Arthropod- and

Rodent-borne virus
part.1

Lutfia Papita D.R

1610911120024
Arthropod-borne and Rodent-borne virus

ARENAVIRIDAE
BUNYAVIRIDAE
FILOVIRIDAE

FLAVIVIRIDAE
REOVIRIDAE
TOGAVIRIDAE
 FLAVIVIRIDAE (Genus Flavivirus)

1) Dengue Virus
2) Japanese Encephalitis virus
3) West Nile Virus
4) Yelow Fever virus
5) Zika Virus

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• Spherical, Enveloped

• (+) single-stranded RNA

• Three structural polypeptides,two glycosylated

• Replication: cytoplasm

• Assembly: within endoplasmic reticulum  enveloped here !

• Most of the flaviviruses are antigenically related, and

antibodies to one virus may neutralize another virus
  These viruses can cause lytic or
persistent infections of both vertebrate
and invertebrate hosts

 >> viral RNA produced on the replication

and transcription  block host mRNA
binding to ribosome  prevents
rebuilding and maintenance of the cell 
Interferon cell deaths
and
cytokine  Female mosquito acquire the virus from
effect viremic vertebrate hostthen  infects
the epithelial cells of the midgut 
spreads to the circulation  the salivary
glands  virus in saliva of mosquito
 Siapa target Flavivirus ?

• The primary target  monocyte-

macrophage lineage

• They express Fc receptors for antibody

and release cytokines on challenge

• Flavivirus infection is enhanced 200- to

1000-fold by nonneutralizing antiviral
antibody that promotes binding of the
virus to the Fc receptors and its uptake
into the cell.
 Immunity

• Early Infection  >> IFN alpha and beta  flu-like symptoms (prodormal)

• IgM  within 6 days of infection  followed by IgG

• Antibody to the viral attachment protein blocks viremic spread of the virus and
subsequent infection of other tissues

• Immunity to these viruses is a double-edged sword  inflammation can damage

the tissue  encephalitis

• HS type 3 (antigen of virus-antibody complex) arthritis

• Immune responses to a related strain of dengue virus that do not prevent infection
can exacerbate immunopathogenesis, leading to dengue hemorrhagic fever or
dengue shock syndrome
 Intermezzo

A 35-year-old man presents to the local urgent care clinic in South

America. He is completing a graduate school exchange program,
studying tropical ecosystems and is bitten by mosquitoes almost every
day. He reports a 3-day history of high fevers, chills, and myalgias. This
morning, he noticed some blood in his urine and while blowing his
nose. On physical exam, there is gingival bleeding. Laboratory
evaluation reveals a mild transaminitis, thrombocytopenia, and
hematuria. Dx ?
 Dengue Virus

• Transmission : Bite of Aedes aegypti and

A.albopictus

• Serotype : DENV 1-4

• tropics and subtropics  endemic  occurs every

year on rainfall season is optimal for breeding

• virus replicates in and destroys the bone marrow

• plasma leakage is caused by increased capillary

permeability
 Dengue fever/ Dengue Hemorrhagic Fever Dengue Shock Syndromes
Breakbone fever
Demam (3-14 hari), Fever or recent history of fever lasting 2–7 Any case that meets the four
Saddle back type days criteria for DHF and (+)
circulatory failure
• Frontal headache Any hemorrhagic manifestation (+
(1) rapid, weak pulse and
• retro-orbital pain torniquest test, gum bleed, epistaxis,
narrow pulse pressure (≤20
• Myalgias microhematuria, petechiae)
mmHg [2.7 kPa]), or
• Arthralgias
• hemorrhagic Thrombocytopenia (platelet
(2) hypotension for age,
manifestations count of < 100.000/mm3
restlessness, and cold,
• Rash
clammy skin
• Low white blood Evidence of increased vascular
cell count permeability (min 1) :
 Hct ≥20% above the population mean

 Hct after volume-replacement treatment

of ≥20% of the baseline Hct

(+) pleural effusion or ascites

Hypoproteinemia or hypoalbuminemia
 Warning signs (2009):
1. Severe abdominal pain
2. Persistent vomiting
3. Fluid accumulation
4. Mucosal Bleed
5. Lethargy, restlessness
6. Liver enlargement > 2
cm
7. Increase Hct, Low
platelet count
 Intermezzo

This MO is the vector of ?

 Japanese encephalitis Virus

• Vertebrate host : wading bird,pig

• Transmission : Bite of Culex sp.  Culex

tritaeniorhynchus

• Human as incidental or dead-end host :’(

• >> Asia, seasonal  Summer-fall

• <1% of people infected with Japanese encephalitis (JE) virus develop clinical illness

• Incubation period : 5-15 hari

• Fever, headache, and vomiting, mental status changes, neurologic symptoms,

weakness, and movement disorders might develop over the next few days.

• Seizures are common, especially among children

• No treatment, only symptomatic

• Inactivated Vero cell culture-derived Japanese encephalitis (JE) vaccine

(manufactured as IXIARO)  available in US  for traveler that planned to visit endemic
area
 Intermezzo

A 60-year-old woman is brought into the emergency room for

confusion and flaccid paralysis. Her family reveals that she
recently made a trip to Asia and arrived home just a few days
ago. On physical exam she is febrile and is not oriented to
person, place, or time. She has hyperreflexia and flaccid
paralysis of both legs. Cerebrospinal fluid analysis reveals
elevated lymphocytes, normal protein, and normal glucose.
Further analysis reveals immunoglobulin M to the suspected
virus. Dx ? What is the risk factor ?
 West Nile Virus
• Vertebrate host : Bird

Transmission :
• Bite of mosquito (Culex sp.)
• Exposure in a laboratory setting (Rare)
• Blood transfusion and organ donation(Rare)
• Mother to baby, during pregnancy, delivery, or breast
feeding(Rare)

• Leading cause of mosquito-borne disease in the continental

United States
• No symptoms in most people

• Febrile illness (fever) with other symptoms such as headache, body aches, joint pains,
vomiting, diarrhea, or rash. Most people with this type of West Nile virus disease
recover completely

• Serious symptoms in a few people

• About 1 in 150 people  affecting the central nervous system such as encephalitis
(inflammation of the brain) or meningitis (inflammation of the membranes that surround
the brain and spinal cord).
• High fever, headache, neck stiffness, stupor, disorientation, coma, tremors,
convulsions, muscle weakness, vision loss, numbness and paralysis.

people over 60 years of age are at greater risk

Tx : symptomatic
 Intermezzo

A 32-year-old woman presents to a local clinic in Nigeria. She had been

working in the rainforest as part of a conservation movement and had
been bitten multiple times over the past few days by mosquitos and other
flying insects. Three days ago, she developed a flu-like viral illness and
recently began having minor nosebleeds. She also noted that her skin
looked more yellow than normal. On exam, she is jaundiced with scleral
icterus. She is also noted to have hepatomegaly and gingival bleeding.
Laboratory testing reveals a transaminitis and hyperbilirubinemia. She is
told that she needs to be admitted for close monitoring.
Dx ? What is the vector ?
 Yellow fever virus
• Reservoir : Nonhuman and human primates

Transmission :
• Bite of mosquito (Aedes sp. and Haemogogus
sp)  3 transmission cycle

1) The sylvatic (jungle) cycle : nonhuman primates

and mosquito species found in the forest canopy
2) intermediate (savannah) cycle involves
transmission of YFV from tree hole-
breeding Aedes spp. to humans living or working in
jungle border areas
3) The urban cycle involves transmission of the virus Endemic area
between humans and peridomestic mosquitoes, Africa and South America
primarily Ae. aegypti
• Incubation period : 3–6 days

• Nonspecific influenzalike syndrome with sudden onset of

fever, chills, headache, backache, myalgia, prostration,
nausea, and Black vomiting

• infects the liver liver cells die via apoptosis coagulopathy

occurs due to loss of hepatic synthesis of clotting factors

• 15% of patients progress to a more serious or toxic form

of the disease, characterized by jaundice, hemorrhagic
symptoms, and eventually shock and multisystem organ
failure

• Dx : px fungsi hepar, enzim hepar, biopsy ( +councilman

body), dan guaiac stool testing

• Tx : symptomatic
 Intermezzo

A 30-year-old G1P0 woman delivers a baby with microcephaly at 38 weeks

via normal spontaneous vaginal delivery. During her first trimester, she went
on a trip to Puerto Rico in December of 2015 and had multiple mosquito bites
there. A week after this trip, she had a low-grade fever, itchy maculopapular
rash, and conjunctivitis that resolved within 10 days. She had not gone
consistently to her prenatal appointments. On physical exam, the baby has
congenital microcephaly. A serum sample from the baby is collected.
Dx ? Tx ?
 Zika virus

Transmission :
• Bite of mosquito (Aedes albopictus and Aedes aegypti)
• From mother to fetus (Vertically)
• Sexual intercourse

 Tropical and subtropical climates, Central and South America, Caribbean

 the Zika virus replicates in skin cells (e.g., keratinocytes and fibroblasts),

 the virus spreads via blood and induces an innate immune response
may potentially penetrate through the placental barrier, leading to
teratogenicity
Symptoms
• Pruritic rash
• Miscarriage
• Arthralgia
• Headache
• hematospermia (in males)

Sign
• conjunctival injection
• low-grade fever
• macular or papular rash

Fetus :
• congenital microcephaly
• intracranial calcifications
• ocular lesions

Complication :
Permanent neurologic damage, GBS
Labs
 Screening  serum or urine Zika virus immunoglobulin M (IgM) in
pregnant women with risk factors during the first and second
trimester, if (+) we should do Confirmatory test (RT-PCR)

 Tx : Supportive care