DNA Viral Pathogens

Is parvovirus large or small?

Small! Fun fact it is the smallest DNA virus!

Is parvovirus DNA or RNA?

DNA

Kids who have parvovirus B19 typically have what symptoms?

Arthritis and a red face (slapped cheek disease)

How is parvovirus transmitted?

Through the respiratory system

At what temperature does parvovirus peak?

Mild temperatures

True or false: 50% of the population has a primary parvovirus infection by age 15.

True

Is there are vaccine available for parvovirus?

No

True or false: parvovirus can be a congenital disease.

True

How does parvovirus pass from mother to offspring?

Mothers who are exposed to a child with 5ths disease (aka parvovirus) can pass to their child bc it can cross the placenta.

If a mother is exposed to slapped cheek disease while child is a fetus, what can this cause?

Fetal risk! Severe birth defects, CNS anomalies, craniofacial anomalies, organ damage, eye anomalies, fetal anemia, hydrops fetalis, spontaneous miscarriage

What are 2 things that fetal anemia can cause?

1) Fetalis hydrops

2) Spontaneous miscarriage

How do we prevent fetal death if we suspect mom has been exposed to parvovirus?

Test for Antibodies - specifically IgG and IgM

What two antibodies should mothers be tested for if we suspect exposure to parvovirus?

IgG and IgM

True or False: if the mother HAS IgM and IgG antibodies, she and fetus will be fine even if exposed to parvovirus.

True

When is the fetus at most risk?

If primary exposure of parvovirus happens during pregnancy.

-Aka if the mom was never exposed before prior to pregnancy, and has not developed the IgG and IgM antibodies against it.

Is the packed red blood cell infusion used to combat anemia given to the mom or to the fetus? (in relation to parvovirus)

The fetus

What eye related condition does Adenovirus cause?

Viral Conjunctivitis

Name 3 systemic conditions and 1 ocular condition that Adenovirus causes.

1) Gastroenteritis

2) Urinary tract infections & Upper respiratory infection

3) Viral conjuncitivitis

How is Adenovirus transmitted?

Respiratory system and direct inoculation (direct touching of infected areas)

What is the immunity of Adenovirus?

Lifelong! You get it once and you are protected. BUT there are 50 different serotypes (aka you can get 1 strain and be immune to that one strain, but still be susceptible to the other 49).

What are 4 associated outcomes with an upper respiratory tract infection caused by adenovirus?

1) Acute febrile pharyngitis

2)Pharyngoconjunctival fever

3) Acute respiratory disease

4) Viral pneumonia

Which serotypes of the upper respiratory infections do we often look at?

Types 1-7

Adenovirus can cause urinary tract infections, what can this lead to?

Hemorrhagic cystitis

Adenovirus can cause gastroenteritis, specifically which kind?

Infantile gastroenteritis (infants get diarrhea)

What are all the ocular manifestation that's adenovirus can cause?

APE

1) Acute nonspecific follicular conjunctivitis

2) Pharyngoconjunctivitis fever

3) Epidemic keratoconjunctivitis *big one*

Out of all of the Adenovirus serotypes, how many are associated with ocular infections?

1/3

Typically how long is someone with adenovirus contagious for?

12-14 days

Ocular diseases from adenovirus can present with what 3 symptoms?

Follicles, conjunctival redness, pseudomembranes

What is a membrane that grows in the palpebral conjunctiva (usually in the fornix)

Pseudomembrane (could also be a true membrane, depends on the conditions)

Which ocular manifestation of Adenovirus is most common?

Acute nonspecific Follicular Conjuncitivitis (serotypes 1-11 and 19).

What are symptoms of Acute nonspecific follicular conjunctivitis? (5)

1) Diffuse red eye

2) Conjunctival follicles in the inferior palpebral

3) Tearing

4) Redness

5) Discomfort

(NO CORNEAL INVOLVEMENT)

Which ocular manifestation of adenovirus is called "swimming pool conjuncitivitis"?

- side note its just called this bc it affects children and is super contagious.

Pharyngoconjunctival Fever (PCF)

Which serotypes are included in PCF?

3-5 and 7

What are symptoms of PCF?

1) Follicular conjuncitivitis

2) Low grade fever

3) Pharyngitis

What is the most severe form of Adenoconjuntivis?

Epidemic Keratoconjunctivits (EKC)

What serotypes are included in Epidemic Keratoconjunctivitis?

Serotypes 8, 19, 37

What are the symptoms of Epidemic Keratoconjunctivits in general?

1) Tearing

2) Discomfort

3) Horrible redness

4) Pseudomembranes

True or False: 20% of patients have pain and corneal involvement with EKC (epidemic Keratoconjunctivitis)

False! 80%

How soon after exposure to EKC, do clinical symptoms appear?

8 days

What is seen in the first 1-2 weeks of infection of EKC?

Superficial keratitis in acute phase

What is seen at week of infection with EKC?

Subepithelial infiltrates

After what is seen in the patient 3 weeks after they are no longer contagious?

Subepithelial infiltrates

What is a ways to test for Adenovirus? For especially which serotypes?

Adenoplus (an antigen detection kit). EKC serotypes

How long are Adenovirus ocular infections contagious for?

12-14 days

What are 3 symptoms in all of ocular diseases from adenovirus?

1) Follicles

2) Conjunctival redness

3) Pseudomembranes

Papillomavirus has a strong preference for which type of cells?

Epithelial and Mucosal (specifically Basal cell layer of the mucosa)

HPV attacks what cells?

Basal and Squamous cells

What is the most common viral sexually transmitted infection in the USA?

HPV

Of the sexually active population, approx. how many have HPV?

80%

What does HPV cause?

Cutaneous Warts/Papillomas

What refers to squamous slow growing epithelial tumors, has a finger/cauliflower like appearance with a central vascular core?

Viral warts

What is warts synonymous with?

Papilloma

HPV proliferates in ________ containing cells

Keratin

HPV causes excess _________

Keratin

How can we diagnose HPV?

It can be isolated from lesions (biopsy)

Which serotypes cause 90% of genital warts/papillomas and can be spread to oral mucosa via sexual contact?

Serotypes 6 and 11

True or False: Many serotypes of HPV are oncogenes and cause malignancies.

True

What is a protein encoding gene that has potential to cause cancer?

Oncogene

Most common cancers are due to what?

HPV

What type of cancer arises from epithelium?

Carcinoma

What are the three most common cancers that are due to HPV?

1) Squamous cell carcinomas (conjunctival)

2) Testicular carcinoma

3) Cervical carcinoma

HPV causes what percentage of all cervical cancers?

90%

Serotypes ____ and _____ are associated with 70% of all cervical cancer

16 and 18

What is prevention for HPV cervical cancer?

Vaccines (garadsil 9)

What does the Gardasil 9 vaccine protect against?

HPV serotypes 6, 11, 16, 18, and 5 other serotypes.

Vaccination is good to prevent HPV cervical cancer BUT what ocular conditions can arise from HPV vaccination?

1) Uveitis

2) Papillitis

3) MEWDs (retinal inflammation)

Conjunctival papillomas do exist, and what can they turn into?

1) Conjunctival squamous cell carcinoma

2) Conjunctival intraepithelial neoplasia (CIN)

List the serotypes of HPV ocular manifestations and their degrees of severeness

6 and 11: less aggressive

6a and 45: moderate

16 and 18: more severe/virulent

What are two examples of Polymavirinae?

BK and JC

What is the transmission process of polyomavrinae?

Droplets

Which type (BK or JC) of Polyomavirinae can cause a progressive multifocal leukoencephalopathy?

JC virus

Which type (BK or JC) of Polyomavirinae can cause a bladder infection or nephropathy in transplant patients?

BK

True or False: You treat BK/JC Polyomavirinae with antiviral therapy.

False! There is no antiviral therapy for BK/JC, it is a latent virus (treat the symptoms)

What are the members of the Herpes Simplex group?

1) Herpes simplex 1

2) Herpes simplex 2

3) Varicella Zoster Virus

Where is Herpes Simplex latent in?

Nerve ganglia (usually trigeminal)

Describe the locations of affected areas for HSV 1 and HSV 2.

- HSV 1 is "above the belt" (aka ocular and oral manifestation)

- HSV 2 is "below the belt" (aka genital)

What percentage of HSV ocular infections are type 1?

98% (aka only 2% of the time does HSV 2 cause ocular infections)

Which HSV type is more common in neonatal hermetic keratitis?

Type 2 (75% of cases are type 2 and transmitted via. birth canal)

How is neonatal herpetic keratitis transmitted?

via birth canal

90% of adults have antibodies of HSV 1 by the age of 50. When does primary infection take place?

As a child

Reoccurrence (aka it comes out of hiding) of HSV is typically associated with what? (5)

1) Physical stress

2) Emotional stress

3) UV exposure

4) Hormones

5) Fever or trauma

True or false: HSV manifestations is unique to the individual

True

True or False: transmission of HSV is through indirect contact

False! it is through direct contact with secretion, lesions, open wounds

How do primary infections of HSV look? (2)

1) Dermatitis

2) Conjuncitivitis

Virus can be isolated from nearly all ___________ and ____________ sites of the body. It stays in targeted areas.

Visceral and mucosal

True or false: Herpes infections can reactivate at any time, and like the nervous system

True

What types of herpes tends to reoccur more frequently and can be asymptomatic?

Herpes simplex Type 2 (aka genital herpes)

True or false: HSV can reactivate at any time

True

If someone has trauma to their eye, as a result of that physical stress, HSV can reoccur. Trauma can cause what type of herpetic infection?

Secondary

What is the second most common cause of corneal blindness?

HSV

How is Varicella Zoster Virus transferred?

Droplet transmission

What is primary infection of Varicella Zoster Virus?

Varicella (aka chicken pox)

What percentage of children have varicella antibodies via primary infection or vaccine by age 5?

95%

What is the first sign varicella zoster virus?

Generalized illness

If someone is having macular eruptions that become vesicular and then crust over, what do they likely have?

Chicken pox! Aka varicella virus!!

Is varicella virus more concerning in adults or children?

Adults

What other populations (besides) adults do we need to be concerned about in VZV?

Immunocompromised patients

VZV is contagious _______ days before rash

1-2

How long do breakouts due to VZV continue for?

1 week after the initial rash

What refers to long term complications?

Sequelae