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7/21/2019 Infeksi virus pada tumbuh kembang anak(2).pptx
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IMPORTANT PATHOGENIC VIRUS
DURING CHILD GROWTH (2)
Microbiology Department
Medical Faculty,
University of Sumatera Utara
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Parainuenza virus
Causing a spectrum of respiratory illnessfrom upper respiratory tract symptomsin healthy children to severe pneumonia
in the immunosupressed Member paramyoviridae, genus
Paramyovirus, species parainuenza
virus !"# virus single stranded
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Parainuenza virus
Pathogenesis
$ransmission is by droplet spread%
!eplication occurs in cells of therespiratory epithelium%
Clinically , illness most fre&uentlyinvolves larger air'ays of the lo'er
respiratory tract, causing croup(laryngotracheobronchitis)%
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Parainuenza virus
Pathogenesis (con*t)
!e+infection may occur and tends to causemilder upper air'ay disease, probably
representing 'aning of immunity% #ntigenic variation is not progressive
(unlie inuenza virus)
Mucosal immunity is most important forresisting infection% CD- $ cells areimportant in viral clearance%
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Parainuenza virus
Clinical Feature
Upper respiratory tract illness (Childrenunder . years )
/titis media
Croup
0ronchiolitis (infants undert 1 months)
Severe pneumonia in theimmunosupressed
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Parainuenza virus
Diagnosis
2iral isolation by tissue culture andimmunouorescence is the standard
PC! based tests are faster and candistinguish viral type
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!espiratory Syncytial 2irus
!S2 is a ma3or cause of lo'er respiratory tractinfection in young children (bronchiolitis)
#n important nosocomial infection
Member of the Paramyoviridae family, genuspneumovirus, species !espiratory Syncytial2irus
ss!"# virus
May survives up to 45 hour in patient secretionsdepositing on non+porous surface and aroundan hour on porous surfaces (tissue, fabric, sin)
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!espiratory Syncytial 2irus
Pathogenesis
6ncubation bet'een 4 and - days%6noculation is by nose and eye, 'ith
infection con7ned to the respiratorytract%
8ymphocytic in7ltration of the areas
around the bronchioles 'ith 'all andtissue oedema is follo'ed byproliferation and necrosis of thebronchiolar epithelium 9 bronchiolitis
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!espiratory Syncytial 2irus
Clinical Feature
:oung children 9 pneumonia andbronchiolitis
/lder children 9 a severe common cold
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!espiratory Syncytial 2irus
Diagnosis
Clinical diagnosis can be made 'ith somecon7dence in children during an outbrea
Serology is only useful epidemiologically
Cell culture 9 nasopharingeal aspirateprovides the best sample 'ith a high rate of
virus isolation% 6t should be inoculated intocell lines as soon as possible%
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!espiratory Syncytial 2irus
Diagnosis (con*t)
6nfection is characterized by the typicalsyncytial appearance , and the
cytopathic e;ect is visible at around day<+=
!apid test 9 immunouorescence
antibody test (6F#$), PC! and enzymeimmunoassays are all available%
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!espiratory Syncytial 2irus
Prevention
#ctive immunization is not available%
!S2 monoclonal antibody reducesmorbidity in infants at ris of severe !S2%
6nfection control in hospital%
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Mumps
#cute generalized viral infection ofchildren and adolescents causings'elling and tenderness of the salivaryglands
# member of the Paramyoviridaefamily, genus rubulavirus, species
mumps virus !"# virus, single stranded
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Mumps
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Mumps
Pathogenesis
$ransmitted by droplet spread or direct contact
6ncubation is 4+5 'ees
During incubation the virus proliferates in theupper respiratory tract 'ith conse&uentviraemia and localization to glandular andneural tissue
Parotid glands sho' interstitial oedema andsero7brinous eudate 'ith mononuclear cellin7ltration
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Mumps
Clinical feature
Prodrome of fever, headache andanoreia
>arache and ipsilateral parotidtenderness% $he gland s'ells over 4+<days% S'elling can lift the ear lobe up
and out'ard $he other side follo's 'ithin a couple of
days in most cases
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Mumps
Diagnosis
8ab con7rmation is re&uired forepidemiological purposes or 'hen
disease is atypical 8eucocytosis may be seen particularly
'ith meningitis, orchitis, or pancreatitis
Serum amylase is elevated in parotitis orpancreatitis
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Mumps
Diagnosis (con*t)
Serology 9 most reliably determinedusing >86S# for 6gM
2irus isolation 9 present in saliva from4 days before symptom onset to . daysafter onset
Prevention
2accination is more than ?.@ e;ective
and taes place at A4+A. months and
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!ubeola (Measles)
#n acute highly infectious disease of childrencharacterized by cough, coryza, fever andrash
# member of the family Paramyoviridae,genus Morbillivirus, species Measles virus
ss !"#
$his virus sensitive to light and drying but
can remain infective in droplet form for somehours
6mmunity after infection is lifelong
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!ubeola (Measles)
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!ubeola (Measles)
Pathogenesis
#irborne, spread by contact 'ith aerosolizedrespiratory secretions and one of the most
communicable of the infectious diseases Patients are most infectious during the late
prodromal phase 'hen coughing is at itspea%
2irus invades the respiratory epithelium andlocal multiplication leads to viraemia andleucocyte infection%
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!ubeola (Measles)
Pathogenesis (con*t)
!eticulo+endothelial cells becomeinfected and their necrosis leads to asecondary viraemia
$he ma3or infected blood cell is themonocyte
$issue that become infected include thethymus, spleen, lymph node, liver, sinand lung
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!ubeola (Measles)
Pathogenesis (con*t)
Secondary viraemia leads to infection ofthe entire respiratory mucosa 'ith
conse&uent cough and coryza Bopli*s spots and rash appear a fe'
days after respiratory symptoms (may
represent host hypersensitivity to thevirus)
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!ubeola (Measles)
Clinical Features
# prodromal phase of malaise, fever,anoreia, con3unctivitis and cough isfollo'ed by Bopli*s spot then rash%
!ash begins on the face and proceeddo'n involving palms and soles last% 6tlast around . days and maydes&uamate as it heals
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!ubeola (Measles)
Diagnosis
Usually clinically
8ab con7rmation is useful in atypical cases
2irus isolation possible in renal cell lines,useful in the immunode7cient 'hereantibody responses may be minimal
Serology, a fourfold increase in measlesantibody titres bet'een acute andconvalescent specimens is diagnostic
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!ubeola (Measles)
Diagnosis (con*t)
>86S# is capable of detecting speci7c6gM on a single sample
6mmunouoresent microscopy of cells insecretions
PC!
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!ubeola (Measles)
Prevention
Measles vaccine is given as part ofmeasles, mumps, rubella (MM!), at A4
months and preschool% Passive immunization 'ith
immunoglobulin is recommended for thoseeposed susceptible people at ris ofsevere or fatal measles% 6t must be given'ithin 1 days of eposure to be e;ective%
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!ubeola (Measles)
Prevention ( con*t)
Such groups include 9
Children 'ith malignant disease,
particularly if receiving chemo orradiotherapy
Children 'ith 62 should be given
immunoglobulin after eposure even ifalready vaccinated
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6nuenza virus
/ne of the commonest infectious disease ofman, primarily causing epidemics of upperrespiratory tract infection
6nuenza is a moderate to severe illness mostoften caused by inuenza # or 0 viruses%
Members of family /rthomyoviridae
ss !"# viruses
ave haemagglutinin (#) orneuraminidase("#) activities as ey antigeniccomponents and may alter by mutation(antigenic drift)
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6nuenza virus $hree distinct inuenza viruses 9
6nuenza # (A1 # and ? "# variants havebeen identi7ed)% >ample of subtype9A"A, ."A, etc
$ypical inuenza syndrome and can
precipitate pandemics% 6nuenza 0
causes the typical inuenza syndrome but
does not cause pandemic 6nuenza C (does not possess
neuraminidase structures)
causes afebrile common cold lie syndrome
and does not occur in epidemics%
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6nuenza virus
Pathogenesis
6t is highly infectious
6ts short incubation period (A+4 day) can
rapidly cause large epidemics andpandemics
2irus enters respiratory epithelial cells,replicates and progeny are released, the cell
dies% 2iral shedding may start 'ithin 45 hour of
infection + 6llness follo's 45 hour later
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6nuenza virus
Pathogenesis (con*t)
$here is di;use infammation of the tracheaand bronchi 'ith an ulcerative, necrotizing
tracheobronchitis in severe cases% Primary viral pneumonia is uncommon but is
severe 'hen it occurs%
0acterial superinfection is common,
facilatated by damage to the mucociliaryescalator, and virus+induced defects inlymphocyte and leucocyte function%
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6nuenza virus
Pathogenesis (con*t)
2iral levels fall rapidly after 5- hour ofillness, becoming undetectable by .+A
days%
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6nuenza virus
Clinical features
A+4 day incubation is follo'ed by anabrupt onset of symtomps% Fever, chills,
headache, malaise, myalgia, eye pain,anoreia, dry cough, sore throat, andnasal discharge%
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6nuenza virus
Diagnosis
6n the contet of a community outbrea,the diagnosis of inuenza can be made
'ith some con7dence on clinical criteriaalone
2iral culture, virus is readily isolated
from sputum, throat, or nasal s'abs% 6t iscultured in cell lines and detected 'ithin<+. days by its cytophathic e;ect
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6nuenza virus
Diagnosis (con*t)
2iral antigen detection 9 rapid detection'ithin A+4 days is possible 'ith
immunouoresence or >86S#% PC! are inincreasing use%
Serology 9 acute and convalescent (A+
4days apart) samples sho'ing afourfold rise in antibody titre%
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6nuenza virus
Prevention
6nactivated vaccines are the maincontrol measure
$hey are prepared each yearcontaining t'o type # and one type 0strain
$'o doses are re&uired in childrenunder ? years
Protection is around =@ and last for A
year
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!ubella virus
#cute mild eanthematous viral infection ofchildren and adults resembling mild measles
Potential to cause fetal infection and birth
defects # member of $ogaviridae family, genus
!ubivirus, species rubella virus
!ubella is also called Eerman Measles andthird disease*, measles and scarlet feverbeing the 7rst and second eanthematousinfections in children
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!ubella virus
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!ubella virus
Pathogenesis
Spread is by droplets
Moderately contagious
6ncubation is A4+4< days
Patients are at their most contagious'hen the rash is erupting
2irus may be shed from A daysbefore to 4 'ees after itsappearance
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!ubella virus
Pathogenesis (con*t)
!ash appears as immunity develops andviral titres fall
Primary viraemia follo's infection of therespiratory epithelium, secondary viraemiaoccurs a fe' days later once the 7rst 'aveof infected leucocytes release virions
#fter infection or vaccination most peopledevelop lifelong protection
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!ubella virus
Clinical feature
Many cases are subclinical
$he main symtomps are
lymphadenopathy and a maculopapularrash
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!ubella virus
Diagnosis
6ts mild nature maes clinical diagnosis diGcult
Serology , positive 6g M on a single sample or a
fourfold rise in 6gE in paired sera is diagnostic% Serological diagnosis of congenital rubella in
neonates need analysis of several samplesover time to determine 'hether antibody titres
are falling (maternal antibody) or rising (recentinfection)
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!ubella virus
Diagnosis ( Con*t)
Detection of rubella 6g M in ne'born*sserum indicates infection
6ntrauterine diagnosis has been made byplacental biopsy and by cordocentesis'ith detection by PC!
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!ubella virus
Prevention
2accination achives a seroconversionrate of ?.@
#ll 'omen of child bearing age should bevaccinated before pregnancy
Homen should not become pregnant in
the < months follo'ing vaccination
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Candida species
# yeast and the most common cause of fungalinfection
Candida albicans is responsible for ?@ ofinfection
Small ovoid cells that reproduce by budding
C. albicans may be found in soil, food andhospital environment% $hey are commensal ofhuman (sin, sputum, E6 tract, female genital
tract, etc
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Candida species
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Candida species
Pathogenesis
$he rise of Candida sp% infection relatesto the increase in medical intervention 9
+ $he use of antibiotics (supressing normalbacterial ora and permittingproliferation of Candida organism
+ 6ntravenous catheters (providing route ofentry)
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Candida species
Pathogenesis (con*t)
6mmune supression mediated by disease(e%g%62) or therapy such as steroids are alsoassociated 'ith increase rates of infection
6mmune response to Candida infection ismediated by humoral and cellular mechanism
Candida sp. virulence factors include surface
molecules that permit organism adherence toother structures ( human cells), acid protease
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Candida species
Clinical features 9 /ral thrush
/ral candidiasis characterized by 'hite,creamy patches on the tongue and oral
mucosa%
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Candida species
Diagnosis
Can be con7rmed using a B/ smear or gramstain to demonstrate hyphae and yeast form
Culture 9 smooth 'hite colony
Presumtive identi7cation of C. albicans is
possible by inoculating organism from acolony into a small tube of serum, germ tubeshould form 'ithin ? minutes%
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Thank you