Diarrhoeal

Viruses
Titiek Djannatun
Bagian Mikrobiologi-FKUY

Viral Gastroenteritis

It 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

Rotaviruses
Adenoviruses 40 41
Caliciviruses
Norwalk like viruses or SRSV (Small Round
Structured Viruses)
Astroviruses
SRV (Small Round Viruses)
Coronaviruses
Toroviruses

Viruses found in the gut

(2)
B. Found in the gut, not normally associated with gastroenteritis

Polio
Coxsackie A
Coxsackie B
Echo
Enteroviruses 68-71
Hepatitis A
Hepatitis E
Adenoviruses 1-39
Reoviruses

C. Found in the gut as opportunistic infection

CMV
HSV
VZV
HIV

VIRUS PENYEBAB GASTROENTERITIS AKUT

PADA MANUSIA
VIRUS

UKURAN
(nm)

EPIDEMIOLOGI

KEPENTINGAN
DLM
MENYEBABKAN
PENY

ROTAVIRUS
GRUP A

70

PENY TPTG DIARE ENDEMIS BERAT PD BAYI & ANAK KCL DI

SELURUH DUNIA

GRUP B

70

WABAH DIARE PD ANAK & DEWASA DI CHINA

TIDAK

GRUP C

70

KASUS SPORADIS & KDG WABAH DIARE PD ANAK-ANAK

TIDAK

ADENOVIRUS
ENTERIK

70-80

TERPENTING KE DUA PENYAKIT DIARE ENDEMIS PD BAYI &

ANAK KCL DI SELURUH DUNIA

NORWALKVIRUS &
VIRUS MIRIPNYA

27-32

PENY PTG WABAH MUNTAH & PENY DIARE PD ANAK YG LBH

BESAR & DEWASA DI KELUARGA, KOMUNITAS, PERKANTORAN ,
SERING KRN PENGOLAHAN MAKANAN

TIDAK

CALICIVIRUS

28-40

KASUS SPORADIS & KDG WABAH PENY DIARE PD BAYI, ANAK

KCL & LANJUT USIA

TIDAK

ASTROVIRUS

28

KASUS SPORADIS & KDG WABAH PENY DIARE PD BAYI, ANAK

KCL & LANJUT USIA

TIDAK

YA

YA

ROTAVIRUS

PENDAHULUAN
FAMILIA
GENUS
SPECIES

: REOVIRIDAE
: ROTAVIRUS
: ROTAVIRUS

GENUS REOVIRIDAE PENTING BAGI MANUSIA YANG LAIN

ORTHOREOVIRUS, COLTIVIRUS, ORBIVIRUS
PENYEBAB ENTERITIS, DIARHAE DISEASES PADA BAYI
MANUSIA DAN HEWAN
PENYEBAB PENTING GASTROENTERITIS AKUT PADA BAYI
DI SELURUH DUNIA TERUTAMA PADA ANAK PRA SEKOLAH
SERING 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
VIRION

IKOSAHEDRAL, DIAMETER 60-80 nm, 132

KAPSOMER, BERKULIT TUNGGAL

GENOM

Ds RNA, LINIER, 11 SEGMEN, 680 bp,

PROTEIN

9 PROTEIN STRUKTURAL, CORE BERISI BEBERAPA

ENZIM

ENVELOPE

TDK ADA ( TRANSIENT PSEUDOENVELOPE),

TERDAPAT SELAMA MORFOGENESIS PARTIKEL

REPLIKASI

SITOPLASMA

CIRI KHAS

PENYUSUNAN GENETIK TERJADI MUDAH

PENYEBAB UTAMA DIARE PADA BAYI

Rotavirus Particle

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

TUGAS MENGKODE GEN

STRUKTUR ANTIGEN
OUTER STRUCTURAL PROTEIN:
VP4 VIRAL HEMAGLUTININ
VP7 ANTIGEN SUBGRUP
INNER CORE STRUCTURAL PROTEIN:
VP6 ANTIGEN SUBGRUP
ANTIGEN DETERMINANT PENTING
VP1,2,3
GRUP A F:
D, E, F TDK DITEMUKAN PD MANUSIA
A DIARE RINGAN PD ANAK & DEWASA
B DI CHINA DIARE PD ANAK2, DIARE
RINGAN PD DEWASA

STRUKTUR ANTIGEN
15 SEROTIPE:
6 BERDASARKAN AB THDP VP7 (P TYPE)
9 BERDASARKAN VP4 (G TYPE)
9 SEROTIPE ROTAVIRUS MANUSIA
5 SEROTIPE ROTAVIRUS HEWAN
ROTAVIRUS GRUP A GASTROENTERITIS PADA
MANUSIA
DETEKSI ELISA, IMMUNOFLUORESCENS

PATOGENESA

Rotavirus, 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 droplets

24-48 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.

PATOGENESA
RESIKO INFEKSI:
ANAK USIA 3 TH, MAX INSIDEN UMUR 6-24 BLN
SERING PADA USIA 5 BLN PENURUNAN IMUNITAS DIDAPAT
DARI IBU
DITEMUKAN PD PETUGAS MILITER, PEKERJA RS, SEBABKAN
TRAVELERS DIARRHEA
WABAH NOSOKOMIAL
PADA ORG DEWASA ASIMPTOMATIS, SERING TERTULAR
DARI ANAK TERINFEKSI
TIDAK TERJADI REINFEKSI PD ANAK DAN DEWASA
PENULARAN ANTAR MANUSIA VIA FECAL ORAL,
FOMITES, MAKANAN, AIR

PATOGENESA
VIRUS 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 FESES
EKSKRESI VIRUS BERAKHIR 2-12 HARI SEHAT
BILA NUTRISI BAIK
DIARE (3-8 MINGGU) KELEMAHAN ABSORPSI
NATRIUM DAN GLUKOSA AKIBAT KERUSAKAN VILLI
USUS

GEJALA KLINIS DAN DIAGNOSA

BAYI & ANAK FEVER, MUNTAH, DIARE, DEHIDRASI
DIARE WATERY WITHOUT BLOOD OR MUCUS
KASUS BERAT NEUROLOGIC SYMPTOM
PD ANAK DG IMUNODEFISIENSI BERMINGGU/BERBULAN
DIAGNOSA:
IDENTIFIKASI VIRUS FESES/RECTAL SWAB
ELISA
LATEX AGGLUTINATION
POLYACRYLAMIDE GEL ELECTROPHORESIS GRUP A /
NON GRUP A

TERAPI
MENGGANTI CAIRAN DAN ELEKTROLIT YANG
HILANG CEGAH DEHIDRASI
ASI PADA BAYI 24 JAM STLH ONSET
MAKANAN BERGIZI LAKTOSA BEBAS KH 24
JAM SETELAH ONSET
MINUMAN MENGANDUNG RENDAH SODIUM,
OSMOLARITAS TINGGI
JUICE BUAH & SOFT DRINK JANGAN
ANTIVIRAL

PENCEGAHAN
CEGAH INFEKSI FECAL ORAL
BAYI EKSKRESI VIRUS PADA FESES 4 7 HARI STLH ONSET,
PENDERITA DENGAN GANGGUAN IMUN 30 HARI ATAU LEBIH
HYGIENE PERAWATAN BAYI
VIRUS TAHAN PADA PERMUKAAN, TANGAN, AIR
TERKONTAMINASI SELAMA BEBERAPA HARI
RESISTEN DESINFEKTAN BIASA, DIINAKTIF DENGAN KLORIN
CUCI TANGAN SEBELUM DAN SESUDAH MENANGANI PASIEN
ATAU BAYI
1999 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 Adenoviruses

Naked 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 rotaviruses

Most 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.

Caliciviruses

Small 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 Viruses

Small RNA viruses, with ragged surface, 35 nm in diameter, now

classified as caliciviruses.

Always associated with epidemic outbreaks of

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.

gastroenteritis,

KLASIFIKASI
FAMILIA
GENUS
SPESIES

: CALICIVIRIDAE
: CALICIVIRUS
: NORWALKVIRUS

Norwalk-like Virus Particles

(Source: ICTV database)

PENDAHULUAN
VIRUS PENYEBAB GASTROENTERITIS EPIDEMIKA MELALUI
AIR, MAKANAN, KERANG BERBENTUK BULAT KECIL
Ss RNA (7,6 kb), POLARITAS POSITIF, TIDAK BERENVELOPE,
27-35 nm, MEMPUNYAI PROTEIN KAPSID TUNGGAL,
RAGGED SURFACE
1972 DITEMUKAN DR FESES PASIEN GASTROENTERITIS
DI NORWALK, OHIO
SEROTYPE HAWAII, SNOW MOUNTAIN (CO), MC (MD),
TAUNTON (ENGLAND), OTOFUKE (JAPAN), SAPPORO
(JAPAN)
AB ROTAVIRUS AWAL MASA ANAK-ANAK
AB NORWALK 50% ORANG DEWASA, NEGARA
BERKEMBANG USIA 4 TAHUN

PATOGENESA

GEJALA KLINIS
ANAK-ANAK & DEWASA BISA TERTULAR
MASA INKUBASI PENDEK < 24 JAM (6-96 JAM, RATA-RATA
24-30 JAM), ONSET CEPAT
PERJALANAN KLINIS PENDEK < 3 HARI, BERAKHIR 24-48
JAM
NAUSEA, VOMITING, KRAM ABDOMEN, WATERY DIARRHEA
DISERTAI SAKIT KEPALA, DEMAM, MALAISIE
TIDAK IMUNITAS JANGKA PANJANG, 2 TH BISA TERTULAR
DG VIRUS YANG SAMA
KEJADIAN INSTITUSI, KAPAL MAKANAN & MINUMAN
TERKONTAMINASI
PENYEBARAN FECO-ORAL, VOMITUS

DIAGNOSA & TERAPI

DIAGNOSA:
IMMUNE EM
SEROLOGI EPIDEMIOLOGI
TERAPI:
SIMTOMATIS
CUCI TANGAN
PENGOLAHAN MAKANAN YG BAIK
PEMURNIAN AIR MINUM, AIR KOLAM
RENANG

CALICIVIRUS YANG LAIN

DITEMUKAN 1976
Ss RNA, TIDAK BERENVELOPE, 30-45 nm, BULAT,
IKOSAHEDRAL, PROTEIN KAPSID TUNGGAL
ANTIGENIC TYPE UK 1 5, JAPAN/SAPPORO
EPIDEMIOLOGI WORLWIDE DISTRIBUTION
KEJADIAN PADA BAYI, ANAK-ANAK USIA
SEKOLAH, TERUTAMA USIA 4 TAHUN
TRANSMISI FECO-ORAL, MAKANAN
KONTAMINASI (SEAFOOD)

GEJALA KLINIS & DIAGNOSA

MASA INKUBASI 12 JAM SAMPAI 4 HARI
INFEKSI ASIMTOMATIS
DIARE RINGAN, MUNTAH, ANOREXIA, FEVER
SIMPTOM PERNAFASAN (1/3 PENDERITA) SEPERTI
FLU
DIAGNOSA:
EM EKSKRESI VIRAL
ELISA
IMMUN EM

ASTROVIRUS
1975 WABAH GASTROENTERITIS
Ss RNA, TIDAK BERENVELOPE, 27-32 nm,
FAMILIA ASTROVIRIDAE
PADA FESES BAYI, ANAK USIA SANGAT MUDA
7 SEROTIPE MANUSIA
GEJALA DIARE, HEADACHE, NAUSEA, FEVER (SUHU TIDAK
TERLALU TINGGI), MUNTAH
EPIDEMIOLOGI WORLDWIDE, TERUTAMA ANAK USI < 7
TAHUN
TRANSMISI FECAL-ORAL
PENULARAN SEAFOOD/AIR TERKONTAMINASI FESES
DIAGNOSA EM, IMMUNE EM, IMMUNEFLUORESCENS
(SEROTIPE)

Astroviruses

Small 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

Viruses
Coronaviruses

RNA viruses with a crown-like appearance

Not convincing associated with gastroenteritis at present

Small Round Viruses

Small virus-like particles with a smooth surface, 22-28nm in

diameter

May possibly be parvoviruses, enteroviruses, or cubic

bacteriophages

Occasionally seen in the faeces of endemic or epidemic

cases of gastroenteritis