Neurotropic Viral

7/29/2019 Neurotropic Viral

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NEUROTROPIC VIRUSESDr. EDHIE DJOHAN UTAMA, SpMK


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Meningitis : Characterized by highfever, headache, stiff neck

Encephalitis : Characterized bychanges in mental state, consciousness(kesadaran), behavior (tabiat)

Brain Abscess : Headache, focal

signs and seizures indicate a brainabscess. There are also characteristiccomputed tomography (CT) andmagnetic resonance image (MRI)findings


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INFEKSI PADA SISITIM SYARAF

PUSAT

BISA DISEBABKAN OLEH SEMUA AGENT YANGINFECTIOUS :

= BAKTERI -

PYOGENIK

= MYCOBACTERIA

= FUNGI

= SPIROCHAETA

= VIRUS


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INFEKSI SELAPUT OTAK I. MENINGITIS PURULENTA

MENINGOCOCCUS (40%) PNEUMOCOCCUS HAEMOPHILUS INFLUENZAE STAPHYLOCOCCUS AUREUS LISTERIA MONOCYTOGENES

II. MENIGITIS GRANULOMATOUS MYCOBACTERIUM TUBERCULOSIS COCCIDIODES IMMITIS (meningitis)

CRYPTOCOCCUS NEOFORMAN (meningitis) HISTOPLASMA CAPSULATUM TREPONEMA PALLIDUM JAMUR JAMUR LAIN

III. ASEPTIC MENINGITIS ENTEROVIRUS

POLIOMYELITIS COXSACKIEVIRUS ECHOVIRUS (Enteric Cytopathic Human Orphan) RABIES HERPES SIMPLEX PARAMYXOVIRUS (Mumps virus) LEPTOSPIRA CLOSTRIDIUM TETANI


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ASEPTIC MENINGITIS

ENTEROVIRUS POLIOMYELITIS

COXSACKIEVIRUS

ECHOVIRUS (Enteric Cytopathic HumanOrphan)

RABIES

HERPES SIMPLEX

PARAMYXOVIRUS (Mumps virus)

LEPTOSPIRA

CLOSTRIDIUM TETANI


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VIRAL MENINGITIS

ENTEROVIRUS POLIOMYELITIS

COXSACKIEVIRUS


RABIES

HERPES SIMPLEX

PARAMYXOVIRUS (Mumps virus)


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ENTEROVIRUS

Enterovirus termasuk PICORNAVIRIDAE POLIOMYELITIS

COXSACKIEVIRUS Group A dan B


TRANSMISI : RESPIRATORY DROPLETS

FECAL ORAL (fingers, foodstuffs, milk flies andcockroaches)

Port de antre : alimentary tracts


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PATHOGENESIS

Enhancement factors : During pregnancy

Corticosteroids

Multiplications :

Lymphoid tissue of gut and pharynx Reticuloendothelial system

Target organs : Spinal cord brain meningenes myocardium skin.

Pathology : Cells injury intrauterine transfer of Cocksacchieviruses Severe and fatal disease

Severe neural damages paralytic poliomyelitis


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GROWTH IN TISSUE CULTURE

Depend on the virus : Can growth inMokey kidney tissue or Human cells(Diploid cell culture or human fetal

kidney tissue) or gray minkey tissueculture.

Cytophatic Effect on the tissue

culture.


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COLLECTING SPECIMENS &

DIAGNOSE

Specimens : Feces 4 8 gr / (rectal swab)

Pharyngeal swab

CSF

Blood ( 10 20 cc) / serum for antibody tests Vesicle fluids

Conjunctival swabs

Urine ( 10 cc)

Times of collection After onset of illness third/fourth weeks of illness

Volume of the specimens : Accute phase / during illness / convalescent phase


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Laboratory Diagnosis

Direct examination of specimens Isolation of viral agents / Isolation on

tissue cultures

Serological diagnosis Neutralization test

Complemen fixation

Haemagglutination Inhibition antibodies Pssive hemagglutination test


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Infections of Neural Tissue Viral

Polio = poliomyelitis fecal/oral route of transmission spread by contaminated water 90% asymptomatic infections 10% flu-like illness 0.01% paralytic poliomyelitis Replicates inside epithelial cells of nose, throat, intestine

lymphatics bloodstream If enters CNS infected cells die paralytic polio

Historical rate of paralytic polio US - 21,000/yr Peak year US - 1958 Last case wild virus in US - 1979 Western hemisphere declared free - 1994 Discontinuation of oral polio vaccine - 1999 Worldwide eradication


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Poliomyelitis1. The symptoms of poliomyelitis are usually headache, sore

throat, fever, stiffness of the back and neck, and occasionally

paralysis (less than 1% of cases).

2. Poliovirus is found only in humans and is transmitted by

the ingestion of water contaminated with feces.

3. Poliovirus first invades lymph nodes of the neck and small

intestine. Viremia (free viruses in the blood) and spinal cordinvolvement may follow. Replicate in the motor neurons atthe anterior horn of spinal cord. Death of the cells results inparalysis of the muscle innervated by these neurons. Theviruses also affects the brain stem result with respiratory

paralysis (bulbar poliomyelitis)

4. Diagnosis is based on isolation of the virus from feces andthroat secretionsor by rise in antibody titer.


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Poliovaccine

5. The Salk vaccine (an inactivatedpolio vaccine, IPV) involves injection offormalin-inactivated viruses andboosters every few years.

6. The Sabin vaccine (oral polio vaccine,OPV) contains three attenuated live

strains of poliovirus and is administeredorally.

Polio will be eliminatedthrough vaccination.


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VACCINE POLIOMYELITIS SALK VACCINE : parenteral

Menghasilkan humoral AB Diberikan 4kali dalam 1-2 tahun Efektivitas 70-90%

SABIN VACCINE : per oral

Trivalent vaccine Idealnya diberikan pada usia 6 bulan berturut turut 3kali jarak 6-8 minggu

Efektivitas 100% Menghasilkan IgM, IgG dan secretory IgA dalam

saluran pencernaan

Dengan prasyarat pemberian vaksin Anak sehat Tidak baru baik sakit Tidak prematur / malnutrisi / daya tahan sedang jelek


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COXSACKIE VIRUSES Group A : Herpangina (fever, sore throat and tender

vescicle in the oropharynx. Hand Food and Mouthdisease : vesicular rash on the hands and feet andulcerations in the mouth (children)

Group B : Pleurodynia (Bornholm disease, epidemic

myalgia,devils grip) characteristic by fever andsevere pleuritic chest pain. Myocardial and pericarditis(chest pain and congestive failure)

Both groups can cause aseptic meningitis, mild

paresis and transient paralysis.

Diagnosis : virus isolated or rise in titer of neutrali-zing antibody.


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ECHOVIRUS ECHO = acronym of Enteric cytophatic

Human orphan Cause of variety of disease such as

asceptic meningitis, upper respiratoryinfection, febrile illness with or without

rash, imfantile diarrhae and haemorrhagicconjuctivitis.

Fecal oral Pathogenesis : similar to enteroviruses.

Diagnosis : virus isolated from tissueculture.


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Viral meningitis = aseptic

meningitis

Fairly common (40%)

Self-limiting, non-fatal

CSF is clear

Many different viruses 1. Enteroviruses - 40%

Poliovirus

Cocksachievirus

Echovirus

2. Mumps virus - 15%

3. Other


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Infections of Neural Tissue

Viral - RABIES Rabies - Rhabodovirus Bite, Multiplies at site and enter the damage nerve

tissue (demyelinated nerve tissue). Travels to local nerves Peripheral nerves spinal cord brain Long incubation (tergantung lokasi gigitan) Phases :

Prodromal phase - flulike symptoms, tingling, burning,depression

Excitation phase - muscle function, speech, vision,

anxiety, hydrophobia Paralytic phase - muscles weaken, consciousness fades,

death.

Mortality - 100% with best treatment Post exposure prophylaxis (PEP) - has never failed

in US


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Rabies, is usually acquired through the

bite of a rabid warm-blooded animal.

This virus spreads by axonal transportfrom the inoculated skin or muscle to thecorresponding dorsal root ganglion or

anterior horn cells and then to populationsof neurons throughout the CNS.

The early involvement of neurons of the

limbic system cause the typical behavioralchanges of clinical rabies.


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Rabies

1. Rabies virus (rhabdovirus) causes an acute,

usually fatal, encephalitis called rabies.2. Rabies may be contracted through the bite of a

rabid animal, by inhalation of aerosols, orinvasion through minute skin abrasions. The

virus multiplies in skeletal muscle and connectivetissue.

3. Encephalitis occurs when the virus moves alongperipheral nerves to the CNS.

4. Symptoms of rabies include spasms of mouthand throat muscles, followed by extensive brain

and spinal cord damage and death.

5. Hydrophobia


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Rabies

5. Laboratory diagnosis may be made by directimmunofluorescent tests of saliva, serum, and

CSF or brain smears (animal).6. Reservoirs for rabies in the United States

include skunks, bats, foxes, and raccoons.Domestic cattle, dogs, and cats may get rabies.

Rodents and rabbits seldom get rabies.7. Current postexposuretreatment includes

administration of human rabies immune globulin(RIGH) along with multiple intramuscularinjections of vaccine.

8. Preexposure treatment consists of vaccination.


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VIRUS PENYEBAB ENCEPHALITIS TOGAVIRIDAE (Genus Alphavirus)

Chikungunya

Eastern equine encephalitis (EEE), transmisi nyamuk Culiseta Western Equine Encephalitis (WEE), transmisi oleh nyamuk Culex

St.Louis Encephalitis (SLE), trasmisi oleh nyamuk Culex

California Encephalitis (CE), transmisi oleh nyamuk Aedes triseriatus

FLAVIVIRUS

Flavivirus berukuran kecil (40 nm), berbeda dalam morfogenesis danberbeda dalam struktur genomnya dari Togavirus

Yang teriinfeksi sering menyebabkan encephalitis, dasarnya adalahneurotrofik khususnya pd binatang pengerat

VIRUS RABIES Progressive encephalitis terjadi jika virus mencapai / menyebar ke

CNS, gejala klinis hyrdophobia


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ArboviralEncephalitis

1. Symptoms of encephalitis are chills,

headache, fever, and eventually coma.

2. Many types ofarboviruses transmittedby mosquitoes cause encephalitis.

3. The incidence of arboviral encephalitisincreases in the summer months when

mosquitoes are most numerous.

A b i l E h liti


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ArboviralEncephalitis

5. Diagnosis is based on serological

tests.

6. Control of the vector is the mosteffective way to control encephalitis.

4. Horses are frequently infected by EEE(eastern equine encephalitis) and WEE(western equine encephalitis) viruses.

MUMPS VIRUS


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MUMPS VIRUS

Member of Paramyxovirus : only in human

Transmision :saliva containing virus / air droplets Clinical aspect : infected of salivary glands

enter the blood stream Complication :

orchitis &meningitis / meningoencephalitis

Collection of specimens : Blood Spinal fluid

Viral isolation / embryonated eggs Serological diagnosis :

CF / HAI / Nt antibodies Microscopic examination :

acidophilicintracytoplasmic inclusions Immunofluorescent antibody technic


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Lymphocytic Choriomeningitis

Virus

Lymphocytic Choriomeningitis Virus is amember of the Arenavirus family.

Rare cause of Aseptic meningitis

Cannot be disitinguished clinically fromfrequent viral causes. (Echovirus, Cosackievorus ormumps viorus)

Diagnosis : isolate the virus or increasetiter antibody.


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Neurotropic Viral