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STUDY OF VIRUS VIRUSES infectious agents that are too small to be seen with a light microscope “virus” in Latin means “poison” WHAT ARE VIRUSES lack cell nucleus, cell organelles, or cytoplasm replicate only inside a living host cell contain either DNA or RNA but not both herpes = DNA polio = RNA virus do not grow or divide DIVERSITY & CLASSIFICATION Criteria used to classify viruses: 1) Disease symptoms 2) Physical structure of virus particles 3) Structure & sequence of the virus genome RNA VIRUSES comprise70% of all viruses the high error rate of the enzymes involved in RNA replication results in: viruses which show much higher mutation rates than do DNA viruses high mutation rates lead to the continuous generation of virus variants which show great adaptability to new hosts VIRAL MULTIPLICATION viral multiplication requires: 1) that a virus particle infect a cell 2) and program the host cell’s machinery to synthesize the components required for the assembly of new virus particles COMPONENTS OF VIRUSES core nucleic acid capsid protein coat envelope lipid bilayer membrane not all viruses have an envelope CORE “a piece of bad news wrapped up in a protein” nucleic acid is the “bad news” viruses use their genetic information to replicate themselves in host cells disrupts host cell functions CAPSIDS accounts for most of the viruses mass protein coat which protects the nucleic acids determines the shape of the virus capsid structure is determined by the enclosed viral nucleic acid ENVELOPES acquire their envelope after they are assembled in a host cell as they move through one or several membrane systems ER, Golgi apparatus, plasma membrane combinations of host derived lipids, proteins and carbohydrates ENVELOPES spikes may or may not be present assist the virus in attaching to receptor sites on the host cell membrane envelopes are made from host cell membranes and the virus is effectively “hidden” from attack by host’s immune system enveloped viruses are damaged easily naked viruses are more resistant to harsh environmental conditions BUDDING Some viruses have devised strategies to exit the infected cell without its total destruction The viability of the cell depends on the integrity of the cell membrane Viruses leaving the cell must therefore allow this membrane to remain intact achieved by budding of the particle through the membrane during which process the particle becomes coated in a lipid envelope derived from the host cell membrane & with a similar composition Not all enveloped viruses bud from the cell surface membrane may use cytoplasmic membranes the golgi complex herpes viruses which replicate in the nucleus may utilize the nuclear membrane the virus is transported to the cell surface & subsequently released NAKED VIRUS PARTICLES those in which the capsid proteins are exposed to the external environment this strategy has drawbacks In some circumstances it is wasteful resulting in the premature death of the cell ENUMERATION OF VIRUSES enumerated by spreading a suspension on the surface of a lawn of actively growing cells susceptible to the virus a virus particle infects, reproduces, and its progeny re-infect surrounding cells a zone of clearing in the cell layer is produced The plaque presumably originated from one virus particle the number of virus in the original suspension is proportional to the number of plaques obtained VIRAL FORMS Viruses can infect all forms of life bacteria, plants, protozoa, fungi, insects, fish, reptiles, birds, and mammals VIRAL GENOMES smaller than bacterial systems one of the largest viral genomes is 190 kilobases compared to 590 for the smallest bacterial system economy is achieved with overlapping genes some nucleotide sequences are read in more than one reading frame As genome size increases, virus structure and life cycle become more complicated REPRODUCTIVE CYCLES two types of reproductive cycles 1) lytic or virulent infection new virus particles are made and released (burst) from the host cell 2) transformation or lysogenic infection virus genome is integrated into that of the host cell replicated as part of the host as it grows LYTIC REPRODUCTIVE CYCLE 1) Attachment 2) Penetration 3) Take-over 4) Replication 5) Synthesis 6) Assembly 7) Release LYTIC REPRODUCTIVE CYCLE 1) Attachment to the surface of the cell The type of cells a virus can infect is highly specific A virus protein binds specifically to a cell receptor Viral Specificity CD4 on T-cells for HIV ICAM on upper respiratory epithelial cells - Rhinoviruses (common cold) Immunoglobulin-like receptors - polio virus The association between the virus and its host imposes specific conditions for pathogenesis ex: rhinoviruses require a temperature not exceeding 34°C this restricts growth to only those cells in the cool outer layer of the nasal mucosa thereby preventing spread to deeper cells where temperatures are higher 2) Penetration the cell wall and membrane are breached by enzymatic degradation injection of the genetic material into the cell the protein coat does not enter the cell 3)Take-over of host biosynthetic machinery prevents synthesis of cellular proteins enables expression of viral genes 4) Replication of nucleic acid 5) Synthesis of coat proteins 6) Assembly of genomes into protein coats 7) Release from the cell The time-frame for the reproductive cycle can be: 20-30 min in bacteria 8-40 hours in animal cells HOST CELL PROTECTION STRATEGY 1) have no receptor sites for the virus to bind with 2) produce restriction enzymes attack the foreign nucleic acid TRANSFORMATION REPRODUCTIVE CYCLE virus repress expression of the genes used to initiate lytic infections viral genes are held in a transformational stage a switch or signal converts the virus to the lytic growth cycle described earlier LATENT INFECTIONS Some viruses have a capacity for latent infections symptoms only arise under stress ex: Herpesviruses has a gene that controls the timing of gene expression VIRAL INFECTION some viruses may establish forms of “silent” infection in most cases their multiplication usually causes cell damage or death viruses must depend on host survival for their own survival thus tend to establish mild infections in which death of the host is more an aberration than a regular outcome VIRUS INCORPORATION Viruses use normal human cell reactions to antigens to invade the cell membrane In this case a virus needs only to come into contact with the cell membrane VIRAL PATHOGENESIS vast majority of virus infections are sub-clinical (asymptomatic) critical stages in replication determine the nature of the disease they produce 1) Entry into the Host 2) Primary Replication 3) Spread Through the Host 4) Host Immune Response 5) Secondary Replication 6) Cell & Tissue Damage 7) Persistence 1) ENTRY INTO THE HOST the site of entry can influence the disease symptoms produced Skin (dead cells) cannot support virus replication Most viruses which infect via the skin require a breach in the physical integrity of the barrier some viruses employ vectors ticks mosquito's (yellow fever) bats (rabies) Respiratory tract Most common site possess immune defense mechanisms ciliated epithelium, mucus secretion, lower temperature adenoviruses, rhinoviruses, herpesviruses, orthomyxoviruses Gastrointestinal tract hostile environment; gastric acid, bile salts ingestion enteroviruses, poliovirus, hepatitis A, reoviruses Genitourinary tract less hostile than GI tract usually sexually transmitted human papillomaviruses, herpes simplex, HIV Conjunctiva exposed and relatively unprotected 2) PRIMARY REPLICATION virus must initiate an infection by entering a susceptible cell frequently determines whether the infection will remain localized at the site of entry or spread to become a systemic infection 3) SPREAD THROUGHOUT THE HOST via direct cell-to-cell contact via the bloodstream insects, blood transfusion, I.V. drug abuse via the nervous system spread occurs by direct contact with neurons at the primary site of infection from peripheral nerves the virus can spread to the CNS by axonal transport along neurons 4) HOST IMMUNE RESPONSE has a major impact on the outcome of an infection 5) SECONDARY REPLICATION Occurs in systemic infections when a virus reaches other tissues in which it is capable of replication Poliovirus gut epithelium - neurons in brain & spinal cord If a virus can be prevented from reaching tissues where secondary replication can occur, generally no disease results 6) CELL & TISSUE DAMAGE Viruses may replicate widely throughout the body without any disease symptoms if they do not cause significant cell damage or death some viruses may not cause cell death being released from the cell by budding rather than by cell lysis causing persistent infections May be passed vertically to offspring if they infect the germ line All vertebrate genomes including humans are stuffed with retrovirus genomes which have been with us for millions of years Conversely, Picornaviruses cause lysis and death of the cells in which they replicate, leading to fever and increased mucus secretion 7) PERSISTENCE Long term persistence of virus results from two main mechanisms: a) Regulation of lytic potential b) Evasion of immune surveillance VIRAL EFFECTS ON CELL 1) cell death 2) little direct effect 3) cell transformation CELL DEATH The effect of viruses is seen in the whole body respiratory viruses destroy respiratory epithelium polio virus destroys anterior horn cells in spinal column, causing paralysis LITTLE DIRECT EFFECT Some viruses produce very little cell death hepatitis B virus does not cause pathology in the liver Most of the tissue damage is caused by the host's immune response to the viral infection CELL TRANSFORMATION Viruses can transform cells leading to malignancy Human papillomaviruses (genital cancers) Hepatitis B (liver carcinoma) Epstein Barr virus (EBV) (mononucleosis) Human T-cell Leukemia Virus VIRAL STRATEGY The intracellular location of the virus protects the virus against some of the host's immune mechanisms The intracellular location also makes the virus vulnerable because of its dependence on the host cell's synthetic machinery host cell metabolism may be altered by subtle changes produced by the viral infection (inflammation, fever, circulatory alterations, and interferon) VIRAL CHEMOTHERAPY Viruses are difficult targets for chemotherapy because they replicate only within host cells The similarity of host and virus makes it difficult to find antiviral agents specific enough to exert effect on viral replication in infected cells but not in host cells each virus has a few specific steps of replication that may be used as targets for highly selective chemotherapeutic agents HOST VIRUS INTERACTIONS Hit and Run infections Systemic infections Persistent infections HIT AND RUN INFECTIONS common cold viruses (rhinoviruses) Short incubation period (36 to 48 hours) Pathology in the upper respiratory tract and secondary invasion by normal flora of oral bacteria Symptoms last for 5-7 days and then eliminated by the host immune protection is poor since there are >100 serotypes of rhinovirus orthomyxoviruses (influenza A and B) immune protection against subsequent infection may be poor because these viruses can change their antigenic profile of their surface proteins SYSTEMIC INFECTIONS measles, chickenpox, mumps, and rubella Incubation period 14 to 21 days recovery is mainly due to cell-mediated responses long term protection from subsequent infection is good may be due to the fact that there is only one serotype PERSISTANT VIRAL INFECTIONS Latent infections virus does not replicate may occur in non-dividing cells such as neurons Chronic infections active replication of virus Transformation of virus infected cells may occur after years of persistence (hepatitis B) VIRUS EVADE IMMUNE RESPONSE strategies to evade the immune response 1) Latent infection Herpes simplex and varicella zoster infect dorsal root ganglia In these nerve cells, there is very little expression of viral RNA and protein host immune response is unaware of virus presence 2) Mutation alteration of the important proteins recognized by the immune system HIV and influenza A 3) Inhibition of immune recognition Inhibition of cell surface expression of molecules on infected cells Inhibition of antigen processing 4) Target host cytokines Inhibition of inflammatory cytokines interleukin tumor necrosis factor (TNF) 5) Lysis of immune cells HIV kills helper T- cells PREVENTION & TREATMENT Prevention Vaccination and public health measures Treatment Antiviral Vaccines PREVENTION 1) Public health measures laws, sanitation practices 2) Vaccination Most of the damage to cells in virus infections occurs very early before clinical symptoms of disease appear makes treatment difficult VACCINES following exposure to an antigen, a rapid secondary immune response is generated leading to the accelerated elimination of the organism and protection from clinical disease Success depends on the generation of memory T and B cells and the presence in the serum of neutralizing antibody introduction of vaccination has lead to a dramatic downward trend in incidence of viral diseases The principle of vaccination is to induce a "primed" state in the vaccinated subject IMMUNE RESPONSE vaccines must stimulate as many of the body's defense mechanisms as possible mimic the disease (without pathogenesis) 1) Humoral Immunity antibodies & complement 2) Cell Mediated Immunity T-cells most important in virus infections VACCINATION STRATEGIES Types of vaccine 1) Recombinant Vaccines 2) Sub-cellular fractions 3) Attenuated (Live Virus) Vaccines 4) Heterologous Vaccines 5) Inactivated (Killed) Vaccines 1) RECOMBINANT VACCINES newest types completely safe, except for rare adverse reactions also tend to be the least effective 1) Synthetic Vaccines 2) Recombinant Vaccines 3) Virus Vectors Following injection into the subject, the recombinant organism will replicate and express sufficient amounts of the foreign protein induces a specific immune response to the protein genetic engineering can be used to introduce a gene for a protein from one organism into the genome of another ex: vaccinia virus Such an organism (expressing a foreign gene) is called a recombinant 2) SUBCELLULAR FRACTIONS possible to use a vaccine directed against only one or two proteins of a virus The organism is inactivated and the protein of interest is purified and concentrated from the culture medium advantages safe few local reactions occur at the injection site disadvantages poor immunogenicity need multiple boosters 3) ATTENUATED VACCINES Live, attenuated vaccines virus have been sufficiently weakened, or attenuated, in the laboratory reduced temperature results in the selection of mutants which replicate poorly in the human host and are therefore of reduced virulence replication of the vaccine strain in the host reproduces features of wild type infection without causing clinical disease do infect cells and multiply in the body stimulate immunity without causing a full-blown infection measles, mumps and rubella vaccines oral poliovirus vaccine (OPV) do not spread from a vaccinated child to another person Potential drawbacks to these vaccines include a) danger of reversion to virulence b) possibility of causing extensive disease in immunocompromised individuals 4) HETEROLOGOUS VACCINES Closely related organism of lesser virulence share many antigens with the virulent organism vaccine strain replicates in the host and induces an immune response that cross reacts with antigens of the virulent organism Small pox vaccine Both cowpox virus and vaccinia virus are closely related to variola virus causative agent of small pox Edward Jenner (18th century physician) observed that milkmaids who had been infected with cowpox virus were immune to smallpox Wide spread use of vaccinia virus as a vaccine lead to the world wide eradication of smallpox 5) INACTIVATED (KILLED) VACCINES exposure to denaturing agent propiolactone formaldehyde results in loss of ineffectivity without loss of antigenicity Inactivated vaccines and purified protein vaccines do not have any living germs in them stimulate the immune system without causing any infection inactivated polio vaccine(IPV) killed pertussis vaccine diphtheria, tetanus toxoids, and hepatitis B vaccine These vaccines are not infectious and are therefore relatively safe are usually of lower immunogenicity multiple doses may be needed to induce immunity More effective than subunit vaccines expensive to prepare denaturation may lead to loss of antigenicity (measles) useful when living vaccines are not available because attenuated strains have not been developed reversion to wild type occurs too readily possible to use an inactivated preparation of the virulent organism to immunize the host ANTIVIRAL DRUGS Historically, the discovery of antiviral drugs has met with relatively little success Any stage of virus replication can be a target for a drug, but drug must be more toxic to virus than to the host Principal drugs are: Acyclovir, Famciclovir, Valaciclovir herpesvirus infections Ribavirin respiratory virus infections Azidothymidine (AZT), Dideoxyinosine HIV infection Rimantidine, Amantadine influenza virus infections CHEMOTHERAPUTIC INDEX Dose of drug which inhibits virus replication / Dose of drug which is toxic to host The smaller the value of this number the better several orders of magnitude difference is required for a really safe drug DIAGNOSIS OF VIRAL INFECTION Diagnosis can be by detection of : virus electron microscopy viral antigen immunofluorescence effect of virus cytopathic effect on cells virus nucleic acid by PCR (polymerase chain reaction) anti-viral antibody by ELISA VIRAL DISEASES 1) Influenza 2) Measles (Rubella) 3) Mumps 4) Herpes Simplex 5) Hepatitis 6) Polio 7) “Common cold” 8) Rabies 9) Small pox 10) HIV INFLUENZA RNA virus Influenza is a disease of the upper respiratory tract envelope is from the host's plasma membrane There are three distinct influenza viruses based on the differences of their glycoprotein in the envelope Type A is found in horse, swine, birds and humans cause of most pandemics Types B and C are found in humans only Because the RNA segments can be rearranged the virus can evade previous immunity via changes in composition of the spikes MEASLES RNA virus Transmission is by respiratory droplet has an envelope for adsorption to the cell surface MUMPS RNA virus virus enter through the respiratory tract, replicate, then spread to other areas causing cell necrosis and inflammation maintain an envelope of lipid membrane to assist in fusion to the host cell live attenuated vaccine is available for infants after one year and adults who have not had the disease during childhood HERPES SIMPLEX DNA virus causes cold sores, keratitis, genital and neonatal infections Herpes has an envelope with spikes from the nuclear membrane of the host two types of herpes simplex: Type 1 Found primarily in the oral and facial areas the most prevalent type and can become latent in sensory root ganglia Type 2 Found primarily in the genitals and is sexually transmitted Recurrent infections are common but they are milder than the primary infection because of partial immunity Recurrence can be due to stress, hormones, excessive sunlight causes lesions on the genitals and is associated with cancer of the cervix neonatal transmission can occur during delivery because of an undeveloped immune system mortality rate is about 60% neonatal survivors usually have neurological disorders HEPATITIS inflammation of the liver caused by numerous different viruses Hepatitis A Virus (HAV) Hepatitis B Virus (HBV) Hepatitis C Virus (HCV) Hepatitis D Virus (HDV) Hepatitis E Virus (HEV) HAV and HEV fecal-oral route is the predominant mode of transmission HBV, HCV, and HDV bloodborne viruses and are primarily transmitted by percutaneous and mucosal exposures HEPATITIS A RNA virus Transmission is by the fecal - oral route source can be contaminated water, seafood or an infectious food preparer Antibody to the virus persists in serum so patients become immune to infection Gamma globulin provides passive immunization HEPATITIS B enveloped DNA virus Humans are the only natural reservoirs for HBV transmission may be by direct contact, or indirect contact through transfusion, contaminated needles Chronic infection is associated with viral replication in liver and lymphoid tissues HEPATITIS C RNA virus primarily transmitted parenterally and is one of the primary causes of post transfusion hepatitis No vaccine is available and there is no immunity with infection HEPATITIS D RNA virus transmitted parenterally HEPATITIS E RNA virus spreads by fecal - oral route In most cases it is waterborne Mortality is generally low except in infants and pregnant women No vaccine is available POLIOVIRUS cause poliomyelitis (flaccid muscular paralysis) transmitted by the fecal-oral route Primary site of infection is lymphoid tissue associated with the oropharynx and gut following which the virus may infect the CNS The effectiveness of vaccination for polio is underscored by the fact that the World Health Organization and the UN Childrens' Fund predict if present trends continue, polio will join smallpox as the second ever human disease to be eradicated RHINOVIRUS Cause of 'the common cold' but not the only one! 105 serotypes hence repeated infections Relatively fragile viruses Extensive human volunteer studies show no evidence for susceptibility when exposed to cold/wet conditions (!) although general immune status is probably important Symptoms due to damage to ciliated epithelium in upper respiratory tract predisposes to secondary bacterial infections a major problem in infants and elderly a major economic pest worldwide lost working days No effective prophylaxis or treatment little or no cross-protection between serotypes Protection relies on levels of antibodies may be relatively short-lived (a few years rather than life-long) RABIES Infects neurons of the CNS rabies virus are disclosed as the yellow-green bodies HIV (HUMAN IMMUNODEFICIENCY SYNDROME) Classified as a retrovirus RNA genome contains the enzyme reverse trancriptase envelope of lipoprotein envelop has spikes allow HIV to attach to the CD4 receptor on a host cell The viral RNA becomes integrated into the the chromosomal DNA of the host cell HIV TRANSMISSION Transmission of HIV requires transfer of or exposure to infected bodily fluids HIV virus are located within macrophage cells in fluids blood 10-1000 infectious particles (IP) per milliliter semen 10-50 IP/ml Routes of HIV transmission include intimate sexual contact anal receptive intercourse (most dangerous form of sexual contact) breast milk blood contaminating needles organ transplants artificial insemination blood transfusions BLOOD TRANSFUSIONS transmission by blood is unlikely in developed countries blood is tested for HIV antibodies slight risk because blood might be donated during the interval between infection and appearance of detectable antibodies Tests for the virus itself are also available, but they have not proved to be superior in screening blood There is no risk at all in donating blood HIV TRANSMISSION HIV is not transmitted by insects hugging sharing household facilities drinking glasses towels kissing is not known to spread the infection Saliva usually contains less than 1 IP/ml STAGES OF HIV 1) A few weeks after primary HIV infection there is a burst of virus replication and high levels of virus particles 2) Within weeks to months, a humoral and cellular immune response to HIV is detected levels of culturable virus decrease dramatically 3) Patients then enter a phase of clinical latency characterized by lack of symptoms moderately decreased levels of T cells low levels or absence of culturable virus in the blood HIV THERAPY Current strategies aim at: blocking virus dissemination decreasing viral burden available agents are only partially effective in suppressing virus replication Clear cut but limited benefit is realized when azidothymidine (AZT) is given to a patient with advanced HIV disease benefits of early intervention are only temporary and do not result in significant long term advantages with regard to course of disease and death HIV Listeria monocytogenes a bacterium found in spoiled cheese has been genetically engineered to produce one of the HIV virus' protein products Researchers believe this may prove to be a safe and effective way to help build immunity to HIV without exposing patients to the HIV virus itself AIDS Acquired Immunodeficiency Syndrome only the end stage of HIV infection average time from infection to development of AIDS is 10 years PRIONS convert normal protein molecules into dangerous ones simply by inducing the benign molecules to change their shape Prions are responsible for transmissible and inherited disorders of protein conformation can also cause sporadic disease post mortem appearance of the brain shows large vacuoles in the cortex and cerebellum KNOWN PRION DISEASES widespread in animals all fatal cause the brain to become riddled with holes can lie dormant for years (or even for decades in humans) SCRAPIE most common form found in sheep and goats Afflicted animals lose coordination and eventually become so incapacitated that they cannot stand in some cases, an intense itch develops that leads them to scrape off their wool or hair hence the name "scrapie” OTHER PRION DISEASE transmissible mink encephalopathy chronic wasting disease of mule deer and elk feline spongiform encephalopathy bovine spongiform encephalopathy often called “mad cow disease” very worrisome MAD COW DISEASE identified in 1986 began striking cows in Great Britain causing them to became uncoordinated and unusually apprehensive source was traced to a food supplement that included meat and bone meal from dead sheep The methods for processing sheep carcasses had been changed in the late 1970s British government banned the use of animal-derived feed supplements in 1988, and the epidemic has probably peaked HUMAN PRION DISEASE human prion diseases are more obscure 1) Kuru 2) Creutzfeldt-Jakob disease 3) Gerstmann-Strussler-Scheinker disease 4) Fatal Familial Insomnia KURU has been seen only among the Fore highlanders of Papua New Guinea natives call it the "laughing death." individuals become afflicted with a fatal disease marked by loss of coordination dementia The affected individuals probably acquired kuru through ritual cannibalism natives reportedly honored the dead by eating their brains The practice has since stopped and kuru has virtually disappeared CREUTZFELDT-JAKOB DISEASE occurs worldwide becomes evident as dementia strikes one person in a million typically around age 60 10 to 15 percent of cases are inherited a small number of cases has been transmitted by corneal transplantation implantation of dura mater electrodes in the brain use of contaminated surgical instruments injection of growth hormone derived from human pituitaries GERSTMANN-STRUSSLER-SCHEINKER DISEASE manifest as loss of coordination signs of damage to the cerebellum usually inherited typically appear in midlife FATAL FAMILIAL INSOMNIA manifest as dementia difficulty sleeping usually inherited typically appear in midlife was discovered only recently EMERGING INFECTIONS "new, or drug-resistant infections whose incidence in humans has increased or whose incidence threatens to increase " "environmental changes probably account for most emerging diseases” changes wrought by urbanization changes wrought by travel emergence of AIDS may reflect changes in urbanization and travel that have allowed rapid spread of a sexually-transmitted infection throughout the world It can be assumed that other diseases may also emerge in the coming decades by the year 2025, it is estimated that 65% of the human population will live in cities Emerging infections are often the result of an initial trans-species transmission event “Zoonosis” followed by viral replication and spread in the new host Most such infections involve RNA viruses have a higher rate of mutation than DNA viruses GENE (VIRAL) THERAPY Viruses can be used to introduce copies of their genetic information into animal cell genomes may prove useful to incorporate new genes into animal cells replace a defective gene that is responsible for a disease condition with a good copy of that gene The virus would serve as a vector for the gene therapy the virus is genetically modified so that it is incapable of replication itself DNA VACCINES most recent development in vaccine technology is the use of DNA expression vectors as vaccines inject a purified preparation of a DNA vector into which the gene for a protective antigen has been cloned DNA molecules are taken up by a few host cells the DNA is then translated into the antigenic protein which is then "recognized" by the immune system experimental DNA vaccines against hepatitis have been shown to be very effective DNA vaccines are administered by delivery of gold particles coated with the purified DNA The particles are physically driven into the skin with a blast of air under high pressure MANTOUX TEST a test for tuberculosis (TB) injection of tuberculin a protein derived from the tubercle bacillus or a purified protein derivative of tuberculin If the patient is (or has been) infected with tuberculosis a positive reaction occurs at the site of the injection within 48 to 72 hours tuberculin being a 'foreign protein' recognized by the body of a person who has experienced TB evokes a delayed immune response in the form of a raised, red, itchy swelling The reaction may also be positive in a person who has previously been immunized against the disease by a vaccine A negative response is certain proof that the individual concerned has not had TB and has no immunity to it END VIRUS