infeksi anearob muskuloskeletal (batam 8-3-2014)
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INFEKSI ANAEROB
PADA OTOT
dr ROSLAILI Rasyid M.Biomed
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Infeksi anaerob adalah infeksi yangdisebabkan oleh bakteri yang didalampertumbuhan dan perkembangannya tidakmembutuhkan oksigen. Bakteri anaerob dapat menginfeksi luka
dalam, jaringan yang terletak lebih dalamdan organ-organ internal yang sangatsedikit membutuhkan oksigen. Infeksi ini sangat khas yaitu
pembentukkan abses berisi cairan nanahyang berbau busuk disertai kerusakkan
jaringan.
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Bagian tubuh yang mengalami kerusakkan
jaringan (nekrosis) atau suplai alirandarahnya sedikit merupakan tempat-tempat yang disenangi oleh bakterianaerob untuk tumbuh dan berkembang
karena miskin akan oksigen.Keadaan yang kurang mengandung
oksigen dapat disebabkan karena penyakitpembuluh darah, keadaan syok,trauma/cedera dan tindakkanpembedahan.
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Clostridial diseasesClostridial diseases
!etanus
Botulism#as gangrene
%oodborne gastroenteritis$seudomembrane colitis
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Clostridium tetaniClostridium tetani
&orfologi
-Batang #ram positif
-'pora terminal-!idak berkapsul
-punya flagel peritrich
-tersebar luas di tanah dalam bentuk spora
-pada usus binatang(kuda) manusianormal banyak terdapat dalam bentukegetatif
Clostridium tetani
“Drumstick” appearance
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SporesSpores
Cell divisionand partitioning
Elaboration of a spore coat
Free spore
Spore positioning and speciesSpore positioning and species
Terminal spore C. tetani
Central spore C. perfringens
Subterminal spore C. septicum, novyi, histolyticum
dicile, botulinum
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9
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Clostridium Associated HumanDisease
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PatogenesisPatogenesis
'pora masuk melalui *uka +,kotor dalam
$roses germinasi dibantu oleh - aringan nekrotik- Infeksi campuran dg kuman piogenik- sam laktat
- #aram alsium'pora egetatif dan membelah, toksin
meningkat jumlahnya
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!oksin .tetani dalam usus akan hancuroleh enym0 pencernaan. 1al ini berbeda
dengan toksin .botulinum!oksin .tetani bila disuntikkan I&/I2/'K
dapat menimbulkan kejang. $aling cepatbila disuntik intraneural +
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Toksin : eksotoksin yang kuatToksin : eksotoksin yang kuat
3. !etanolisin tidak tahan 40 dan dapatmenghemolisis eritrosit
0. !etanospasmin toksin kuat, tahan 40dan dapat dikristalkan untuk dibuattoksoid.In aktif dengan cara pemanasanatau ditambah %ormalin. !oksin bekerja
seperti 'triknin menghambat transmisineuromuskuler sehingga terikat pada
jaringan otak. !erjadi kejang spastik.1iperrefleksi dan opistotonus
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5aktu munculnya gejala tetanustergantung dari
lamanya tercapai kondisi anaerob ditempat infeksiarak tempat infeksi dg susunan syaraf
pusat
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Teatanospasmin: mencegah pelepasan mediator penghambatTeatanospasmin: mencegah pelepasan mediator penghambat
pada neuron motorik, shg tjd kekejangan otot pada neuron motorik, shg tjd kekejangan otot
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Opisthoto
nus
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Pemeriksaan LaboratoriumPemeriksaan Laboratorium
Bahan aringan nekrotik pada luka atautalipusat +Biakan anerob pada agar darah, biasanya
di tambahkan polimiksin B, untukmembunuh kuman lain
Koloni s"arming (menyebar)1emolisa type alfa
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Biakan/ kulturBiakan/ kultur
4bligat anaerob +Koloni menyebar ( s"arming)
1emolisa alfa pada agar darah (tetanolisin)
6aya tahan
'pora -tahan dididihkan 3 jam -$ada autoclae mati -1idup di tanah sampai bertahun0 -1040 378 dapat mati
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Laboratory diagnosisLaboratory diagnosis
!o cultiate anaerobes, the specimen should not be e9posed to air
Sources undetermined
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Grown in the laboratory
under anaerobic conditions
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Tes biokimia untuk membedakan speciesTes biokimia untuk membedakan species
ClostridiumClostridium
Rx biokimia C.tetai C.bot!"i!m C.#er$ri%es C.di$$i&i"e
Lactosa - - - -
Glukosa - +/- +/- +/-
Sacarosa - +/- +/- -/+
H2S - -/+ + -
Indol + - - -
Maltosa - +/- -/+ -/+
Galatinosa + + + +
Hemolisis + - - -
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PencegahanPencegahan
Imunisasi aktif 6$!Imunisasi pasif !'/!#
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TETANS !ACC"NETETANS !ACC"NE
-S-S-
Toxin Toxoid
Active Inactive
n!yme
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C C lostridiumlostridium botulinumbotulinum
&orfologi
- Batang #ram positif
-'pora sentral/subterminal
-%lagel peritrich
-!erdiri atas : tipe . ; #
-!oksin neurotoksin (presinaptik)
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PatogenesisPatogenesis
Kuman masuk melalui makanan/minumankaleng (anaerob)'pora tersebar di tanah,lumpur,sayur0an!oksin diserab di usus halusBila sudah menempel akan berikatan di
presinap, bersifat permanen!erapinya dengan memberi kompetitornyaseperti #uanidin 1l (blok presinap)
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#e$ala#e$ala
&untah dan sulit menelanKaku otot mata%lacid (otot lemas), tidak ada hiperrefleksi6apat menyerang otot polos jantung
sehingga cardiac arrest+
<ksotoksin sangat kuat (paling toksis)
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Botox injection
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Boto% Cosmatic/medicalBoto% Cosmatic/medical
applicationapplication
Before After
Toxi A
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disebabkan oleh: C. perfringens, ( paling sering)C. novyi,
C. septicum,C. histolyticum
'as %a%ree
Geala muncul ! "2 amsetela# trauma arin$an
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C&Per'ringens (C&)elchii*C&Per'ringens (C&)elchii*
&orfologi
-Batang #ram positif
-'pora sentral-Berkapsul
-!idak punya flagel
-da = tipe -<
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$ada manusia penularan le"at luka,terjadi #as gangren (mionekrosis) .spora tumbuh menjadi sel egetatif meragikan karbohidrat jaringan
membentuk gas,!erjadi fermentasi glukosa jaringan ; #as
positif+peregangan jaringan (bengkak) gangguan aliran darah.
Pato%eesis
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PatogenesisPatogenesis
'ekresi toksin menyebabkan nekrosis enim hialuronidase mempercepat
penyebaran infeksi,anemia hemolitik, toksemia berat,
kematian.#as yg dihasilkan adalah 40 dan 10
Kematian krn efek toksin$engobatan antiserum, antibiotik
(penisilin,tetrasiklin), terapi oksigenhiperbarik.
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C. perfringens Virulence Factors
M a j o r
M
i n o r
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C. perfringens
'as %a%ree
Cre#itatio i t(e s!b&!taeo!s
tiss!e
myonecrosis
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#as #angrene+ pada $ari kaki#as #angrene+ pada $ari kaki
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"one #racture with
$as in surroundin$
muscular tissue
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C C lostridiumlostridium difficiledifficile
$seudo membranous collitisdampak negatif dari komsumsi antibiotika
yang tidak rasional dalampenanggulangan infeksi. Kuman C. difficile baik yang toksigenik
maupun yang non toksigenik merupakanflora normal dalam saluran pencernaanneonatus dan anak-anak
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6alam keadaan normal kuman C. difficile juga menghasilkan toksin tetapi dalam jumlah yang sangat sedikit sehingga dapatdinetralisir
$ada keadaan penderita mendapakanpengobatan antibitoika dalam jangka "aktulama dan dosis tinggi dapat mengakibatkanflora normal di usus banyak yang mati,
sehingga kuman yang resisten terhadapantibiotika dapat tumbuh dan berkembangbiak dengan cepat.
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