Viruses - Key Vignette Clues
Rhinovirus (Picorna)
#1 cause of common cold
Coxsackie A (Picorna: Enterovirus)
*Hand, foot & mouth disease*: oval-shaped vesicles on palms & soles; vesicles and ulcers in oral mucosa Aseptic meningitis Acute lymphoglandular pharyngitis *Common cold*
Measles (Paramyxo)
3 Cs: cough, coryza (swelling of nose) & conjunctivitis - w. photophobia Koplik spots (hypopigmented, irregular oral lesions on anterior buccal mucosa) maculopapular rash from ears down giant cell pneumonia (Warthin-Finkeldey cells)
Kaposi's sarcoma (HHV-8)
AIDS patients w. sarcoma
HSV-1
Above waist Latent in trigeminal ganglion
Ebola (Filo)
Abrupt onset of flu-like symptoms, diarrhea/vomiting, high fever, myalgia. Can progress to DIC, diffuse hemorrhage, shock. *Fatal hemorrhagic fever*
Dengue (Flavi)
Aedes mosquito Break bone fever: rash, muscle & joint pain Can result in dengue hemorrhagic shock
Yellow fever virus (Flavi)
Aedes mosquito High fever, black vomit & jaundice Liver, kidney, heart & GI damage May see Councilman bodies (eosinophilic apoptotic globules) on liver biopsy
Mumps (Paramyxo)
Asymptomatic to bilateral parotitis w. fever, headache & malaise
HSV-2
Below waist Latent in sacral nerve
Coxsackie B (Picorna: Enterovirus)
Bornholm disease Severe systemic disease of newborns *myocarditis*
Fifth disease (erythema infectiosum)
Caused by parvovirus B19 Infection of a pregnant woman in 1st trimester may result in a fetus w. aplastic anemia, leading to non-immune hydrops fetalis
HSV-1 and HSV-2
Cold sores/genital vesicles Keratoconjunctivitis Meningoencephalitis/encephalitis Neonatal disseminated/encephalitis Tzanck smear, Cowdry type A inclusion bodies
St. Louis Encephalitis & West Nile virus (Flavi)
Culex mosquito Encephalitis
HHV-5
Cytomegalovirus (CMV) Latent in mononuclear cells
Shingles (HHV-3)
Elderly w. unilateral vesicular rash that follows dermatome Tzanck smear, Cowdry type A inclusion bodies
HHV-4
Epstein-Barr virus Latent in B cells
Marburg (Filo)
Fatal hemorrhagic fever
Echoviruses (Picorna: Enterovirus)
Fever & rash of unknown origin Aseptic meningitis
Polio (Picorna: Enterovirus)
Fever of unknown origin, aseptic meningitis Flaccid asymmetric paralysis, no sensory loss
Hep E virus (Hepe)
Fulminant hepatitis is in pregnant women
Rotavirus (Reo)
Gastroenteritis Acute diarrhea during winter, esp. in day care centers, kindergartens Decreased absorption of Na and loss of K
Rubella (Toga)
German measles Erythematous rash begins on face, progresses to torso
Haparnavirus, HAV (Picorna)
Hep A
Hepatitis B
Hepadna Acute fever, malaise, headache, anorexia, vomiting, dark urine & jaundice
CMV (HHV-5)
Heterophile-negative mononucleosis in children & adults Neonate w. jaundice, hepatosplenomegaly, thrombocytic purpura Owl-eye intranuclear inclusion bodies in biopsy
HIV (Retro)
Homosexual male, IV drug user, sexually active adult Decreasing CD4 count Opportunistic infection Fatigue, weight loss, lymphadenopathy, low-grade fever
HHV-6 (Roseola)
Infant w. fever -> lacy body rash
RSV (Paramyxo)
Infants/*preemies* - bronchiolitis and necrosis of bronchioles atypical pneumonia (low fever, tachypnea, tachycardia, expiratory wheezing)
Parainfluenza (Paramyxo)
Infants: croup (an upper airway infection that blocks breathing and has a distinctive barking cough)
HHV-8
Kaposi'a sarcoma
Rabies (Rhabdo)
Patient bitten by bat or dog Influenza-like prodrome: hydrophobia, hallucination, coma, death
Hantavirus (Orthomyxo)
Patient w. acute respiratory distress (cough, myalgia, dyspnea, tachycardia, pulmonary edema & effusion, hypotension) Four-corner region Exposure to rodent excrement Spring/early summer incidence
SARS-CoV (Corona)
Patient w. acute respiratory distress - atypical pneumonia Dry cough, dyspnea & progressive hypoxia Travel to Far East or Toronto Winter/spring peak incidence
Influenza (Orthomyxo)
Patient w. headache, malaise, fever, myalgia & cough
JC (Polyoma)
Progressive multifocal leukoencephalopathy (PML) in AIDS and transplant patients
BK (Polyoma)
Renal disease in AIDS patients
Norwalk virus (Calici)
School-aged child -> adult Acute viral gastroenteritis (non-inflammatory) Watery diarrhea, nausea & vomiting
B19 (Parvo)
School-aged child w. fever & indurated facial rash (*lacy appearance*) Causes (*slapped-cheek rash*) (Fifth disease or erythema infectiosum) Adult w. arthritis & exposure to school-aged children Pregnant woman w. flu-like symptoms -> hydrops fetalis or spontaneous abortion
Chickenpox (HHV-3)
Unvaccinated child w. asynchronous rash Tzanck smear, Cowdry type A inclusion bodies
HHV-3
Varicella zoster virus Latent in dorsal root ganglion
Variola/Smallpox (Pox)
Virus extinct Prodrome of flu-like illness for 2-4 days Synchronous rash begins in mouth, then spreads to face & body within 24 hours Guarnieri bodies (intracytoplasmic inclusions)
HPV (Papilloma)
Warts Cervical intraepithelial neoplasia Biopsy or Pap smear - koilocytic cells
Molluscum contagiosum (Pox)
Young adult (wresting, swim team) Umbilicated warts Eosinophilic cytoplasmic inclusion bodies
EBV (HHV-4)
Young adult with fever, lymphadenopathy, splenomegaly Downey type II atypical lymphocytes reach 70% in blood Heterophile (monospot) positive
Adenovirus (Adeno)
Young adults & young military recruits: acute respiratory disease (ARD) Swimmers & shipyard workers: nonpurulent conjunctivitis Daycare: viral gastroenteritis