MIKROORGANISME PENYEBAB INFEKSI KULIT

Click to edit Master subtitle style BAGIAN MIKROBIOLOGI FK UISU MEDAN 2011

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PENDAHULUAN
Mikroorganisme

adalah organisme hidup yang berukuran mikroskopis sehingga tidak dapat dilihat dengan mata telanjang bakteri, virus, jamur, protozoa Mikroorganisme dapat berifat parasit (patogen) dan komensal pada tubuh manusia (flora normal) Flora normal pada manusia terdapat di mukosa (selaput lendir) dan di kulit
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Flora

normal dalam tubuh umumnya tidak patogen, namun dapat menyebabkan penyakit bila karena keadaan tertentu berada di tempat yang tidak semestinya atau bila ada faktor predisposisi menimbulkan perubahan fisiologi normal tubuh Penyakit

Infeksi

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KULIT

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BAKTERI PENYEBAB INFEKSI KULIT

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PENDAHULUAN
Bakteri

merupakan Prokariota bersel tunggal (uniseluler) Spesies bakteri dapat ditentukan berdasarkan sifat-sifat struktural, biokimia, fisiologis, ekologi, komposisi basa DNA, homologi, dan sifat genetik Kebanyakan flora normal yang terdapat pada tubuh manusia adalah jenis bakteri Bakteri yang mengontaminasi kulit dapat hidup dan bermultiplikasi (kolonisasi) yang kemudian dapat menimbulkan penyakit infeksi
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Frekuensi

kontaminasi menimbulkan kolonisasi dan kolonisasi menimbulkan penyakit infeksi bergantung pada:
1.

2. 3. 4.

Virulensi organisme: Daya invasi Toksigenitas Besarnya inokulasi Tempat masuk kuman (port d entree) Pertahanan atau imunitas hospes

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BAKTERI PENYEBAB INFEKSI KULIT

Pioderma

Non

Staphylococcus sp. Sterptococcus sp.

Pioderma Corynebacterium sp. Mycobacterium sp. Other bacteria

PIODERMA
Penyakit

kulit yang purulen Etiologi utama: Pyogenes-cocci Staphylococcus aureus Streptococcus B hemolyticus

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Staphylococcus sp Impetigo bulosa Impetigo neonatorum Staphylococcal Scalded Skin Syndrom Folikulitis Furunkel dan Karbunkel Paronikia/ Pionikia Abses multipel kelenjar keringat Hidraadenitis supuratif

Streptococcus sp Impetigo Krustosa Ektima Erisipelas Selulitis Flegmon Scarlet Fever

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IMPETIGO

Pioderma superfisialis (terbatas pada epidermis) 2 bentuk klinis: 1. Impetigo krustosa: Streptococcus B hemolyticus 2. Impetigo bulosa: Staphylococcus aureus Impegtinization terjadinya impetigo pada area yang sebelumnya terkena penyakit kulit yang lain General bula & deskuamasi pada infant Impetigo Neonatorum

EKTIMA
Pioderma ulceratif atau ulkus superfisial dengan krusta diatasnya Etiologi: Streptococcus haemolyticus grup A Pada lokasi cedera ringan Secara predominan mengenai tulang kering dan punggung kaki Umumnya menyembuh dengan pembentukan jaringan parut yang bervariasi

FOLIKULITIS
Pyoderma

rambut Etiologi: Staphylococcus aureus Karakteristik dengan folikular papula, pustula, erosi atau krusta pada folikular infundibulum (epidermis) Bagian yang terlibat dpt sampai dalam hingga seluruh

pada folikel

FURUNKEL DAN KARBUNKEL

Abses

akut pd folikel rambut dan sekitarnya Etiologi: Staphylococcus aureus Furunculosis: lebih dari 1 folikel Carbuncle: kumpulan furunkel

PARONIKIA/ PIONIKIA
Inflamasi

akut pada lateral dan posterior lipatan kuku Etiologi: Staphylococcus aureus Streptococcus B hemolyticus

ERISIPELAS, SELULITIS & FLEGMON

Peradangan akut, penyebaran infeksi pada dermal dan jaringan subkutan Karakterisasi: merah, panas, nyeri sekitar lesi, sering pada tempat bakteri masuk Penyebab tersering: Streptococcus pyogenes dan mikroorganisme lain yang dapat menyebabkan gangguan sistemik 12/25/12

ERISIPELAS Dermis dan subkutan bagian atas Batas nyata + lymphangitis Etiologi: Streptococcus hemolyticus grup A SELULITIS Melibatkan seluruh jaringan subkutan, difus Infiltrate with raised + pembengkakan area Etiologi: Streptococcus pyogenes , Staphylococcus aureus, H.influenzae FLEGMON Selulitis yang mengalami supuratif dan 12/25/12 pecah

Selulitis

Erisipelas

NON PIODERMA
Corynebacterium

spp.:

Erythrasma: C. Minutissimum Tichomycosis axillaris: C. tenuis Pitted keratolysis: Corynebacterium spp. dan Micrococcus sedentarius

Mycobacterium

Lepra (Morbus Hansen): M. leprae Tuberculosis cutis: M. tuberculosis (Scrofuloderma; TBC cutis verrucosa dll.)

sp:

Atypical Mycobacterium Infection: M. Marinum, M.scrofulaceum, M. fortuitum, M. chelonei, dll.

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 Gram

Erysipeloid: Erysipelothrix rhusiopathiae Anthrax: Bacillus anthracis Pseudomonas folliculitis: Pseudomonas aeruginosa Gram negatif folliculitis: Klebsiella, Enterobacter, Proteus sp.

(+)/(-) bacteria:

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DIAGNOSA LABORATORIUM
Pemeriksaan

mikroskopik: Identifikasi bakteri dapat dilakukan Pewarnaan Gram atau Pewarnaan BTA

Kultur

Perbenihan pada media padat dalam inkubator dengan suhu 37C selama 24 jam
Uji

kerentanan

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JAMUR PENYEBAB INFEKSI KULIT

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Introduction
Fungi

are eukaryotic organisms that do not contain chlorophyll but have cell walls filamentous structures produce spores These organisms grow as saprophytes and decompose dead organic matter. There are between 100,000 to 200,000 species depending on how they are classified. About 300 species are presently known to be pathogenic for man.
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CLINICAL CLASSIFICATION OF THE MYCOSES

Fungal diseases may be discussed in a variety of ways. The most practical method for medical students is the clinical taxonomy which divides the fungi into:

Superficial mycoses Subcutaneous mycoses Systemic mycoses Opportunistic mycose

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MIKOSIS
Superficialis
Dermatofitosis Non Dermatofitosis

Intermediate

Profunda
Subcutis Sistemik

Tinea capitis Pitiriasis versikolor Kandidiasis Tinea barbae Piedra hitam Aspergillosis Tinea corporis Piedra putih ( T. imbrikata & T. Tinea nigra favosa ) palmaris Tinea manum Otomikosis Tinea pedis Tinea kruris Tinea unguium

Misetoma Kromomikosis Sporotrikosis Fikomikosis subkutan Rinosporodiosis

Aktinomikosis Nokardiosis Histoplasmosis Kriptokokosis Koksidioidomikosis Blastomikosis Fikomikosis -sistemik

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Mikosis utama dan jamur penyebab Agen jamur penyebab Tipe mikosis Mikosis
Permukaan
Malassezia furfur Hortaea werneckii Piedra hortae Spesies Trichophyton
Pityriasis versikolor Tinea nigra Piedra hitam Piedra putih

Kulit

Spesies Microsporum, Dermatofitosis Spesies Trichophyton, epidermophyton floccosum Spesies Candida Candidiasis kulit, mukosa Sporothrix schenckii Histoplasma capsulatum Blastomyces dermatitidis Candida albicans Aspergillus fumigatus Penicillium marneffei
Sporotrichosis Histoplasmosis Blastomikosis Candidiasis Aspergillosis Penicillosis 12/25/12

Subkutan Endemis (primer,sistemik) Oportunistik

DERMATOPHYTOSIS

Trichophyton rubrum

SUPERFICIAL MYCOSES
The

superficial (cutaneous) mycoses are usually confined to the outer layers of skin, hair, and nails and do not invade living tissues. The fungi are called dermatophytes. Dermatophytes, or more properly, keratinophilic fungi, produce extracellular enzymes (keratinases) which are capable of hydrolyzing keratin.
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CLINICAL MANIFESTATIONS

Tinea means "ringworm" or "moth-like". Dermatologists use the term to refer to a variety of lesions of the skin or scalp.
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Tinea corporis

small lesions occurring anywhere on the body Tinea corporis lesions, or ringworm on this patients arm due to the dermatophytic fungus Trichophyton rubrum. Dermatophytic members of the genus Trichophyton inhabit the soil, humans or animals, and are some of the leading causes of hair, skin and nail infections, or dermatophytosis in their human hosts.

 Patient

with ringworm on the arm, or tinea corporis due to Trichophyton mentagrophytes. The genus Trichophyton inhabits the soil, humans or animals, and is one of the leading causes of hair, skin and nail infections, or dermatophytosis in humans.

This patient, a native of New Guinea, has ringworm on the skin of the right axilla and flank due to Trichophyton rubrum. Usually occurring as a skin parasite, or dermatophyte on man and animals, the genus Trichophyton is characterized by colorless spores that can cause ringworm on the body. This condition is called Tinea corporis. CDC/Lucille K. Georg

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Tinea pedis
"athlete's

foot". Infection of toe webs and soles of feet. Trichophyton rubrum, Epidermophyton floccosum

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Tinea unguium
Trichophyton

rubrum Epidermophyton floccosum

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Tinea capitis (Trichophyton mentagrophytes, Microsporum canis)

Microsporum canis

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Tinea cruris
"jock

itch". Infection of the groin, perineum or perianal area. Trichophyton rubrum, Epidermophyton floccosum

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Tinea barbae
Ringworm

of the bearded areas of the face and neck, known as tinea barbae, or barbers itch. Tinea barbae is due to a dermatophytic infection around the bearded area of men. Generally, the infection occurs as a follicular inflammation, or as a cutaneous granulomatous lesion, i.e. a chronic inflammatory reaction.

DIAGNOSA
1. Lampu wood (wood light)

Beberapa spesies dermatofita seperti M.canis, M.audolnii, M.distortum, M.ferrugineum dan kadang- kadang M.scheeleinii memberikan floresensi putih kebiru-biruan

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2. Direct smear:
Pemeriksaan langsung dengan larutan NaOH atau KOH 10-20% dan LPCB Cara kerja : 1. Ambil sebuah object glass tetesi dengan NaOH atau KOH 1020%, lalu letakkan spesimen yang akan diperiksa dan tutup dengan deck glass 2. Ambil sebuah object glass tetesi dengan Lacto Phenol Cotton Blue (LPCB), lalu letakkan spesimen yang akan diperiksa kemudian tutup dengan deck glass 3. Lihat dibawah

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3. Kultur Dengan menggunakan media: Sabouraoud Desxtrose Agar Potato Dextrose Agar Corn Meal Agar
Pertumbuhan

jamur umumnya dapat terlihat dalam waktu 710 hari pada suhu 37C
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Mikosis Superfisialis Non dermatophytosis

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NON DERMATOPHYTOSIS
A. B. C. D.

Pityriasis versicolor Tinea nigra Piedra hitam Piedra putih

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Pityriasis Versicolor
Etiologi Malassezia furfur
(Pityrosporum orbiculare) Bag tubuh >> kel.keringat Flora normal kulit Lipofilik Perlu media dengan suplementasi asam lemak untuk tumbuh Ragi bertunas
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Gejala Klinik

Lesi bagian atas kaki, tangan, perut

lesi

makular hipopigmentasi /hiperpigmentasi yang diskret Sisik, gambaran kering seperti kapur Bentuk papula jarang Pd bbrp kasus dimana fol.rambut terkena folikulitis

Pityriasis folliculitis

Diagnosis Kerokan kulit pada lesi + KOH 10% Spaghetti & meatballs appereance Lampu wood fluoresensi berwarna kuning keemasan pada lesi yang bersisik Kultur tidak rutin dilakukan untuk mengkonfirmasi diagnosis

Tinea Nigra
Etiologi Exophiala werneckii Menghasilkan melanin coklathitam Pd isolasi primer pertumbuhan dlm bentuk ragi dgn byk sel dlm berbagai tahap pembelahankarakte ristik strukt 2 sel oval

Gejala Klinik
Asimptomatik Lesi

makular, batas jelas, meluas ke perifer Lesi coklat s/d hitam daerah tangan dan kaki Sering muncul di daerah tubuh lain

Diagnosis
khas pigmentasi gelap Pemeriksaan mikroskopik: - struktur seperti ragi dan fragmen hifa (dgn KOH) Harus dikonfirmasi dgn pemeriksaan kultur
gambaran

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Piedra Hitam
Etiologi
Piedraia hortae
Ditemukan

dalam bentuk teleomorfik ketika berkoloni pd rambut Kultur ditemukan hanya stadium aseksual dari jamur yang terdiri dari: miselium tumbuh lambat warna coklat samapai dengan hitam kemerahan
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Gambaran Klinik Nodul sepanjang rambut yang terinfeksi Nodul : konsistensi keras, mengandung karbon, berisi askus Diagnosis Infeksi mudah didiagnosis dengan pemeriksaan mikroskopik pada rambut yang terinfeksi

Etiologi Trichosporon beigelii Tumbuh pada semua media lab. kecuali media dengan sikloheksimid Kultur muda: wrn putih, konsistensi seperti bubur Kultur dewasa: koloni semakin masuk kedalam media, menyebar warna kuning seperti krim Pem. mikroskopis adanya hifa bersepta & fragmen-fragmen yang dengan cepatarthrokonidia

Piedra Putih

Gejala Klinik Mengenai rambut kepala,kumis dan jenggot Perkembangan koloni seperti krim yang lembut sepanjang rambut.

Diagnosis
Identifikasi:

Berbagai tes biokimia & kemampuan untuk asimilasi KH Pemeriksaan mikroskopis rambut yg terinfeksi & konfirmasi melalui kultur organisme. DD/: trichomycosis axillaris , pedikulosis

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PENGOBATAN
Respon

pengobatan baik Pendekatan umum perawatan pityriasis versicolor dan tinea nigra

menghilangkan organisme dari kulit penggunaan secara topikal agen keratolitik

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 Th/

yang efektif dari infeksi jamur pada rambut akibat P. hortae dan T. beigelii

mencukur

rambut yang terinfeksi sampai dengan mengerok kulit pada daerah tersebut. Infeksi ini tidak akan muncul kembali jika pasien memperhatikan higienis perorangan.

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VIRUS PENYEBAB INFEKSI KULIT

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DNA VIRUSES

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RNA VIRUSES

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 Skin

as port d entree of viral infection in human The pathogenesis of infections causing mucocutaneus lesion Viruses causing mucocutaneus lesions:
1. 2. 3. 4.

Herpes simplex virus Herpes zoster virus Papilloma virus Poxvirus

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HERPES VIRUS
INTRODUCTION

Herpes viruses are a leading cause of human viral disease, second only to influenza and cold viruses. They are capable of causing overt disease or remaining silent for many years only to be reactivated, for example as shingles. The name herpes comes from the Latin herpes which, in turn, comes from the Greek word herpein which means to creep. This reflects the creeping or spreading nature of the skin lesions caused by many herpes virus types. There are at least 25 viruses in the family Herpesviridae (currently divided into three subfamilies). Eight or more herpes virus types are known to infect man frequently
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HERPES VIRUS

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Herpes Virus structure.

Herpesviruse

have a large, enveloped icosahedral capsids containing doublestranded DNA genome Between the nucleocapsid and the membrane is the ill-defined tegument
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HERPES SIMPLEX VIRUS (HSV)

These are very large viruses and their genome encodes at least 80 proteins. Many of these proteins (about half) are not directly involved in the virus structure or controlling its replication but function in the interaction with the host cell or the immune response of the host. There are two types, HSV1 and HSV-2 with very similar characteristics

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Site at which HSV-1 and HSV-2 cause disease in humans

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Diseases caused by Herpes Simplex Viruses

Herpes simplex 1 and 2 are frequently benign but can also cause severe disease. In each case, the initial lesion looks the same. A clear vesicle containing infectious virus with a base of red (erythomatous) lesion at the base of the vesicle. This if often referred to as a 'dewdrop on a rose petal'. From this pus-containing (pustular), encrusted lesions and ulcers may develop.

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Herpes whitlow
This

disease of persons who come in manual contact with herpes-infected body secretions can be caused by either type of HSV and enters the body via small wounds on the hands or wrists. It can also be caused by transfer of HSV-2 from genitals to the hands (figure 10)
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Eczema herpeticum
This

is found in children with active eczema, preexisting atopic dermatitis, and can spread over the skin at the site of eczema lesions The virus can spread to other organs such as the liver and adrenals A similar disease may also be caused by vaccinia (eczema vaccinatum).

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VARICELLA-ZOSTER VIRUS
Diseases caused by Varicella-Zoster virus:

chicken-pox (Varicella), usually in childhood, and shingles, later in life. Shingles (Zoster) is a reactivation of an earlier varicella infection

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CHICKENPOX
Each

spot starts as a 2-4 mm diameter red papule which develops an irregular outline (rose petal) as a small vesicle appears on the surface. This 'dew drop on a rose petal' appearance is very characteristic of chickenpox.
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SHINGLES
The skin lesions are somewhat different from those in chicken pox, being restricted to small areas of the skin, usually in the thorax They are small and close together. They are maculopapular with an erythematous base and usually heal in about two weeks

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DIAGNOSIS
Both

chicken pox and shingles are diagnosed by their characteristic appearance but a definitive diagnosis can be made by culture of the virus from the lesions (a difficult procedure) followed by detection of specific antigens. The characteristic appearance of cells in biopsy specimens of skin lesions can also be used

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TERIMA KASIH
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