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File : First 2 Fkep_USU / Pertusis 03/04/2011.

4. TOPIK LAGI

1.PERTUSIS. . . . . . . . . . . .50 MENIT


2.DIFTERIA . . . . . . . . . . . 50 MENIT
3.ISPA . . . . . . . . . . . . . . . .. 50 MENIT
4.PENY. JANTUNG BAWAAN
TETRA LOGI FALLOT. . . 50 MENIT
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Mahasiswa harus mampu
menjelaskan /
memahami,
Menegerti mengenai:
Definisi
Etilogi
Patofisiologi
Manifestasi klinik
Tatalaksana
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1. Pertusis
Tusis Quinta
Batuk Rejan
Batuk Panjang
Batuk 100 hari
Whooping Couhg
Kinghuist
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Defini Pertusis : Batuk panjang /
B. rejan, / B. 100 hari, / Whooping
couhg,/ Kinghuist, yang disebabkan
oleh karena infeksi saluran pernafa-
san oleh Bordetella pertusis atau
Bordetella para pertusis

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Bordetella pertussis

http://www.hhmi.princeton.edu/sw/2002/psidelsk/Microlinks.htm

Prof.dr.H. Rusdidjas, SpA(K)


Prof.dr.Hj.Rafita Ramayati, SpA(K)
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Bordetella pertussis Basics
Aerobic, Gram negative coccobacillus
Alcaligenaceae Family
Specific to Humans (spesifik pd manusia)
Colonizes the respiratory tract
Whooping Cough (Pertussis)

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Transmission
Very Contagious (Sangat menlar)
Transmission occurs via respiratory
droplets (percikan)

http://www.universityscience.ie/imgs/scientists/whoopingcough.gif 7
Adhesions melekat ke mucosa
saluran napas ada 3 cara
Filamentous hemagglutinin
Pertactin
Fimbriae

http://www.rivm.nl/infectieziektenbulletin/bul1306/kinkhoest.jpg 8
http://www.my-pharm.ac.jp/~yishibas/research/Pertussis1.jpg
Toxins
Pertussis Toxin
Adenylate Cyclase Toxin
Tracheal cytotoxin
Dermonecrotic toxin

(timbul micronecrosis
pd sub mucosa bron
Ujung syaraf aff batuk)
Heat-labile toxin
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www.ibl.fr/u447/u447.htm
Adenylate Cyclase Toxin
Invasive toxin
Activated by host cell calmodulin
Impairment of immune effector cells

Babu et al., 2001

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Whooping Cough
Also known as Pertussis
Outbreaks first described in the 16th
Century
Major cause of childhood fatality prior to
vaccination

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paaap.org/immunize/ course/slide27.html
Clinical Features
Incubation period 4-21 days
3 Stages
1st Stage- Catarrhal Stage1-2 weeks
2nd Stage- Paroxysmal Stage 1-6 weeks
3rd Stage- Covalescent Stage weeks-months

http://www.cdc.gov/nip/publications/pertussis/chapter1.pdf 12
Batuknya paroxysmal
Satu kali Inspirium diikuti batuk
beruntun sampai muntah

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Pertussis Infection

gsbs.utmb.edu/ microbook/ch031.htm
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Diagnosis
Isolation by culture
PCR
Direct fluorescent antibody
Serological testing
Klinis batuk khas
Ada komplikasi

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http://medinfo.ufl.edu/year2/mmid/bms5300/images/d7053.jpg
Komplikasi batuk rejan
1. Tek. Intraorbital -Subconjunctiva Bleeding
2. Tek, Intracranial Kejang / stroke
3. Tek Intrathoracal - -- Batuk darah
4. Tek. Intrabdominal -- Hernia Umbilic/Inguna

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Os. Dibawa ibunya ke Sarana Kes.
Karena ada komplikasi diatas

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Treatment
Antibiotic therapy
Erythromycin
Azithromycin and clarithromycin

http://www.aboutthatbug.com/AboutThatBug/files/CCLIBRARYFILES/
FILENAME/0000000032/033_lg.jpg http://www.vet.purdue.edu/bms/courses/lcme510/chmrx/macrohd.htm

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Pertussis Vaccine
1st Pertussis vaccine- whole cell
Acellular vaccine now used
Combination vaccines

http://www.tdh.state.tx.us/immunize/providers.htm 19
http://www.nfid.org/publications/clinicalupdates/pediatric/pertussis.html
Increase in Pertussis cases
Incidence of disease increasing in
countries with high vaccination levels
US- Massachusetts
Netherlands
France
Finland

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http://www.cdc.gov/nip/publications/pertussis/chapter1.pdf
Cases in 2003

http://www.pertussis.com/digest/index.html
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Massachusetts

Yih et al., 2000

Substantial increase in the number of cases


in adolescents and adults since 1980s 22
Netherlands
Mismatch between
vaccine strains and
circulating strains
played role in
reemergence

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Mooi et al., 2001


Strain Variation
B. pertussis population has changed
significantly since vaccine introduction
Adaptation to vaccine
Antigenic divergence

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Mooi et al., 2001
Vaccine problems
Complications/Safety
Multiple administration
Waning adolescent and adult immunity
Strain Variability

http://www.healthcareforhoosiers.com/Member/vaccineschedule.html

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Conclusions
Reemerging in adult and adolescent
populations as worldwide vaccination
rates increase
High vaccination rates not enough
Better vaccine development needed

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References
Ahuja, N., Kumar, P., Bhatnagar, R. The Adenylate Cyclase Toxins. Critical Reviews in Microbiology. 2004; 30(3):
187-196.
Babu, MM., Bhargavi, J., Singh Saund, R., Singh, S.K. Virulence Factors in Bordetella pertussis. Current Science.
June 2001; 80(12): 1512-1522.
Coote, JG. Environmental Sensing Mechanisms in Bordetella. Advances in Microbial Physiology. 2001; 44: 141-
181.
Dalet, K., Weber, C., Guillemot, L., Njamkepo, E., Guiso, N. Characterization of Adenylate Cyclase-Hemolysin Gene
Duplication in a Bordetella pertussis isolate. Infection and Immunity. Aug 2004; 72(8): 4874-4877.
Forsyth, K.D., Campins-Marti, M., Caro, J., Cherry, J.D., Greenberg, D., Guiso, N., Heininger, U., Schellenkens, J.,
Tan, T., von Konig, C., Plotkin, S. New Pertussis Vaccination Strategies beyond Infancy: Recommendations
by the Global Pertussis Initiative. Clinical Infectious Diseases. Dec 2004: 39: 1802-1809.
Hardwick, T.H., Cassiday, P., Weyant, R.S., Bisgard, K.M., Sanden, G.N. Changes in the Predominance and Diversity
of Genomic Subtypes of Bordetella pertussis Isolated in the United States, 1935-1999. Emerging Infectious
Diseases. Jan 2002; 8(1): 44-49.
Mattoo, S., Foreman-Wykert, A., Cotter, P., Miller, J. Mechanisms of Bordetella Pathogenesis. Frontiers in
Bioscience. Nov 2001; 6: E168-186
Merkel, T.J., Stibitz, S., Keith, J.M., Leef, M., Shahin, R. Contribution of Regulation by the bvg Locus to Respiratory
Infection of Mice by Bordetella pertussis. Infection and Immunity. Sept 1998; 66(9): 4367-4373.

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Reference cont.
Mooi, F.R., van Loo, I.H.M., King, A.J. Adaptation of Bordetella pertussis to Vaccination: A Cause for Its
Reemergence? Emerging Infectious Disease. June 2001; 7(No. 3 Supplement): 526-528.
Pishko, E.J., Betting, D.J., Hutter, C.S., Harvill, E.T. Bordetella pertussis Aquires Resistance to Complement
Mediated Killing In Vivo. Infection and Immunity. Sept 2003; 71(9): 4936-4942.
Robbins, J.B., Schneerson, R., Trollfors, B., Sato, H., Sato, Y., Rappuoli, R., Keith., J.M. The Diphtheria and
Pertussis Components of the Diphtheria-Tetanus Toxoids-Pertussis Vaccine Should Be Genetically Inactivated
Mutant Toxins. The Journal of Infectious Diseases. 2005;191: 81-88.
Schouls, L.M., van der Heide, H.G.J., Vauterin, L., Vaurerin, P., Mooi, F.R. Multiple-Locus Variable-Number Tandem
Repeat Analysis of Dutch Bordetella pertussis Strains Reveals Rapid Genetic Changes with Clonal Expansion
during the Late 1990s. Journal of Bacteriology. Aug 2004; 186(16): 5496-5505.
Shumilla, J.A., Lacaille, V., Hornell, M.C., Haung, J., Narasimhan, S., Relman, D.A., Mellins, E.D. Bordetella
Pertussis Infection of Primary Human Monocytes Alters HLA-DR Expression. Infection and Immunity. Mar
2004; 72(3): 1450-1462.
Steele, RW. Pertussis: Is Eradication Achievable? Pediatric Annals. Aug 2004; 33(8): 525-534.
Veal-Carr, W., Stibitz, S. Demonstration of differential virulence gene promoter activation in vivo in Bordetella
pertussis using RIVET. Molecular Microbiology. 2005; 55(3): 788-798.
Yih, W.K., Lett, S.M., des Vignes, F.N., Garrison, K.M., Sipe, P.L., Marchant, C.D. The Increasing Incidence of
Pertussis in Massachusetts Adolescents and Adults, 1989-1998. The Journal of Infectious Diseases. 2000;
182: 1409-1416.

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TKS

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