respiratory baru

Respiratory Viruses

Titiek Djannatun

Bagian Mikrobiologi Fakultas kedokteran

Universitas YARSI

Viruses Associated with Respiratory Infections

Syndrome Commonly Associated Viruses Less Commonly Associated Viruses

Corza Rhinoviruses, Coronaviruses Influenza and parainfluenza viruses,

enteroviruses, adenoviruses

Influenza Influenza viruses Parainfluenza viruses, adenoviruses

Croup Parainfluenza viruses Influenza virus, RSV, adenoviruses

Bronchiolitis RSV Influenza and parainfluenza viruses,

adenoviruses

Bronchopneumonia Influenza virus, RSV, Adenoviruses Parainfluenza viruses, measles, VZV, CMV

INFEKSI VIRUS PADA SALURAN

PERNAPASAN

Virus Penyebab yang Paling Sering

Sindroma Gejala Utama Bayi Anak-anak Dewasa

Flu Hidung tersumbat,

pilek

Rino

Adeno

Rino

Adeno

Rino

Corona

Faringitis Sakit tenggorokan Adeno

Herpes Simplex

Adeno

Coxackievirus

Adeno

Coxackievirus

Laringitis, batuk dengan

sesak napas

Serak, batuk Parainfluenza

Influenza

Parainfluenza

Influenza

Parainfluenza

Influenza

Trakeobronkitis Batuk Parainfluenza

Influenza

Parainfluenza

Influenza

Influenza

Adeno

Bronkiolitis Batuk, sesak napas Sinsitial pernapasa

Parainfluenza

Jarang

Jarang

Pneumonia Batuk, nyeri dada Sinsitial pernapasan

Influenza

Influenza

Parainfluenza

Influenza

Adeno

Common Cold (Rhinitis/Selesma)

Virus Tipe Reseptor pd sel hospes

Penyakit

Rhinovirus (> 100 tipe) Beberapa tipe ICAM-1 Common cold

Coxsackie virus A (24

tipe)

Terutama A21 ICAM-1 Common cold, herpangina

Virus Influenza Beberapa tipe glikoprotein Bisa menyebabkan infeksi

LRT

Virus Parainfluenza 1, 2, 3, 4 glikosida Dapat menyerang laring

RSV (2 tipe) Reseptor Protein G Bisa menyebabkan infeksi

LRT

Coronavirus semua glikoprotein Common cold, SARS

Adenovirus (41 tipe) 5 - 10 Reseptor Penton Faringitis, bronchitis,

conjunctivitis

Echovirus (34 tipe) 4, 9, 11, 20, 25 - Common cold

Viral Pharingitis

Rhinovirus, Coronavirus Common cold

Adenovirus (3, 4, 7, 14, 21) Pharyngoconjunctival fever

Parainfluenza virus > Berat dari CC

Influenza virus, CMV Tidak selalu ada

Coxsackie A dan enterovirus lain Herpangina

Epstein-Barr virus Glandular fever

Herpes simplex virus tipe 1 Ulkus dan vesikel pada palatum

Viral Pneumonia

Virus Manifestasi klinis

Influenza A dan B Pneumonia primer

Parainfluenza (tipe 1-4) Croup, Pneumonia pada anak

Measles Pneumonia sekunder

RSV Bronchiolitis (bayi)

Adenovirus Pharyngoconjunctival fever,

pharyngitis, atypical pneumonia

CMV Interstitial pneumonia

Coronavirus SARS

Common Cold Viruses

Common colds account for one-third to one-half of all

acute respiratory infections in humans (> 200 virus type).

Rhinoviruses are responsible for 30-50% of common

colds, coronaviruses 10-30%.

The rest are due to adenoviruses, enteroviruses, RSV,

influenza, and parainfluenza viruses, coxsakie virus, echo

virus, which may cause symptoms indistinguishable to

those of rhinoviruses and coronaviruses.

Common Cold

CC bisa menjadi faktor predisposisi infeksi sekunder, e.g. bakteri

Faktor virulensi adalah adhesin pada permukaan partikel virus

Diagnosis Lab: umumnya tidak perlu

Rhinovirus ssRNA virus

Belong to the picornavirus

family

ssRNA virus

Tidak berenvelope

acid-labile (Lebih

thermostabil dari

Enterovirus

Replikasi: sitoplasma

at least 100 serotypes are

known Reconstructed Image of rhinovirus particle (Institute for Molecular Virology)

RHINOVIRUS

Virus penyebab common cold (rhinitis,

selesma)

Jarang menyebabkan infeksi pada saluran

nafas bawah

Penularan dengan droplet, tangan

Tidak ada terapi dan pencegahan spesifik

COXSACKIEVIRUS

Subgrup dari Enterovirus; dibagi menjadi grup A dan B

Coxsackievirus grup A menyebabkan:

Herpangina (vesicular pharyngitis)

Hand-foot-and-mouth disease

Acute hemorrhagic conjunctivitis

Coxsackievirus grup B menyebabkan:

Pleurodynia

Myocarditis, pericarditis

meningoencephalitis

COXSACKIEVIRUS (lanj)

Patogenesis dan Patologi:

Virus dapat diisolasi dari darah, dan tenggorokan

Manifestasi klinis infeksi Coxsackievirus:

Sistem saraf pusat:

Aseptic meningitis grup B dan A7, A9

Pasien dapat sembuh total dari kelumpuhan

Kulit dan Mukosa:

Herpangina grup A 2-6, 8, 10

Hand-foot-and-mouth disease grup A16, 5, 10


Manifestasi klinis infeksi Coxsackievirus:

Jantung dan Otot:

Pleurodynia (epidemic myalgia) grup B

Myocarditis grup B

Mata:

Acute hemorrhagic conjunctivitis grup A24

RT infection:

Common cold grup A21, 24, B1 dan B3-5

Lain-lain:

Grup B dihubungkan dengan Undifferentiated febrile illnesses


Diagnosis Laboratorium:

Sampel berupa throat washing, swab conjunctiva,

CSF

Serologi antibodi netralisasi

PCR

Terapi dan Pencegahan tidak ada terapi dan pencegahan spesifik

Influenzae Viruses

An Overview

Influenza Virus RNA virus, genome consists of 8

segments

enveloped virus, with

haemagglutinin and neuraminidase

spikes

3 types: A, B, and C

Type A undergoes antigenic shift

and drift.

Type B undergoes antigenic drift

only and type C is relatively stable

(Courtesy of Linda Stannard,

University of Cape Town, S.A.)

NOMENKLATUR

FAMILIA ORTHOMYXOVIRIDAE

GENUS INFLUENZAVIRUS A

INFLUENZAVIRUS B

INFLUENZAVIRUS C

SIFAT-SIFAT PENTING :

VIRION BULAT, PLEOMORFIK,HELIKS, 80-120 nm

SS RNA, BERSEGMEN (8MOL), POLARITAS - ,

REPLIKASI TRANKRIPSI : NUKLEUS; MATURASI : M PLASMA

MENYEBABKAN EPIDEMI DI SELURUH DUNIA

NOMENKLATUR

PERBEDAAN ORTHOMYXOVIRUS &

PARAMYXOVIRUS

SIFAT-SIFAT ORTHOMYXOVIRUS PARAMYXOVIRUS

PENYAKIT PD MANUSIA Influenza tipe A, B, C Parainfluenza 1-4, peny.

Sinsitium pernafasan, gondong,

campak

PENGATURAN GENOM ss RNA DLM 8 BAGIAN ss RNA DLM 1BAGIAN

HELIKS

RIBONUKLEOPROTEIN

BERDIAMETER 9 nm BERDIAMETER18 nm

RNA DLM NUKLEOKAPSID PEKA THDP RNase RESISTEN THDP RNase

FUSI VIRUS -SEL ENDOSOM MEMBRAN PLASMA

TRANSKRIPSI NUKLEUS SITOPLASMA

PEMILIHAN GENETIK SERING JARANG

PERUBAHAN GENETIK TINGGI RENDAH

PERBEDAAN INFLUENZA A, B DAN C

TIPE A TIPE B

TIPE C

DERAJAT PENYAKIT ++++ ++ +

HEWAN RESERVOIR YA TIDAK TIDAK

PANDEMIK PADA MANUSIA YA TIDAK

TIDAK

EPIDEMIK PADA MANUSIA

YA YA TIDAK

(SPORADIK)

PERUBAHAN ANTIGENIK SHIFT, DRIFT DRIFT DRIFT

GENOM BERSEGMEN YA YA YA

AMANTADINE, RIMANTIDINE SENSITIF TIDAK

BEREFEK

TIDAK

BEREFEK

ZANAMIVIR SENSITIF SENSITIF

GLIKOPROTEIN PERMUKAAN 2 2 1

STRUKTUR ANTIGEN

HA 15 SUBTIPE

NA 9 SUBTIPE

STRUKTUR ANTIGEN

STRUKTUR ANTIGEN

HEMAGLUTININ

KEMAMPUAN MENGAGLUTINASI ERITROSIT

FUNGSI MEDIASI ADHESI VIRUS SEL HOSPES

FASILITASI PENETRASI VIRUS

NEURAMINIDASE

MERUSAK PERTAHANAN MUKOSA

MEMBANTU BUDDING VIRAL & PELEPASAN VIRUS

MERUPAKAN TONJOLAN GLIKOPROTEIN (FAKTOR VIRULENSI VIRUS ) BERUBAH TIBA2/SEC GRADUAL TERHINDAR DARI KEKEBALAN MEMORI SEL VARIABILITAS TINGGI

MORFOLOGI VIRUS

Influenza A Virus

Undergoes antigenic shifts and antigenic drifts with

the haemagglutinin and neuraminidase proteins.

Antigenic shifts of the haemagglutinin results in

pandemics. Antigenic drifts in the H and N

proteins result in epidemics.

Usually causes a mild febrile illness.

Death may result from complications such as

viral/bacterial pneumonia.

Epidemiology

Pandemics - influenza A pandemics arise when a virus

with a new haemagglutinin subtype emerges as a result of

antigenic shift. As a result, the population has no immunity

against the new strain. Antigenic shifts had occurred 3

times in the 20th century.

Epidemics - epidemics of influenza A and B arise through

more minor antigenic drifts as a result of mutation.

Past Antigenic Shifts

1918 H1N1 Spanish Influenza 20-40 million deaths

1957 H2N2 Asian Flu 1-2 million deaths

1968 H3N2 Hong Kong Flu 700,000 deaths

1977 H1N1 Re-emergence No pandemic

At least 15 HA subtypes and 9 NA subtypes occur in nature.

Up until 2007, only viruses of H1, H2, H3 and H5 and NA

(N1,N2) are known to infect and cause disease in humans.

Influenzae A viruses The Influenzae virus can subdivided into different serotypes

base on Antibody response to these viruses. The serotypes

that have been confirmed in humans ordered by the number

of known human pandemic deaths are:

H1N1 spanish flu

H2N2 Asian Flu

H3N2 Hongkong flu

H5N1 Pandemic threat in 2007-2008 flu season

H7N7 Zoonotic potential

H1N1 endemic in human and pigs

H9N2, H7N2, H7N3, H10N7

Avian Influenza

H5N1

An outbreak of Avian Influenza H5N1 occurred in Hong Kong in 1997 where 18 persons were infected of which 6 died.

The source of the virus was probably from infected chickens and the outbreak was eventually controlled by a mass slaughter of chickens in the territory.

All strains of the infecting virus were totally avian in origin and there was no evidence of reassortment.

However, the strains involved were highly virulent for their natural avian hosts.

H9N2

Several cases of human infection with avian H9N2 virus occurred in Hong Kong and Southern China in 1999.

The disease was mild and all patients made a complete recovery

Again, there was no evidence of reassortment

VARIASI ANTIGENIK

ANTIGENIC DRIFT

MUTASI KONSTAN PADA GLIKOPROTEIN

SERING PADA SISI TEMPAT GLIKOPROTEIN

BINDING AB, JARANG PADA SISI UNTUK

MELEKAT PADA SEL HOSPES

PERUBAHAN SECARA GRADUAL KOMPOSISI ASAM

AMINO MENURUN KEMAMPUAN SEL MEMORI SEL HOSPES UNTUK VIRUS

VARIASI ANTIGENIK

ANTIGENIC SHIFT GENETIC REASSORTMENT

PERTUKARAN DARI 1 GEN (GENOM VIRUS T/D 8

GEN DIKODE SS RNA) DENGAN GEN / STRAND DARI VIRUS INFLUENZAE YANG LAIN

SEBABKAN PANDEMIK

VARIASI ANTIGENIK

Theories Behind Antigenic Shift

1. Reassortment of the H and N genes between human and

avian influenza viruses through a third host. There is

good evidence that this occurred in the 1957 H2N2 and

the 1968 H3N2 pandemics.

2. Recycling of pre-existing strains this probably occurred

in 1977 when H1N1 re-surfaced.

3. Gradual adaptation of avian influenza viruses to human

transmission. There is some evidence that this occurred

in the 1918 H1N1 pandemic.

Reassortment

Avian H3 Human H2

Human H3

Reassortment

PATOGENESA

TRANSMISI INHALASI (KONTAK DIREK/INDIREK)

DROPLETS

AEROSOLS

FOMITES

MASA INKUBASI 18 72 JAM

VIRUS ADA PADA SEKRESI TRACHEA/HIDUNG 24-48 JAM SETELAH GEJALA

PATOGENESA

RECOVERY & PROTECTION SEL HOSPES

VIRAL REPLIKASI

GEJALA DAN KOMPLIKASI

INFLUENZA TANPA KOMPLIKASI:

DEMAM (38 400C)

MIALGIA, HEADACHE

OCULAR SYMPTOM FOTOPOBIA, BERAIR, ACHE

BATUK KERING, NASAL DISCHARGE

PULMONARY COMPLICATIONS, SEQUELE:

CROUP (LARYNGOTRACHEOBRONCHITIS AKUT) PADA

ANAK2

PRIMARY INFLUENZA VIRUS PNEUMONIA

INF SEK BAKTERI S. pneumonia, S. aureus, H. influenzae

GEJALA DAN KOMPLIKASI

NON-PULMONARY COMPLICATIONS:

MYOSITIS JARANG, PADA ANAK STLH INF TIPE B

CARDIAC COMPLICATIONS

ENCEPHALOPATHY

SINDROM REYE

SINDROM GUILLAIN BARRE

DIAGNOSA DAN PENCEGAHAN

DIAGNOSA :

ISOLASI DAN IDENTIFIKASI VIRUS 3 10 HARI SROLOGI PCR, ELISA, IMMUNOFLUORESCENSI

PENCEGAHAN :

VAKSINASI EFEKTIF 70 90% VIRUS MATI YANG DITUMBUHKAN PADA TET

(MENGANDUNG 3 MACAM VIRUS) USIA 6 BLN

FLUMIST NASSAL VACCINE 3 STRAIN ATTENUATED VIRUS

MERANGSANG KEKEBALAN MUKOSA (SECRETORY)

AMAN & EFEKTIF UNTUK ORANG USIA 5 49 TAHUN

TIDAK UNTUK INDIVIDU YANG IMUN RENDAH

Laboratory Diagnosis

Detection of Antigen - a rapid diagnosis can be made by

the detection of influenza antigen from nasopharyngeal

aspirates and throat washings by IFT and ELISA

Virus Isolation - virus may be readily isolated from

nasopharyngeal aspirates and throat swabs.

Serology - a retrospective diagnosis may be made by

serology. CFT most widely used. HAI and EIA may be

used to give a type-specific diagnosis

PCR

Management

Amantidine is effective against influenza A if given early in

the illness. However, resistance to amantidine emerges

rapidly

Rimantidine is similar to amantidine but but fewer

neurological side effects.

Ribavirin is thought to be effective against both influenza A

and B.

Neuraminidase inhibitors are becoming available. They are

highly effective and have fewer side effects than amantidine.

Moreover, resistance to these agents emerge slowly

Prevention

Inactivated split/subunit vaccines are available against

influenza A and B.

The vaccine is normally trivalent, consisting of one A

H3N2 strain, one A H1N1 strain, and one B strain.

The strains used are reviewed by the WHO each year.

The vaccine should be given to debilitated and elderly

individuals who are at risk of severe influenza infection.

Amantidine can be used as an prophylaxis for those who

are allergic to the vaccine or during the period before the

vaccine takes effect.

Parainfluenza Virus

ssRNA virus

enveloped, pleomorphic

morphology

5 serotypes: 1, 2, 3, 4a and

4b

No common group antigen

Closely related to Mumps

virus

(Linda Stannard, University of Cape Town, S.A.)

PENDAHULUAN

TAKSONOMI :

FAMILIA PARAMYXOVIRIDAE

GENUS PARAMYXOVIRUS

SPESIES HUMAN PARAINFLUENZA VIRUS

AGEN PENYEBAB INFEKSI PADA SALURAN

PERNAFASAN BAYI DAN ANAK KECIL USIA DI BAWAH 5 TAHUN

SIFAT-SIFAT PENTING

VIRION BULAT, PLEOMORFIK, DIAMETER 150-300 nm, NUKLEOKAPSID HELIX 18 nm

GENOM SS RNA, TIDAK BERSEGMEN, LURUS, - , 16 20 KB

PROTEIN 6 PROTEIN STRUKTURAL

ENVELOPE GLIKOPROTEIN :

HEMAGLUTININ (HN) KADANG MEMBAWA AKTIVITAS NEUROAMINIDASE

FUSI (F) RINGKIH

REPLIKASI SITOPLASMA, BERTUNAS DI M PLASMA

CIRI KHAS ANTIGEN STABIL, PARTIKEL LABIL JUGA SANGAT INFEKSIUS

STRUKTUR DAN KOMPOSISI

MIRIP VIRUS INFLUENZA, UKURAN LEBIH BESAR

GENOM TIDAK BERSEGMEN STABIL

PROTEIN :

6 PROTEIN STRUKTIRAL

3 PROTEIN BERSATU RNA-NUKLEOPROTEIN (NP/N)

PROTEIN P & L AKTIVITAS POLIMERASE VIRUS DLM TRANSKRIPSI DAN REPLIKASI

3 PROTEIN PEMBENTUK ENVELOPE

PROTEIN MATRIX (M) MENDASARI ENVELOPE

GLIKOPROTEIN HN / H AKTIVITAS HEMAGLUTININ & NEURAMINIDASE

GLIKOPROTEIN F FUSI MEMBRAN & AKTIVITAS HEMOLISIN

VIRAL STRUCTURE

Viral Life Cycle (RER=Rough endoplasmic

reticulum)

SPECIES PARAMYXOVIRUS

PARAINFLUEZAE (TIPE 1-4)

CROUPS (TIPE 1&2), PNEUMONIA PADA

ANAK < 5 THN

PENY SAL PERNAFASAN ATAS (SERING

SUBKLINIK) PADA ANAK & DEWASA

TIPE 1 VIRUS SENDAI

COMMOND COLD


Virus Measles :

PNEUMONIA DI NEGARA BERKEMBANG

SEBABKAN GIANT CELL PNEUMONIA

VIRUS REPLIKASI PADA SAL PERNAFASAN

BAWAH KERUSAKAN SEL INFEKSI SEKUNDER DENGAN BAKTERI PNEUMONIA

MALNUTRISI RESPON IMMUN BURUK

KOPLIKS SPOT PADA MUKOSA BUCCAL


VIRUS MUMPS :

GONDONG, PAROTITIS, ORCHITIS

VIRUS SINSITIA PERNAFASAN :

PNEUMONIA

INFEKSI VIRUS

PATOGENESA & PATOLOGI

IMUNITAS

DIAGNOSA LABORATORIUM

EPIDEMIOLOGI

PENGOBATAN DAN PENCEGAHAN

Clinical Manifestations

Croup (laryngotraheobroncitis) - most common

manifestation of parainfluenza virus infection. However

other viruses may induce croup e.g. influenza and RSV.

Other conditions that may be caused by parainfluenza

viruses include Bronchiolitis, Pneumonia, Flu-like

tracheobronchitis, and Corza-like illnesses.



the detection of parainfluenza antigen from

nasopharyngeal aspirates and throat washings.


nasopharyngeal aspirates and throat swabs.


serology. CFT most widely used.

Management

No specific antiviral chemotherapy available.

Severe cases of croup should be admitted to

hospital and placed in oxygen tents.

No vaccine is available.

Respiratory Syncytial Virus (RSV)

ssRNA eveloped virus.

belong to the genus Pneumovirus, sub family

Pneumovirinae of the Paramyxovirus family.

Considerable strain variation exists, may be classified into

subgroups A and B by monoclonal sera.

Both subgroups circulate in the community at any one

time.

Causes a sizable epidemic each year.

Clinical Manifestations

Most common cause of severe lower respiratory tract disease in infants and chidren, responsible for 50-90% of Bronchiolitis and 5-40% of Bronchopneumonia

Other manifestations include croup (10% of all cases).

In older children and adults, the symptoms are much milder: it may cause a corza-like illness or bronchitis.

Infants at Risk of Severe Infection

1. Infants with congenital heart disease - infants who were hospitalized within the first few days of life with congenital disease are particularly at risk.

2. Infants with underlying pulmonary disease - infants with underlying pulmonary disease, especially bronchopulmonary dysplasia, are at risk of developing prolonged infection with RSV.

3. Immunocompromized infants - children who are immunosuppressed or have a congenital immunodeficiency disease may develop lower respiratory tract disease at any age.

RESPIRATORY SYNCYTIAL VIRUS

Penyebab penting infeksi sal nafas bawah (LRT) pada bayi dan anak.

Virus bereplikasi pada epitel nasofaring menyebar ke LRT, menyebabkan bronchiolitis dan pneumonia.

Bisa terjadi reinfeksi (anak dan dewasa) tapi umumnya terbatas pada URT

Kekebalan:

Bayi baru lahir mempunyai kekebalan dari ibu

Infeksi berat terjadi pada bayi umur 2 4 bln

Antibodi netralisasi akan terbentuk

RSV (lanj)

Epidemiologi:

Penularan droplet dan kontak langsung

Virus bersifat labil, tapi dapat bertahan 6

jam pada permukaan kering

Port dentre mukosa hidung


Detection of Antigen - a rapid diagnosis can be made by the detection of RSV antigen from nasopharyngeal aspirates. A rapid diagnosis is important because of the availability of therapy imunofluoresen, ELISA dan PCR

Virus Isolation - virus may be readily isolated from nasopharyngeal aspirates. However, this will take several days sel HeLa dan HEp-2

Serology - a retrospective diagnosis may be made by serology. ELISA, Nt test, imunofluoresen. CFT most widely used

Tidak mempunyai hemaglutinin

Treatment and Prevention

Aerosolised ribavirin can be used for infants with severe infection, and for those at risk of severe disease.

There is no vaccine available.

RSV immunoglobulin can be used to protect infants at risk

of severe RSV disease.

Adenovirus

ds DNA virus

non-enveloped

At least 47 serotypes are

known

classified into 6 subgenera:

A to F

(Linda Stannard, University of Cape Town, S.A.)

Clinical Syndromes

1. Pharyngitis 1, 2, 3, 5, 7

2. Pharyngoconjunctival fever 3, 7

3. Acute respiratory disease of recruits 4, 7, 14, 21

4. Pneumonia 1, 2, 3, 7

5. Follicular conjunctivitis 3, 4, 11

6. Epidemic keratoconjunctivitis 8, 19, 37

7. Pertussis-like syndrome 5

8. Acute haemorrhaghic cystitis 11, 21

9. Acute infantile gastroenteritis 40, 41

10. Intussusception 1, 2, 5

11. Severe disease in AIDS and other immunocompromized patients 5,

34, 35

12. Meningitis 3, 7

ADENOVIRUS

Efek adenovirus pada mekanisme kekebalan memproduksi protein yang menghambat efek sel T sitotoksik dan menghambat TNF-alfa

Efek virus pada sel CPE Patogenesis replikasi pada sel epitel sal nafas,

mata, sal pencernaan dan hepar

RT infection: Common cold, pada anak dan bayi grup C Tipe 3, 7 dan 21 penyebab 10-20% pneumonia pada

anak

ADENOVIRUS (lanj)

Gastroenteritis:

Tipe 40 dan 41 telah dihubungkan dengan infantile gastroenteritis

15% dari kasus gastroenteritis pada anak

Infeksi mata:

Pharyngoconjunctival fever (swimming pool conjunctivitis) tipe 3 dan 7

Epidemic keratoconjunctivitis

terjadi pada orang dewasa tipe 8, 19 dan 37

Sangat menular, virus tahan sp 2 minggu di handuk

ADENOVIRUS (lanj)

Lain-lain:

Tipe 11 dan 21 dapat menyebabkan acute

hemorrhagic cystitis pada anak, terutama anak

laki-laki

Adenovirus juga sering menyebabkan infeksi pada

pasien transplantasi adenovirus hepatitis, myocardial adenovirus infection

Penderita AIDS adenovirus gastroenteritis



the detection of adenovirus antigen from nasopharyngeal

aspirates and throat washings.


nasopharyngeal aspirates, throat swabs, and faeces.

(Sampel hrs diambil awal, Kultur memerlukan human

cells, Hasil kultur harus diinterpretasikan dengan hati-hati


serology. CFT most widely used.

Treatment and Prevention

There is no specific antiviral therapy.

A vaccine is available against Adult Respiratory

Distress Syndrome. It consists live adenovirus 4,

7, and 21 in enterically coated capsules. It is given

to new recruits into various arm forces around the

world.

Pencegahan:

Cuci tangan, klhorinasi kolam renang, sterilisasi alat

Coronavirus

ssRNA Virus

Enveloped, pleomorphic

morphology

2 serogroups: OC43 and

229E

Pendahuluan Coronavirus

Virus RNA polaritas positif, berenvelop

Coronavirus manusia menyebabkan

Common cold (rhinitis, selesma) dan

gastroenteritis pada bayi.

Corona virus yang ditemukan tahun 2003 SARS Associated Coronavirus infeksi saluran nafas bawah.

Coronavirus sulit dikultur

Sifat Coronavirus

Genom terdiri atas RNA-ss tidak bersegmen, positif-sense

Envelope mempunyai tonjolan membentuk korona

Replikasi di sitoplasma

Famili Coronaviridae Genus Coronavirus dan Totovirus

Human Coronavirus ada 2 strain 229E dan OC43

SARS Associated Coronovirus

Infeksi pada Manusia

Virus mempunyai tropisme pada sel epitel saluran

nafas dan pencernaan.

Virus manusia biasanya terbatas pada sal nafas

atas, kecuali SARS Coronavirus yang

menyebabkan pneumonia berat.

Manifestasi klinis:

Common cold (seperti rhinovirus)

Gastroenteritis partikel virus pernah ditemukan dari

feses

SARS virus berasal dari non-human

Imunitas

Imunitas yang terbentuk sesudah infeksi

tidak bersifat mutlak

Ab terpenting adalah Ab terhadap protein

permukaan virus

95% pasien SARS membentuk Ab thd Ag

virus (immunofluoresens/ELISA); serum

konvalesens diambil > 28 hari sesudah

gejala timbul

Pemeriksaan Laboratorium

Deteksi Ag dan As. Nukleat

ELISA

Mikroskop elektron, sampel dari feses

PCR, sampel dari sekret sal nafas atau feses

Kultur:

Sukar dilakukan

SARS virus sel Vero dari sampel orofaring

Serologi:

Konfirmasi diagnosis dengan ELISA

Epidemiologi

Coronavirus tersebar di seluruh dunia

Penyebab 15-30% kasus CC

SARS:

Penularan dengan kontak dekat

Dikenal adanya super spreader (seperti pada

infeksi rubella, Ebola, dan tbc) tergantung faktor hospes, virus dan lingkungan.

Terapi dan Pencegahan

Tidak ada terapi dan vaksin spesifik untuk Coronavirus

Kontrol SARS efektif dengan cara:

Isolasi penderita

Karantina orang yang kontak dengan penderita

Pembatasan kunjungan (travel restriction)

Pemakaian alat pelindung (masker, goggles, baju, sarung tangan) bagi tenaga medis

SARS VACCINE

Attenuated vaccine

SARS VACCINE

Drugs Development

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