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Influenza A, B, C viruses● Klasifikasi, Struktur, Genom, Kultur dan Sifat Virus - Famili Orthomyxoviridae Influenza A virus tdd : subtipe ~ 15 HA dan 9 NA ( ~ outbreaks in humans : H1-3 dan N1-2 )

- Virion berbentuk spheris, tdd : a. Segmented, minus strand RNA b. Helically coiled nucleocapsid c. Enveloped (hemagglutinin&neuraminidase glycoprotein spikes)

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- Genom :13000-15000 nt, tdd 7-8 segmen (reassortment !); menyandi 10-11 macam protein.

Influenza C virus : gen NA Ө- Dapat dikultur pada a.l. monkey kidney cells - Host : Influenza A virus : wild avian, humans, swine, horses

Influenza B & C virus : humans

: swine, dogs, cats, horse- Inaktivasi dgn : radiasi ionisasi, pH <5/>9, >50C,

deterjen, drying

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- Seasonal : winter / spring (temperate) & rainy (tropic) (Influenza C virus : non seasonal)

- Influenza A virus : > avian; ~ epidemik influenza (peran swine) : non human & human (reassortment!) Influenza B & C virus : ~ milder disease; winter outbreaks

● Epidemiologi - Worldwide outbreak tiap tahun pandemik : Influenza A virus H1N1 (swine) 1918, H2N2 (Asian) 1957, H3N2 (Hongkong) 1968, H5N1 (chicken/bird) 1997 1947 : WHO surveillance program

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- Low mortality (~ lower respiratory/ cardiovascular disease)

- Transmisi : by airborne droplets (orang ke orang, zoonotik)

- Sering reinfeksi

- ~ Infeksi nosokomial (Influenza A virus >>)

● Manifestasi Klinis - Gejala/sindroma influenza (all age groups) - Komplikasi : sering ( otitis media/sinusitis, bronchitis, croup, pneumonia, CNS, myocarditis, gagal ginjal akut)

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● Diagnosis Lab - Isolasi virus dari sputum, usap hidung/tenggorok, nasal aspirate/washing (kultur sel) & deteksi CPE - Deteksi asam nukleat (RT-PCR) - Uji serologis : deteksi ag & ab (IF, RIA, EIA)

● Prevensi (vaksin, isolasi penderita : di RS, antiviral)

● Terapi (simtomatik dan antiviral)

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Parainfluenza virus● Klasifikasi, Struktur, Genom dan Kultur Virus - Genus Paramyxovirus, Famili Paramyxoviridae PIV : tipe 1, tipe 2, tipe 3, tipe 4

- Virion berbentuk pleomorfik (spheris/filamentous) tdd :

a. Single stranded of negative sense RNA

b. Helical nucleocapsid

c. Envelope (spike-like glycoproteins & lipid from host cell)

- Genom tdd 15500 nt yg mengkode 6 VP (H=hemaglutinin,

N= Neuraminidase) & 1 NSP

- Dapat dikultur pada monkey kidney cells

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● Epidemiologi - Worldwide (early childhood) mortalitas : ~ pneumonia (anak <5 tahun) di neg. berkembang - PIV tipe 1 : epidemik croup (~ autumn) 2 : ~ PIV tipe 1 (> ringan) 3 : least predictable (late winter &spring) daerah tropis/subtropis : musim hujan - Transmisi : droplet (port d’entry : hidung dan mata) - Host range : humans. - Faktor inang : usia dan imunodefisiensi - Sering terjadi reinfeksi (PIV tipe 3) - Infeksi nosokomial (PIV tipe 3)

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● Manifestasi Klinis : - infeksi sal. napas atas “croup” (laringotrakheobronchitis)

dan infeksi sal. napas bawah

- Komplikasi : otitis media, pneumonia bakterial

● Diagnosis Lab - Spesimen : nasal wash/ nasal aspirate

Isolasi virus dan deteksi CPE dan hemadsorpsi

- Deteksi ag dan ab (ELISA, CFT)

- Deteksi asam nukleat (RT-PCR)

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● Prevensi (vaksin ~ PIV tipe 3, cuci tangan, glove-goggle-masker)

● Terapi (suportif, no licensed antiviral)

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Mumps virus● Klasifikasi, Struktur, Genom & Kultur Virus - Genus Rubulavirus, Famili Paramyxoviridae

- Virion berbentuk pleomorfik (irregularly spherical), tdd :

a. Linear, ss negative-sense RNA, non segmented

b. Helically coiled nucleocapsid

c. Envelope tdd : glycoprotein spikes, lipid bilayer,

inner structural matrix protein

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● Epidemiologi - Worldwide (> school-aged children : 5-9 years old)

- Lifelong immunity

- Transmisi : ~ airborne/ droplet sekresi respiratorius

- Highly contagious, namun jarang fatal

- Human : the only known natural host

- Genom tdd 15300 nt yang mengkode 7 protein utama

(N, P, M, F, SH, HN, L)

- Dapat dikultur pada a.l. Vero cells, HeLa cells,

human embryonic kidney cells

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● Diagnosis Laboratoris - Spesimen : saliva - Isolasi virus (kultur) - Deteksi as. nukleat (PCR) - Uji serologis (CFT, ELISA) : deteksi ab

● Prevensi (vaksin : MMR)

● Terapi (Simtomatik)

● Manifestasi Klinis - Parotitis dan meningitis aseptik-ensefalitis

- Komplikasi : gonadal infections, polyarthritis, myocarditis, dll

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Measles/Rubeola virus ● Klasifikasi, Struktur, Genom & Kultur Virus - Genus Morbillivirus, Famili Paramyxoviridae

(!! tak memiliki aktivitas neuraminidase)

Measles virus : hanya memiliki 1 serotipe

: tdd 15 genotipe (~ sekuens gen H & N)

- Virion berbentuk spheris, tdd :

a. Linear ss, non segmented negative sense RNA

b. Helical nucleocapsid

c. Envelope (lipid bilayer) carries surface projections

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- Genom tdd 15900 nt yg menyandi protein N, P, M, F, H, L.

- Host : only humans

- Dapat dikultur pada human & monkey kidney cells

- Inaktivasi : pH <4.5, panas, ether/acetone, deterjen,

drying, sinar matahari

● Epidemiologi - Worldwide , endemik (> anak-anak)

- Seasonal : late winter & early spring (temperate)

hot/dry season (tropics)

- Transmisi : via droplet sekresi respiratorius (periode katharal!)

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- The most contagious infections of humans,

no latent/persistent infections, no animal reservoirs

- Morbiditas & mortalitas : ~ infants, elderly adults,

low socioeconomic status people

- Lifelong immunity

- Reinfeksi hampir selalu asimtomatik.

● Manifestasi Klinis (→ mukosa respiratorius)

- Prodromal (demam, malaise) → gejala katarhal : coryza,

conjunctivitis, sneezing, cough → Koplik’s spot → rash.

- Komplikasi : otitis media, diare, pneumonia, ensefalitis.

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● Diagnosis - Berdasar klinis - Laboratoris : - Spesimen : sekresi respiratorius, swab nasofaring/ conjunctiva, , PBMC, urin Isolasi virus (kultur) & deteksi CPE - Uji serologis : deteksi ag & ab (IF, CFT, EIA) - Deteksi asam nukleat (RT-PCR)

● Prevensi (vaksin MMR, IG, isolasi penderita di RS)

● Terapi (simtomatik, vitamin A, terapi komplikasi)

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SARS-Coronavirus● Klasifikasi, Struktur , Genom dan Sifat Virus - Termasuk dalam Coronaviridae

Coronavirus tdd 4 grup :

I (a.l. canine, feline, porcine, human coronavirus 229E),

II (a.l. bovine, murine, rat, human coronavirus OC43),

III (only avian virus),

IV (SARS-Coronavirus ?)

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- Virion berbentuk pleomorfik, tdd : a. Single stranded positive-sense RNA b. Membrane-bound (covered with a distinctive fringe of widely spaced, club-shaped surface projections)

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- Genom tdd 27-32 kb Protein struktural (S, E, M, N) & Protein non struktural (replicase polyprotein)

- Host : hewan (?) dan manusia Dapat eksis di luar tubuh manusia - Human coronavirus sulit dapat dikultur dgn baik

- Lebih stabil daripada human Coronavirus lain Inaktivasi : ether dan kloroform, suhu 56C

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● Epidemiologi - Infeksi saluran respiratorius bawah akut

- Hongkong, Vietnam, Taiwan, Singapura

- Transmisi : lewat droplet respiratorius,

lewat kontak langsung dan tidak langsung

~ pasar hewan ??

- Moderately transmissible

● Manifestasi Klinis - Asimtomatis - Simtomatis (SARS = Severe Acute Respiratory Syndrome) : demam tinggi, batuk kering, napas pendek

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● Diagnosis Laboratoris - Spesimen : sputum, usap/washing tenggorok, stool

Isolasi virus

- Deteksi ab (ELISA)

- Deteksi asam nukleat (RT-PCR)

● Prevensi (masker N95, cuci tangan)

● Terapi : (antiviral, antibakteri, terapi simtomatik)