VIRUS PADA SISTEM

MUSKULOSKELETAL

DR. RAHMIATI
SISTEM MUSKULOSKELETAL
 INFEKSI DAN INFLAMASI PADA SISTEM
MUSKULOSKELETAL

Osteomyelitis
Myositis/Polymyositis
/Pyomyositis/
Muscular dystrophy

Bursitis/Tendinitis/ Arthritis/Polyarthritis
Tunnel syndrom
ETIOLOGI INFEKSI DAN INFLAMASI PADA SISTEM
MUSKULOSKELETAL
VIRUSES THAT CAN GIVE RISE TO VIRAL ARTHRITIS

• Parvovirus B19
• Hepatitis viruses ( hepatitis A virus [HAV], hepatitis B virus [HBV], and HCV)
• Rubella virus
• Alphaviruses and flaviviruses
• Retroviruses
PARVOVIRUS B19 (B19V)

• A single-stranded DNA virus of the family Parvoviridae and genus Erythrovirus

• Clinical features of arthritis associated with parvovirus B19 infection in children
include the following:
As many as 70% of patients are asymptomatic
A few may have flulike symptoms (eg, fever, headache, sore throat, cough, anorexia,
vomiting, diarrhea, or arthralgia)
A bright red rash is typically noted, often characterized as having a “slapped-cheek”
appearance (see the images below)
Joint symptoms are rare (5-10%)
ALPHAVIRUSES
ALPHAVIRUSES

Geographic distributions are as follows:

• Chikungunya virus – Historically,, East Africa, India, Southeast Asia, and Philippines [4] ; however, in
2013 the virus spread to the Caribbean and in 2014 it reached the United States [5]
• O’nyong-nyong virus – East Africa
• Ross River virus – Australia, New Zealand, and South Pacific islands
• Mayaro virus – South America
• Sindbis virus – Europe, Asia, Africa, Australia, and Philippines
• Barmah Forest virus – Australia
ALPHAVIRUS-
INDUCED
ARTHRITIS
ROSS RIVER VIRUS

• Characterization of the inflammatory infiltrate within the skeletal muscle

tissue identified inflammatory macrophages, NK cells, and CD4+ and
CD8+ T lymphocytes
RETROVIRUSES
HIV infection is associated with several rheumatic manifestations:
• Psoriatic arthritis
• Painful articular syndrome (10%)
• Undifferentiated spondyloarthropathy
• Inflammatory myopathy
• Systemic vasculitis
• Diffuse infiltrative lymphocytosis syndrome (5%)
• Fibromyalgia (30%)
• Avascular necrosis
• Gout
 OTHER VIRUSES
• Epstein-Barr virus – This infection is usually associated with polyarthralgia, but monoarthritis of the
knee and ruptured Baker cysts may occur
• Varicella-zoster virus (VZV) – This infection in children rarely develops into pauciarticular arthritis [8]
• Mumps virus – In infected adults, this infection is associated with small or large joint synovitis that
lasts for several weeks; arthritis may precede or follow parotitis by up to 4 weeks
• Adenovirus or coxsackieviruses A9, B2, B3, B4, and B6 – These infections have been associated with
recurrent episodes of polyarthritis, pleuritis, myalgia, rash, pharyngitis, myocarditis, and leukocytosis
• Echovirus - This infection can be associated with polyarthritis, fever, and myalgias
• Herpes simplex virus (HSV) or cytomegalovirus (CMV) – Arthritis with these infections is rare; CMV
arthritis has been reported in patients after bone marrow transplantation; vaccinia virus has been
associated with postvaccination knee arthritis in only 2 reported cases
PATOPHYSIOLOGY

• Viruses can cause infection or act as cofactors in the development of rheumatic diseases. Viral
infection depends on both host and viral factors. Key host factors include age, sex, genetic
background, infection history, and immune response. Key viral factors include mode of host entry,
tissue tropism, replication, effects of cytokines, ability to establish persistent or latent viral
infections, and alterations of host antigens. Infected cells can undergo apoptosis (programmed cell
death).
• The immune complexes from an antibody response can be deposited at sites of viral infection or in
the synovium. Virus-induced autoimmunity, polyclonal B-cell activation, and immunodeficiency may
result in opportunistic infection, largely because of an inability of the immune system to eliminate
the virus (eg, HIV, human T-lymphotropic virus [HTLV]-1, or hepatitis C virus [HCV]). Molecular
mimicry may cause abnormal self-reactivity by altering immune tolerance