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7/25/2019 Bahan Infeksi TORCH
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DETEKSI INFEKSI DENGAN
IMUNOSEROLOGI
STEFANUS LEMBAR
BLOK KONSEP PATOLOGI 3
21 DESEMBER 2013
7/25/2019 Bahan Infeksi TORCH
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PENDAHULUAN
Kultur mikroorg!i"m# m"i$
m#ru%k! gol& "t!&r& u!tuk
&ig!o"tik %#!'kit i!(#k"i1)*0 &! 1)+0! &ik#m,!gk! t#k!ik
"#rologi -Ou&i! &! Ou.$t#rlo!'/
Ko!"#% imu!ologi -(ik""i kom%l#m#!RIA EIA &ll/
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PENDAHULUAN
R#"%o!" imu! &im#&i"i !ti,o&i '!g
&i"#kr#"ik! ol#$ "#l lim(o"it B
P#!g#!l! !tig#! "#.r "%#"i(ik"u&$ &imiliki "#k l$ir "m%i
"#lm $i&u%!'
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PENDAHULUAN
r k#r !ti,o&iM#l#kt %& %#rmuk! %tog#! gr
l#,i$ &%t &it#rim ol#$ (go"it-o%"o!i""i/
B#rikt! &! m#!g$l!gi r#"#%tor
%#rmuk! %& "#l $o"%#" -!#trli""i/
M#l#kt %& %#rmuk! %tog#! &!
,#r%#r! &lm m#!g$!.urk! 4i "i"t#m
kom%l#m#! -(ik""i kom%l#m#!/
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RESPONS IMUN
BAGAIMANA APLIKASI KLINIK
PEMERIKSAAN RESPONS IMUN UTK
DIAGNOSTIK INFEKSI????
BAGAIMANA IgM DAN IgG
DIBEDAKAN?
7/25/2019 Bahan Infeksi TORCH
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[TOKSOPLASMA, RUBELA, CITOMEGALOVIRUS
AN HERPES 1,2]
TORCH
7/25/2019 Bahan Infeksi TORCH
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ETIOLOGI
To6o%l"m go!&ii o,ligt# i!tr.#llul#r
%roto7o "%oro7o8
9iru" Ru,#ll (mili Tog4iru"89iru" 'tom#glo4iru" (mili :#r%#" 9iru"8
9iru" :#r%#" Sim%l#6 (mili :#r%#" 9iru" :S9 ti%# 1 m#!'#,,k! i!(#k"i %& tu,u$
,gi! t" "#%#rti gi!ggi4o"tomtiti" (ri!giti"k#rtoko!u!gti4iti" &! #!"#(liti"8
:S9 ti%# 2 m#!'#,,k! $#r%#" g#!itli"8
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GEJALA KLINIK
1/ DE;ASA A"im%tomtik tu i!(#k"i ri!g!
&#mm %#m,#"r! KGB #rit#m %& kulit
-ru,#ll/ $#%titi" -M9/8
2/ ;ANITA :AMIL i!(#k"i i!trut#ri! -k#gugur!
l$ir mti ..t ,5! i!(#k"i ko!g#!itl/8
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DIAGNOSIS
18 KULTUR i"ol"i %roto7o < 4iru" &lm
&r$ &! .ir! tu,u$ li!8
28 SEROLOGI tit#r !ti,o&i &lm "#rum8
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PEMERIKSAAN SEROLOGI (2)
A&!' !ti,o&i t#r$&% mikroorg!i"m# t#rt#!tu
m#!u!ukk! "#"#or!g "#&!g i!(#k"i %#r!$
t#ri!(#k"i tu %#r!$ &i4k"i!"i &#!g!mikroorg!i"m# t#r"#,ut8
P& i!(#k"i kro!ik ui "#rologi tu!ggl u!tuk
m#!#!tuk! !ti,o&i &%t &i%ki u!tuk m#!u!!g
&ig!o"i"8 S#&!gk! %& i!(#k"i kut &i%#rluk! ui
g!& &#!g! !gk 5ktu 1* = 21 $ri8
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PEMERIKSAAN ANTIBODI
TORCH ( Ig M aa! Ig G ) (")
I!(#k"i i!trut#ri! m#!'#,,k! !i! m#m,#!tuk
IgM "%#"i(ik "#$i!gg &!' IgM "%#"i(ik &i &lm
&r$ ,'i m#!u!ukk! i!(#k"i ko!g#!itl8
IgG "%#"i(ik ,ru t#r,#!tuk "#g#r "#t#l$ l$irIgG t#r"#,ut "ukr &i,#&k! &ri IgG "%#"i(ik '!g
,#r"l &ri i,u8
Ol#$ kr#! IgG "%#"i(ik '!g ,#r"l &ri i,um#m%u!'i 5ktu %ru$ kir = kir 1 ,ul! mk
&!' IgG "%#"i(ik &i &lm &r$ ,'i '!g
k&r!' m#!#t% "#lm 2 = 3 ,ul! tu
m#!i!gkt m#!u!ukk! i!(#k"i ko!g#!itl8
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INDIKASI PEMERIKSAAN
ANTIBODI TERHADAP TORCH
1/ P& 5!it $mil u!tuk m#!#!tuk! i!(#k"i
kut
) S#roko!4#r"i &ri ->/ m#!&i -@/
) K#!ik! tit#r IgG "#,!'k * kli tu l#,i$
) IgM -@/
2/ P& ,'i u!tuk m#!#!tuk! i!(#k"i ko!g#!itl
) Tit#r IgG m#!#t% tu m#!i!gkt) IgM -@/
3/ U!tuk m#!#!tuk! "ttu" k#k#,l! &!
k#,#r$"il! imu!i""i -Ru,#ll/8
7/25/2019 Bahan Infeksi TORCH
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RUBELLA
P#m#rik"! !ti,o&i t#r$&% Ru,#ll -IgG
&! tu IgM/8
IgM tim,ul %& "t tim,ul!' g#lm#!.%i %u!.k &lm 5ktu 10 $ri &!
k#mu&i! m#!g$il!g "#t#l$ +0 $ri8
IgG tim,ul 1 mi!ggu "#t#l$ tim,ul!' g#l
m#!.%i %u!.k &lm 5ktu 1 = 2 mi!ggu &!
k! m#!#t% "m%i ,#,#r% t$u!8
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AIDS
( AC&UIRED IMMUNODEFFICIENC$
S$NDROME ) A&l$ kum%ul! g#l '!g &i"#,,k! ol#$
i!(#k"i 4iru" :I9 '!g m#ru"k T $#l%#r .#ll" -"#l T
%#!olo!g/8 Dik#!l 2 ti%# :I9 'itu :I9 1 &! :I9
28 K#&u!' m#m%u!'i "truktur '!g miri% "tu
"m li!8
Struktur i!i t#r&iri &ri .or# -i!ti/ &! #!4#lo%#
-"#lu,u!g/8 P& i!&i4i&u '!g t#ri!(#k"i :I9 !ti>.or# tim,ul t#rl#,i$ &$ulu &iikuti &#!g!
tim,ul!' !ti>#!4#lo%#8 B#,#r% %rot#i! .or#
&! #!4#lo%# i!i &i&ik! %#g!g! &lm
&ig!o"i" l,ortorium8
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PEMERIKSAAN LABORATORIUM (1)
U!tuk %#m#rik"! %#!'ri!g &ilkuk! t#" Eli"u!tuk m#!&#t#k"i !ti :I98 A!ti :I9 %o"iti( %&
or!g '!g "#$t "#.r kli!i" &%t ,#rrti
I!(#k"i :I9 "u,kli!i"
rri#r
Po"iti( %l"u
U!tuk ko!(irm"i &ilkuk! %#m#rik"! !ti :I9
.r ;#"t#r! Blotti!g8 D#!g! .r i!i &%t&ili$t &!' !ti %2* tu%u! !ti g%*1 &ll8
U!tuk &ig!o"i" %"ti &i.ri &!' 4iru" &lm
&r$8
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PEMERIKSAAN LABORATORIUM (2)
P& %#!&#rit "#ro%o"iti( %#rlu &ilkuk!
%#m!tu! t#ru" kr#! g#l ,ru tim,ul
"#t#l$ ,#,#r% t$u! "#$i!gg or!g i!i &%tm#!&i "um,#r %#!ulr!8
P& (ull,lo5! AIDS "#ri!g t#r&i i!(#k"i
o%ortu!i"tik &! k#g!"! "#$i!gg
%#m#rik"! l,ortorium ug %#rlu &ir$k!u!tuk m#!.ri &!' i!(#k"i &! k#g!"!
t#r"#,ut8
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DEMAM TIFOID
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PATOGENESIS
Bik %& t'%$oi& mu%u! %& #!t#ri. (#4#r
i!(#k"i muli t#r&i %& u"u" $lu" &#!g!
g#l g"troi!t#"ti!l '!g mi!iml8 Org!i"m#t#r"#,ut m"uk &! m#m%#r,!'k &iri &lm
mkro(g &i %lu# P#'#ri k#mu&i! m#!'#,r
k# $ti k!&u!g #m%#&u &! lim%8 S#t#l$ itu
k! t#r&i ,kt#ri#mi &i"#rti &#mm &!g#l li!!' k#mu!gki!! &i"#,,k! ol#$
#!&otok"i!8
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GAMBARAN KLINIS
G#l %#rtm ,i"!' &#mm &!ko!"ti%"i8 S#t#l$ 1 mi!ggu &#!g!
&!' ,kt#ri#mi tim,ul &#mm
ti!ggi "kit k#%l "%l#!om#gli &!
l#uko%#!i8
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MANIFESTASI IMUNOLOGIK (2)
B#r,gi (ktor m#m%#!gru$i m!i(#"t"i
i!i "#$i!gg m#m%#r"ulit $"il t#" "#rologi8
Fktor = (ktor i!i !tr li! St&ium %#!'kit
Tit#r ,"i" '!g ti!ggi &i &#r$ #!&#mik
tu kr#! 4k"i!"i
R#k"i "il!g
P#!go,t! &#!g! !ti,iotik "#,#lum
%#m#rik"! &ilkuk!
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DIAGNOSIS LABORATORIUM (2)
K#!ik! tit#r 7t !ti "#,#"r * kli tu
l#,i$ m#m,#rik! i!&ik"i &!' &#mm
t'%$oi&8 S#li! itu ,il tit#r !ti O l#,i$
,#"r &ri 1<1?0 ug m#!'oko!g &!'
i!(#k"i Slmo!#ll t#t%i %#rlu &i%#r$tik!
(ktor = (ktor '!g t&i t#l$ &i"#,utk!8K#!ik! tit#r !ti O l#,i$ ,#rmk! &ri
!ti : kr#! %& 4k"i!"i tit#r !ti : i!i
m#!i!gkt8
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SEPSIS
o Norml ti&k & mikroorg!i"m# &i &lmlir! &r$8 Klu & mikroorg!i"m#
%#!'#,, &ik#!l &!' 4ir#mi ,kt#ri#mi
(u!g#mi &! %r"it#mi8
) S#%"i" tu "#%tik#mi &l$ i"til$ '!g
m#!ggm,rk! g#l kli!i" ki,t #!&otok"i!
'!g &ik#lurk! ol#$ ,kt#ri8 K#&! i!i
&%t &i"#rti tu t!% &i"#rti &!',kt#ri &lm "irkul"i &r$ -,kt#ri#mi/8
) P& "#%"i" &ium%i &!' &#mm
m#!ggigil $i%ot#!"i $i%ot#rmi &! r#!t!8
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DIAGNOSIS
Dig!o"i" "#%"i" &ilkuk! ,#r&"rk! g#l
kli!i" "#rt %#m#rik"! l,ortorik8 U!tuk
m#!.ri ,kt#ri %#!'#,, "#%"i" &ilkuk!
,ik! &r$ 5lu%u! %#rlu &ii!gt ,$5ti&k "#mu "#%"i" &i"#rti ,kt#ri#mi8
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DENGUE HEMORRHAGIC
FEVER
D:F m#ru%k! %#!'kit m#!ulr '!g
&i"#,,k! ol#$ i!(#k"i 4iru" -Art$ro%o&#
Bor!# 9iru"/8 P#!ulr! t#r&i m#llui
gigit! !'muk A#&#" #g'%ti tu A#&#"l,o%i.tu"8
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GAMBARAN SEROLOGIK
9ir#mi tu &!' 4iru" &lm lir! &r$
k! ,#rl!g"u!g "#lm 1 mi!ggu8 P& 5l
%#!'kit k! &i,#!tuk IgM !ti D#!gu# t#t%i$!' u!tuk 5ktu "i!gkt8 S#l!ut!' k!
&i,#!tuk IgG8 A!ti,o&i t#r$&% D#!gu# &%t
&i&#t#k"i &#!g! ,#r,gi .r
N#utrli7tio! t#"t T#" $m,t! gluti!"i
om%l#m#!t (i6tio! t#"t
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DIAGNOSIS LABORATORIUM
Dig!o"i" l,ortorium &ituuk! u!tuk m#!&#t#k"i
!ti,o&i "%#"i(ik -%#m#rik"! "#rologi"/ &! u!tuk
m#!gi"ol"i 4iru" "#rt m#!gi&#!ti(ik"i 4iru"8
P#m#rik"! "#rologi" '!g %li!g &%t
&i%#r.' &l$ ui !#trli""i8 Ui i!i &%t
&ilkuk! "#.r i!4i4o m#!ggu!k! "u.kli!g
mi.# tu "#.r i!4i4o &#!g! ,ik! ri!g!8 Ak$ir = k$ir i!i t#l$ &ik#m,!gk! t#" Eli" '!g
&%t m#!&#t#k"i IgM !ti D#!gu# mu%u! IgG
!ti D#!gu#8
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I*!-.g/.0!/- a-g 0''a-
3a/a* '+.-+ *!- 'a4+ *'
a3a/a,518 Ig G
28 Ig A
38 Ig M
*8 Ig D
+8 Ig E
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S'.4.-9'+ !-!4 IgG a3a -7'4+
TORCH a3a/a, 4'-a4a- IgG ::# 3a
' IgG +'*!/a;
18 2
28 3
38 *
*8 +
+8 ?
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M'.3' '*'4+aa- a-g
0'!8!a- !-!4 4.-7*a+ ,a+/
a- HIV18 #li"
28 5#"t#r! ,lotti!g
38 S$out#! ,otti!g
*8 i"ol"i 4iru"
+8 PR
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Dag-.++ a+ 3'*a* ,.3
a3a/a,5
18 5i&l
28 kultur "lmo!#ll
38 Ig M "lmo!#ll
*8 kogul"i
+8 !#trli""i
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P'-'0a0 !a*a 3'*a* ,.3
18 S$ig#ll "%
28 Kl#,"i#ll "%
38 P!#umokoku"
*8 Slmo!#ll "%
+8 A.i!#to,.t#r "%
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$a-g 0!4a- *'!a4a-
-''a+ a-g 0'-a ',a3a
,a+/ a- HIV < a3a/a,5
18 Kri#r
28 Po"iti( %l"u
38 I!(#k"i "u,kli!i"
*8 I!&#t#rmi!t#
+8 M#miliki k#k#,l!
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I*!-.g/.0!/- a-g *'*/4
*a4-a 4/-4 +'=aa !g'-+a+
a3a DHF a3a/a,518 Ig G
28 Ig A
38 Ig M
*8 Ig D
+8 Ig E
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I*!-.g/.0!/- a-g *'*/4
*a4-a 4/-4 a3a -7'4+ TORCH
a3a/a,5
18 Ig G
28 Ig A
38 Ig M
*8 Ig D
+8 Ig E