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

KLASIFIKASIKLASIFIKASI

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

IDENTIFIKASI IDENTIFIKASI KUMAN STAFILOKOKUSKUMAN STAFILOKOKUS

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

KASUSKASUS KLINIK KLINIK

KASUS KLINIKKASUS KLINIK

OsteomielitisOsteomielitis

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

KLASIFIKASIKLASIFIKASI

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

Koloni Koloni StreptococcusStreptococcus dalam dalam Blood agarBlood agar

gamma

alpha beta

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

a Gram staining of Streptococcus pyogenes: Gram-positive cocci in twisted chains

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

Koloni Koloni StreptococcusStreptococcus

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

Erysipelas caused by Erysipelas caused by S. S. pyogenespyogenes

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

Streptococcus pneumoniaeStreptococcus pneumoniae(Pneumococci)(Pneumococci)

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)

KULTURKULTURStreptococcus pneumoniaeStreptococcus pneumoniae

IDENTIFIKASI

ISOLAT STREPTOKOKUS PNEUMONIAE

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.