11 Virus

  • coin machine: Positive-sense mechanism of replication, uses host RNA polymerase. Insert coin and that's it
  • All + sense RNA replicate in cytoplasm, since host mRNA in cytoplas

Picorna Overview

  • "Peak" = Picornaviridae
  • orange color, day time: Positive-sense RNA virus
  • statue of David: Naked virus

  • poops: Fecal-oral transmission
  • coin machine: Positive-sense mechanism of replication, uses host RNA polymerase. Insert coin and that's it
  • ticket booth continuous ticket: Polyprotein product made at first
  • ticket booth broken tickets: Cleaved portion of polyprotein
  • All + sense RNA replicate in cytoplasm, since host mRNA in cytoplasm

  • A: heptatitis A with A tag; liver spot: Hepatosplenomegaly
  • B: birds = entero
  • C: common cold = rhino; mud on rhino face: Upper respiratory infection

  • enter aviary: Enteroviruses
  • flamingos: Poliovirus
  • cockatiels bird: Coxsackie A and B
  • echoing mockingbirds: Echovirus

  • cage shaped like head, 100% aseptic sign: Aseptic meningitis (nonbacterial)
  • no added sugar: CSF glucose levels normal
  • no organisms: CSF shows no organisms
  • source of protein: CSF has elevated protein levels
  • child with helmet: Children most affected by meningitis

Polio

  • flamingo: polio
  • orange color, sun: Positive-sense RNA virus
  • Pico baby = picornavirus
  • David: Naked virus
  • flamingo stable in acid pool: Acid stable; fecal oral transmission so must be resistant to acid

  • eggs (virus) with orange plants (villi) : "Replication occurs in lymphoid tissue, such as Peyer's Patches"
  • sign: Peyer's patches, 2-3 weeks onset
  • bird with large anterior horn: Affects the anterior horn of the spinal cord

  • flamingo bent leg: Asymmetrical paralysis, hyporeflexia
  • flamingo smoke air: Respiratory insufficiency
  • kid with helmet: Causes aseptic viral meningitis

  • no treatment
  • sulky teenager with skull: Salk = killed vaccine, bypass GI tract via injection. Only forms IgG, no IgA
  • savin' a life: Sabin = live-attenuated vaccine
  • A in life: IgA response on top of IgG

Cox

  • Cockatoos: cox virus
  • Pico counterpart = picornavirus
  • Positive-sense RNA virus
  • Naked virus

  • Coxsackie A
  • bird seeds in mouth, hand, foot: Hand, foot and mouth disease
  • red bird seeds: Red vesicular rash
  • kid with helmet: Aseptic viral meningitis
  • girl in bathing suit: Infection common in summer months

  • Coxsackie B
  • floppy bags of seeds: Dilated cardiomyopathy
  • zoo keeper grab: "Devil's grip = Bornholm's disease / pleurodynia" Strange sharp pain in unilateral lower chest
  • supportive

Rhino

  • Naked virus
  • Positive-sense RNA virus
  • pico rhino: picorna virus
  • lemon: Acid labile; can't resist stomach acid and can't transmit fecal-oral
  • tent with different colors: Rhinovirus has many different serotypes, no vaccine

  • sneezing, please wash hands sign: Transmitted through fomites (dirty hands)

  • mud on small rhino face/neck: Causes URI/common cold
  • camera: rhinovirus attach to host molecule ICAM-1
  • 33: Grows best in cooler temperatures - around 33 degrees Celsius, upper respiratory tract where air flows better

Hep A

  • Positive-sense RNA virus
  • Pico = picornavirus
  • A tag: "Hippo"titis A
  • Naked virus

  • hippo stable on rock: Acid stable, make it through stomach
  • poop: Fecal-oral transmission
  • Contaminated water is a common source of infection in DEVELOPING countries
  • USA shellfish and fishing: Uncooked shellfish a common source of infection in DEVELOPED countries
  • backpack: Commonly seen in travelers to endemic areas

  • inactivation sign: How to inactivate Hepatitis A

  • Often silent but can cause acute
  • yellow guy: Jaundice, especially in adults
  • young kid not wearing yellow: Anicteric hepatitis in young children and infants
  • smoker: Smokers with Hep A develop an aversion to smoking
  • 1 month sign: One month duration of symptoms
  • limit: Self-limiting
  • no carrying: No carrier state

  • tranquilizer gun: Inactivated vaccine

Calicivirus

  • Calicivirus: Cali Sea
  • Positive-sense RNA virus
  • Naked virus
  • 1 long ticket: Produces one long polyprotein that is cleaved by viral proteases

  • Narwhal: Norovirus is the most common Calicivirus
  • lots of kids: Young children = outbreaks common in daycare centers and schools
  • cruise scene: Responsible for over 90% of outbreaks of diarrheal illness on cruises
  • shellfish buffet: Consumption of shellfish is associated with Norovirus
  • liquid brown mud: Causes explosive watery diarrhea

Flavivirus

  • New flavors: Flaviviruses
  • Positive-sense RNA virus
  • toga party with clothes: Enveloped virus
  • single straw: Non-segmented RNA

  • dengue
  • yellow fever
  • west nile
  • Hep Sea: Hepatits C

  • swimming dinghy: Dengue fever
  • Dengue Mosquitoes = Aedes Egyptei
  • 2 broken oars: Type 2 dengue = break-bone fever
  • RBC's: Thrombocytopenia and hemorrhagic fever
  • blue/red ribbons off of boat look like blood vessels: Dengue fever can lead to renal failure, septic shock
  • floating down river: supportive treatment only

  • yellow buffalo: Yellow fever
  • Aedes mosquito
  • liver shaped spot: Jaundice
  • buffalo hump: Backache
  • red stool: Bloody stool
  • large syringe: Live-attenuated vaccine for travelers

  • Nile bird: West Nile virus = reservoir in birds
  • Mosquito vector
  • red turbans: Encephalitis
  • neck brace: Meningitis, rigidity
  • floppy drooping neck: Flaccid paralysis
  • flapping wings: Seizures
  • passed out bird: Coma
  • floating down: no treatment

Hep C

  • FLAVIful Hep C = Hepatitis C is a Flavivirus
  • Positive-sense RNA virus
  • robe: Enveloped
  • C ring and out in sea: Hep C
  • "C" ear ring = Hep C

  • bloody water: Transmitted in blood products (blood transfusion in 70s/80s)
  • needle in ear: Needle-sharing and needle sticks are sources of transmission

  • liver spot: Hepatitis
  • yellow hippo: Jaundice
  • sign, C for chronic: 60-80% of Hepatitis C infections will become a chronic infection.
  • multicolored tent: Antigenic variability of envelope
  • no viewing: Hepatitis C lacks proof-reading, which is what leads to its antigenic variation
  • "No 3'- 5' exonuclease activity (proofreading) in the viral RNA polymerase"

  • ALT rise/fall with tide: Acute infection characterized by a large rise and then fall in ALT. Usually will fall by 6 months.
  • salt precipitate on shore. 5 sided: Cryoglobulins seen in Hepatitis C. Cryoglobulins are serum proteins containing IgM that precipitate in cooler temperatures.

  • corral: Can lead to fibrosis/cirrhosis
  • crab: Can lead to Hepatocellular Carcinoma

  • ribs: Ribavirin used in combination therapy for Hepatitis C
  • walky talky with a, interference: Interferon Alpha (part of combination therapy)
  • meat cleaver: Can also use protease inhibitors to treat Hepatitis C.

Togavirus

  • Positive-sense RNA virus
  • scene outside nucleus dome: replication in cytoplasm
  • toga: Toga viruses are enveloped

  • man hitting head on arbor: Arbovirus
  • Rubies = rubella

Arbovirus

  • man hitting head on arbor: Arbovirus
  • mosquitos around head: Arthropod vector
  • compass and horse: Western, Eastern, and Venezuelan equine encephalitis
  • turban: Encephalitis, neuro symptoms

Rubella

  • Rubies = rubella
  • aka German measles
  • water droplets: Spread via respiratory droplets
  • torches: transplacental transmission, TORCHeS infection
  • tickets: Long polyprotein precursor cleaved by viral proteases
  • immigrant: usually unvaccinated

  • child king: Rubella is a childhood exanthem (rash)
  • grabbing back of neck: tender Postauricular and occipital lymphadenopathy
  • rubies falling off crown: Rash starts at the head and moves downward

  • open aqueductus arteriosis: Patent ductus arteriosis
  • sculptures with creepy blank eyes: Congenital cataracts
  • covering ear: Sensorineural deafness
  • blue gems: Purpuric blueberry muffin rash
  • yellow babies: Jaundice

  • kneeling adults: Arthritis in adults

  • live puppet show for children: MMR = live-attenuated vaccine
  • pregnant puppy without syringe: Pregnant women should not be given MMR vaccine
  • 200 ticket count: HIV positive patients should receive the vaccine only if CD4 count is over 200

Corona

  • Positive-sense RNA virus
  • crown: "Corona" virus
  • robe: Encapsulated virus
  • spiraling road: Helical capsid
  • sneezing: Causes the common cold
  • red/enflamed respiratory tract: SARS or MERS = acute bronchitis can lead to acute respiratory distress syndrome
  • king out in field with castle (nucleus) in back: replicate in cytoplasm

Retrovirus

  • wizard: HIV
  • staph: immunocompromised
  • orange sun: + sense RNA
  • robe: enveloped
  • 2 orange dragon hat: diploid RNA positive virus. 2 RNA in each virion
  • replicate in nucleus

  • round 24h sundial: gag gene = p24, capsule for RNA strands
  • pipe: env protein = gp 41, 120
  • pipe in mouth: gp41 transmembrane protein
  • pipe in pocket sticking out: gp120 outer protein
  • reverso transcriptum book: pol = reverse transcriptase

  • transmission: sexual and blood
  • torches: TORCH infection

  • busted jail: initially infects macrophages
  • esquire helper with 4 buckles: infects helper T cells, especially CD4
  • CCR5/CXCR4 flag: gain entry via CCR5 early and CXCR4 late

  • 1st esquire crying and touching back neck: prodrome involves flu/mono like symptoms with cervical LAD
  • mouth open: enlarged tonsils
  • pearls around waist: LAD
  • red faced/sweaty: fever
  • sleeping esquire: latent period lasting up to 10 years
  • Steep cliff with 200 ft: steep drop below CD4 200 develops into AIDS
  • AIDS also defined if above 200 but with aids defining illness

  • large crab marching up to archers in stronghold (B cells in lymphoma): AIDS can cause Diffused Large B Cell Lymphoma

  • She elf with ELiSA shield standing in front: ELISA screening for antibody
  • tabestry: confirmed with Western blot for antibody
  • vertical transmission: neonates will always be positive because has maternal antibody; use HIV RNA/DNA nucleic acid amplification to find virus itself
  • TCR used to track progression of CD count

  • pregnant elf swinging nucleotide shaped chain: NRTI backbone of retroviral therapy; nucleotide analog, halts prolongation
  • Z: zidovudine, good for pregnancy, labor, post partum
  • He Elf holding mace without chain: NNRTI, doesn't incorporate in to chain but still inhibit transcriptase
  • both elves standing on book: both inhibit reverse transcriptase
  • esquire can't pull sword: protease inhibitors
  • Mare on hind legs crushing esquire: CCR5 inhibitor

RNA Negative Sense

  • RNA must be transcribed to + sense first, thus must bring own RNA polymerase
  • all are single stranded except Reovirus
  • All replicate in cytoplasm, except orthomyxovirus
  • BOAR: bunya, ortho, arena, reovirus are segmented. Only segmented can have antigenic shift

Orthomyxovirus

  • Orthodontist: ortho
  • yellow moon: Negative-sense RNA
  • Warm / Orange hues = RNA
  • robe: Enveloped
  • octopus repilcates in helmet: Orthomyxovirus is the ONLY RNA virus that replicates in the nucleus.
  • Octopus legs = 8 segments in Orthomyxovirus
  • water droplets: respiratory transmission

  • Heme aquarium and stuck together RBC's: Hemagglutinin (HA) is a virulence factor for Orthomyxovirus. Glycoprotein, binds SA on RBC, cause RBC to clump together
  • plants in tank: Sialic acid residues - carbohydrate chains to which the virus attaches.
  • Scalpel missing from Nurse Assistant tray= symbol for Neuraminidase (NA), a virulence factor of Influenza
  • scalpel: Neuraminidase (NA) cleaves silica acid to free newly formed viral particles
  • shell with 2 M ridges: M2 Protein = Allows virus to manipulate pH for viral uncoating.

  • Doktor drift: Antigenic Drift = point mutations that cause seasonal flu or epidemics. "DoKtor" has a point mutation. Slightly altered each year.
  • Night Shift with falling H with reassortment at bottom: Antigenic Shift = segment rearrangements in HA and NA that cause Pandemics. The "H" in "Shift" has fallen to become recombined with other Influenza H's and N's.

  • Fluoride on wall: Influenza is an Orthomyxoviridae
  • ABC: Influenza types A, B and C. A is most important with shift and drift. B is just drift

  • Multicolored curtains: Antigenic variation
  • Multicolored suckers: H1, H2, H3, etc. Determines cell tropism and which cells can bind to
  • NA and HA from swine, avian and human influenza viruses can undergo reassortment during antigenic shifts to form pandemics.

  • Manta dining = A-Manta-Dine (Amantadine) is an M2 protein inhibitor, thus preventing viral uncoating.
  • Tammy V = Tamiflu (Oseltamivir / Anamivir ). V = "-vir"
  • Tamiflu (Oseltamivir) is an NA inhibitor (Tammy is putting caps on the NA scalpels)

  • Dec - Feb most common infection. Give vaccine in October to allow immune buildup

  • syringe impale pirate skeleton: Killed vaccine given IM
  • bubbles up through nose: Live vaccine is intranasal

  • lung chest: pneumonia major complication. (Case: elderly with flu develop productive cough later)
  • Golden staff: Staph Aureus is a common pathogen in superimposed bacterial pneumonia. However, Strep Pneumo is still the most common!
  • influenza associated with Guillou-Barre syndrome. Boy grabbing leg of bear to illustrate ascending paralysis.

  • aspirin uncouples oxidative phosphorylation in hepatic mitochondria: extensive damage
  • Sun with rays: "Rays = Reye's syndrome "
  • fat cow with liver spot: "Fatty liver seen in Reye's syndrome"
  • man with turban: "Encephalitis seen in Reye's syndrome"
  • sun: fever
  • "Beware of giving Aspirin to a child with influenza. They may develop Reye's syndrome."

Paramyxovirus

  • paranormal mixer: paramyxovirus
  • Negative-sense RNA virus
  • ghost robes with envelopes: Enveloped virus
  • sprinkler droplets: Transmitted by respiratory droplets

  • live puppet show: MMR: Live attenuated vaccine
  • "Don't give MMR to pregnant women."

  • Weasels represent Measles, aka rubeola
  • Mumps mummy: mumps
  • RSV tombstone: Respiratory Syncytial Virus
  • parainfluenza seal: Seal bark cough seen in Croup (caused by parainfluenza virus)

  • Weasels represent Measles
  • Ruby-"Hola" dress = Rubeola

"4 C's of prodrome (early symptoms) = Cough, Coryza, Conjunctivitis, Koplik Spots"

  • coughing: cough
  • drippy nose: coryza (runny/stuffy nose)
  • red eyes
  • blue and white candies: Koplik spots = bluish white spots on buccal mucosa
  • sweating: High Fever (>40, 104), last 4 days

late:

  • rash on lady on right: Rash starts after initial symptoms
  • Rubies falling off: Rash starts from face and moves downward
  • solid flamingo dress: Rash becomes confluent (starts as dots and blend in together)

  • pneumonia tie: pneumonia is a complication of measles
  • turban, tales of SSPEnce: Subacute Sclerosing Panencephalitis (SSPE) (inflammation and sclerosing of brain caused by persistent measles). Child with measles or unvaccinated develop neuro (myoclonus, personality change, seizures, ataxia, coma) symptoms 15 years later.

  • sticky hands: Fusion protein is a virulence factor for measles, multinucleated giant cell found in lymphoid tissues
  • yummy tentacles with stuck together berries: Hemagglutinin (HA) is a virulence factor for measles
  • No NA

  • A party hat: Vitamin A reduces morbidity and mortality from measles. Pneumonia especially.

  • Mumps mummy: mumps
  • big cheeks: Parotitis
  • single orchid: Orchitis, inflammation of epididymis, unilateral
  • neck brace: Meningitis
  • pancreatitis

  • tentacles: Hemagglutinin (HA) = = mumps virulence factor
  • mummy child sticky hands: Mumps vaccine, Fusion protein = mumps virulence factor
  • scalpel: Neuraminidase (NA) = mumps virulence factor

  • RSV tombstone: Respiratory Syncytial Virus
  • little ghosts: infants < 6 months
  • G shaped worm: Virus attaches to G protein to infect epithelial cells
  • sticky hand: Fusion protein = RSV virulence factor

  • bronchiole trees: RSV causes bronchiolitis and pneumonia in infants.
  • Ribs: Ribavirin (nucleoside analog) for adults,but not for children or pregnant women.
  • extra pale baby with IgG toy: Give Palivizumab to premature and high-risk infants. Palivizumab (IgG shaped rattle) is an antibody against the RSV fusion protein (slime)

  • parainfluenza seal: Seal bark cough seen in Croup (caused by parainfluenza virus)
  • wind blowing in: Inspiratory stridor seen in Croup
  • church with steeple: Patients with Croup will often have a "steeple sign" on Chest X-ray, narrowing of subglottic region
  • Three wolves = Parainfluenza has all THREE virulence factors. HA, NA and Fusion proteins.

  • aka laryngotrachealbronchitis.

Rhabdovirus

  • rabies

  • Negative-sense
  • Orange / warm hues = RNA virus
  • hoodie: Enveloped
  • bullet collar: Bullet-shaped virus
  • curly tail: Helical capsid

  • bats: #1 carrier in US
  • fox, skunk, rodents: Carriers
  • transmission: bite

  • nicotine cigar: Nicotine = Nicotinic Acetylcholine Receptors. The receptors in the motor-endplate that the virus binds to during infection
  • cola cans: Acetyl Cola = Acetylcholine. Rhabdovirus binds to Nicotinic Acetylcholine Receptors
  • socket behind dog: Binds to receptors in the postsynaptic motor endplate
  • bullets travel backwards to car: Virus moves retrograde along peripheral nerve
  • puppy replicas underneath car motor: Replicates in motor neurons
  • roots of trees behind tree: Virus spreads to Dorsal Root Ganglia

  • thief sweating with turban: Encephalitis and Fever
  • drooling/foaming at mouth

  • pink spots on Integrity boat: Negri Bodies = Eosinophilic (pink), cytoplasmic inclusions
  • bungee cords on purkinje looking tree: Negri bodies seen in Purkinje cells (Bungee cords)
  • red in tree: Eosinophilic negri bodies in Purkinje cells
  • seahorse: Negri bodies in hippocampus (greek for seahorse)
  • pyramid canopy: Negri bodies in Pyramidal cells in Hippocampus

  • key chains with antibody keys: Passive immunization for post-exposure prophylaxis. Give Rhabdovirus immunoglobulins
  • tranquilizer gun with skull: Killed vaccine for active immunity

Filovirus

  • Soccer field: filovirus
  • Negative-sense RNA virus
  • orange lights: RNA (orange) with helical capsid
  • jersy: Enveloped virus

  • bats: Bats may be the viral reservoir
  • monkeys: Possibly transmitted via primates
  • medics on field: Transmitted to healthcare workers through exposure to bodily fluids

  • marburg player: Marburg virus
  • goal: Ebooooooooooooooooooola, Ebola

  • sweating goalie: Fever
  • rashes: Petechial rash
  • pool of blood: Hemorrhagic fever
  • blood spots: End-organ failure within days
  • lightning bolt: Hemorrhagic (hypovolemic) shock

Bunyavirus

  • Paul bunyan = bunyavirus
  • Orange hues = RNA virus
  • Negative sense
  • robe: Enveloped. Gold = Specifically obtained from Golgi body
  • 3 tree trunks: Segmented virus with three segments (BOAR)
  • 3 stumps with rings inside: circular segments

  • arbo in background: Arboviruses (California Encephalitis and Rift Valley Fever)
  • rodents: Hantavirus are roden born

  • Haunted = Hantavirus
  • mouse running away: Reservoir is the deer mouse
  • mouse feces: Transmitted via rodent urine/feces
  • sweaty chest: Pulmonary capillary leak
  • kidney water bottle leaking without top: Pre-renal azotemia
  • sweating with blood dripping: Hemorrhagic fever

  • California rift valley school: California Encephalitis, Rift Valley Fever
  • mosquitos: Arboviruses are transmitted by the Aedes Mosquito
  • shaking: Seizures
  • turban: Encephalitis
  • Myalgia/fever

Arenavirus

  • Arena: arenavirus
  • Negative-sense RNA virus
  • robe: Enveloped virus
  • 1 sword in each hand, ambidextrous: Ambisense = can encode its RNA both positively and negatively
  • spiral banners: Helical capsid
  • Two rings = 2 RNA segments (BOAR)

  • sandy floor: Grainy appearance on electron microscopy

  • rodents: Rodent transmission

  • LCV sign: Lymphocytic choriomeningitis virus (LCV)
  • turban: Meningoencephalitis
  • sweating: Fever
  • fire spear: Inactivated by heat
  • reflect shield: Inactivated by irradiation

Reovirus

  • Rio Grande: Reovirus
  • David: Naked virus
  • DNA rope: Double-stranded RNA virus, no positive or negative sense
  • 11 boats = 11 RNA segments (BOAR)

  • rotating propeller: Rotavirus
  • welcome to colorado sign with tick: Colorado tick virus

  • brown water: Rotavirus causes watery diarrhea
  • Nine SPeed 4 stroke: NSP4 toxin causes secretory diarrhea
  • Chlo-rider: NSP4 toxin causes chloride permeability, water secretion
  • snow caps: More common in winter months
  • kid contestants: Children are at risk for rotavirus infection, especially in daycare
  • #1 sign: Rotavirus = #1 cause of severe diarrhea in infants and children
  • water bottle: Treatment = oral rehydration

  • welcome to colorado sign with tick: Colorado tick virus
  • kid sweating, vomiting, on ground: Colorado tick virus causes myalgia, fevers, and vomiting

  • live camera crew with mic to mouth: Live-attenuated oral vaccine
  • telescope: Vaccine side effect = intussusception: telescoping of the bowel, due to enlargement of Peyer's Patches

  • Enveloped virus
  • Double-stranded, linear DNA virus
  • Intranuclear inclusion bodies (Cowdry bodies)
  • Vertical transmission (TORCHeS infection)
  • Gingivostomatitis is first sign of HSV-1
  • Herpes labialis, or "cold sores"
  • Keratoconjunctivitis
  • Serpiginous corneal ulcers on Fluorescein slit lamp exam
  • HSV-1 causes temporal lobe encephalitis
  • #1 cause of sporadic encephalitis in the United States
  • HSV-1 latent in trigeminal ganglia
  • "Dew drops on a rose petal" appearance = vesicles on an erythematous base
  • Herpetic whitlow, more common in dentists (HSV-1 and 2)
  • Erythema multiforme may appear 1-2 weeks after infection
  • Painful inguinal lymphadenopathy associated with HSV-2
  • HSV-2 latent in sacral ganglia
  • HSV-2 may cause aseptic meningitis in adolescents and adults
  • Tzanck smear = multinucleated giant cells
  • Acyclovir or valacyclovir to prevent breakouts

DNA Virus

EBV

  • Ebstein Bar: EBV, also Herpes virus
  • blue color: Epstein-Barr virus = double-stranded DNA virus
  • EBV causes mono
  • saliva girl: Primarily transmitted through saliva, kissing disease
  • Cytomegalovirus and Epstein-Barr virus are members of the Herpesviridae family. All viruses within this family contain an icosahedral core surrounded by a lipoprotein envelope and have double-stranded, linear DNA. These are the only viruses to acquire their envelopes by budding from the nuclear membrane.

  • sleeping archer: EBV remains latent in B cells
  • must B 21: EBV envelope glycoprotein binds CD21 (c3b) to infect B cell

  • sweating: Fever
  • grabbed neck: Tender posterior lymphadenopathy (can also be generalized)
  • cow spot: Splenomegaly more common
  • drooling: Pharyngitis (severe sore throat) and tonsillar exudates
  • fatigue

  • strep pneumo: children, adolescence; mono: asymptomatic in young age (late teens, adults symptomatic)
  • Pencil drawing rash: If mistakenly given amoxicillin or ampicillin for strep pneumo, can develop maculopapular rash

  • Owl sitting in weeds: Hodgkin lymphoma = Reed-Sternberg cells that look like "owl's eyes"
  • AA bar kid with swelling jaw: Endemic or African Burkitt lymphoma = large jaw lesion and swelling
  • crab pinching nose: Nasopharyngeal carcinoma associated with Asian patients with EBV
  • bearded man with cane: Oral hairy leukoplakia in HIV patients, non-cancerous lesion; can't scrape off

left: CMV; right: EBV

  • reacting T knight with 8's: Reactive cytotoxic CD8+ T cells (Downey, or atypical cells) lymphocytosis, seen on blood smear (stain on cloth)
  • Atypical lymphocytes good response. Kills B cells and prevent lymphoma.
  • dart sport: Monospot test = rapid diagnosis. Clumped IgM

  • No contact: Warn patients to not participate in contact sports, splenic rupture

CMV

  • Mega lo prices: Cyto"Mega-Lo" Virus
  • Blue = DNA virus, replicate inside nucleus, since host DNA inside nucleus
  • Herpes figure: Member of the Herpesvirus family
  • Cytomegalovirus and Epstein-Barr virus are members of the Herpesviridae family. All viruses within this family contain an icosahedral core surrounded by a lipoprotein envelope and have double-stranded, linear DNA. These are the only viruses to acquire their envelopes by budding from the nuclear membrane.

  • sleeping man next to archers and knights: Can be latent in B and T cells (mononuclear cells)
  • cages: Can be latent in macrophages
  • cane waking up: reactivation in immunosuppressed

  • blood, sexual contact, saliva, breast milk
  • torches: TORCHeS infection
  • Also in utero

  • blueberry muffin: Blueberry muffin rash in congenital CMV (thrombocytopenia causing petechiae rash, same as rubella)
  • cataracts
  • cow: Hepatosplenomegaly and Jaundice in Congenital CMV
  • covering ears: Sensorineural hearing loss
  • large helmet symbol: Ventriculomegaly in Congenital CMV
  • milk on ventricles: Periventricular calcifications
  • slipping man: Seizures in Congenital CMV due to changes in brain structure
  • 80-90% off: 80-90% of those with congenital CMV infections are asymptomatic

  • balloon animal in water: Hydrops fetalis, heart failure leading to severe edema with fluid accumulation in multiple compartments, spontaneous abortion. In utero transmission
  • Number 1 shirt: CMV is the #1 cause of mental retardation due to a viral infection. Also #1 cause of virus induced hearing loss.

  • Butcher: Transplant patients
  • Butcher coughing with lung stains: Transplant patients at risk for CMV pneumonia
  • old man with cane: CMV in AIDS patients
  • Charity drive 50c: CMV infections in CD4 counts < 50
  • pizza pie: CMV retinitis causes "pizza pie" appearance on ophthalmoscopy; blind spot, flashing lights
  • conveyer belt with ulcers: Linear ulcerations scene in CMV esophagitis (singular, deep, linear compared to multiple/shallow in herpes)
  • bags with red dots: CMV colitis

  • "Owl O cereal = Owl's eye inclusions seen in CMV"
  • no mo spot: Monospot test will be negative in patients with CMV and mononucleosis-like symptoms

left: CMV; right: EBV

  • Green for G, cans only: Ganciclovir
  • UL97 sticker: UL97 Kinase gene mutation leads to resistance to Ganciclovir, use foscarnet
  • Fast car net = Foscarnet for patients with resistance to Ganciclovir

  • mom screaming: Pharyngitis seen in CMV infection in adults (similar to the pharyngitis of mono)
  • Lymphadenopathy seen in CMV infection in adults (similar to the lymphadenopathy seen in mono)

Varicella

  • zeus: zoster
  • Hermes: Herpes virus family
  • robe: Enveloped Virus

  • torch: Vertical transmission (TORCHeS infection)
  • kid squirting droplets: Respiratory droplet transmission

  • doll with small arms, stuffing coming out, blind: Congenital varicella syndrome = limb hypoplasia, cutaneous dermatomal scarring, blindness
  • chicken: Chicken pox
  • shingles on roof: Herpes zoster, or shingles, is reactivated form

  • doll with small arms, stuffing coming out, blind: Congenital varicella syndrome = limb hypoplasia, cutaneous dermatomal scarring, blindness

  • chicken: Chicken pox
  • sweating and touching head: Fever and headache
  • kid squirting droplets: Respiratory droplet transmission
  • rose petals: Vesicular "dew drops on a rose petal" lesions, same as herpes simplex
  • All ages: Lesions in different stages of healing (smallpox: all at same stage)
  • tank: Tzanck smear = multinucleated giant cells

  • adult: Pneumonia complication
  • red turban with cane: Encephalitis, especially in immunocompromised

  • live show: Live-attenuated vaccine for children
  • live show > 60: Live-attenuated zoster vaccine recommended for adults over 60 (don't give to immunocompromised)
  • Max occupant 200: HIV patients with CD4 count >200 may be given shingles vaccine

  • recycle bin: Acyclovir treatment for children ages 12+, adults, and immunocompromised
  • family: Famciclovir treatment for shingles
  • violet cycling bin: Valacyclovir also treatment for shingles

  • sleeping on tree roots in back: Latent in dorsal root ganglia
  • elderly with canes: Reactivation occurs with emotional stress, aging, or immunocompromised state

  • shingles on roof: Herpes zoster, or shingles, is reactivated form
  • rose petals on shirt: Herpes zoster, or shingles, has "dew drop on a rose petal" appearance with dermatomal distribution (trave down sensory ganglia on reactivation)
  • If rash crosses midline = disseminated VZV in immunocompromised patients
  • stabbed in chest: Extremely painful rash
  • shirtless with lightning bolt: Postherpetic neuralgia = pain after rash subsides
  • red eye patch: Herpes zoster opthalmicus = vision loss possible if V1 affected (case: immunocompromised with vesicles on forehead and blindness in one eye)

Roseola

  • Roses: Roseola
  • 6th disease: 6th in childhood (Rosixola)
  • Hermes with 6: HHV-6 is in the Herpes Virus family = double-stranded DNA virus
  • Esquire with 4: HHV6 infects CD4 cells, can cause immunosuppression

  • child in arm: Affects children ages 6 months to 2 years, and is usually self limiting
  • sweating with 4 suns: Roseola, or exanthema subitem, is characterized by a high fever generally lasting 4 days, followed by rash
  • trembling esquire: Children with roseola can develop febrile seizures (very high fever > 104)
  • blue fire cooled and lace covering everything but face: After fever, a diffuse lacy body rash occurs that spares the face

Kaposi

  • Kate's posies: Kaposi
  • Hermes with 8: Human herpes virus 8 causes Kaposi sarcoma
  • HHV-8 = double-stranded DNA virus

  • sexual contact, kissing, especially gay men
  • AIDS ribbon and cane: AIDS and immunosuppressed associated with Kaposi sarcoma
  • "Russian rhododendrons" = higher incidence in Russian men
  • "African azaleas" = endemic in areas of Africa

  • Veg Fertilizer: Causes dysregulation of VEG-F
  • red hose and red branching plant: Causes proliferation of vasculature (color)
  • flower petals on nose/extremities: Causes violacious lesions on nose, extremities, and mucous membranes; maybe present as patch, plaque, macule, nodule
  • colon covering: Lesions can be found within the GI tract (spindle shaped cells)
  • violet flowers on ceiling: Kaposi lesions most commonly occur on the hard palate
  • B rating and medieval archer: Infection of B cells can cause Primary Effusion Lymphoma (B-cell lymphoma)

  • lepard: Differentiate Kaposi (lymphocytic infiltrate, viral) from bacillary angiomatosis caused by bartonella (neutrophilic infiltrate, bacterial)

Polyomavirus

  • JC (julius caesar) and BK (Brutus's knife)

  • politicians: Polyomavirus
  • round room: Circular, double-stranded DNA virus
  • David: Naked virus

  • Julius Caesar with toga falling off = JC virus
  • PML: JC virus causes Progressive Multifocal Leukoencephalopathy (PML)
  • senator count 200 and cane: JC virus reactivated in HIV positive patients with CD4 count <200
  • white crown leaves: Non-enhancing multifocal brain lesions in white matter (toxoplasma: ring enhancing lesions)
  • white leaves: white matter affected
  • peeling legs of table: Leukoencephalopathy is a demyelinating process
  • pts die in a few months

Nonenhancing:

Enhancing:

  • "Brutus's knife = BK virus"
  • organs falling: BK nephropathy in transplant patients
  • stabbed in flank: BK virus causes nephropathy
  • BK fountain with red stream: BK virus causes hemorrhagic cystitis (hematuria)

Papillomavirus

_

  • Anogenital cancers
  • These characters represent HPV 1-4
  • Verruca vulgaris = common wart
  • Represent HPV 6 and 11
  • Laryngeal papillomatosis - caused by HPV 6 and 11
  • Anogenital warts (condyloma acuminata) - from sexual transmission
  • Accumulating bugs in jar = Condyloma Acuminata
  • HPV 16, 18, 31, 33 increase risk for anogenital cancers
  • HPV 16 (age at which people can drive)
  • HPV 18 (age at which people can vote)
  • E6 gene disrupts P53 tumor suppressor
  • Gardasil an inactivated subunit vaccine covers HPV 6,11,16,18 (all the people enclosed within the fence)
  • Naked virus
  • circular virus
  • Blue colors = DNA virus
  • E7 gene (straw shaped like a 7) disrupts RB tumor suppressor (Root Beer)
  • P53 (the crab cracker) arrests cell cycle at G1/S phase to prevent abherrant replication
  • Koilocytes - atypical cells seen on pap smear
  • Pap smear
  • Immunocompromised (AIDS patients) at risk of developing these cancers

Parvovirus

  • B19 bomber: Parvovirus B19
  • David: Naked virus
  • tiny town: Parvo virus is the smallest DNA virus… what a quaint little town
  • single runway: Single-stranded DNA virus

  • water gun: Respiratory droplet transmission
  • torch: Vertical transmission (TORCHeS infection)

  • balloon baby: Hydrops fetalis in utero, fetal anemia and resulting CHF from heart pumping harder
  • slapped kid with 5 fingers: "Slapped cheek" rash = Fifth's disease, aka erythema infectiosum (low grade fever, then slapped cheek, then rash downward)
  • plane with red on nose and point downward: Lacy rash starts on the face and moves downward
  • adult kneeling on floor: Joint pain, arthritis, and edema in adults
  • communist plane with sickle with plastic bone and web: Aplastic anemia in sickle cell patients, only left is adipocytes (cobweb look)

Adenovirus

  • Lion's den: Adenolions = adenovirus
  • Cool, blue tones = DNA virus
  • Naked virus

  • dripping water: Transmitted in respiratory droplets
  • poop: Fecal-Oral transmission
  • kids: Children commonly affected.
  • Camo = Outbreaks known to occur in military barracks
  • red pool: Public swimming pool outbreaks

  • red cave with lions yarning : most common cause of Tonsilitis / Adenitis
  • hematuria: Adenovirus causes hemorrhagic cystitis
  • red eyes in cave: Adenovirus causes conjunctivitis (pink eye)
  • enteric adenovirus: cause of intussusception

  • camo with gun: Military recruits may be administered a live vaccine.
  • live lions: Live vaccine

Poxvirus

  • boxes: poxvirus
  • blue color: DNA virus
  • dumbells: Dumbell shaped core
  • world's largest: Largest known DNA virus
  • workers make own envelops: Poxviruses make their own envelopes
  • workers stuffing packages: "Poxvirus has a special DNA-dependent RNA polymerase" (RNA polymerase that reads DNA). Only DNA virus that replicates in cytoplasm.

  • map HQ nucleus, G across world: Guarnieri bodies, or inclusion bodies, type B inclusions, are sites of viral replication in the cytoplasm

  • small box: Small pox
  • udder styrofoam unit: Cowpox = contact with infected cow udders
  • snail mail with shell: Molluscum contagiosum = flesh-colored, dome shaped, umbilicated skin lesions

  • small box: Small pox
  • same day shipping: Same age lesions

  • snail mail with shell: Molluscum contagiosum = flesh-colored, dome shaped, umbilicated skin lesions
  • kid with stamps: Umbilicated lesions on trunk in children (dimples in middle)
  • cane: Diffuse molluscum contagiousum infection in adults suggests an HIV infection. Healthy adult has 1 lesion

Hep B

  • Hippies: Hep B
  • Hippo van = Causes hepatitis
  • Hippie Pad: Hepadenavirus family
  • clothes: Enveloped
  • blue colors. Circle of people with incomplete outer circle: Partially double-stranded DNA Virus

  • Hippies outside and inside dome: Intranuclear and Cytoplasmic Replication
  • spell book: Uses a reverse transcriptase. RNA Dependent DNA Polymerase. DNA to single RNA to double DNA. Does not incorporate in host DNA

  • Sex/drugs/rock and roll: Transmitted via sex (HCV rare with sex) and blood products (IV drug use, needle sticks or transfusions)
  • baby with blood: Transmitted during delivery from mixing of blood. Does not cross placenta because large
  • torches: TORCH infection

  • baby 90% cookie: 90% of neonatal infections progress to chronic infections
  • mother 10% cookid: 10% of adult infections progress to chronic infections

  • red beads: Polyarteritis Nodosa
  • rash on body: Rash (purpuric macules). Urticaria vasculitis
  • kneeling: Arthralgias. Serum sickness like syndrome
  • compared with HCV (usually asymptomatic)
  • kidney boxes: Kidney disease (secondary to Polyarteritis Nodosa)
  • thick knots in string: Associated with membranous glomerulonephritis
  • 3 string: Associated with membranoproliferative glomerulonephritis. Tram track appearance
  • rock liver and crab: Chronic infection may lead to cirrhosis and hepatocellular carcinoma.

  • high ALT ball: ALT rises during acute infection and then falls after symptomatic phase is over in chronic. In viral hepatitis ALT>AST. (alcoholic AST > ALT)
  • deflated ALT: ALT often normal in neonatal hepatitis

  • S: HbSAg (Hep B Surface antigen) = First marker of infection
  • E: HBeAg (Hep b E antigen) - Sign of increased infectivity.
  • flat tire: Symptomatic phase. Patient will be positive for HBsAg or HBeAg.
  • C in window: Anti-HBc (Core antibodies) - First detectable antibody. On the window, signifying that it may be the only antibody/antigen detectable during the window period.
  • E: Anti-HBe
  • S: Anti-HBs (Surface antibodies). If positive, indicative of recovery from infection. No longer infection, acute or chronic
  • Blue around syringe: An immunized person will only test positive for Anti-HBs (surface antibodies). Will not be positive for Anti-HBc or Anti-HBe.

  • orange children with clothes and moon: Hep D = RNA negative, enveloped
  • headbands: Circular genome

  • mom attaching antigen: Hep D requires HBsAg to be infectious
  • kid holding dad's hand: Co-infection of Hep D and Hep B occurs at same time. Better prognosis.
  • kid on shoulder: Hep D after Hep B infection. Superinfection = Worse prognosis (as noted by grimacing father).

  • lamb: Lamivudine
  • elf with nucleoide: "NRTI's"
  • interference: Interferon alpha
  • keys to hippie van: IgG antibodies - Give at risk infants anti-hep b immunoglobulins along with passive vaccination.