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Blok Imunologi & Infeksi

20 Desember 2010

 Ilmu itu LUAS

Ilmu itu dipelajari
bertahap.

Disease. (not just

infection)

The physiologic correlation among Host

Factors

GENETIC

Cell & Tissue

Immune
Responce

Endocrine

The role of Host as a factors that influencing

infectious disease

Endocrine

Cell
&
Tissue

Genetic

Immune

Evidence of genetic involvement in

infectious disease
Disorders of red blood
cells have been widely
studied as they contribute
a huge public health
burden, particularly in
Africa and Asia.
They were among the
earliest genetic diseases
to be characterized
molecularly,
owing to their visible
clinical and laboratory
phenotypes.
Early observational
studies noted the
similarity in
geographical distribution

The hypothesis of J. B. S.Haldane

red-blood-cell disorders, such as
thalassaemia, might protect an individual
from life-threatening infection with
malaria.

Evidence of genetic involvement in

infectious disease

Another puzzling observation about the natural history of viral

illness, that is, why some patients who are regularly exposed to
the human immunodeficiency virus (HIV) do not become
infected, recently
has been explained, at least in part, at the molecular level.

Liu et al. (1996) observed that the

CD4+ T cells of two such
individuals were highly resistant in
vitro to the entry of primary
macrophagetropic virus but were
readily infected with transformed
T-cell-line-adapted viruses.
It was found that these individuals
were homozygous for a defect in
the CKR-5 gene, which codes for
the coreceptor for primary HIV-1
isolates. It turned out that they had
inherited a defective CRK-5 allele
containing an internal 32-bp
The resulting protein is truncated and cannot be detected at the
deletion
cell surface. This mutation has been observed in other patients
who were resistant to HIV infection, although not in all.

Variation in Clinical Manifestation of Dengue Disease

Dengue Virus

Immune Responses

Virus Serotype
AND genotype
DEN 1
DEN 2
DEN 3
DEN 4

Polymorphisms
CD 209
Cytokine Receptors
HLA types
Secondary Infection
Dengue Disease
Asymptomatic
Mild Symptom
Plasma leakage (DHF/DSS)
Hemorrhage
Encephalopathy/encephalitis
Dual Infection
Plasma Cell Leukemia (Leukemia
like)

Vaccination Problem in
Congenital (genetic) Immunesystem defect

INNATE IMMUNITY

kuma
n

ADAPTIVE IMMUNITY

cellular
property
soluble property
T-CELL
B-CELL

BARIER:
-Kulit
-Mukosa Paru
-Mukosa GI T

 Sistem pertahanan tubuh

manusia sangat bagus tetapi
mengapa masih ada yang
sakit ??

Bagaimana kita membantu tubuh

melindungi diri dari infeksi ?

Vaksin
kuma
n

Vaksin

Respon tubuh
terhadap vaksin
Respon tubuh
terhadap infeksi

Produksi
Antibodi
Aktifitas
Kekebalan
Proses infeksi

Imunisasi pada anak imunodefisiensi

Genetik

Obat

Infeksi

1
3

Keganasan

1
2

4
4

6 7

8
Imunodefisiensi primer

Imunodefisiensi sekunder

Defisiensi
imunoglobulin
predominan (1)
Defisiensi sel B
(Brutons
agamma-globulinemia)

gangguan produksi
antibodi
gangguan aktivitas
kekebalan
risiko infeksi

Defisiensi
imunoglobulin
predominan (2)

Gangguan produksi IgG

Gangguan aktivitas
aglutinin, antitoksin,
Fagositosis
Risiko infeksi

Defisiensi sel T (1)

Defisiensi sel T
(Wisskott-Aldrich)

gangguan
produksi antibodi
gangguan aktivitas
kekebalan
risiko infeksi

Defisiensi sel T (2)

Defisiensi sel T
(Ataxia-telangiectasia)

gangguan
produksi antibodi
gangguan aktivitas
kekebalan
risiko infeksi

Defisiensi sel T (3)

Defisiensi sel T
(Di George syndrome)

gangguan
produksi antibodi
(+/-)
gangguan
aktivitas kekebalan
risiko infeksi

Defisiensi Kombinasi
Defisiensi sel B dan T
(berat)

Down Syndrome

gangguan produksi
antibodi
gangguan aktivitas
kekebalan
resiko infeksi

Keadaan Imunodefisiensi
Imunodefisiensi primer
Lokasi

Jenis

Kontra
indikasi

Sel B
(Humoral)

X-linked ,
agammaglobulinemia

OPV, vaksin
bakteri hidup.
SP: campak&
varisela

Ig A& IgG

OPV, vaksin
hidup aman
tapi perlu SP

Efektivitas
Jelek pada semua vaksin
yang berespon humoral.
IGIV interferensi dengan
vaksin campak & mungkin
varisela.
Semua vaksin mungkin
efektif.

Keadaan Imunodefisiensi
Imunodefisiensi primer
Lokasi
Sel T
(humoral &
seluler)

Jenis
Severe
combined

Komplemen C1, C4, C2, C3,

C5-C9
properdin,
faktor B
Fagosit

K.I

Efektivitas

Semua
Jelek pada semua
vaksin hidup vaksin yang berespon
humoral dan seluler
Tidak ada
Tidak ada

Semua vaksin rutin

mungkin efektif.
Vaksin pneumokok dan
meningokok

Chronic
Vaksin
Semua vaksin rutin
granulomatous bakteri hidup mungkin efektif.
disease
Vaksin influensa
Leukocyte
direkomendasikan
adhesion
defect
Myeloperoxida
se deficiency

Keadaan Imunodefisiensi
Imunodefisiensi primer
Lokasi

Jenis

Kontra
indikasi

Efektivitas

HIV/AIDS

OPV, BCG, MMR,

varisela untuk
anak yang sangat
imunokompromais

Mungkin efektif :
MMR, varisela &
semua vaksin
tak aktif,
termasuk
influensa

Kanker
ganas,
transpantasi,
terapi dan
radiasi
imunosupre
sif

Vaksin bakteri &

virus hidup
tergantung status
imun

Efektivitas
tergantung pada
status imun

EPI Vaccines HIV-infected children

WHO recommendations for the immunization of
HIV-infected children

Vaccine

Asymptomatic
HIV infection

Symptomatic
HIV infection

Optimal timing of
immunization

BCG

Yes

No

Birth

DPT

Yes

Yes

6, 10, 14 weeks

OPV

Yes

Yes

0, 6, 10, 14 weeks

Measles

Yes

Yes

6 and 9 months

Hepatitis B

Yes

Yes

As for uninfected
children

Yellow fever

Yes

No

Modified from WHO 2001.

Notes: IPV can be used as an alternative for children with symptomatic infection

Seorang Mahasiswa Kedokteran

terekspos dengan jarum dari pasien
Apa yang harus dilakukan
..????

MANAGE OCCUPATIONAL
EXPOSURES

HUMAN IMMUNODEFICIENCY
VIRUS

Ilmu Kesehatan Anak

Fakultas Kedokteran Universitas Tarumanagara

AIDS History
Year 1981
Cases

among gay in
California and New York
Kaposi Sarkoma and
Opportunistic Infection

AIDS History
Year 1982

Guy Related Immunodeficiency

Gay-related Immune Deficiency
(GRID)
Acquired Immunodeficiency
Disease (AID)
Acquired Immunodeficiency
Syndrome (September, CDC)
Cases in Europe and Uganda

AIDS History

Year 1983
Heterosexual, Children receiving
blood product
CDC Person who are increased risk
for AIDS
Institute Pasteur, France
Lymphadenopathy Associated
Virus)

AIDS History
Year 1984
Robert Gallo : Human T
Lymphotropic Virus III
The same with LAV ??

Test to detect virus in blood

AIDS History
Year 1985
HTLV III = LAV
Pasteur Institute filed a lawsuit
against NCI

AIDS History
Year 1986
International Committee on the
Taxonomy of Virus HUMAN
IMMUNODEFICIENCY VIRUS
AZT (azidothymidine)

chimpanzee,
Pan troglodytes troglodyte

The sooty
mangabey,
Cercocebus atys

HIV CLASSIFICATION

www.avert.org/hivtypes.htm

Sequence diversity

 HIV bisa lewat Nyamuk atau Air liur

DC-SIGN (dendritic
cell)

Clinical Aplication
DC SIGN terdapat pada Kulit,
sal Pencernaan, sal Pernafasan,
peritoneum, dll
Cara penularan selain melalui gigitan
nyamuk ???

Naturally infected human tissues were positive for DV by Immunochemistry & ISH

ART

WHO Indications for ART

When CD4+ testing available:
WHO stage 3 or 4 irrespective
of CD4%
WHO stage 2 with:
CD4 < 20% for children < 18
month OR
CD4 < 15% fro children > 18
month

WHO Indications for ART

When CD4+ test is not available:
< 18 month:
WHO stage 3 or 4 irrespective of total
lymphocyte count (TLC)
WHO stage 2 with TLC < 3,400 or mother
with AIDS or died of AIDS

> 18 month
WHO stage 3 or 4 irrespective of TLC
WHO stage 2 with TLC < 2,300/mm3 (up to
6 years) or < 1,200/mm3 (more than 6
years)

ARV for treatment

Principle:
Do not start too soon or too late
Choose drug regimen wisely
Consider affordability and availability
Provide ongoing support