Difference between revisions of "Viruses"

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This article deals with '''viruses'''.  The more general topic of infective things is dealt with in [[microorganisms]].
This article deals with '''viruses'''.  The more general topic of infective things is dealt with in [[microorganisms]].
Many viruses afflict humans.  Only a few of them can be diagnosed histologically.
Many viruses afflict humans.  Only a few of them can be diagnosed histologically. 
 
[[cancer viruses|Several viruses cause cancer]] and seen directly or indirectly by pathologists frequently.


==Viral inclusions - types==
==Viral inclusions - types==
Line 15: Line 17:
=Viruses=
=Viruses=
==Herpes simplex virus==
==Herpes simplex virus==
:''In the context of gynecologic cytopathology see: [[Gynecologic_cytopathology#Herpes_simplex_virus]]''.
*Abbreviated ''HSV''.
*Abbreviated ''HSV''.
===General===
===General===
Several subtypes:
Several subtypes:
Line 30: Line 32:


Mnemonic - 3 Ms: Margination, Multinucleation, Molding.
Mnemonic - 3 Ms: Margination, Multinucleation, Molding.
====Images====
www:
*[http://www.virology.org/sbpgphoto2.html Herpes simplex virus - multinucleation (virology.org)].
<gallery>
Image:Herpes_simplex_virus_pap_test.jpg | HSV on a Pap test - showing multinucleation. (WC)
Image:Herpes_esophagitis_-_very_high_mag.jpg | HSV esophagitis - very high mag. (WC)
Image:Herpes_esophagitis_-_intermed_mag.jpg | HSV esophagitis - intermed. mag. (WC)
</gallery>
===IHC===
*HSV-1 +ve (cytoplasmic and strong nuclear).
*HSV-2 +ve.


Images:
Images:
*[http://www.virology.org/sbpgphoto2.html Herpes simplex virus - multinucleation (virology.org)].
*[http://path.upmc.edu/cases/case120/images/d-1.jpg HSV-1 staining (upmc.edu)].<ref>URL: [http://path.upmc.edu/cases/case120/dx.html http://path.upmc.edu/cases/case120/dx.html]. Accessed on: 28 February 2013.</ref>
*[http://commons.wikimedia.org/wiki/File:Herpes_simplex_virus_pap_test.jpg HSV on a Pap test - showing multinucleation (WC)].
*[http://www.antibodies-online.com/media/57/images/anti-Herpes+Simplex+Virus+1+HSV1+antibody_original_rp018.jpg HSV-1 staining (antibodies-online.com)].<ref>URL: [http://www.antibodies-online.com/antibody/100405/anti-Herpes+Simplex+Virus+1+HSV1/ http://www.antibodies-online.com/antibody/100405/anti-Herpes+Simplex+Virus+1+HSV1/]. Accessed on: 28 February 2013.</ref>
*[http://commons.wikimedia.org/wiki/File:Herpes_esophagitis_-_very_high_mag.jpg HSV esophagitis - very high mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Herpes_esophagitis_-_intermed_mag.jpg HSV esophagitis - intermed. mag. (WC)].


==Cytomegalovirus==
==Cytomegalovirus==
*Abbreviated ''CMV''
*Abbreviated ''CMV''.
:''For pneumonia caused by CMV - see [[Cytomegalovirus pneumonia]]''.
:''For colitis caused by CMV - see [[Cytomegalovirus colitis]]''.
===General===
===General===
*The name comes from the microscopic appearance.
*The name comes from the microscopic appearance.
Line 47: Line 62:
Features:
Features:
*Very large nucleus (as the name implies) with clearing.
*Very large nucleus (as the name implies) with clearing.
**Classically described as owl's eye-like.
*Granular cytoplasmic inclusions (red on H&E sections).
*Granular cytoplasmic inclusions (red on H&E sections).


Line 53: Line 69:
**In the context of [[esophagus|esophageal ulcers]], it is therefore useful to biopsy the base of the ulcer - if this is suspected.
**In the context of [[esophagus|esophageal ulcers]], it is therefore useful to biopsy the base of the ulcer - if this is suspected.


Images:
====Images====
*[http://commons.wikimedia.org/wiki/File:CMV_placentitis2_mini.jpg CMV placentitis (WC)].
<gallery>
*[http://www.asm.org/division/c/photo/cmv1.jpg CMV (asm.org)].
Image:CMV_placentitis2_mini.jpg | CMV [[acute villitis|placentitis]]. (WC)
File:Cmv neuronal inclusions.jpg | CMV [[encephalitis]]. (WC)
</gallery>
www:
*[http://www.asm.org/division/c/photo/cmv1.jpg CMV - owl's eye-like (asm.org)].
*[http://path.upmc.edu/cases/case149.html CMV - case 1 - several images (upmc.edu)].
*[http://path.upmc.edu/cases/case481.html CMV - case 2 - several images (upmc.edu)].


===IHC===
===IHC===
*IHC for CMV is available - highlights granular cytoplasmic inclusions; increases [[sensitivity]].
*IHC for CMV is available - highlights granular cytoplasmic inclusions; increases [[sensitivity]].


==Human papilloma virus==
==Human papillomavirus==
*Abbreviated ''HPV''.
*Abbreviated ''HPV''.
 
{{Main|Human papillomavirus}}
===General===
*Causes a lot of pathology:
**Benign:
***[[Verruca vulgaris]].
***[[Condyloma acuminatum]].
***[[Esophagus#Human_papilloma_virus_esophagitis|HPV esophagitis]].
**Malignant:
***[[Uterine cervix|Cervical cancer]] and precursors ([[LSIL]], [[HSIL]]).
***Anal cancer and precurors ([[Anus#Anal_intraepithelial_neoplasia|AIN]])
***Squamous cell carcinoma in the [[Head & neck pathology|head & neck]].
 
Oncocytic types:
*HPV 18 - predominantly adenocarcinoma.<ref name=pmid15551313>{{Cite journal  | last1 = De Boer | first1 = MA. | last2 = Peters | first2 = LA. | last3 = Aziz | first3 = MF. | last4 = Siregar | first4 = B. | last5 = Cornain | first5 = S. | last6 = Vrede | first6 = MA. | last7 = Jordanova | first7 = ES. | last8 = Fleuren | first8 = GJ. | title = Human papillomavirus type 18 variants: histopathology and E6/E7 polymorphisms in three countries. | journal = Int J Cancer | volume = 114 | issue = 3 | pages = 422-5 | month = Apr | year = 2005 | doi = 10.1002/ijc.20727 | PMID = 15551313 }}</ref>
**''Eigh''teen = ''a''denocarcinoma.
*HPV 16 - predominantly squamous cell carcinoma.<ref name=pmid15551313/>
**''S''ixteen = ''s''quamous.
 
Recombinant vaccine (Gardasil, Silgard) - covers:<ref name=pmid21942919>{{Cite journal  | last1 = McCormack | first1 = PL. | last2 = Joura | first2 = EA. | title = Spotlight on Quadrivalent Human Papillomavirus(Types 6, 11, 16, 18) Recombinant Vaccine(Gardasil®) in the Prevention of PremalignantGenital Lesions, Genital Cancer, and Genital Warts in Women†. | journal = BioDrugs | volume = 25 | issue = 5 | pages = 339-43 | month = Oct | year = 2011 | doi = 10.2165/11205060-000000000-00000 | PMID = 21942919 }}</ref>
*HPV 6.
*HPV 11.
*HPV 16.
*HPV 18.
 
===Microscopic===
Features:
*Koilocytes:
** Perinuclear clearing.
** Nuclear changes.
*** Size similar (or larger) to those in the basal layer of the epithelium.
*** Nuclear enlargement should be evident on low power, i.e. 25x.
*** Central location - nucleus should be smack in the middle of the cell.
 
Images:
*[http://commons.wikimedia.org/w/index.php?title=File:Low-grade_squamous_intraepithelial_lesion.jpg LSIL (WC)].
*[http://commons.wikimedia.org/wiki/File:Low-grade_sil_and_endocx.jpg LSIL & endocervix (WC)].
 
===IHC===
*p16 +ve -- stains most cells infected by HPV.


==Adenovirus==
==Adenovirus==
===General===
===General===
*Common in kids.
*Common in kids - usually a mild respiratory infection with fever and pharyngitis.
**Can cause post-infectious [[bronchiolitis obliterans]].<ref name=pmid20717912>{{Cite journal  | last1 = Aguerre | first1 = V. | last2 = Castaños | first2 = C. | last3 = Pena | first3 = HG. | last4 = Grenoville | first4 = M. | last5 = Murtagh | first5 = P. | title = Postinfectious bronchiolitis obliterans in children: clinical and pulmonary function findings. | journal = Pediatr Pulmonol | volume = 45 | issue = 12 | pages = 1180-5 | month = Dec | year = 2010 | doi = 10.1002/ppul.21304 | PMID = 20717912 }}</ref>
**May be seen in the context of [[adenovirus appendicitis|(adenovirus) appendicitis]].
**May be seen in the context of [[adenovirus appendicitis|(adenovirus) appendicitis]].


Line 120: Line 105:
*[http://www.flickr.com/photos/ckrishnan/3746778007/in/photostream/ Viral inclusions - high mag. (flickr.com)].
*[http://www.flickr.com/photos/ckrishnan/3746778007/in/photostream/ Viral inclusions - high mag. (flickr.com)].
*[http://www.flickr.com/photos/ckrishnan/3747567554/in/photostream/ IHC for adenovirus (flickr.com)]
*[http://www.flickr.com/photos/ckrishnan/3747567554/in/photostream/ IHC for adenovirus (flickr.com)]
*[http://path.upmc.edu/cases/case620.html Adenovirus encephalitis - several images (upmc.edu)].


==Parvovirus==
==Parvovirus==
Line 126: Line 112:
*Most significant in pregnant women.
*Most significant in pregnant women.
**Parvovirus attacks the nucleated RBCs of the fetus - causes an ''aplastic [[anemia]]''.
**Parvovirus attacks the nucleated RBCs of the fetus - causes an ''aplastic [[anemia]]''.
*May cause ''[[collapsing glomerulopathy]]''.<ref name=pmid12704581>{{Cite journal  | last1 = Schwimmer | first1 = JA. | last2 = Markowitz | first2 = GS. | last3 = Valeri | first3 = A. | last4 = Appel | first4 = GB. | title = Collapsing glomerulopathy. | journal = Semin Nephrol | volume = 23 | issue = 2 | pages = 209-18 | month = Mar | year = 2003 | doi = 10.1053/snep.2003.50019 | PMID = 12704581 }}</ref>


Trivia:
Trivia:
Line 136: Line 123:
*Nuclear enlargement.
*Nuclear enlargement.


Images:
====Images====
*[[WC]]:
<gallery>
**[http://commons.wikimedia.org/wiki/File:Parvovirus_infection_-_cropped_2_-_very_high_mag.jpg Parvovirus - version 1 - very high mag. (WC)].
Image:Parvovirus_infection_-_cropped_2_-_very_high_mag.jpg | Parvovirus - version 1 - very high mag. (WC)
**[http://commons.wikimedia.org/wiki/File:Parvovirus_infection_-_cropped_1_-_very_high_mag.jpg Parvovirus - version 2 - very high mag. (WC)].
Image:Parvovirus_infection_-_cropped_1_-_very_high_mag.jpg | Parvovirus - version 2 - very high mag. (WC)
*www:
</gallery>
**[http://info.fujita-hu.ac.jp/~tsutsumi/photo/photo210-1.htm Parvovirus (fujita-hu.ac.jp)].<ref>URL:[http://info.fujita-hu.ac.jp/~tsutsumi/case/case210.htm http://info.fujita-hu.ac.jp/~tsutsumi/case/case210.htm]. Accessed on: 8 February 2011.</ref>
www:
**[http://www.scielo.br/img/revistas/rimtsp/v49n2/07f1a.jpg Parvovirus - placenta - (scielo.br)].<ref>URL: [http://www.scielo.br/scielo.php?pid=S0036-46652007000200007&script=sci_arttext http://www.scielo.br/scielo.php?pid=S0036-46652007000200007&script=sci_arttext]. Accessed on: 18 August 2011.</ref>
*[http://info.fujita-hu.ac.jp/~tsutsumi/photo/photo210-1.htm Parvovirus (fujita-hu.ac.jp)].<ref>URL:[http://info.fujita-hu.ac.jp/~tsutsumi/case/case210.htm http://info.fujita-hu.ac.jp/~tsutsumi/case/case210.htm]. Accessed on: 8 February 2011.</ref>
**[http://www.fujita-hu.ac.jp/~tsutsumi/case/case219.htm Parvovirus - several images (fujita-hu.ac.jp)].
*[http://www.scielo.br/img/revistas/rimtsp/v49n2/07f1a.jpg Parvovirus - placenta - (scielo.br)].<ref>URL: [http://www.scielo.br/scielo.php?pid=S0036-46652007000200007&script=sci_arttext http://www.scielo.br/scielo.php?pid=S0036-46652007000200007&script=sci_arttext]. Accessed on: 18 August 2011.</ref>
*[http://www.fujita-hu.ac.jp/~tsutsumi/case/case219.htm Parvovirus - several images (fujita-hu.ac.jp)].


==Epstein-Barr virus==
==Epstein-Barr virus==
*Abbreviated ''EBV''
{{Main|Epstein-Barr virus}}
 
==Polyomavirus==
{{Main|Polyomavirus}}
 
==Human herpesvirus-8==
{{Main|Human herpesvirus-8}}
 
==West Nile virus==
*Abbreviated ''WNV''.
===General===
*Uncommon pathologen.
 
Clinical:
*Fever.
*Muscle weakness.
 
===Microscopic===
Features:<ref>{{Cite journal  | last1 = Sampson | first1 = BA. | last2 = Ambrosi | first2 = C. | last3 = Charlot | first3 = A. | last4 = Reiber | first4 = K. | last5 = Veress | first5 = JF. | last6 = Armbrustmacher | first6 = V. | title = The pathology of human West Nile Virus infection. | journal = Hum Pathol | volume = 31 | issue = 5 | pages = 527-31 | month = May | year = 2000 | doi =  | PMID = 10836291 }}</ref>
*Perivascular clusters in grey and white matter:
**Mononuclear infiltrates (lymphocytes, plasma cells).
**Microglial nodules (macrophage clusters).
 
==Measles virus==
===General===
===General===
*Cases [[mononucleosis]].
*Causes ''Measles''.
*Part of the herpes group of viruses.<ref>URL: [http://www.meddean.luc.edu/lumen/MedEd/orfpath/herpes.htm http://www.meddean.luc.edu/lumen/MedEd/orfpath/herpes.htm]. Accessed on: 14 April 2011.</ref>
**Should '''not''' be confused with ''Rubella'' ([[AKA]] ''German measles'').
*Uncommon due to widespread MMR vaccine.
**However increasing in the last years most likely due to insufficient vaccination.
*May develop weeks to years after infection.
*Illness may be complicated by ''subacute sclerosing panencephalitis'' (SSPE) - a chronic neurodegenerative condition.<ref>URL: [http://path.upmc.edu/cases/case595/dx.html http://path.upmc.edu/cases/case595/dx.html]. Accessed on: 26 January 2012.</ref>


====Associations====
===Microscopic===
Cancer:<ref name=Ref_PCPBoD8_169>{{Ref PCPBoD8|169}}</ref>
Features:  
*Classical [[Hodgkin lymphoma]].
*+/-Intranuclear Cowdry type A inclusions.
*[[Burkitt lymphoma]].
**Glassy (pink) nucleus.
*[[Nasopharyngeal carcinoma]].
*Lymphocytes and macrophages (microglial cells).
*B cell lymphomas -- in immunosuppressed individuals.
**May be mild in in measles inclusion body encephalitis.
**[[Post-transplant lymphoproliferative disorder]].
*Multinucleated cells.
*Microglial nodules.
*Demyelination.
*Gliosis.


*[[Hemophagocytic syndrome]].<ref name=pmid20819601>{{cite journal |author=Jin YK, Xie ZD, Yang S, Lu G, Shen KL |title=Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis: a retrospective study of 78 pediatric cases in mainland of China |journal=Chin. Med. J. |volume=123 |issue=11 |pages=1426–30 |year=2010 |month=June |pmid=20819601 |doi= |url=}}</ref>
Notes:
*Measles inclusions are intranuclear. RSV inclusions are intracytoplasmic.{{fact}}
 
====Images====
<gallery>
Image:Morbillo.jpg | Measles pneumonia. (WC/CDC)
</gallery>
*[http://path.upmc.edu/cases/case595.html SSPE - several images (upmc.edu)].
 
==Rabies virus==
===General===
*Causes rabies.
 
Virus affects:<ref>{{Ref APBR|424 Q36}}</ref>
*Cerebral cortex.
*Hippocamus pyramidal cells.
*Purkinje cells.


===Microscopic===
===Microscopic===
Features:
Features:
*Variable - see specific pathologies in ''Associations'' section.
*[[Negri bodies]]:
**+/-Atypical lymphocytes.
**Dense-appearing eosinophilic cytoplasmic bodies with a pale halo.
**+/-Hemophagocytosis (uncommon).


==Polyomavirus==
====Images====
May refer to:
<gallery>
#BK virus.
Image:Rabies_encephalitis_Negri_bodies_PHIL_3377_lores.jpg | Negri bodies. (WC/CDC)
#*See: ''[[Renal_transplant_pathology#Polyomavirus]]'' and ''[[Urine_cytopathology#Human_polyoma_infection]].
Image:Rabies_Virus_EM_PHIL_1876.JPG | Negri bodies - EM. (WC)
#Merkel cell polyomavirus.
File:Rabies negri bodies brain.jpg | Negri bodies in cerebellar Purkinje cells. (WC/CDC).
#*See: ''[[Merkel cell carcinoma]]''.
</gallery>
www:
*[http://www.nature.com/modpathol/journal/v18/n1/fig_tab/3800274f1.html#figure-title Rabies encephalitis (nature.com)].<ref name=pmid15389258>{{Cite journal  | last1 = Nuovo | first1 = GJ. | last2 = Defaria | first2 = DL. | last3 = Chanona-Vilchi | first3 = JG. | last4 = Zhang | first4 = Y. | title = Molecular detection of rabies encephalitis and correlation with cytokine expression. | journal = Mod Pathol | volume = 18 | issue = 1 | pages = 62-7 | month = Jan | year = 2005 | doi = 10.1038/modpathol.3800274 | PMID = 15389258 | url = http://www.nature.com/modpathol/journal/v18/n1/full/3800274a.html}}</ref>


=See also=
=See also=

Latest revision as of 15:43, 9 December 2021

This article deals with viruses. The more general topic of infective things is dealt with in microorganisms. Many viruses afflict humans. Only a few of them can be diagnosed histologically.

Several viruses cause cancer and seen directly or indirectly by pathologists frequently.

Viral inclusions - types

Cowdry types:[1]

  • Cowdry type A inclusion:[2]
    • Round eosinophilic material surrounded by a clear halo.
  • Cowdry type B inclusion:[3]
    • Neuropathology thingy. (???)

Images:

Viruses

Herpes simplex virus

In the context of gynecologic cytopathology see: Gynecologic_cytopathology#Herpes_simplex_virus.
  • Abbreviated HSV.

General

Several subtypes:

  • Canker sores - usually HSV-1.
  • Genital herpes - usually HSV-2.

Histology/cytology

Features:[4]

  • Clear "ground glass" nuclei.
    • Rim of peripheral chromatin.
  • Nuclear inclusions.
  • Multinucleation with nuclear molding, i.e. multiple nuclei that touch over a large surface area.

Mnemonic - 3 Ms: Margination, Multinucleation, Molding.

Images

www:

  • HSV on a Pap test - showing multinucleation. (WC)

  • HSV esophagitis - very high mag. (WC)

  • HSV esophagitis - intermed. mag. (WC)

IHC

  • HSV-1 +ve (cytoplasmic and strong nuclear).
  • HSV-2 +ve.

Images:

Cytomegalovirus

  • Abbreviated CMV.
For pneumonia caused by CMV - see Cytomegalovirus pneumonia.
For colitis caused by CMV - see Cytomegalovirus colitis.

General

Microscopic

Features:

  • Very large nucleus (as the name implies) with clearing.
    • Classically described as owl's eye-like.
  • Granular cytoplasmic inclusions (red on H&E sections).

Notes:

  • Classically in endothelial cells.
    • In the context of esophageal ulcers, it is therefore useful to biopsy the base of the ulcer - if this is suspected.

Images

www:

IHC

  • IHC for CMV is available - highlights granular cytoplasmic inclusions; increases sensitivity.

Human papillomavirus

  • Abbreviated HPV.
Main article: Human papillomavirus

Adenovirus

General

Microscopic

Features:

  • "Smudge" cells[9] - black/blue blob ~ 10-15 micrometers. (???)

Notes:

  • May be morphologically similar to CMV, HSV, VZV inclusions.

Images:

Parvovirus

  • AKA Parvovirus B19.

General

Trivia:

  • First described in 1975.[12]
    • The "B19" part comes from the label for the specimen.[13]

Microscopic

Features:

  • Glassy (red) nuclear inclusions.[14]
  • Nuclear enlargement.

Images

  • Parvovirus - version 1 - very high mag. (WC)

  • Parvovirus - version 2 - very high mag. (WC)

www:

Epstein-Barr virus

Main article: Epstein-Barr virus

Polyomavirus

Main article: Polyomavirus

Human herpesvirus-8

Main article: Human herpesvirus-8

West Nile virus

  • Abbreviated WNV.

General

  • Uncommon pathologen.

Clinical:

  • Fever.
  • Muscle weakness.

Microscopic

Features:[17]

  • Perivascular clusters in grey and white matter:
    • Mononuclear infiltrates (lymphocytes, plasma cells).
    • Microglial nodules (macrophage clusters).

Measles virus

General

  • Causes Measles.
    • Should not be confused with Rubella (AKA German measles).
  • Uncommon due to widespread MMR vaccine.
    • However increasing in the last years most likely due to insufficient vaccination.
  • May develop weeks to years after infection.
  • Illness may be complicated by subacute sclerosing panencephalitis (SSPE) - a chronic neurodegenerative condition.[18]

Microscopic

Features:

  • +/-Intranuclear Cowdry type A inclusions.
    • Glassy (pink) nucleus.
  • Lymphocytes and macrophages (microglial cells).
    • May be mild in in measles inclusion body encephalitis.
  • Multinucleated cells.
  • Microglial nodules.
  • Demyelination.
  • Gliosis.

Notes:

  • Measles inclusions are intranuclear. RSV inclusions are intracytoplasmic.[citation needed]

Images

  • Measles pneumonia. (WC/CDC)

Rabies virus

General

  • Causes rabies.

Virus affects:[19]

  • Cerebral cortex.
  • Hippocamus pyramidal cells.
  • Purkinje cells.

Microscopic

Features:

  • Negri bodies:
    • Dense-appearing eosinophilic cytoplasmic bodies with a pale halo.

Images

  • Negri bodies. (WC/CDC)

  • Negri bodies - EM. (WC)

  • Negri bodies in cerebellar Purkinje cells. (WC/CDC).

www:

See also

References

  1. ↑ URL: http://www.pathconsultddx.com/pathCon/largeImage?pii=S1559-8675%2806%2970864-6&figureId=fig3&ecomponentId=mmc3. Accessed: 12 January 2010.
  2. ↑ URL: http://www.whonamedit.com/synd.cfm/3495.html. Accessed on: 22 January 2010.
  3. ↑ http://www.whonamedit.com/synd.cfm/3496.html. Accessed on: 22 January 2010.
  4. ↑ SM. 11 January 2010.
  5. ↑ URL: http://path.upmc.edu/cases/case120/dx.html. Accessed on: 28 February 2013.
  6. ↑ URL: http://www.antibodies-online.com/antibody/100405/anti-Herpes+Simplex+Virus+1+HSV1/. Accessed on: 28 February 2013.
  7. ↑ Tongsong, T.; Sukpan, K.; Wanapirak, C.; Phadungkiatwattna, P. (2008). "Fetal cytomegalovirus infection associated with cerebral hemorrhage, hydrops fetalis, and echogenic bowel: case report.". Fetal Diagn Ther 23 (3): 169-72. doi:10.1159/000116737. PMID 18417974.
  8. ↑ Aguerre, V.; Castaños, C.; Pena, HG.; Grenoville, M.; Murtagh, P. (Dec 2010). "Postinfectious bronchiolitis obliterans in children: clinical and pulmonary function findings.". Pediatr Pulmonol 45 (12): 1180-5. doi:10.1002/ppul.21304. PMID 20717912.
  9. ↑ URL: http://www.pathguy.com/lectures/infect.htm. Accessed on: 8 July 2010.
  10. ↑ URL:http://www.medscape.com/viewarticle/438534_2. Accessed on: 8 July 2010.
  11. ↑ Schwimmer, JA.; Markowitz, GS.; Valeri, A.; Appel, GB. (Mar 2003). "Collapsing glomerulopathy.". Semin Nephrol 23 (2): 209-18. doi:10.1053/snep.2003.50019. PMID 12704581.
  12. ↑ Cossart, YE.; Field, AM.; Cant, B.; Widdows, D. (Jan 1975). "Parvovirus-like particles in human sera.". Lancet 1 (7898): 72-3. PMID 46024.
  13. ↑ Servey JT, Reamy BV, Hodge J (February 2007). "Clinical presentations of parvovirus B19 infection". Am Fam Physician 75 (3): 373–6. PMID 17304869. http://www.aafp.org/afp/991001ap/1455.html.
  14. ↑ URL: http://www.pathguy.com/lectures/infect.htm. Accessed on: 8 July 2010.
  15. ↑ URL:http://info.fujita-hu.ac.jp/~tsutsumi/case/case210.htm. Accessed on: 8 February 2011.
  16. ↑ URL: http://www.scielo.br/scielo.php?pid=S0036-46652007000200007&script=sci_arttext. Accessed on: 18 August 2011.
  17. ↑ Sampson, BA.; Ambrosi, C.; Charlot, A.; Reiber, K.; Veress, JF.; Armbrustmacher, V. (May 2000). "The pathology of human West Nile Virus infection.". Hum Pathol 31 (5): 527-31. PMID 10836291.
  18. ↑ URL: http://path.upmc.edu/cases/case595/dx.html. Accessed on: 26 January 2012.
  19. ↑ Lefkowitch, Jay H. (2006). Anatomic Pathology Board Review (1st ed.). Saunders. pp. 424 Q36. ISBN 978-1416025887.
  20. ↑ Nuovo, GJ.; Defaria, DL.; Chanona-Vilchi, JG.; Zhang, Y. (Jan 2005). "Molecular detection of rabies encephalitis and correlation with cytokine expression.". Mod Pathol 18 (1): 62-7. doi:10.1038/modpathol.3800274. PMID 15389258. http://www.nature.com/modpathol/journal/v18/n1/full/3800274a.html.
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