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| Polyomaviridae | |
|---|---|
| Micrograph showing a polyomavirus infected cell—large (blue) cell below-center-left. Urine cytology specimen. | |
| Virus classification | |
| Group: | Group I (dsDNA) |
| Family: | Polyomaviridae |
| Genera | |
|
|
Polyomaviridae is a family of viruses. Mammals and birds serve as natural hosts. There are currently 13 species in this family, contained within a single genus, Polyomavirus, whose type species is Simian virus 40. Not all members of the family infect humans, but among those that do, several are associated with human disease: JC virus with progressive multifocal leukoencephalopathy, BK virus with mild respiratory infection,[1][2] and Merkel cell virus with Merkel cell cancer.[3] Some members of the family are potentially oncogenic (tumor-causing); they often persist as latent infections in a host without causing disease, but may produce tumors in a host of a different species, or a host with an ineffective immune system. The name polyoma refers to the viruses' ability to produce multiple (poly-) tumors (-oma).
The current classification of the family Polyomaviridae came from a split of the now obsolete family Papovaviridae (the other family being Papillomaviridae).[2] The name Papovaviridae derived from three abbreviations: Pa for Papillomavirus, Po for Polyomavirus, and Va for "vacuolating."
Contents
- 1 Structure
- 2 Life cycle
- 3 History
- 4 Taxonomy
- 4.1 Proposed classification
- 4.1.1 Unclassified viruses
- 4.1.2 Proposed taxonomy
- 4.1 Proposed classification
- 5 Genome
- 6 Replication
- 7 The polyoma large and small T-antigens
- 8 The polyoma middle T-antigen
- 9 Agnoprotein
- 10 Human polyomaviruses
- 10.1 Virus listing
- 11 Clinical relevance
- 11.1 SV40
- 11.2 Possible association with prostate cancer
- 12 Diagnosis
- 13 Treatment
- 14 References
- 15 External links
Structure
Genome structure of human polyomaviruses BK and JC.jpg
Polyomaviruses are DNA-based (double-stranded DNA, ~5000 base pairs, circular genome) viruses. They are small (40–50 nanometers in diameter), and icosahedral in shape (T=7 symmetry), and do not have a lipoprotein envelope. Moreover, the genome possess early and late genes, contributing to its complex transcription program. The genome codes for 5 to 9 proteins.[1]
| Genus | Structure | Symmetry | Capsid | Genomic arrangement | Genomic segmentation |
|---|---|---|---|---|---|
| Polyomavirus | Icosahedral | T=7 | Non-Enveloped | Circular | Monopartite |
Life cycle
Viral replication is nuclear, and is lysogenic. Entry into the host cell is achieved by attachment of the viral proteins to host receptors, which mediates endocytosis. Replication follows the dsDNA bidirectional replication model. DNA-templated transcription, with some alternative splicing mechanism is the method of transcription. Translation takes place by leaky scanning, and viral initiation. The virus exits the host cell by nuclear envelope breakdown, and nuclear pore export. Mammals and birds serve as the natural host. Transmission routes are egg transmission, feces, contamination, and air-borne particles.[1]
| Genus | Host details | Tissue tropism | Entry details | Release details | Replication site | Assembly site | Transmission |
|---|---|---|---|---|---|---|---|
| Polyomavirus | Mammals; birds | Respiratory system; kidneys, brain | Cell receptor endocytosis | Lysis | Nucleus | Nucleus | Oral-fecal |
History
Murine polyomavirus was the first polyomavirus discovered by Ludwik Gross in 1953.[4] Subsequently, many polyomaviruses have been found to infect birds and mammals. Dr. Sarah Stewart and Dr. Bernice E. Eddy were the first to describe the polyoma virus. The virus was later named the SE polyoma virus in their honor.[citation needed]
For nearly 40 years, only two polyomaviruses were known to infect humans. Genome sequencing technologies have recently discovered seven additional human polyomaviruses, including one causing most cases of Merkel cell carcinoma and another associated with Trichodysplasia spinulosa associated-virus (TSV), that are natural infections of humans. Discovery of these polyomaviruses and other new—but previously undiscovered—viruses may provide clues to the etiologies for human diseases.[citation needed]
Taxonomy
Group: dsDNA
Order: Unassigned
-
Family: Polyomaviridae
-
Genus: Polyomavirus
- African green monkey polyomavirus
- Baboon polyomavirus 2
- BK polyomavirus
- Bovine polyomavirus
- Budgerigar fledgling disease polyomavirus
- Hamster polyomavirus
- Human polyomavirus
- JC polyomavirus
- Murine pneumotropic virus
- Murine polyomavirus
- Rabbit kidney vacuolating virus
- Simian virus 12
- Simian virus 40
-
[2]
Proposed classification
The classification of Polyomaviruses is constantly evolving due to the explosion of newly discovered viruses. Previously, the family of Polyomaviridae was divided into three major clades (genetically-related groups)—the SV40 clade, the avian clade, and the murine polyomavirus clade:[5] Recent reclassification by the International Committee on Taxonomy of Viruses (ICTV) recommended dividing the family of Polyomaviridae into three genera:[6]
- Genus Orthopolyomavirus (type species SV40)
- Genus Wukipolyomavirus (type species KI polyomavirus)
- Genus Avipolyomavirus (type species Avian polyomavirus)
Many of the known viruses have not been fully classified or have not yet been officially accepted; hence, the taxonomy of this family is on going.
Unclassified viruses
A further 12 putative species have been identified in bats.[7] These await classification.
A polyoma virus has been isolated from horses.[8] This virus appears to be related to the human and other primate polyoma viruses.
Two further polyoma viruses have been isolated from humans—STL polyomavirus and MW polyoma virus.[9][10]
A new species has been identified from vervet monkeys.[11]
Another eight viruses have been described in bats.[12] Some of these viruses are related to human polyomavirus 9 and trichodysplasia spinulosa-associatedpolyoma virus.
Proposed taxonomy
Genus Orthopolyomavirus (type species SV40):
| Species name | Abbreviation |
|---|---|
| B-lymphotropic polyomavirus (formerly known as African green monkey polyomavirus, AGMPyV) | LPyV |
| Baboon polyomavirus 1 (formerly known as Simian Agent 12) | SA12 |
| Bat polyomavirus (formerly known as myotis polyomavirus, MyPyV) | BatPyV |
| BK polyomavirus | BKPyV |
| Bornean orang-utan polyomavirus | OraPyV1 |
| Bovine polyomavirus | BPyV |
| California sea lion polyomavirus | SLPyV |
| Dolphin polyomavirus 1 | DolPyV |
| Hamster polyomavirus | HaPyV |
| JC polyomavirus | JCPyV |
| Merkel Cell polyomavirus | MCPyV |
| Murine pneumotropic virus (formerly known as Kilham strain of Polyomavirus, Kilham virus, K virus) | MPtV |
| Murine polyomavirus | MPyV |
| Simian virus 40 (formerly known as Simian vacuolating virus 40) | SV40 |
| Squirrel monkey polyomavirus | SqPyV |
| Sumatran orang-utan polyomavirus | OraPyV2 |
| Trichodysplasia spinuolsa-associated polyomavirus | TSPyV |
Other related virus that may be a member of the genus Orthopolyomavirus but has not been approved as a species:
ChPyV: chimpanzee polyomavirus
Genus Wukipolyomavirus (type species KI polyomavirus)
| Species name | Abbreviation |
|---|---|
| Human polyomavirus 6 | HPyV6 |
| Human polyomavirus 7 | HPyV7 |
| KI polyomavirus (formerly known as Karolinska Institute polyomavirus) | KIPyV |
| WU polyomavirus (formerly known as Washington University polyomavirus) | WUPyV |
Genus Avipolyomavirus (type species Avian polyomavirus):
| Species name | Abbreviation |
|---|---|
| Avian polyomavirus (formerly known as budgerigar fledgling disease polyomavirus, BFPyV) | APyV |
| Canary polyomavirus | CaPyV |
| Crow polyomavirus | CPyV |
| Finch polyomavirus | FPyV |
| Goose hemorrhagic polyomavirus | GHPyV |
Other viruses with similarities to members of the family Polyomaviridae that have not been assigned to a polyomavirus species:
| Species name | Abbreviation |
|---|---|
| African elephant polyomavirus 1 | AelPyV-1 |
| Athymic rat polyomavirus | RatPyV |
| Baboon polyomavirus 2 | BPyV2 |
| Cynomolgus polyomavirus | CyPV |
| Gorilla gorilla gorilla polyomavirus 1 | GggPyV1 |
| Human polyomavirus 9 | HPyV9 |
| Mastomys polyomavirus (multimammate mouse – Mastomys species) | ? |
| Pan troglodytes verus polyomavirus 1a | PtvPyV1a |
| Pan troglodytes verus polyomavirus 2c | PtvPyV2c |
| Rabbit kidney vacuolating virus | RKV |
Genome
The genome is circular, composed of double stranded DNA and has six genes: large T, small t, viral protein 1 (VP1), viral protein 2 (VP2), and viral protein 3 (VP3) and agnoprotein. It is about 5 kilobase pairs in length. VP1-3 form the viral capsid.
Replication
Prior to genome replication, the processes of viral attachment, entry and uncoating occur. Cellular receptors for polyomaviruses are sialic acid residues of gangliosides. The attachment of polyomaviruses to host cells is mediated by viral protein 1 (VP1) via the sialic acid attachment region. This can be confirmed as anti-VP1 antibodies have been shown to prevent the binding of polyomavirus to host cells.[13]
Polyomavirus virions are subsequently endocytosed and transported first to the endoplasmic reticulum where a conformational change occurs revealing Vp2.[citation needed] Then by an unknown mechanism the virus is exported to the nucleus.[citation needed]
Polyomaviruses replicate in the nucleus of the host. They are able to utilise the host’s machinery because the genomic structure is homologous to that of the mammalian host. Moreover, the promoter sequence of Polyomavirus' promoter sequence is a strong attractant for the host's RNAP. Viral replication occurs in two distinct phases; early and late gene expression, separated by genome replication.[citation needed]
Early gene expression is responsible for the synthesis of non-structural proteins. Since Polyomaviruses rely on the host to control both the gene expression, the role of the non-structural proteins is to regulate the cellular mechanisms. Close to the N terminal end of polyomavirus genome are enhancer elements which induce activation and transcription of a molecule known as the T-antigen (see SV40 large T-antigen). Early mRNA’s, encoding T-antigen are produced by host RNA polymerase II. T-antigen autoregulates early mRNA’s, subsequently leading to elevated levels of T-antigen. At high concentrations of T-antigen, early gene expression is repressed, triggering the late phase of viral infection to begin.[citation needed]
Genome replication acts to separate the early and late phase gene expression. The duplicated viral genome is synthesised and processed as if it were cellular DNA, exploiting the host’s machinery. As the daughter viral DNA are synthesised they associate with cellular nucleosomes to form structures that are often referred to as "minichromosomes". In this manner the DNA is packaged more efficiently.[citation needed]
Late gene expression synthesises the structural proteins, responsible for the viral particle composition. This occurs during and after genome replication. As with the early gene expression products, late gene expression generates an array of proteins as a result of alternative splicing.[citation needed]
Within each viral protein are 'nuclear localization signals' which cause the viral proteins to amass in the nucleus. Assembly of new virus particles consequently occurs within the nucleus of the host cell.[14]
Release of newly synthesized polyomavirus particles exit the infected cell by one of two mechanisms. Firstly and less commonly, they are transported in cytoplasmic vacuoles to the plasma membrane, where budding occurs. More frequently, they are released when the cell lyses due to the cytotoxicity of virus particles present in the infected cell.[citation needed]
The polyoma large and small T-antigens
The large T-antigen plays a key role in regulating the viral life cycle by binding to the viral origin of DNA replication where it promotes DNA synthesis. Also as the polyomavirus relies on the host cell machinery to replicate the host cell needs to be in s-phase for this to begin. Due to this, large T-antigen also modulates cellular signaling pathways to stimulate progression of the cell cycle by binding to a number of cellular control proteins.[15] This is achieved by a two prong attack of inhibiting tumor suppressing genes p53 and members of the retinoblastoma (pRB) family,[16] and stimulating cell growth pathways by binding cellular DNA, ATPase-helicase, DNA polymerase α association, and binding of transcription preinitiation complex factors.[17] This abnormal stimulation of the cell cycle is a powerful force for oncogenic transformation.
The small T-antigen protein is also able to activate several cellular pathways that stimulate cell proliferation. Polyomavirus small T antigens commonly target protein phosphatase 2A (PP2A),[18] a key multisubunit regulator of multiple pathways including Akt, the mitogen-activated protein kinase (MAPK) pathway, and the stress-activated protein kinase (SAPK) pathway.[19][20] Merkel cell polyomavirus small T antigen encodes a unique domain, called the LT-stabilization domain (LSD), that binds to and inhibits the FBXW7 E3 ligase regulating both cellular and viral oncoproteins.[21] Unlike for SV40, the MCV small T antigen directly transforms rodent cells in vitro.[22]
The polyoma middle T-antigen
The polyoma middle T-antigen is used in animal breast cancer model systems like the PYMT system where it is coupled to the MMTV promoter. There it functions as an oncogene, while the tissue where the tumor develops is determined by the MMTV promoter.
Agnoprotein
The agnoprotein is a small multifunctional phospho-protein found in the late coding part of the genome. It appears to be involved in DNA replication but the exact mechanism remains unclear.[23]
Human polyomaviruses
Several polyomaviruses have been found in humans. Four of these viruses (JC virus, BK virus, KI virus and WU virus) are closely related to SV40 and infection with these viruses can be confused with SV40 infection.[24][25] Merkel cell polyomavirus (MCV) is highly divergent from the other human polyomaviruses and is most closely related to murine polyomavirus. Trichodysplasia spinulosa-associated polyomavirus (TSV) is distantly related to MCV. Two viruses—HPyV6 and HPyV7—are most closely related to KI and WU viruses, while HPyV9 is most closely related to the African green monkey-derived lymphotropic polyomavirus (LPV).
Virus listing
- JC virus can infect the respiratory system, kidneys, or brain (sometimes causing the fatal progressive multifocal leukoencephalopathy in the latter case). This virus like BK virus was described in 1971.
- BK virus produces a mild respiratory infection and can affect the kidneys of immunosuppressed transplant patients. Both of these viruses are very widespread: approximately 80 percent of the adult population in the United States have antibodies to BK and JC.
- Two polyomaviruses, KI (Karolinska Institute)[26] and WU (Washington University)[27] viruses, are closely related to each other and have been isolated from respiratory secretions. These viruses, discovered almost simultaneously in 2007, were the first of an expanding group of polyomaviruses found to naturally infect humans beyond JCV and BKV.
- In January 2008, a new virus, Merkel cell polyomavirus, was described and shown to cause most Merkel skin cancer.[28][29][30]
- In 2010, three new polyomaviruses infecting skin were discovered: HPyV6 and HPyV7:[31] these two viruses are as yet not associated with human disease. Trichodysplasia spinulosa-associated polyomavirus (TSV) was discovered in the proliferative skin lesion termed trichodysplasia spinulosa seen in immunosuppressed patients.[32][32] All three of these viruses were discovered by rolling circle amplification of human skin DNA that preferentially amplifies small circular genomes, such as polyomaviruses.
- In March 2011, a ninth polyoma virus, HPyV9, related to a monkey lymphotropic virus (LPV), was cultured from the blood of immunosuppressed patients. The finding partially explains why some humans had antisera cross-reactive with monkey LPV but none of the known human polyomaviruses cross-reacted with those patients' sera.[33]
- In 2012, a new polyoma virus (Malawi polyomavirus—MWPyV) was isolated from the stool of a healthy child from Malawi.[10] This virus has also been isolated in St. Louis, Missouri. It appears to be highly divergent from other members of this virus family.
- In 2012, another new polyoma virus—human polyoma virus 10—was isolated from patient with the warts, hypogammaglobulinemia, infections and myelokathexis syndrome.[34]
- In 2012, another polyoma virus—MX polyomavirus—was isolated from stool samples.[35] This virus was isolated from samples from California, Chile and Mexico. This virus was also isolated from a respiratory tract infection in Mexico. Its potential for pathogenicity (if any) is currently unknown.
- In 2013, a new polyoma virus (human polyomavirus 12) was found in resected liver tissue.[36] Subclinical infection with this virus appears to be common (10–20% of asymptomatic population).
- In 2013, a new polyoma virus—STL polyomavirus—was isolated from human faeces.[9]
Clinical relevance
Polyomaviruses have been extensively studied as tumor viruses in humans and animals, leading to fundamental insights into carcinogenesis, DNA replication and protein processing. The tumor suppressor molecule p53 was discovered, for example, as a cellular protein bound by the major oncoprotein (cancer-causing protein) T antigen made by Simian vacuolating virus 40 (SV40). The avian polyomavirus sometimes referred to as the budgerigar fledgling disease virus is a frequent cause of death among caged birds.[citation needed]
All the polyomaviruses are highly common childhood and young adult infections.[37] Most of these infections appear to cause little or no symptoms. These viruses are probably lifelong persistent among almost all adults. Diseases caused by human polyomavirus infections are most common among persons who become immunosuppressed by AIDS, old age or after transplantation and include Merkel cell carcinoma, PML and BK nephropathy.
In addition to its role in Merkel cell carcinoma, Merkel cell polyomavirus has been reported from a number of other conditions including non small cell lung carcinoma,[38] cervical cancer, squamous cell cancer of the skin, Bowen's disease and basal cell carcinoma.[39][40][41][42] These putative associations await confirmation. It has also been associated with atypical fibroxanthoma.[43]
SV40
Main article: SV40
The SV40 replicates in the kidneys of monkeys without causing disease, but causes sarcomas in hamsters. It is highly controversial whether it can cause disease in humans since the virus may have been introduced into the general population in the 1950s through a contaminated polio vaccine. Thus far, no widely accepted evidence for the virus being present in human cancer has been reported although reports for it being present in pleural mesothelioma, some nonHodgkin's lymphomas and other human cancers have been published. This is confounded by the high level of cross-reactivity for SV40 with known human polyomaviruses (BK virus and JC virus) that are widespread and by common use of SV40 DNA as a near universal reagent in scientific laboratories.[25] Most virologists dismiss SV40 as a cause for human cancers.[24]
Possible association with prostate cancer
BK viral genomes have been found in benign and malignant prostate tissue.[44] It has been suggested that this virus may play a role in the development of malignancy but further work in this area is required.
Diagnosis
The diagnosis of polyomavirus almost always occurs after the primary infection as it is either asymptomatic or sub-clinical. Antibody assays are commonly used to detect presence of antibodies against individual viruses.[45] Competition assays are frequently needed to distinguish among highly similar polyomaviruses.[46]
In cases of progressive multifocal leucoencephalopathy (PML), a cross-reactive antibody to SV40 T antigen (commonly Pab419) is used to stain tissues directly for the presence of JC virus T antigen. PCR can be used on a biopsy of the tissue or cerebrospinal fluid to amplify the polyomavirus DNA. This allows not only the detection of polyomavirus but also which sub type it is.[47]
There are three main diagnostic techniques used for the diagnosis of the reactivation of polyomavirus in polyomavirus nephropathy (PVN): urine cytology, quantification of the viral load in both urine and blood, and a renal biopsy.[45] The reactivation of polyomavirus in the kidneys and urinary tract causes the shedding of infected cells, virions, and/or viral proteins in the urine. This allows urine cytology to examine these cells, which if there is polyomavirus inclusion of the nucleus, is diagnostic of infection.[48] Also as the urine of an infected individual will contain virions and/or viral DNA, quanitation of the viral load can be done through PCR.[49] This is also true for the blood.
Renal biopsy can also be used if the two methods just described are inconclusive or if the specific viral load for the renal tissue is desired. Similarly to the urine cytology, the renal cells are examined under light microscopy for polyomavirus inclusion of the nucleus, as well as cell lysis and viral partials in the extra cellular fluid. The viral load as before is also measure by PCR.[citation needed]
Tissue staining using a monoclonal antibody against MCV T antigen shows utility in differentiating Merkel cell carcinoma from other small, round cell tumors.[50] Blood tests to detect MCV antibodies have been developed and show that infection with the virus is widespread although Merkel cell carcinoma patients have exceptionally higher antibody responses than asymptomatically infected persons.[51][52][53][54]
These viruses have been found in breast tumours.[55] The importance of this finding—if any—is not known.[citation needed]
Treatment
There is no known treatment for infection with these viruses. However it appears that some of fluoroquinolones may have therapeutic potential.[56]
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External links
- Viralzone: Polyomavirus
- ICTV
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UpToDate Contents
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- 1. Overview of JC polyomavirus, BK polyomavirus, and other polyomavirus infections
- 2. 腎移植におけるBKウイルス（ポリオーマウイルス）腎症のマネージメント management of bk virus induced polyomavirus induced nephropathy in kidney transplantation
- 3. Virology, epidemiology, and pathogenesis of JC polyomavirus, BK polyomavirus, and other human polyomaviruses
- 4. 腎移植におけるBKウイルス（ポリオーマウイルス）腎症の臨床症状および診断 clinical manifestations and diagnosis of bk virus induced polyomavirus induced nephropathy in kidney transplantation
- 5. メルケル細胞（神経内分泌）癌の病因、臨床的特徴、および診断 pathogenesis clinical features and diagnosis of merkel cell neuroendocrine carcinoma
English Journal
- High diversity of human polyomaviruses in environmental and clinical samples in Argentina: Detection of JC, BK, Merkel-cell, Malawi, and human 6 and 7 polyomaviruses.
- Torres C1, Barrios ME2, Cammarata RV3, Cisterna DM4, Estrada T5, Martini Novas S5, Cahn P5, Blanco Fernández MD3, Mbayed VA3.
- The Science of the total environment.Sci Total Environ.2016 Jan 15;542(Pt A):192-202. doi: 10.1016/j.scitotenv.2015.10.047. Epub 2015 Oct 29.
- New human polyomaviruses have been recently described. The aim of this work was to detect and characterize human polyomaviruses circulating in Argentina by recovering viruses from environmental and sewage samples and evaluating their potential role as viral indicators of human waste contamination. A
- PMID 26519580
- The role of infection in miscarriage.
- Giakoumelou S1, Wheelhouse N2, Cuschieri K3, Entrican G4, Howie SE5, Horne AW6.
- Human reproduction update.Hum Reprod Update.2016 Jan;22(1):116-33. doi: 10.1093/humupd/dmv041. Epub 2015 Sep 19.
- BACKGROUND: Miscarriage is the spontaneous loss of a pregnancy before 12 weeks (early miscarriage) or from 12 to 24 weeks (late miscarriage) of gestation. Miscarriage occurs in one in five pregnancies and can have considerable physiological and psychological implications for the patient. It is also
- PMID 26386469
- Occurrence, genotypic characterization, and patterns of shedding of human polyomavirus JCPyV and BKPyV in urine samples of healthy individuals in São Paulo, Brazil.
- Urbano PR1, Oliveira RR1, Romano CM1, Pannuti CS1, Fink MC1.
- Journal of medical virology.J Med Virol.2016 Jan;88(1):153-8. doi: 10.1002/jmv.24318. Epub 2015 Jul 21.
- The objective of this study was to evaluate the prevalence, genotypic characterization, and determination of the patterns of shedding of human polyomavirus JC (JCPyV) and BK (BKPyV) in consecutive urine samples collected from healthy adults. Urine samples collected monthly over a 6 month period were
- PMID 26147595
Japanese Journal
- 症例 Merkel細胞癌ポリオーマウイルスが陰性であった皮下型Merkel細胞癌の1例
- 八田 尚人,荒井 美奈子
- 皮膚科の臨床 57(4), 455-457, 2015-04
- NAID 40020439840
- BKウイルス感染とHLA
- 升谷 耕介
- 日本臨床腎移植学会雑誌 = Journal of Japanese Society for Clinical Renal Transplantation 2(1), 29-35, 2014-07
- NAID 40020445660
- Differential Expression of ETS Family Transcription Factors in NCCIT Human Embryonic Carcinoma Cells upon Retinoic Acid-Induced Differentiation
- Park Sung-Won,Do Hyun-Jin,Ha Woo Tae [他]
- Biological & pharmaceutical bulletin 37(4), 659-665, 2014-04
- NAID 40020030237
Related Links
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- Polyomavirus (PVD) viral infection in parrots and other psittacines. Symptoms, diagnosis and testing.
Related Pictures
★リンクテーブル★
| リンク元 | 「急性尿細管間質性腎炎」「ポリオーマウイルス」 |
| 拡張検索 | 「polyomavirus hominis 1」「BK polyomavirus」「human polyomavirus BK」「human polyomavirus JC」「JC polyomavirus」 |
| 関連記事 | 「polyomaviruses」 |
「急性尿細管間質性腎炎」
原因
- 薬剤性
- antibiotics (lactams, sulfonamides, quinolones, vancomycin, erythromycin, minocycline, rifampin, ethambutol, acyclovir)
- NSAIDs,COX-2阻害薬
- 利尿薬(thiazides, furosemide, triamterene)
- 抗てんかん薬(フェニトイン、フェノバルビタール、カルバマゼピン、バルプロ酸)
- その他(カプトプリル、H2受容体阻害薬、プロトンポンプ阻害薬、mesalazine、indinavir、アロプリノール)
- 感染症
- 細菌(Streptococcus、Staphylococcus、Legionella、Salmonella、Brucella、Yersinia、Corynebacterium diphtheriae)
- ウイルス(Epstein-Barr virus、cytomegalovirus、Hantavirus、polyomavirus、HIV)
- その他(レプトスピラ、リケッチア、マイコプラズマ)
- 特発性
「ポリオーマウイルス」
「polyomavirus hominis 1」
- ・リオーマウイルスホミニス1
「BK polyomavirus」
- BK・リオーマウイルス
「human polyomavirus BK」
- ヒト・リオーマウイルスBK