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

Reconstructed Image of rhinovirus particle (Institute

for Molecular Virology)

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

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

COXSACKIEVIRUS (lanj)

Manifestasi klinis infeksi Coxsackievirus:

Jantung dan Otot:

Mata:

Acute hemorrhagic conjunctivitis grup A24

RT infection:

Pleurodynia (epidemic myalgia) grup B

Myocarditis grup B

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

Lain-lain:

Grup B dihubungkan dengan Undifferentiated febrile illnesses

COXSACKIEVIRUS (lanj)

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

(Courtesy of Linda Stannard,

University of Cape Town, S.A.)

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

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

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

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

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

ssRNA virus
enveloped, pleomorphic
morphology
5 serotypes: 1, 2, 3, 4a and
4b
No common group antigen
Closely related to Mumps
virus

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

SPECIES PARAMYXOVIRUS
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

SPECIES PARAMYXOVIRUS
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.

Laboratory Diagnosis

Detection of Antigen - a rapid diagnosis can be made by

the
detection
of
parainfluenza
antigen
from
nasopharyngeal aspirates and throat washings.

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.

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

Laboratory Diagnosis

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

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

ds DNA virus

non-enveloped

At least 47 serotypes are

known

classified into 6 subgenera:

A to F

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

Gastroenteritis:

(lanj)

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

Laboratory Diagnosis

Detection of Antigen - a rapid diagnosis can be made by

the detection of adenovirus antigen from nasopharyngeal
aspirates and throat washings.

Virus Isolation - virus may be readily isolated from

nasopharyngeal aspirates, throat swabs, and faeces.
(Sampel hrs diambil awal, Kultur memerlukan human
cells, Hasil kultur harus diinterpretasikan dengan hati-hati

Serology - a retrospective diagnosis may be made by

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