Atypical Mycobacteriadg dasar epidemiologi, mycobacteria dibagi :1. M. tuberculosis komplek - M. tuberculosis - M. bovis - M. africanum2. Mycobacterium atypic Nontuberculous mycobacteria /NTM Mycobacteria other than tubercle bacilli /MOTT3. M. leprae

Mycobacterium bovis sumber : susu yg terkontaminasi penetrasi : - jaringan limfatik oropharynx - mukosa gastrointestinal pencegahan : pasteurisasi Mycobacteriophaga : phaga 33D

niasinDiagnosis lab (-) (+)1. Mikroskopis : BTA 2. Kultur lebih sukar diisolasi dihambat gliserol kurang aerotoleran M. tuberculosis : niasin (+) M. bovis : niasin (-) M. bovis dihambat TCH

mutan M. bovis yg dilemahkan dg cara subkultur berulang pd glycerol-potato-bile medium

BCG digunakan untuk 1. Pencegahan tuberkulosis vaksinasi intrakutan 2. imunoajuvan seluler & humoral regresi tumor Bacillus of Calmette-Guerin (BCG)

banyak terdapat di lingkungan, flora normal kulit, sal. napas, sal. cerna potensial patogen pd mns : - virulensi pd marmot - isolasi berulang dari Px Klinis = tuberkulosis beda terapi uji kepekaan Katalase heat stabil (68C)

Mycobacterium atypic

Dasar : kecepatan pertumbuhan & pigmentasi koloniInkubasi : 1 dibungkus aluminium foil, 1 tidak Group I : Slow-growers (koloni 7 hr pd media padat) photochromogenic : pigmen + cahaya II : Slow-growers scotochromogenic : pigmen + tanpa cahaya scotos (Yunani) : gelap III : Slow-growers nonphotochromogenic IV : rapid growers (< 7hr)pigmen karotenoid : gradasi warna kuning-merah tidak larut air (hanya mewarnai koloni)Klasifikasi Mycobacterium atypic menurut Runyon

M. kansasii Group I : slow grower, photochromogen natural reservoir : tap water Klinis : Pd Px peny. paru kronis (silikosis) Diagnosis lab 1. Mikroskopis : BTA 2. Photochromogen koloni halus pigmen kuning-oranye suhu optimal 37C

M. marinum Group I : slow grower, photochromogen saprofit di tanah, danau, pantai, ikan Klinis : swimming pool granuloma Diagnosis lab 1. Mikroskopis : BTA 2. Photochromogen kuning-oranye-merah 3. Suhu optimal : 30-32C

niasin (+)M. simiae kuning Group I : slow grower photochromogen saprofit di water supply Diagnosis lab 1. Mikroskopis : BTA 2. Photochromogen : kuning 3. Niacin +

M. schrofulaceum Group II : slow grower, schotochromogen sumber : produk peternakan yg terkontaminasi Klinis : limfadenitis Diagnosis lab : 1. Mikroskopis : BTA 2. Schotochromogen pigmen kuning-oranye suhu optimal 37C

M. xenopi Group II : slow grower, schotochromogen saprofit di air (saluran air panas/dingin) Diagnosis lab : 1. Mikroskopis : BTA, gambaran mirip hyphae 2. Schotochromogen : kuning 3. Suhu optimal : 42-45C

M. avium-M. intracellulare Group III : slow growers, nonphotochromogens M. avium-M. intracellulare complex (MAC) - ciri overlap, reservoir : natural water - NTM terbanyak pd Px AIDS specimen AIDS : darah 1. Mikroskopis BTA, granula bipolar 2. t optimal : 37C koloni halus, transparan

M. ulcerans Group III : slow grower, nonphotochromogen tropical skin disease (Afrika, Asia) ulkus nekrosis , jarang terjadi granuloma Diagnosis lab : 1. Mikroskopis : BTA 2. Suhu optimal : 30-33C biochemically unreactive

M. fortuitum-M. chelonei complex Group IV : rapid grower (< 7 hari) kemungkinan komensal di kulit penyebab infeksi nosokomial karena iatrogenik pd Px immunocompremise

Mycobacterium :1. M. tuberculosis komplek M. tuberculosis - growth rate slow - pigmen (-) - niasin (+) - nitrat (+) - katalase (-) pd 68C - tidak dihambat TCH M. bovis - niasin (-) - dihambat TCH M. africanum : hanya ada di Afrika

2. Mycobacterium atypic : I : Slow-growers, photochromogenic M. kansasii : koloni halus pigmen kuning-oranye, t opt. 37C M. marinum : t optimal : 30-32C M. simiae : niasin (+) II : Slow-growers, scotochromogenic M. schrofulaceum : scoto, t opt. 37C M. xenopi : suhu optimal : 42-45C III : Slow-growers, nonphotochromogenic M. avium-M. intracellulare : koloni halus M. ulcerans : 30C, biochemically unreactive IV : rapid growers M. fortuitum-M. chelonei complex (< 7 hari)

3. M. leprae Belum bisa dikultur pada media buatan

Ket. tabel :K : koloni kering, kasarHf : koloni halus, photochromogenicHs : koloni halus, scotochromogenicH : koloni halusN : niasinNt : nitratRG : rapid growerK - : belum bisa dikultur di media buatan

M. tuberculosisK37N +Nt +M. bovisK37N -M. kansasiiHf37M. marinumHf30M. simiaeHfN +M. schrofulaceumHs37M. xenopiHs42M. avium-intracellu.H37M. ulceransH30--M. fortuitum-cheloRGM. lepraeK -

TERIMA KASIH