Perkembangan Virulensi

(Pathogenicity) Virus SARS-CoV-

2 selama pengobatan

Kuntaman
Department of Microbiology
Faculty of Medicine - Universitas Airlangga
Dr. Soetomo Academic Hospital
-Surabaya.
Kuntaman, ARSADA 2020
 INTRODUCTION
Terminology:
• 2019-nCov (novel)
• SARS-CoV-2
• COVID-19

Kuntaman, ARSADA 2020

 INTRODUCTION

Corona:
• an Infectious Disease (an sich): ?
• Political issue
• Economical issue
• Medical issue
• Global issue
Kuntaman, ARSADA 2020
 INTRODUCTION
Taxonomy:
• RNA Virus: 25-32 kb
• 4 Sub-groups: Alpha, Beta, Gamma, Delta
• Human CoV: Alpha & Beta

tiny.cc/IMCOVID-19
www.fk.unair.ac.id
Kuntaman, ARSADA 2020
 INTRODUCTION
Human CoV:
• 2003: SARS-CoV-1 à SARS à SARS-1
• 2012: MERS-CoV ß Arabic
• 2019: SARS-CoV-2 à COVID-19

tiny.cc/IMCOVID-19
www.fk.unair.ac.id
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 VIRUS ENTRY:
First step for
Infection

Kuntaman, ARSADA 2020

 VIRUS ENTRY:
First step for
Infection

Plasma
Therapy
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 DXSXTXV
PROBABILITY OF INF = ---------------------
HD
Virulence à Pathogenicity = Interaction

• D = Dose of Virus;
• S = Host susceptibility;
• T = Contact time;
• V = Virulence;
• HD = Host defence: Nutrition, Immune status,
Physical status & Barrier
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Underlying Dis 8
 Question mark !!!

1. Mengapa ada OTG: Virus (+), Gejala (-) (HD)

2. Rapid Test (+), RT_PCR Neg (HD)
3. DM menjadi Risk factor (S)
4. Masker à bisa menurunkan kasus baru (D)
5. Banyak orang sehat, tapi bisa sakit (V)
6. Jam Kerja dikurangi (T)
7. Kesembuhan, ada yg cepat & lambat (V,S,HD)

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 Apakah Virulensi berubah:?

Diduga perubahan terjadi pada saat kolonisasi di Kelelawar?

Virus sangat mudah berubah setiap ada tantangan baru

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 How Dangerous is the COVID-19
1. Transmission Rate (Ro) – ….2.68 (HK)
newly infected people from a single case
2. Case Fatality Rate (CFR) – 2.14%à 8% ?
percent of cases that result in death:
3. Contagious rate: …..1.4 – 2.5 …. 3.5
∑ people to which a single infected person will
transmit the virus
vs Common Flu: 1.3; SARS: 2
Kuntaman, ARSADA 2020
Kuntaman, ARSADA 2020
 How to suspect Cases: ?
Case-1: NOT COVID-19 Blood:
- WBC: 4.800/ml
• Mrs.Z, 39 y.o.
• Fever
• Cough, Short Breathness
• Geenish sputum
• Ronchy +/+
Micro: H1N1
Kuntaman, ARSADA 2020
 Epidemiology
Wuhan: Dec. 2019, a cluster of "pneumonia of unknown
cause" was linked to Huanan Seafood Wholesale Market,
- fish, chickens, pheasants, bats, venomous snakes,
- Marmots (Ground squirrel), spotted deer,
- and other wild animals (ye wei, bushmeat).[56]
- Feb 2020, have confirmed a highly pathogenic strain
of the H5N1 bird flu in chickens in the Hunan
province.
Kuntaman, ARSADA 2020
 Huanan Seafood Wholesale Market

Which one as the source of 2019-nCov: ???

bats
Otherssssss
Marmots

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Camel
 Epidemiology
Indonesia:
Corona Inf.: à mild symptoms à common cold –
but two, SARS & MERS, have proved particularly
deadly.

9.6% 34.4%

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 Update: June 3, 2020
Confirm Dead
Cases

27.549 1.663:6% Indonesia

5.135 418:8% Jatim

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Apakah Virus Jatim: lebih ganas: ???
 5.135
JATIM

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 JATIM
CFR: 418 = 8% Sembuh: 699=13.6%

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Kuntaman, ARSADA 2020
 Pathophysiology

• Virus à Inflamm. à Imm. Responds.

• 15-20%: Cytokine storm

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 Severe Cases

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 SARS-CoV-2 Viral Load

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 Viral Load:
Decrease in two weeks

Shedding RNA virus

à longer time

Zou et al, 2020;

Xu et al, 29020
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 Sero-conversion
Seroconversion:
Prev: 70%
Severe > Mild

Neth: COVID à Seroconversion à move to regular ward

Sing: Covid + symptom relief à discharge (even RT-PCR +
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 Virus Persistence
WHO, May 2020:
PCR can Pos in many weeks &
PCR w’d be Pos, after days/weeks Neg
Lan et al, J Am Med Ass 2020
Kim et al, The Korea Herald 29/4/20
WHO 2020

NCID Sing, May 2020 à Revised Protocol:

Discharge after symptoms relief rather than PCR Neg
Aims: improve patient’s mental & physical well being
Focus: diagnosis COVID-19 in early presentation
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 Management of Prolong Pos PCR
What When
1. Discont. Transm. Precau Symptom onset > 10 days
2. Discharge & Release No Clinical Presentation
Hosp Isolation
3. Self isolation (at home):? Control Comorbid
4. PPE Level 1 Ct Value > 30 ?
Kuntaman, ARSADA 2020
 Co-infection during course of COVID-19

Bacterial/Fungi: à PCT ++ Aciba;

K. pneu
Others corona V
Viral/Atipical:
Rawson et al.; Clin Inf Dis, 2
May 2020, ,

Influ. A/B Virus https://doi.org/10.1093/cid/ciaa5

30

Mycoplasma
Legionella pneu
Wang et al, 2020, http://medrxiv.org/lookup/doi/10.1101/2020.02.12.20022327
Fan et al, https://onlinelibrary.wiley.com/doi/pdf/10.1002/ajh.25785
Touzard-Romo,Fetal.R.I.Med.J.2013103,75–76(2020)
Kuntaman, ARSADA 2020 WuXetal.https://wwwnc.cdc.gov/eid/article/26/6/20-0299_article.
 Severity

Ferritin:
• Non-Surv, ++ in 71-96%
D-Dimer: Coagulopathy
• 90% in Covid + Pneu
• Non-Surv. ++
D-dimer > 1 μg/mL à
poor prognosis
(Zhou F et al. Lancet March 2020)
Kuntaman, ARSADA 2020
 Summary
1. SARS-CoV-2: virulent m.o.
2. New virulence: was developed in bat: ?
3. BUT New binding site ACE2 is proven
4. Clinical manifestation: is probability of
factors: D, S, V, T, HD
5. CFR is an indicator: 6-8% (Bird Flu: 34%)
6. Co-infection & Co-morbid: as co-factors
Kuntaman, ARSADA 2020
 Summary
7. SARS-CoV-2 higher burden: minus 3 & plus
10 days of symptoms
8. Perspective of Prolong PCR Pos.
(WHO/NCID-Sing) for Covid-19 Manag:
a) Non viable virus
b) Discontinue Transmission Precaution à
Regular ward (Neth)
c) ‘Not transmitting Cases’
d) Patient Discharge
Kuntaman, ARSADA 2020
 SARS-CoV-2 is ‘NEW’ for everything

Kuntaman, ARSADA 2020