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Virus
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Structure
virus is composed of two major parts: (i) Capsid and (ii) Nucleic acid.
virus has only one type of nucleic acid, either DNA or RNA, but not both.
Complex or irregular, e.g. bacteriophage, vaccinia.
- Glycoproteins (i.e., proteins with carbohydrates attached) that project from some
enveloped viruses.
Helical virus
Icosahedral virus
I.
Classification of virus
1. Baltimore classification
The system was defined in 1971. It is a classification system that places viruses into one of
seven groups depending on a combination nucleic acid (RNA or DNA), strandedness (singlestranded or double-stranded), Senses, and method of replication.
Group I: double-stranded DNA viruses (listed only few important genus)
Adenoviridae: Adenovirus.
- non-enveloped, icosahedral
Papillomaviridae: Papillomavirus
- non-enveloped, icosahedral
Herpesviridae: Herpes simplex virus, varicella-zoster virus, cytomegalovirus, EpsteinBarr virus
- ds DNA, enveloped virus
Group II: single-stranded DNA viruses (+)sense DNA
Parvoviridae: Parvoviruses
- Non-enveloped, icosahedral
Group III: double-stranded RNA
Reoviridae: Rotavirus, Reoviruses
- Non-enveloped, icosahedral
Group IV: positive-sense single-stranded RNA viruses
Picornaviridae: Enterovirus e.g polio, coxsackie
Rhinovirus e.g common flu viruses
Cardiovirus e.g encephalomyocarditis virus
Aphthovirus e.g FMDV
- Non-enveloped, icosahedral
Flaviviridae:
Dengue virus
Hepatitis C virus
Yellow fever virus
- Enveloped, Icosahedral
Coronaviridae: Corona virus
- Enveloped helical
Astroviridae: Astrovirus
- Non-enveloped, icosahedral
Orthomyxoviridae: Influenzavirus A
Influenzavirus B
Influenzavirus C
Thogotovirus
- Enveloped, helical
Group VI: positive sense single-stranded RNA-RT viruses with DNA intermediate in lifecycle
Retroviridae: Retroviruses
Group VII: double stranded DNA-RT viruses
Hepadnaviruses: Hepatitis B virus
- Enveloped, Icosahedral, partially circular ds
Bacterial virus: These are pathogenic viruses infecting bacteria and are called bacteriophages
or simply phages. Their nucleic acid is DNA, e.g. T2, T4, T6 bacteriophages
Bacteriophages (or phages) are viruses that infect bacteria
II.
Serological, molecular biological and tissue culture methods are used to diagnose viral
infections and to accertain the extent of viral damage and the quality and intensity of the body's
immune response.
A. Growth of the virus in Tissue Cultures
The type of cell culture used for virus cultivation depends on the sensitivity of
the cells to that particular virus. In the clinical laboratory, multiplication of the
virus can be followed by determining the following:
1. The Cytopathic effect or cytopathogenic effect (abbreviated CPE)
refers to degenerative changes in cells, especially in tissue culture,
and may be associated with the multiplication of certain viruses
e.g. HSV, VZV, Influenza A and B, Parainfluenza 1, 2, and 3, Adenovirus,
RSV, CMV, Enterovirus, and Rhinovirus
2. The appearance of a hemagglutinin (e.g mumps, influenza) or
complement-fixing antigen (e.g, poliomyelitis, varicella, measles).
Altered shape
Detachment from substarte
Lysis
Altered membrane
permeability
Inclusion bodies
apoptosis
Hepatitis B virus
Papillomavirus
III.
Anti-viral agents
Nomenclature of currently approved antiviral agents
(excluding antiretriviral agents)
1. Acyclovir
A synthetic analog of the purine nucleoside, guanosine, with potent antiviral
activity against herpes simplex viruses type 1 and 2, varicella-zoster virus and
other viruses. After conversion in vivo to the active metabolite acyclovir
triphosphate, acyclovir competitively inhibits viral DNA polymerase, incorporates
into and terminates the growing.
A. Human herpesvirus :
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HSV infection of some neuronal cells does not result in cell death, instead maintained by
cell in a repressed state called latency. Subsequently activation of the viral gene release
is called reactivation
Capsid (icosahedral)
Envelop
Clinical features
1) Oral-Facial Infections: Gingivostomatitis and pharyngitis
- most frequently HSV-1
- vesicles on the hard and soft palate, gingival, tongue and lip.
2) Genital Infections
- most frequently HSV-2
3)
Herpetic Whitlow
HSV infection of the finger
4)
5)
Investigation/Laboratory diagnosis
Serology
IgM & IgG titre from blood & CSF
B. Varicella-zoster virus
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Causes two distinct clinical entities: varicella or chicken pox and herpes zoster or
shingles.
Varicella is the primary illness usually in childhood extremely contagious by an
exanthematous vesicular rash
Zoster is a recurrent manifestaion of latent infection from the dorsal root ganglia
presents dermatomal vesicular rash
Chicken pox
herpes zoster
Investigation/Laboratory diagnosis
1) Mainly clinical
2) Serology EIA using serum by detection of IgM antibodies
C. Cytomegalovirus
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can affect almost every organ of the body, resulting in fever of unknown origin,
pneumonia, hepatitis, encephalitis, myelitis, colitis, uveitis, retinitis, and neuropathy.
infections are frequently associated with salivary glands, infection can also be life
threatening in immunocompromised patients (e.g. patients with HIV, organ transplant
recipients).
Neonates: congenital cytomegalovirus infection
Investigation/Laboratory diagnosis
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D. Influenzavirus A
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Influenza A viruses are classified, based on the viral surface proteins hemagglutinin (HA
or H) and neuraminidase (NA or N)
The type A viruses are the most virulent human pathogens among the three influenza
types and causes the most severe disease. The serotypes that have been confirmed in
humans, ordered by the number of known human pandemic deaths, are:
H1N1 caused "Spanish Flu" in 1918, "Swine flu" in 2009.
H2N2 caused "Asian Flu".
H3N2 caused "Hong Kong Flu".
H5N1 is a pandemic threat.
H7N7 has unusual zoonotic potential.
H1N2 is endemic in humans and pigs.
H9N2, H7N2, H7N3, H10N7.
Investigation/Laboratory diagnosis
Nasopharyngeal specimens are typically more effective than throat swab specimens for
viral isolation, polymerase chain reaction (PCR) and immunofluorescence assays.
E. Human Papillomavirus
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HPV are typically transmitted through sexual contact and infect the anogenital region.
Two vaccines are available to prevent infection by some HPV types, Gardasil, marketed
by Merck and Cervarix, marketed by GlaxoSmithKline.
Infections associated with HPV types are listed in Table.
Disease
HPV type
Common warts
Plantar warts
Flat warts
Anogenital warts
Genital cancers
2, 7
1, 2, 4, 63
3, 10
6, 11, 42, 44 and others
Highest risk: 16, 18, 31, 45
Investigation/Laboratory diagnosis
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Papanicolaou smears from cervical scrapings often show cytologic evidence HPV
infection
F. Rotavirus
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the most common cause of severe diarrhoea among infants and young children.
by the age of five, nearly every child in the world has been infected with rotavirus at
least once.
adults are rarely affected.
transmitted by the faecal-oral route.
Investigation/Laboratory diagnosis
G. Coxsackievirus
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I.
Enterovirus 71
one of the major causative agents for hand, foot and mouth disease (HFMD), and is
sometimes associated with severe central nervous system diseases.
Investigation/Laboratory diagnosis
J. Dengue virus
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caused dengue fever may lead to dengue hemorrhagic fever (DHF) and dengue shock
syndrome .(DSS)
a mosquito-borne flavivirus. Mosquitos Aedes aegypti and Aedes albopictus
four distinct serotypes of the dengue virus( dengue-1, dengue-2, dengue-3 and dengue
4)
Investigation/Laboratory diagnosis
The diagnosis of dengue is usually made clinically. The classic picture is high fever with
no localising source of infection, a rash with thrombocytopenia, low platelet and white
blood cell count.
Serology: detection of dengue IgM & IgG in the blood by ELISA.
Culture: only for early stage of infection.
K. Chikungunya virus
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Investigation/Laboratory diagnosis
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L. Rubella virus
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Investigation/Laboratory diagnosis
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Note: The CRS comprises cardiac, cerebral, ophthalmic and auditory defects. Rubella may also
cause prematurity, low birth weight, and neonatal thrombocytopenia, anaemia and hepatitis.
The risk of major defects or organogenesis is highest for infection in the first trimester.
Reverse transciptase : catalyses the reverse transcription of the RNA genome into a
DNA copy, the resulting DNA is called the provirus.
Provirus can integrate into host DNA and remain dormant for weeks, months or even
years without being expressed i.e. it remains latent
reverse transcriptase makes errors relatively frequently and does not have a proofreading mechanism to check for errors, resulted the emergence of HIV mutants .
HIV Classification:
HIV-1
Group M: A, B, C, D, F, G, H, J, K, CRF, URF
Group O: west-central Africa
Group N : rare, a strain discovered in 1998 in Cameroon.
Group P: discovered in a Cameroonian woman in 2009, closely relating to gorilla
simian immunodeficiency virus.
HIV-2
Investigation/Laboratory diagnosis
SEROLOGICAL WINDOW
HIV Antibody
Serological window
HIV RNA
HIV p 24 Antigen
10
20
30
40
50
Days
Infection
* M.P. Bush. AABB 1992
J.B. Jackson. Transfusion.1995
N. Hepatitis B virus
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Liver cirrhosis
Investigation/Laboratory diagnosis
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Reports
HBsAg:
not detected
Anti-HBS:
not detected
i.e. no history of exposure, vaccination needed
HBsAg:
detected
HBeAg:
detected
i.e. HBV infection. If persisted for >6months, hepatitis
B carrier
HBsAg:
not detected
anti-HBs:
>100 mIU/ml
i.e. ? vaccination or natural acquired infection. Anti-HBs 10 mIU/mL is considered as
immunity to HBV infection.
HBsAg:
not detected
anti-HBc:
detected
i.e. in the window period, previous exposure to HBV infection
HBsAg:
detected
anti-HBs:
15 mIU/ml
- concurrently circulating HBsAg & anti-HBs
- anti-HBs has no clinical significant, low level
- found in chronic HBV carrier poor prognosis
N.
Hepatitis C virus
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