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
DALAM
MENYEBABKAN
PENYAKIT

Rotavirus
GrupA

70

Penyebab terpenting diare endemis berat pada bayi &

anak kecil di seluruh dunia

Grup B

70

Wabah diare pada anak & dewasa di China

Tidak

Grup C

70

Kasus sporadis & kadang wabah diare pada anak-anak

Tidak

Adenovirus
enterik

70-80

Terpenting kedua penyakit diare endemis pada bayi &

anak kecil di seluruh dunia

Ya

Norwalkvirus &
virus miripnya

27-32

Penyebab penting wabah muntah & penyakit diare pada

anak yang lebih besar & dewasa di keluarga, komunitas,
perkantoran. Sering karena pengolahan makanan

Tidak

Calicivirus

28-40

Kasus sporadis & kadang wabah penyakit diare pada

bayi, anak kecil & lanjut usia

Tidak

Astrovirus

28

Kasus sporadis & kadang wabah penyakit diare pada

bayi, anak kecil & lanjut usia

Tidak

Ya

ROTAVIRUS

PENDAHULUAN
FAMILIA
: REOVIRIDAE
GENUS : ROTAVIRUS
SPECIES
: 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
selururuh 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

Tidak 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 Tidak ditemukan pada manusia
A Diare ringan pada anak dan dewasa
B Di CHINA Diare pada anak-anak, Diare ringan pada
dewasa

STRUKTUR ANTIGEN
15 SEROTIPE:
6 Berdasarkan Antibodi terhadap VP7 (P Type)
9 Berdasarkan VP4 (G Type)
9 Serotipe Rota virus manusia
5 Serotipe Rota virus hewan
Rota virus 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 tahun, maksimum insiden umur 6-24 bulan
Sering pada usia 5 bulan Penurunan Imunitas didapat dari ibu
Ditemukan pada petugas militer, pekerja RS, sebabkan Travelers
diarrhae
Wabah Nosokomial
Pada orang dewasa Asimptomatis, sering tertular dari anak
terinfeksi
Tidak terjadi reinfeksi pada anak dan dewasa
Penularan antar manusia Via fecal oral, fomites, makanan, air

PATOGENESA
Virus Villi usus (VP4) Replikasi pada sel usus,
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

Bacteria
Parasites
Enteroadherant E.coli
GiardiaCryptosporidia
Parasite
Bacteria

Viruses

Helminth

GEJALA KLINIS DAN DIAGNOSA

Bayi & anak Fever, muntah, diare, dehidrasi
Diare Watery without blood or mucus
Kasus berat Neurologic symptom
Pada anak dengan imunodefisisnsi Berminggu/berbulan
Diagnosis:
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 setelah onset
Makanan bergizi Laktosa bebas KH 24 jam
setelah onset
Minuman mengandung rendah sodium, osmolaritas
tinggi
Juice buah & soft drink dilarang
Antiviral

PENCEGAHAN
Cegah infeksi Fecal Oral
Bayi Ekskresi virus pada feses 4 7 hari setelah 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, 2735 nm, mempunyai protein kapsid tunggal, ragged surface
1972 Ditemukan dari feses pasien gastroenteritis di
Norwalk, Ohio
Serotype Hawaii, snow mountain (CO), MC (MD),
Taunton (England), Otofuke (Japan), Sapporo (Japan)
Antibodi Rota virus Awal masa anak-anak
AB Norwalk 50% orang dewasa, Negara berkembang
usia 4 tahun

PATOGENESA

GEJALA KLINIS
Anak-anak & dewasa dapat tertular
Masa inkubasi pendek < 24 jam (6-96 jam, rata-rta 2430 jam), onset cepat
Perjalanan klinis pendek < 3 hari, berakhir 24-48 jam
Nausea, vomiting, kram abdomen, Watery diarrhea disertai
sakit kepala, sakit kepala, demam, malaisie
Tidak imunitas jangka panjang, 2 tahun dapat tertular
dengan virus yang sama
Kejadian Institusi, kapal Makanan & minuman
terkontaminasi
Penyebaran Feco-oral, vomitus

DIAGNOSIS & TERAPI

DIAGNOSIS:
Immune EM
Serologi EpidemiologiI
TERAPI:
Simptomatis
Cuci tangan
Pengolahan makanan yang 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 terkontaminasi
(Seafood)

GEJALA KLINIS & DIAGNOSA

Masa inkubasi 12 jam sampai 4 hari
Infeksi asimptomatis
Diare ringan, muntah, anoreksia, fever
Simptom pernafasan (1/3 penderita) seperti flu
Diagnosia:
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 usia < 7 tahun
Transmisi fecal-oral
Penularan Seafood/air terkontaminasi feses
Diagnosis EM, IMMUNE EM, Immunofluorescens (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