SkM - DNA Viruses

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Herpes Simplex Virus Types 1 & 2 (Herpesviridae)

#1 Hermes sprinting

HSV types 1 & 2 (DNA viruses in the Herpesviridae family)

Herpes Simplex Virus Types 1 & 2 (Herpesviridae)

#2 cool colors

HSV 1 & 2 are DNA viruses

Herpes Simplex Virus Types 1 & 2 (Herpesviridae)

#3 enveloping toga

HSV 1 & 2 are enveloped viruses

Herpes Simplex Virus Types 1 & 2 (Herpesviridae)

#4 double road lines

HSV 1 & 2 are double stranded, linear DNA viruses

Herpes Simplex Virus Types 1 & 2 (Herpesviridae)

#5 cow spots

intranuclear eosinophilic inclusions, known as Cowdry type A bodies, are characteristic histopath findings in cells infected with HSV (as well as CMV & VZV)

Herpes Simplex Virus Types 1 & 2 (Herpesviridae)

#6 torch

HSV 1 & 2 are considered TORCHeS infections (He) as they can be transmitted vertically

Herpes Simplex Virus Types 1 & 2 (Herpesviridae)

#7 red lips

the primary infection of HSV-1 often manifests as gingivostomatitis, characterized by vesicular lesions and ulcerations within the oral cavity and surrounding perioral region

Herpes Simplex Virus Types 1 & 2 (Herpesviridae)

#8 lip ulcers

herpes labialis, colloquially known as cold sores, primarily manifests on the lips and is predominantly caused by HSV-1

Herpes Simplex Virus Types 1 & 2 (Herpesviridae)

#9 serpent caduceus

keratoconjunctivitis, primarily attributable to HSV-1, is identifiable by serpiginous corneal ulcers on a fluorescein slit lamp examination

Herpes Simplex Virus Types 1 & 2 (Herpesviridae)

#10 wings on helmet

herpes encephalitis is the most common form of acute encephalitis, almost always caused by latent HSV1

Herpes Simplex Virus Types 1 & 2 (Herpesviridae)

#11 crazy eyes

HSV1 is the most common cause of life-threatening sporadic encephalitis

Herpes Simplex Virus Types 1 & 2 (Herpesviridae)

#12 three helmet gems

latent HSV1 typically resides in the trigeminal ganglia, posing a risk for reactivation

Herpes Simplex Virus Types 1 & 2 (Herpesviridae)

#13 dew drops on roses

HSV lesions appear as grouped vesicles or pustules on an eythematous base and are likened to “dew drops on a rose petal”

Herpes Simplex Virus Types 1 & 2 (Herpesviridae)

#14 dew drops on finger

herpetic whitlow is an HSV-induced condition characterized by painful lesions on one or more fingers

Herpes Simplex Virus Types 1 & 2 (Herpesviridae)

#15 target stamps on hand and arm

erythema multiforme is a hypersensitivity reaction associated with certain medications and infections (such as HSV) that presents with distinct target lesions on the back of the hands and feet and move centrally

Herpes Simplex Virus Types 1 & 2 (Herpesviridae)

#16 ruffles by groin

during an initial genital herpes outbreak, often caused by HSV2, patients may present with tender lymphadenopathy in the inguinal region

Herpes Simplex Virus Types 1 & 2 (Herpesviridae)

#17 codpiece

HSV2 primarily establishes latency in the sacral ganglia, posing a risk for reactivation

Herpes Simplex Virus Types 1 & 2 (Herpesviridae)

#18 neck brace

HSV2 infections have been linked to cases of aseptic meningitis in both adolescent and adult populations

Herpes Simplex Virus Types 1 & 2 (Herpesviridae)

#19 tank + giant spots

the Tzank smear was used historically to visualize multinucleated giant cells infected with HSV; however, multinucleated giant cells can also be seen in other conditions like VZV infections & specific identification requires other tests, such as PCR or viral culture

Herpes Simplex Virus Types 1 & 2 (Herpesviridae)

#20 violet recycling bin

prophylactic measures against HSV outbreaks include the use of valacyclovir & acyclovir

Cytomegalovirus (Herpesviridae)

#1 “Mega-Lo prices!”

Cytomegalovirus (CMV; a DNA virus in the Herpesviridae family)

Cytomegalovirus (Herpesviridae)

#2 cool colors

CMV is a DNA virus

Cytomegalovirus (Herpesviridae)

#3 Hermes toys

CMV is part of the Herpesviridae family

Cytomegalovirus (Herpesviridae)

#4 sleeping + macro-cages

CMV establishes latency in mononuclear myeloid cells (monocytes, MACROPHAGES, dendritic cells)

Cytomegalovirus (Herpesviridae)

#5 torches

CMV is a TORCHeS infection (C) as it can be transmitted vertically, resulting in congenital CMV

Cytomegalovirus (Herpesviridae)

#6 Epstein’s Beer + back of throat

clinical manifestations of CMV infection can resemble those of EBV, presenting with symptoms like fever, sore throat, lymphadenopathy (commonly involving the lymph nodes of the head and neck), and fatigue

Cytomegalovirus (Herpesviridae)

#7 “No Mo’ Spot” detergent

the MonoSpot test can help distinguish between CMV and EBV infections as it is generally positive in EBV infections and negative in CMV infections; however, the monospot test has limitations, and standard laboratory tests for diagnosing both CMV & EBV infection include PCR and serology

Cytomegalovirus (Herpesviridae)

#8 walking man with immunocompromised cane

in immunocompromised individuals, there is an increased risk of CMV reactivation

Cytomegalovirus (Herpesviridae)

#9 solid organs

patients who receive transplants (especially solid organ, bone marrow, and stem cells) are more likely to get an active CMV infection

Cytomegalovirus (Herpesviridae)

#10 coughing + lung stains

transplant patients are at higher risk for developing CMV pneumonia and pneumonitis (as well as other CMV infections, including hepatitis, gastritis, colitis, and encephalitis)

Cytomegalovirus (Herpesviridae)

#11 immunocompromised can + AIDS ribbons

immunocompromised individuals, especially those with CD4+ counts below 50 (AIDS patients) are more vulnerable to CMV infections

Cytomegalovirus (Herpesviridae)

#12 “Charity drive 50Ac”

immunocompromised individuals, especially those with CD4+ counts below 50 (AIDS patients) are more vulnerable to CMV infections

Cytomegalovirus (Herpesviridae)

#13 retina pizza

CMV retinitis can manifest in patients with AIDS and is often characterized as “pizza pie” retinopathy due to its distinctive appearance resembling scattered cheese and tomato on a pizza

Cytomegalovirus (Herpesviridae)

#14 linear tears in conveyor belt

CMV-associated esophagitis in HIV patients typically presents with singular, deep, and linear esophageal ulcers

Cytomegalovirus (Herpesviridae)

#15 torn mucosal bags

CMV colitis can manifest with distinct ulcerative lesions in the colon, leading to symptoms like abdominal pain, hematochezia, and diarrhea

Cytomegalovirus (Herpesviridae)

#16 Owl-O Cereal

on microscopy, CMV infected cells may show characteristic “owl’s eyes” inclusions, cells with large ovoid nuclei containing intranuclear basophilic inclusions

Cytomegalovirus (Herpesviridae)

#17 blueberry muffins

congenital CMV muffins can manifest with a “blueberry muffin” rash, jaundice, hepatosplenomegaly, sensorineural hearing loss, intellectual disabilites/developmental delays, and distinct brain abnormalities like microcephaly, ventriculomegaly, and periventricular calcifications

Cytomegalovirus (Herpesviridae)

#18 yellow cow + spleen and liver spots

congenital CMV muffins can manifest with a “blueberry muffin” rash, jaundice, hepatosplenomegaly, sensorineural hearing loss, intellectual disabilites/developmental delays, and distinct brain abnormalities like microcephaly, ventriculomegaly, and periventricular calcifications

Cytomegalovirus (Herpesviridae)

#19 covering ears

congenital CMV muffins can manifest with a “blueberry muffin” rash, jaundice, hepatosplenomegaly, sensorineural hearing loss, intellectual disabilites/developmental delays, and distinct brain abnormalities like microcephaly, ventriculomegaly, and periventricular calcifications

Cytomegalovirus (Herpesviridae)

#20 large helmet vents

congenital CMV muffins can manifest with a “blueberry muffin” rash, jaundice, hepatosplenomegaly, sensorineural hearing loss, intellectual disabilites/developmental delays, and distinct brain abnormalities like microcephaly, ventriculomegaly, and periventricular calcifications

Cytomegalovirus (Herpesviridae)

#21 milk on head

congenital CMV muffins can manifest with a “blueberry muffin” rash, jaundice, hepatosplenomegaly, sensorineural hearing loss, intellectual disabilites/developmental delays, and distinct brain abnormalities like microcephaly, ventriculomegaly, and periventricular/intracranial calcifications

Cytomegalovirus (Herpesviridae)

#22 “Expect DELAYS”

congenital CMV muffins can manifest with a “blueberry muffin” rash, jaundice, hepatosplenomegaly, sensorineural hearing loss, intellectual disabilites/developmental delays, and distinct brain abnormalities like microcephaly, ventriculomegaly, and periventricular calcifications

Cytomegalovirus (Herpesviridae)

#23 shake lines

congenital CMV muffins can manifest with a “blueberry muffin” rash, jaundice, hepatosplenomegaly, sensorineural hearing loss, intellectual disabilites/developmental delays, and distinct brain abnormalities like microcephaly, ventriculomegaly, and periventricular calcifications, which can lead to seizures

Cytomegalovirus (Herpesviridae)

#24 ballon bear in water

congenital CMV infection can result in hydrops fetalis, a condition in which abnormal amounts of fluid build up in two or more fetal compartments

Cytomegalovirus (Herpesviridae)

#25 “80-90% off!”

The majority (80-90%) of newborns with congenital CMV infection are asymptomatic

Cytomegalovirus (Herpesviridae)

#26 “UL97” sticker + fast car net

strains of CMV with the UL97 gene mutation demonstrate resistance to ganciclovir, and often require foscarnet for effective management

Epstein-Barr Virus (Herpesviridae)

#1 Epstein’s Bar

Epstein-Bar virus (EBV; a FNA virus in the Herpesviridae family)

Epstein-Barr Virus (Herpesviridae)

#2 cool colors

EBV is a DNA virus

Epstein-Barr Virus (Herpesviridae)

#3 saliva drips

EBV is primarily transmitted via saliva, making close personal contact a common route of spread, especially among young adults and college students

Epstein-Barr Virus (Herpesviridae)

#4 sweat drops

a hallmark of EBV-induced infectious mononucleosis is the presentation of fever, in combination with lymphadenopathy and pharyngitis, forms the classic triad of symptoms frequently observed in affected individuals

Epstein-Barr Virus (Herpesviridae)

#5 grabbing back of shirt

patients with EBV-induced mononucleosis frequently manifest tender lymphadenopathy, particularly in the posterior cervical region

Epstein-Barr Virus (Herpesviridae)

#6 reactive “8” T-knight + atypical stains

EBV infection causes peripheral lymphocutosis and the presence of atypical lymphocytes (also known as Downey cells), abnormally large, reactive CD8+ T-cells with strongly basophilic cytoplasm that respond to EBV-infected B-cells; these atypical lymphocytes can be seen on peripheral blood smear

Epstein-Barr Virus (Herpesviridae)

#7 enlarged spleen spot

EBV infection typically leads to a proliferation of mononuclear cells that accumulate within the lymphoid tissue, including the spleem which may result in splenomegaly

Epstein-Barr Virus (Herpesviridae)

#8 sleeping B-cell archer

EBV maintains latency within B-cells, persisting indefinitely within the host, potentially leading to reactivated EBV under certain conditions or when exposed to certain triggers

Epstein-Barr Virus (Herpesviridae)

#9 entrance + “must B 21”

to enter host cells, the EBV viral envelope protein gp350 binds to CD21 on the surface of B-cells

Epstein-Barr Virus (Herpesviridae)

#10 white drool

a common clinical feature of EBV-induced mononucleosis is pharyngitis accompanied by tonsillar exudate

Epstein-Barr Virus (Herpesviridae)

#11 red pencil spots

when patients with an active EBV infection are inadvertently administered penicillin due to suspicion of a bacterial infection, they may develop a characteristic maculopapular rash

Epstein-Barr Virus (Herpesviridae)

#12 crab meals

EBV infection is associated with a higher risk for development of some cancers, including Hodgkin and non-Hodgkin lymphoma (particularly Burkitt lymphoma)

Epstein-Barr Virus (Herpesviridae)

#13 stern owl’s eyes

Hodgkin lymphoma, which is strongly associated with EBV infection, is characterized by Reed-Sternberg cells, large, abnormal B-cells with a distinctive bilobed nucleus resembling “owl eyes”

Epstein-Barr Virus (Herpesviridae)

#14 bar kid

EBV is associated with a higher risk for development of Burkitt lymphoma, a rare but highly aggressive B-cell non-Hodgkin lymphoma

Epstein-Barr Virus (Herpesviridae)

#15 jaw lump

Endemic Burkitt lymphoma, a specific subtype that occurs predominantly in children in certain regions of equitoral Africa, often presents as a swelling or lesion in the jaw

Epstein-Barr Virus (Herpesviridae)

#16 crab pinching nose

nasopharyngeal carcinoma, a malignancy with a tendency to metastasize, has a strong association with EBV

Epstein-Barr Virus (Herpesviridae)

#17 bearded man + immunocompromised cane

oral hairy leukoplakia, which presents with benign white lesions primarily found on the tongue, is triggered by EBV in individuals with HIV or AIDS

Epstein-Barr Virus (Herpesviridae)

#18 bullseye soit + star darts

the monospot test can be used to provide a quick diagnosis for acute EBV infection by detecting heterophile IgM antibodies, which induce agglutination

the CDC no longer recommends the Monospot test due to low sensitivity and specificity (currently, gold standard = EBV-specific antibodies)

Epstein-Barr Virus (Herpesviridae)

#19 “No contact jousting”

patients with infectious mononucleosis are advised to avoid contact sports for several weeks or until a physician clears them due to the elevated risk of SPLENIC RUPTURE

Varicella-Zoster Virus (Herpesviridae)

#1 Zeus

Varicella-zoster virus (VZV; a DNA virus in the Herpesviridae family)

Varicella-Zoster Virus (Herpesviridae)

#2 cool colors

VZV is a DNA virus

Varicella-Zoster Virus (Herpesviridae)

#3 Hermes

VZV is in the Herpesviridae family

Varicella-Zoster Virus (Herpesviridae)

#4 wrapped in toga

VZV is an enveloped virus

Varicella-Zoster Virus (Herpesviridae)

#5 chickens

VZV causes chickenpox, which manifests as a pruritic rash characterized by small, fluid-filled blisters

Varicella-Zoster Virus (Herpesviridae)

#6 sweat

fever, headache, fatigue, and loss of apetite often appear one to two days before development of chickenpox lesions

Varicella-Zoster Virus (Herpesviridae)

#7 holding head

fever, headache, fatigue, and loss of apetite often appear one to two days before development of chickenpox lesions

Varicella-Zoster Virus (Herpesviridae)

#8 water gun spray

VZV is primarily transmitted via respiratory droplets

Varicella-Zoster Virus (Herpesviridae)

#9 dew on rose petals

the vesicular lesions caused by VZV are often likened to “dew drops on a rose petal”

Varicella-Zoster Virus (Herpesviridae)

#10 “all ages welcome”

chickenpox vesicles typically appear in varying stages of development and healing; this contrasts with many other viral rashes where the entire rash uniformly moves through stages together

Varicella-Zoster Virus (Herpesviridae)

#11 tank + giant spots

historically, a Tzanck smear to visualize multinucleated giant cells infected with VZV; however, multinucleated giant cells can be seen in other infections like HSV, so more specific identification via other test like PCR is required

Varicella-Zoster Virus (Herpesviridae)

#12 adult coughing

adults are more likely to develop complications from chickenpox (caused by VZV) than children; one of the more serious complications is varicella pneumonia

Varicella-Zoster Virus (Herpesviridae)

#13 red turban

encephalitis is a rare but serious complication that can arise from VZV

Varicella-Zoster Virus (Herpesviridae)

#14 immunocompromised cane

immunocompromised patients have an elevated risk for severe VZV complications, including varicella pneumonia and encephalitis

Varicella-Zoster Virus (Herpesviridae)

#15 “Live Show” syringe sign

the vaccine for VZV is a live attenuated formulation typically administered in childhood

Varicella-Zoster Virus (Herpesviridae)

#16 recycling bin

acyclovir reduces the number of lesions and duration of illness if started within 24 hours of rash appearance

Varicella-Zoster Virus (Herpesviridae)

#17 sleeping on dorsal tree roots

after an initial chickenpox infection, VZV becomes dormant in the dorsal root ganglia and can reactivate later, causing shingles

Varicella-Zoster Virus (Herpesviridae)

#18 elderly people + immunocompromised cane

factors such as stress, aging, decreased immunity, or underlying diseases can trigger the reactivation of V>V, leading to shingles (herpes zoster)

Varicella-Zoster Virus (Herpesviridae)

#19 shingles

when VZV reactivates, it causes shingles (herpes zoster), which predominantly affects adults over 50 and immunocompromised individuals

Varicella-Zoster Virus (Herpesviridae)

#20 rose petals falling across abdomen

shingles presents with a painful rash resembling “dew drops on a rose petal” and typically follows a dermatomal distribution, meaning it appears in the specific area of skin served by one spinal nerve root

Varicella-Zoster Virus (Herpesviridae)

#21 pain bolt

shingles is typically characterized by an intensely painful, blistering rash that follows the path of a single spinal nerve root, often exacerbated by even a gentle touch or breeze

Varicella-Zoster Virus (Herpesviridae)

#22 chest bolt

postherpetic neuralgia, a potential complication of shingles, results in persistent, burning pain in the affected area, long after the shingles rash has resolved

Varicella-Zoster Virus (Herpesviridae)

#23 red eye patch

herpes zoster opthalmicus results when VZV reactivates in the opthalmic division of the trigeminal nerve (V1), potentially causing vision loss

Varicella-Zoster Virus (Herpesviridae)

#24 “live show - seniors only 60 & over”

historically, the CDC recommended that people 60+ receive Zostavax (live attenuated vaccine), to prevent shingles and post-herpetic neuralgia;

however, SHINGRIX (recombinant subunit vaccine) is now used for shingles prevention

Varicella-Zoster Virus (Herpesviridae)

#25 “Max occupancy 200”

HIV patients with a CD4+ count exceeding 200 are eligible for the varicella-zoster vaccine

Varicella-Zoster Virus (Herpesviridae)

#26 Family’s recycling shirts

for VZV-induced shingles, both famciclovir and valacyclovir serve as effective therapeutic options

Varicella-Zoster Virus (Herpesviridae)

#27 violet recycling bin

for VZV-induced shingles, both famciclovir and valacyclovir serve as effective therapeutic options

Varicella-Zoster Virus (Herpesviridae)

#28 torches

VZV can transmit from mother to fetus and is categorized under the “other” (O) segment of the TORCHeS infections

Varicella-Zoster Virus (Herpesviridae)

#29 torn seams + plucked eye + stubby limbs

exposure to VZV during early pregnancy can precipitate congenital varicella syndrome, marked by skin scarring in dermatomal patterns, visual impairment, and underdeveloped limbs

HHV-6 & Roaseola (Herpesviridae)

#1 “6” on Hermes

Human herpesvirus 6 (HHV-6; a DNA virus in the Herpesviridae family)

HHV-6 & Roaseola (Herpesviridae)

#2 roses

roseola, also known as the sixth disease or exanthem subitum, is primarily caused by HHV6

HHV-6 & Roaseola (Herpesviridae)

#3 cool colors

HHV-6 is a DNA virus

HHV-6 & Roaseola (Herpesviridae)

#4 helper squire

HHV6 primarily targets CD4+ helper T-cells, which may result in immunosuppresion

HHV-6 & Roaseola (Herpesviridae)

#5 hermes

HHV6 is part of the Herpesviridae family

HHV-6 & Roaseola (Herpesviridae)

#6 sweat

the fever associated with roseola typically lasts around 4 days (but can vary in duration)