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Home , Alphaherpesvirinae, Betaherpesvirinae, Bowenoid papulosis, B virus, Chordopoxvirinae, Fifth disease

FAST FACTS for Board Review

Series Editor: William W. Huang, MD, MPH

Viruses, Part 1: DNA Dr. O’Neill is from Buffalo Medical Group, New York. The author reports no conflict of interest. Jenna O’Neill, MD

Clinical Classification Presentation Treatment Miscellaneous

Hepadnaviridae  Enveloped, dsDNA May lead to cirrhosis  pegylated virus (HBV) of the and alfa-2a; prevention hepatocellular via hepatitis B  Enveloped, dsDNA; Orolabial herpes Acyclovir, valacyclovir, 80% of recurrent virus type 1 (most common famciclovirbb multi- (HHV-1) subfamily cause)a forme cases are associated with Herpes simplex Enveloped, dsDNA; (most Acyclovir, valacyclovir, 80% of recurrent virus type 2 Alphaherpesvirinae common cause)a; famciclovirb; erythema multi- (HHV-2) subfamily multiple painful ulcers, or for resistant forme cases often with LAD strains are associated with herpes simplex virus Varicella-zoster Enveloped, dsDNA; (primary Acyclovir, valacyclovir, virus (HHV-3) Alphaherpesvirinae varicella ), famciclovirc; prevention via subfamily (herpes zoster) live (attenuated) varicella virus vaccine in children (administered SC in 2 doses: first at 12–15 mo, second at 4–6 y) and in adults >50 y (administered SC in a single dose) Epstein-Barr Enveloped, dsDNA; Infectious mononucleo- Supportive care, steroids Posttransplant virus (HHV-4) sis, oral hairy , only for complicated cases lymphoproliferative subfamily endemic , (eg, patients with sple- disorder may be , nomegaly or risk for end a in posttransplant lymphoprolif- organ damage) of infectious both solid organ erative disorders, Gianotti- mononucleosis, Epstein-Barr and hematopoi- Crosti syndrome virus–associated lymphopro- etic stem cell liferative disorders: reduction transplantation, in immunosuppression usually in first year posttransplantation

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(continued) Clinical Presentation Treatment Miscellaneous

Herpesviridae (continued)  Enveloped, dsDNA; Congenital cytomegalo- , ; Most common (HHV-5) virus infection: hearing foscarnet and cidofovir in congenital subfamily loss, seizures, growth and resistant cases; prevention viral infection mental retardation, HSM, via screening of transplant (90% asymptom- chorioretinitis, intracranial donors and recipients atic); leading cause calcifications; cutaneous of congenital deaf- findings are nonspecific: ness and mental classic presentation is retardation in the “blueberry muffin baby” due to extramedullary hematopoiesis; cytomega- lovirus retinitis in AIDS  Enveloped, dsDNA; infantum Supportive care Most cases herpesvirus 6 Betaherpesvirinae (exanthema subitum, caused (HHV-6), subfamily sixth ): high fever by HHV-6 herpesvirus 7 followed by of (HHV-7) rose red macules as fever subsides; red on soft palate (Nagayama spots) Kaposi Enveloped, dsDNA; Kaposi sarcoma Cryosurgery, radiotherapy, May affect oral sarcoma–associated Gammaherpesvirinae (subtypes: classic, topical alitretinoin, intra- mucosa (especially herpesvirus subfamily AIDS related, immu- lesional interferon alfa, in AIDS-related (HHV-8) nosuppression associ- systemic ; Kaposi sarcoma), ated, African/endemic), HAART in AIDS-related lymph nodes, and , Kaposi sarcoma GI and respiratory primary effusion tracts; predilec- lymphoma tion for lower legs and feet in classic Kaposi sarcoma; primarily occurs in Mediterranean and Central/Eastern European male populations Human Nonenveloped, dsDNA HPV-1: plantar ; Local destructive Use of radiation papillomavirus (HPV) HPV-2, HPV-4: common therapies (cryosurgery, therapy controver- warts; HPV-3, HPV-10: surgical excision, laser sial in treatment flat warts; HPV-7: butcher’s vaporization, TCA, of Buschke- warts; HPV-5, HPV-8, curettage); podophyllin; Lowenstein others: EV; HPV-6, ; intralesional tumors due to HPV-11: condyloma or Candida reports of acuminatum (genital warts), injections, or interferon; transformation to Buschke-Lowenstein prevention via quadrivalent high-grade SCC tumor, recurrent respi- vaccine of HPV-6, HPV-11, ratory papillomatosis; HPV-16, and HPV-18, and HPV-16, HPV-18, others: bivalent vaccine of HPV-16 EQ, , and HPV-18 invasive carcinoma; HPV-13, HPV-23: Heck disease (focal epithelial hyperplasia)

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(continued) Clinical Virus Classification Presentation Treatment Miscellaneous

Parvoviridae Parvovirus Nonenveloped, ssDNA, Erythema infectiosum Supportive care, Aplastic crisis may B19 (B19V) subfamily (, slapped transfusion be precipitated cheek syndrome): bright in aplastic in sickle cell red macular erythema crisis anemia, thalas- on cheeks, reticulate semia, hereditary erythematous macules spherocytosis, and more frequently on extremi- hemolytic anemias ties than trunk; disease is evanescent and may recur with overheating; PPGSS; aplastic crisis in susceptible individuals; Molluscum Enveloped, dsDNA, MOCV: cantharidin, Complications of contagiosum curettage, topical vaccina- virus (MOCV), subfamily keratolytics; resolve tion: generalized virus, spontaneously; others: sup- vaccinia infection, virus, portive care; preven- eczema vaccina- virus, vaccinia virus, tion via vaccinia vaccine tum, progressive variola virus vaccinia, postvac- cinal

Abbreviations: dsDNA, double-stranded DNA; LAD, ; SC, subcutaneous; HSM, hepatosplenomegaly; HAART, highly active antiretroviral therapy; GI, gastrointestinal; EV, epidermodysplasia verruciformis; EQ, erythroplasia of Queyrat; TCA, trichloroacetic acid; SCC, ; ssDNA, single-stranded DNA; PPGSS, papular-purpuric gloves and socks syndrome. aOverlap exists between clinical manifestations of HSV-1 and HSV-2. bDosing regimens for oral herpes: oral valacyclovir 2000 mg twice daily for 1 d or oral 1500 mg for 1 dose; genital herpes first episode: oral acyclovir 200 mg 5 times daily for 10 d or 400 mg 3 times daily for 10 d, oral valacyclovir 1000 mg twice daily for 10 d, or oral famciclovir 250 mg 3 times daily for 10 d; recurrent genital herpes: oral acyclovir 200 mg 5 times daily for 5 d or 400 mg 3 times daily for 5 d, oral valacyclovir 500 mg twice daily for 3–5 d, or oral famciclovir 1000 mg twice daily for 1 d or 125 mg twice daily for 5 d. cDosing regimens for varicella: oral acyclovir 20 mg/kg 3 times daily for 5 d (maximum of 800 mg daily); zoster: oral acyclovir 800 mg 5 times daily for 7–10 d, oral valacyclovir 1000 mg 3 times daily for 7 d, or oral famciclovir 500 mg 3 times daily for 7 d.

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Practice Questions

1.  Which human papillomavirus (HPV) subtype causes epidermodysplasia verruciformis? a. HPV-1 b. HPV-3 c. HPV-7 d. HPV-8 e. HPV-13

2. Which is the appropriate treatment regimen for a patient presenting with the first episode of genital herpes? a. acyclovir 20 mg/kg intravenously 4 times daily for 10 d b. famciclovir 125 mg orally twice daily for 5 d c. human papillomavirus vaccination d. valacyclovir 1000 mg orally twice daily for 1 d e. valacyclovir 1000 mg orally twice daily for 10 d

3. Which is the most common congenital viral infection? a. adeno-associated virus b. cytomegalovirus c. Epstein-Barr virus d. herpes simplex virus type 1 e. varicella-zoster virus

4. Which virus can cause aplastic crisis in patients with thalassemia? a. hepatitis b. herpes simplex virus c. human papillomavirus d. e. variola virus

5. Which herpesvirus belongs to the Gammaherpesvirinae subfamily? a. HHV-3 b. HHV-5 c. HHV-6 d. HHV-7 e. HHV-8

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