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VIRUS OBLIGATE INTRACELLULAR PARASITE W/C DERIVE ENERGY EXCLUSIVELY FROM METABOLISM OF THE CELLS THAT THEY INFECT 2 STAGES IN VIRAL LIFE CYCLE A. REPLICATION (INTRACELLULAR) B. INFECTIOUS (EXTRACELLULAR) - VIRIONS ARE EXTRACELLULAR VIRAL PARTICLES CONSISTING OF AN INTERNAL CORE OF NUCLEIC ACID SURROUNDED BY A PROTEIN COAT (CAPSID) CAPSID - PROTECT THE NUCLEIC ACID FROM NUCLEASES - INITIATES INFECTION BY PROVIDING SPECIFIC RECEPTORS FOR VIRION ATTACHMENT TO CORRESPONDING SITES ON THE SURFACE OF THE CELL - CLASSIFIED INTO: 1. RNA – CONTAINING VIRUS 2. DNA – CONTAINING VIRUS - VIRAL NUCLEIC ACID FUNCTIONS AS: 1. TEMPLATE ON W/C NUCLEIC ACID ID REPLICATED 2. CONTAINS THE GENETIC INFORMATION 3. CAN MUTATE AND CAN MATE W/ NUCLEIC ACID OF A HOMOLOGOUS VIRUS BY RECOMBINATION VIRAL INFECTIONS OF THE NERVOUS SYSTEM VIRUS VIRUS RNA-CONTAINING VIRUSES PICORNA VIRUS (Enterovirus) 70 & 71 72 (Hep A) TOGAVIRUS ENCEPHALITIS (Arbovirus) Western, & Venezuela) ENCEPHALITIS REPRESENTATIVE POLIO VIRUS COXSACKIE ECHOVIRUS ENTEROVIRUS ENTEROVIRUS EQUINE (Eastern, ST. LOUIS ENCEPHALITIS JAPANESE ENCEPHALITIS BUNYAVIRUS ENCEPHALITIS (Arbovirus) TICK-BORNE RUBELLA CALIFORNIA ORBIVIRUS (Arbovirus) COLORADO TICK FEVER ORTHOMYXOVIRUS INFLUENZA PARAMYXOVIRUS MEASLES (Subacute sclerosing encephalitis) MUMPS ARENAVIRUS LYMPHOCYTIC CHORIOMENINGITIS RHADOVIRUS RETROVIRUS IMMUNODEFICIENCY RABIES HUMAN VIRUS (Acquired immunodeficiency Syndrome) DNA-CONTAINING VIRUSES HERPESVIRUSES HERPES SIMPLEX VARICELLA-ZOSTER CYTOMEGALOVIRUS EPSTEIN-BARR VIRUS (Infectious mononucleosis) PAPOVA VIRUS PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATH Y (PML VIRUS) POXVIRUS SEROTYPES ADENOVIRUS VACCINIA ADENOVIRUS ENTEROVIRUS CONJUNCTIVITIS DISEASE 70 ACUTE HEMORRHAGIC 71 HAND-FOOT AND MOUTH 72 HEPATITIS A VIRUS PATHWAYS OF VIRAL SPREAD TO THE CNS 1. BLOOD 2. ALONG THE NERVE FIBERS VIRUSES HAVE DEFINITE TROPISMS (Predilection) 1 – Herpes Simplex Virus Peripheral sensory nerves Gasserian ganglion --- Ophthalmic Zoster Geniculate ganglion --- Ramsay Hunt Syndrome Meningss Brain Parenchyma ----------- Temporoparietal lobes 2 – Poliovirus Motor neurons ----------------- Cranial nerves and spinal cord 3 – Rabies Virus Neurons ------------------------- Cerebellum (Purkinje cells) Hippocampus (Pyramidal cells) Spinal cord PORTAL OF ENTRY INNOCULATION ANIMAL BITE MOSQUITO/TICK BITE RESPIRATORY ROUTE MEASLES VIRUS, ENTERIC ROUTE TRANSPLACENTAL ROUTE CYTOMEGALOVIRUS RABIES VIRUS ARBOVIRUSES MUMPS, HERPES SIMPLEX, CHORIOMENINGITIS VIRUS POLIOVIRUS, COXSACKIE VIRUS, ECHOVIRUSES RUBELLA VIRUS, INCLUSION BODIES (site where viral components are synthesized and assymbled) TYPE A) 1 – INTRANUCLEAR - HERPES VIRUS (COWDRY CYTOMEGALOVIRUS PROGRESSIVE FOCAL LEUKOENCEPHALOPATHY 2 – INTRACYTOPLASMIC - RABIES (NEGRI BODIES) VIRUSES W/ PROCLIVITY TO INVADE THE NERVOUS SYSTEM 1 – HUMAN IMMUNODEFICIENCY VIRUSES (HIV – 1 AND HIV – 2) 2 – HERPES SIMPLEX VIRUSES (HVS – 1 AND HVS – 2) 3 – HERPES ZOSTER / VARICELLA ZOSTER (VZ) VIRUS 4 – EPSTEIN-BARR VIRUS (EBV) 5 – CYTOMEGALOVIRUS (CMV) 6 – POLIOVIRUS 7 – RABIES VIRUS 8 – SEASONAL ARTHROPOD BORNE VIRUSES VIRUSES WITH PARTICUALR NEURONS 1. POLIOMYELITIS VIRUSES W/ MOTOR NEURONS 2. VZ VIRUS AND PERIPHERAL SENSORY NEURONS 3. RABIES VIRUS AND PURKINJE CELLS VIRAL INFECTIONS PRODUCE 2 EFFECTS: 1 – IMMEDIATE EFFECT 2 – DELAYED / SLOW EFFECT virus A. Subacute Sclerosing Panencephalitis (SSPE) caused by measles caused by papova Virus B. Progressive Mulitfocal Leukoencephalopathy (PML) Encephalopathy C. Creutzfeldt-Jacob Disease or Subacute Spongioform D. Kuru E. Malignancies caused by HSV II NEUROLOGIC SYNDROMES CAUSED BY VIRUSES ENCEPHALITIS ARBOVIRUS RABIES HERPES POST-INFECTIOUS GROUP (MEASLES, RUBELLA, INFLUENZA) INFECTIOUS MONONUCLEOSIS POLIOVIRUS COXSACKIE ECHOVIRUS MENINGITIS COXSACKIE ECHOVIRUS MUMPS LYMPHOCYTIC CHORIOMENINGITIS PARALYTIC POLIOVIRUS HERPES VIRUS POST-INFECTIOUS GROUP POLIOVIRUS COXSACKIE ARBOVIRUS RABIES POST-INFECTIOUS GROUP VIRAL INFECTIONS MAY LEAD TO: 1 – INFLAMMATORY CHANGES 2 – CONGENITAL DEFECTS (Cerebellar agenesis; Aqueductal stenosis) 3 – SYSTEM DEGENERATION 4 – NEOPLASTIC TRANSFORMATION THE SYNDROME OF ASEPTIC MENINGITIS bacterial cultures are negative “fever, headache, signs of meningeal irritation and a predominantly lymphocytic pleocytosis with normal CSF glucose” majority of cases are due to viral infections (most common are due to enteroviral infections caused by echovirus, coxsackievirus and nonparalytic poliomyelitis) but other bacteria can also produce aseptic meningitis such as mycoplasma, Q fever, Rickettsia) rarely fatal precise pathologic changes are uncertain but are presumably limited to the meninges Differential Diagnosis of Viral Meningitis Important: - recent respiratory / gastrointestinal symptoms immunizations past history of infectious diseases family outbreaks insect bites contact with animals areas of recent travel presence / absence of epidermis the season during which the illness occurs geographic location Nomenclature and Dosage Forms of Available Antiviral Agents GENERIC NAME DOSAGE NORMS OTHER NAMES AVAILABLE Antiherpesvirus agents Acyclovir ACV, acycloguanosine IV, O, T, Ophth* Famciclovir FAMVIR Foscarnet FOSCAVIR Ganciclovir GCV, DHPG IV, O Idovuridine HERPES, STOXIL, Sorivudine Trifluridine Valacyclovir Vidarabine Antiretroviral agents Didanosine Stavudine IV,* O* VIRONTIC TRADE NAMES (USA) ZOVIRAX FCV O PFA, phosphonoforntate IV, O* CYTOVENE IDUR Ophth DENDRID BV-ara-U, brovavir TFT, trifluorothymidine Ophth VALTREX O ara-A, adenine arabinoside IV, Ophth O d4T O ddl VIRA-A VIDEX ZERIT _____* Zalcitabine Zidovudine Other antiviral agents Amantadine Interferon alpha (tinterferon alfa) O RETROVIR ddC AZT, ZDV, azidothymidine O O Injectible WELLFERON* Ribavirin Rimantadine HIVID SYMMETREL, SYMADINE INTRON A, ROFERON A, ALFERON N, VIRAZOLE Aerosol.,O,* ,IV* O FLUMADINE *Not currently approved for use in the United States NOTE: IV-intravenous; O-oral; T- topical; Ophth-ophthalmic -BIOLOGIC PROPERTIES OF VIRUS APPEAR TO BE THE REASON FOR ITS EPIDEMIC OR SPORADIC OCCURRENCE PICORNA VIRUSES – ARE ACID AND HEAT RESISTANT RESULTING TO FECAL-HAND- ORAL TRANSMISSION DURING SUMMER MONTHS TOGAVIRUSES – REQUIRE A MULTIPLICATION PHASE IN MOSQUITOES / TICKS BEFORE THEY CAN INFECT PEOPLE HUMAN EPIDEMIC OCCURS WHEN CLIMACTIC AND OTHER CONDITIONS FAVOR A LARGE POPULATION OF INFECTED INSECT VECTORS - IMMUNITY TO THE VIRUS IS SPECIFIC - MOST CASES OF VIRAL INFECTIONS ARE SELF-LIMITED - PRESENT AS EITHER EPIDEMIC OR SPORADIC FORM - DIAGNOSIS: 1 – SEROLOGICAL TESTS - COMPLIMENT FIXATION TEST - NEUTRALIZATION TEST - HEMAGLITINATION-INHIBITION TEST POSITIVE (+) RESULT IS A GRADUAL INCREASE IN TITER OF ANTIBODIES (4-FOLD) 2 – TISSUE CULTURE/INOCUALTION OF BLOOD, FECES, CSF, INTO SUSCEPTIBLE ANIMALS 3 – BIOPSY/FLOURESCENCE STAINING OF INCLUSION BODIES 4 – CSF ANALYSIS HERPES VIRUS DNA-containing virus notorious for establishing latent infections acidophilic inclusion bodies in the nucleus (COWDRY Type A inclusion) members of the HIV associated with neurologic diseases: o Herpes simplex virus o Varicella Zoster virus o Cytomegalovirus o Epstein-Barr (EB) virus SIGNS AND SYMPTOMS psychotic features hallucinations Fever and Headache seizures confusion stupor delirium aphasia coma (respiratory arrest secondary to herniation due to sever brain swelling during the first 24-72 hours) - CSF – is under increased pressure o pleocytosis (predominantly lymphocytes) o protein content increased o glucose levels maybe reduced to slightly <40mg/dL o presence of red cells, sometimes xanthochromia reflecting the hemorrhagic nature of the lesions - Pathology – intense hemorrhagic necrosis of the frontal and temporal lobes Diagnosis – Absolute method – 1 – fluorescent antibody study 2 – viral culture of cerebral tissue obtained by biopsy - Polymerase chain reaction assay – detection of HSV antigen in the CSF - HERPES SIMPLEX ENCEPHALITIS “Acute Inclusion Body Encephalitis” commonest and gravest form of acute encephalitis occurs sporadically throughout the year affecting patients of all ages 2 Antigenic types of HSV (HV Hominis) 1- Type I strain (HSV I) o causes common herpetic lesions of the oral mucosa (stomatitis, pharyngitis, and respiratory infections) o transmitted by respiratory / salivatory contact o encephalitis results from endogenous reactivation of virus o virus abode in the trigeminal ganglia 2- Type II strain (HSV II) o causes genital herpetic infection in adults o causes acute encephalitis, usually in neonate in relation to genital herpetic infection in the mother o in adults, spread is by venereal transmission CLINICAL FEATURES Itching / Burning / Tingling (sensations in the involved dermatome(s)) or Fever and body malaise or Localized pain (Pleurisy / cholecystitis / Appendicitis) Appearance of vesicles (after 48 to 72 hours) Dry, crusted and scaly (5 to 10 days) - Thoracic dermatome (T5 to T10) are the most common sites of zoster infection Cranial Herpetic Lesions 1 – Ophthalmic Herpes accounts for 10 to 15% of all cases of zoster pain and rash are in file distribution of the first division of the trigeminal N.; the pathologic changes are centered in the Gasserian ganglion main hazard is herpetic involvement of the cornea and conjunctiva with corneal anesthesia and residual scarring palsies of the extraocular muscles, ptosis and mydriasis are frequently associated 2 – Ramsay Hunt Syndrome herpetic infection of the geniculate ganglion of the facial nerve a facial nerve palsy in combination with herpetic eruption of the external auditory meatus, sometimes with tinnitus, vertigo and deafness 3 – Herpes Occipitocollaris herpes zoster of the palate, pharynx, neck and retroauricular region involving the upper cervical roots and ganglia of the vagus and glossopharyngeal nerves EPSTEIN-BARR VIRUS (EBV) CAUSES INFECTIOUS MONONUCLEOSIS OR “GLANDULAR FEVER” PATHOLOGIC CHANGES ARE FOUND IN THE LYMPH NODES, SPLEEN, LIVER, SKIN, AND CNS SIGNS AND SYMPTOMS: FEVER AND HEADACHE WITH ASSOCIATED BODY MALAISE FOLLOWED LATER BY SORE THROAT ENLARGEMENT OF LYMPH NODES IN THE CERVICAL REGION CYTOMEGALOVIRUS (CMV) CAUSES CYTOMEGALIC INCLUSION BODY DISEASE – AN INFECTION THAT OCCURS IN UTERO BY TRANSPLANTAL TRANSMISSION WHICH MAY RESULT TO STILLBIRTH OR PREMATURITY PATHOLOGY CEREBRUM IS AFFECTED BY A GRANULOMATOUS ENCEPHALITIS WITH EXTENSIVE SUBEPENDYMAL CALCIFICATIONS ASSOCIATED FINDINGS o = CONGENITAL DEFECTS o = MENTAL RETARDATION o = SEIZURES o = HEPATOSPLENOMEGALY W/ JAUNDICE o =HEMOLYTIC ANEMIA o = PURPURIC LESIONS DIAGNOSIS o PRESENCE OF TYPICAL CELLS o CYTOMEGALIC CELLS IN STAINED PREPARATIONS OF URINE / SALIVA SYNDROMES OF HERPES ZOSTER called also as “shingles” affects all ages with higher rates in the elderly . readily characterized clinically by radicular pain, a vesicular cutaneous eruptions, and less often, by segmental sensory and motor loss the common agent, referred to as varicell or varicella-zoster (VZ) virus, is a DNA virus that is similar in structure to the virus of herpes simplex; no antigenic similarity with herpes simplex virus chickenpox or varicella infection is a highly contagious zoster infection, on the other hand it is NOT COMMUNICABLE except to a person who has had chickenpox infection higher incidence in immunocompromised individuals and with malignancy PATHOLOGIC changes consists of the following: 1.) an inflammatory reaction in several unilateral adjacent sensory ganglia of the spinal or cranial nerves 2.) an inflammatory reaction in the spinal roots an peripheral nerve contiguous with the involved ganglia 3.) a poliomyelitis that closely resembles acute anterior poliomyelitis but is distinguished by its unilaterally, segmental localization and greater involvement of the dorsal horn, root and ganglion 3.) a relatively mild leptomeningitis RNA-VIRUSES ARBOVIRUSES - “arthropod-borne disease” includes: 1. Alphaviruses – formerly Group A arboviruses 2. Flaviviruses – formerly Group B arboviruses 3. Bunyaviruses - Arboviruses multiply in a blood-sucking arthropod vector (mosquito and ticks) Birds – is the principal host People and horses – incidental host. Once infected, it terminates the chain of infections. EQUINE ENCEPHALITIS - 3 distinct types: a) Eastern Equine Encephalitis (EEE) b) Western Equine Encephalitis (WEE) c) Venezuela Equine Encephalitis (VEE) - RARE HUMAN INFECTION - Mortality rate is over 50% - EEE 10% - WEE 0.5% - VEE MEASLES VIRUS (MYXOVIRUS) - CAUSES WIDE SPECTRUM OF NEUROLOGIC DISEASES 1 – subclinical involvement 2 – acute measles encephalitis (postinfectious encephalitis) 3 – chronic subacute sclerosing panencephalitis (SSPE) Subacute ,easles encephalitis occurs as an opportunistic infection in immunosuppressed or immunodeficient patients. - affects mostly children - disease is characterized by generalized and focal seizures occasional focal deficits, and a progressive deterioration of mental function leading to coma and death in several weeks to 4 to 5 months. MYXOVIRUS INFECTIONS MUMPS - a disease cause by paramyxovirus with a predilection for the salivary glands, mature gonads, pancreas, breasts, and the nervous system - spread via respiratory droplets - two sexes are equally susceptible to mumps, neurologic complications are 3x more frequent in males - the symptoms of involvement of NS appear 2 to 10 days after the onset of parotitis - COMPLICATIONS: 1. deafness – most common sequel of mumps 2. orchitis 3. oophoritis 4. pancreatitis 5. thyroiditis ECHOVIRUS - “ENTERIC CYTOPATHOGENIC HUMAN ORPHANS” - 32 SEROTYPES RECOGNIZED - CAUSE – gastroenteritis, macular exanthema, URTI - COMMON RECOVERED FROM – feces, throat swabs, CSF ENTEROVIRUS 70 - can cause epidemic of ACUTE HEMORRHAGIC CONJUNCTIVITIS (AHC) - neurologic involvement occurs 2 weeks after the AHC in the form of polio-like syndrome ENTEROVIRUS 71 - causes HAND-FOOT and MOUTH DISEASE (HFMD) RNA (ARBO) VIRUSES - “ARTHROPOD-BORNE” VIRUS - “RNA-CONTAING” VIRUS - blood sucking arthropod vector - mosquitoes and ticks – common vector EQUINE ENCEPHALOMYELITIS (EEE) (WEE) Grp.A Arboviruses (VEE) EASTERN EQUINE ENCEPHALITIS – most serious JAPANESE ENCEPHALITIS - mosquito – transmitted Flavivirus (Group B Arbovirus) - mostly affected are the children RUBELLA (GERMAN MEASLES) - TOGA VIRUS not an Arbovirus POLIOMYELITIS PICORNAVIRUS ● “PICO” means small ● smallest RNA virus ● nonenveloped multiplying in the cytoplasm of the cells ● 2 Subgroups: 1 – ENTEROVIRUSES – GIT POLIOVIRUSES COXSACKIEVIRUSES ECHOVIRUSES 2 – RHINOVIRUSES – NASOPHARYNX ● cannot be inactivated by most agents ● highly cytocidal ● produce acidophilic inclusion bodies POLIOMYELITIS ● “INFANTILE PARALYSIS” , “HEINE-MEDIN DISEASE” ● acute generalized disease characterized by destruction of the motor cells in the spinal cord and brainstem, resulting to flaccid paralysis of the muscles innervated by the affected neurons ● highly communicable disease ● may occur in sporadic, endemic or epidemic form at any time of the year main reservoir of infection is the human intestinal tract main route of infection is fecal-oral the disease may occur at any age but it is rare before the age of 6 mos. there are 3 antigenically distinct types: Type I – most often associated w/ paralytic disease Type II Type III ● clinically may manifest as: 1 – inapparent infection 2 – minor illness / abortive poliomyelitis 3 – nonparalytic / preparalytic poliomyelitis 4 – paralytic poliomyelitis A – SPINAL POLIO (ACUTE ANTERIOR POLIOMYELITIS) - affects ventral horn cells of the SC (cervical and lumbar levels) B – BULBAR POLIO - affects cranial nerve motor nuclei in the BS particularly (IX, X, XI, XII) C – SPINOBULBAR POLIO D – ENCEPHALITIC TYPE ● pathogenesis: A – enteric type B – virus multiplication C – viremia thru hematogenous or lymphatics D – w/in the CNS – virus spreads along nerve affecting BS & SC ● Biphasic or Dromedary Phase 95% - subclinical form (inapparent infection) 5% = 4% - meningitis (aseptic) 1% - paralytic type ● pathological changes: 1 – necrosis of ventral horn cells and cranial nerve motor nuclei 2 – chromatolysis w/ acidophilic inclusion bodies ● laboratory findings 1 – CBC – leucopenia 2 – SEROLOGICAL TEST - ↑ titer of Anb 3 – TISSUE CULTURE – (+) 4 – CSF ANALYSIS - ↑ OP; clear colorless pleocytosis ↑ protein content normal sugar (-) gram stain 5 – ELECTROMYOGRAHY (EMG STUDIES) *1 – fibrillations 2 – fsaciculations ● treatment 1 – prophylaxis – polio vaccination SABIN-OPV / SALK VACCINE (TOPV) (LIVE ATTENUATED) 2 – symptomatic / supportive treatment 3 – physiotherapy ● prognosis bulbar – poor COXSACKIEVIRUSES - has the same structural and biologic features as the picornaviruses - 2 Subgroups: 1 – Group A – 24 serotypes 2 – Group B – 6 serotypes - a number of echovirus and coxsackie virus infections are associated w/ exanthemata GROUP A INFECTIONS GROUP B INFECTIONS ASEPTIC MENINGITIS ASEPTIC MENINIGITIS PARALYTIC ILLNESS PARALYTIC ILLNESS ENCEPHALITIS ENCEPHALITIS HERPANGINA PLEURODYNIA(BORNHOLM DIS) HAND-FOOT&MOUTH DISEASE PERICARDITIS MYOCARDITIS MYALGIA ORCHITIS - diagnosis: > established by recovery of the virus from the feces, throat washings > demonstrating an increase in viral antibodies in the serum - muscles sites of predilection: A. SPINAL CORD – ventral horn cells 1 – LUMBAR – origin of lumbosacral plexus 2 – CERVICAL – origin of brachial plexus C3 C5 – supplies the diaphragm (phrenic nerve) INTERCOSTAL N. SPINAL ACCESSORY NERVE ( C.N.XI)Spinal segment supplies the trapezius and sternocleidomastoid B. BRAINSTEM – lower medulla 1 – DORSAL N. OF VAGUS (C.N.X) 2 - HYPOGLOSSAL N. 3 – NUCLEUS AMBIGUUS (C.N. IX,X,XI)origin of motor fibers to the larynx and pharynx; recurrent laryngeal nerve RABIES ● HYDROPHOBIA ● LYSSA ● RAGE > acute viral disease transmitted by the bite of a rabid animal > Signs and Symptoms: ● restlessness, hyperesthesia, convulsions, ● laryngeal spasms, widespread paralysis ● almost invariably – death > Etiology: ● enveloped bullet shaped RNA virus present in the saliva of infected animal ● BITE → virus replicates in muscle cells → sensory → motor nerves (axonal transport) → CNS involvement (limbic system) > Incubation Period: ● average: 1-3 months ● facial wounds → shortest incubation > Pathology: ● Generalized Encephalitis, Myelitis ● CNS – perivascular infiltration with lymphocytes ● NEGRI BODIES – cytoplasmic eosinophilic inclusion w/ central basophilic granules ● NEGRI BODIES contain rabies virus antigen ● BABES NODULES – rod cell formation; proliferative changes of microglia > Incidence: ● 15% incidence among individuals bitten by rabid dog > Manifestations: ● numbness in region of bite ● apathy, drowsiness, HA’S, anorexia ● excitability → generalized convulsions ● spasmodic contractions of pharynx and larynx → hydrophobia ● fever ● respiratory paralysis ● death > Diagnosis: ● characteristics symptoms after the bite ● brain biopsy > Course: ● invariably fatal in 2-5 days > Treatment: non-specific; entirely prophylactic 1. Passive Immunization ● HRIG (Human Rabies Immune Globulin) 2. Active Immunization ● Human Diploid Cell Vaccine ● Equine Rabies Antiserum ● Duck Embryo Vaccine ECHOVIRUSES ECHO – “ENTERIC CYTOPATHOGENIC HUMAN ORPHANS” > There are about 33 serotypes can cause: GASTROENTERITIS MACULAR EXANTHEMA UPPER RESPIRATORY INFECTIONS ECHO VIRUS 9 – petechial rash may be confined with Meningococcemia > Clinical Manifestations: 1 – ASEPTIC MENINGITIS 2 – NONPARALYTIC POLIOMYELITIS LIKE DISEASE 3 – CEREBELLAR ATAXIA 4 – OCULOMOTOR N. PARALYSIS W/ PUPILLOMOTOR FIBER 5 – ECHOVIRUS – induced meningoencephalitis - persistent CNS infection in children w/ agammaglobulinemia associated with a dermatomyositis-like syndrome > Diagnosis: - recovery of virus from feces, throat swabs & CSF Nomenclature and Dosage Forms of Available Antiviral Agents GENERIC NAME FORMS Antiherpesvirus Agents Acyclovir Famciclovir Foscarnet OTHER NAMES TRADE NAMES DOSAGE AVAILABLE ACV, acycloguanosine FCV PFA, phosphono- OVIRAN IV,O,T,Ophth FAMVIR OSCAVIR O IV,O Ganciclovir Idovuridine Sorivudine Trifluridine Valacyclovir Vidarabine Antiretroviral Agents Didanosine Stavudine Zalcitabine Zidovudine Other antiviral Agents Amantadine Interferon alpha (interferon alta) Ribavirin Rimantadine Forntate GCV, DHPG IDUR STOXIL DENDRID BV-ara-U,brovavir TFT, trifluorothymidine ara-A, adenine Arabinoside ddl d4T ddC AZT, ZDV, Azidothymidine SYMADINE ROFERON A WELLFERON VIRAZOLE CYTOVENE HERPES, IV,O Ophth --* IROPTIC IV,* O* Ophth VALTREX VIRA-A O V,Ophth VIDES ZERIT HIVID RETROVIR O O O O SYMMETREL, O INTRON A, Injectible ALFERON N, FLUMADINE Aerosol, O,* IV O