Oleh :

Dr.dr. Efrida Warganegara, M.Kes., Sp.MK

Arthropod Borne VirusesArthropod Borne virus disingkat menjadi ARBO VIRUS

Yang penting pada manusia : Togaviridae dan Flaviviridae yang banyak mirip dengan Bunyaviridae dan Reoviridae

Reservoir alami dari virus ini adalah : hewan, burung, reptil pada mana mereka ditransmisikan oleh gigitan arthropod penghisap darah, misal : Nyamuk, sandfly, atau Ticks

Manusia terinfeksi hanya jika mereka masuk kedalam area dimana mereka ada dan mendapat gigitan oleh arthropod yang terinfeksi

Infeksi sering inapparent atau trivial, tapi beberapa virus ini dapat menyebabkan penyakit sangat berat dan bahkan fatal, antara lain : - Penyakit panas, sering dengan rash dan arthritis- Infeksi sistem syaraf pusat- Hemorrhagic fever

Japanese encephalitis virus, St.Louis encephalitis virus, Powassan, & tick-borne encephalitis viruses Encephalitis

Dengue virus Febrile illness with rash & sometimes Hemorrhagic fever

Other diseases : Kyasanur Forest disease virus, hemorrhagic fever with hepatitis, yellow fever virus.

Dengue Fever is a mosquito-borne viral disease, also known as break-bone fever, because it causes severe joint and muscle pain

The disease is found in many tropical areas and is now endemic in more than 100 countries worldwide. It is the most common vector-borne viral disease in the worldDengue Fever

Dengue fever is caused ny a single-stranded RNA Virus of the Flavivirus familyThere are four closely related serotype of the virus : DENV-1, DENV-2, DENV-3, DENV-4, which are transmitted by the bite of an infected mosquito of the Aedes family.The most common vector is Aedes aegyptie, the same species that carries Yellow feverDengue Fever causative agent

Another important vector of dengue virusses is Aedes albocpitus, the Asian tiger mosquito, now spreading worldwide.This vector also transmits the dengue-like viral disease chikungunya.Both of these mosquito species feed only during the day.Dengue Fever causative agent

Found at 1779.VIRAL CHARACTERISTIC :Survive at t 8 C for 5 years4 type : DENV-1, DENV-2, DENV-3, DENV-4 E envelope proteins as specific antigenic.

The major protein in dengue virus, called 'E' for envelope protein (color-coded blue, green and yellow), protective shell around the virus.

When an infected mosquito feeds on a human host, dengue viruses are injected into the bite wound, where they infect keratinocytes and epidermal dendritic cells.Some of these cells migrate to the lymph nodes, where monocytes and macrophage are recruited and also become infectedDengue viruses multiply in the macrophages and are then dessiminated systemicaly in these cellsHumoral and Cell-mediated immune response clear the virusesDengue Fever pathogenesis

The infected macrophage produce pro-inflamatory cytokines, resulting in a cytokine storm. This, along with activated complement and cytokines released by memory T-cells, causes changes in vascular permeability, leading to plasma leakage, that may result in respiratory distress and dehydration.Capillaries become fragile, resulting in the observed hemorrhages (petechiae etc). Infected macrophages die and release toxic products that causes blood clotting and DICLeucopeni occurs, blood pressure drops, sometimes to life-threatenin levelsgDengue Fever pathogenesis

DENGUE VIRUS : -Reservoir : Aedes aegypti & albopictus Skin cell Perivacsular oedema . capillary endothelium Infiltration of mononuclear cell-- Hyporoteinaemia hypertrophy & hyperplasi Dehydration hypovolemia capillary wall Shock.

increase permeability Shock heart works harder transport O2 < Extravasage Anoxia tissue acidosis & hyper-potasiumemia death Incubation period between 1 - 7 days

Dengue is an emerging disease and the fastest spreading mosquito-borne viral disease in the worldIt is found in mostly tropical and subtropic regions that have high rainfall and plenty of fresh water, conditions that aid in disease development because the mosquito vector breeds in standing waterDengue Fever epidemiology

Clinical appearance :

1. Classical Dengue syndrome (CDS = SDK) :- Not fatal.- Children : fever, weak, anorexia, skin rash heal.-Adult : saddle-like fever always followed headache, myalgia and bone ache fever rash.

2. Dengue Hemorrhagic Fever (DHF) :- Firstly like CDS 3-4 days hemorrhage of : nose, gingival, conjunctiva, vagina, & hemetemesis, melena- Can healing but death is more frequent.

3. Dengue Shock Syndrome (DSS) :-Mortality rate >>-WITH OR WITHOUT bleeding.

Symptoms : i. Firstly as CDSii. Day II IV : epigastrium palpation painfuliii. Patient nervous death.

DiagnosisDiagnosis DBD dengan kriteria WHO (1986)Klinis :Demam tinggi mendadak, tanpa sebab jelas, berlangsung terus menerus selama 2-7 hari.Terdapat menifestasi perdarahan termasuk uji torniquet positif, petikie, ekimosis, epistaksis, perdarahan gusi, hematemesis dan atau melena.Pembesaran hatiSyok, ditandai denan nadi cepat, lamah serta penurunan tekanan nadi, hipotensi kaki tangan dingin, kulit lembab dan gelisahLaboratorium :Trombositopenia (100.000/mm3 atau kurang)Hemokonsentrasi

Diagnosis........Hemokonsentrasi akibat permeabilitas kapiler dgn manifestasi :Peningkatan Ht > 20% dibandingkan standar sesuai umur dan jeis kelamin.Penurunan Ht > 20% atau lebih setelah mendapat pengobatan cairanPerembesan plasma yaitu efusi pleura, asites atau proteinemia.

Diagnosis:

A. Isolation : - Spec : - blood (first 3 days illness) intra cerebral inoculation to mouse baby or to salivary gland A. aegypti - Isolation is difficult diagnosis established by serologic.

B. Serologic : - To look at increase of dengue titer with Nt & HI test

Strategy of Management :

Treatment: 1. Not yet present specific treatment.2. Dont let to become shock. 3. We have several action must be done : - Blood transfusion if Hb

Pengobatan Demam Dengue Tirah baring selama demamAntipiretik anjuran parasetamoltidak dianjurkan:asetosal, ibuprofenAnalgesik bila perlu (anak besar)Cairan & elektrolit oraljus buah, sirup,susuoralit, pocari sweatMonitorsuhu, trombosit

Polio VirusEfrida Warganegara

RNA viruses positive sense

RNA viruses negative sense

Characteristic : see tableReplication cytoplasmCPE : Virus crystallization in cytoplasmTo cause infected-host cell deathSpecimen from : respiratory tract., gastro intestinal tract., & blood.Viral growth on cell-culture : human kidney cell, monkey, and Hela cell.

PoliovirusEnterovirus Echovirus CoxsackievirusPicornaviridae

Rhinovirus

Etiology of poliomyelitis, pleurodynia, myocarditis, meningitis, encephalitis, & ARTI.PathogenesisPort of entry ; per oral - droplet infection - food & drink - mechanic : fly, cockroach, ant Primary replication at oropharynx & GI tract., followed by viremia.Damage in CNS & muscleLocal Ig A & Ig M/G formation after natural infection

Virus characteristic :- Inactive by heating at 55C, 30 min. & chlorine 0.01ppm, formaline & UV.- Stable by added 1 mol/dl Mg2+.- Can be found in milk, ice cream pasteurization.- Based on antigenic differentiated in 3 type :Type I = Brunhilde the most virulentType II = LansingType III = Leon

The disease can be mild illness, aseptic meningitis to flaccid paralysis

Infection characteristic:

- Incubation period 1-2 weeks (sometimes 5-6 weeks)- Kind of infections : 1. Inapparent infection :- Clinical sign (-).- Virus can be isolated from feces.- increased antibody titter. 2. Minor Illness : = poliomyelitis abortive- Pharyngitis, fever; + diarrhea, + headache.- Virus isolation : throat swab & feces. 3. Major Illness :- Non paralytic poliomyelitis- Paralytic poliomyelitis - Clinical appearance biphasic Dromedaris fever.

*Diagnosis :a. LCS examinationb. isolation : throat swab at initial of infection and feces at late phasec. serologic : Nt & Cf tests

* Preventing, treatment & Control 1.Immunization 2.Treatment symptomatic & rehabilitation