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
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
- 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 (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
- 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
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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
- 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.