7
Microbiology, Inflammation, and Viral Infections
Fig. 7.40
(A)
Atypical cellular proliferation,
LBGS (Papanicolaou x MP).
(B) "Atypical” cellular changes in cervical herpes, LBGS (Papanicolaou x PIP).
Cellular Proliferation
Transient cellular proliferation is commonly seen in viral infec-
tions. These changes may be extreme and mimic dyskaryosis
and neoplastic forms (Fig. 7.40).
Cellular Cohesion
In certain viral infections, the initial step is attachment to the
host cell; viral proteins (antireceptors) adsorb to the cell surface
furnished with appropriate receptors. The interaction may alter
not only the surface of the infected cell but also the structure
of the virion. Although not fully understood, viral detachment
and readsorption perhaps contribute to cell clumps or plaque
formation.
Cytoskeleton Changes
Cytoplasmic and nuclear changes frequently occur not as a
result of the damage caused by the virus, but rather as a result
of specific reorganization of the cellular or skeletal elements
necessary for its growth. Alteration in intermediate keratin fila-
ments and microtubules, and cellular metabolism contribute to
the formation of ciliocytophthoria (CCP) seen in certain viral
infections. It should be distinguished from detached ciliary tufts
Fig. 7.41 Hemadsorption.
This patient had herpes infection at the time
when these and many other similar cells were seen. Vaginopancervical smear
(Papanicolaou x HP).
(DCT) described by Hollander and Gupta that may be observed
in lower genital tract smears in the absence of a viral infection.6,54
In vivo hemadsorption observed occasionally may be a related
phenomenon (Fig. 7.41).
Oncogenesis
Both in vitro and in vivo neoplastic transformation of viral-
infected cells may occur. Numerous DNA viruses and a group of
retroviruses are capable of neoplastic transformation. These com-
monly manifest as dyskaryosis and atypical nuclear alterations.
Quite often, in the presence of florid viral infection, no dis-
cernible morphologic changes may occur in the infected cells
and tissues.
The previously mentioned cellular manifestations may or
may not be reflected in all cytologic preparations and in the
presence of all viral infections.
Specific Infections
Specific viral infections commonly observed in the female geni-
tal tract include herpes infection: Herpes is a Greek word mean-
ing "to creep." It is believed that this word was used in relation
to certain clinical features of an infection that eventually was
found to be related to the particular DNA virus. There are at least
six different viruses in this group causing disease in humans.
These are:
• Herpes simplex virus, type 1 and type 2 (HSV 1, HSV 2);
• Cytomegalovirus (CMV);
• Varicella-zoster virus;
• Epstein-Barr (EB) virus; and
• Lymphoma-associated viruses.
In the cytologic preparations from the female genital tract
herpes, CMV and varicella may be detected.
Herpes Simplex Virus
Distinction between HSV 1 and HSV 2 was made based on sero-
logic studies by Schneweis.55 Most people acquire antibodies to
HSV 1 during the first 2 years of their life. Herpetic vulvovagin-
itis or stomatitis due to HSV 1 may occur at the time of initial
infection, generally in infancy or early adolescence. Infection
is mostly asymptomatic, or it may be accompanied by upper
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