Diarrhoeal VirusesTitiek DjannatunBagian Mikrobiologi-FKUY

Viral GastroenteritisIt is thought that viruses are responsible for up to 3/4 of all infective diarrhoeas. Viral gastroenteritis is the second most common viral illness after upper respiratory tract infection.In developing countries, viral gastroenteritis is a major killer of infants who are undernourished. Rotaviruses are responsible for half a million deaths a year.Many different types of viruses are found in the gut but only some are associated with gastroenteritis.

Viruses found in the gut (1)A. Associated with gastroenteritis

RotavirusesAdenoviruses 40 41CalicivirusesNorwalk like viruses or SRSV (Small Round Structured Viruses)AstrovirusesSRV (Small Round Viruses)CoronavirusesToroviruses

Viruses found in the gut (2)B. Found in the gut, not normally associated with gastroenteritisPolioCoxsackie ACoxsackie BEchoEnteroviruses 68-71Hepatitis AHepatitis EAdenoviruses 1-39Reoviruses

C. Found in the gut as opportunistic infection CMVHSVVZVHIV

VIRUS PENYEBAB GASTROENTERITIS AKUT PADA MANUSIA

ROTAVIRUS

PENDAHULUANFAMILIA : REOVIRIDAEGENUS: ROTAVIRUSSPECIES: ROTAVIRUS

GENUS REOVIRIDAE PENTING BAGI MANUSIA YANG LAIN ORTHOREOVIRUS, COLTIVIRUS, ORBIVIRUSPENYEBAB ENTERITIS, DIARHAE DISEASES PADA BAYI MANUSIA DAN HEWANPENYEBAB PENTING GASTROENTERITIS AKUT PADA BAYI DI SELURUH DUNIA TERUTAMA PADA ANAK PRA SEKOLAHSERING JUGA PADA ORANG DEWASA

Rotaviruses (1)Naked double stranded RNA viruses, 80 nm in diameter.Also found in other mammals and birds, causing diarrhoea.Account for 50-80% of all cases of viral gastroenteritis.Usually endemic, but responsible for occasional outbreaks.Causes disease in all age groups but most severe symptoms in neonates and young children. Asymptomatic infections common in adults and older children. Symptomatic infections again common in people over 60.Up to 30% mortality rate in malnourished children, responsible for up to half a million deaths per year.

SIFAT PENTING

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

TUGAS MENGKODE GEN

STRUKTUR ANTIGENOUTER STRUCTURAL PROTEIN: VP4 VIRAL HEMAGLUTININVP7 ANTIGEN SUBGRUPINNER CORE STRUCTURAL PROTEIN:VP6 ANTIGEN SUBGRUPANTIGEN DETERMINANT PENTINGVP1,2,3GRUP A F:D, E, F TDK DITEMUKAN PD MANUSIAA DIARE RINGAN PD ANAK & DEWASAB DI CHINA DIARE PD ANAK2, DIARE RINGAN PD DEWASA

STRUKTUR ANTIGEN15 SEROTIPE:6 BERDASARKAN AB THDP VP7 (P TYPE)9 BERDASARKAN VP4 (G TYPE)9 SEROTIPE ROTAVIRUS MANUSIA5 SEROTIPE ROTAVIRUS HEWANROTAVIRUS GRUP A GASTROENTERITIS PADA MANUSIADETEKSI ELISA, IMMUNOFLUORESCENS

PATOGENESARotavirus, an RNA virus, is a member of the family Reoviridae and includes seven distinct antigenic groups (A-G). Group A viruses are the major cause of rotavirus diarrhea in the U.S. and groups B and C can cause gastroenteritis in adults

In developing countries, rotavirus accounts for a significant number of gastroenteritis-associated deaths. In the United States, rotavirus accounts for a 3.5 million cases of diarhea, 50,000 hospitalizations, and 20 deaths in children younger than 5 years of age.

Rotavirus is an important cause of gastroenteritis in infants and young children in both developed and developing countries (4). promote growth

Rotaviruses (2)80% of the population have antibody against rotavirus by the age of 3.More frequent during the winter.Faecal-oral spread. ? respiratory droplets24-48 hr incubation period followed by an abrupt onset of vomiting and diarrhoea, a low grade fever may be present.Diagnosed by electron microscopy or by the detection of rotavirus antigens in faeces by ELISA or other assays.Live attenuated vaccines now available for use in children.

PATOGENESARESIKO INFEKSI:ANAK USIA 3 TH, MAX INSIDEN UMUR 6-24 BLNSERING PADA USIA 5 BLN PENURUNAN IMUNITAS DIDAPAT DARI IBUDITEMUKAN PD PETUGAS MILITER, PEKERJA RS, SEBABKAN TRAVELERS DIARRHEAWABAH NOSOKOMIALPADA ORG DEWASA ASIMPTOMATIS, SERING TERTULAR DARI ANAK TERINFEKSITIDAK TERJADI REINFEKSI PD ANAK DAN DEWASAPENULARAN ANTAR MANUSIA VIA FECAL ORAL, FOMITES, MAKANAN, AIR

PATOGENESAVIRUS VILLI USUS (VP4) REPLIKASI PADA SITOPLASMA SEL USUS, MASUK DENGAN CARA ENDOSITOSIS (MERUSAK MEKANISME TRANSPORT) NSP4 (ENTEROTOKSIN, MERANGSANG SEKRESI) VIRUS + SEL USUS YANG RUSAK MASUK KE LUMEN USUS FESESEKSKRESI VIRUS BERAKHIR 2-12 HARI SEHAT BILA NUTRISI BAIKDIARE (3-8 MINGGU) KELEMAHAN ABSORPSI NATRIUM DAN GLUKOSA AKIBAT KERUSAKAN VILLI USUS

GEJALA KLINIS DAN DIAGNOSABAYI & ANAK FEVER, MUNTAH, DIARE, DEHIDRASIDIARE WATERY WITHOUT BLOOD OR MUCUSKASUS BERAT NEUROLOGIC SYMPTOMPD ANAK DG IMUNODEFISIENSI BERMINGGU/BERBULANDIAGNOSA:IDENTIFIKASI VIRUS FESES/RECTAL SWABELISALATEX AGGLUTINATIONPOLYACRYLAMIDE GEL ELECTROPHORESIS GRUP A / NON GRUP A

TERAPIMENGGANTI CAIRAN DAN ELEKTROLIT YANG HILANG CEGAH DEHIDRASIASI PADA BAYI 24 JAM STLH ONSETMAKANAN BERGIZI LAKTOSA BEBAS KH 24 JAM SETELAH ONSETMINUMAN MENGANDUNG RENDAH SODIUM, OSMOLARITAS TINGGIJUICE BUAH & SOFT DRINK JANGANANTIVIRAL

PENCEGAHANCEGAH INFEKSI FECAL ORALBAYI EKSKRESI VIRUS PADA FESES 4 7 HARI STLH ONSET, PENDERITA DENGAN GANGGUAN IMUN 30 HARI ATAU LEBIHHYGIENE PERAWATAN BAYIVIRUS TAHAN PADA PERMUKAAN, TANGAN, AIR TERKONTAMINASI SELAMA BEBERAPA HARIRESISTEN DESINFEKTAN BIASA, DIINAKTIF DENGAN KLORINCUCI TANGAN SEBELUM DAN SESUDAH MENANGANI PASIEN ATAU BAYI1999 DIKEMBANGKAN VAKSIN DI USA (RRV-TV) LIVE TETRAVALENT RHESUS-HUMAN REASSORTANT VACCINE (ROTASHILD) HUMAN G TYPE 1, 2, 4 & SIMIAN G TYPE 3

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

Enteric AdenovirusesNaked DNA viruses, 75 nm in diameter. Fastidious enteric adenovirus types 40 and 41 are associated with gastroenteritis.Associated with cases of endemic gastroenteritis, usually in young children and neonates. Can cause occasional outbreaks.Possibly the second most common viral cause of gastroenteritis (7-15% of all endemic cases).Similar disease to rotavirusesMost people have antibodies against enteric adenoviruses by the age of three.Diagnosed by electron microscopy or by the detection of adenovirus antigens in faeces by ELISA or other assays.

CalicivirusesSmall RNA viruses, characteristic surface morphology consisting of hollows. particles 35 nm in diameter.Associated mainly with epidemic outbreaks of gastroenteritis, although occasionally responsible for endemic cases.Like Norwalk type viruses, vomiting is the prominent feature of disease.Majority of children have antibodies against caliciviruses by the age of three.Diagnosed by electron microscopy only, often difficult to diagnose because of small size.

Calicivirus Particles(Source: ICTV database)

NORWALKVIRUS

Norwalk-like VirusesSmall RNA viruses, with ragged surface, 35 nm in diameter, now classified as caliciviruses.Always associated with epidemic outbreaks of gastroenteritis, adults more commonly affected than children.Associated with consumption of shellfish and other contaminated foods. Aerosol spread possible as well as faecal-oral spread.Also named "winter vomiting disease", with vomiting being the prominent symptom, diarrhoea usually mild.Antibodies acquired later in life, in the US, only 50% of adults are seropositive by the age of 50.Diagnosis is made by electron microscopy and by PCR.

KLASIFIKASIFAMILIA: CALICIVIRIDAEGENUS: CALICIVIRUSSPESIES: NORWALKVIRUS

Norwalk-like Virus Particles(Source: ICTV database)

PENDAHULUANVIRUS PENYEBAB GASTROENTERITIS EPIDEMIKA MELALUI AIR, MAKANAN, KERANG BERBENTUK BULAT KECILSs RNA (7,6 kb), POLARITAS POSITIF, TIDAK BERENVELOPE, 27-35 nm, MEMPUNYAI PROTEIN KAPSID TUNGGAL, RAGGED SURFACE1972 DITEMUKAN DR FESES PASIEN GASTROENTERITIS DI NORWALK, OHIOSEROTYPE HAWAII, SNOW MOUNTAIN (CO), MC (MD), TAUNTON (ENGLAND), OTOFUKE (JAPAN), SAPPORO (JAPAN)AB ROTAVIRUS AWAL MASA ANAK-ANAKAB NORWALK 50% ORANG DEWASA, NEGARA BERKEMBANG USIA 4 TAHUN

PATOGENESA

GEJALA KLINISANAK-ANAK & DEWASA BISA TERTULARMASA INKUBASI PENDEK < 24 JAM (6-96 JAM, RATA-RATA 24-30 JAM), ONSET CEPATPERJALANAN KLINIS PENDEK < 3 HARI, BERAKHIR 24-48 JAMNAUSEA, VOMITING, KRAM ABDOMEN, WATERY DIARRHEA DISERTAI SAKIT KEPALA, DEMAM, MALAISIETIDAK IMUNITAS JANGKA PANJANG, 2 TH BISA TERTULAR DG VIRUS YANG SAMAKEJADIAN INSTITUSI, KAPAL MAKANAN & MINUMAN TERKONTAMINASIPENYEBARAN FECO-ORAL, VOMITUS

DIAGNOSA & TERAPIDIAGNOSA:IMMUNE EMSEROLOGI EPIDEMIOLOGITERAPI:SIMTOMATISCUCI TANGANPENGOLAHAN MAKANAN YG BAIKPEMURNIAN AIR MINUM, AIR KOLAM RENANG

CALICIVIRUS YANG LAINDITEMUKAN 1976Ss RNA, TIDAK BERENVELOPE, 30-45 nm, BULAT, IKOSAHEDRAL, PROTEIN KAPSID TUNGGALANTIGENIC TYPE UK 1 5, JAPAN/SAPPOROEPIDEMIOLOGI WORLWIDE DISTRIBUTIONKEJADIAN PADA BAYI, ANAK-ANAK USIA SEKOLAH, TERUTAMA USIA 4 TAHUNTRANSMISI FECO-ORAL, MAKANAN KONTAMINASI (SEAFOOD)

GEJALA KLINIS & DIAGNOSAMASA INKUBASI 12 JAM SAMPAI 4 HARIINFEKSI ASIMTOMATISDIARE RINGAN, MUNTAH, ANOREXIA, FEVERSIMPTOM PERNAFASAN (1/3 PENDERITA) SEPERTI FLUDIAGNOSA:EM EKSKRESI VIRALELISAIMMUN EM

ASTROVIRUS1975 WABAH GASTROENTERITIS Ss RNA, TIDAK BERENVELOPE, 27-32 nm, FAMILIA ASTROVIRIDAEPADA FESES BAYI, ANAK USIA SANGAT MUDA7 SEROTIPE MANUSIAGEJALA DIARE, HEADACHE, NAUSEA, FEVER (SUHU TIDAK TERLALU TINGGI), MUNTAHEPIDEMIOLOGI WORLDWIDE, TERUTAMA ANAK USI < 7 TAHUNTRANSMISI FECAL-ORALPENULARAN SEAFOOD/AIR TERKONTAMINASI FESESDIAGNOSA EM, IMMUNE EM, IMMUNEFLUORESCENS (SEROTIPE)

AstrovirusesSmall RNA viruses, named because of star-shaped surface morphology, 28 nm in diameter.Associated with cases of endemic gastroenteritis, usually in young children and neonates. Can cause occasional outbreaks.Responsible for up to 10% of cases of gastroenteritis.Similar disease to rota and adenoviruses.Most people have antibodies by the age of three.Diagnosed by electron microscopy only, often very difficult because of small size.

Astrovirus Particles(Source: ICTV database)

Other Possible Diarrhoeal VirusesCoronavirusesRNA viruses with a crown-like appearanceNot convincing associated with gastroenteritis at present

Small Round VirusesSmall virus-like particles with a smooth surface, 22-28nm in diameterMay possibly be parvoviruses, enteroviruses, or cubic bacteriophagesOccasionally seen in the faeces of endemic or epidemic cases of gastroenteritis