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Virology (DNA, RNA, COVID-19)
Virology (DNA, RNA, COVID-19)
Virology (DNA, RNA, COVID-19)
C. VIRAL ENVELOPE
I. VIRAL STRUCTURE
● Enveloped viruses are less stable and more easily
A. STRUCTURE inactivated
● All enveloped viruses acquire their envelope from the
● Genome consists of DNA or RNA plasma membrane except herpes virus (from the
nuclear membrane)
● Capsid
○ Protein shell or coat that encloses the nucleic acid
genome Naked DNA Virus Naked RNA Virus
○ Maybe helical, icosahedral, or complex
○ Composed of protein subunits called Papillomavirus Calicivirus
capsomeres.
○ Protects nucleic acid, enabling viruses to attach to Adenovirus Picornavirus
and enter the host cell.
● Nucleocapsid Parvovirus Reovirus
○ The genome and its protein coat together (nucleic
acid genome + capsid) Polyomavirus Hepevirus
● Virion
○ Complete viral particle
○ Infectious unit II. VIRAL GENETICS
● Envelope
○ Lipid-containing membrane that surrounds some A. VIRAL GENOME
viruses acquired by budding through the cell
membrane ● All viruses are haploid except retroviruses
● Genomes can be either single-stranded or
○ Naked viruses double-stranded
■ Non-enveloped viruses ● Genomes of RNA viruses can be either
■ Ether resistant positive-polarity or negative-polarity
○ Enveloped viruses ● Some RNA viruses have a segmented genome
■ Ether sensitive (BOAR)
Bunyaviruses 3
Orthomyxoviruses 8
(influenza)
Arenaviruses 2
Reoviruses 10 or 11
B. MORPHOLOGY
B. RNA VS DNA VIRUS
● Helical, icosahedral, or complex
● All helical viruses are enveloped ● Positive-stranded RNA Viruses
● Icosahedral viruses can be enveloped or naked ○ RNA is just like a messenger RNA (mRNA)
● All DNA viruses are icosahedral except Poxvirus ○ When a positive-stranded RNA virus enters a host
● Only RNA viruses have helical symmetry cell, its RNA can immediately translate by the
○ Most assume a helical shape except host’s ribosomes into protein
rhabdoviruses, which have a bullet-shaped
capsid. ● Negative-stranded RNA viruses
● RNA viruses that have icosahedral symmetry instead: ○ Must transcribe (–) strand → (+) strand before
○ Flaviviruses translation
○ Caliciviruses ○ Virion brings its own RNA-dependent polymerase
○ Reoviruses needed for transcription of the negative strand
○ Picornavirus ○ Viruses: (Always Bring Polymerase Or Fail
○ Togaviruses Replication)
○ Hepevirus ■ Arenaviruses
■ Bunyaviruses
■ Paramyxoviruses
■ Orthomyxoviruses
■ Filoviruses
■ Rhabdoviruses
● DNA Viruses
○ Unlike RNA, DNA cannot be translated directly
into proteins.
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○ It must be transcribed into mRNA with a E. RECEPTORS USED BY VIRUSES
subsequent translation of mRNA into structural
proteins and enzymes
○ Most DNA viruses have both a negative strand Virus Receptors
and a positive strand except
■ Parvoviruses, which have single-stranded CMV Integrins (heparan sulfate)
DNA genome
○ Negative strand EBV CD21
■ Refers to the DNA strand that is read
■ Used as a template for transcription into HIV CD4, CXCR4, CCR5
mRNA,
○ Positive strand Parvovirus B19 P antigen on RBCs
■ Ignored
Rabies Nicotinic AChR
B. DEFINITIVE DIAGNOSIS
● Complement fixation
● Hemagglutination inhibition
● Neutralization
● Fluorescent antibody assay
● Radioimmunoassay
● Enzyme-linked immunosorbent assay (ELISA)
C. SEROLOGIC TESTS
D. VIRAL LIFE CYCLE AND PHARMACOTHERAPY ● Seroconversion
○ Finding antibody in one who previously had none
● Presence of IgM
Replication stage Drugs available ○ Can be used to diagnose current infection
● Presence of IgG
1 Adsorption Fusion inhibitors ○ Cannot be used to diagnose current infection
○ Antibody may be due to an infection in the past
2 Penetration, uncoating Amantadine
D. DETECTION OF VIRAL ANTIGENS
3 Viral nucleic acid synthesis Acyclovir, Zidovudine,
Lamivudine, Nevirapine,
Ribavirin ● Presence of viral proteins, commonly used in
diagnosis
4 Viral protein synthesis Interferons ● Example: p24 of HIV and HBsAg
● Presence of viral DNA or RNA of the gold standard in
5 Assembly Protease inhibitors viral diagnosis
6 Release -
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○ Only virus with fibers
IV. DNA VIRUSES
○ 41 antigenic types
A. OVERVIEW
● Transmission
○ Aerosol droplet
○ Fecal-oral
○ Direct contact
● Spectrum of Disease
○ Upper Respiratory Tract
■ Pharyngitis
■ Conjunctivitis
■ Coryza
○ Lower Respiratory Tract
■ Bronchitis
■ Atypical pneumonia
○ Gastrointestinal Tract
■ Acute gastroenteritis
○ Urinary Tract
B. NAKED DNA VIRUSES ■ Hemorrhagic cystitis
1. PARVOVIRIDAE
○ Histopathology
■ Cowdry type B intranuclear inclusions
● Parvovirus B19 (Fifth Disease)
➢ Intranuclear and basophilic
➢ Circumscribed and multiple
● Characteristics
○ Naked virus with icosahedral symmetry
○ Single-stranded DNA genome
○ One serotype
3. PAPOVAVIRIDAE
● Characteristics
● Transmission ○ Naked viruses with double-stranded circular
○ Respiratory droplets and transplacental DNA
○ Icosahedral nucleocapsid
● Spectrum of Disease ○ At least 100 types
○ Erythema Infectiosum (Fifth Disease) ○ More than half of cancers are due to HPV 16
■ Bright red cheek rash (slapped cheeks) with (high-risk HPV)
fever, coryza, and sore throat
○ Aplastic crisis ● Transmission
■ Interferes with erythroid progenitor cells ○ Direct contact
■ Transient but severe aplastic anemia in ○ Sexually
children sickle cell anemia, thalassemia or
spherocytosis ● Pathogenesis
○ Fetal Infections ○ Infect squamous cells and induce formation of
■ 1st trimester: fetal death cytoplasmic vacuole (koilocytes)
■ 2nd trimester: hydrops fetalis ○ Genes E6 and E7
○ Arthritis ■ Inactivation of tumor suppressor genes
■ Immune-complex arthritis of small joints ■ E6 inhibits p53
○ Chronic B19 Infection ■ E7 inhibits Rb
■ Pancytopenia in immunodeficient patients
● Spectrum Of Disease
○ HPV-1 to 4
2. ADENOVIRIDAE ■ Skin and plantar warts
○ HPV-6 and 11
● Adenovirus ■ Genital warts (condyloma acuminata)
■ Respiratory tract papilloma
● Characteristics ■ Most common viral STD
○ Naked viruses with double-stranded linear DNA ○ HPV-16, 18, 31, 33
○ Icosahedral nucleocapsid ■ Carcinoma of cervix, penis, and anus
● Treatment
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○ Genital warts ○ Large, pink to purple intranuclear inclusions
■ Podophyllin (Cowdry type A)
○ Skin warts ■ Variable and granular
■ Liquid nitrogen
○ Plantar warts
■ Salicylic acid
● Prevention
○ Vaccine for HPV-6, 11, 16 and 18
○ Cervarix
■ 16 and 18
○ Gardasil
■ 6, 11, 16, and 18
● JC Polyoma Virus
○ Only causes disease in immunocompromised ● Spectrum of Disease
hosts ○ Herpes Simplex Virus Type 1
○ Causes progressive multifocal ■ Gingivostomatitis
leukoencephalopathy (PML) in patients with AIDS ■ Keratoconjunctivitis
○ Demyelinating disease that affects ■ Temporal lobe encephalitis
oligodendrocytes ➢ Often with characteristic necrosis
■ Characterizedby deficits in speech, ■ Cold sores
coordination, and memory ➢ Herpes labialis (lips)
➢ Herpetic whitlow (fingers)
● BK Polyoma Virus ➢ Herpes gladiatorum (trunk)
○ Only causes disease in immunocompromised ○ Herpes Simplex Virus Type 2
hosts ■ Genital herpes
○ Causes hemorrhagic cystitis and nephropathy in ➢ Painful anogenital vesicles
patients with solid organ (kidney) and bone ■ Neonatal herpes
marrow transplants ➢ Contact within birth canal
■ Aseptic meningitis
● Pathogenesis ● Pathogenesis
○ Vesicle filled with virus particles and cell debris ○ Infects URT, then spreads via the blood to the skin
○ Site of latency ○ Becomes latent in the dorsal root ganglia
■ HSV-1: trigeminal ganglia ■ May reactivate as zoster
■ HSV-2: lumbosacral ganglia ○ Histopathology
○ Multinucleated giant cells are seen on Tzanck ■ Multinucleated giant cells with intranuclear
smear inclusions
● Spectrum of Disease
○ Varicella
■ “Chickenpox”
■ Incubation period of 14–21 days
■ Vesicular centripetal rash
➢ “Dewdrop on a rose petal” appearance
■ Complications:
➢ Pneumonia
➢ Encephalitis
➢ Reye syndrome
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○ Zoster ● Treatment
■ “Shingles” ○ DOC is Ganciclovir
■ Painful vesicles along dermatomal ○ CMV is largely resistant to Acyclovir
distribution
■ Debilitating pain
➢ Postherpetic neuralgia ● Epstein-Barr Virus (HHV-4)
● Transmission
○ Close contact (perinatal, venereal)
○ Body fluids
○ Transplacental
○ Transfusion
○ Organ transplantation
● Pathogenesis
○ Immediate early proteins
■ Translated from premade mRNAs
■ Impair assembly of the MHC class I–viral
peptide complexes
○ Histopathology ● Spectrum of Disease
■ Giant cells with owl's-eye nuclear inclusions ○ Infectious Mononucleosis
■ “Kissing disease”
■ Fever, sore throat, lymphadenopathy, and
splenomegaly
■ Splenic rupture is a rare complication
➢ Rapid increase in size produces a tense,
fragile splenic capsule
○ Malignancies
■ Oncogenicity associated with expression of
latency-associated membrane protein 1
(LMP-1)
■ B-cell lymphomas
■ African people
➢ Burkitt lymphoma
● Spectrum of Disease ■ Chinese people
○ Congenital CMV infection ➢ Nasopharyngeal carcinoma
■ Most common cause of congenital ■ AIDS patients
abnormalities ➢ Hairy leukoplakia
➢ One of the TORCH pathogens ➢ CNS lymphoma
■ Causes teratogenic symptoms in fetus ○ Post-transplant lymphoproliferative disease
➢ Microcephaly, seizures, deafness, ○ Encephalitis
jaundice, and purpura
■ Most common when mother infected in 1st
trimester ● Human Herpesvirus-6 (HHV-6)
○ Heterophil-negative mononucleosis
■ Lymphadenopathy ● Characteristics
■ Fever, lethargy, and abnormal lymphocytes in ○ Enveloped virus with linear double-stranded
PBS DNA
○ Systemic CMV infections ○ Icosahedral nucleocapsid
■ Pneumonitis, hepatitis, colitis, retinitis ○ 90% of all humans are infected by age 3
■ In immunocompromised patients (particularly ■ Usually benign course
transplant recipients)
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● Transmission ○ Largest viruses
○ Saliva ○ Brick-shaped poxvirus containing linear
double-stranded DNA
● Spectrum of Disease
○ Roseola / Exanthem Subitum / Sixth Disease ● Transmission
■ Caused by adenopathy ○ Aerosol
■ Rose-colored macules appear on body after ○ Contact
several days of high fever
■ Can present with febrile seizures; usually ● Pathogenesis
affects infants ○ Histopathology
■ Guarnieri bodies or intracytoplasmic
○ Nagayama spots eosinophilic inclusions
■ Erythematous papules on soft palate and
base of the uvula
○ Hepatitis
● Characteristics
○ Enveloped virus with linear double-stranded
DNA
○ Icosahedral nucleocapsid
● Transmission
○ Sexual ● Spectrum of Disease
○ Body fluids ○ Incubation period: 7–14 days
○ Prodrome of fever and malaise followed by
● Spectrum of Disease centrifugal rash
○ Kaposi sarcoma (KS)
■ A rare type of cancer that can affect both the
skin and internal organs ● Molluscum Contagiosum Virus
■ Primary infection asymptomatic
■ Causes purpuric, raised skin lesions ● Characteristics
■ Most common symptoms ○ Pinkish, papular skin lesions with an umbilicated
➢ Red or purple patches on the skin. center
2. POXVIRIDAE
● Characteristics
○ Largest DNA viruses
○ The only DNA virus that is complex ● Treatment
■ Not icosahedral ○ Cidofovir
○ The only DNA virus that replicates in the
cytoplasm
■ Not in the nucleus 3. HEPADNAVIRIDAE
● Hepatitis B Virus
● Variola Virus (Smallpox)
● Characteristics
● Characteristics ○ Enveloped virus with incomplete circular
○ Only disease that has been eradicated from the double-stranded DNA
face of the Earth
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● Transmission
Time Period HBsAg Anti-HBs Anti-HBc HBeAg
○ Blood
○ During birth
Incubation + - - +
○ Sexual
period
● Memory Aid:
Acute + - + +
○ The VOWELS (A and E) hit your BOWELS.
infection IgM
■ Hepatitis A and E cause enteric infections
Window - - + -
HEPATITIDES period IgM
● Serological Evolution
○ Surface antigen ● Memory Aid:
■ Describes whether the patient is diseased or ○ The only positive during window period
immune ■ Anti-HBc IgM
■ HBsAg ○ The only positive among vaccinated patients
➢ Having this antigen means the patient ■ Anti-HBs
has the disease ○ What can differentiate chronic active (+)
★ Chronic, acute, or asymptomatic infection from chronic carrier (-)
carrier ■ HBeAg
➢ Precedes onset of symptoms and ○ Chronic infection is characterized by:
elevation of liver enzymes ■ Persistence of HBsAg for at least 6 months
■ Anti-HBsAg ■ Persistence of HBsAg is the principal marker
➢ Presence of this antibody indicates that of risk for developing chronic liver disease
patient is immune and/or cured and liver cancer (hepatocellular carcinoma)
➢ NO active disease present later in life.
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● Polio vaccine
V. RNA VIRUSES
● Spectrum of Disease
○ Now known to cause:
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■ Aseptic meningitis
■ Upper respiratory tract infection ● Transmission
■ Febrile illness with and without rash ○ Oral-fecal route
■ Infantile diarrhea
■ Hemorrhagic conjunctivitis ● Spectrum of Disease
○ Viral Gastroenteritis
○ Most common cause of non-bacterial diarrhea in
● Rhinovirus adults.
○ Sudden onset of vomiting and diarrhea
● Characteristics accompanied by fever and abdominal cramping.
○ Naked nucleocapsid with single-stranded, positive
polarity RNA (1SS+)
○ More than 100 serotypes 3. REOVIRIDAE
● Transmission ● Rotavirus (Norovirus)
○ Aerosol droplets
○ Hand-to-nose contact ● Characteristics
○ Right Out The Anus
● Pathogenesis ■ ROTAvirus causes diarrhea
○ Replicated better at 33°C than at 37°C ○ Naked double-layer capsid with 10 or 11
■ Affect primarily the nose and conjunctiva segments of double-stranded RNA
rather than the lower respiratory tract.
○ Acid-labile ● Spectrum of Disease
■ Killed by gastric acid when swallowed ○ Viral Gastroenteritis
■ Do not infect the gastrointestinal tract, unlike ○ Most common cause of childhood diarrhea
the enteroviruses.
■ Host range is limited to humans and ● Treatment
chimpanzees. ○ Oral Rotavirus Vaccine
■ RotaTeq (Pentavalent RV5)
● Spectrum of Disease ➢ 3 doses (2, 4, 6 months)
○ Common colds ■ Rotarix (Monovalent RV1)
➢ 2 doses (2, 4 months)
● Hepatitis A Virus ■ Given at a minimum age of 6 weeks with a
○ Characteristics minimum interval of 4 weeks between doses
■ Naked nucleocapsid with single-stranded, ■ The last dose should be given not later than
positive polarity RNA (1SS+) 32 weeks of age (PidsPhil)
■ Also known as Enterovirus 72
■ Only 1 serotype
■ No antigenic relationship to HBV or other
hepatitis viruses C. NEGATIVE ENVELOPED RNA VIRUSES
■ Anti-HAV IgM is the most important test. 1. ORTHOMYXOVIRIDAE
● Spectrum of Disease
ADDITIONAL INFO ○ Incubation period
■ 10-14 days
● Sudden Shift is more deadly than graDual Drift ○ Pathognomonic Koplik spots
■ Bright red lesions with a white, central dot on
buccal mucosa (mouth)
● Spectrum of Disease
○ Maculopapular rash
○ Influenza A
■ Face-trunk-extremities palms and soles
■ Worldwide epidemics (pandemics)
■ Patients are contagious from 4 days before
■ Each year, influenza is the most common
the rash to 4 days after the appearance of the
cause of respiratory tract infections.
rash.
○ Influenza B
● Complications
■ Major outbreaks of influenza
○ Most common
■ Does not lead to pandemic
■ Otitis media
■ Only humans infect humans
○ Most life-threatening
■ No animal source of new RNA segments
■ Bacterial pneumonia
○ Influenza C
○ Complications in 1 month
■ Mild respiratory tract infections but does not
■ Post-infectious encephalomyelitis
cause outbreaks of influenza.
○ Complications in 1-10 months
■ Measles inclusion body encephalitis
● Treatment
○ Complications in 1-15 years
○ Oseltamivir or Zanamivir
■ Subacute Sclerosing Panencephalitis
○ Influenza A
(SSPE)
■ Amantadine or Rimantadine
● Cardinal Manifestations of Measles (3Cs)
● Prevention
○ Cough
○ Yearly vaccination
○ Coryza
○ Conjunctivitis
Mumps + + +
RSV - - +
Parainfluenza + - +
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● Mumps Virus ● Parainfluenza Virus 1 & 2
● Spectrum of Disease
○ Incubation period
■ 18-21 days
○ Parotitis
■ Tender swelling of the parotid glands
■ The period of maximum communicability was
considered to be several days before and
parotitis onset
○ Resolves within 1 week
○ Complications
■ Orchitis
■ Meningitis
● Spectrum of Disease
○ Viral Pneumonia
■ Most important cause of pneumonia and
bronchiolitis in infants
■ Severe disease in infants due to immunologic
● Treatment
○ Ribavirin
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● Clinical Manifestations D. POSITIVE ENVELOPED RNA VIRUSES
○ Prodromal period 1. CORONAVIRIDAE
■ Symptoms suggestive of rabies:
➢ Paresthesia
● Coronavirus
➢ Fasciculations at around the bite
○ Encephalitic phase
● Characteristics
■ Excessive motor activity, excitation and
○ Enveloped virus with helical nucleocapsid and one
agitation
piece of single-stranded positive-polarity RNA
■ Periods of mental aberration are
(SS+)
interspersed with lucid intervals.
○ Prominent club-shaped spikes form a “corona”
■ Prominent brainstem dysfunction
○ Displays high frequency of recombination
○ Coma or death
○ Four main sub-groupings of coronaviruses:
■ Alpha
● Diagnosis
■ Beta
○ Fluorescent antibody testing (direct and
■ Gamma
indirect)
■ Delta
■ Occurrence of rabies antibodies in the CSF is
diagnostic for rabies a
● Structure
➢ Antibodies from vaccination do not cross
○ Made up of 4 structural proteins:
the blood-brain barrier.
■ Spike (S)
■ Antibodies in serum and CSF develop late in
■ Membrane (M)
the clinical course and may be undetectable
■ Envelope (E)
in the acute phase.
■ Nucleocapsid (N)
○ RT-PCR on fresh saliva
■ Viral shedding precedes signs
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○ Autoimmune reactions 4. RETROVIRIDAE
■ Thyroiditis
■ Autoantibodies ● Distinguished from all other RNA viruses by the
■ MPGN presence of an unusual enzyme
■ Porphyria cutanea ○ Reverse transcriptase
■ TARDA ■ Converts a single-stranded RNA viral
■ DM genome into double-stranded viral DNA.
○ Main cause of essential mixed
cryoglobulinemia
● Human Immunodeficiency Virus (HIV)
● Treatment
○ Acute hepatitis C infection ● Characteristics
■ Interferon ○ Enveloped with two copies (diploid) of a
○ Chronic hepatitis single-stranded, positive-polarity, RNA genome
■ Peginterferon ○ Most complex of the known retroviruses
■ Ribavirin
○ Liver transplantation for severe cirrhosis ● Structural and Regulatory Genes
■ Most common indication for liver
transplantation
○ New antivirals against Hepatitis C Structural Genes
■ Simeprevir
■ Sofosbuvir Gene Protein Function
■ Ledipasvir
p24, p7 Nucleocapsid
gag
p17 Matrix
3. TOGAVIRIDAE
reverse Transcribes RNA genome into
● Rubella Virus transcriptase DNA
ADDITIONAL INFO
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< 200 P. jiroveci PCP pneumonia
C. neoformans Meningoencephalitis
C. immitis Coccidioidomycosis
H. capsulatum Histoplasmosis
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E. MISCELLANEOUS VIRUSES
VI. COVID-19
● Human T-Cell Lymphotropic Virus (HTLV) A. OVERVIEW
B. CORONAVIRUS FAMILY
● Characteristics
○ Enveloped, non-segmented, positive-sense RNA
viruses
○ Club-like spikes that project from their surface
■ Defining feature of the virion
■ Gives the appearance of a solar corona
○ Are the largest group of viruses belonging to the
Nidovirales order
■ Coronaviridae
■ Arteriviridae
■ Mesoniviridae
● Ebola Virus ■ Ronivirida
● Characteristics
○ Belongs to the Filoviruses
○ “Threadlike” viruses
○ Longest viruses
○ Natural hosts
■ Fruit bats
● Transmission
○ Direct contact with body fluids
○ Fomites
■ Including dead bodies
○ Infected bats
○ Primates
● Spectrum of Disease
○ Ebola Hemorrhagic Fever
○ Abrupt onset of flu-like symptoms, diarrhea,
vomiting, high fever, myalgia ● 4 genera of CoVs
○ Can progress to ○ Alphacoronavirus (alphaCoV)
■ Disseminated intravascular coagulation (DIC) ○ Betacoronavirus (betaCoV)
■ Diffuse hemorrhage ○ Deltacoronavirus (deltaCoV)
■ Shock ○ Gammacoronavirus (gammaCoV)
○ Mortality rate can be as high as 100%
● Spectrum of Disease
○ Some cause disease in animals
● Japanese B Virus ■ Enteritis in cows, and pigs
■ URT in chickens
● Characteristics
○ Member of the flavivirus family ■ Severe acute respiratory syndrome (SARS)
○ Most prevalent in Southeast Asia and Middle East respiratory syndrome
(MERS) is also caused by coronaviruses that
● Transmission “jumped” from animals to humans
○ Culex tritaeniorhynchus mosquitoes
● Variants of Concern (VOCs)
● Pathogenesis ○ Potential to cause enhanced transmissibility or
○ Thalamic infarcts on CT scan virulence
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○ Gamma (P.1) ○ Coronaviruses are also known for their ability to
■ First reported in Brazil in early January 2021 recombine using both homologous and
○ Delta (B.1.617.2) nonhomologous recombination
■ First reported in India in December 2020
○ Omicron (B.1.1.529) ● Assembly and Release
■ First reported in South Africa in November ○ The viral structural proteins, S, E, and M are
2021 translated and inserted into the endoplasmic
reticulum (ER)
C. CORONAVIRUS LIFE CYCLE ○ These proteins move along the secretory pathway
into the endoplasmic reticulum–Golgi intermediate
compartment (ERGIC)
○ Viral genomes encapsidated by N protein bud into
membranes of the ERGIC
■ Containing viral structural proteins
■ Forming mature virions
D. EPIDEMIOLOGY
E. PATHOPHYSIOLOGY
1. TRANSMISSION
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● Occupational Risk ■ Deteriorating sensorium
○ Employees of seafood and wet animal wholesale ■ Multi-organ failure
markets in Wuhan ■ Thrombosis
○ Healthcare workers
○ Frontliners
3. UPDATED PROTOCOLS
4. EFFECT ON RESPIRATORY SYSTEM
Protocols
● Increased vascular permeability and subsequent
development of pulmonary edema in patients with
Asymptomatic close No need to quarantine
severe COVID-19 are explained by multiple
contact exposed to
mechanisms.
confirmed Wear a well-fitted face mask for
● These mechanisms include
COVID-19-positive 10 days
○ Endotheliitis
individual
■ Result of direct viral injury and perivascular
inflammation leading to microvascular and
Asymptomatic but Home isolation for 5 days or until
microthrombi deposition
confirmed afebrile (fever-free) for at least 24
○ Dysregulation of RAAS
COVID-19-positive hours without using antipyretics
■ Due to increased binding of the virus to the
case (Paracetamol) and with an
ACE2 receptors
improvement of respiratory
○ Activation of the kallikrein-bradykinin pathway
symptoms
■ The activation of which enhances vascular Confirmed
permeability COVID-19-positive Wear a well-fitted face mask for
○ Enhanced epithelial cell contraction case with mild 10 days
■ Causes swelling of cells and disturbance of symptoms
intercellular junctions
Isolation may be shortened as per
○ Binding of SARS-CoV-2 to the Toll-Like Receptor Individuals with acute a healthcare provider
(TLR) respiratory symptoms
■ Induces the release of pro-IL-1β
➢ Mediates lung inflammation until fibrosis.
Isolation for at least 10 days from
onset of signs and symptoms
F. CLINICAL MANIFESTATIONS following the advice of attending
physician, including whether to be
1. SIGNS AND SYMPTOMS Confirmed
admitted in a healthcare facility
COVID-19-positive
● Ranges from asymptomatic or mild symptoms to case with moderate to
Wear a well-fitted face mask for
severe illness and mortality severe symptoms
10 days
○ Fever
○ Cough Immunocompromised
For severe and
○ Shortness of breath immunocompromised,
○ Malaise discontinue isolation only upon
○ Myalgia the advice of healthcare provider
○ Fatigue
○ Respiratory distress or Dyspnea
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○ Open the smaller, top cap on the vial of liquid
■ Squeeze three drops of your sample into the
collection area of the strip.
○ Set a timer for 15 minutes.
■ Don’t disturb the test strip during this time.
○ Read your test.
● Collecting Saliva
5. ANTIBODY TESTING
● IgM antibodies
○ Detectable days after initial infection
● IgG antibodies
○ Detected later
6. VIRAL CULTURE
● Increased ALT/AST
● Elevated CRP
● Elevated BUN
● Elevated Procalcitonin
● Elevated D-Dimer
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