DISEASES
I N AYAT I H A B I B
Tropical diseases
ARBOVIRUS
Rubella
Dengue
Campak
Morbili
Mump’s
etc
PARAMYXOVIRUS
ARBOVIRUS
2. Urban cycle.
Siklus terjadi antara manusia dengan species arthropoda
Pada Yellow fever dan Dengue fever , keduanya terdapat urban cycle
juga sylvatic/jungle cycle
DEAD END HOSTS ??
ALPHAVIRUSES
26 recognized viruses
RNA viruses-single stranded,+ sens RNA
Enveloped particles, roughly spherical, 70 nm
Haemaglutinate avian red cells
Grow in cell culture: pathogenic for suckling mice
(mencit yang menyusu )
Properties of Most Arbovirus :
FLAVIVIRUS
67 viruses
RNA viruses-single strand ,+ sens RNA
Envelope particles- diameter 40 – 50 nm
Haemaglutinate avian red cells
Grow in cell culture: pathogenic for suckling mice
Properties of Most Arbovirus :
BUNYAVIRUS
positive-sense
single-stranded RNA viruses that form particles
of 40 to 50 nm in the endoplasmic reticulum
DENGUE VIRUS (Flavivirus family)
DENGUE FEVER
DENGUE HAEMORHAGIC FEVER
DF dan DHF
Gejala klinis 4–7 hari (range of 3–14 days) setelah gigitan nyamuk
terinfeksi
Onset demam terjadi segera atau gejala prodromal : malaise, chills,
and headache. Rasa nyeri pada punggung, sendi, otot dan bola mata
Viremia terjadi pada saat demam dan persisten selama 3–5 hari
Suhu tubuh kembali normal setelah 5–6 hari atau hari ke-3 dan
kemudian naik sekitar 5–8 hari ("saddleback" form).
Rash muncul pada hari ke-3 atau ke-4 dan berlangsung selama 1 – 5
hari.
Limfonodi membesar
self-limited disease atau fase Convalescence memerlukan beberapa
minggu
Komplikasi dan kematian jarang
Dengue hemorrhagic fever
A severe syndrome terjadi pada individu terutama anak-anak dengan passively
acquired (as maternal antibody) or preexisting nonneutralizing heterologous
dengue antibody berkaitan dengan infeksi sebelumnya dengan virus Dengue yang
berbeda serotipe.
Pada gejala awal seperti dengue normal, keadaan pasien semakin memburuk
Dengue shock syndrome adalah penyakit dengan keadaan yang lebih
berat dengan karakteristik adanya shock and hemokonsentrasi
Terdapat bukti bahwa adanya infeksi sekunder oleh virus Dengue tipe 2 setelah
infeksi primer virus Dengue 1 merupakan faktor resiko utama terjadinya infeksi
yang berat.
Pathogenesis severe syndrome melibatkan adanya preexisting dengue antibody.
Virus-antibody complexes dibentuk selama beberapa hari pada saat infeksi
sekunder dan nonneutralizing enhancing antibodies memicu terjadinya infeksi
pada banyak sel mononuklear diikuti dengan pelepasan sitokin mediator
vasoaktif, pro-koagulan yang mengakibatkan disseminated intravascular
coagulation ( DIC) yang terjadi pada hemorrhagic fever syndrome.
Dengue
•Arbovirus
Flaviviridae fam, flavivirus genus
•single-stranded RNA
•DEN-1, 2, 3, 4
•Genetic var within serotypes Female
•Each serotype provides A daytime feeder
specific lifetime immunity Human habitation
short term cross immunity Lays eggs & produces
larvae preferentially
in artificial containers
Hypothesis on Pathogenesis of DHF
DEN-1
Kimura & Hotta, 1943
Sabin & schlesinger, 1945
(Haw-Den-1) as a prototype
DEN-2
Isolates from New Guinea
New Guinea C (NG”C”-DEN-2) as prototype
DEN-3
From patient with hemorrhagic disease in Manila, 1956
DEN-4
From patient with hemorrhagic disease in Manila, 1956
Genome organization and virion structure
Flaviviruses
Sperical particle
Isometric nucleocapsid core (30 nm in diameter)
Lipid envelope
Single strand (+) sense RNA
11 kb in length
Genome has cap and lack of 3’ Poly A
Genome organization
virion structure
Genome organization and virion structure
Flaviviruses
Spherical particle
Isometric nucleocapsid core (30 nm in diameter)
Lipid envelope
Single strand (+) sense RNA
11 kb in length
Genome has cap and lack of 3’ Poly A
CAPSID & MEMBRAN PROTEIN
CAPSID
112-127 aa
purified C protein tidak menginduksi viral
neutralizing antibody
MEMBRAN
prM contained in intracelullar immature virions
M protein contained in extracellular mature virions
ENVELOPE PROTEIN
NS-3 PROTEIN
• Help in viral replication
• Serine protease
• helicase
Mature Dengue-2 virus particles
replicating in five day old tissue culture cells.
The original magnification is 123,000 times. CDC
VIREMIA
Problems:
Co-sirculation of Dengue Virus with other flaviviruses
Serologic test available are using antibodies that may cross
reaction with other flaviviruses
Some reagents are not commercially available.
Immune response detection
Imunoglobulin M Imunoglobulin G
IgM antibodies
NS1 antigens
Diproduksi sekitar 5 hari setelah
gejala muncul
Diproduksi mulai hari 1 setelah Meningkat 1 -3 minggu dan
onset demam dan naik sampai hari
ke-9 mungkin menetap sampai 60 hari
Tidak dapat terdeteksi apabila anti- Mungkin dapat terdeteksi sampai 6
NS1 IgG antibodies diproduksi bulan
Sirkulasi pada kadar yang tinggi
pada serum selama fase klinik dan
pada beberapa hari awal fase IgG antibodies
penyembuhan
• Muncul sekitar 14 hari setelah
munculnya gejala dan menetap
sepanjang hidup
Response to secondary infection
Sekitar 20-30% pasien dengan infeksi sekunder dengue tidak memproduksi anti-
dengue IgM antibodies pada kadar yang dapat terdeteksi sampai hari ke 10 dan
harus didiagnosis sebagai the elevation of dengue specific IgG antibodies
Interpretation of Result
Primary Dengue
is characterised by the presence of detectable IgM antibodies 3 -5 days
after the onset of infection
Secondary Dengue
is characterised by elevation of spesific IgG antibodies 1-2 days after
the onset of infection, often accompanied by an elevation of IgM
Detection of IgM antibody
Mouse inoculation
Mammalian cell culture (BHK-21, LLC- MK2, Vero)
Mosquito cell culture
Mosquito inoculation
PCR
Hybridization probes
Immunohistochemistry
AN OUTBREAK OF DENGUE VIRUS SEROTYPE 1 INFECTION IN CIXI, NINGBO,
PEOPLE’S REPUBLIC OF CHINA, 2004, ASSOCIATED WITH A TRAVELER FROM
THAILAND AND HIGH DENSITY OF AEDES ALBOPICTUS
Am J Trop Med Hyg June 2007 vol. 76 no. 6 1182-1188
Figure
Dengue virus isolated from two of five cases + for dengue viral RNA.
A, C6/36 cell monolayer inoculated with control serum
B, Cytopathic effect (CPE) in monolayer cultured with patient serum at second passage
C, RNA isolated from supernatants of cell culture with CPE by reverse transcription–
polymerase chain reaction. The DNA product (511-basepair [bp] fragment) was obtained
after amplification with consensus primers D1 and D2.
Lane 1, parental C6/36 control;
Lane 2, DNA marker;
Lanes 3 and 4, supernatants from cells cultured with sera of two patients.
D, DNA fragment (482 bp) for dengue 1 virus amplified with the serotype-specific
primer pairs.
Lanes 1 and 2, supernatants of culture with sera of two patients;
lane 3, DNA marker.
ARBOVIRUS-ASSOCIATED ENCEPHALITIS
ARBOVIRUS-ASSOCIATED ENCEPHALITIS