family enterobacteriaceae manik retno w., dr., mkes
DESCRIPTION
Family Enterobacteriaceae Manik Retno W., dr., MKes. • Banyak di usus besar mns, hewan, serangga (normal flora), tanah & air (25 genus, 110 species) • Media diferensial : 1. MacConkey agar Gula : laktosa Indikator warna : neutral red - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Family Enterobacteriaceae Manik Retno W., dr., MKes](https://reader036.vdocuments.site/reader036/viewer/2022062323/568167f0550346895ddd60b7/html5/thumbnails/1.jpg)
1
Family EnterobacteriaceaeEnterobacteriaceae
Manik Retno W., dr., MKesManik Retno W., dr., MKes
![Page 2: Family Enterobacteriaceae Manik Retno W., dr., MKes](https://reader036.vdocuments.site/reader036/viewer/2022062323/568167f0550346895ddd60b7/html5/thumbnails/2.jpg)
2
• Banyak di usus besar mns, hewan, serangga (normal flora), tanah & air(25 genus, 110 species)
• Media diferensial :1. MacConkey agar Gula : laktosa Indikator warna : neutral red - Kuman yg memfermentasi laktosa → koloni- nya berwarna merah - kuman yg tak fermentasi → tak berwarna
![Page 3: Family Enterobacteriaceae Manik Retno W., dr., MKes](https://reader036.vdocuments.site/reader036/viewer/2022062323/568167f0550346895ddd60b7/html5/thumbnails/3.jpg)
3
2. Eosin Methylene Blue agar (EMB)gula : laktosa & sukrosaindikator warna : Eosin & methylene blueE. coli : memfermentasi laktosa → koloninya
metallic sheen
![Page 4: Family Enterobacteriaceae Manik Retno W., dr., MKes](https://reader036.vdocuments.site/reader036/viewer/2022062323/568167f0550346895ddd60b7/html5/thumbnails/4.jpg)
4
Kuman yg tak memfermentasi laktosa
1. Proteus 3. Shigella2. Salmonella 4. Yersinia
Enterobacteriaceae → 2 kelompok1. Intestinal pathogen
Salmonella, Shigella, Yersinia2. Opportunistic pathogen : flora normal →
baru menimbulkan peny jika immun Px ↓
![Page 5: Family Enterobacteriaceae Manik Retno W., dr., MKes](https://reader036.vdocuments.site/reader036/viewer/2022062323/568167f0550346895ddd60b7/html5/thumbnails/5.jpg)
5
Mikroba Habitat Klinis
Proteus Flora normal Inf nosokomial
Salmonella spp. Bukan flora normal
1. Gastroenteritis 2. Bacteremia3. typhoid
Shigella spp. (+) hanya pd inf
Dysentery (drh, lendir)
Yersinia pestis Tikus Bubonic plaquePneumonic plaque(lymphadenitis,panas)
Y. EnterocolitiocaY. pseudotuberculosis
AnjingKucingTikus
Enterocolitis ≈ appendicitis
![Page 6: Family Enterobacteriaceae Manik Retno W., dr., MKes](https://reader036.vdocuments.site/reader036/viewer/2022062323/568167f0550346895ddd60b7/html5/thumbnails/6.jpg)
6
Laktosa motil Urea Ket
Proteus - ++ + swarmingS. typhi - + -S. paratyphi A - + -S. paratyphi B - + -S. dysenteriae - -Y enterocolitica - - +Y. pseudotuberculosis - - +Y. pestis - - -
Urease +Urease + → → batu ginjalbatu ginjal
Peritrichous flagellaPeritrichous flagella
![Page 7: Family Enterobacteriaceae Manik Retno W., dr., MKes](https://reader036.vdocuments.site/reader036/viewer/2022062323/568167f0550346895ddd60b7/html5/thumbnails/7.jpg)
7
• LPS (Lipopolysaccharide) : suatu endotoksin - bagian dari dinding sel- menjadi toksin jika kuman hancur- menyebabkan demam pada inang
![Page 8: Family Enterobacteriaceae Manik Retno W., dr., MKes](https://reader036.vdocuments.site/reader036/viewer/2022062323/568167f0550346895ddd60b7/html5/thumbnails/8.jpg)
8
Proteus• Flora normal usus• Menimbulkan penyakit jika berpindah tempat :
1. infeksi sal kencing2. pneumonia3. sepsis
![Page 9: Family Enterobacteriaceae Manik Retno W., dr., MKes](https://reader036.vdocuments.site/reader036/viewer/2022062323/568167f0550346895ddd60b7/html5/thumbnails/9.jpg)
9
Kuman yg memproduksi urease :1. Klebsiella → memfermentasi laktosa2. ProteusJika menginfeksi sal kencing→ menghidrolisa urea → ammonia→ pH urine menjadi basa→ presipitasi Ca & Mg → batu sal kencing
![Page 10: Family Enterobacteriaceae Manik Retno W., dr., MKes](https://reader036.vdocuments.site/reader036/viewer/2022062323/568167f0550346895ddd60b7/html5/thumbnails/10.jpg)
10
• Proteus sangat motilpd lempeng agar tampak swarming
• Peritrichous flagella
![Page 11: Family Enterobacteriaceae Manik Retno W., dr., MKes](https://reader036.vdocuments.site/reader036/viewer/2022062323/568167f0550346895ddd60b7/html5/thumbnails/11.jpg)
11
SalmonellaStruktur Antigenik : aglutinasi pd uji Widal(tube dilution agglutination test) 1. Vi (kapsule = capsular) Ag2. H (flagellar) Ag
peritrichous flagellajika titer H ↑ : pernah terinfeksi
pernah immunisasipositif : > 1:640
3. O (somatic) Agjika titer O ↑ : sedang sakitpositif : > 1:320
![Page 12: Family Enterobacteriaceae Manik Retno W., dr., MKes](https://reader036.vdocuments.site/reader036/viewer/2022062323/568167f0550346895ddd60b7/html5/thumbnails/12.jpg)
12
• tak hanya menembus sel epithel ususSalmonella dpt menembus lamina propria → menyebar ke jr lain (meningitis dll)
• endotoxin / LPS : bag dinding sel → demam
![Page 13: Family Enterobacteriaceae Manik Retno W., dr., MKes](https://reader036.vdocuments.site/reader036/viewer/2022062323/568167f0550346895ddd60b7/html5/thumbnails/13.jpg)
13
• sumber inf: 3% mjd carrier S. typhi berkembang biak pd batu empedu& dikeluarkan dlm jml banyak melalui faeces
• dpt bertahan hidup lama dlm air yg dibekukanpencegahan : chlorinasi air
• dpt mengkontaminasi telur
![Page 14: Family Enterobacteriaceae Manik Retno W., dr., MKes](https://reader036.vdocuments.site/reader036/viewer/2022062323/568167f0550346895ddd60b7/html5/thumbnails/14.jpg)
14
Water borne disease → penyebaran : fecal – oral : † dg pemanasan, chlorinasi
FiltrasiKhlorinasicarrier
![Page 15: Family Enterobacteriaceae Manik Retno W., dr., MKes](https://reader036.vdocuments.site/reader036/viewer/2022062323/568167f0550346895ddd60b7/html5/thumbnails/15.jpg)
15
3 bentuk klinis Salmonellosis :1. Gastroenteritis :
inf colon, self limiting (2-5 hr)2. Bacteremia + lesi focal (pneumonia, osteomyelitis, jantung)3. Enteric fever / typhoid fever
ingesti 105 kuman → penetrasi colon→ kel regional → darah → kd empedu → colon
Peyer’s patches
![Page 16: Family Enterobacteriaceae Manik Retno W., dr., MKes](https://reader036.vdocuments.site/reader036/viewer/2022062323/568167f0550346895ddd60b7/html5/thumbnails/16.jpg)
16
Typhoid fever
• Masa inkubasi 10-14 hari• Klinis :
1. panas tinggi2. necrosis jaringan lymphoid (Peyer's patches)3. rose spots di kulit dada & perut 4. pembesaran hati & limpa
![Page 17: Family Enterobacteriaceae Manik Retno W., dr., MKes](https://reader036.vdocuments.site/reader036/viewer/2022062323/568167f0550346895ddd60b7/html5/thumbnails/17.jpg)
17
Shigella• Penyebab dysentery basiler• Gx : abdominal cramps
tenesmus (spasme rectum) low-volume stools + lendir + darah
▪ Dosis infektif : 103 kuman (salmonella : 105 - 108)▪ masa inkubasi : 1-2 hari▪ penyebaran : 5 f
food, fingers, feces, flies & person to person
![Page 18: Family Enterobacteriaceae Manik Retno W., dr., MKes](https://reader036.vdocuments.site/reader036/viewer/2022062323/568167f0550346895ddd60b7/html5/thumbnails/18.jpg)
18
• Berkembang biak pd epithel colon menyebabkan inflamasi, † sel colon → gg absorpsi cairan → diare lendir + darah▪ invasif, dpt berpindah
dari epithel ke epithel
![Page 19: Family Enterobacteriaceae Manik Retno W., dr., MKes](https://reader036.vdocuments.site/reader036/viewer/2022062323/568167f0550346895ddd60b7/html5/thumbnails/19.jpg)
19
• † epithel colon krn shiga toxin yg bersifat1. enterotoxic : diare2. cytotoxic : nekrosis epithel3. neurotoxic : meningismus, coma
▪ pencegahan :1. sanitasi air & makanan2. sampah & fly control3. isolasi pasien & disinfeksi faeces4. deteksi carrier, khususnya food handlers
![Page 20: Family Enterobacteriaceae Manik Retno W., dr., MKes](https://reader036.vdocuments.site/reader036/viewer/2022062323/568167f0550346895ddd60b7/html5/thumbnails/20.jpg)
20
Yersinia• peny zoonosis
1. Y. pestis : penyebab plaque/pes2. Y. enterocolitica : enteritis3. Y. pseudotuberculosis
• Siklus plaque progresstikus mns mns
serangga bubonic pneumonic plaque plaque
tikus
![Page 21: Family Enterobacteriaceae Manik Retno W., dr., MKes](https://reader036.vdocuments.site/reader036/viewer/2022062323/568167f0550346895ddd60b7/html5/thumbnails/21.jpg)
21
• Pengecatan Gram : batang pleomorphic gram-negative (bipolar)
• Pengecatan Giemsaseperti peniti/jepit rambut
• Ditularkan langsung oleh tikusatau melalui gigitan serangga
![Page 22: Family Enterobacteriaceae Manik Retno W., dr., MKes](https://reader036.vdocuments.site/reader036/viewer/2022062323/568167f0550346895ddd60b7/html5/thumbnails/22.jpg)
22
• Serangga tertular Y pestis ketika serangga menggigit tikus
• Kuman multiplikasi di usus serangga & membuntu usus (koagulasi pd 20-28ºC)
• Serangga yg merasa lapar menularkan ke mns yg digigitnya
• Kuman difagosit polymorphonuclear/PMN (†) & monosit (dpt bermultiplikasi)
• Masa inkubasi 2-7 hari• Tjd bubonic plaque : lesi hemorrhagic kelenjar• Penularan dari Px ke Px secara droplet →
pneumonic plaque