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OVERVIEW AGENT PENYEBAB INFEKSI MATA

BACTERIAL INFECTIONS
Bacterial conjuntivitis
Common causative agents: Flora normal of the eye: Staphylococcus epidermidis, Propionibacterium, Streptococcus sp., Corynebacteria sp Haemophylus influenzae Streptococcus pneumonia Moraxella catarhalis Staphylococcus aureus Contact lens conjuntivitis caused by Pseudomonas or other gram negative bacteria

Neisseria gonorrhoeae infection Chlamydia trachomatis infections

Bacterial Diseases of the Eye


1. Conjunctivitis - many bacteria or viruses watery, stinging eyes, pus - e.g. Pseudomonas aeruginosa grows in contact lens solution Treatment - viral treat symptoms - bacterial eye drops with broad spectrum antibiotics

2. Neonatal Gonorrheal Opthalmia - newborn infant picks up bacterium Neisseria gonorrheae from infected mother when passing through birth canal Ophthalmia neonatorum - Keratitis Ulceration and scaring blindness Treatment - 1% silver nitrate eye drops to newborn - give Mom broad spectrum antibiotics if she is infected with Neisseria gonorrheae

3. Chlamydia trachomatis Infections - mild cases swimming pool conjunctivitis - Serious cases Trachoma blindness - Neonatal opthalmia if Mother is infected
Chlamydia is a bacterium which can only live within a host cell called an intracellular parasite Treatment - broad spectrum antibiotic eye drops for conjunctivitis - oral if have trachoma, or infected Mom

Chlamydia
Obligate intracellular bacteria Require the biochemical source of the eucariotic host cell Gram negative bacteria, lack of peptidoglycan layer Genus Chlamydia, three species:
C. trachomatis C. suis C.muridarum Posses a heat stable, family specific antigen cell membrane lipopolysacharida

Chlamydia trachomatis
C. trachomatis is found worldwide primarily in areas of poverty and overcrowding. It is estimated that 500 million people are infected worldwide and 7 - 9 million people are blind as a consequence. C. trachomatis : trachoma is endemic in Africa, the Middle East, India and Southeast Asia. Infections occur most commonly in children. The organism can be transmitted by droplets, hands, contaminated clothing, flies, and by passage through an infected birth canal.

Chlamydia trachomatis serotypes D to K ---cause conjuntivitis Transmission by contact with fingers, towel and flies (are important vectors) (autoinfection form genital infection, or infection of the new born during birth)

The infection is characterized by a mucopurulent discharge, corneal infiltrates and occasional corneal vascularization. In chronic cases corneal scarring may occur. In neonates infection results from passage through an infected birth canal and becomes apparent after 5 - 12 days. Ear infection and rhinitis can accompany the ocular disease.

Chlamydia trachomatis serotype A to C---cause Trachoma The name trachoma comes from trakhus meaning rough which characterizes the appearance of the conjunctiva. Chronic infection or repeated reinfection with C. trachomatis results in inflammation and follicle formation involving the entire conjunctiva. Scarring of the conjunctiva causes turning in of the eyelids and eventual scarring, ulceration and blood vessel formation in the cornea, resulting in blindness.

trachoma

Pink-eye

Laboratory diagnosis of Chlamydial infection


Conjuntival scrappings fluorescent antibody Conjuntival swabs for cell culture Antigen detection PCR

Direct Immuno fluorescence (DIF) v Antibody labeling

Laboratory diagnosis and treatment


Light Microscopy Direct Immuno fluorescence (DIF) Antibody labeling Direct enumeration by electron microscopy(EM) Flow Cytometric Analysis Nucleic Acid Amplification Methods

VIRAL EYE INFECTIONS


1. Adenovirus infections
Epidemic keratokonjuntivitis (EKC) caused by adenovirus serotypes 8,19, dan 37 Sign symptoms: conjuntiva inflamed, painfull, foreign body sensation, watery eyes and photofobia

Transmission : direct contact with infected individual, often transmitted in epidemic form in eye clinics via contaminated equipment or hands Resolve spontaneously within 2-6 weeks

2. Herpes simplex infections HSV 1 HSV 2

Herpes simplex type 1 infection

HERPES SIMPLEK VIRUS (HHV-1 & HHV-2)


HSV-1 : Genom 152 kbp G & C : 68,3% Infeksi mulut, mata, SSP Laten : ganglia trigeminal Usia infeksi I : anak kecil Penularan : kontak (air liur yg terinfeksi), ciuman, droplet infeksi (orofaring) HSV-2 : Genom 152 kbp G & C : 69% Infeksi kelamin, Herpes neonatorum, mungkin berperan pd Ca cervix & vulva. Laten : ganglia sacral Usia infeksi : dewasa muda Penularan : seksual (sekresi genital), infeksi kelamin ibu ke anak yg baru lahir

EPIDEMIOLOGI :
Manusia host alamiah 50% orang dewasa punya antibodi Terinfeksi pada awal-awal tahun kehidupan Insiden terbanyak HSV-1 = 6 bulan-3 tahun. HSV-2 berhubungan PHS HSV-2 lebih sering kambuh daripada HSV-1 Infeksi I sebelum hamil 20 mg : abortus spontan. + 70% herpes neonatal dilahirkan dari wanita yang tidak memiliki riwayat herpes genital dan bersifat asimptomatik pada saat persalinan

INFEKSI PRIMER
A. Stomatitis Herpetika/Penyakit orofaring/ Ginggivostomatitis B. Keratokonjungtivitis

tidak secara langsung (Kelainan yg timbul mrpkn reaksi thd replikasi virus dan atau gangguan imunitas kornea dan iris) HSV-1 menimbulkan keratokonjungtivitis yg berat. Lesi mata yg berulang tampak sbg keratitis dendritik atau ulkus kornea

Herpes simplex dendritic keratitis

C. Herpes Genital
Biasanya HSV-2, 20-30% HSV-1

D. Infeksi Kulit herpes traumatic herpetic whitlow herpes gladiatorum Infeksi primer HSV-1 sering menyebabkan Eksema Herpetikum pd penderita Eksema kronik

INFEKSI LATEN :
Virus menetap sampai akhir hidup inang. Reaktivasi : sinar matahari, stres, sakit demam, menstruasi, imunosupresif, trauma mekanik (fraktur oro-facial atau karena operasi), bahan kimia, hormon, transplantasi organ, iradiasi sinar-X, khemoterapi. Imunitas spesifik tidak dpt mencegah kembali aktifnya virus Manifestasi : cold sores, recurrent herpes genital, dan keratitis

Latency and Recurrent disease

Diagnosis of viral eye infections


Electron microscopic Cell Culture :
Sampel dikultur pada cell culture : terlihat cytophatic effect (CPE)

Imunologi/serologi
ELISA Aglutination test

Immunofluorescense Analisis asam nukleat


Nucleic acid amplification (PCR)

Adenovirus (electron mycroscopy)

Prominent foci, or plaques, of rounded cells typifies infection with HSV-1

OTHER EYE INFECTIONS


Keratitis Blepharitis Endophthalmitis Retinitis

TYPE OF EYE INFECTIONS


Type of Infection
Bacterial conjuntivitis

Common cause
Haemophylus influenzae Streptococcus pneumoniae Moraxella catarhalis Staphylococcus aureus Chlamydia trachomatis Adenovirus Herpes simplex virus types 1&2 All causative conjuntivitis, pseudomonas spp Staphylococcus aureus Staphylococcus aureus Pseudomonas aerugenosa Enterobacteriaceae

Trachoma Viral conjuntivitis Keratitis Blepharitis Endopthalmitis

Retinis
Preseptal cellulitis

Cytomegalovirus HIV
Staphylococcus aureus Streptococcus Haemophylus influenzae Staphylococcus aureus Streptococcus Haemophylus influenzae

Orbital cellulitis

Causative Organism Blepharitis OR

Drug of choice Topical Bacitracin + Neomycin Topical Fusidic acid

Dosage 4 - 6 times per day x 1 2 weeks and then once nocte x 4 - 8 weeks 1 -2 drops 12 hourly x 1 - 2 weeks

Hordeola Externa hordeolum(styes) Internal hordeolum No antibiotics Cloxacillin 500 - 1000 mg PO 8 hrly x 5 days

Conjunctivitis
Viral conjunctivitis Bacterial conjunctivitis No antibiotics Chloramphenicol OR Gentamicin OR Tobramycin OR Fusidic acid Topical Topical Topical Topical

Chlamydia (adults)

Tetracycline OR Doxycycline OR

500 mg PO 8 hrly x 7 days 100 mg PO 12 hrly x 7 days

Erythromycin OR
Azithromycin

500 mg PO 6 hrly x 7 days


1 g PO as a single dose

Gonococcus (adults)

Ceftriaxone

1 g1M as a single dose