MUMPS

Laboratory of Microbiology
Faculty of Medicine
Brawijaya University
 MUMPS ( gondong )
• Mumps is an acute viral infection
• Paramyxoviruses family infectious parotitis
suggests,
• characterized by swelling, more commonly
bilateral than unilateral of the parotid salivary
glands.
• The incubation period is 14-21 days and is
communicable from 6 days before to 9 days (
infeksius ) after facial swelling is apparent. It can
lead to brain inflammation, deafness or sterility.
• Menyerang anak2 <1th ( jarang )
• Preschool age ( 2-3 th )
• School age ( TK – SD )
• Bilateral lebih parah
• Low grade fever ( sumer )
• Sering pada parotis di bawah telinga, bisa di
submax & submand
• Sebelum bengkak sudah bisa ditularkan (
infeksius )  air ludah
Data on Mumps
 Mumps belongs to Paramyxoviridae
• Viruses in the family Paramyxoviridae are
classified in two subfamilies,
Paramyxovirinae and Pneumovirinae 
pneumonia
• The latter subfamily contains two genera,
Pneumovirus and Metapneumovirus. The
number of genera in the Paramyxovirinae
was increased in 2002 from three
(Respirovirus, Morbillivirus ( campak ) and
Rubulavirus) to five by the addition of two
new genera, Avulavirus and Henipavirus.
• Henipavirus ~ nippah virus, hendra virus (
australia )  menyerang kuda di sungai nipah
mortalitas sangat tinggi, lebih bahaya dari HIV! 
pneumonia yg sangat fatal, belum ada antivirus (
penyebaran melalui kelelawar/fruitbat )
• Isolasi  pake BSL tipe 3 ( ruangan khusus ky
laminer tp untuk yg infeksius )
ORTHOMYXO / PARAMYXO
Viruses
• Single stranded
• RNAvi sangat Mudah mutasi
• ParamyxoVi tidak terlalu banyak mutasi
dibanding influenza virus
• Spike  neuraminidase, hemaglutinin untuk
perlekatan
 Mumps belongs to Paramyxoviridae

• Looks similar to Orthomyxovirus,

• Larger in size, more pleomorphic ( bervariasi )
• Spherical in shape 100 to 300 nm
• Some times appear as filamentous ( sprti
benang ),giant forms are present.
• But contains only single stranded RNA.
• Do not contain segmented RNA like
Orthomyxoviruses, Antigenic variation:
absent.
• Reassortments like Influenzae viruses: ABSENT.
Hostnya adalah burung2 yang suka migrasi (
reservoir host ), hewan lain sbg pabrik
Swine ~ sebagai mesin genetik dalam tubuh
babi terjadi reassortments  gabungin gen flu
dari burung yg mengandung virus & gen flu dari
manusia  muncul virus flu baru krn dicaampur
dg gen flu babi  masuk lagi ke manusia ( flu
babi )
Banyak macemnya flu babi krn ada kemampuan
reassortments
 Properties of MUMPS virus.

• Posses HN and F
properties.
• Growth in Chick Embryos,
in the amniotic cavity,
adopts in allantoic cavity,
• Cell cultures – Primary
Monkey kidney,
• Typical Paramyxoviruses,
produce cytopathic effects.
 MUMPS virus

• Tidak bisa dibiakkan di medium padat

• Komponen virus di  disuntik ke cav amnion
cytopathic effect yg dilihat
• Kultur sel  kera makak? Kera  reservoir host
HIV
 Involvement of Salivary Glands

• Painful swelling of the

salivary glands
(classically the parotid
gland is the most
typical presentation)
• Painful testicular
swelling (orchitis) and
rash may also occur
• Bells palcy ~ kelumpuhan saraf sementara
krn bengkak  N7 kena ( kecepit )
• Otot masetter bisa terlibat  tidak bisa
mecucu , kalo minum tidak bisa simetris,
air liur menetes spontan
Involvement of Parotid Gland a Major
Manifestation

• Swelling of the salivary

glands follows these
symptoms. Swelling of the
glands near the jaw line
below the ears may give
"chipmunk cheeks”
 Mumps
• Acute viral illness

• Parotitis and orchitis described by Hippocrates in

5th century B.C.

• Viral etiology described by Johnson and Good Pasture in

1934

• Frequent cause of outbreaks among military personnel in

prevaccine era
Mumbling speech ( susah bicara )-
Mumps
• Name "mumps"
comes from an
old word for
"lump" or an old
word for
"mumble."
Pathogenesis - Mumps
• Respiratory transmission
of virus
• Replication in
nasopharynx and
regional lymph
nodes
• Viremia 12-25 days after
exposure with spread to
tissues ( telinga, otak,
testis, ovari )
• Multiple tissues infected
during viremia
Mumps Clinical Features • Incubation period 14-18
days
• Nonspecific prodrome
of myalgia, malaise,
headache, low-grade
fever
• Parotitis in 30%-40%
• Up to 20% of infections
asymptomatic
• Kalo pada laki-laki cek jg
testisnya, biasanya kalo
parotis kiri yg kena,
testis kiri kena (
unilateral )
 Mumps Clinical Case Definition

• Acute onset of
unilateral or bilateral
tender, self-limited
swelling of the parotid
or other salivary gland
lasting more than 2
days without other
apparent cause
Immunity

• Antibodies are
produced against the
S and V surface
antigens.
• Mumps rare before 6
months of age.
Karena masih ada Ab
protektif dari ibu
 Complication with MUMPS.
• Epididymoorchitis.
• May lead to atrophy, sterility, low sperm counts. 
Tergantung dg viremianya berat ga?
• CNS involvement in 60% cases
• May manifest with aseptic meningitis.
• Deafness. ( jarang )  sensori neural uni/bilateral,
bisa sembuh/permanent
• Arthritis, oophoritis ( ovari ), nephritis and
myocarditis.(jarang)
• Untuk cegah komplikasi ya tergantung
viremianya, harus cepet dibasmi virusnya
dengan tx suportif
• Kalo demam ya kasi PCL, nutrisi dll
 Complication with MUMPS.
• Orchitis. This inflammatory condition causes
swelling of one or both testicles. Orchitis is
painful.
• Pancreatitis  life threatening! ( jrg )
• Encephalitis. A viral infection, such as mumps,
can lead to inflammation of the brain
(encephalitis). Although it's serious,
encephalitis is a rare complication of mumps.
 Complication with MUMPS.

• Meningitis. Meningitis is infection and

inflammation of the membranes and fluid
surrounding your brain and spinal cord.
• Inflammation of the ovaries. Pain in the lower
abdomen in women may be a symptom of this
problem. Fertility doesn't seem to be affected.
• Hearing loss. ( SNHL )
• Miscarriages  abortus
 Laboratory Diagnosis
• No Laboratory confirmation needed.
• Atypical infection needs laboratory diagnosis.
• Virus isolated from
Saliva
Urine
CSF.
Culturing in Human amnion, He La cells  untuk kanker
biasanya.
Immunoflorecence Methods. Isolation in chicken embryos
ELISA  deteksi ikatan Ag-Ab, Complement fixation tests cek
Ab px.
Vaccination

• Live attenuated vaccine

Jernyl Lynn Strain
Grown in chick embryo
fibroblasts
Vaccine as MMR vaccine
A single dose protects for
10 years.
Dosis pertama
12-18 bulan
Mumps (MMR) Vaccine Indications
• One dose (as MMR) for preschool-age children 12
months* of age and older and persons born during
or after 1957 not at high risk of mumps exposure
Need for second dose
• Second dose (as MMR) for school-age children and
adults at high risk of mumps exposure (i.e., healthcare
personnel, international travelers and students at post-
high school educational institutions
• 12-18 bulan ~ preschool age
• Kalo udah kena kasi imunoglobulin
Passive immunization against mumps

 Immune globulin ineffective for post

exposure prophylaxis
 does not prevent disease or reduce
complications

 Transplacental maternal antibody

appears to protect infants for first year of
life
 Epidemiology
• Endemic – prevalence all over the world
• Immunization  reduce the incidence.
• Epidemics in children between 5-15 yrs
• No carriers.
• Spread by direct contact
• Saliva and urine are infective ( infeksius )
• One attack produces life time immunity.
 MMR Vaccine
Contraindications and Precautions
• Severe allergic reaction to vaccine component
or following a prior dose
• Pregnancy
• Immunosuppression
• Moderate or severe acute illness of other
etiologies
 MMR Vaccine and Autism
• There is no scientific evidence that the risk of
autism is higher among children who receive
measles or MMR vaccine than among
unvaccinated children
“The evidence favors a rejection of a causal
relationship at the population level between
MMR vaccine and autism spectrum disorders
(ASD).”

(Institute of Medicine, April 2001)

 MMR combined vaccine is beneficial
than separate component vaccines
• Separate administration of measles, mumps,
and rubella vaccines to children provides no
benefit over administration of the
combination MMR vaccine and could result in
delays in immunization.
Pediatricians need to work with families to
ensure that children are protected early in the
second year of life from these preventable
diseases.
*9 bulan campak, boleh diulang 12-18bulan
 Mumps control :
• Mumps control: The control of mumps can be
achieved through high routine coverage with an
effective mumps-containing vaccine administered at
12–18 months of age. Children immunized with most
mumps vaccines at the age of 12 months or older
have excellent serological response rates.
Programmes should aim at infant coverage of more
than 90%. Low immunization coverage may reduce
the number of cases in infants but fails to interrupt
circulation of the mumps virus in the community.
ROTAVIRAL DIARRHEA

Laboratory of Microbiology
Faculty of Medicine
Brawijaya University
 Importance of Rotaviruses

• Rotaviruses are major cause of diarrheal

illness in human infants in the world
• Adults too can get infected  diare lebih
ringan
• Young animals, calves, piglets can also infected
• Terbanyak pada anak <2th
Global Impact of Rotavirus
Infections
 Characters of Rotavirus
• A rotavirushas a characteristic wheel-like
appearance when viewed by electron microscopy
(the name rotavirus is derived from the Latin: rota,
meaning "wheel"). Rotaviruses are non
enveloped, double-shelled viruses. The
genome is composed of 11 segments of double-
stranded RNA, which code for six structural and
five nonstructural proteins. The virus is stable in the
environment
• Non enveloped ~ susah dibasmi dengan
alkohol dsb, krn envelop itu dari lemak
Rotavirus resembles a wheel
( Rota = Wheel )
 Classification of Rotaviruses

• Rotaviruses are classified as five species (A- E)

• Two other species are tentatively identified (F
and G)
 Structure of Rotaviruses

• Antigenic classification
mainly dependent on
structural protein VP6
• Group A is important
human pathogen
• Outer capsid protein VP4
and VP7 carry epitopes
important in neutralizing
antibodies
Structural configuration of
Rotavirus
 Pathogenicity
• The virus infect the villi of the small intestine (gastric
and colonic mucosa are not infected) krn reseptor hanya
di vili small intestine ( vili untuk absorpsi )
• They multiply in the cytoplasm of the enterocytes and
damage their transport mechanisms.
• The Rotaviral encoded particle NSP4 is a viral enterotoxin
and induces secretions by triggering a signal transduction
pathway
• Damaged cell may show into lumen of the intestinal and
release large quantities of virus which appear in the
stool  virusnya yg mati tertumpuk di lumen
• Viral excretion usually lasts for 2 – 12 days in otherwise
healthy patients
 Why Diarrhea in Rotaviral
Infections
• Diarrhea caused by
Rotaviruses may be due
to impaired sodium
and glucose
absorption as damaged
cell on villi are replaced
by non absorbing
immature crypt cell 
memicu peristaltik
berlebihan  diare
 Immunity in Rotaviral Infections
• By age 3 years, 90% of the
children have serum
antibodies to one or more
types
• Young children suffer up
to to five reinfections by 2
years of age
• Secretory IgA or Interferon are important
in protection against Rotaviral infections 
suplemen susu, probiotik ( usia 6bulan baru
boleh)
 Impact of Rotaviral Infections

• Rotavirus is the most common cause of severe

diarrhea among children, resulting in the
hospitalization of approximately 55,000 children each
year in the United States and the death of over
600,000 children annually worldwide.
• The incubation period for rotavirus disease is
approximately 2 days.
• The disease is characterized by vomiting and watery
diarrhea for 3 - 8 days, and fever and abdominal pain
occur frequently. Immunity after infection is
incomplete, but repeat infections tend to be less
severe than the original infection.
 Rotaviral infection damages
intestines
• Pathogens, e.g., rotavirus, may strip the tips of
the villi from large patches of the intestinal
wall thus decreasing the surface area and
decreasing by more than 50% the specific
absorptive capacities of the intestine. The
result is malabsorption which can cause
malnutrition - most especially in a child
already nutritionally compromised by
repeated previous attacks of diarrhea.
 Clinical Findings
• Rotavirus cause major events of diarrheal
diseases in children and infants worldwide
• Incubation period is 1 – 3 days.
• Present with
Watery diarrhea
Fever
Abdominal pain
Vomitting leading to dehydration
Loss of electrolytes and fluids
May be fatal unless treated
Patients with milder disease recover promptly
in 3 – 8 days
Dehydration is leading cause in Morbidity
and Mortality
• Dehidrasi ringan  mulut kering, turgor masih
bagus
• Dehidrasi Sedang  turgor >2detik
• Dehidrasi Berat  Lemes, tidak ada tenaga
untuk nangis, tidak ada air mata, mulut
tambah kering, sunken fontanela ( cekung )
Rotavirus have great impact on Infants and
Children
 Laboratory Diagnosis

• Microscopy ( EM )
Demonstration of virus
in stool helps in early
disease
Electron Microscopy has
made the identification
simpler
Gumpalan  Ag virus
 Other Methods in Diagnosis
• Virus can be
demonstrated by IEM
• Latex agglutination tests
• ELISA can detect
antibodies and
establishing raise in titers
 Genotyping

• Genotyping is most
sensitive method for
detection of
Rotavirus nucleic
acid from stool
specimens
 Treatment
• Treatment of gastroenteritis is supportive
• Correction of water and electrolytes loss
• Failure for prompt correction of dehydration leads to
Acidosis
Shock
Death
– Correction electrolyte remain the goal treatment in
Rota viral infections!!!
• Lesser deaths if effective replacement therapy is
initiated
 UNICEF/WHO O.R.S

• Sodium Chloride 3.5 grams

• Sodium Bicarbonate 2.5 grams
• Potassium Chloride 1.5 grams
• Glucose 20 grams
• To be dissolved in one liter of clean drinking
water
 Fluid Replacement

• Management consists of replacement of fluids

(ORS) and restoration of electrolyte balance
• Oral rehydration therapy is highly effective in
reducing morbidity and mortality
• Severe dehydration needs parenteral
administration of fluids.
• Oral fluids penting untuk merangsang vili
 Basic measures in Rotaviral
prevention

• Keep your hands

clean. Wash hands
often with soap and
warm water after
using the toilet,
diapering and before
preparing or eating
food.
 Epidemiology
• Rotaviral infections continue to be most
important cause of gastroenteritis in young
children
• Estimates range 3 billion – 5 billion infections
• Children < 5 years age highly susceptible to
infections
• Results in 1 million deaths
 Impact on Hospitals

• Up to 50 % of cases of acute gastroenteritis of

the hospitalized children through out the
world are caused by Rotavirus
• Winter season highly predisposing
• Nosocomial infections need attention
 Prevention and Control
• In view of fecal oral route of transmission
waste water management, safe water
supplies sanitation are significant control
measurers.

• Vaccine – In 2006 an Oral Bovine based

Rotaviral vaccine was licensed in USA
 FUNGAL DISEASE OF THE
DIGESTIVE SYSTEM

• Some fungi produce toxins called mycotoxins.

 kena GIT ( mual muntah dsb )
• The toxins may cause blood diseases, nervous
system disorders, kidney damage, liver
damage, even cancer.
 Ergot poisoning (ergotism)
• Is caused by mycotoxin produced by Claviceps
purpurea.
• Cereal grains ( gandum ) are the crop often
contaminated with the Claviceps mycotoxin.
• Penyimpanan yg kurang tepat & terlalu lama
 jamur
• This toxin are indole alkaloids; the effects
including smooth muscle contraction, central
sympatholytic activity, and peripheral α-
adrenergic blockade.
• Vasospasm induced by this toxin can affect any
organ, resulting in ischemia to the tissue and
manifestations related to anoxia and infarction of
the affected organ.
• There are 2 major clinical syndromes: the
gangrenous ( luka  makin konstriksi ) and
convulsive ( kurang suplai darah ke otak )
syndromes; gangrene did not usually occur in
patient with the convulsive syndrome and vice
versa.
• It may also cause hallucinogenic symptoms,
producing mental impairment and bizarre
behavior.
 Aflatoxin poisoning
• Aflatoxin is produced by Aspergillus flavus.
• Peanuts are the crop most often
contaminated.
• The primary target organ is the liver, where
cytochrome P450 enzymes convert aflatoxin
to a reactive form, which can bind to proteins
and DNA.
• Konsumsi kacang terus menerus  Toxin
kebanyakan  There are acute and chronic
toxicosis ~ ex.hepatitis akut
• Acute toxicosis
– Manifest as an acute hepatitis with
centrilobular necrosis.
– Kwashiorkor in children may have many of
the manifestation of this toxicosis and
aflatoxin is found in the livers of children
who died with this disease.
• Chronic toxicosis
– Epidemiologic studies showed that aflatoxin
is related to hepatocellular carcinoma (
konsumsi kacang terlalu banyak walaupun
toxin dikit )
THANK YOU