neurotropic viral
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NEUROTROPIC VIRUSESDr. EDHIE DJOHAN UTAMA, SpMK
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Meningitis : Characterized by highfever, headache, stiff neck
Encephalitis : Characterized bychanges in mental state, consciousness(kesadaran), behavior (tabiat)
Brain Abscess : Headache, focal
signs and seizures indicate a brainabscess. There are also characteristiccomputed tomography (CT) andmagnetic resonance image (MRI)findings
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INFEKSI PADA SISITIM SYARAF
PUSAT
BISA DISEBABKAN OLEH SEMUA AGENT YANGINFECTIOUS :
= BAKTERI -
PYOGENIK
= MYCOBACTERIA
= FUNGI
= SPIROCHAETA
= VIRUS
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INFEKSI SELAPUT OTAK I. MENINGITIS PURULENTA
MENINGOCOCCUS (40%) PNEUMOCOCCUS HAEMOPHILUS INFLUENZAE STAPHYLOCOCCUS AUREUS LISTERIA MONOCYTOGENES
II. MENIGITIS GRANULOMATOUS MYCOBACTERIUM TUBERCULOSIS COCCIDIODES IMMITIS (meningitis)
CRYPTOCOCCUS NEOFORMAN (meningitis) HISTOPLASMA CAPSULATUM TREPONEMA PALLIDUM JAMUR JAMUR LAIN
III. ASEPTIC MENINGITIS ENTEROVIRUS
POLIOMYELITIS COXSACKIEVIRUS ECHOVIRUS (Enteric Cytopathic Human Orphan) RABIES HERPES SIMPLEX PARAMYXOVIRUS (Mumps virus) LEPTOSPIRA CLOSTRIDIUM TETANI
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ASEPTIC MENINGITIS
ENTEROVIRUS POLIOMYELITIS
COXSACKIEVIRUS
ECHOVIRUS (Enteric Cytopathic HumanOrphan)
RABIES
HERPES SIMPLEX
PARAMYXOVIRUS (Mumps virus)
LEPTOSPIRA
CLOSTRIDIUM TETANI
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VIRAL MENINGITIS
ENTEROVIRUS POLIOMYELITIS
COXSACKIEVIRUS
ECHOVIRUS (Enteric Cytopathic HumanOrphan)
RABIES
HERPES SIMPLEX
PARAMYXOVIRUS (Mumps virus)
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ENTEROVIRUS
Enterovirus termasuk PICORNAVIRIDAE POLIOMYELITIS
COXSACKIEVIRUS Group A dan B
ECHOVIRUS (Enteric Cytopathic HumanOrphan)
TRANSMISI : RESPIRATORY DROPLETS
FECAL ORAL (fingers, foodstuffs, milk flies andcockroaches)
Port de antre : alimentary tracts
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PATHOGENESIS
Enhancement factors : During pregnancy
Corticosteroids
Multiplications :
Lymphoid tissue of gut and pharynx Reticuloendothelial system
Target organs : Spinal cord brain meningenes myocardium skin.
Pathology : Cells injury intrauterine transfer of Cocksacchieviruses Severe and fatal disease
Severe neural damages paralytic poliomyelitis
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GROWTH IN TISSUE CULTURE
Depend on the virus : Can growth inMokey kidney tissue or Human cells(Diploid cell culture or human fetal
kidney tissue) or gray minkey tissueculture.
Cytophatic Effect on the tissue
culture.
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COLLECTING SPECIMENS &
DIAGNOSE
Specimens : Feces 4 8 gr / (rectal swab)
Pharyngeal swab
CSF
Blood ( 10 20 cc) / serum for antibody tests Vesicle fluids
Conjunctival swabs
Urine ( 10 cc)
Times of collection After onset of illness third/fourth weeks of illness
Volume of the specimens : Accute phase / during illness / convalescent phase
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Laboratory Diagnosis
Direct examination of specimens Isolation of viral agents / Isolation on
tissue cultures
Serological diagnosis Neutralization test
Complemen fixation
Haemagglutination Inhibition antibodies Pssive hemagglutination test
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Infections of Neural Tissue Viral
Polio = poliomyelitis fecal/oral route of transmission spread by contaminated water 90% asymptomatic infections 10% flu-like illness 0.01% paralytic poliomyelitis Replicates inside epithelial cells of nose, throat, intestine
lymphatics bloodstream If enters CNS infected cells die paralytic polio
Historical rate of paralytic polio US - 21,000/yr Peak year US - 1958 Last case wild virus in US - 1979 Western hemisphere declared free - 1994 Discontinuation of oral polio vaccine - 1999 Worldwide eradication
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Poliomyelitis1. The symptoms of poliomyelitis are usually headache, sore
throat, fever, stiffness of the back and neck, and occasionally
paralysis (less than 1% of cases).
2. Poliovirus is found only in humans and is transmitted by
the ingestion of water contaminated with feces.
3. Poliovirus first invades lymph nodes of the neck and small
intestine. Viremia (free viruses in the blood) and spinal cordinvolvement may follow. Replicate in the motor neurons atthe anterior horn of spinal cord. Death of the cells results inparalysis of the muscle innervated by these neurons. Theviruses also affects the brain stem result with respiratory
paralysis (bulbar poliomyelitis)
4. Diagnosis is based on isolation of the virus from feces andthroat secretionsor by rise in antibody titer.
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Poliovaccine
5. The Salk vaccine (an inactivatedpolio vaccine, IPV) involves injection offormalin-inactivated viruses andboosters every few years.
6. The Sabin vaccine (oral polio vaccine,OPV) contains three attenuated live
strains of poliovirus and is administeredorally.
Polio will be eliminatedthrough vaccination.
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VACCINE POLIOMYELITIS SALK VACCINE : parenteral
Menghasilkan humoral AB Diberikan 4kali dalam 1-2 tahun Efektivitas 70-90%
SABIN VACCINE : per oral
Trivalent vaccine Idealnya diberikan pada usia 6 bulan berturut turut 3kali jarak 6-8 minggu
Efektivitas 100% Menghasilkan IgM, IgG dan secretory IgA dalam
saluran pencernaan
Dengan prasyarat pemberian vaksin Anak sehat Tidak baru baik sakit Tidak prematur / malnutrisi / daya tahan sedang jelek
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COXSACKIE VIRUSES Group A : Herpangina (fever, sore throat and tender
vescicle in the oropharynx. Hand Food and Mouthdisease : vesicular rash on the hands and feet andulcerations in the mouth (children)
Group B : Pleurodynia (Bornholm disease, epidemic
myalgia,devils grip) characteristic by fever andsevere pleuritic chest pain. Myocardial and pericarditis(chest pain and congestive failure)
Both groups can cause aseptic meningitis, mild
paresis and transient paralysis.
Diagnosis : virus isolated or rise in titer of neutrali-zing antibody.
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ECHOVIRUS ECHO = acronym of Enteric cytophatic
Human orphan Cause of variety of disease such as
asceptic meningitis, upper respiratoryinfection, febrile illness with or without
rash, imfantile diarrhae and haemorrhagicconjuctivitis.
Fecal oral Pathogenesis : similar to enteroviruses.
Diagnosis : virus isolated from tissueculture.
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Viral meningitis = aseptic
meningitis
Fairly common (40%)
Self-limiting, non-fatal
CSF is clear
Many different viruses 1. Enteroviruses - 40%
Poliovirus
Cocksachievirus
Echovirus
2. Mumps virus - 15%
3. Other
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Infections of Neural Tissue
Viral - RABIES Rabies - Rhabodovirus Bite, Multiplies at site and enter the damage nerve
tissue (demyelinated nerve tissue). Travels to local nerves Peripheral nerves spinal cord brain Long incubation (tergantung lokasi gigitan) Phases :
Prodromal phase - flulike symptoms, tingling, burning,depression
Excitation phase - muscle function, speech, vision,
anxiety, hydrophobia Paralytic phase - muscles weaken, consciousness fades,
death.
Mortality - 100% with best treatment Post exposure prophylaxis (PEP) - has never failed
in US
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Rabies, is usually acquired through the
bite of a rabid warm-blooded animal.
This virus spreads by axonal transportfrom the inoculated skin or muscle to thecorresponding dorsal root ganglion or
anterior horn cells and then to populationsof neurons throughout the CNS.
The early involvement of neurons of the
limbic system cause the typical behavioralchanges of clinical rabies.
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Rabies
1. Rabies virus (rhabdovirus) causes an acute,
usually fatal, encephalitis called rabies.2. Rabies may be contracted through the bite of a
rabid animal, by inhalation of aerosols, orinvasion through minute skin abrasions. The
virus multiplies in skeletal muscle and connectivetissue.
3. Encephalitis occurs when the virus moves alongperipheral nerves to the CNS.
4. Symptoms of rabies include spasms of mouthand throat muscles, followed by extensive brain
and spinal cord damage and death.
5. Hydrophobia
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Rabies
5. Laboratory diagnosis may be made by directimmunofluorescent tests of saliva, serum, and
CSF or brain smears (animal).6. Reservoirs for rabies in the United States
include skunks, bats, foxes, and raccoons.Domestic cattle, dogs, and cats may get rabies.
Rodents and rabbits seldom get rabies.7. Current postexposuretreatment includes
administration of human rabies immune globulin(RIGH) along with multiple intramuscularinjections of vaccine.
8. Preexposure treatment consists of vaccination.
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VIRUS PENYEBAB ENCEPHALITIS TOGAVIRIDAE (Genus Alphavirus)
Chikungunya
Eastern equine encephalitis (EEE), transmisi nyamuk Culiseta Western Equine Encephalitis (WEE), transmisi oleh nyamuk Culex
St.Louis Encephalitis (SLE), trasmisi oleh nyamuk Culex
California Encephalitis (CE), transmisi oleh nyamuk Aedes triseriatus
FLAVIVIRUS
Flavivirus berukuran kecil (40 nm), berbeda dalam morfogenesis danberbeda dalam struktur genomnya dari Togavirus
Yang teriinfeksi sering menyebabkan encephalitis, dasarnya adalahneurotrofik khususnya pd binatang pengerat
VIRUS RABIES Progressive encephalitis terjadi jika virus mencapai / menyebar ke
CNS, gejala klinis hyrdophobia
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ArboviralEncephalitis
1. Symptoms of encephalitis are chills,
headache, fever, and eventually coma.
2. Many types ofarboviruses transmittedby mosquitoes cause encephalitis.
3. The incidence of arboviral encephalitisincreases in the summer months when
mosquitoes are most numerous.
A b i l E h liti
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ArboviralEncephalitis
5. Diagnosis is based on serological
tests.
6. Control of the vector is the mosteffective way to control encephalitis.
4. Horses are frequently infected by EEE(eastern equine encephalitis) and WEE(western equine encephalitis) viruses.
MUMPS VIRUS
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MUMPS VIRUS
Member of Paramyxovirus : only in human
Transmision :saliva containing virus / air droplets Clinical aspect : infected of salivary glands
enter the blood stream Complication :
orchitis &meningitis / meningoencephalitis
Collection of specimens : Blood Spinal fluid
Viral isolation / embryonated eggs Serological diagnosis :
CF / HAI / Nt antibodies Microscopic examination :
acidophilicintracytoplasmic inclusions Immunofluorescent antibody technic
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Lymphocytic Choriomeningitis
Virus
Lymphocytic Choriomeningitis Virus is amember of the Arenavirus family.
Rare cause of Aseptic meningitis
Cannot be disitinguished clinically fromfrequent viral causes. (Echovirus, Cosackievorus ormumps viorus)
Diagnosis : isolate the virus or increasetiter antibody.
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