PYOGENIC COCCI

Oleh : Dr.Priyambodo Lab Mikrobiologi FK UNS Surakarta

Pyogenic Cocci
bakteri berbentuk kokus dapat menyeragn semau jaringan/organ tubuh dan menyebabkan infeksi disertai dengan pernanahan Kokus Gram positif:

-Staphylococcus aureus
-Streptococcus pyogenes -Streptococcus pneumoniae Kokus Gram negatif:

-Neisseria gonorrhoeae
-Neisseria meningitidis

Staphylococcus sp.

S. aureus
- skin - nasal mucosa

S. epidermidis
- skin - Respiratory tract - GI tracts

S. saprophyticus
- urinary tract

Staphylococcus aureus
Morfologi :- kokus bergerombol - tidak berflagel - tidak berspora - Gram (+)
Kultur : T. opt 37C (15-40) pH opt 7,4 aerob, fakultatif anaerob Hemolytic zones

KLASIFIKASI

Staphylococcus aureus

Gram staining of a pus preparation: Grampositive cocci, some in grapelike clusters. Clinical diagnosis: furunculosis.

Blood agar is frequently used as a universal enrichment medium. Most human bacterial pathogens grow on it. Here is a pure culture of Staphylococcus aureus on blood agar: convex colonies with yellowish pigment and porcelain like surface, d:1-2 mm.

Toxins and Enzymes

-toxin damages membranes, dermonecrosis Leukocidin Exfoliatin Enterotoxin Toxic shock syndrome toxin-1 (TSST-1)

Plasma coagulase Catalase Hyaluronidase Stafilokinase fibrinolisis Proteinase Lipase -lactamase

Some diseases caused by Staph. S. aureus

Invasive

purulent infections: furuncles, carbuncles, bullous impetigo, wound infections, sinusitis, otitis media, mastitis puerperalis, ostitis/osteomyelitis, sepsis illnesses: food poisoning (by enterotoxins), dermatitis exfoliativa/S4/ Ritter disease, pemphigus neonatorum, and bullous impetigo (by exfoliatins), toxic shock syndrome (by TSST-1)

Toxin-caused

Some diseases caused by Staph. S. epidermidis

most frequent coagulase-negative Staph. pathogen opportunist, infection requires host predisposition foreign body infections (intranasal catheters, continuous ambulant peritoneal dialysis/CAPD catheters, endoprostheses, metal plates and screws in osteosynthesis, cardiac pacemakers, artificial heart valves, and shunt valves)

S. saprophyticus
urinary tract infections in young women (1020%) occasional nonspecific urethritis in men

SKEMA IDENTIFIKASI KUMAN KOKUS GRAM POSITIF

Bahan Pemeriksaan Gram Agar darah Gram

Staphylococcus
Katalase / Koagulase Mannitol /DNA ase

S. aureus

Novobiocin Resisten Sensitif

S. saprophyticus

S. endermidis

IDENTIFIKASI KUMAN STAFILOKOKUS

Coagulase Test utk membedakan Staphylococcus aureus dari spesies yang lain

Catalase Test utk membedakan Staphylococcus dari Streptococcus

Streptokokus

Stafilokokus

catalase

H2O2

H20 + O2

KASUS KLINIK

KASUS KLINIK

Osteomielitis

Multiple Furuncles Furuncles in a patient with type 2 diabetes mellitus.

Therapy
-lactamase resistant Penicillin Cephalosporin Vancomycin Topical Tetracycline for skin infection Abscess drainage The most important preventive measure in hospitals is washing the hands thoroughly before medical and nursing procedures

Streptococcus sp.
Gram-positive nonmotile catalase-negative Facultatively anaerobic cocci that occur in chains or pairs

KLASIFIKASI

Klasifikasi Streptococcus sp.

Berdasarkan kemampuan hemolisisnya:
1. 2. 3.

hemolise (gol. viridan) hemolise (gol. hemolitik) hemolise (gol. nonhemolitik)

Lancefield system of classification:

further classification of (-hemolytic) Strep. based on carbohydrates in their cell walls Groups A-G normally infect people

Koloni Streptococcus dalam Blood agar

gamma

alpha

beta

Pathogenic Streptococci

S. pyogenes S. pneumoniae Enterococcus faecalis

Streptococcus pyogenes
Morfologi : kokus berantai tidak berflagel tidak berspora aerob/fakultatif anaerob

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

Streptococcus pyogenes

Kultur : - t opt 37C (35-43) - pH opt 7,4

Koloni : - bulat kecil - opalesen - cembung, tepi rata - mukoid

Koloni Streptococcus

Culture on blood agar: small, whitish-gray colonies surrounded by large -hemolysis zones, 5-10% CO2 atmosphere provides optimum conditions for hemolysis

Extracellular toxins and enzymes :

1.
2.

3.
4. 5.

Hemolisin: Streptolysin O, Streptolysin S Pyrogenic streptococcal exotoxins (PSE) A, B, C Streptokinase / Fibrinolisin DNase DNA depolimerisation Hyaluronidase

Pathogenesis and clinical pictures

Invasive

infections

local: impetigo, erysipelas, cellulitis, pharyngitis, sinusitis, otitis media, tonsillitis general: sepsis, septic shock, necrotizing fasciitis

Sequelae
- Glomerulonephritis - Acute rheumatic fever

Erysipelas caused by S. pyogenes

Therapy
The agents of choice are penicillin G or V. Alternatives are oral cephalosporins or macrolide antibiotics (erythromycin). In treatment of septic shock, a polyvalent immunoglobulin is used to inactivate the PSE.

Streptococcus pneumoniae (Pneumococci)

Morfologi Gram-positif Oval / seperti lancet Berpasangan dlm rantai pendek Sel dikelilingi kapsul tebal

Streptococcus pneumoniae (Pneumococci)

Kultur pada agar darah

S. pneumoniae tumbuh sbg koloni hemolitik
Capsules Mutants

mucoid (smooth, shiny) appearance (hence S form) without capsules produce colonies with a rough surface (R form)

Streptococcus pneumoniae

KULTUR

IDENTIFIKASI ISOLAT STREPTOKOKUS PNEUMONIAE

Streptococcus pneumoniae
Normal

flora of upper respiratory tract Pneumococcal infections usually arise from this normal flora (endogenous infections). Predispose factors: primary cardiopulmonary diseases, previous infections (e.g., influenza), extirpation of the spleen or complement system defects, malnutrition.

Clinical Features:
Lung:

lobar pneumonia, bronchopneumonia Bacteremia meningitis, endocarditis, septic arthritis Severe pneumococcal infections frequently involve sepsis

Therapy
Penicillin is still the antibiotic of choice. Macrolide antibiotics are an alternative to penicillins. Penicillin resistance is not due to penicillinase, but rather to modified penicillin-binding proteins (PBPs) to which penicillins have a lower level of affinity. Biochemically, penicillin resistance extends to cephalosporins as well. However, certain cephalosporins (e.g., ceftriaxone) can be used against penicillin-resistant pneumococci due to their higher levels of activity.