Misc virus

Miscellaneous Viruses

• BK Virus

• Chikungunya Virus

• Coxsackie B Virus

• Epstein-Barr Virus (EBV)

BK Polyomavirus

• Type: Nonenveloped DNA virus

• Transmission:

  • Urine-oral, fecal-oral, or respiratory secretions

• Geography/Seasonal:

  • Worldwide distribution

  • 90% of individuals infected by age 4

  • No seasonal incidence

• At Risk Groups:

  • Immunocompromised individuals

Clinical Syndrome

• Life-long, can reactivate in immunocompromised

• Latent in the kidney

• Symptoms:

  • Asymptomatic to mild flu-like symptoms

  • Severe Disease:

    • Cystitis

    • Loss of kidney transplant function in renal patients due to immunosuppressive agents

Diagnosis and Treatment/Prevention of BK Virus

• Diagnosis:

  • Molecular detection

  • Cytology

• Treatment/Prevention:

  • No approved antiviral, supportive care only

  • Screen kidney transplant donors and recipients

  • Monitor kidney transplant recipients, reduce immunosuppression if detectable

Coxsackievirus B

• Type: Nonenveloped RNA virus (Enterovirus family, Picornavirus)

• Transmission:

  • Fecal-oral route or respiratory secretions, fomite transmission possible

• At Risk Groups:

  • Neonates, immunocompromised individuals

Clinical Syndrome

• Symptoms:

  • Asymptomatic (90%)

  • Severe Disease:

    • Myopericarditis (flu-like symptoms and chest pains)

    • Aseptic meningitis

    • Pancreatitis (may lead to type-1 diabetes)

Diagnosis and Treatment/Prevention

• Diagnosis:

  • Molecular detection

  • Antibody detection

• Treatment/Prevention:

  • No approved antivirals, supportive care only

  • Education on hygiene practices and handwashing

Chikungunya Virus

• Type: Enveloped RNA virus

• Transmission:

  • Arthropod vector (mosquito, same as yellow fever)

  • Humans as reservoir during epidemic periods

• Geography/Season:

  • Mainly Africa, Asia, Americas

  • Notable outbreak in Caribbean (December 2013)

• At Risk Groups:

  • Travelers to endemic areas (8-12 days in mosquito)

Clinical Syndrome

• Incubation: 2-12 days

• Symptoms:

  • Asymptomatic (3 to 28%)

  • Mild flu-like symptoms with severe joint pain (may last weeks to years)

  • Severe symptoms in newborns and older adults, potential neurological complications

Diagnosis and Treatment/Prevention

• Diagnosis:

  • Molecular detection, antibody detection

• Treatment/Prevention:

  • No approved antivirals, supportive care only

  • Vaccine in development

  • Education, use insect repellent, protective clothing

Epstein-Barr Virus (EBV)

• Type: Enveloped DNA virus (Herpes family)

• Transmission:

  • Direct contact with saliva, sexual contact, blood transfusions, organ transplants

• Geography/Season:

  • Worldwide distribution, >90% of adults infected

  • No seasonal incidence

• At Risk Groups:

  • Children and teenagers

Clinical Syndrome

• Life-long virus, dormant in B lymphocytes

• Incubation: 4-6 weeks

• Symptoms:

  • Asymptomatic in most

  • Mild disease: "Kissing disease" (infectious mononucleosis)

    • Symptoms: extreme fatigue, fever, body aches, pharyngitis

Severe Disease

• Reactivation of latent infection can lead to severe diseases:

  • Hodgkin lymphoma (~50% cases)

  • Burkitt lymphoma (~25% cases)

  • Nasopharyngeal carcinoma (~75% cases)

  • Primary effusion lymphoma (100% cases infected with HHV-8, ~70% cases)

Diagnosis of EBV

• Methods:

  • Clinical presentation, antibody detection, heterophile antibodies (IgM)

  • Point of care assay (Monospot test), issues with cross-reactions

  • Molecular detection

• <4 years age presents sensitivity issues

Treatment and Prevention

• Treatment/Prevention:

  • No approved antivirals, supportive care

  • Education on avoiding transmission