11 Virus

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

Picorna Overview

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

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

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

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

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

Polio

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

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

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

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

Cox

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

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

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

• supportive

Rhino

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

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

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

Hep A

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

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

• inactivation sign: How to inactivate Hepatitis A

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

• tranquilizer gun: Inactivated vaccine

Calicivirus

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

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

Flavivirus

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

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

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

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

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

Hep C

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

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

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

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

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

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

Togavirus

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

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

Arbovirus

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

Rubella

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

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

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

• kneeling adults: Arthritis in adults

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

Corona

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

Retrovirus

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

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

• transmission: sexual and blood
• torches: TORCH infection

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

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

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

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

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

RNA Negative Sense

• RNA must be transcribed to + sense first, thus must bring own RNA polymerase
• all are single stranded except Reovirus
• All replicate in cytoplasm, except orthomyxovirus

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

Orthomyxovirus

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

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

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

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

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

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

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

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

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

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

Paramyxovirus

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

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

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

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

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

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

late:

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

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

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

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

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

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

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

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

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

• aka laryngotrachealbronchitis.

Rhabdovirus

• rabies

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

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

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

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

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

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

Filovirus

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

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

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

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

Bunyavirus

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

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

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

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

Arenavirus

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

• sandy floor: Grainy appearance on electron microscopy

• rodents: Rodent transmission

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

Reovirus

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

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

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

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

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

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

DNA Virus

EBV

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

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

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

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

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

left: CMV; right: EBV

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

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

CMV

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

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

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

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

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

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

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

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

left: CMV; right: EBV

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

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

Varicella

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

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

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

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

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

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

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

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

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

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

Roseola

• Roses: Roseola
• 6th disease: 6th in childhood (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

_

• 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.