virology in tropical infection
TRANSCRIPT
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Tropical condition (as in Indonesia)
optimal condition for many diseases agent
Virus >>
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HIV
Arboviruses
Rabies
Varicella
Herpes Virus
Influenza virus
Polio Virus
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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
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2 form of Retrovirus Virion active
Provirus inactive
2 type of Retrovirus Endogen
Exogen
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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
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Discovered in Seattle, USA
Isolated from patient with Hairy Cell
Leukemia
Minimal information
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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
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Family Retroviridae
Genus Lentivirus
Characteristic Nucleoid has the shape of vases or cones
No oncogenicity
Obvious clinical sign and symptoms
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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
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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
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Clinical Manifestation Neoplasm
Kaposis Sarcoma, B-Cell Lymphoma, NHML
Infection Skin and mucous membranes infection
TB
Opportunistic infection
Neurological Dementia, encephalopathy, myelopathy etc
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Zoonosis, rarely transmitted to human
Recognized since 2300 bc
Low incidence, high mortality
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Family Rhabdoviridae
Genus Lyssavirus
Bullet-shaped ss-RNA virus
Helical nucleocapsid contained in a bullet-
shaped lipoprotein
180 nm
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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
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Insidious onset
1-10 prodromal period
Psychologycal disturbances (rare)
Pain & tingling around area of bite
Subsequent course : Furious type
Paralytic type
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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
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Lasting for a month
Ascending paralysis
Hydrophobia not prominent
Spinal cord more affected than brain
Death still inevitable
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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
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Reservoir : warm blooded animal (dog, cat,
etc)
Present everywhere except Australia and
NZ
Quarantine & removal of stray animal is
the best precaution
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Clinical manifestation usually sufficient
Demonstration of rabies antigen by
immunofluorescence in cell
Cytoplasmic inclusion (Negri bodies) in
brain cell (post mortem)
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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)
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Good wound management decrease
risk after animal bite
ATS as adjuvant
Vaccine is effective when administered
during incubation period
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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
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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)
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Herpes Simplex Virus (HSV)
HSV-1 = herpes labialis
HSV-2 = herpes genital
Also causes herpes neonatorum, keratoconjunctivitis &encephalitis
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Transmission HSV 1 = direct contact
HSV 2 = STD
Vaccine (-)
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Diagnostic Clinical
Viral culture
PCR
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Varicella-Zoster Virus (VCV)
Primary infection= chickenpox
Reaktivation = Herpes Zoster
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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
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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
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Diagnosis Microscopic
IgG, IgM
Isolation
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Human Herpes Virus (HHV) 6 & 7 Infect lymphocytes
Clinical manifestation
Fever Exanthema subitum / Roseola
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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
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KSHV (Kaposi Sarcoma-related Herpes Virus)
Herpes virus whose DNA sequence was found in
Kaposis Sarcoma
Unclear relationship
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~Arthropod-Borne Viruses
Diverse viruses; similarity in epidemiology
and clinical concerns
Important family Togaviridae Chikungunya Flaviviridae Dengue Bunyaviridae Reoviridae
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Togaviridae 2 genera : Togavirus (arbovirus) & Rubivirus (non-
arthropod-borne)
Flaviviridae 3 genera : flavivirus (arbovirus), pestivirus & HCV
(non-arthropod-borne)
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Togavirus & Flavivirus Single positive-sense RNA
Virion
Spherical Enveloped
40 90 nm in diameter
Cubic symmetry
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Febrile illness with rashes and arthritis
Haemorrhagic fever Yellow fever
Dengue
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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
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Clinical
Serological
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Influenza virus
Tipe : A : sering , epidemik sampai pandemik
B : endemik, jarang KLB
C : jarang
Terbaru H5N1, H1N1
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Virus menyebar aerogen
Replikasi di mukosa nasofaring Faringitis
Trakeobronkitis
Berat Pneumonia
Seringkali koinfeksi dengan bakteri
Pencegahan
imunisasi
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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
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Keluaran infeksi poliovirus dipengaruhi
oleh Virulensi virus
Jumlah paparan Status kekebalan inang
Predisposisi
Trauma
tonsilektomi Hamil
Imunodefisiensi
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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
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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
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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
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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
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The Sabin-type live attenuated oral
poliovirus vaccine (OPV) Mengandung 3 serotipe virus
Campuran : sukrosa atau molar magnesiumklorida
Menstimulasi pembentukan antibodi, interferon
dan IgA
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Bila serotipe diketahui, monovalen lebih
baik dibandingkan dengan polivalen
Efek samping : vaccine-associated
paralysis 1 per 2-4 juta kasus
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