Post on 21-Oct-2015
PYOGENIC COCCIPYOGENIC COCCI
Oleh :Oleh :Dr.Priyambodo Dr.Priyambodo
Lab Mikrobiologi FK UNS Lab Mikrobiologi FK UNS SurakartaSurakarta
Pyogenic CocciPyogenic Cocci bakteri berbentuk kokus dapat menyeragn bakteri berbentuk kokus dapat menyeragn
semau jaringan/organ tubuh dan semau jaringan/organ tubuh dan menyebabkan infeksi disertai dengan menyebabkan infeksi disertai dengan pernanahanpernanahan
Kokus Gram positif:Kokus Gram positif:
-Staphylococcus aureus-Staphylococcus aureus -Streptococcus pyogenes-Streptococcus pyogenes
-Streptococcus pneumoniae-Streptococcus pneumoniae Kokus Gram negatif:Kokus Gram negatif:
-Neisseria gonorrhoeae-Neisseria gonorrhoeae-Neisseria meningitidis-Neisseria meningitidis
Staphylococcus spStaphylococcus sp..
S. aureusS. aureus
- skin- skin
- nasal mucosa- nasal mucosa S. epidermidisS. epidermidis
- skin - skin
- Respiratory tract- Respiratory tract
- GI tracts- GI tracts S. saprophyticusS. saprophyticus
- urinary tract - urinary tract
Staphylococcus aureusStaphylococcus aureus
Morfologi :- kokus bergerombolMorfologi :- kokus bergerombol - tidak berflagel- tidak berflagel - tidak berspora- tidak berspora - Gram (+)- Gram (+)
Kultur :Kultur : - T. opt 37- T. opt 37C (15-40)C (15-40)- pH opt 7,4- pH opt 7,4- aerob, fakultatif anaerob- aerob, fakultatif anaerob- Hemolytic zones- Hemolytic zones
Staphylococcus aureusStaphylococcus aureus Gram staining of a pus preparation: Gram-Gram staining of a pus preparation: Gram-
positive cocci, some in grapelike clusters. positive cocci, some in grapelike clusters. Clinical diagnosis: furunculosis.Clinical diagnosis: furunculosis.
Blood agar is frequently used as a universal enrichment medium. Blood agar is frequently used as a universal enrichment medium. Most human bacterial pathogens grow on it. Here is a pure Most human bacterial pathogens grow on it. Here is a pure culture of culture of Staphylococcus aureusStaphylococcus aureus on blood agar: on blood agar: convex colonies with yellowish pigment and porcelain like convex colonies with yellowish pigment and porcelain like surface, d:1-2 mm.surface, d:1-2 mm.
Toxins and EnzymesToxins and Enzymes
-toxin -toxin → → damages damages membranes, membranes, dermonecrosis dermonecrosis
Leukocidin Leukocidin Exfoliatin Exfoliatin Enterotoxin Enterotoxin Toxic shock Toxic shock
syndrome toxin-1 syndrome toxin-1 (TSST-1) (TSST-1)
Plasma coagulase Plasma coagulase CatalaseCatalase HyaluronidaseHyaluronidase Stafilokinase Stafilokinase → →
fibrinolisisfibrinolisis ProteinaseProteinase LipaseLipase -lactamase-lactamase
Some diseases caused by Some diseases caused by Staph.Staph.
S. aureusS. aureus Invasive purulent infections: furuncles, Invasive purulent infections: furuncles,
carbuncles, bullous impetigo, wound carbuncles, bullous impetigo, wound infections, sinusitis, otitis media, mastitis infections, sinusitis, otitis media, mastitis puerperalis, ostitis/osteomyelitis, sepsispuerperalis, ostitis/osteomyelitis, sepsis
Toxin-caused illnesses: food poisoning Toxin-caused illnesses: food poisoning (by enterotoxins), dermatitis (by enterotoxins), dermatitis exfoliativa/S4/ Ritter disease, pemphigus exfoliativa/S4/ Ritter disease, pemphigus neonatorum, and bullous impetigo (by neonatorum, and bullous impetigo (by exfoliatins), toxic shock syndrome (by exfoliatins), toxic shock syndrome (by TSST-1) TSST-1)
Some diseases caused by Some diseases caused by Staph.Staph.S. epidermidisS. epidermidis most frequent coagulase-negative Staph. pathogen most frequent coagulase-negative Staph. pathogen opportunist, infection requires host predispositionopportunist, infection requires host predisposition foreign body infections (intranasal catheters, foreign body infections (intranasal catheters,
continuous ambulant peritoneal dialysis/CAPD continuous ambulant peritoneal dialysis/CAPD catheters, endoprostheses, metal plates and screws catheters, endoprostheses, metal plates and screws in osteosynthesis, cardiac pacemakers, artificial in osteosynthesis, cardiac pacemakers, artificial heart valves, and shunt valves) heart valves, and shunt valves)
S. saprophyticusS. saprophyticus urinary tract infections in young women (10–20%) urinary tract infections in young women (10–20%) occasional nonspecific urethritis in menoccasional nonspecific urethritis in men
SKEMA IDENTIFIKASI KUMAN KOKUS GRAM POSITIFSKEMA IDENTIFIKASI KUMAN KOKUS GRAM POSITIF
Bahan PemeriksaanBahan Pemeriksaan GramGram
Agar darahAgar darah
GramGram
Staphylococcus Staphylococcus
Katalase / KoagulaseKatalase / Koagulase
Mannitol /DNA ase Mannitol /DNA ase
S. aureusS. aureus NovobiocinNovobiocin
Resisten Resisten Sensitif Sensitif
S. saprophyticus S. S. saprophyticus S. endermidisendermidis
Coagulase Test utk membedakan Coagulase Test utk membedakan Staphylococcus aureusStaphylococcus aureus dari dari
spesies yang lainspesies yang lain
Catalase Test utk membedakan Catalase Test utk membedakan StaphylococcusStaphylococcus dari dari StreptococcusStreptococcus
catalasecatalase
HH22OO2 2 H H220 + O0 + O22
Streptokokus
Stafilokokus
Multiple FurunclesMultiple FurunclesFuruncles in a patient with type 2 diabetes mellitus.Furuncles in a patient with type 2 diabetes mellitus.
TherapyTherapy
-lactamase resistant Penicillin-lactamase resistant PenicillinCephalosporin Cephalosporin VancomycinVancomycinTopical Tetracycline for skin infectionTopical Tetracycline for skin infectionAbscess drainageAbscess drainageThe most important preventive measure The most important preventive measure
in hospitals is washing the hands in hospitals is washing the hands thoroughly before medical and nursing thoroughly before medical and nursing procedures procedures
Streptococcus sp.Streptococcus sp.
Gram-positiveGram-positive nonmotilenonmotile catalase-negativecatalase-negative Facultatively anaerobic cocci Facultatively anaerobic cocci
that occur in chains or that occur in chains or pairspairs
Klasifikasi Klasifikasi Streptococcus sp.Streptococcus sp.
Berdasarkan kemampuan hemolisisnya:Berdasarkan kemampuan hemolisisnya:1.1. hemolise (gol. viridan) hemolise (gol. viridan)
2.2. hemolise (gol. hemolitik)hemolise (gol. hemolitik)
3.3. hemolise (gol. nonhemolitik)hemolise (gol. nonhemolitik)
Lancefield system of classification:Lancefield system of classification: further classification of (β-hemolytic) further classification of (β-hemolytic) Strep.Strep. based on carbohydrates in their cell wallsbased on carbohydrates in their cell walls Groups A-G normally infect peopleGroups A-G normally infect people
Pathogenic Pathogenic StreptococciStreptococci
S. pyogenesS. pyogenes
S. pneumoniaeS. pneumoniae
Enterococcus Enterococcus
faecalisfaecalis
Streptococcus Streptococcus pyogenespyogenes
Morfologi : Morfologi : kokus berantaikokus berantai tidak berflageltidak berflagel tidak bersporatidak berspora aerob/fakultatif anaerobaerob/fakultatif anaerob
Streptococcus Streptococcus pyogenespyogenes
Kultur : - t opt 37Kultur : - t opt 37C (35-43)C (35-43)
- pH opt 7,4- pH opt 7,4
Koloni : - bulat kecilKoloni : - bulat kecil - opalesen - opalesen - cembung, tepi rata - cembung, tepi rata - mukoid - mukoid
Culture on blood agar: small, whitish-gray colonies Culture on blood agar: small, whitish-gray colonies surrounded by large surrounded by large -hemolysis zones, 5-10% CO-hemolysis zones, 5-10% CO22 atmosphere provides optimum conditions for atmosphere provides optimum conditions for -hemolysis-hemolysis
Extracellular toxins and Extracellular toxins and enzymesenzymes : :
1.1. Hemolisin: Streptolysin O, Streptolysin S Hemolisin: Streptolysin O, Streptolysin S
2.2. Pyrogenic streptococcal exotoxins (PSE) Pyrogenic streptococcal exotoxins (PSE) A, B, C A, B, C
3.3. Streptokinase / Fibrinolisin Streptokinase / Fibrinolisin
4.4. DNase DNase → → DNA depolimerisationDNA depolimerisation
5.5. Hyaluronidase Hyaluronidase
Pathogenesis and clinical picturesPathogenesis and clinical pictures Invasive infectionsInvasive infections
local: impetigo, erysipelas, cellulitis, local: impetigo, erysipelas, cellulitis, pharyngitis, pharyngitis, sinusitis, otitis sinusitis, otitis media, tonsillitis media, tonsillitis
general: sepsis, septic shock, general: sepsis, septic shock, necrotizing fasciitis necrotizing fasciitis
Sequelae Sequelae - Glomerulonephritis- Glomerulonephritis
- Acute rheumatic fever- Acute rheumatic fever
TherapyTherapy
The agents of choice are penicillin G The agents of choice are penicillin G or V.or V.
Alternatives are oral cephalosporins Alternatives are oral cephalosporins or macrolide antibiotics or macrolide antibiotics (erythromycin). (erythromycin).
In treatment of septic shock, a In treatment of septic shock, a polyvalent immunoglobulin is used to polyvalent immunoglobulin is used to inactivate the PSE.inactivate the PSE.
Streptococcus pneumoniaeStreptococcus pneumoniae(Pneumococci)(Pneumococci)
MorfologiMorfologi Gram-positif Gram-positif Oval / seperti Oval / seperti
lancetlancet Berpasangan Berpasangan
dlm rantai dlm rantai pendekpendek
Sel dikelilingi Sel dikelilingi kapsul tebalkapsul tebal
KulturKultur pada agar darahpada agar darah
S. pneumoniaeS. pneumoniae tumbuh sbg koloni tumbuh sbg koloni --
hemolitikhemolitik
Capsules Capsules → → mucoid (smooth, shiny) mucoid (smooth, shiny)
appearance (hence “S” form)appearance (hence “S” form)Mutants without capsules produce Mutants without capsules produce
colonies with a rough surface (“R” form)colonies with a rough surface (“R” form)
Streptococcus pneumoniaeStreptococcus pneumoniae
Normal flora of upper respiratory tract Normal flora of upper respiratory tract Pneumococcal infections usually arise Pneumococcal infections usually arise
from this normal flora (endogenous from this normal flora (endogenous infections).infections).
Predispose factors: Predispose factors:
primary cardiopulmonary diseases, primary cardiopulmonary diseases, previous infections (e.g., influenza), previous infections (e.g., influenza), extirpation of the spleen or extirpation of the spleen or complement system defects, complement system defects, malnutrition.malnutrition.
Clinical Features:Clinical Features:
Lung: lobar pneumonia, Lung: lobar pneumonia, bronchopneumoniabronchopneumonia
Bacteremia Bacteremia → → meningitis, meningitis, endocarditis, septic arthritisendocarditis, septic arthritis
Severe pneumococcal infections Severe pneumococcal infections frequently involve sepsisfrequently involve sepsis
TherapyTherapy Penicillin is still the antibiotic of choice. Macrolide Penicillin is still the antibiotic of choice. Macrolide
antibiotics are an alternative to penicillins. antibiotics are an alternative to penicillins. Penicillin resistance is not due to penicillinase, Penicillin resistance is not due to penicillinase,
but rather to modified penicillin-binding proteins but rather to modified penicillin-binding proteins (PBPs) to which penicillins have a lower level of (PBPs) to which penicillins have a lower level of affinity. Biochemically, penicillin resistance affinity. Biochemically, penicillin resistance extends to cephalosporins as well. However, extends to cephalosporins as well. However, certain cephalosporins (e.g., ceftriaxone) can be certain cephalosporins (e.g., ceftriaxone) can be used against penicillin-resistant pneumococci used against penicillin-resistant pneumococci due to their higher levels of activity.due to their higher levels of activity.