NATIVIDAD, SHAREE ROSE G.

Mycology - “Mykes“ - Study of fungi

Fungi OR Thallophycytes
 EUKARYOTES (with true nucleus)
 Eukaryotic organism
 Obligate aerobes ( mostly)
 Achlorophyllous and heterotrophic
 Have Chitin cell wall and Sterol cell membrane
 Unique characteristics: why KOH cannot destroy the fungi or penetrate the fungal cell
 Lactophenol Cotton blue - stains the fungi
 Exist as dimorphic or monomorphic
Note: Most pathogenic fungi are DIMORPHIC
 Dimorphism - exist either as yeast (37 C) or mold (25 C)
 Yeast ( 37 C)  Molds (25 C)
 Unicellular, Round and Non filamentous  Multicellular, Filamentous
 Capable of forming pseudohyphae  Capable of forming a hyphae
 Colonies at SDA: moist, creamy and buttery  Colonies: Dry with velvety surface
with an alcohol like odor  Can be ID by the appearance of spores and hypha
 Can be identified by biochemical tests

Two Structures: Spores and Hypha

1. Hypha ( plural: Hyphae) - basic structural units of the molds 2. Mycelium - aggregates or mass of hypha
 Dermatiaceous - pigmented - consists of:
 Hyaline/Moniliaceous - non-pigmented  THALLUS ( vegetative portion)
 Septate - cross wall  AERIAL (reproductive part)
 Conidiophore - phialide
 Aseptate (coenocytic)- no cross wall
 Zygomycetes - phycomyes, rhizopus
 Sporangiophore
Two forms of reproduction
1. Sexual
- gives rise to telemorph or telomorph or perfect state
2. Asexual
- gives rise to an anamorph or imperfect state
- these are called as Fungi imperfecti ( Deuteromycota) - fungi that do not possess sexual state
Ex: Candida
Epidermophyton
Torulopsis
Note: C. albicans - found in oral cavity
- yeast used to ferment alcoholic beverages
- used in making bread or any pastry

PHASES OF FUNGAL LIFE CYCLE

1. Somatic phase - feeding or trophic phase
2. Reproductive phase
a) Asexual Reproduction b) Sexual Reproduction
- formation of spores and conidia - fusion of the nuclei
- no fusion of nuclei - sexual spores
- spore production is through the differentiation of spores bearing 1. Ascospores- - enclosed in an ascus
hypha: - ascocarps - fruiting bosy of ascospores
- includes: 2. Basidiospores - formed inside a basidium
1. Fragmentation 3. Zygospores - thick walled spores formed by
2. Budding - formation of blastoconidia ( in yeast) fusion of 2 hyphal strands
3. Fission 4. Oospers - fusion of cell from two (2) separate
- Asexual spores non-identical hyphal
1. Sporangiospores - borne in a sporangia
2. Conidium - does not involve in cleavage; produce singly
or in long chains or clusters bu conidiospores
a) Chlamydospores - produces by rounding up and
enlargement of the terminal hyphal cells
( terminal, intercallary, sessile)
b) Arthrospores - barrel shape with dysjunctor cells
giving a checkered appearance
c) Blastospore - budding off
d) Macro-microconidia - dermatophytes

MEDICAL MYCOLOGY
*Fungal disease : Mycoses - mycotic infections

Pathogenicity
 Mycotoxins - exotoxins produced by fungi
 Aflatoxins - produces by Aspergillus flavus; aflatoxin B1 ( most toxic)
 Ergot alkaloids - produced by Claviceps purpurea, causes ergotism or St. Anthony’s Fire ( gangrenousor convulsive
type)
 Psychotropics

SPECIMEN COLLECTION AND HANDLING

 Type 2 & 3 Biological safety cabinet - used
BSC II - also known as vertical laminar flow BSC III
- filters exhausted and recirculated the air - filters supplied and exhausted air
- 2 types: - used by WHO and DOH
1. BSC IIA - air going into the air
 2. BSC IIB - air is going outside of the building
 Petri dishes - not recommended in fungi
 Sterile screw tubes - preferred
 Apply ASEPTIC technique
DIRECT MICROSCOPIC EXAM
1. Wet prep (1-2 drops of sterile NSS) Other direct preparations
- simplest but lack contrast 1. Giemsa/wright’s stain - for
- used to observe yeast, pseudohyphae, hyphae Histoplasma found in the blood and BM
2. 10-20 KOH% - initial prep of keratinized tissue 2. Lactophenol cotton blue ( Aman) -
- KOH - dissolves the keratin to visualized the fungal elements stain the fungi (+) : color blue
Procedure: 3. India ink/nigrosin - for capsule
1. Add small amount of specimen to 1 drop of KOH demonstration
2. Press the Coverslip 4. Periodic Acid schiff - presence of
3. Warming in low flame to hasten the clearing process fungal hypha (+: purplish red)
*Can add GLYCEROL to prevent crystallizing 5. Gram stain ( Hucker Modification)
4. Let it stand for 5 to 10 minutes to clear and settle down 6. Gomoru methenamine silver
* Advantage : able to determine if the infections in hair samples ID 7. Acridine orange
 Best stain for detecting viable fungal elements 8. Masson fontana stain - black
 Addition of INDIA INK - for capsule demonstration
ENDOTHRIXOR ECTOTHRIX
- VARIATIONS in the KOH Preparation:
 Blue-black ink/ methylene blue = 2 parts of KOH : 1 part of ink
 DMSO (dimethyl sulfoxide) - penetrating agent to speed up the
process
 Calcoflour white - binds to chitin and cellulose and flouresce under
Wood’s lamp ( or white color)

COMMON Collections Possible test/s

SPECIMENS
1. Hair Collect by clipping or plucking from the base of the hair Wood’s lamp - used to identify the infected hair
shaft ( flouresce)
20% KOH - fungal elements
- determine: endothrix or ectothrix infection
2. Skin 1. Disinfect the skin 70% alcohol 10% KOH - used to break the tissue debris
2. Scraped from the outer edge of the surface lesion using KOH wet mount is used for deeper scrapings
a slides
3. Nails 1. Disinfect the skin with 70% 20% KOH
2. Scrapings or cutting or the whole nail
4.Abscess and obtain an exudate Gram stain - check the fungal elements
subcutaneous infection C/S
5.Respiratory Deep cough collection Gram stain - check for fungal elements
specimens ( sputum) Inoculated directly in the SDA - less viscous C/S
6. Blood Can be collected: C/S ( BactAlert) - colorimetric
1. BHI
2. Isolator tube
3. Septicheck
7. Buffy coat FOR DIAGNOSIS OF THE HISTOPLASMOSIS
8. Bone Marrow Heparinized
Can be inoculated at the bedside
9. CSF Collect the specimen India Ink
Centrifuge to obtain concentrated specimen Culture inoculation
3rd tube is sent to the micro. Section
- for detection of Cryptococcus neoformans
10. Eye Corneal scraping & Eye discharge
11. Urogenital and May yeast in SDA C/S
fecal specimen Urine: 1ST voided morning specimen - preferred
Centrifuge for 10 minutes
Decant and check the sediment at LPO
Surface streak method at BAP and MAC - urine
12. Tissues Minced or grinded
CULTURE MEDIA
1. Cornmeal agar - with 1% glucose
- used to differentiate Trichophyton rubrum ( red pigment) and trichophytum mentagrophytes ( w/out red pigment)
2. Czapek’s - for Aspergillus
3. Birdseed /Nigerseed/ Staib’s
- used thistle ( Guizotia seeds); for cryptococcus ( brown or black due to prod. Of PHENOL OXIDASE)
4. Cottonseed - converts mold phase of Blastomyces to yeast phase
5. Rice medium - ID of the Microsporum audounii
6. Sabouraud Dextrose Agar = general and routine media for yeast and fungi ; pH 5.6
7. Mycosel ( aka mycobiotic) = SDA + cycloheximide
8. Urea Agar
- detects urease prod. Of C. neoformans
- differentiate T. mentagrophytes (+) from T. rubrum
9. Potato dextrose agar - pigment
10. Cornmeal Tween 80 agar - chamydospores
11. Brain heart infusion agar - yeast
12. Casein medium - Nocardia
13. Dermatophyte test medium - indicator : dermatophytes (CUTANEOUS MYCOSES) : macro-microconidia

Incubation and cultures

 Incubation: up to 4 weeks or a month ( periodically examined before reporting as negative)
 30 C - optimally temp that most FUNGI grow
 1-3 days - growth ng yeast
  10-12 weeks - growth ng Histoplasma
MICROSCOPIC EXAMINATIONS
1. TOPOGRAPHY
2. GROWTH RATE
1. Rapid growers - less than 5 days ( Saprobes)
2. Intermediate growers - 6-10 days ( opportunistic fungi and dermatophytes
3. Slow growers - 11 up to 8 weeks ( systemic and opportunistic)

Other test
1. Germ tube test
(+): germ tube ( hyphal like extensions of yeast cell or tube-like with parallel walls without constriction at point of projection/origin)
= C. albicans and C. dubliniensis
(-): pseduhyphae and hyphae = other member of the Candida spp except from C. albicans and C. dubliniensis

Procedure:
1. Serum + yeast colony at media
2. Incubate at 35 to 37 C for 2-3 hrs
3. 1 drop of suspension
4. Examine at HPO

2. Serum culture test

- serum is incubated with yeast cell at 37 C for 2 to 3 hrs
(+) = yeast only - NOT CANDIDA
(-) = yeast and hyphae - CANDIDA
Note:
 CULTURE = CONFRIMATORY TEST
 C. albicans and C. dubliniensis = germ tube, hyphae, yeast, chlamydoconidia are present
3. Hair baiting test - for dermatophytes (keratinophilic - CUTANEOUS MYCOSES) since they selective grown on it
4. Hair penetration test - in vitro test from T. mentagrophytes (V shaped penetration) from T. rubrum ( no penetration at 1 month)
5. Thiamine - requirements for dermatophytes
6. Growth of Rice Grain
- diff. M. canis (+ growth) from M. audoinii ( no growth after 10 days)
7. Temperature studies
8. Biochemical test ( API20C and ID32C) - vitel
9. Serology test - Ag test
- Mannan Ag - Candida
- Galactomannan - Aspergillus
10. AST methods: broth microdilution and E-test
- used: 1.0 McFarland

Classification of the FUNGI

1. Superficial mycoses
 Non-invasive
 Horny non-living if the skin and extrafollicular parts of the hair
TWO TYPES
1. Tinea - skin infection ( KOH)
2. Piedras - hair infection ( wet prep and wood’s lamp)

Malassezia furfur ( spag and Piedra agent Phaeoannelomyces werneckii/ Hortaea

meatballs under PAS) - superfical hair infection w/ nodular masses of werneckii/Exophiala
- causative agent: ptyriasis fungal elements surround hair shaft werneckii/Clasdosporium werneckii
(tinea)versicolor A. Black piedras - Piedra hortai -causes TINEA NIGRA
- cause: hypo ( an-an) or - black colony, hard PALMARIS
hyperpigmentation of the - black nodule - have brownish,dark
skin - ascospore pigmentation - mistaken as
- needs lipids (+) SDA with melanoma
olive oil B. White piedras - Trichosporon beigelii
- creamy colony and soft
- white and cream to light nodule
-arthrospore
2. Cutaneous Mycoses
 keratinized layer of the skin
 Epidermis out growth ( hair& nail)
1. Keratinophilic
2. Tinea or ringworm
 Macroconida ( large and multicellular) & microconidia (small and unicellular) in LPCB stain
Ectothrix: Endothrix:
1. M. gypseum 1. T. tonsuran ( #1 tinea capitis agent) - black dot
2. M. Canis 2. T. Violoceum
3. T. Verrucosum -

Athropophilic Zoophilic Geophilic

1. E. Floccusom 1. M. Canis 1. M. gypseum
2. T. Audounii 2. T. Verrucosum
3. T. concentricum
4. T. Mentagrophytes
5. T. Rubrum
6. T. Schoenleinii
7. T. Tonsuran
8. T. violeceum

Classification Acc. to the ecological niches

1.Trichophyton - skin, hair & nail
2.Epidermophyton - skin and nail ONLY
 3.Microsporum - skin and hair ONLY
CUTAENEOUS MYCOSES TYPICAL CLINICAL FEATURES CAUSATIVE AGENTS
Tiner corporis Ring worm of the body T. Rubrum
T.Mentragrophytes
Tinea cruris Ring worm of the groin or jock itch Trichophyton rubrum
Tinea pedis Ringworm of the foot ( athlete’s foot) Trichophyton dermatophytes
Tinea manuum Ringworm infection of the hand Epidermophtyon floccusom
Tinea ungium Ringworm of the nail
Tinea capitis Scalp ringworm Microsporum audounii
A. Gray patch tinea Microsporum canis
B. Black dot capitis Trichophyton tonsuran
Tine barbae Ringworm that affects the bearded areas of the face and neck
A. Superficial Trichophyton rubrum
Trichophyton violeceum
B. Inflammatory Trichophyton mentagrophytes
Trichophyton verrucosum

1. Trichophyton
 MACROconidia - rare, thin walled, smoooth
 Microconidia - abundant
Causative agents Cutaneous Mycoses and its typical clin features
T. rubrum - teardrop shaped microconidia  Tinea corporis ( ringworm of the body) - same with T.
- fluffy white w/ red color reverse mentagrophytes
 Superficial Tinea barbae (ringworm affecting the
bearded areas of the face or neck - along side w/ T.
violeceum
 Tinea cruris ( ringworm of the groin/ jock’ s itch)
 Tinea pedis ( athlete’s foot/ foot ringworm)
 Tinea ungium ( nail ring worm or onchomycosis)
T. mentagrophytes - grape -like cluster microconidia, spiral hyphae  Tinea corporis ( ringworm of the body) - same with T.
- can be differentiate to T. rubrum by: rubrum
(Urea agar - positive  Inflammatory tinea barbae
Cornmeal agar - no red pigment  Tinea cruris ( ringworm of the groin/ jock’ s itch)
(+) - hair penetration - formed V- shaped  Tinea pedis ( athlete’s foot/ foot ringworm)
 Tinea ungium ( nail ring worm or onchomycosis)
T. tonsuran - with thiamine for growth  Tinea capitis ( black dot capitis) - scalp ringworm
- balloon shaped microconidia
- CA: black dot tinea capitis (endothrix)
T. schoeleinii - NO macro and microconidia
- cause FAVUS ( chronic hair infection)
- DX: favir chandelier hyphae
T. verrucosum - requires thiamine and inositol  Inflammatory Tinea barbae
- clavate/ pyriform microconidia
- rat tail/ string bean shaped MACROconidia

2. Epidermophyton
 MACROconidia: numerous, smooth walled
 Microconidia - absent
Causative agents Cutaneous Mycoses and its typical clin features
E. Floccusom club shaped MACROconidia  Tinea cruris ( groin, jock’s itch)
-DUTCH pants fuseax  Tinea pedis ( feet, athletes foot)
- Treatment (Tx): azoles, griseofulvin  Tinea manuum ( hand)
 Tinea ungium ( nail, onchomycosis)

3. Microsporum - skin and hair only

 MACRO - numerous thick walled, rough
 Micro - rare
Causative agents Cutaneous Mycoses and its typical clin features
M. Canis - grows on rice medium ( +)  Tinea capitis ( scalp) gray patch
- spindle shaped/ fusiform MACROconidia
- FLOURESCE UV light - POSITIVE
M. Gypseum - geophilic, ectothrix
- Flouresce UVL - NEGATIVE
- OBLONG MACROconidia

M. Audouinii - anthrophilic  Tinea capitis ( scalp) gray patch

- TINEA CAPITIS (OLD) agent - GRAY PATCH TINEA
- DO NOT GROW ON RICE MEDIUM

3.Subcutaneous mycoses
- skin trauma/prick
- inoculation of mycoses
- usually confined in the subcutaneous tissues
- Chronic nature - DSE usually
Causative agents Features
1. SPOROTRICHOSIS Sporothrix schenckii  Mostly seen Lymphocutaneous sporotrichosis
Aka: Rose Gardener/ Rose  Pathology: granuloma formation in the
 Handler’s dse tissues
 Splendore -Hoeppli phenomenon ( asteroid
bodies)
 Dimorphic Fungi
 Cigar- shape (yeast)
 Flowerette/ daisy- head appearance (mold)
 Specimen:
 Skin biopsy
 Curetings or pus
 Aspirate
2. LOBOMYCOSIS Lacazialoboi ( formerly loboaloboi)  Keloidal blastomycosis - subepidermal infections
 Monomorphic fungi
 Looks like a P. braziliensis ( dimorphic)
 Tissue: multiple budding cells in chain
3. RHINOSPORIDIOSIS Rhinosporidium seeberi ( protozoan)  Found in WATER
 Polypoid masses in nose and pharynx
 Tissue form: SPORANGIUM- SAC LIKE STRUCTURE
FILLED WITH ENDOSPORES
 Looks like C. immitis (smaller)
4. RHINOENTOMOPH- Conidiobolus coronatus/Enthaphtora  Chronic inflammatory or Granulomatous
THOROMYCOSIS ( zycomytes member) disease restricted in the nasal mucosa
 Predisposition : 80% IN MALES
5. MYCETOMA/MADURA FOOR Fungi (eumycotic mycetomas)  Characteristics:
AGENTS Bacteria ( actinomycotic mycetomas)  Swelling and suppuration of subcutaneous
Aka: Madura’s foot,  Eumycotic: tissue
maduromycosis  Madurella mycetomatis (most  Formation of sinus tract w/ extension to
common) the bone
 Madurella grisea  Granules (grains) seen in the draining pus
 Exophiala jeanselemie  HANDS AND FEETS ARE AFFECTED
 Acremonium faciforme
 Pseudallescheria boydii
 Actinomycotic actinomycetes:
 Streptomyces
 Nocardia
 Actinomadura
 Botyromycotic:
 S. Aureus
 Bacteroide
 E. Coli
 P. Aeruginosa
6. CHROMOMYCOSIS/ Fonsecaea compacta  Culture medium: SDA
CHROMOBLACTOMYCOSIS Fonsecaea pedrosoi (most common)  Sclerotic bodies ( fusion or medlar
Aka: chromoblastomycosis, Shor chain (acrotheca) bodies) seen in INFECTED TISSUES
Mossy foot disease, Phialophora verrucosa (vase like)  Cauliflower-like lesion - lesions seen in
dermatitis, hematomycosis Cladophialophora carrionii ( long chain) extremities ( feet and lower legs
Rhinocladiella aquaspersa  Dark colonies w/ jet black reverse
7. PHAEHYPHOMYCOSIS Exophiala jeanselemie  Formation of SOLITARY ASYMPTOMATIC
Wangilla dermatitidis NODULES OR CYSTS
Cladosporium  Culture medium: SDA
Cladophialophora bantiana
Phialophora

4. Systemic mycoses (AKA: PRIMARY MYCOSES)

 Caused by DIMORPHIC FUNGI
 Laboratory hazards
 Cell Mediated Immune Response ( CMIR)
 Pathogens Inhabit in the SOIL (primarily)
 BSCL II and III
 MOT: inhalation of spores
 LUNGS (pulmonary) = primary site of infection = Probability of dissemination id HIGH
 Tissue (yeast): DIAGNOSTIC
Causative agents Features
1. BLACTOMYCOSIS Blastomyces dermatitiditis  Endemic in North America (Mississippi and Ohio river
Aka: Gilchrist disease, North American valley basin)
Blactomycosis, Chicago disease  Tissue/ yeast form: SINGLE BUDDING YEAST
with broad based or doubled countered
 Mold form: LOLLIPOP, PYRIFORM CONIDIA
 Culture medium: SDA + CYCLOHEXIMIDE
2. PARACOCCIDIODOMYCOSIS Paracoccidiodes  13 t 80 times more common in men
Aka: south American Blactomycosis, brasiliensis  Mickey mouse cup
para, Paracocci, Brazillian  Larges yeast cells (larger than blastomyces) with
blastomycosis, Lutz-Splendore-Almeida multiples buds or MARINER’S WHEEL
disease, paracoccidiodal Granuloma  Mold: LOLLIPOP
3. COCCIDIODOMYCOSIS Coccidiodes posadasii  Presence of ERYTHEMA NODOSUM ( women)
Aka: San Joaquin valley fever, desert C. immitis ERYTHEMA MULTIFORME( children)
fever, desert rheumatism, cocci; the  MOT: inhalation of ARTHROCONIDIA
bumps  BIOTERROR AGENTS ( U.S.)
 Presents as SPORANGIA WITH THICK WALLED IN
varying sizes
 Tissue form: SPHERULE WITH ENDOSPORES
 Mold: BARREL SHAPED ARTHROCONIDIA
4. HISTOPLASMOSIS Histoplasma capsulatum  Mississippi - Ohio river valley in africa - found in the
 Aka: Darling’s dse, reticuloendothelial Var. US - major endemic region
cytomycosis, Cave dse, spelunker dse, Capsulatum, H.  Size: 3 TO 5 um
African histoplamosis, FUngus Flue, capsulatum var. Duboisii  Exist as Non-encapsulated intracellular yeast
RES parasites ( leishmania spp) ( African Histoplasmosis ( mistaken as leishmania spp.)
(bone) double cell, figure  MOT: Inhalation of Microconidia through guano
8) droppings
 Mimic the TB symptoms
 Reside in Guano -containing soil of certain
birds ( starlings, chicken , black birds and bats
 CROSS REACT W/ B. DERMATITIDITIS
 Tissue form: Yeast cell intracellular in macrophages
 Mold form: TUBERCULATE MACROCONIDIA
5. PENICILLOSIS MARNEFFIE Penicillin marneffei  DIMORPHIC
 1st isolated = BAMBOO RAT ( Rhizomys sinensis)
 May appear as TB
 Skin lesion: appear like thoses in central necrotic
umbicitaion = Molluscum contagiosum
 Direct exam = Giemsa stained touch smear or BM
aspirate
 Yeast like cells : SPHERICAL OR ELLIPSOIDAL ; may
have CROSSWALL

 EXOANTIGEN TESTS - immunodiffusion tests

 A Ag = B. dermatitiditis
 1,2, &3 Ag = P. braziliensis
 H and M Ag = H. capsulatum
 HS, HL, F -= C. immitis

5.Opportunistic Mycoses
 Fungal infections seen in immunocompromised or debilitated patients
 Usually a saprophytic Fungi
Causative agents Features
1. . CANDIDIASIS Candida,  C. Albicans -major etiologic of candidiasis
Aka: Moniliasis , perionychia/C.  Diaper candidiasis: nappy rash candidiasis
Thrush, Mycotic Endocarditis/C.Albica  Paronychia of the fingernails
vulcoaginatis, ns / C. glabrata  Onchomycosis
 Vaginal trush ( vulvovaginatl candidiasis)
 Balinitis
 Oropharyngeal Candidiasis: Thrush
 White Plaques: MILK CURD APPEARANCE
 Conjunctivitis, UTI, Candidemia
 Lab diagnosis:
 Direct exam: KOH, GMS, Gram stain, Calcoflour white, PAS
 (+): budding yeast cells,pseudohyphae, chlamydoconidia
 Germ tube test
 C. Albicans (+)chlamydospores , sucrose
 C. Stellatoidea - (-) chlamydospores , sucrose
 Geotrichium candidum (+): arthospores
 Negative control: C. tropicalis
 Chlamydospore cornmeal (CONFIRMATORY)
 C. Albican - inoc. On corn meal --> inc. At RT for 48 to 72 hrs
-> chlamydospore
 Double chlamydospore-
 Rules out Vaginoses / Trichomoniasis ( ALK)
 Vaginal pH:
 Vaginal discharge:
 Treatment: amphotericin B, Nystatin, Azoles
2. CRYPTOCOCCOSIS C. Gattii/ C.  C. Gatti
neoformans  envi reservoir: EUCALYPTUS TREE ( RED GUMTREE)
 C. Neoformans:
 envi reservoir: PIGEON GUANO
 Most common cause of FUNGAL MENINGITIS ( BRAIN)
 MOST FREQUENT AND SERIOUS
 SIGN/S: Absence of stiff neck, Kernig’s and Brudzinski’s signs
 India ink for capsule demo
 Latex agg. = capsular Ag
 Urease -POSITIVE
 Nitrate -negative
 Phenol oxidase POSITIVE
 Birdseed. Niger seed afar - POSITIVE : BLACK DUE TO assimilation
of crea. and phenol oxidase prod
 Culture medium: SDA with cycloheximide.

3. ASPERGILLOSIS Aspergillus fumigatus -  MOT dissemination of SPORES

most common cause of  Asthma and Farmer’s lung
invasive and non-  Aspergilloma - FUNGUS BALL
invasive aspergillosis _
A. flavus = food
poisoning
A. Terrus, A. niger, A.
nidulans
4. ZYGOMYCOSIS Rhizopus, Mucor  UBIQUITOUS FUNGI, FOUND IN WW
 Lichtheimia (absidia),  Rhinocerebral mucromycosis
Rhizomucor,  Cutaneous
Syncephalastrum,  Tissue: NON SEPTATE HYPHAE
Cunnhinghamella

5. PENICILLOSIS Penicillum marneffei Rat bamboo - Rhizomys sinensis = First isolated

MARNEFFIE
6 FUSARIUM  SICKLE CANOE SHAPED, MULTISEPTATE MACROCONIDIA
 White cottony pink to purple colony
7 PHAEHYPHOMYCOSIS  DERMATICEOUS  Mycotic keratitis- infect the eyes
AGENTS:
 Alternaria
 Bipolaris
 Curvularia
 Dreschlera
 exophialia
7 PNEUMONOCYSTIS  PROTOZAAN BEFORE (CONSIDERED)
JIROVECII( CARINII)  ONLY FUNGUS THAT WILL NOT GROW IN THE CULURE MEDIA
 #1 OPORTUNISTUC INFECTION AND CAUSE OF PNEUMONIA IN AIDS
 HONEYCOMBED EXUDATES = foam exudates within the alveolar

VIROLOGY
 OBLIGATE INTRACELLULAR ORGANISM
 Protein coated genetic material
 Either RNA (ss, segmented ) or DNA (ds, linear/circular) not both
 25 to 250 X 350 nm in size
 Largest = small pox
 Smallest = poliovirus
 Sense or plus strand RNA virus
 Anti-sense or Minus strand virus

Viral structure
1. Nucleic acid core - RNA/DNA
2. Capsid = Shell or protein coat
3. __________ = acquired during viral maturation by a budding process through cellular membrane ; surrounded by CAPSIP
4. _______________ viruses that ETHER LABILE OR ETHER SENSITIVE
= LIPIDS are easily destroyed than proteins
= _________ more sensitive as compare to Naked Viruses

Taxonomy ( based on the international Four structural pattern VIRAL REPLICATION IN ANIMAL VIRUSES
Committee on Taxonomy of viruses) 1. Helical - tobacco mosaic, EBOLA VIRUS 1. Adsorption - attachment
1. VIRIDAE - every ending ng family 2. Icosahedral - adenovirus 2. Penetration - entry of virus
2. Virus - bawat genus end 3. Enveloped - Influenza virus 3. Uncoating -= release of nucleic
3. Viral species - common name ng 4. Complex - pox virus, bacteriophage acid
virus na na-used na (eaters of bacteria) 4. Synthetic phase - transcription and
4. Subspecies - number designated translation - protein synthesis
sya 5. Assembly - virion formation
6. Release - exit
SPECIMEN COLLECTION AND HANDLING
1. Collect at
a) :EARLY STAGE OF INFECTION
b) DURING THE FIRST 3 TO 4 DAYS AFTER THE ONSET OF SIGNS AND SYMPTOMS
- except: adenoviruses, enteroviruses and CMV diagnosis - prolonged viral shedding in stool
2. Immediately transported and procesess dapat ang specimens sa laboratory
3. 4 C = have delay ( stored not more than 5 days)
4. Negative (-) 70 C - for longer delayed for 6 up to more days

Commercial viral transport media

- contain buffer isotonic solution with albumin, gelatin, and serum
- antibacterials or anti-fungal agents - added
Ex: Hank’s Balanced salt solution Veal Infusion broth Sucrose phosphate Glutamate Broth
Leibovitz Emory medium Stuart’s medium Annie’s medium
Eagle’s tissue culture Viral cuturettes Virocult

 Dacron or cotton or Rayon ( plastic)- best swab to be used

 Calcium alginate, charcoal and swabs with wooden shafts - inactivate the viruses

 Specimens DO NOT require TM includes:  Specimens REQUIRES TM includes:

 Blood  Respiratory specimens
 BM  Swabs
 CSF  Tissue samples
 Amniotic Fluid
 Urine
 Pericardial and pleural fluid

Laboratory diagnosis:
Four methods used:
1. Direct detection
 Microscopy : electron microscope
 Detect the cytopathic effect: pathognomonic for the presence if a viral infection
 Inclusion bodies:
 Negri bodies = rabies
 Councilman body = yellow fever
 Lipshcultz body, Hendersons-Paterson bodies = molloscum contangiosum
 HSV = cowdry
 Guarneri body = Poxvirus ( Vaccinia, Variola)
 Rosette type = adenovirus
 Owls ’eye = CMV
 Koilocytosis =HPV
 Multinucleated giant cell (SYNCYTIA): HERPESVIRIDAE
 Dawson bodies (SSPE), Warthin-Finkeldey cells = measles
2. Nucleic acid based detection
 MORE SENSITIVE, molecular methods
 PCR, Nucleic acid probes, hybridization test
 PCR test ( polymerase chain reaction)
 Method for rapid producing multiple copies of a DNA nucleotide sequence ( gene)
 Able to produce billions of copies in a few hours
 Requirements:
i. Source of gene to be copied
ii. Thermostable DNA polymerase
iii. Deoxynucleotide triphospahtes (dATP, dGTP,dCTP, and dTTP)
iv. 2 set of oligonucleotide with complentray sequnces (primers)
v. Source of heat
vi. Thermostable heat
 3 steps of PCR test: denaturation, Annealing, Elongation
 3. Isolation of viruses using cell cultures
 Primary cell cultures = removes tissue from animal
 Examples of primary cell culture:
 Human embryonic kidney
 Rabbit kidney
 Primary monkey kidney
 Rhesus monkey kidney
 Cynomolgus monkey kidney
 African green monkey kidney
 USE: sensitive to influenza, Parainfluenza, mumos, enterovirus, adenovirus
 Primary cell cultures are cultivated are known as ___________________
1. Low passage (Finite) or diploid cell lines
 At least have 75% cells with generations
 Increasing passage = cells becoming insensitive to the viral infection
 Ex: W1-38, MRC-5
2. Continuous OR Heteroploid or immortal cell lines
 Capable of infinite passage
 Cell line: 75% of the normal cells and 25% of the cells possess ab abnormal karyotypes
 Usually obtained from MALIGNANT TISSUE
 EX: HeLA, Hep-2, Vero, A-549,KB
 Use: sensitive to CMV, HSV, rhinovirus, adenovirus, VZV
 Maintained at:
 Normal: 35 to 37 C for 1 week
 Respiratory viruses: 33 C for 2 weeks
3. Viral isolation - shell vial
 Rapid modification of cell cultures
 Identified through HEMAAGGLUTINATION AND HEMAADSORPTION sinnce unable to EXHIBIT
IN CPE
 EX: INFLUENZA A and B : exhibit both
 PARAINFLUENZA AND MUMPS= exhibit hemaadsorption
4. Serology
 Samples: PAIRED Sera ( acute and convalescence samples)
 Requires Fourfold (4x) rise in titer to establish diagnosis of recent infection
 TORCH TESTING: among preggy women
 Toxoplasma
 Others such as syphilis
 Rubella
 Cytomegalovirus
 HSV
DNA VIRUSES: ( HEHE PAPA-AD -POX)
1. Hepadnaviridae
2. Herpesviridae
3. Adenoviridae
4. Poxviridae
5. Papovaviridae ( papillomaviridae or Polyomaviridae
6. Parvoviridae
Generalities:
1. All are linear except Papova and hepadnaviridae
2. All and DS except for Parvoviridae
3. All are naked except Herpes, Hepadna Poxviridae
4. All are icosahedral and replicate in the nuclues except poxviridae
 Smallest DNA: Parvoviridae
 Largest DNA : Poxviridae

DNA VIRUSES
1. HERPESVIRIDAE  DS DNA genome
 Enveloped and icosahedral
 Known to develop LATENT EFFECT
 Cytopathic effect seen in the MULTINUCLEATED GIANT SYNCYTIAL w/ inclusion bodies
 Eight (8) HHV known:
1. HSV-1 - neuron ( attacks to trigeminal ganglion)
 Orally transmitted
 Oral herpes - primary herpes gingivostomatitis, cold sores
2. HSV -2 - neuron ( attacks sacral ganglion)
 Sexually transmitted
 Genital herpes, neonatal herpes
 Herpertic whitlow
 Dx: tzanck smear ( multinucleated giant cell), cell culture, serolocg, Mol. methods
3. Varicella zoster ( highest form of Chicken pox) - neuron ( attacks in dorsal root ganglion
 Chicken pox/ varicella -cause by HHV-3
 Shingles zoster - reactivaing itself; painful and specific part in the body
 MOT: Droplet inhalation or direct contact with the lesions
 Dx: Tzanck smear ( Multinucleated giant cell)
4. Epstein- BARR virus (EBV) - attacks the B cells
 Causative agents: HHV-4 or Toxoplasma gondii
 Caused infectious mononucleosis
 AKA: Mono ( kissing disease) ,glandular Fever
 MOT: close-oral contact (Kissing), sharing of personal items ( toohbrush)
 Infected B cells destroyed by the T cells
 Hairy leukoplakia:
 Blood picture: lymphocytosis w/ atypical lymphocyte or DOWNEY cells
 Presence EBV nuclear Ag (EBNA test)
  Presence of Heterophile Ab against in EBV:
1. Monospot
2. Paul-Bunnell heterophile test
 Malignancy: nasopharyngeal Carcinoma
5. Cytomegalovirus - attacks both lympho and monocytes
 MOT: orally, sexually, in utero at birth, blood transfusion tissue transplant by nursing
 CAN CROSS THE PLACENTA
 CMV Mononucleosis : Mono-like symptoms and hepatitis
 CPE:
6. Roseolovirus - herpes lymphotropic virus - attacks the T cells
7. Pityriasis rosea - attacks the T cells
8. Kaposi’s sarcoma - attacks B cells (led site of latency = asymptomatic)
 Associated w/ herpesvirus
 MSM - more prone, common on AIDs px
2. HEPADNAVIRIDAE  Enveloped and icosahedral
 Dane particle
 Causes hepatitis B or serum hepatitis
3. PARVOVIRIDAE  ONLY SINGLE STRANDED DNA
 JC AND BK VIRUSES - SV 40 and SV -40 like viruses
 Requires B19 growing cells or helper virus ( dependovirus) for replication
 Parvovirus B19- fifth disease
 Dominant in neonatal ages
 Causes erythema infectiosum or fifth disease
 Slapped- cheek appearance
 Original SIX (6) exanthematous diseases
1. Measles
2. Scarlet fever
3. Dukes
4. Rubella
5. Erythema Infectiosum
6. Erythema Subitum
4. PAPOVAVIRIDAE/ PAPIMALLOVIRIDAE
POLYOMAVIRIDAE/ 1. Skin warts
PAPIMALLOVIRIDAE  Common warts ( cauliflower-like “ Verrucae vulgaris”
 Plantar warts, Flat warts (Verrucae Planae)
 Butcher’s warts = serotype 7
2. Genital warts
 Prone/high risk to have cervical cancer or HPV ( Human Papilloma virus ) and Oropharyngeal
cancer = serotype 16, 18
 Pap’s smear: (+)koilocytes - cells with perinuclear clearing w/ an increase in density of the
surrounding ream
 Venereal warts or Condyloma Acuminate = serotype 6, 7
5. ADENOVIRIDAE  Orbiting satellite
 Causes pneumonia ( respiratory tract) , GI, ARD, epidemic keratoconjunctivitis, acute hemorrhagic
cystitis, pharyngoconjunctival fever
 Serotype 4, 7 = ARD among military recruits
 Serotypes 9, 18 = epidemic keratoconjunctivitis
6. POXVIRIDAE  Enveloped
 Largest and most complex
 Brick shaped morphology
 2 two types of morphology
 Mulberry (M)
 Capsule (C )
 GUARNERI BODIES -inclusion bodies
 Human disease: variola or smallpox
 Variola major = severe form and more deadly caused more disfigurement
 Variola minor = alastrism; milder form of varioa other poxviruses
 Vaccini virus = used to vaccinate against small pox
 Monkeypox
 Cowpox = Milker’s nodule
 Mollusci poxviruses = Molluscum infectiosum Virus

GENERALITIES OF RNA VIRUSES

1. All RNA viruses are single stranded except REOVIRIDAE
SINGLE STRANDED RNA DOUBLE STANDED RNA
1. ARENAVIRIDAE 7. FLAVIVIRIDAE 1. REOVIRIDAE
2. BUNYAVIRIDAE 8. OTHROMYXOVIRIDAE
3. CALICIVIRIDAE 9. PARAMYXOVIRIDAE (LARGEST)
4. DELTAVIRIDAE 10. RETROVIRIDAE
5. ENTEROVIRIDAE ( OR PICORNAVIRIDAE) - 11. RHABDOVIRIDAE
SMALLEST 12. TOGAVIRIDAE
6. FILOVIRIDAE
2. ALL RNA VIRUSES POSSESS HELICAL STRUCTURE EXCEPT POSITIVE SENSE RNA VIRUSES: CALICI, FLAVI, PICORNA, REO, RETRO
TOGA
HELICAL STRUCTURE NOT HELICAL STRUCTURE (CIRCULAR)
1. ARENAVIRIDAE - 6. OTHROMYXOVIRIDAE 1. POSITIVE SENSE RNA VIRUSES
2. BUNYAVIRIDAE 7. PARAMYXOVIRIDAE a) CALICIVIRIDAE
3. DELTAVIRIDAE 8. RHABDOVIRIDAE b) FLAVIVIRIDAE
4. ENTEROVIRIDAE c) PICORNAVIRIDAE
5. FILOVIRIDAE d) REOVIRIDAE
e) RETROVIRIDAE
f) TOGAVIRIDAE
3.ALL RNA VIRUSES ARE ENVEOPLED EXCEPT PICORNA, CALICI, REO
ENVELOPED NAKED
1. ARENAVIRIDAE - 7. OTHROMYXOVIRIDAE 1. PICORNAVIRIDAE
2. BUNYAVIRIDAE 8. PARAMYXOVIRIDAE 2. CALICIVIRIDAE
3. DELTAVIRIDAE 9. RETROVIRIDAE 3. REOVIRIDAE
4. ENTEROVIRIDAE 10. RHABDOVIRIDAE
5. FILOVIRIDAE 11. TOGAVIRIDAE
6. FLAVIVIRIDAE

4. ALL RNA VIRUSES ARE REPLICATES IN THE CYTOPLASM EXCEPT ORTHOMOCY, RETRO
REPLICATE IN THE CYTOPLASM REPLICATE IN THE NUCLEUS AND OTHER PART OF THE CELL
1. ARENAVIRIDAE - 7. FLAVIVIRIDAE 1. ORTHOMOXYVIRIDAE
2. BUNYAVIRIDAE 8. PARAMYXOVIRIDAE 2. RETROVIRIDAE
3. CALICIVIRIDAE 9. PICORNAVIRIDAE
4. DELTAVIRIDAE 10. REOVIRIDAE
5. ENTEROVIRIDAE 11. RHABDOVIRIDAE
6. FILOVIRIDAE 12. TOGAVIRIDAE

NEGATIVE SENSE RNA VIRUSES ( DBAPORF) SEGMENTED RNA VIRUSES ARTHROPOD BORNE (ARBOVIRUSES)
(RABOR)
1. ARENAVIRIDAE 5. OTHROMYXOVIRIDAE 1. RETROVIRIDAE 1. BUNYAVIRIDAE
2. BUNYAVIRIDAE 6. PARAMYXOVIRIDAE 2. ARENAVIRIDAE 2. FLAVIVIRIDAE
3. DELTAVIRIDAE 7. RHABDOVIRIDAE 3. BUNYAVIRIDAE 3. TOGAVIRIDAE
4. FILOVIRIDAE 4. ORTHOMOXYVIRIDAE 4. REOVIRIDAE
5. REOVIRIDAE

RNA VIRUSES
1. ENTEROVIRUS 1. Poliovirus (smallest virus of all)
 Causes poliomyelitis
 MOT: fecal -oral, respiratory droplets
 Resides at anterior horn cells of the spinal cord
 Vaccines:
 Live-attenuated virus (oral)
 Inactivated virus
2. Coxsackie A (flaccid paralysis) - foot, hand,mouth
3. Coxsackie B (spastic paralysis) - heart (myocarditis) pleural, pancreas, liver
4. Enteric Cytopathic Human Orphan ( ECHO) virus - aseptic meningitis - only positive in virus; high
lymphocytes and macrophages
5. Enterovirus 72 - Hepatitis A
6. Enterovirus 71 - Encephalitis
2. ARENAVIRIDAE  Arena : SAND = sandy granular appearance
( exotic virus at BSL 4)  Rodent borne
 Old world - LCM ( lymphocytic Choriomeningitis Virus) and Lassa virus
 New world - tacaribe complex virus ( Tacaribe Guanarito, Junin, and Machupo Viruses)
 Causes hemorrhagic fever
3. ORTHOMOXYVIRID  Helical, segmented, enveloped
AE ( replicate in the  HA - ability to agglutinates the RBCs
nucleus together with  N - mushroom like spikes - destroys sialic/neuraminic acid
retro)  Antigenic changs:
 DRIFT - point of mutation, slower, epidemic, minor changes ( ex: parainfluenza A,B,C)
 SHIFT - genetic reassortment, abrupt, pandemic major changes ( occur in influenza A)
 Major flu pandemics:
1. Spanish Flu (1918-1919) = caused by (AH1N1)
2. Asian Flu( 1957-1958) = caused by A(H2N2)
3. Hongkong Flu (1968-1969) = caused by the A(H3N2)
4. Bird flu (1998) = caused by( A(H5N1)
4. CALICIVIRIDAE  Have 32 - calyxlike concavities
 Appearance of capsid :
 1. Norwalk virus/Norovirus/Small rounded Structures Virus
 Outbreaks gastroenteritis among schools, colleges, cruise ship and nursing homes
 Most important epidemic Viral GI among adults - viral GI
 2. Sapovirus
 Causes GI on infants, young children and elderly
 3. Hepatitis E virus
 Oral-fecal ; No chronic state
 High mortality rate among 3rd trimester of preggy ( fulminant hepatitis -
5. CORONAVIRIDAE  Crown; solar crown - under EM
1. SARS: Severe acute respiratory syndrome
 Caused by a novel coronavirus ( SARS-CoV)
 ACE - target ng SARS-CoV
 MOT: from civet cat to human
2. MERS-Cov - middle eastern Respiratory syndrome coronavirus
 1st reported in Saudi Arabia in 2012 - whole Arabian peninsula

6. FILOVIRIDAE  Shepherd’s Crooks, letter “U” or 6 - shaped

 2 types:
1. Marburg virus - Congo- crimean hemorrhagic fever, Lake Victoria Marburg virus
2. Ebola virus - circular virus
 Ebola zaire - most virulent
 Ebola sudan
 Ebola reston - contact w/ monkeys; less severe; no dev’t of the disease
 Tai forest strains - cause viral hemorrhagic fevers
7. PARAMOXYVIRID  Enveloped containing surface glycoproteins:
AE  HA - hemagglutinin
 NA - neuramidase activity
 F - mediated membrane fusion and hemolysin activity
 Paramoxyvirus -PIV 1,3
 Rubeola virus -PIV 2,4 - MUMPS
 Morbilivirus - measles
 Nonclassified - Nipah and Hendra Virus
 Dse include: common cold syndrome (cold like symptoms) bronchitis, Croup ( Laryngotracheobronchitis),
bronchiolitis, pneumonis
 Parainfluenza - flu-like respiratory dse in young children that can progress to pneumonia
 Serotypes para-influenza:
1. PIV 1-croup
2. PIV 3 - bronchiolitis and pneumonia
3. PIV 4 - mild upper respiratory disease
4. MUMPS - acute illness producing unilateral orbitaletal swelling pf parotid glands and
other organs
5. Measles or RUBEOLA/ german measles - kopliks spots -lesions on the oral mucosa w/c
consist of irregulat red spots w/ brush ink speck in the center
 Complications: OTITIS MEDIA
8. RHABDOVIRIDAE  Rhabdo - bullet shaped
 Genus: Lyssavirus
 Causes: Rabies (madness)
 Acute infcetion of CNS (very fatal )
 MOT: bite, scratch of a rabid animals
 Widely distributed in the Nervous system, saliva, urine, lymph, milk, and blood of infected animals
 CPE: presence of the Eosinophilic Cytoplasmic Inclusion : NEGRI BODIES
9. ARBOVIRUSES 1. DENGUE VIRUS
 Can cause dengue fever, breakbone fever
 5 serotypes: DENV 1DENV2 and 3 ( most common, DENV 4, DENV 5 ( less studied)
 Most spreading mosquito borne disease in the world
 Two important Vectors:
1. Aedes (Stegomyia( aegypti
2. Aedes ( stegomyia) albopictus
 Dengue vaccine: Dengvaxia CYD-DTV ( december 2015 in Mexico)
 Live recombinant tetravalent vacicine ( 3-doses shot 0/6/12 months-WHO for 9 to 45 y/o)
 Discovered by SANOFI PASTEUR
 ADA-1 ( adenosne deaminase -1 ) - prevents the ADE of the vaccin; acts as adjuvants that
slowsdown the potential intracellular enzyme to modify and enter the ThF cell function
2. REOVIRIDAE
 Colorado tick fever
 Rotaroviruses - most important cause oF INFANT GASTROENTERITIS IN THE WORLD
3. TOGAVIRIDAE
 Alphavirus (arbovirus)
 Eastern Equine encephalitis
 Westerm Equine encephalitis
 Venezuelean Equine Encehalitis
 Chikungunya ( same vector w/ dengue)
 Rubrivirus
 German measles (koplik’s spot)
 Rubella (forscheimer spots)

10. RETROVIRIDAE  RNA that replicates in the nucleus together with the orthomoxyviridae
 Requires a Reverse Polymerase (RNA dependent DNA polymerase) - Reverse transcriptase
 Subfamily oncovirinae:
 Human T-cell lymphoptropic Virus ( HTLV)
 2 types:
1. HTLV -1- px w/ lymphoma, tropical spastic paraperesis, first human retrovirus, causes t-cell
adult leukemia
2. HTLV-2 - Px with hair cell leukemia
 Family lentivirinae:
 Slow viral disease - genus Lentivirus (slow)
 It causes HIV-1 and HIV-2
 HIV causes AIDS
 2 types:
1. HIV-1 = WW, causes AIDS ( within 3 months)
2. HIV-2 = west Africa - less severe compared to HIV-1
 Receptor:
 P24 (major) - major capsid
 Gp160 ( gp 120, gp 41) surface glycoprotein
 Main receptor: CD4 molecule ( part. Gp120 receptor)
 Found in T- helper cell and other CD4 cells
 AIDS = CD4 levels is less than 200 /ul (NV: 500 to 1,600 ul)
 Normal ratio or CD4:CD8 = 2:1
 HIV: CD4:CD8 ratio: 0.5:1
 Dr.Robert Gallo and DR. Luc Montagnier - 1st recognized HIV among homosexual sexual in 1981in US
 In SACCL/RITM
 Serum samples are screened TWICE
 THREE (3) screening test:
1. ELISA - antibody
2. Rapid testing (serodia HIV1/2)
3. 4th generation EIA (HIV1/2 and p24)
 Positive: WESTERN BLOT ( confirmatory test)
  It detects all receptors ( p31, p24, gp160, gp120, gp41
 Positive results: 2 out 3 major antigens receptors (p24, gp 120, gp41)
 INTERMEDIATE = re-test after 6 months
 Window period:
 4 weeks for a 4th generation Ag/Ab test
 Retest after 3 to 6 months

HEPATITIS VIRUSES Other name Family Mode of INFORMATION

transmission
HEPATITIS A Infectious Picornaviridae Oral -fecal  Enterovirus 72 ( hepatovirus)
hepatitis route  24 -incubation
 Self-limiting
 Serology:
1. Anti-HAV - the agent
2. Total anti-HAV - detectable at onset of symptoms
( persist throughout of life)
3. IgM anti-Hav - indicates recent infection ( 4to 6 months
re-infections)
HEPATITIS B Serum hepatitis Hepadnavirida Sexually  7 days - survival ability in the envi.
e  Incubation period: 3 months
 5 to 10% - infected px that develop chronic hepatitis
 Serological Markers:
1. HbsAg - detected in high levels of acute or chronic HBV
2. HBeAg -product of nucleocapsid, viral replication
3. HBcAg - bot detected in serum; high levels of HBV if
infected
4. IgM anti-HBc - lifelong marker
5. Anti-Hbe - seroconversion; indicates lower levels or
HBeAg
6. Anti-HBs - recovery anf immunity developes
invaccinated persons
HEPATITIS C Post transfusion Flaviviridae Sexually,  Based on serological test: non related to HAV and HBV
non-a, non-b Genus blood  Caused by most post transfusion NANB
Hepaciviridae transfusion  Detection:
Needle prick 1. Persistence of anti-HCV - indicates HCV replication
2. Elevation of ALT
3. Gene amplification test to detect HCV RNA
4. EIA - screening tests; high false positivity
5. 2nd gen. Immunoblot test - RIBA ( recombinant
Immunoblot assay) = CONFIRMATION
HEPATITIS D Delta hepatitis Unclassified  HDag surrounded by HBsAG envolope
 HDV: ss RNA, smallest of known pathogens
 40% of fulminant hepatitis
 Highly depended on the HBV for replication
 Defective virus that aquires HBsAg coat for transmission
 CO-INFECTION OR SUPER-INFECTION
HEPATITIS E Enteric Non-A, Unclassified Oral-fecal  Acute-self limiting disease similar to HAV
Non-B route  20% mortality rate of preggy if FULMINAT HEPATITIS
DEVELOPED
 DX: ELISA ( IgM anti anti-HEV, IgG anti-HEV

HEPATITIS F Mutant strain of  Viral -like particle (dsDNA)

HBV)
HEPATITIS G GBV-C virus Flaviviridae Transfusion  No associated diseases
 Transfusion related to the HCV
SEN- V NANE and Post transfusion Annelloviridae Transfusion-  Torque-teno virus
TTV (transfusion- hepatitis transmitted  1977 (DISCOVERED) in the plasma of japaneses
transmitted virus): patients (T.T initials) w/ post transfusion hepatitis
viruses (DNA
Viruses)