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Virus Characteristics Epidemiology Pathogenesis and Virulence Diseases Lab Diagnosis Treatment
Enterovirus Icosahedral Spread: contaminated Pathogenesis Poliovirus Culture Pleconaril
(Picornaviridae) Non-enveloped food/water 1. Can replicate in various tissues 1. Asymptomatic Illness (90%) Serology Salk Killed Polio
SS+ non- Location: stomach (tropism) 2. Abortive Poliomyelitis (5%): fever, PCR Vaccine: IgG
segmented and GIT 2. Binds to specific receptors on host cell headache, malaise, pharyngitis Meningitis: CSF Sabin Live
Stable at low pH of Risk Factors: surface 3. Non-paralytic Poliomyelitis or cytology (inc Attenuated
stomach 1. Summer 3. Viremia: via blood/lymphatics Aseptic Meningitis: virus progresses lymphocytes, Vaccine: IgG
At Risk: to CNS and meninges normal and IgA
1. Neonates Virulence 4. Paralytic Polio: virus spreads to glucose)
(coxsackie, 1. Cytolytic anterior horn of SC and motor cortex
enterovirus) 2. Shed in feces for long period of brain; spinal paralysis; usually
2. Children and permanent
adults (poliovirus) Clearance 5. Postpoliomyelitis syndrome: 20-30%
1. Antibodies and interferon (secreted of patients who recover from PP
by TH1 cells) experience muscle weakness, atrophy
25-35 years after the illness

Coxsackie A
1. Herpangina: fever, sore throat;
ulceration in mouth and uvula
2. Hand-foot-mouth Disease

Coxsackie B
1. Myocardial and Pericardial Infections:
sudden, unexplained onset of heart
failure; high mortality
2. Pleurodynia (Bornholm Disease,
Devil’s Grip): unilateral, acute,
excruciating chest pain; vomiting

Echovirus
1. Viral Meningitis: most common viral
cause; milder than bacterial; CSF:
increased lymphocytes, normal glucose
levels
Rhinovirus Icosahedral Spread: respiratory, 1. Optimal temperature is 33°C for Common Cold: mild cough, Usually not Self-limiting
(Picornaviridae) Non-enveloped hand to hand growth (nasal passages) pharyngitis, malaise, myalgia, low-grade required No vaccine
SS+ non- contact 2. 100 different serotypes: difficult to fever; self-limiting
segmented Location: URT establish a protective mechanism
Acid Labile
Require lower
temperatures
Norovirus Icosahedral Spread: persons 1. GIT replication and shed in the stool Adult Gastroenteritis: major viral PCR: gold Bismuth
(Caliciviridae) Non-enveloped Location: GIT 2. Inhibits intestinal brush border function cause in adults; nausea, vomiting, standard salicylate:
SS+ non- Risk Factors: 3. Improper absorption of nutrients and watery diarrhea, self-limiting ELISA: viral Ab reduce
segmented 1. Schools, camps, water symptoms
prisons, cruises
2. Oysters
At Risk:
1. Adults
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Rotavirus Icosahedral Spread: feco-oral and 1. Initial infection through small intestine Infantile Gastroenteritis: most Serology Ganciclovir
(Reoviridae) Enveloped respiratory epithelia common cause in infants; mild to Electron Foscarnet
Double stranded Location: GIT 2. Toxin-like action: virus causes atrophy severe watery, non-bloody diarrhea microscopy Screening
Segmented Risk Factors: and shortening of villi with loss of electrolytes reduces
1. Jan-Mar 3. Decrease reabsorption of sugars and intrauterine
At Risk: water à diarrhea transmission
1. Infants

Measles Virus Helical Spread: respiratory 1. Initial infection in RT; attaches to CD46 Measles: Visual diagnosis Live, attenuated
(Paramyxoviridae) SS- non-segmented Location: RT via Hemaggluitinin (HA); F (fusion) protein 1. Fever, cough, coryza and conjunctivitis (Koplik spots) vaccine
One serotype Risk Factors: facilitates uptake of virion 2. Koplik spots: small white spots on (MMR)
1. Unimmunized 2. Replication in respiratory epithelia bright red mucous membrane on throat
3. Viremia: spread to LN, conjunctiva, RT, 3. Generalized macular rash: from
urinary tract, blood vessels, CNS head to lower extremities; patient is no
4. CMI controls infection longer infectious

*No neuraminidase (NA) Atypical Measles

1. Occur in people with older,
inactivated vaccine
2. More intense rash

Complications
1. Otitis media, secondary bacterial
infection, pneumonia
2. Giant cell pneumonia: T-cell deficient
patients
3. Postinfectious encephalitis: rare
(1/1000); autoimmune vs. myelin basic
protein
4. Subacute sclerosing panencephalitis:
rare, slow viral infection with CNS
manifestations
Mumps Virus Helical Spread: respiratory 1. Initially infects RT; local replication 1. Parotiditis: infection and swelling of Virus recovered MMR vaccine
(Paramyxoviridae) SS- non-segmented Location: RT 2. Viremia: infects parotid gland salivary glands (primarily parotid); from saliva,
One serotype Risk Factors: inflamed ostium of Stensen’s duct urine
1. Unimmunized 2. Orchitis/Oophritis: testicular Multi-nucleated
inflammation; may cause sterility giant cells
3. Aseptic Meningitis and Encephalitis: ELISA
rare IF
4. Pancreatitis Hemagglutinin
inhibition
Parainfluenza Helical Spread: respiratory, 1. Only infects the respiratory tract 1. Croup (serotype 1&2): seal bark Unnecessary Nebulized air
Virus SS- non-segmented person-person 2. Does not cause viremia cough; subglottal swelling;
(Paramyxoviridae) No viremia Location: RT only 3. Hemagglutinin and neuraminidase laryngotracheobronchitis
Limited to RT Risk Factors: activity 2. Bronchitis and pneumonia (serotype
Common infection 1. Nosocomial 4. Short protective immunity 3): common in infants and elderly
At Risk: 3. Cold-like upper RTI (serotype 4):
1. Infants treat with nebulized air
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Respiratory Helical Spread: respiratory 1. HA and F protein facilitates attachment 1. Common cold with rhinorrhea (URT): Culture Ribavarin
Syncytial Virus SS- non-segmented Location: URT and and entry into respiratory epithelia adults RT-PCR No vaccine
(Paramyxoviridae) LRT 2. Cell-cell spread of virus 2. Bronchiolitis (LRT): most important ELISA
Risk Factors: 3. No antibody protection: maternal Ab viral cause in infants
1. Nosocomial and natural infection do not protect from
At Risk: virus
1. Infants
Influenza Virus Helical Spread: respiratory Pathogenesis Influenza Culture Amantadine &
(Orthomyxoviridae) SS- segmented Location: respiratory 1. Hemagglutinin (HA) facilitates 1. Classic: malaise, headache, Hemadsorption rimantadine
tract attachment by binding to sialic acid myalgia, high fever, non- ELISA (M2 protein)
Risk Factors: 2. P proteins cleave cap from host mRNA productive cough Serology Zanamivir &
1. Seasonal: Oct to for capping of viral mRNA 2. Asymptomatic to severe depending on RT-PCR Oseltamivir
May 3. RNA-dep RNA pol: facilitate synthesis existing immunity and circulating strain (NA protein)
At Risk: of progeny mRNA from pre-existing viral 3. Children: high fever, croup, otitis Vaccine
1. Infants and mRNA media (formalin-
elderly 4. Infects URT then LRT (descending 4. Usually self-limiting inactivated):
2. Adults: classic flu infection 5. Complications in contains
3. Seronegative 5. Cause damage to respiratory epithelia immunocompromised: common
individuals 6. IFN, NK and T cells facilitate a. Primary viral pneumonia subtypes of
4. Immunocomp: immune resolution b. Secondary bacterial infection virus currently
high risk 7. Neuraminidase (NA) facilitates viral c. Post-infectious encephalitis in circulation
release and spread from infected cell d. Guillen-Barre Syndrome
**Currently, H7N9 is 8. Could lead to influenza, primary viral e. Myositis
a pandemic (human pneumonia, secondary bacterial infection f. Reye’s syndrome: aspirin-associated
and avian flu strains) or post-infectious encephalitis

Virulence
1. Antigenic Drift: mutation in genes
encoding HA or NA; error prone RNA-
dependent RNA polymerase; both
influenza A & B exhibit this
2. Antigenic Shift: reassortment of
genomic segments (H1N1 to H3N2);
causes pandemic due to novelty and lack
of immunity; only influenza A

*Antigenic shift occurs due to

reassortment of influenza A viruses in
different species (swine, avian, horses)
Coronavirus Helical Spread: respiratory 1. Transmitted in respiratory droplets SARS (Severe Acute Respiratory Serology No treatment
(Coronaviridae) SS+ non- Location: respiratory from bodily fluids Syndrome) PCR
segmented tract, GIT 2. Establish infection in RT and GIT 1. Outbreak in South China and spread
Risk Factors: throughout the world
1. H/O exposure to **MERS: Middle East Respiratory 2. Atypical Pneumonia: high fever,
place with Syndrome chills, rigors, headache, dizziness, cough
coronavirus 3. Gastroenteritis: present in 20% of
patients (adults or children)
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Rabies Virus Helical Spread: saliva from Pathogenesis Rabies Negri bodies!! Post-exposure
(Rhabdoviridae) SS- non-segmented animal 1. Bite of an animal transfers saliva to Stages: DFA: viral Ag prophylaxis:
Neurotropic Location: peripheral human victim. 1. Incubation: 60-365 days after bite RT-PCR virus travels
Bullet-shaped nerves 2. Ascending infection via peripheral (depends on location); asymptomatic ELISA slow
Risk Factors: nerves to brain 2. Prodrome: fever, nausea, vomiting, Immediate
1. Unvaccinated 3. Massive viral replication in the brain lethargy; pain on site of bite; virus wound
animals 4. Descending infection to salivary glands, reaches CNS and multiplies; 2-10 days cleansing:
2. Bats, raccoons, cornea, skin and muscles 3. Neurologic: hydrophobia (severe KMNO4 and
skunks pain upon drinking); pharyngeal spasms, antiseptics
At Risk: anxiety, hyperactivity, depression; CNS Active and
1. Vets and animal symptoms arise: confusion, delirium, passive
handlers paralysis; 2-7 days immunization
2. Person bitten by 4. Coma: cardiac arrest, hypotension,
rabid animal hypoventilation
3. Inhabitants of 5. Death
countries with no
pet vacc.
Alphavirus Helical Spread: mosquito 1. Mosquito bite introduces virus to 1. Acute Encephalitis: Eastern and Rise in Ab titers Control of
(Togaviridae) SS+ non- bite (Culex) human. Western equine encephalitis v. mosquito
segmented 2. Viremia: spread to target organs 2. Acute arthropathy: Chikungunya v. population
Arbovirus 3. Febrile illness: Venezuelan equine
(arthropod- encephalitis v.
borne) WEE, EEE, VEE
Rubella Virus Helical Spread: respiratory 1. Respiratory secretions of an infected 1. German Measles: descending RT-PCR MMR vaccine
(Togaviridae) SS+ non- Location: RT person is the only mode of transmission maculopapular rash that starts from the Serology No treatment
segmented Risk Factors: 2. Viremia: spread from lungs to liver, face; occipital lymphadenopathy; more Blueberry
Congenital Disease 1. Unvaccinated spleen, LN severe in adults with arthritis muffin baby
One serotype 2. Crowded 3. No cytopathic effect 2. Congenital Rubella Syndrome:
conditions 4. CMI limits infection; Ab helps virus replicates in placenta and spread to
At Risk: fetal blood; teratogenic effect; depending
1. Children on tropism and stage of development;
2. Adults cataracts, deafness, hepatitis, CHD
3. Neonates and CNS deficits
Flavivirus Helical Spread: mosquito Pathogenesis 1. Dengue Fever: breakbone fever; Mosquito cell Control of
(Flaviviridae) SS+ non- or tick bite 1. Mosquito bite introduces virus to transmitted by Aedes mosquito; high line mosquito
segmented (Aedes or Culex) human. fever, headache, rash, back and bone RT-PCR population
Arbovirus Location: 2. Viremia: spread to target organs pain ELISA
Over 60 serotypes macrophages 2. Dengue Shock syndrome & Dengue
Virulence Hemorrhagic fever: occur on rechallenge
1. Cytolytic by other dengue fever strains
2. Non-neutralizing Ab: can enhance 3. Encephalitis: SLE, WNV, JE
infection via Fc receptors on macrophages
by stimulating phagocytosis à activation
of memory T cells
Other Medically Important RNA Viruses
Human Metapneumovirus – RSV-like; cause bronchiolitis
Nipah and Hendra virus – fruit bat reservoir; flu-like symptoms, possible complications with seizures and coma
Filoviridae – Ebola/Marburg hemorrhagic fever – often fatal!
Bunyavirus (Hantavirus) – hemorrhagic fever; Hantavirus Respiratory Syndrome: death within 10 days
Arenavirus – lymphocytic choriomeningitis virus; Lassa fever encephalitis