Virology in Tropical Infection

7/29/2019 Virology in Tropical Infection

1/57


2/57

Tropical condition (as in Indonesia)

optimal condition for many diseases agent

Virus >>


3/57

HIV

Arboviruses

Rabies

Varicella

Herpes Virus

Influenza virus

Polio Virus


4/57

All RNA viruses who possess reverse

transcriptase (RNA-dependent DNA

polymerase)

Reverse transcriptase RNA to DNA

3 Important Genus Oncovirus HTLV-1, HTLV-2

Spumavirus Lentivirus HIV


5/57

2 form of Retrovirus Virion active

Provirus inactive

2 type of Retrovirus Endogen

Exogen


6/57

1978 Robert Gallo isolates a species of

retrovirus from a patient with T-cell

Leukemia

Its endemic in Southern Japan and other

countries

Probably originated from African primates

Mode of transmission is unclear


7/57

Discovered in Seattle, USA

Isolated from patient with Hairy Cell

Leukemia

Minimal information


8/57

1981 outbreak ofPneumocystis carinii

pneumonia & Kaposis Sarcoma on

homosexual male immunodeficiency

AIDS

First isolation Luc Montagnier (Paris

1983)

2 species : HIV-1 & HIV-2 HIV-1 : higher patogenicity


9/57

Family Retroviridae

Genus Lentivirus

Characteristic Nucleoid has the shape of vases or cones

No oncogenicity

Obvious clinical sign and symptoms


10/57

Morphology Diameter :100 nm

Lipid enveloped

Posses receptor-binding site for CD4 cell

HIV attached itself with CD4 receptors on

the surface of T-helper cells


11/57

Sel CD4+ / lDarah

KATEGORI KLINIS

A B C

500 A1 B1 C1

200 - 499 A2 B2 C2

< 200 A3 B3 C3

A = Asymptomatic or Persistent Generalized Lymphadenopathy

B= AIDS-related complex

C= Full-blown AIDS


12/57

Clinical Manifestation Neoplasm

Kaposis Sarcoma, B-Cell Lymphoma, NHML

Infection Skin and mucous membranes infection

TB

Opportunistic infection

Neurological Dementia, encephalopathy, myelopathy etc


13/57

Zoonosis, rarely transmitted to human

Recognized since 2300 bc

Low incidence, high mortality


14/57

Family Rhabdoviridae

Genus Lyssavirus

Bullet-shaped ss-RNA virus

Helical nucleocapsid contained in a bullet-

shaped lipoprotein

180 nm


15/57

Acquired from infected animal bites

(primarily), contact from abraded skin or

aerogenically

Incubation period 10 days 1 year; avg 1-3 month

Depends on viral deposit and distance from head-

wound


16/57

Insidious onset

1-10 prodromal period

Psychologycal disturbances (rare)

Pain & tingling around area of bite

Subsequent course : Furious type

Paralytic type


17/57

Stage of excitement Anxious and apprehensive expression

Fast pulse

Rapid breathing

Classical sign : hydrophobia

Neurological : CN paralysis, autonomic

dysfunction, impaired consciousness

Terminal : generalized paralysis & cardiovascular

collapse


18/57

Lasting for a month

Ascending paralysis

Hydrophobia not prominent

Spinal cord more affected than brain

Death still inevitable


19/57

Animal bites Centripetal spread via

peripheral nerves to CNS Centrifugal

spread

Virus replicates in epithelial or striated

muscle cell; gain acces to PNS via

neuromuscular spindle


20/57

Reservoir : warm blooded animal (dog, cat,

etc)

Present everywhere except Australia and

NZ

Quarantine & removal of stray animal is

the best precaution


21/57

Clinical manifestation usually sufficient

Demonstration of rabies antigen by

immunofluorescence in cell

Cytoplasmic inclusion (Negri bodies) in

brain cell (post mortem)


22/57

History 1884 Pasteur vaccine

1911 Semple vaccine cheaper, neurological

side effect 1957 Duck embryo allergic reaction >,

ineffective discontinue

1964 Human diploid cell strain virus (HDCS)


23/57

Good wound management decrease

risk after animal bite

ATS as adjuvant

Vaccine is effective when administered

during incubation period


24/57

Icosahedral , 100-200 nm

Enveloped Major determinant on viral infectivity

Offer protection against human immune system

>100 species with several factor in

common

Generalized contamination Latent infection and reactivation


25/57

Family Herpesviridae SubfamiliAlphaherpesvirinae HSV-1 (Herpes Simplex Virus 1)

HSV-2 (Herpes Simplex Virus 2)

VZV (Varicella-Zoster Virus)

Subfamili Betaherpesvirinae CMV (Cytomegalovirus)

HHV-6 (Human Herpes Virus 6)

HHV-7 (Human Herpes Virus

7) Subfamili Gammaherpesvirinae EBV (Epstein-Barr Virus)

KSHV (Kaposi Sarcoma-related Herpes Virus)


26/57

Herpes Simplex Virus (HSV)

HSV-1 = herpes labialis

HSV-2 = herpes genital

Also causes herpes neonatorum, keratoconjunctivitis &encephalitis


27/57

Transmission HSV 1 = direct contact

HSV 2 = STD

Vaccine (-)


28/57

Diagnostic Clinical

Viral culture

PCR


29/57

Varicella-Zoster Virus (VCV)

Primary infection= chickenpox

Reaktivation = Herpes Zoster


30/57

Difference with HSV Only 1 subtype

Unable to grow other in primate cell

Grow slower

Diagnosis Clinical

Lab : PCR, viral isolation, serodiagnosticTransmitted aerogenically, highly infectious

Vaccine controversive


31/57

Cytomegalovirus (CMV) ~Giant cell virus swelling on infected cell

Can be transmitted by various mode of

transmission Clinical manifestation Mostly asymptomatic

Mild fever with impaired liver and spleen function

Rejection in transplantation

Pneumonitis interstisialis

Pregnancy prematurity, stillborn, mental retardation

Fatal in immunocompromised


32/57


33/57

Diagnosis Microscopic

IgG, IgM

Isolation


34/57

Human Herpes Virus (HHV) 6 & 7 Infect lymphocytes

Clinical manifestation

Fever Exanthema subitum / Roseola


35/57


36/57

Epstein-Barr virus (EBV) Causes various diseases

Infectious Mononucleosis

Burkitts Lymphoma Ca Nasopharynx

B-cell lymphoma

Differ wit other herpes viruses

Unique antigen compositionAbility to immortalize host


37/57


38/57

KSHV (Kaposi Sarcoma-related Herpes Virus)

Herpes virus whose DNA sequence was found in

Kaposis Sarcoma

Unclear relationship


39/57

~Arthropod-Borne Viruses

Diverse viruses; similarity in epidemiology

and clinical concerns

Important family Togaviridae Chikungunya Flaviviridae Dengue Bunyaviridae Reoviridae


40/57

Togaviridae 2 genera : Togavirus (arbovirus) & Rubivirus (non-

arthropod-borne)

Flaviviridae 3 genera : flavivirus (arbovirus), pestivirus & HCV

(non-arthropod-borne)


41/57

Togavirus & Flavivirus Single positive-sense RNA

Virion

Spherical Enveloped

40 90 nm in diameter

Cubic symmetry


42/57

Febrile illness with rashes and arthritis

Haemorrhagic fever Yellow fever

Dengue


43/57

Transmission : mosquitos

Virus replicates in lymphatic system and

endothelial after bites

1st sign : fever & malaise because ofviremia

2nd sign : sign of infection in target organ

(4-5 days later) 1st & 2nd biphasic illness


44/57

Clinical

Serological


45/57


46/57

Influenza virus

Tipe : A : sering , epidemik sampai pandemik

B : endemik, jarang KLB

C : jarang

Terbaru H5N1, H1N1


47/57

Virus menyebar aerogen

Replikasi di mukosa nasofaring Faringitis

Trakeobronkitis

Berat Pneumonia

Seringkali koinfeksi dengan bakteri

Pencegahan

imunisasi


48/57


49/57

Kelainan yang dapat terjadi adalah

poliomyelitis paralisis tanpa gejala

pendahulu

Dapat juga muncul meningitis aseptik yangdisertai dengan nyeri otot leher dan

punggung

Periode inkubasi 3-5 hari untuk kelainan ringan

1-2 minggu untuk kelainan SSP


50/57

Keluaran infeksi poliovirus dipengaruhi

oleh Virulensi virus

Jumlah paparan Status kekebalan inang

Predisposisi

Trauma

tonsilektomi Hamil

Imunodefisiensi


51/57

Manusia satu-satunya inang alami

Replikasi primer terjadi pada mukosa

orofaring dan saluran cerna

Virus kemudian menuju tonsil dan plakPeyer serta nodus mesenterikus dan

servikal untuk bermultiplikasi

Virus dapat juga terbawa oleh aliran darahke berbagai organ gejala atipikal


52/57

Virus dapat menyebar sampai medulla

spinalis dan atau batang otak fase

neurologis

Kelainan Kerusakan menyebar kelemahan otot tidak jelas

Kerusakan terkonsentrasi lumpuh layu

Kelainan umumnya ireversibel

Tipe paralisis Spinal poliomyelitis

Bulbar poliomyelitis


53/57

Poliomyelitis dapat menyerang semua

kelompok usia

Awal pajanan menentukan perjalanan

penyakit Awal kehidupan imunitas aktif dibantu dengan

antibodi maternal

Selanjutnya

rentan , terutama usia kurang dari2 tahun


54/57

The Salk-type inactivated poliovirus

vaccine (IPV) mengandung 3 serotipe poliovirus

Dilarutkan dengan formalin noninfeksius 2 injeksi intramuskular dengan selang 1 bulan,

ditambah dengan booster periodik

Merangsang antibodi yang dapat menahan

penyebaran virus


55/57

The Sabin-type live attenuated oral

poliovirus vaccine (OPV) Mengandung 3 serotipe virus

Campuran : sukrosa atau molar magnesiumklorida

Menstimulasi pembentukan antibodi, interferon

dan IgA


56/57

Bila serotipe diketahui, monovalen lebih

baik dibandingkan dengan polivalen

Efek samping : vaccine-associated

paralysis 1 per 2-4 juta kasus


57/57

Virology in Tropical Infection

Documents

Transcript of Virology in Tropical Infection