Beruflich Dokumente
Kultur Dokumente
KULIT
Modul Kulit & Jaringan
Penunjang
References:
Jawetz, Melnick, and Adelbergs : Medical
Microbiology, ed. 23, Appleton and Lange,
California, 2003 (chapters 33, 34, 43)
PORT DE ENTREE
Mild trauma
Virus group Produce local symptoms at Produce generalized infection
portal of entry
+ specific organ diseases
Papillomavirus
most types
Injection
Virus group Produce local symptoms at
Produce generalized infection
portal of entry
+ specific organ diseases
Hepadnavirus
Hepatitis B virus
Flavivirus
Hepatitis C virus
Retrovirus
HIV
Bites
Virus group
Produce local symptoms at
Produce generalized infection
portal of entry
+ specific organ diseases
Flavivirus
Rhabdovirus
dengue virus
yellow fever virus
rabies virus
Virus
Route of infection
Respiratory
Rubella
Respiratory, transplacental
Togaviridae
Respiratory
Roseolovirus
Oral secretions
(Herpesviridae)
HERPESVIRIDAE
Ukuran besar (120-200nm), berselubung, ikosahedral,
double-stranded DNA
HERPESVIRIDAE
Early proteins
Late proteins
HERPESVIRIDAE (1)
Karakteristik
Menyebabkan infeksi laten
Bertahan pada pasien terinfeksi dorman
Reaktivasi oleh immnuosupresi
Herpesviruses
Primary target Site of
Cells
Latency
Alphaherpesvirinae
Herpes simplex type 1
Mucoepithelial
Mucoepithelial
Means of
spread
Neuron
Neuron
(sexually transmitted)
Mucoepithelial
Neuron
Close contact
B cells &
B cells
epithelial cells
B cells &other cells
B cells
saliva?
Close contact
Close contact
Respiratory and
Saliva
Close contacts (sexual),
Betaherpesvirinae
Cytomegalovirus
Monocytes, lympomonocytes.
Close contacts, transfussion,
cytes, epithelial cells lymphcytes
Tissue transplants,
and?
Transplacental
Herpes lymphotropic
T cells and?
T cells & ?
Respiratory & close contac
virus
Human herpesvirus 7
T cells and?
T cells & ?
?
10
11
HSV-1
Site of latency
ganglia
HSV-2
Trigeminal ganglia
Sacral
Young adults
Sexual
12
MEKANISME PENYAKIT
Kontak langsung
Kelainan sitopatologi
Terhindar dari antibodi penyebaran via sel
pembentukan sinsitia
Bersifat laten di neuron
Reaktivasi imunosupresi, stress
Cell mediated immunity resolusi
Cell mediated immunopathologic gejala
13
PATHOGENESIS
14
15
Keratoconjunctivitis
Herpetic whitlow
Herpetic whitlow,
nurses and doctors
Primary infection of the skin,
by direct contact to any part of body
Stomatitis with secondary lesion
on skin, the face, neck and chest
Hepes simplex
mimicking
herpes zoster
Recurrent infection
vesicles on
an erythematous
base, pustules,
heal without scars
17
on the vulva of an
adult woman
18
Laboratory diagnosis
Cytopathology
19
Serology
Antibodi muncul 4-7 hari setelah infeksi, puncak 2-4
minggu
Digunakan untuk studi epidemiologi
20
Tatalaksana
21
Pencegahan
Tenaga kesehatan:
Menggunakan hand scoen, mencuci tangan dengan sabun
22
23
HISTOLOGI VESIKEL
A= VESIKEL INTRAEPIDERMAL
B= SEL RAKSASA BERINTI BANYA
C= DERMIS
24
25
26
Varicella-zoster virus
27
Lymphatics
Liver, spleen,
RES
Viremia
Fever
Malaise
Headache
Skin
Vesicle proggression:
Macule
Papule
Vesicle
Pustule
crust
Latency in neurons
28
Zoster (shingles)
Karakteristik : erupsi kulit terbatas satu gangglion
sensorik
Lesi sama dengan varicella
29
30
Rekuren imunosupresi
31
32
Laboratorium
Cytology : similar to HSV
Tzanck smear
Imunofluoresen
33
35
36
Tatalaksana
Anak tidak diperlukan terapi
Dewasa dan pasien dengan imunosupresi atau infeksi
herpes zoster
Antiviral : acyclovir, famciclovir, valacyclovir
37
Epidemiologi
Tersebar luas
Varicella menyebar melalui udara dan kontak langsung
38
39
Human papillomavirus
- >100 types
HPV genome :
- dsDNA, circular
- regulatory region, early and
late
genes
40
HPV proteins
Protein
Function
E1
Binds DNA at ori, has helicase activity,
promotes viral DNA replication
E2
Binds DNA, helps E1, regulates mRNA synthesis
E4
Disrupts cytokeratin to promote release
E5
activates EGF receptor to promote growth
E6
binds to tumor supressor protein p53
E7
binds to tumor supressor protein p105RB
41
Replikasi
virus:
HPV tidak dapat
dikultur pada
jaringan
monolayer
HPV hanya dapat
dikultur pada
kultur
keratinocyte
cultured on raft
system
42
Replikasi Virus
Immune response
Innate dan cell mediated immunity penting untuk mengontrol
HPV; Koilocytes HPV bersembunyi
43
HPV types
Rare
Cutaneous syndromes
Plantar wart
1,2
Common wart
2,4
Flat wart
3, 10
Epidermodysplasia
5, 8, 17
verruciformis
20, 36
Mucosal syndromes
Laryngeal papilloma
Oral papilloma
6,
Conjunctival papilloma
Condyloma acuminatum
Cervical intraepithelial
44
neoplasia, cancer
4, 63
1,7,26,29
27, 28, 41
9, 12, 14, 15, 19
21-25, 38, 47, 50
6, 11
11
6, 11
16, 18
2, 16
1, 2, 10, 16, 30, 44, 45
11, 31, 33, 35, 42-
44
Oncogenic potential :
High risk HPV
types 16, 18, 30, 31, 33,
35, 39, 45, 51, 52, 56
(cervical cancer)
Types 5, 8, etc (skin
cancer)
HPV oncogene is
necessary but not
sufficient to cause cancer
Inoculation of
epithelium
Wart
Resolution
(latency)
Hand, foot,
throat, cervix
Local
multiplication
46
CLINICAL SYNDROMES
Skin warts
Usually on the hands and feet
Occur frequently in childhood or early adolescence
Deep plantar warts (verrucae plantaris), common
warts
(verrucae vulgaris), plane warts (verrucae planae).
Usually asymptomatic, although they may bleed &
can
be painful when located over weight bearing surface
or
point of friction.
Spontaneous resolution in 50% and 90% of children
whithin 1 and 5 years, respectively.
47
Epidermodysplasia verruciformis
- An autosomal recessive genodermatosis linked to gene
loci on chromosome 17
- Associated with many HPV types, mainly types :
2,3,10,5,,9,12,14,15, 17
- May resemble flat warts but more commonly resemble
Pithyasis versicolor, covering the torso and upper
extremities
- Mostly appear tn the first decade of life
- Highly correlated with malignant transformation, especially
in sun-exposed area
- Lesions are not contagious to healthy individuals.
48
GEJALA KLINIK
Anogenital warts
Genital warts (condyloma acuminata) terjadi pada epitelium
genitalia eksterna dan area perianal
90% disebabkan HPV tipe 6 dan 11
Jarang menjadi maligna
in situ cancer
49
50
Flat wart
FLAT WARTS
Condyloma acuminata
Genital warts
51
Patogenesis HPV
52
Diagnosis
Laboratorium:
Mendeteksi HPV dan
high risk HPV
Cytology
(keilocytotic
cells)
Electron Microscope
Immunofluorescent
dan immunostaining
Nucleic acid
hybridization
Polymerase chain
reaction (PCR)
PCR and hybridization
:
for type
determination
53
54
Terapi
Pembedahan
Caustic agents
Cryotherapy
DNA synthesis inhibitor(5-fluorouracil)
Pencegahan
Kontak langsung
Vaccine :
- Empty virus-like particle consist of L1 & L2 protein
- Bivalent (HPV-16 & 18), or tetravalent (HPV-16,18, 6,11)
- Prophylactic
Vaccine for cutaneous HPV is not yet available
55
POXVIRUS
56
POXVIRUSES
Orthopoxvirus
Parapoxvirus
57
MEMBERS
VIRUS
GENUS
Orthopoxvirus
Parapoxvirus
Moluscipoxvirus
Yatapoxvirus
PRIMARY HOST
Variola
Human
Vaccinia
Vaccine strain/human
Buffalopox
Water buffalo
Monkeypox
MOnkey
Cowpox
Cow
Orf
Sheep
Pseudopoxvirus
Cow
Bovine papular
stomatitis
Molluscum
contagiosum
Tanapox
Cow
Yabapox
Monkey
Human
Monkey
58
59
STRUKTUR
Virus terbesar dan komplek
Virion : oval atau brick-shaped, 400nm x 230 nm,
Genome : double-stranded DNA, linear
Proteins : lebih dari 100 polypeptides, banyak enzim
terdapat di inti, termasuk sistem transkripsi
60
POXVIRIDAE
Molluscum contagiosum
Genus : Molluscipoxvirus
61
Replikasi Poxvirus
62
63
Virus
Inhalation or
Transmission by scabs
(less effective)
Lymph nodes
Multiplication in
upper respiratory tract
Lymphatics
(macrophages)
GEJALA KLINIK
Smallpox
Inkubasi 5-17 hari
Variola major : mortality 15% - 40%
Variola minor : mortality ~1%
Febris, sakit kepala, nyeri punggung
Karakteristik lesi:
- Lesi dalam stadiumyang sama
- Sentrifugal
Involvement of visceral organ : spleen, liver, lung
66
Molluscum contagiosum
Inkubasi : 2 8 minggu
Kontak langsung
Lesi : nodular to wartlike : papul jernih
(pearly), umbilicated nodules
Predileksi : Trunk, genitalia dan ekstremitas
proximal
Molluscum contagiosum
epidermal keratinocyte
hypertrophy basal cell
hyperplasia,
in AIDS patient can be
generalize and recurrent
67
68
69
IMMUNITAS
70
LABORATORY DIAGNOSIS
Isolation and identification of virus
71
Electron microscopy
Viral antigen detection
PCR
Serology
Cannot differentiated orthopoxviruses
Antibodies appear the first week of infection
HI, Nt, ELISA, RIA, Immunofluorescence
72
TREATMENT
Vaccinia immunoglobulin
- Indication : accidental inoculation of
vaccine in the eye or
eczema
vaccinatum
73
Time of vaccination :
- 1st : between 1 2 y.o.
- Revaccination : 3 years interval
Reactions of vaccination
Complication of vaccination
74
Selamat belajar
75