11 Virus

RNA Positive Sense

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• 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

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• "Peak" = Picornaviridae

• orange color, day time: Positive-sense RNA virus

• statue of David: Naked virus

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• 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

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• A: heptatitis A with A tag; liver spot: Hepatosplenomegaly

• B: birds = entero

• C: common cold = rhino; mud on rhino face: Upper respiratory infection

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• enter aviary: Enteroviruses

• flamingos: Poliovirus

• cockatiels bird: Coxsackie A and B

• echoing mockingbirds: Echovirus

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• 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

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• 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

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• 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

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• flamingo bent leg: Asymmetrical paralysis, hyporeflexia

• flamingo smoke air: Respiratory insufficiency

• kid with helmet: Causes aseptic viral meningitis

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• 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

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• Cockatoos: cox virus

• Pico counterpart = picornavirus

• Positive-sense RNA virus

• Naked virus

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• 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

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• 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

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• supportive

Rhino

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• 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

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

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• 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

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• Positive-sense RNA virus

• Pico = picornavirus

• A tag: "Hippo"titis A

• Naked virus

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• 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

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• inactivation sign: How to inactivate Hepatitis A

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• 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

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• tranquilizer gun: Inactivated vaccine

Calicivirus

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• Calicivirus: Cali Sea

• Positive-sense RNA virus

• Naked virus

• 1 long ticket: Produces one long polyprotein that is cleaved by viral proteases

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• 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

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• New flavors: Flaviviruses

• Positive-sense RNA virus

• toga party with clothes: Enveloped virus

• single straw: Non-segmented RNA

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• dengue

• yellow fever

• west nile

• Hep Sea: Hepatits C

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• 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

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• yellow buffalo: Yellow fever

• Aedes mosquito

• liver shaped spot: Jaundice

• buffalo hump: Backache

• red stool: Bloody stool

• large syringe: Live-attenuated vaccine for travelers

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• 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

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• 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

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• bloody water: Transmitted in blood products (blood transfusion in 70s/80s)

• needle in ear: Needle-sharing and needle sticks are sources of transmission

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• 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"

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• 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.

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• corral: Can lead to fibrosis/cirrhosis

• crab: Can lead to Hepatocellular Carcinoma

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• 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

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• Positive-sense RNA virus

• scene outside nucleus dome: replication in cytoplasm

• toga: Toga viruses are enveloped

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• man hitting head on arbor: Arbovirus

• Rubies = rubella

Arbovirus

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• 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

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• 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

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• 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

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• 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

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• kneeling adults: Arthritis in adults

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• 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

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• 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

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• 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

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• 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

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• transmission: sexual and blood

• torches: TORCH infection

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• 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

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• 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

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

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• 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

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• 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

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• 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

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• BOAR: bunya, ortho, arena, reovirus are segmented. Only segmented can have antigenic shift

Orthomyxovirus

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• 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

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• 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.

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• 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.

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• 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

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• 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.

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• 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)

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

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• syringe impale pirate skeleton: Killed vaccine given IM

• bubbles up through nose: Live vaccine is intranasal

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• 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.

[_](reye's syndrome cause and symptoms)..

• 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

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• paranormal mixer: paramyxovirus

• Negative-sense RNA virus

• ghost robes with envelopes: Enveloped virus

• sprinkler droplets: Transmitted by respiratory droplets

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• live puppet show: MMR: Live attenuated vaccine

• "Don't give MMR to pregnant women."

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• 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)

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• 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)

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• 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.

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• 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

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

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• Mumps mummy: mumps

• big cheeks: Parotitis

• single orchid: Orchitis, inflammation of epididymis, unilateral

• neck brace: Meningitis

• pancreatitis

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• tentacles: Hemagglutinin (HA) = = mumps virulence factor

• mummy child sticky hands: Mumps vaccine, Fusion protein = mumps virulence factor

• scalpel: Neuraminidase (NA) = mumps virulence factor

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• 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

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• 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)

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• 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.

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• aka laryngotrachealbronchitis.,

Rhabdovirus

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• rabies

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• Negative-sense

• Orange / warm hues = RNA virus

• hoodie: Enveloped

• bullet collar: Bullet-shaped virus

• curly tail: Helical capsid

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• bats: #1 carrier in US

• fox, skunk, rodents: Carriers

• transmission: bite

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• 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

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• thief sweating with turban: Encephalitis and Fever

• drooling/foaming at mouth

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• 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

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• key chains with antibody keys: Passive immunization for post-exposure prophylaxis. Give Rhabdovirus immunoglobulins

• tranquilizer gun with skull: Killed vaccine for active immunity

Filovirus

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• Soccer field: filovirus

• Negative-sense RNA virus

• orange lights: RNA (orange) with helical capsid

• jersy: Enveloped virus

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• bats: Bats may be the viral reservoir

• monkeys: Possibly transmitted via primates

• medics on field: Transmitted to healthcare workers through exposure to bodily fluids

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• marburg player: Marburg virus

• goal: Ebooooooooooooooooooola, Ebola

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• sweating goalie: Fever

• rashes: Petechial rash

• pool of blood: Hemorrhagic fever

• blood spots: End-organ failure within days

• lightning bolt: Hemorrhagic (hypovolemic) shock

Bunyavirus

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• 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

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• arbo in background: Arboviruses (California Encephalitis and Rift Valley Fever)

• rodents: Hantavirus are roden born

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• 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

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• California rift valley school: California Encephalitis, Rift Valley Fever

• mosquitos: Arboviruses are transmitted by the Aedes Mosquito

• shaking: Seizures

• turban: Encephalitis

• Myalgia/fever

Arenavirus

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• 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)

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• sandy floor: Grainy appearance on electron microscopy

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• rodents: Rodent transmission

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• LCV sign: Lymphocytic choriomeningitis virus (LCV)

• turban: Meningoencephalitis

• sweating: Fever

• fire spear: Inactivated by heat

• reflect shield: Inactivated by irradiation

Reovirus

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• Rio Grande: Reovirus

• David: Naked virus

• DNA rope: Double-stranded RNA virus, no positive or negative sense

• 11 boats = 11 RNA segments (BOAR)

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• rotating propeller: Rotavirus

• welcome to colorado sign with tick: Colorado tick virus

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• 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

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• welcome to colorado sign with tick: Colorado tick virus

• kid sweating, vomiting, on ground: Colorado tick virus causes myalgia, fevers, and vomiting

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• 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

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• 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.

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• sleeping archer: EBV remains latent in B cells

• must B 21: EBV envelope glycoprotein binds CD21 (c3b) to infect B cell

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• 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

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• 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

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• 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

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• 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

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

CMV

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• 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.

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• 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

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• blood, sexual contact, saliva, breast milk

• torches: TORCHeS infection

• Also in utero

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• 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

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• balloon animal in water: Hydrops fetalis, heart failure leading to severe edema with fluid accumulation in multiple compartments, spontaneous abortion. In utero transmission

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• Number 1 shirt: CMV is the #1 cause of mental retardation due to a viral infection. Also #1 cause of virus induced hearing loss.,

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• 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

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• "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

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• 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

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• 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

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• zeus: zoster

• Hermes: Herpes virus family

• robe: Enveloped Virus

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• torch: Vertical transmission (TORCHeS infection)

• kid squirting droplets: Respiratory droplet transmission

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• 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

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

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• 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

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• adult: Pneumonia complication

• red turban with cane: Encephalitis, especially in immunocompromised

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• 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

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• recycle bin: Acyclovir treatment for children ages 12+, adults, and immunocompromised

• family: Famciclovir treatment for shingles

• violet cycling bin: Valacyclovir also treatment for shingles

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• sleeping on tree roots in back: Latent in dorsal root ganglia

• elderly with canes: Reactivation occurs with emotional stress, aging, or immunocompromised state

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• 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

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• Roses: Roseola

• 6th disease: 6th in childhood (Ro- six- ola)

• 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

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• 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

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• Kate's posies: Kaposi

• Hermes with 8: Human herpes virus 8 causes Kaposi sarcoma

• HHV-8 = double-stranded DNA virus

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• 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

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• 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)

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

Polyomavirus

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

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• politicians: Polyomavirus

• round room: Circular, double-stranded DNA virus

• David: Naked virus

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• 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:

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• "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

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• 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

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• 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

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• water gun: Respiratory droplet transmission

• torch: Vertical transmission (TORCHeS infection)

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• 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

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• Lion's den: Adenolions = adenovirus

• Cool, blue tones = DNA virus

• Naked virus

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• 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

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• 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

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

• live lions: Live vaccine

Poxvirus

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• 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.

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

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• 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

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• small box: Small pox

• same day shipping: Same age lesions

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• 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

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• 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

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• 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

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• 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

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• baby 90% cookie: 90% of neonatal infections progress to chronic infections

• mother 10% cookid: 10% of adult infections progress to chronic infections

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• 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.

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• 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

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• 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.

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

• headbands: Circular genome

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• 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).

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• 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.