Kuliah Mikrobiologi Bakteri Coccus Gram Positif - Dr Lely Saptawati

7/24/2019 Kuliah Mikrobiologi Bakteri Coccus Gram Positif - Dr Lely Saptawati

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S

Coccus Gram

positive LeliSaptawati,dr.,Sp.MK


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Berbagai Infeksi di Kulit dan lokasi Infeksinya


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S

Staphylococcus


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topik

Fisiologi dan struktur

Patogenesis dan immunitas

Epidemiologi

Clinical disesase


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Epidemiologi

Clinical disesase


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Gb. Struktur dinding sel Staphylococcus


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1. Capsule or slime layer

A. Capsule :

Melindungi bakteri dari proses agositosis

!. Slime layer :

Membantu bakteri untuk menempel pada "aringandan benda asing #misal kateter$ grats$ prosthetic%al%es and "oint$ and shunts&


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'. Peptidoglycan

(as endoto)in like acti%ity

Stimulating the production o endogenous pyrogen

Acti%ation o complement

Production o interleukin*1 rom monocytes

Aggregation o PM+


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,. Polysaccharide A

#-heicoic acid&

Mediate the attachment o Staphylococci to

mucosal suraces through their specic binding tobronectin


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/. Protein A

-he surace o S. aureus strains #but not the

coagulase negati%e staphylococci& is coated 0ithProtein A

t has a uni2ue a3nity or binding to the Fcreceptors o immunoglobin #g&G1$ gG'$ and gG/

so can e4ecti%ely pre%ent antibody*mediatedimmune clearance o the organism


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Coagulase

-he outer surace o most strains o S. aureus

contains clumping actor #also called boundcoagulase&

-his protein is an important %irulence actor in S.aureus.

t binds brinogen and con%erts it to insolublebrin$ causing the Staphylococci to clump oraggregate

Primary test or identiying S. aureus


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Cytoplascmic membrane

t ser%es as an osmotic barrier or the cell and

pro%ides an anchorage or the cellular biosynthetic and respiratory en5ymes


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Epidemiologi

Clinical disesase


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Pathogenesis 6 immunity

Staphylococcal to)ins

Alpha to)in

!eta to)in

7elta to)in

Gamma to)in andPanton*8alentine9eukocidin

E)oliati%e to)ins

Enteroto)ins -o)ic Shocksyndrome -o)in*1

Staphylococcal enzyme

Coagulase

Catalase

(yaluronidase

Fibrinolysin

9ipase +uclease

Penicilinase


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Epidemiologi

Clinical disesase


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Human normal flora


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Epidemiologi

Clinical disesase :

9aboratory diagnosis S. aurus

S. epidermidis and other coalgulase negati%e staphylococci

-ratment$ pre%ention and control


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Clinical disease :

-o)in*mediated disesase :

Staphylococcal Scalded*skin syndrome

Food poisoining

-o)ic shock

Suppurative infection

mpetigo

Folliculitis

Furuncles

Carbuncles

!acteremia and

endocarditis Pneumonia and

empyema

steomyelitis

Septic arthritis


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Staphylococcal disease


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Clinical disease o S.

aureus


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Cutaneous infection

mpetigo : 9ocali5ed cutaneous inection characteri5ed by pus*lled %esicle

on an erythematous base

Folliculitis : mpetigo in%ol%ing hair ollicles

Furuncle or boils : 9arge$ pain ull$ pus*lled cutaneous nodules

Carbuncles : Coalesce o uruncles 0ith e)tensions into the subcutaneous

tissue and e%idence o systemic disease #chills$ e%er$ bacteremia&


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Impetigo


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olliculitis


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uruncle


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Car!uncle


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S. auerus

Patogenesis hair ollicle inectionkarena Staphylococcus aureus

8irulent S. aureusMelekat pada

sel ollicle rambut

Melakukanmultiplikasi

Menyebar ke ba0ahollicle dan

Glandula sebacea

Merangsang respon

in;amasi

neksi berlan"ut$membentuk abces

kecil

neksi menyebarke "aringan lebihdalam #subkutan&

-erbentuk abcesyang lebih besar

di subcutan


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Staphylococcal scalded s"insyndrome # $itters%s disease


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Patogenesis Staphylococcal scaldedskin syndrome #SSSS&

S. aureusmengeluarkan e)oliatin

di tempat ineksi

7iabsorbsi dan diba0aoleh aliran darah

ke kulit #area luas&

-erpisahnya lapisan seldari epidermis tepat

di ba0ahlapisan luar keratin yang

mati

=ulit kehilanganlapisan luarnya #sepertipada luka bakar berat&

>isiko kehilangan cairandan ter"adinya ineksisekunder oleh kuman

Gram#*& atau C. albican

>isiko kematianmencapai /?@-ergantung

ketepatan diagnosa 6 terapi$usia$ dan kondisi umum


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SSSS..lanjutan

-o)in mediated disesase

7isseminated des2uamation oepithelium in inants

!listers 0ith no organisms orleucocytes


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&ullous impetigo


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'o(ic shoc" syndrome


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Toxic shocksyndrome.lanjutan

Multisystem into)ication characteri5ed

initially by e%er$ hypotension$ and a

di4use$ macular erythematous rash

(igh mortality 0ithout prompt antibiotictherapy and elimination o the ocus o

inection


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&acteremia and endocarditis

Spread o bacteria into the blood rom aocus o inection

Endocarditis characteri5ed by damageto the endothelial lining o the heart


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Clinical disease of S. epidermidis and othercoagulase)negative staphylococcal

Endocarditis

Catheter and shunt inection

Prosthetic "oint inection

-


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Epidemiologi

Clinical disesase :

S. aurus


9aboratory diagnosis



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La!oratory diagnosis

Microscopic

Culture

Serology

dentication


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Microscopy useul or pyogenic inection but

not blood inection or to)ic*mediated inection

Staphylococcus gro0th rapidly 0hen culturedon non selecti%e media

7etection o Staphylococcal antibodiesgenerally o little %alue


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Epidemiologi

Clinical disesase :

S. aurus


9aboratory diagnosis



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Antibiotics o choice

-he ocus o inection #e.g abcess& must be identied and

dried

-reatment is symptomatic or patient 0ith ood poisoning#although the source o inection should be identied so thatappropriate pre%enti%e procedures can be enacted&

Proper cleansing o 0ounds and use o disinectant helppre%ent inection

-horough hand 0ashing and co%ering o e)posed skin helpsmedical personel pre%ent inection or spread to other patients


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S

Streptococcus


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'opics

S. pyogenes

S. agalactiae

ther beta haemolytic Streptococci

8iridans streptococci S. pneumoniae


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S

S'$*+'CCC-S

pyogenes


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+hysiology structure

Gram positi%e cocci arranged in pairs and long chains

!eta hemolytic$ more %irulent strain 0ith capsule

Facultati%e anaerob

Catalase negati%e$ PB> positi%e$ bacitracin sensiti%e

Group specic carbohydrate #A antigen& and type*

specic antigens #M and - proteins& in cell 0all

Produce streptolysin and 7+ase ! #antibodiesagainst these Ag #AS$ anti*7+ase !& are clinicallyimportant&


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8irulence actor


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*pidemiology

Asymptomatic coloni5ation in upper

respiratory tract and transient coloni5ation oskin

Person to person spread by respiratory dropletor by through breaks in skin ater directcontact 0ith inected person$ omite oranthropod %ector


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disease

Suppurati%e inections :

Pharyngitis

Scarlet e%er

Pyoderma

Erysipelas

Cellulitis

+ecroti5ing asciitis

Streptococcla to)ic shock syndrome

ther suppurati%e disesae

+onsuppurati%e inections

>heumatic e%er

Acute glomerulonephritis


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Suppurative infection

Pharyngitis :

>eddened pharyn) 0ith e)udates generally present$ cer%icallymphadenopathy can be prominent

Scarlet e%er

7i4use erythematous rash beginning on chest and spreadingto the e)tremities$ complication o streptococcal pharyngitis

Pyoderma :

9ocali5ed skin inection 0ith %esicles progressing to pustules$no e%idence o systemic disease


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Erysipelas : 9ocali5ed skin inection 0ith pain$ in;ammation$ lymph node enlargement

and systemic symptoms

Cellulitis : nection o the skin that in%ol%es the subcutaneous tissues

+ecroti5ing asciitis : 7eep inection o skin that in%ol%es destruction o muscle and at layers

Streptococcal to)ic shock syndrome Multiorgan systemic inection resembling staphylococcal to)ic shock

syndrome$ ho0e%er most patients bacteremic and 0ith e%idence o asciitis

ther suppurati%e disease 8ariety o other inections recogni5ed including puerperal sepsis$

pymphangitis$ pneumonia


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*rysipelas /"iri0 necrotizing fasciitis /"anan0


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Patogenesis group A Streptococcal;esh eatersD

!akteri melakukankolonisasi menggunakan

Fibronectin*bindingprotein

=adang melakukanpenetrasi ke ascia disekitar otot dan "uga

merusak "aringan otot

-er"adi pembengkakan

karena peningkatantek osmotik dari

rusaknya "aringanrganisme terusbermultiplikasi dan

menghasilkan produkto)ic dalam

"aringan yang mati

=adang organisme danProduk to)ic masuk

=e aliran darah

Menyebabkan shockkarena lepasnya cytokine

dan mekanisme lain

1 ti


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1onsuppurativeinfection

>heumatic e%er : Characteri5ed by in;ammatory changes o the heart

#pericarditis&$ "oints #artharalgias to arthritis&$ blood%essels$ and subcutaneous tissues

Acute glomerulonephritis : Acute in;ammation o the renal glomeruli 0ithedema$ hypertension$ hematuria$ and proteinuria


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diagnosis

Microscopyis useul in skin an sot tissue inecions

7irect antigen test are useul or the diagnosis o

streptococcal pharyngitis$ but negait%e results must beconrmed by culture

Cultureis highly sensiti%e

solates identied by catalase #negati%e&$ positi%e PB>

reaction$ susceptible to bacitracin$ and presence ogroup*specic antigen #group A antigen&

AS test is useul or conrming rheumatic e%er andacute glomerulonephritis anti*7+Ase ! test should alsobe perormed in acute glomerulonephritis is suspected


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'reatment, control and prevention

Penicillin is drug o choice$

Erythromycin or oral cephalosporin is usedor patient allergic to penicillin$

Antistaphylococcal antibiotics are gi%en or

mi)ed inection


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S

>ESS-E+S

A+-!-=


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Kuliah Mikrobiologi Bakteri Coccus Gram Positif - Dr Lely Saptawati

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