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TORCH
• T oksoplasma• O ther: Syphilis, Strepto Gr-B, Listeriosis• R ubella• C ytomegalovirus, Chlamydia• H erpes, HIV, HPV, H.Parvovirus B19, HBV,
HCV
SOURCE OF TORCH IN THE BODY: Live in nucleated cell only
HSV2 (Nerve)
HSV1 (Nerve)
CMV (Mucosa)
Toxoplasma (Muscle)
Rubella (Respiratory)
CLINICAL STAGES OF TORCH INFECTION
SOURCE CASE:Agent:PopulationTransmissionGeneration
EXPOSURE TO CONTACT:Intensity and duration
CONTACT:Inborn defensesImmune defenses
NO INFECTION INFECTION:Cell mediated immunityHumoral mediated “Latency, tolerance
NO DISEASE DISEASE:EarlyLate
MORFOLOGI TORCH (SKEMA)
ConoidPole-ring
Rhoptrien
Nucleus
Mitochondria
Micronemen
T. Gondii Rubella
surface and transmembrane Antigen
Nucleocapsid andssRNA genome
Herpesviridae
HSV1/2
CMV
VZV
EBV
THE ANTIBACTERIAL ROLE & EFFECT OF ANTIBODY
Antibody to
LipotheicFimbriaeCapsules
Lipid bilayer
M proteinCapsule
Toxin
Attachment
Bacterialproliferation
Phagocyteavoidance
Host damage
Toxic
Invasive
Bacterial metabolictransportand receptor
Antibody neutralize antigen
Antibody neutralize spreadingfactors, hyaluronidase
Antibody block/neutralize
X
X
X
X
X
X
X
Survival of 100 bacteria (%)
1 2 hour
100
10
1
0.1
0.01
Effect Antibody & Complement
Non Ab, non C3b(+) Ab, non C3b(+) Ab, (+) C3b
IMMUNE SYSTEM IN ACUTE INFLAMMATION
Inflammatory mediators
Injury
Antigen: Viral, Bacteria, Parasite, Fungal, Tumor
IgM/G IgE
Mast cell C3a/C5a
BradikininFibrinogen
2A2
2B43
4
1B 1A
Histamine
2B2
2B3
Tumor, Rubor, Calor, Dolor, Punctio lesie5
Ts Tc
Th
Hageman.F
B
2B1
REAKTIFASI TORCH & PENYAKIT PENYERTA LAIN PADA BERBAGAI KADAR CD4 PENDERITA
DEFISIENSI IMMUNE
• IM. NORMAL (CD4>750/UL) M.nucleosis : 4L+Mioatralgia
• DEF. DINI (CD4>500/UL, LOW-RISK, OPPORTUNITY): Autoimun.D: Ruam kulit, ITP, S.Sjogren, Guillain-Bare, Polio, Demielinisasi syaraf perifer, M.Ensefalitis, Low Re-activation TB/TORCH
• DEF.MENENGAH (CD4=200-500/UL, MIDLE OPPORTUN)
• Diare, BBturun, Lnnpatia, fever Infeksi ringan-Keganasan: 395/ul = TBC; 275/ul = HZV,HSV, K.oral, HL 240/ul = NHL
• 224/ul = Kaposi.S
• DEF. LANJUT (CD4<200/UL, AIDS-OPPORTUNISTIK) : 122/ul = P.Karinii 98/ul = Kompleks M.Avium 93/ul = E’is Toksoplasma 73/ul = M’is Kriptokokus 29/ul = Retinitis CMV
TRANSMITTY OF TORCH
TOXOPLASMA RUBELLA CMV HSV1/2 (Fecal-oral) Aerosal (In-/direct contact, (Intimate.C)
Trans-fuse/plantation)
Salad (oocyst) Droplet Sexual intercourse Sexual.IRaw meat (cyst)
Mother-baby + +, labor, lactation + labor
SEROPREVALENCE OF IgG/M ANTI-TORCH IN THE MOTHER LIVE IN INDONESIA
CITY TOKSO (%) RUBELLA CMV (%) HSV2 (%)IgG IgM IgG IgM IgG IgM IgG IgM
Jakarta 61,6 16,4 67,1 1,4 93,2 2,7 42,5 12,3Bandung 74,5 11,3 74,5 - 94,3 - 55,7 16,0Semarang 44,0 18,0 78,0 - 99,0 - 48,0 20,0Yogyakarta 55,4 16,3 79,4 - 98,9 - 44,6 28,3Surabaya 55,5 18,8 77,2 1,0 99,0 - 39,6 16,8Denpasar 23,0 5,0 78,0 3,0 98,0 - 56,0 21,0
National 52,1 14,2 76,1 0,9 97,2 0,4 48,1 19,2
SEROPREVALENCE OF IgG ANTI TOKSOPLASMA IN MAMALIA IN INDONESIA
• Goat Cat Dog Fog
• (%) (%) (%) (%)
• Kalimantan 61,0 - - -
• Lampung 47,5 9,0 - -
• Sumut 23,5 3,3 - -
• Tuban 20,6 - - -
• Gresik 20,0 - - -
• Jakarta - 72,7 75,6 -
• Jabar - - - 51,0
• Irian - - - 50,0
• Yogya 50 - - 40,0
• National 20-61 3-73 - 40-50
CMV: Viral excretion from assymptomayic persons
• Neonatus Child Adult• (%) (%) (%)
• Urine 0,5-2,5 10-29 0-2• Oral secrete 0,5-2,5 10-29 0-2• Cement - - 5-10• Cervical secrete - - 10-
28• Milk - - 13-27
MODE OF TORCH INFECTION IN THE FETUS AND NEWBORN
• Fetus Newborn• Transplacental During birth Shortly after
birth
• Toksoplasma ++ - -
• Rubella ++ - -
• Cytomegalo + ++ ++/Milk
• Herpes + ++ +
MOST FREQUENT PHYSICAL SIGNS OF SEVERE CONGENITAL TORCH INFECTION
DEFECT TOK RUB CMV HSV2Apparent at birthMicrocephaly + + + +Intracranial calcification + - + -Pneumonitis + + + +Hepatosplenomegaly, Icteric + + + +Trombocytopenia, Petechial, + + + +Purpura, HaemorraghesChoroidoretinitis + + + -Cataracts + + - -Glaucoma - + - -Patent ductus arteriosus/PDA - + - -Bone defect +Skin vesicles - - - +Apparaent months/years after birthSensorineural deafness, Mental.R + + + -Diabetes Mellitus - + - -
FREQUENCY ORGAN YANG TERLIBAT
BBL Rendah 60% Hepatomegali 65%Abnormal lipat palmar 45% Splenomegali 60%Pneumonia 15% Ikterik 15%
Anemia hemolitik 13%Kardiovaskuler(MI,Septal,Stenosis,PDA) 70% Trombositopenia 50%
Mata 77% Tuli 50%Katarak bilateral 30% Retardasi 40%Retinopatia 25% Protein liquor > 5%Mikroptalmia 10% Mikrosefal 2%Opasitas kornea 7% Radioluscent femur,tibia 35%Glaukoma 5%
RELATIONSHIP BETWEEN SEVERITY CONGENITAL TOXOPLASMOSE and TIME OF INFECTION IN THE GRAVID
Infection risk in fetus X Severity of congenital defect in fetus
A. Increase of trimester in the gravid , increase the risk of fetus to infectedB. More early infection in the fetus, more severe congenital defect in the fetus
TOKSOPLASMOSETIME OF INFECTION Infected Fetus Severe (%) Mild/Non-
(%) symptom (%)
1st Trimester 25 60 402nd Trimester 54 30 703th Trimester 65 0 100
SEVERITY OF CONGENITAL DEFECT IN THE FETUS BY TIME OF RUBELA INFECTION IN THE GRAVID
Umur % Janin % JaninKehamilan terinfeksi Cacat
<11W 90 9011-12W 67 3313-14W 67 1115-16W 47 2417-18W 39 Fetal.D19-22W 34 and23-26W 25 Sequele27-28W 12 -7 Bulan 35 -8 Bulan 60 -9 Bulan 100 -
CLINICAL MANIFESTATION OF CMV INFECTION
TISSUE CHLIDREN/ADULT AIDS
Eyes - ChorioretinitisLung - PneumoniaGIT - EsophagocolitisNervous system Polineuromyelitis MeningoencephalisLymphoid system MI Lpenia, limfositosisMajor organ Carditis HepatitisDiseases Subclinic Severe, generalized
Re-/1st INFECTION REACTIVATIONTransfusion Old ageContact Hydraemia
AIDS/TransplantationChronic diseases
METHODS FOR TORCH DETECTION
Toxo Rub CMV HSV1/2HA inhibition/HAI, Passive HA - + - -Latex agglutination - + - -Neutralization test - + - -Fluorescent immuno assay/FIA - + - -Anticomplement IFA - + - -
Sabin-feldman dye test + - - -Indirect HA assay/IHA + - + -Complemen fixation/CF + - + +
Indirect fluorescent assay/IFA + - - -RIA, EIA + + + +EIA capture, ISAGA + + - -
BASIC TO TORCH DETECTION BY SENSITIVITY
Microscope105/mlPCR1/ml Culture 104/ml 1,2,3,4 Serologic 10,4,3,2,1/ml
1 Particle MO Detection
4 Antigen Detection
4 IgM anti MO Detection
4x5=20 IgG antiMO Detection
4x5x4=80 IgG EIAanti MO Detection
2n PCR gene
KINETICK OF SEROLOGIC MARKER IN TORCH INFECTION
.0 .3 .6 .12 .24 Months
IgE anti-TORCH
IgA
IgM
IgG IgG high avidity
IgG low avidity
1st Infection
PREVALENCE OF TOXOPLASMA AMONG PREGNANT WOMEN FROM DIFFERENT PARTS OF THE WORLD
TORCH PRENATAL/MARITAL CARE PLUS
Jan
R
Feb
R
Mar
R
Apr
R
Mei
R
JunS
R
Jul
R
AgtS
R
Sep
R
OktS
R
Nov
R
DesS
R
Ket
G/MTox
G/MRub
G/Mcmv
G/MHsv
G/MAca
Ket