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Chapter 4 : The Cytopathology of Virus Infection

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Abstract:

This chapter talks about cytopathology of viral infections, and describes the methods used to obtain and prepare cells for cytologic examination. It illustrates characteristic changes encountered in common virus infections. The preparatory methods utilized for the microscopic examination of cytologic specimens can be divided into five categories: direct smears, preparation by cytocentrifugation, membrane filter preparation, monolayer preparation, and cell block preparation. The eye and respiratory, genital, and urinary tracts are locations that readily yield cytologic material for rapid viral diagnosis. Characteristic cytologic changes depend on the cytopathic effect of a virus in infected cells, which need not include all cells of the involved organ. A nonspecific change referred to as ciliocytophthoria is found in various inflammatory diseases of the respiratory tract and, in particular, virus infections. Ciliocytophthoria occurs most frequently with influenza virus, parainfluenza virus, and adenovirus infection but may also occur in bronchiectasis and other nonviral inflammatory conditions. Although many viruses that cause systemic infections have been isolated from urine, those most readily diagnosed by urine cytology are cytomegalovirus (CMV), herpes simplex virus (HSV), and a member of the papovavirus group, designated the BK virus (BKV). Detection of HSV genital tract infection is important in abating the spread of sexually transmitted HSV as well as protecting the neonate from life-threatening infection transmitted to the infant during a vaginal birth. The morphologic changes in conjunctival and corneal cells due to virus infection must be differentiated from the cytologic changes due to chlamydial infections causing trachoma and inclusion conjunctivitis.

Citation: Smith R, Kubat A. 2009. The Cytopathology of Virus Infection, p 52-63. In Specter S, Hodinka R, Young S, Wiedbrauk D (ed), Clinical Virology Manual, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815974.ch4
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Image of FIGURE 1
FIGURE 1

CMV in bronchial brushing; large basophilic IN inclusions in large binucleated cell with small IC inclusions; Pap stain. Magnification, ×800.

Citation: Smith R, Kubat A. 2009. The Cytopathology of Virus Infection, p 52-63. In Specter S, Hodinka R, Young S, Wiedbrauk D (ed), Clinical Virology Manual, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815974.ch4
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Image of FIGURE 2
FIGURE 2

CMV in urine; multiple IC inclusions with small degenerating IN inclusion in late stage of infection; Pap stain. Magnification, ×800.

Citation: Smith R, Kubat A. 2009. The Cytopathology of Virus Infection, p 52-63. In Specter S, Hodinka R, Young S, Wiedbrauk D (ed), Clinical Virology Manual, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815974.ch4
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Image of FIGURE 3
FIGURE 3

HSV in sputum; multinuclear cell with IN inclusions in different stages of development. Magnification, ×600.

Citation: Smith R, Kubat A. 2009. The Cytopathology of Virus Infection, p 52-63. In Specter S, Hodinka R, Young S, Wiedbrauk D (ed), Clinical Virology Manual, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815974.ch4
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Image of FIGURE 4
FIGURE 4

HSV in bronchial brushing; multinucleated cell with IN inclusions having a ground-glass appearance and showing nuclear molding; Pap stain. Magnification, ×800.

Citation: Smith R, Kubat A. 2009. The Cytopathology of Virus Infection, p 52-63. In Specter S, Hodinka R, Young S, Wiedbrauk D (ed), Clinical Virology Manual, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815974.ch4
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Image of FIGURE 5
FIGURE 5

Adenovirus in conjunctival scraping; granular IN inclusions with condensed chromatin at the nuclear membrane, characteristic of the early stage of infection; Pap stain. Magnification, ×600.

Citation: Smith R, Kubat A. 2009. The Cytopathology of Virus Infection, p 52-63. In Specter S, Hodinka R, Young S, Wiedbrauk D (ed), Clinical Virology Manual, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815974.ch4
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Image of FIGURE 6
FIGURE 6

Adenovirus in conjunctival scraping; cells contain a dense, sometimes teardrop-shaped IN inclusion surrounded by a clear halo in the late stage of infection; Pap smear. Magnification, ×800.

Citation: Smith R, Kubat A. 2009. The Cytopathology of Virus Infection, p 52-63. In Specter S, Hodinka R, Young S, Wiedbrauk D (ed), Clinical Virology Manual, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815974.ch4
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Image of FIGURE 7
FIGURE 7

Measles pneumonia; paraffin-embedded lung tissue showing a multinucleated giant cell with multiple IN and IC inclusions; hematoxylin and eosin stain. Magnification, ×800.

Citation: Smith R, Kubat A. 2009. The Cytopathology of Virus Infection, p 52-63. In Specter S, Hodinka R, Young S, Wiedbrauk D (ed), Clinical Virology Manual, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815974.ch4
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Image of FIGURE 8
FIGURE 8

Ciliocytophthoria in sputum; a tuft of detached cilia and nuclear debris; Pap stain. Magnification, ×600.

Citation: Smith R, Kubat A. 2009. The Cytopathology of Virus Infection, p 52-63. In Specter S, Hodinka R, Young S, Wiedbrauk D (ed), Clinical Virology Manual, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815974.ch4
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Image of FIGURE 9
FIGURE 9

BKV polyomavirus in urine; uroepithelial cell with early IN inclusion. The enlarged nucleus is filled with a grayish-staining inclusion having a mucoid appearance. The background cells are yeast. Pap stain. Magnification, ×800.

Citation: Smith R, Kubat A. 2009. The Cytopathology of Virus Infection, p 52-63. In Specter S, Hodinka R, Young S, Wiedbrauk D (ed), Clinical Virology Manual, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815974.ch4
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Image of FIGURE 10
FIGURE 10

BKV in urine. A cell, probably from the renal tubules, contains a large, dense IN inclusion filling and expanding the nucleus. The background contains yeast. Pap stain. Magnification, ×800.

Citation: Smith R, Kubat A. 2009. The Cytopathology of Virus Infection, p 52-63. In Specter S, Hodinka R, Young S, Wiedbrauk D (ed), Clinical Virology Manual, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815974.ch4
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Image of FIGURE 11
FIGURE 11

BKV in urine. In the late stage, there is cytoplasmic degeneration, leaving dense IN inclusions appearing to bud from the nucleus. Pap stain. Magnification, ×800.

Citation: Smith R, Kubat A. 2009. The Cytopathology of Virus Infection, p 52-63. In Specter S, Hodinka R, Young S, Wiedbrauk D (ed), Clinical Virology Manual, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815974.ch4
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Image of FIGURE 12
FIGURE 12

HSV in urine; a renal tubular cast containing characteristic HSV inclusions with nuclear molding; Pap stain. Magnification, ×800.

Citation: Smith R, Kubat A. 2009. The Cytopathology of Virus Infection, p 52-63. In Specter S, Hodinka R, Young S, Wiedbrauk D (ed), Clinical Virology Manual, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815974.ch4
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Image of FIGURE 13
FIGURE 13

HSV in genital smear. At the early stage of the infection, there are ground-glass-appearing IN inclusions in a multinucleated mass of cells. Pap stain. Magnification, ×600.

Citation: Smith R, Kubat A. 2009. The Cytopathology of Virus Infection, p 52-63. In Specter S, Hodinka R, Young S, Wiedbrauk D (ed), Clinical Virology Manual, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815974.ch4
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Image of FIGURE 14
FIGURE 14

HSV in genital smear. A multinucleated cell contains angulated IN inclusions surrounded by halos. There is condensation of chromatin at the nuclear membrane and nuclear molding. Pap stain. Magnification, ×800.

Citation: Smith R, Kubat A. 2009. The Cytopathology of Virus Infection, p 52-63. In Specter S, Hodinka R, Young S, Wiedbrauk D (ed), Clinical Virology Manual, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815974.ch4
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Image of FIGURE 15
FIGURE 15

HSV in genital smear. Note IN inclusions at different stages of development within one multinucleated epithelial cell. Pap stain. Magnification, ×600.

Citation: Smith R, Kubat A. 2009. The Cytopathology of Virus Infection, p 52-63. In Specter S, Hodinka R, Young S, Wiedbrauk D (ed), Clinical Virology Manual, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815974.ch4
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Image of FIGURE 16
FIGURE 16

Papillomavirus in genital smear. Enlarged squamous cells exhibit koilocytotic changes characteristic of a condylomatous lesion. Pap smear. Magnification, ×800.

Citation: Smith R, Kubat A. 2009. The Cytopathology of Virus Infection, p 52-63. In Specter S, Hodinka R, Young S, Wiedbrauk D (ed), Clinical Virology Manual, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815974.ch4
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Image of FIGURE 17
FIGURE 17

Molluscum contagiosum of the genital tract from a skin lesion smear; molluscum bodies showing large IC inclusions displacing and compressing the nucleus. Pap smear. Magnification, ×800.

Citation: Smith R, Kubat A. 2009. The Cytopathology of Virus Infection, p 52-63. In Specter S, Hodinka R, Young S, Wiedbrauk D (ed), Clinical Virology Manual, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815974.ch4
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Image of FIGURE 18
FIGURE 18

Chlamydia in a conjunctival scraping. Epithelial cells contain IC inclusions surrounded by a clear halo. Pap stain. Magnification, ×800.

Citation: Smith R, Kubat A. 2009. The Cytopathology of Virus Infection, p 52-63. In Specter S, Hodinka R, Young S, Wiedbrauk D (ed), Clinical Virology Manual, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815974.ch4
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References

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Tables

Generic image for table
TABLE 1

Cytopathology of respiratory viral infections

Citation: Smith R, Kubat A. 2009. The Cytopathology of Virus Infection, p 52-63. In Specter S, Hodinka R, Young S, Wiedbrauk D (ed), Clinical Virology Manual, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815974.ch4
Generic image for table
TABLE 2

Virus infections of the urinary tract

Citation: Smith R, Kubat A. 2009. The Cytopathology of Virus Infection, p 52-63. In Specter S, Hodinka R, Young S, Wiedbrauk D (ed), Clinical Virology Manual, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815974.ch4
Generic image for table
TABLE 3

Virus infections of the genital tract

Citation: Smith R, Kubat A. 2009. The Cytopathology of Virus Infection, p 52-63. In Specter S, Hodinka R, Young S, Wiedbrauk D (ed), Clinical Virology Manual, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815974.ch4
Generic image for table
TABLE 4

Virus and Chlamydia infections of the eye

Citation: Smith R, Kubat A. 2009. The Cytopathology of Virus Infection, p 52-63. In Specter S, Hodinka R, Young S, Wiedbrauk D (ed), Clinical Virology Manual, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815974.ch4

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