Viral

1. Saleh Bahaj
Prof. of Medical
Microbiology/Immunology
Herpesviridae
(Part 2)
Lecture 6

3. Objectives
By the end of this lecture the students will be able
to:-
V) Test yourself
I) Epstein Barr virus
II) Cytomegalovirus
III) Human Hepes virus-6
IV) Human Hepes virus 7&8

4. II) Classification of DNA
Enveloped Non-enveloped
dsDNA
Herpesviridae
dsDNA
ssDNA
•Adenoviridae
•Papovaviridae
Parvoviridae
* Parvovirus B19
HHAPPPy
Hepadnavridae
(HBV)
Poxviridae

5. Herpes Family
1) Herpes simplex
Viruses (1&2)
2) Varicella-Zoster
virus
3) Cytomegalovirus
(CMV)
4) Epstein-Barr
virus (EBV)
5)Human herpes
virus 6&7
7)Human herpes
virus-8

6. 4) Epstein-Barr virus (EBV)
I) Definition
II) Pathogenesis
III) Lab. Diagnosis
IV) Treatment
V) Prevention

7. EBV
3 B
 Infect B cell
 Latency in B cell
 Burkitt's lymphoma
Nasopharyngeal carcinoma

8. I) Definition
4) Epstein-Barr virus
(EBV)

9. I) Definition of EBV
 ds DNA,
 enveloped,
 icosahedral
that infect
B cell, leading
infectious
mononucleosis

10. II) Pathogenesis
4) Epstein-Barr virus (EBV)

11. II) Pathogenesis of EBV
Saliva
(Kissing)

12. II) Pathogenesis of EBV
 Oropharynx
Shedding of virus
Pharyngitis

13. II) Pathogenesis of EBV
Viremia
Blood
Liver
Hepatitis

14. II) Pathogenesis of EBV
Infect B cells
(Latent)

15. II) Pathogenesis of EBV
Proliferation
of B cells
Immortal

16. II) Pathogenesis of EBV
Proliferation of
B cells
Expression of viral protein
on B cell
Heterophil antibodies Other
Y

17. II) Pathogenesis of EBV
CTLs destroy
EBV-infected
B cells
Atypical
T lymphocytes

18. II) Pathogenesis of EBV
Atypical position

19. Exercise-1
Create

20. II) Pathogenesis of EBV
EBV Saliva
Replication in
the oropharynx
Infect B cell
(immortal)
Expression of viral
protein on B cell
Proliferation
of B cells
Heterophil
antibodies
Activation
of T cell
Atypical T
lymphocytes
Pharyngitis
Shedding of virus
Latency in B cells

21. III) Diseases
4) Epstein-Barr virus (EBV)

22. III) Diseases
1
Subclinical
(Most cases)

23. III) Diseases
Infectious
mononucleosis
2
(Glandular fever)

24. 2) Infectious mononucleosis
Spleen enlarged
Hepatitis
Lymphadenopathy

25. 2) Infectious mononucleosis
3
Oral hairy
leukoplakia
immunocompromised
CD4count ˂ 200

26. III) Diseases
Burkitt's lymphoma
4
(Negroes)

27. 3) Burkitt's lymphoma

28. III) Diseases
5
Nasopharyngeal
carcinoma

29. III) Lab. diagnosis
4) Epstein-Barr virus (EBV)

30. III) Lab. diagnosis
Leukocyte count
(25,000/cmm)
Absolute
Lymphocytosis!!!
CBC

31. III) Lab. diagnosis
Leukocyte count
(25,000/cmm)
Absolute
lymphocytosis Atypical T
lymphocytes

32. III) Lab. diagnosis
Paul Bunnel test
(Heterophil
antibodies)
Sheep
RBCs
Agglutination
Y
Y
Y Y
Y
Y
Y
Y

33. III) Lab. diagnosis
IgM to viral capsid
antigen (VCA)
(Recent infection)

34. III) Lab. diagnosis
IgG to VCA
(Past infection)
!!!

35. III) Lab. diagnosis
Anti-Epstein-Barr
nuclear antigens
(Anti-EBNA IgG)
By ELISA
(Past infection)

36. III) Lab. diagnosis
VCA-IgM
Titre
Anti-
EBV
Weeks after exposure
EBNA-IgG
0 2 4 8 10 12 14 16
VCA-IgG
Acute
Convalescence
EBNA-IgG
VCA-IgG
VCA- IgM
-
+/-
+
Acute
+
+
-
Previous

37. III) Lab. diagnosis
 PCR
(Most specific)

38. IV) Treatment
4) Epstein-Barr virus (EBV)

39. IV) Treatment
No
Treatment

40. IV) Treatment
Self-
limiting

41. V) Prevention
4) Epstein-Barr virus (EBV)

42. V) Prevention
Avoid
kissing

43. V) Prevention
Vaccine
under trial

44. Exercise-1
Case study

45. Answer of Exercise-1
Sarah Ahmed 31 years, she lives a happy life,
in a day, she started complained from sore
throat and fever, suddenly developed
lymphadenopathy, her doctor advised to be
referred to the Oncology Center, she started to
worry. At the Oncology Center they made
some tests and after the results appeared, they
told her that she did not have a tumor.

46. Answer of Exercise-1
Q1) What is the suspicion of her
doctor?
Lymphoma

47. Answer of Exercise-1
Q2) What are the tests that
requested at oncology center?
 CBC
 Paul Bunnel test
 IgM/IgG to VCA

48. Answer of Exercise-1
Q3) What is your expectation
about the results of these tests?
 Absolute lymphocytosis
 Atypical lymphocytes
 +ve Paul Bunnel test
 + IgM

49. Answer of Exercise-1
Q4) What is the most likely
diagnosis?
 Infectious mononucleosis
Q5) What is causative agent?
 EBV

50. Answer of Exercise-1
Q6) What is the mode of
transmission?
 Infected saliva

51. V) Test yourself

52. Q1
The following diseases are associated
with Epstein-Barr virus infection
Monocyte
2-3 days
Monocyte
2-3 days
Infectious mononucleosis
Oral hairy leukoplakia
Nasopharyngeal carcinoma
Burkitt’s lymphoma

53. Q2
Monocyte
2-3 days
After primary infection with Epstein-Barr
virus. It becomes latent in
Monocyte
2-3 days
Red blood cell
Trigeminal ganglia
B cells
T cells

54. Q3
Mono
cyte2-
3 days
Heterophil antibodies are characteristics
to infection with the following virus
CMV
EBV
VZV
HSV

55. Q4
Atypical lymphocytes can be detected in
the following disease
Herpes labilis
Genital herpes
Chickenpox
Infectious mononuclosis

56. 5) Cytomegalovirus
I) Definition
II) Pathogenesis
III) Diseases
IV) Lab. Diagnosis
V) Treatment
VI) Prevention

57. I) Def. of cytomegalovirus
A- Knowledge and
Understanding
D- General
Skills
Cyto = cell
Megalo = large

58. I) Def. of cytomegalovirus
A- Knowledge and
Understanding
 ds DNA,
 enveloped,
 icosahedral virus
leading
serious illness in
immunosuppressed
patients

59. 5) Cytomegalovirus
II) Pathogenesis

60. II) Pathogenesis of cytomegalovirus
A- Knowledge and
Understanding
Transmitted early
Transplacental
Through
breast feeding

61. II) Pathogenesis of cytomegalovirus
A- Knowledge and
Understanding
Transmitted later
Saliva
Sexually
Blood transfusion
Organ transplants

62. II) Pathogenesis of cytomegalovirus
A- Knowledge and
Understanding
1) In the normal host
2) In the
immunocompromised host
3) Congenital infection

63. II) Pathogenesis of cytomegalovirus
A- Knowledge and
Understanding
Latent in leucocytes &
kidney

64. II) Pathogenesis of cytomegalovirus
A- Knowledge and
Understanding
In the normal host
(Immunocompetent)

65. II) Pathogenesis of cytomegalovirus
1) Asymptomatic
(Latent
Leukocytes & Kidney)

66. II) Pathogenesis of cytomegalovirus
2) Infectious
mononuclosis
like syndrome
Heterophil antibodies - negative
Hepatitis

67. II) Pathogenesis of cytomegalovirus
3) Restenosis of
coronary
angioplasty
Association between the presence CMV &
restenosis in coronary angioplasty

68. II) Pathogenesis of cytomegalovirus
II) In the
immunocompromised host
AIDS
Receiving
organ
transplants
Receiving
chemotherapy
Primary or Reactivation

69. II) Pathogenesis of cytomegalovirus
 Retinitis

70. II) Pathogenesis of cytomegalovirus
 Pneumonia

71. II) Pathogenesis of cytomegalovirus
III) Congenital
infection
Primary
Reactivation

72. II) Pathogenesis of cytomegalovirus
(˂24W)
(˃24W)
 Abortion
 still-birth
Cytomegalic inclusion
disease

73. II) Pathogenesis of cytomegalovirus
Cytomegalic
inclusion
disease
Blindness
Deafness
Mental
retardation
Hepato-
splenomegaly
First trimester
of pregnancy

74. 5) Cytomegalovirus
III) Lab. diagnosis

75. II) Pathogenesis of cytomegalovirus
1- Isolation of
the virus from
throat washings
& urine

76. II) Pathogenesis of cytomegalovirus
1- Detection of
intranuclear
cytomegalic
inclusion (Owl’s
eye)

77. II) Pathogenesis of cytomegalovirus
PCR

78. II) Pathogenesis of cytomegalovirus
3- Detection of
IgM by ELISA
Serum

79. II) Pathogenesis of cytomegalovirus
4- Detection of rising titre of
IgG by ELISA
1/80
2nd sample after
7 days
1/320
Serum

80. 5) Cytomegalovirus
IV) Treatment

81. IV) Treatment
Ganciclovir

82. 5) Cytomegalovirus
V) Prevention

83. V) Prevention
Blood transfusion
(free from CMV)

84. V) Prevention
Organ
transplantation
Donors & recipients
should be
free from CMV

85. V) Prevention
Vaccine
Under trial
2018: Positive
Phase I

86. V) Test yourself

87. Q1
The following diseases are associated
with cytomegalovirus infection
Monocyte2
-3 days
Monocyte2
-3 days
Infectious mononucleosis
Restenosis in coronary angioplasty
Retinitis in immunocompromised
Cytomegalic inclusion disease

88. Q2
Monocyte
2-3 days
After primary infection with cytomegalo
virus. It becomes latent in
Monocyte
2-3 days
Leukocytes
Kidney
B cells
T cells

89. Q3
Monocyte2
-3 days
CMV may be transmitted by
Monocyte2
-3 days
Monocyte2
-3 days
Saliva
Blood transfusion
Transplacental
Organ transplantation

90. Q4
The characteristics inclusion bodies in
CMV is
Cowdry I.B.
I.B. in cytoplasm
Owl’s I.B.
I.B. in nucleus

91. 6) Human herpes virus -6
(HHV 6)

92. 6) HHV-6
(Sixth disease)
(Roseola subitem)
Roseola infantum

93. 6) HHV-6
The disease is characterized by
Cervical
lymphadenopathy
Sore throat
Fever After 3 days, the fever
Subside (3 days fever)
Rose rash
appears

94. Exanthematic diseases
1- Measles MS.VRPR
2- Scarlet fever
3- Varicella
4- Rubella
5- Parvovirus
(Fifth disease)
6- Roseola infantum
(Sixth disease)

95. 6) HHV-6
Roseola
infantum
Latent on
T cell
(T-lymphotropic)

96. HHV-7
Roseola infantum
like

97. 8) Human herpes virus -8
(HHV )
(Kaposi’s sarcoma-associated
herpes virus (KSHV)
(Kaposi’s virus )

98. 6) HHV-8
This virus was
identified in
1994
It Causes Kaposi,s
sarcoma in patients
with AIDS.

99. 6) HHV-8
Endothelial
cell tumor
Multiple vascular nodules

100. 6) HHV-8
PCR

101. TORCH
a group of
infection of a
pregnant woman
can lead to severe
fetal anomalies or
even fetal loss.

102. TORCH
Toxoplasmosis
T Other ( Varicella-syphilis &
parvovirus B19 )
Rubella
O
R
C
H
Cytomegalovirus
Herpes simplex virus-2

103. TORCH
TOxoplasmosis
T
Rubella
O
R
C
H
Cytomegalovirus
Herpes simplex virus

104. Objectives
By the end of this lecture the students will be able
to:-
V) Test yourself
I) Epstein Barr virus
II) Cytomegalovirus
III) Human Hepes virus-6&7
IV) Human Hepes virus -8