Titiek Djannatun
Bagian Mikrobiologi Universitas YARSI
Rubella
History
1881 Rubella accepted as a distinct disease
Characteristics of Rubella
RNA enveloped virus, member of the
togavirus family
Spread by respiratory droplets.
In the prevaccination era, 80% of women
were already infected by childbearing age.
Morphology Virus
PATHOGENESIS OF RUBELLA
SITE OF VIRUS
GROWTH
RESULT
COMMENT
Respiratory tract
Skin
Rash
Lymph nodes
Lymphadenopathy
Joints
Immunopathology involved
(Circulating immune complexes)
Placenta/Fetus
Congenital Rubella
Viral Pathogenesis
Rubella Pathogenesis
Viral Pathogenesis
Clinical Features
maculopapular rash
lymphadenopathy
fever
Rash of Rubella
GEJALA KLINIS
POST NATAL :
Masa inkubasi 2-3 minggu
Infeksi virus pada mukosa saluran pernafasan atas Jaringan limfoid
(replikasi pada limfonodi servikal) Viremia (5-7 hari) RES Epitel
permukaan tubuh (Kulit, Saluran pernafasan, conjunctiva (Replikasi
fokal)
Simptom awal Malaise, Mild Fever, SoreThroath, Limfadenopati
aurikular posterior dan suboksipital
Rash/Pink makula papular Wajah Badan Ekstremitas (Advancing
dan resolving 3 days
GEJALA KLINIS
KONGENITAL :
Ibu dapat tanpa gejala viremia infeksi placenta dan janin (IgG ibu
tidak dapat melewati placenta) infeksi sel janin (efek teratogenik)
Ibu hamil (3-4 bln pertama) yang terdeteksi virus selalu menyebabkan
infeksi janin infeksi virus pada sel janin sebabkan efek teratogenik
Infeksi virus dalam rahim menyebabkan neonatus terinfeksi (kronis).
Virus dapat terdeteksi saat bayi lahir padasekresi faring dan berbagai
organ, cairan serebrospinal, urin, rectal swab. Ekskresi berlangsung 12-18
bulan setelah kelahiran
Infeksi pada 1ST trimester pertama kematian janin, aborsi spontan,
bayi lahir dengan BB rendah
BAYI abnormalitas jantung, lesi okuler, tuli, retardasi fisik/mental,
Anemia, Hepatitis, Pneumonia, Corditis, infeksi tulang
minimal risk
0-12 weeks
13-16 weeks
after 16 weeks
Permanent
Prevention (1)
Antenatal screening
All pregnant women attending antenatal clinics are
tested for immune status against rubella.
Prevention (2)
Since 1968, a highly effective live attenuated vaccine has
been available with 95% efficacy
Universal vaccination is now offered to all infants as part
of the MMR regimen in the USA, UK and a number of
other countries.
Some countries such as the Czech Republic continue to
selectively vaccinate schoolgirls before they reach
childbearing age.
Both universal and selective vaccination policies will work
provided that the coverage is high enough.
Laboratory Diagnosis
Diagnosis of acute infection
Rising titres of antibody (mainly IgG) - HAI, EIA
Presence of rubella-specific IgM - EIA
Immune Status Screen
HAI is too insensitive for immune status screening
SRH, EIA and latex agglutination are routinely used
15 IU/ml is regarded as the cut-off for immunity
Note that in reinfection, IgM is usually absent or only present transiently at a low level
MEASLES
RUBELLA
FIFTH DISEASE
ROSEOLA
Causative
Organism(S)
Rubella virus
Parvovirus B 19
Human Herpesvirus 6
or 7
Most common
modes of
transmission
Droplets contact
Droplets contact
Droplets contact ,
Direct contact
Virulence factors
Syncytium formation,
ability to suppress CMI
In fetuses : Inhibition
of mitosis, Induction
of apoptosis, and
damage to vascular
endothelium
Ability to remain
latent
Culture/ Diagnosis
Acute IgM,
Acute/Convalescent
IgG
Usually diagnosis
clinically
Usually diagnosis
clinically
Prevention
Live Attenuated
Vaccine (MMR)
Live Attenuated
Vaccine (MMR)
Treatment
No antivirals, Vitamin A,
Ab for secondary
bacterial Infections
Distinguishing
feature of the
rashes
Slaped-Face Rash
first, spread to limbs
and trunk, Tends to be
conflueent rather than
distinct bumps
MEASLES (RUBEOLA)
Penyebab kematian 1 million anak di negara berkembang
1963/1964 Tersedia vaksin MMR
Virus : Familia Paramyxovirus
Genus Morbilli virus
ss RNA
Tidak ada hewan reservoar
Bahan Pemeriksaan Darah (Hari ke 3 setelah onset), saliva,
Virus tidak dapat dikultur
Transmisi Droplets
Epidemik Padat, imunitas rendah, malnutrisi, tidak tersedia medical
care
Infeksius Periode inkubasi, fase prodomal, Skin rash
Pathogenesis Measles/Rubeolla
Virus via blood vessel body (sel
epitel permukaan yang pertama adalah
sel epitel saluran pernapasan)
Manifestasi awal pada mukosa
Kopliks spot
Manifestasi selanjutnya pada kulit
PATOGENESIS
Virus Mukosa saluran pernafasan Sel trachea dan bronchialis
Sistem limfatik (Replikasi) Pembuluh darah (viremia) Kulit dan
beberapa organ
Membentuk Giant cell
Imunitas Ab, CMI
Gejala : Sore throath, batuk kering, sakit kepala, conjunctivitis,
limphadenopati, fever
Awal Lesi oral (Kopliks spot) Maculapapular exanthum (Ulcerasi
putih kebiruan, kecil pada mukosa buccal berlawanan dengan geraham
bawah, berisi Giant cell dan antigen virus Erupsi pada kepala
Menyebar ke badan dan ekstremitas
Anak Leryngitis, Bronchopneumonia, Infeksi sekunder bakteri (H.
influenzae, S. pneumoniae) sebabkan infeksi telinga dan sinus
Anak dengan leukemia Pneumonia
Measles Pathogenesis
PATOGENESIS
Fase prodomal (2-4 hari) Virus terdapat di air mata, sekresi hidung,
tenggorok, urin, darah
Ruam kulit Hari ke 14 Interaksi sel T dengan sel terinfeksi virus
pada pembuluh darah kecil 1 Minggu (Pada pasien CMI rusak ruam
tidak timbul) viremia demam turun
Masa inkubasi 9-11 hari
Penyakit berlangsung 7-11 hari
Prodomal : 2-4 hari
Fase erupsi : 5-7 hari
Komplikasi serius SSPE (Subacute Sclerosis Panencephalitis)
Degenerasi neurologis Cortex cerebri, batang otak, white matter)
Ibu hamil Keguguran, Bayi dengan berat badan rendah
Kerusakan otak Epilepsi
MALNOURISHED CHILD,GOOD
MEDICAL CARE
Lung
Life-Threatening Pneumonia
Ear
Oral mucosa
Kopliks Spot
Conjunctiva
Conjunctivitis
Skin
Maculapapular rash
Intestinal tract
No lesions
Diarrhae-exacerbates
malnutrition, halt growth, impairs
recovery
Urinary tract
No Known complications
Overall impact