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Virology (MD PhD) (Fach) / Günthard (Lektion)

Günthard

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  • Epstein Barr virus (EBV) Transmission Saliva (potentially rarely also sexually transmitted) 
  • Epstein Barr virus (EBV) Epidemiology Children: 50% with IgG (10% with acute infectious mononucleosis)Adults: 95% with IgG (50-70% with acute infectious mononucleosis)
  • Epstein Barr virus (EBV) Diagnosis 1. Serology (VCA IgM/IgG, EBNA) 2) DNA PCR (plasma) 3) Histology (e.g. Colon, Lung Tissue, Brain) 4) „Monospot“ 5) differential blood count (large monocytic cells: not specific)
  • Epstein Barr virus (EBV) Disease - immunocompetent Acute infectious mononucleosis: - High fevers, fatigue- pharyngitis- lymphadenitis- Splenomegaly - hepatitis- Guillain-Barré Syndrome (muscle weakness as a result of damage to the peripheral nervous system)- Duration of symptoms 1-4 weeks- fatigue may persist for several months Not distinguishable from acute CMV/HIV 
  • Epstein Barr virus (EBV) Disease - immunodeficient Lymphoproliferative disorders (LPD) - Burkitt lymphoma - Posttransplant LPD (Bone Marrow/solid organ) - Non-Hodgkin Lymphoma (AIDS) - Primary CNS lymphoma (AIDS) - Hairy leukoplasia (wart-like disease on tongue, HIV)- Nasopharyngeal carcinoma - hemophagocytosis 
  • Epstein Barr virus (EBV) Treatment - Symptomatic and anti-inflammatory - Antiviral? (Acyclovir in desperate cases) - Lower immunosuppression if possible (e.g. cART instead of HAART in AIDS patients)
  • Frühsommer Menigo-Enzephalitis Virus (FSME) Transmission - Ixodes ricinus (gemeiner Holzbock) = tick
  • Frühsommer Menigo-Enzephalitis Virus (FSME) Epidemiology - Switzerland up to 1000m - 10-30% IgG positive in endemic regions - 1:25 – 1:200 of seropositives developed symptoms (mostly adults) 
  • Frühsommer Menigo-Enzephalitis Virus (FSME) Diagnosis 1) clinical (two phases!) 2) Incubation 3-7 days 3) Serology (IgG/IgM) 4) PCR from cerebrospinal fluid (often negative when neurological symptoms start) 
  • Frühsommer Menigo-Enzephalitis Virus (FSME) Disease biphasic 1) Flu-like symptoms lasting about a week (in 2/3 of patients recovery) 2) In one third of patients, after one week remission: fever, meningits and encephalitis, myelitis, or radiculitis 
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  • Frühsommer Menigo-Enzephalitis Virus (FSME) Complications - Severe neurological sequelae (1-3% mortality in adults) - more severe, the older people are 
  • Frühsommer Menigo-Enzephalitis Virus (FSME) Treatment - No specific treatment! - Prevention by active vaccination and by tick protection 
  • Measles Transmission - Droplets/Aerosol (Isolation), man to man - Incubation Time (5-21 days) 
  • Measles Diagnosis 1) clinical (prodromi/rash/Koplik spots in cheeks)  2) Incubation 5-21 days  3) Serology (IgM/IgG) 
  • Measles Disease biphasic 1) Fever, light aversion, conjunctivitis, pharyngitis, cough - fever can go away for a few days 2) Rash (starts behind ears), adults often pneumonia and hepatitis(maculopapular exanthem)
  • Measles Treatment - No specific treatment! - Prevention by active vaccination (MMR) 
  • Dengue Virus - Type 1-4 (-5!) - Arthropode Born (ARBO Virus) - Hemorrhagic fever - Emerging infection (climate change) - Tropical / subtropical regions 
  • Dengue Virus Transmission - Aedes aegypti (mosquito) - daytime feeder - breeds in containers that collect rainwater
  • Dengue Virus Diagnosis 1) clinical 2) Serology (IgG/IgM) [3) PCR Plasma] 
  • Dengue Virus Epidemiology - South-east Asia- Northern Australia- subsaharan Africa- South and Latin America - Traveler‘s disease 
  • Dengue Virus Disease - Very acute onset (2-7 days incubation time) - High fevers, chills, severe headaches, bone pain, conjunctival congestion, sometimes cough, and respiratory symptoms - rash with island sparing - many patients have mild disease Complications: Dengue hemorraghic fever (re-infection with a different subtype, superantigen, usually worse) 
  • Dengue Virus Treatment No specific treatment No vaccine 
  • Human Cytomegalovirus (HCMV) Transmission 1) Saliva (sexually) 2) pre/perinatally 3) Blood products 
  • Human Cytomegalovirus (HCMV) Epidemiology Adolescents: 40% IgG-positive Adults: 70-90% IgG-positive
  • Human Cytomegalovirus (HCMV) Diagnosis 1) Serology (IgM and IgG) 2) DNA PCR (plasma) 3) Histology (e.g. Colon, Lung Tissue, Brain) 
  • Human Cytomegalovirus (HCMV) Disease - immunocompetent - Often no symptoms - In some cases unspecific febrile illness (unspecific viral syndrome, not to be distinguished from acute EBV or HIV) 
  • Human Cytomegalovirus (HCMV) Disease - immunodeficient - AIDS defining illness- Transplant patients- Long-term critically ill patients- Chemotherapy (relatively rare) --> Endorgan Disease (Colitis, Retinitis, Myelitis, Enzephalitis, Pneumonitis)--> Systemic CMV disease 
  • Human Cytomegalovirus (HCMV) Treatment - Lower immunosuppression if possible - Ganciclovir/Phoscarnet/Cidofovir (Induction, maintenance) 
  • HHV-8 or KSHV Transmission 1) sexual transmission (MSM, bisexual), heterosexual transmission uncommon 2) HHV-8 secreted in oral saliva (but not sperms etc.) 3) potentially by blood products 4) horizontally in children (sub-saharan Africa) 5) Transplantation (infected organ, in 30% of KS in transplant patients, rest by reactivation as in HIV) 
  • HHV-8 or KSHV Diagnosis 1) clinically 2) Histology 3) DNA PCR 
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  • HHV-8 or KSHV Epidemiology - MSM 30-60% HHV-8 positive - Overall 2-3% of Population (Europe/USA) - in Africa higher
  • HHV-8 or KSHV Disease - immunocompetent Acute infection: very rare (fevers can occur)
  • HHV-8 or KSHV Disease - immunodeficient - Kaposi‘s sarcoma (red papular skin lesions) - Primary effusion lymphomas (= body cavity lymphoma) - Multicentric castelmans‘s disease (lymph node hyperplasia)
  • HHV-8 or KSHV Treatment - Improve CD4 count (antiviral therapy) - Liposomal doxorubicin (chemotherapy drug) - Superficial lesions (kryotherapy) - In rare cases, irradiation 
  • Varizella Zoster Virus (VZV) Diagnosis 1) clinically (chickenpox/zoster) 2) virus culture 3) DNA PCR 
  • Varizella Zoster Virus (VZV) Epidemiology - Highly contagious - First case in household mostly milder than secondary cases - Mostly in childhood (milder than in adulthood) - Up to 99% of adults are VZV positive in northern hemisphere (70-79 years old) 
  • Varizella Zoster Virus (VZV) Disease - immunocompetent 1) Acute infection: Chicken pox. Mostly in childhood 2) Reactivation: Zoster (Gürtelrose), mostly in elderly people and in immunocompromised
  • Varizella Zoster Virus (VZV) Disease - immunodeficient - Multisegmented zoster - Enzephalitis - Disseminated herpes zoster 
  • Varizella Zoster Virus (VZV) Treatment - Chickenpox (generally none) - Severe cases and immunosuppressed ones: acyclovir Prevention:- Isolation in Hospital- Attenuated live vaccine- passive immunotherapy (VZIG), pregnant women, immunosuppressed patients: Improve CD4 count (antiviral therapy) 
  • Human Parvovirus B-19 Transmission 1) respiratory tract (close contact) 2) Mother to child 3) Blood products (very rare) 
  • Human Parvovirus B-19 Diagnosis 1) Serology (IgM and IgG) 2) clinical (only in a minority of cases) 3) DNA PCR from blood 
  • Human Parvovirus B-19 Epidemiology - Adolescents: 35-60% IgG-positive - Adults: 75-90% IgG-positive (> age 50) 
  • Human Parvovirus B-19 Disease - immunocompetent - 25-50% no symptoms- Erythema infectiosum (fifth disease, slapped cheek) in children  Adults:- Fevers, lymphadenopathy- Arthralgias and Arthritis 
  • Human Parvovirus B-19 Disease - severe - Hydrops fetalis (mother to child infection, due to fetal anemia) - Immunosuppressed: chronic and life-threatening infections - Pure red cell aplasia (aplastic crises e.g. in HIV-infected patients) 
  • Human Parvovirus B-19 Treatment - No specific treatment - Non-steroidal antiinflammatory drugs - IVIG (Intravenous immunoglobulin) in immunosuppressed patients 
  • Hepatitis C Diagnosis 1) clinical (difficult because often very mild or absent symptoms) 2) Serology (IgG) 3) DNA PCR (plasma) 4) Histology (liver biopsy) 
  • Hepatitis C Epidemiology - adults: 0.5-2% in developed world - IDUs (injection drug users): up to 90% - HIV/HCV co-infected: 30-40% 
  • Hepatitis C Disease - Acute (often no symptoms, 80%) - Chronic (often asymptomatic for years, liver cirrhosis, hepatic carcinoma, cryoglobulinemia) 
  • Hepatitis C Specifics - High viral diversity! (Quasispecies) - Subtypes:1a/1b (Europe)2/345 (South Africa) 6 (Asia)  --> Reinfection!
  • Hepatitis C Treatment - Peg-Interferon-α and Ribavirin (PAST) (~50% sustained virological response (SVR), lots of side effects) - Protease inhibitors (only for genotype I) (PAST) (~ 70-80% SVRI), lots of side effects - Directly acting agents: 95-100% sustained virological response (very few side effects) - More to come   

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