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Papillomaviruses and polyomaviruses 

Papillomaviruses and polyomaviruses
Papillomaviruses and polyomaviruses

Raphael P. Viscidi

and Keerti V. Shah

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date: 12 December 2019

Papillomaviruses and polyomaviruses are small, nonenveloped, double-stranded DNA viruses.

Human papillomavirus

There are over 100 human papillomavirus (HPV) types that infect epithelia of skin and mucous membranes. They infect only humans, and cause conditions including the following:

Skin warts and verrucas—caused by types 1 and 2; infection initiated when, after e.g. minor skin abrasions, the basal cells of the epithelium come in contact with infectious virus.

Anogenital warts—caused by types 6 and 11; transmitted by direct sexual contact, these are the most common sexually transmitted infection; present clinically as multiple exophytic lesions or as subclinical flat lesions. Can be treated topically with podophyllin or imiquimod, or by ablative surgical methods. Recurrences are common. A highly efficacious prophylactic vaccine is available.

Cervical cancer—the second most common tumour in women worldwide; most often caused by types 16 and 18, whose DNA can be recovered from nearly all cases of invasive disease and squamous intraepithelial lesions of the cervix, which precede invasive cancer. Prevention is by cervical screening and vaccination (two highly effective vaccines are available).

Other cancers—HPVs can cause cancers at other lower anogenital tract sites and in the oropharynx. HPV DNA is often detected in nonmelanoma skin cancers, but it is not known whether this is pathogenic.

Respiratory papillomatosis—caused by types 6 and 11; usually involves the vocal cords, leading to presentation with hoarseness or voice change; may rarely cause life-threatening airway obstruction; mainstay of treatment is surgical removal of papillomas, which commonly recur.

Human polyomaviruses

Exposure to polyomaviruses is nearly universal: they cause asymptomatic infection in childhood and then persist as latent infections, primarily in the kidney, producing disease in the context of immunosuppression.

BK virus—can cause (1) nephropathy and renal failure in renal transplant patients; management is by gradual reduction in immunosuppression, but more than 50% of patients lose their allograft; (2) haemorrhagic cystitis in bone marrow transplant patients.

JC virus—causes progressive multifocal leucoencephalopathy, a demyelinating disease of the central nervous system that is usually relentlessly progressive and fatal. Most often seen in patients with HIV/AIDS, but recently reported as a rare complication of treatment with natalizumab in patients with multiple sclerosis or Crohn’s disease.

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