Virology Part 2 39