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ADENOVIRUSES ADENOVIRIDAE
Species Adenovirus Type 1 Adenovirus Type 2 Adenovirus Type 41 (you get the drift) linear double-stranded DNA genome icosahedral capsid (multifaceted protein coat) non-enveloped (naked, not surrounded by a cell membrane) humans (only reservoir, not normal flora - as are all other viruses) direct contact (person-to-person) droplet nuclei (respiratory spray) fecal-oral contaminated fomites (indigestible objects)
Characteristics
Reservoirs Transmission
Diseases
The Common Cold - fever, rhinitis leading to rhinorrhea and pharyngitis leading to sore throat - may complicate by progressing to laryngotracheobronchitis and viral interstitial pneumotitis - primarily occurs in children - caused by Adenovirus infection of the nasopharynx Keratoconjunctivitis - pink eye - keratitis and conjunctivitis leading to conjunctival hyperemia and preauricular lymphadenomegaly - caused by Adenovirus infection of the eye Pharyngoconjunctival Fever - fever, rhinitis, pharyngitis, conjunctival hyperemia and preauricular lymphadenomegaly - caused by simultaneous Adenovirus infection of the pharynx and eye Gastroenteritis - abdominal pain vomiting and watery diarrhea - caused by Adenovirus infection of the GI tract
Treatment
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Herpes Labialis - cold sore - painful ulcerating encrustating vesicles at the site of initial infection - primarily occurs on the lips and/or the bucca - spontaneously resolves in < 2 weeks - may complicate by reactivation of latent HSV-1 in the trigeminal ganglia ! reoccurrence of the painful ulcerating encrustating vesicles at the site of initial infection - may also complicate by HSV-1 viremia ! meningoencephalitis - caused by HSV-1 infection of the oral cavity Herpetic Keratitis - ulcerating coalescing vesicles on the cornea - may complicate by causing corneal scarring ! blindness - caused by HSV-1 infection of the eye Herpetic Whitlow - painful ulcerating encrustating vesicles on the cuticles of the fingernails - caused by HSV-1 infection of the skin
Treatment
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Diseases
Herpes Genitalis - painful ulcerating encrustating vesicles at the site of initial infection - primarily occurs on the external genitalia, periorally (if oral intercourse) or perirectally (if anal intercourse) - spontaneously resolves in < 2 weeks - may complicate by reactivation of latent HSV-2 in the lumbosacral paravertebral ganglia ! reoccurrence the of the painful ulcerating encrustating vesicles at the site of initial infection - may also complicate by HSV-2 viremia ! meningoencephalitis - caused by HSV-2 infection of the skin Herpetic Keratitis - see above Herpetic Whitlow - see above TORCH Syndrome - spontaneous abortion, stillbirth, premature birth, birth defects, viral interstitial pneumonitis, acute viral hepatitis leading to jaundice, hepatosplenomegaly, generalized lymphadenomegaly and neonatal meningoencephalitis leading to mental retardation, seizures, deafness and blindness - caused by intrauterine HSV-2 infection ! HSV-2 viremia
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101. CYTOMEGALOVIRUS
continuation of 100
Infectious Mononucleosis-Like Syndrome - analogous to infectious mononucleosis (see 102) - may complicate by reactivation of latent CMV in the paravertebral ganglia ! viral interstitial pneumonitis, acute viral hepatitis, and retinitis leading to blindness (primarily occurs in immunocompromized) - caused by CMV infection of the nasopharynx ! CMV viremia TORCH Syndrome - see 100
Treatment
indirect viral DNA polymerase inhibitors direct viral DNA polymerase inhibitors
continued in 102
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Infectious Mononucleosis - kissing disease - fever, headache, severe pharyngitis, splenomegaly and generalized lymphadenomegaly - spontaneously resolves in < 6 weeks - primarily occurs in children and young adults - caused by EBV infection of the B lymphocytes in the nasopharynx ! dissemination of EBV in virtually every lymphoid organ - may progress to burkitt lymphoma and/or nasopharyngeal carcinoma (see below) Burkitt Lymphoma - malignant neoplasm of B lymphocytes - primarily occurs in children - caused by persistent EBV infection of B lymphocytes Nasopharyngeal Carcinoma - malignant neoplasm of the pharyngeal epithelium - primarily occurs in adults - caused by reactivation of latent EBV ! EBV infection of the pharyngeal epithelial cells
none in particular
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Diseases
Varicella - chickenpox - fever and headache ! erythematous ulcerating encrustating vesicles beginning on the face and trunk and then progressing towards the extremities (as well as mucous membranes) - spontaneously resolves in < 1 week - may complicate by VZV viremia ! viral interstitial pneumonitis and meningoencephalitis (primarily occurs in immunocompromized) - caused by VZV infection of the nasopharynx ! VZV viremia - may progress to zoster (see below) Zoster - shingles - reoccurrence of the erythematous ulcerating encrustating vesicles on 1 or more dermatomes - occurs years after initial infection - caused by reactivation of latent VZV in the paravertebral ganglia
Treatment
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Roseola Infantum - exanthema subitum - high fever and cervical lympadenomegaly ! erythematous rash on the neck and trunk - spontaneously resolves in < 1 week - may complicate by reactivation of latent Roseola Virus in the paravertebral ganglia ! infectious mononucleosis-like syndrome (see 102), viral interstitial pneumonitis, acute viral hepatitis and meningoencephalitis (primarily occurs in immunocompromized) - primarily occurs in infants - caused by Roseola Virus infection of the nasopharynx ! Roseola Virus viremia indirect viral DNA polymerase inhibitors
Treatment
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Variola Virus
Serotypes Reservoirs Transmission Diseases Variola Major Variola Minor humans (only reservoir, now extinct due to vaccination (!)) direct contact droplet nuclei
Variola - smallpox - high fever and maculopapular rash beginning on the pharynx, oral cavity, face and extremities and then progressing towards the trunk - > 25% mortality - caused by Variola Virus infection of the nasopharynx ! Variola Virus viremia none in particular
Treatment
Vaccinia Virus
Reservoirs Transmission Diseases humans (only reservoir) parenteral (injectional)
Vaccinia - ulcerating encrustating vesicles at the site of initial infection - may complicate by Vaccinia Virus viremia ! meningoencephalitis (primarily occurs in immunocompromized) - caused by inoculation of Vaccinia Virus into the skin (vaccination against Variola Virus, see above) none in particular
Treatment
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Diseases
Molluscum Contagiosum - multiple medium-sized nodules with central invagination (umbilication) at the site of initial infection - spontaneously resolves in < 2 years - caused MCV infection of the skin none in particular
Treatment
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Diseases
Acute Viral Hepatitis - moderate hepatic damage ! fever, abdominal pain, vomiting, hepatomegaly and jaundice - spontaneously resolves in < 3 months none in particular
Treatment
CALICIVIRIDAE
Characteristics linear positive-sense single-stranded RNA genome icosahedral capsid non-enveloped
continued in 106 - 10 -
HEPEDNAVIRIDAE
Characteristics circular double-stranded DNA genome icosahedral capsid enveloped
Diseases
Acute Viral Hepatitis - see 105 - may progress to hyperacute viral hepatitis (see below) Hyperacute Viral Hepatitis - fulminant hepatitis - severe hepatic damage ! hepatic failure leading to generalized edema, ascites, coagulopathies and hepatic encephalopathy - primarily occurs in immunoreactive Chronic Persistent Viral Hepatitis - moderate hepatic cirrhosis ! fever, abdominal pain, vomiting, hepatomegaly and jaundice - primarily occurs in moderately immunocompromized - may progress to chronic aggressive viral hepatitis (see below) Chronic Aggressive Viral Hepatitis - severe hepatic cirrhosis ! hepatic failure (see above) - primarily occurs in severely immunocompromized Chronic Carrier State - no hepatic damage and no hepatic cirrhosis (asymptomatic) Hepatocellular Carcinoma - malignant neoplasm of the hepatocytes
Treatment
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DELTAVIRIDAE
Characteristics linear negative-sense (needs a viral RNA-dependent RNA polymerase to replicate) single-stranded RNA genome icosahedral capsid non-enveloped (needs HBV envelope to become infective (!))
FLAVIVIRIDAE
Characteristics linear positiv-sense single-stranded RNA genome icosahedral capsid enveloped
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Influenza Virus
Serotypes Influenza Virus Type A Influenza Virus Type B Influenza Virus Type C humans animals (primarily birds, only Influenza Virus Type A) direct contact droplet nuclei zoonotic (only Influenza Virus Type A)
Reservoirs Transmission
Diseases
Influenza - the flu - high fever, headache, myalgias, rhinitis leading to rhinorrhea, pharyngitis leading to sore throat, and non-productive cough - may complicate by progressing to laryngotracheobronchitis and viral interstitial pneumonitis (primarily occurs in elderly and immunocompromized) - caused by Influenza Virus infection of the nasopharynx viral uncoating and assembly inhibitors viral exit inhibitors
Treatment
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Mumps Virus
Reservoirs Transmission Diseases humans (only reservoir) direct contact droplet nuclei
Mumps - fever, headache and parotitis leading to painful swollen jaws - may complicate by progressing to meningoencephalitis (primarily occurs in children) - may also complicate by progressing to orchidoepididymitis and/or oophoritis (primarily occurs in teenagers and adults) - primarily occurs in children - caused by Mumps Virus infection of the nasopharynx ! Mumps Virus viremia none in particular
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Rubeola - measles - high fever, rhinitis, pharyngitis, conjunctivitis, non-productive cough and generalized lymphadenomegaly ! medium-sized erythematous rash with bluish-white centers on the bucca and tongue (kopliks spots) ! erythematous maculopapular rash beginning on the face and then progressing descendingly to the feet - spontaneously resolves in < 2 weeks - may complicate by causing viral interstitial pneumonitis, infective myocarditis and meningoencephalitis - primarily occurs in children - caused by Rubeola Virus infection of the nasopharynx ! Rubeola Virus viremia - may progress to subacute sclerosing panencephalitis (see below) Subacute Sclerosing Panencephalitis - SSPE - stupor and myclonic spasms in awaken state (spasms normally occurring in healthy as they fall asleep you know what Im talking about) ! deafness, blindness and seizures ! coma - > 25% mortality - occurs years after initial infection - caused by reactivation of latent Rubeola Virus
Treatment
none in particular
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Rubella Virus
Reservoirs Transmission Diseases humans (only reservoir) direct contact droplet nuclei
Rubella - german measles - low-grade fever, rhinitis, pharyngitis, conjunctivitis and painful postauricular and suboccipital lymphadenomegaly ! small erythematous rash on the soft palate (forchheimers spots) ! erythematous maculopapular rash beginning on the face and then progressing descendingly to the feet - spontaneously resolves in < 1 week - may complicate by progressing to infective arthritis - analogous to rubeola (see 109) - primarily occurs in children - caused by Rubella Virus infection of the nasopharynx ! Rubella Virus viremia TORCH Syndrome - see 100
Treatment
none in particular
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Rotavirus
Reservoirs Transmission humans (only reservoir) direct contact fecal-oral contaminated water contaminated food contaminated fomites
Diseases
Gastroenteritis - most common cause of gastroenteritis - abdominal pain, vomiting and severe watery diarrhea (> 20 liter per day) - may complicate by leading to hypovolemia ! hypovolemic shock ! death - may also complicate by Rotavirus viremia ! meningoencephalitis - primarily occurs in children - caused by Rotavirus infection of the GI tract oral fluid and electrolyte replacement
Treatment
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Norwalk Virus
Characteristics Diseases same reservoirs, transmission and treatment as Rotavirus (see 111)
Gastroenteritis - see 99 - primarily occurs in teenagers and adults - caused by Norwalk Virus infection of the GI tract
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Poliovirus
Reservoirs Transmission humans (only reservoir) direct contact droplet nuclei fecal-oral
Diseases
Inapparent Poliomyleitis - low-grade fever, headache and pharyngitis - spontaneously resolves in < 1 week - primarily occurs in children - caused by Poliovirus infection of the nasopharynx - may progress to non-paralytic poliomyelitis and/or paralytic poliomyelitis (see below) Non-Paralytic Poliomyleitis - meningitis leading to high fever, vomiting and nuchal rigidity - spontaneously resolves in < 1 week - primarily occurs in children - caused by Poliovirus viremia ! Poliovirus infection of the meninges Paralytic Poliomyleitis - asymmetric flaccid paralysis ! muscular atrophy and loss of myotatic reflexes (stretch reflexes) - may complicate by flaccid paralysis of the respiratory muscles ! death - primarily occurs in teenagers and adults - caused by Poliovirus infection of the peripheral motor neurons
none in particular
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Diseases
The Common Cold - see 99 - may complicate by CAV viremia ! meningoencephalitis - caused by CAV infection of the nasopharynx - may progress to herpangina (see below) Herpangina - high fever and painful ulcerating erythematous vesicles on the pharynx - caused by progression of the common cold (see above) - may progress to hand-foot-and-mouth disease (see below) Hand-Foot-and-Mouth Disease - high fever and painful ulcerating erythematous vesicles on the bucca and tongue as well as on the palms and soles - caused by progression of herpangina (see above)
Treatment
none in particular
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Diseases
The Common Cold - see above - may complicate by CBV viremia ! meningoencephalitis, infective myocarditis and acute pericarditis - caused by CBV infection of the nasopharynx - may progress to pleurodynia (see below) Pleurodynia - bornholm disease - high fever, headache and intercostal striated muscle necrosis leading to severe pain during inspiration (pleuritic pain) - caused by progression of the common cold (see above)
Treatment
none in particular
Echovirus
Reservoirs Transmission humans (only reservoir) direct contact droplet nuclei fecal-oral
Diseases
The Common Cold - see above - may complicate by Echovirus viremia ! meningoencephalitis, infective myocarditis and acute pericarditis - caused by Echovirus infection of the nasopharynx Keratoconjunctivitis - see 99 - caused by Echovirus infection of the eye Gastroenteritis - see 99 - primarily occurs in infants - caused by Echovirus infection of the GI tract
Treatment
none in particular
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Rabies Virus
Reservoirs Transmission Diseases humans animals (primarily dogs, cats and bats) direct contact zoonotic
Furious Rabies - fever, headache and neuralgia at the site of initial infection ! encephalitis leading to delirium, psychosis and bursts of furious rage, and severe pharyngeal spasms upon drinking (hydrophobia) leading to foaming of the mouth ! symmetric flaccid paralysis and seizures ! coma and respiratory center dysfunction - > 90% mortality rate (within 2 weeks (!)) - most common - caused by Rabies Virus infection of wounds ! retrograde migration of Rabies Virus through sensory neurons into the CNS Apathetic Rabies - fever, headache and neuralgia at the site of initial infection ! encephalitis leading to insomnia, stupor and apathy ! symmetric flaccid paralysis and seizures ! coma and respiratory center dysfunction - > 90% mortality rate (within 2 weeks (!)) - caused by Rabies Virus infection of wounds ! retrograde migration of Rabies Virus along sensory neurons into the CNS
Treatment
none in particular
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Reservoirs Transmission
Diseases
Variant Creutzfeldt-Jakob Disease - vCJD - (bovine spongiform encephalopathy, BSE, mad cow disease, in cattle) - cerebral and cerebellar granulovacoular degeneration ! chronic progressive encephalopathy leading to insomnia, stupor, apathy, myclonic spasms in awaken state (see 109), and finally coma - 100% mortality (in less than 2 years (!)) - caused by Prion viremia ! Prion accumulation in the CNS none in particular
Treatment
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Diseases
Kaposi Sarcoma - malignant neoplasm of vascular smooth muscle - caused by KSHV viremia ! KSHV infection of vascular smooth muscle cells none in particular
Treatment
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PAPOVAVIRIDAE
Characteristics circular double-stranded DNA genome icosahedral capsid non-enveloped
Diseases
Common Cutaneous Warts - verrucae vulgaris - painless superficial medium-sized rough hyperkeratinized nodules at the site of initial infection - primarily occurs on the hands and fingers (as well as on the feet) - caused by HPV infection of the skin - may progress to deep palmo-plantar warts (see below) Deep Palmo-Plantar Warts - myrmecias - painful deep medium-sized rough hyperkeratinized pigmented nodules at the site of initial infection - primarily occurs on the feet and toes (as well as on the hands) - caused by progression of common cutaneous warts (see above) ! HPV invasion of the dermis Anogenital Warts - condyloma acuminata - multiple small papules coalescing to form a large cauliflower-like lesion at the site of initial infection - primarily occurs on the external genitalia or perirectally (if anal intercourse) - caused by HPV infection of the skin Cervical Intraepithelial Neoplasia - CIN - benign neoplasm of the cervix - caused by HPV infection of the cervix - may progress to cervical carcinoma (see below) Cervical Carcinoma - malignant neoplasm of the cervix - caused by progression of cervical intraepithelial neoplasia (see above)
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Treatment
topical liquid nitrogen (if common cutaneous warts, deep palmoplantar warts and/or anogenital warts)
RETROVIRIDAE
Characteristics linear diploid (2 exact copies) positive-sense single-stranded RNA genome complex capsid enveloped
Diseases
Tropical Spastic Paraparesis - HTLV-1 associated myelopathy - skeletal muscle spasms and generalized striated muscle asthenia (including external urethral and external rectal sphincters) leading to incontinence - caused by HTLV-1 viremia ! HTLV-1 infection of the CNS Acute T-Lymphocytic Leukemia - malignant neoploasm of T lymphocytes - caused by HTLV-1 viremia ! HTLV-1 infection of T lymphocytes
Treatment
none in particular
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118. ARBOVIRUSES (YELLOW FEVER VIRUS AND TICK-BORNE ENCEPHALITIS VIRUSES) FLAVIVIRIDAE
Characteristics see 106
Yellow Fever - fever, headache and myalgias (primarily of the lower back) ! toxic acute tubular necrosis leading to intrarenal acute renal failure and uremia, and acute viral hepatitis leading to jaundice and coagulopathies - > 40% mortality - caused by YFV viremia none in particular
Treatment
TOGAVIRIDAE
Characteristics see 110
Western Equine Encephalitis - WEE - meningitis leading to high fever, vomiting and nuchal rigidity, and encephalitis leading to delirium, stupor and seizures ! coma - < 10% mortality - caused by WEEV viremia
- 27 -
Treatment
none in particular
Eastern Equine Encephalitis - EEE - analogous to WEE (see above) - > 60% mortality - caused by EEEV viremia
Venezuelan Equine Encephalitis - VEE - analogous to WEE (see above) - < 20% mortality - caused by VEEV viremia
BUNYAVIRIDAE
Characteristics linear segmented (3 segments) negative-sense single-stranded RNA genome helical capsid enveloped
California Encephalitis - analogous to WEE (see above) - < 1% mortality - caused by CEV viremia - 28 -
119. ROBOVIRUSES (HANTAAN VIRUS, MARBURG AND EBOLA VIRUSES, LASSA AND LCM VIRUSES) BUNYAVIRIDAE
Characteristics see 118
Diseases
Hantavirus Pulmonary Syndrome - HPS - fever, headache and myalgias (primarily of the lower back) ! alveolar capillary endothelial damage leading to adult respiratory distress syndrome (ARDS) - > 80% mortality (in < 1 week (!)) - caused by Hantavirus viremia (primarily of the pulmonary circulation) Hantavirus Hemorrhagic Fever with Renal Syndrome - HFRS - fever, headache and myalgias (primarily of the lower back) ! disseminated capillary endothelial damage leading to hemorrhages in the skin and mucous membranes, and toxic acute tubular necrosis leading to intrarenal acute renal failure and uremia - < 10% mortality - caused by Hantavirus viremia (primarily of the systemic circulation)
Treatment
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FILOVIRIDAE
Characteristics linear negative-sense single-stranded RNA genome helical capsid enveloped
Marburg Virus
Reservoirs Transmission Diseases humans animals (primarily primates) direct contact zoonotic
Marburg Hemorrhagic Fever - fever headache and myalgias (primarily of the lower back) ! disseminated capillary endothelial damage leading to hemorrhages in the skin, mucous membranes as well as other organs ! multiple organ failure - > 25% mortality - caused by Marburg Virus viremia none in particular
Treatment
Ebola Virus
Characteristics Diseases same reservoirs, transmission and treatment as Marburg Virus (see above)
Ebola Hemorrhagic Fever - analogous to marburg hemorrhagic fever (see above) - > 90% mortality (!) - caused by Ebola Virus viremia
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ARENAVIRIDAE
Characteristics linear segmented (2 segments) negative-sense single-stranded RNA genome helical capsid enveloped
Lassa Virus
Reservoirs Transmission humans animals (primarily rodents) direct contact zoonotic aerosolized contaminated food contaminated fomites
Diseases
Lassa Fever - analogous to marburg hemorrhagic fever (see above) - < 1% mortality - caused by Lassa Virus viremia indirect viral DNA polymerase inhibitors (believe it or not (!))
Treatment
Diseases
Lymphocytic Choriomeningitis - LCM - fever, headache and myalgias ! meningoencephalitis (see 119) - < 1% mortality - caused by LCMV viremia none in particular
Treatment
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Diseases
Erythema Infectiosum - slapped-cheek disease - erythematous rashes of the cheeks as well as on the trunk and extremities - may complicate by infection of the bone marrow ! aplastic anemia ! transient aplastic crisis (primarily occurs in infants, immunocompromized or if already anemic) - spontaneously resolves in < 1 week - primarily occurs in children - caused by Human Parvovirus B19 viremia none in particular
Treatment
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121. VIROLOGY AND LABORATORY DIAGNOSIS OF AIDS 122. EPIDEMIOLOGY AND SPREAD OF AIDS RETROVIRIDAE
Characteristics see 117
Diseases
Acquired Immunodeficiency Syndrome - AIDS - infectious mononucleosis-like syndrome (see 102) ! immunodeficiency leading to a torrent of opportunistic bacterial, viral, fungal protozoal and helmithic superinfections, as well as a torrent of malignant neoplasms - may complicate by HIV infection of both the central and peripheral nervous system ! encephalopathies, myelopathies and peripheral neuropathies (AIDS dementia complex) - 100% mortality (eventually (!)) - caused by HIV viremia ! HIV dissemination in virtually every lymphoid organ ! HIV infection of helper T lymphocytes indirect viral reverse transcriptase inhibitors direct viral reverse transcriptase inhibitors viral protease inhibitors
Treatment
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123. CONGENITAL VIRAL INFECTIONS (RUBELLA AND CMV, DIAGNOSIS AND PREVENTION) 124. IMMUNOSUPPRESSIVE CONDITIONS, TRANSPLANTATION AND VIRAL INFECTIONS, PREVENTION 125. NOSOCOMIAL VIRAL INFECTIONS, EXAMPLES FOR TRANSMISSION OF RESPIRATORY, ENTERIC AND BLOODBORNE VIRUSES
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