0205101430 - MFM II - Papoviruses (Colle)

1. papillomavirus - warts
2. polyomavirus - JC and BK associated with Progressive Multifocal Leukoencephalopathy (PML)

non-enveloped
circular dsDNA
icosahedral
capsid has 4 structural proteins

two phase gene expression
1. early gene expression - genes involved in DNA replication
2. late gene expression - 4 structural genes that form the capsid

there are none. since papillomavirus cannot be grown in culture they are just called "types." these types are all very specific for different types of tissue.

status germinatrium - basal cell layer of epidermis that

usually spontaneously possibly from a good cell mediated immune response

benign - replicate as plasmids
oncogenic - integrate into host cell genome to replicate

autoinnoculation
microtrauma in hands and feet
fomites
sexual contact
childbirth

girls

the most common of all warts caused by HPV-2, HPV-4 and frequently occur in multiples that are usually located on the hands and fingers. will spontaneously resolve, but can be treated.

seen mainly in adolescents and young adults, these are caused by HPV-1 and HPV-4 and are called plantar warts. black dots are bleeding points

flat warts caused by HPV-3 and HPV-10 that usually appear on the face. they usually cause a trivial cosmetic problem. could probably be mistaken for acne sometime, but never ulcerates.

HPV-13 caused mucosal oral cavity warts that present of a rough texture in the mouth that spontaneously resolve

HPV-11 caused oral wart that usually requires surgical excision. rare to have multiple papillomas, which are caused by an unknown HPV

HPV-11 and HPV-6 caused warts and usually are recurrent until puberty and then they self resolve. in very serious cases, extensive hypertrophy can lead to breathing problems and can be malignant after radiation treatment

HPV-11, HPV-1, HPV-2 caused anogenital warts on mainly external mucosal surfaces will present very cauliflower-like in women which can lead to ovarian carcinoma. presents as penile warts in men which is somewhat reduced with circumcision

gay males

cervical intraepithelial neoplasia = cervial dysplasia caused by HPV-16 (50%) and 18, 31, 45, 6, 11 present lower risk. this is the precursor of squamous cell carcinoma.

HPV which 99% of the time correlates with cervical cancer

CIN 1 - mild (occurs in "transformation zone" where columnar epithelial cells of endocervix meet the squamous epithelium of the vagina)
CIN 2 - moderate
CIN 3 - severe/carinoma

halo'd and enlarged nuclei

acetic acid tx

squamous intraepithelium lesions that are easily detected in PAP smears of CIN-1 conditions. as SILs increase, CIN rating increases.

50% had HPV-16
4-24% had HPV-18

the genes that are made by the HPV plasmid are as follows:
E2 - regulates cell cycle
E6, E7 - expressed to encourage proliferation after given permission from E2

in carcinoma causing HPV, the HPV plasmid breaks at E2, integrates into the host genome and then has unregulated proliferation and replication. no E2, no brakes.

patient prerogative, bcause most of the time it's simply cosmetic. tx does NOT get rid of HPV. no tx exists for HPV removal.

single
small
< 1y/o

1. topical salicylic acid (compound-w)
2. topical formalin, glutalaldehyde
3. podphyllin (apple mayapple resin) used for genital warts
4. cryotherapy

1. cryosurgery
2. laser surger
3. LEEP - loop electrosurgical Excision Procedure (hot loop that cuts out a large surface
4. cone biopsy - cuts out a cone plug
5. hysterectomy

preventative anti-HPV vaccine that is quadrivalent and composed of HPV-like particles of 16, 18, 6, 11. these are empty capsids with no genome. best for girls from 9-12.

causes progressive multifocal leukoencephalopathy (PML). this virus gets into the white matter, specifically the oligodendrocytes and causes demyelination. death w/i 6 mos. no tx.