MIKROBIOLOGI II

(KPMB 1213)
Topik 1.7

Mycobacterium

Oleh
Erik Abdullah
Kolej Kesihatan Awam
Kuching
 Pengenalan
Mycobacterium adalah bacilli ‘acid-fast’
yang hanya dapat dicelup dgn
Zielh-Neelsen Stain.
Dua spesis Mycobacterium penting
dalam kesihatan awam dan perubatan:-
M. tuberculosis, agen etiologi penyakit
tuberculosis. [TB]
M. leprae, agen etiologi penyakit kusta.
Terdapat bnyk spesis lain yg kurang
patogenik.
 KANDUNGAN PENGAJARAN
1. Spesis-spesis penting dalam perubatan dan
kesihatan awam
2. Ciri-ciri penting Mycobacterium
3. Habitat Mycobacterium
4. Patogenisiti Mycobacterium
5. Cara-cara infeksi M. tuberculosis & M.
leprae
6. Kepentingan M. tuberculosis & M. leprae
dalam kesihatan awam
7. Pendiagnosan makmal M. tuberculosis & M.
leprae
 Spesis-spesis penting dalam perubatan
dan kesihatan awam
Mycobacterium Penyakit
species
M. tuberculosis tuberculosis
M. bovis tuberculosis - lembu
M. leprae leprosy (kusta)
M. kansassi pulmonary disease
M. avium- cervical adenitis
intracellular
 Ciri-ciri am
Morfologi
1. Acid fast bacilli:-(retain dyes following
an acid-alcohol decolorization step)
- dinding sel tebal yang terdiri daripada
mycolic acid & lipid.
- sukar diwarnakan dgn pewarna Gram.
- dicelup dgn Ziehl Neelsen stain.
2. Non-motile
3. Non-sporing
4. Non-capsulated
Acid-fast bacilli
 Ciri-ciri am
Kultur
Perlu media khas;
Lowenstein-Jensen Agar.
Dgn 5-10% CO2
Suhu: 35⁰C-37⁰C.[won’t grow @RT)
Tumbuh dgn perlahan. (3-6 minggu)
 Ciri-ciri am
Resistence
Tahan kering, disinfektan, asid &
alkali.
Boleh hidup dalam kahak kering
selama 6-8 bulan.
Sensitif
Cahaya ultra unggu.
Haba panas.
Pasteurization.
 Habitat
Habitat
Saluran pernafasan
M. tuberculosis Saluran penghadaman
Saluran genitourinari
Kulit
Kulit
Permukaan mukosa
M. leprae (hidung)
Sistem saraf
Mata
Buah zakar
 Patogenisiti
M.tuberculossis agen etiologi penyakit
tuberculosis.
Tuberculosis adalah penyakit sistemik
dgn manifestasi gerakbalas imun dlm
individu yg terdedah kpd M.tuberculosis.
Penyakit kadangkala tidak ada simptom.
Progresif dgn simptom pneumonia, demam,
batuk dgn kahak berdarah, hilang berat
badan.
 Mycobacterium tuberculosis
Patogenisiti
Inhale contaminated droplets/dust particles

Develop primary infection

(self-healing depends on immune response)

TB bacillus multiply in lungs

(develop pulmonary tuberculosis)

If TB bacillus enter the vein, pt develop

miliary tuberculosis
 Patogenisiti
Mycobacterium tuberculosis

Simptom:
Batuk kering
Hilang berat badan
Hilang selera makan
lethargy
Demam
 Patogenisiti
Mycobacterium leprae

Inhale / enter thru skin

Affect the pheripheral nerves or skin

Patient develop leprosy

(depends on pt’s immune response)

Tuberculoid leprosy /Borderline leprosy /lepromatous

leprosy
(TT) (BT/BB/BL) (LL)
 Patogenisiti
Mycobacterium leprae

Simptom:-
Hypopigmentation of the skin
Skin lesion
Anaesthesia
Muscle paralysis
Nerve damage
Bone destruction
This disease is characterized by the formation of skin bumps or
lesions which looks like blister. The skin color may change and
the affected person may not be sensitive to heat or touch as the
disease progresses. The lesions will not heal even after several
months of treatment. In the long run, it would cause nerve
damage and muscular weakness. For some people, there may
be feeling of numbness in the arms, hands and legs, indicating
nerve damage.
Since the symptoms develop very slowly, it becomes difficult
to detect the signs. For some people, it may take months even
years for the signs to appear evidently. The symptoms of
leprosy are very much similar to that of syphilis and tetanus.
This disorder is marked by loss of sensation and numbness on
the affected part of the body. In case if it affects the eyes, you
will feel dryness in the eyes and will eventually reduce
blinking.
Obviously, if a nasal droplet is
near you and you breathe it in,
then you will be at risk,
otherwise it is not that easy to
catch especially with a healthy
immune system, adequate
nutrition, clean water, etc.
M.Leprae can be grown in the footpad of armadillos
The bacteria that causes
leprosy, M. Leprae,
multiplies slowly with an
average incubation time
of 5 years while
symptoms can take as
long as 20 years before
showing.
 treatment
Strong antibiotics like clofazamine, dapsone, macrolides and
rifampin are given to destroy the bacteria and reduce infection. It
is essential to detect the disease in early stages to avoid severe
infection and damage. If the individual is affected with
multibacillary leprosy it can be completely removed using
antibiotics. However the treatment should begin in the early
stages, failing which the damage done to the body becomes
irreversible. People having first sign of skin lesion can take
minocycline or Floxin injection to prevent further damage and
spreading the infection to others.
Once the body starts responding to treatment, the course of
treatment is completed by performing surgery for clearing the skin
smears. The basic purpose of treatment is to restore the lost
functions and reduce nerve damage.
 complications
• Leprosy, if detected in the advance stages,
can cause complications like permanent
nerve damage, sensory loss in the hands and
feet, muscular weakness and disfigurement
of the physique. Further, the affected person
may have lot of injuries without noticing
and his body becomes room for infections.
Muka pesakit kusta Kaki pesakit kusta
 Cara-cara infeksi

Mycobacterium tuberculosis
- inhaling droplets/dust particles
containing the bacteria

Mycobacterium leprae
- Inhalation
- skin
 Kepentingan Mycobacterium
tuberculosis dlm kesihatan awam
EPIDEMIOLOGY:
Tuberculosis is spread by airborne droplets
M.tuberculosis causes tuberculosis, a
communicable disease.
With the AIDS epidemic, the number of
multiple drug resistant (MDR) strains has
increased, making it even more difficult to
treat cases.
Most transmission occur within household and
environments where individuals are close
together.
 Kepentingan Mycobacterium
tuberculosis dlm kesihatan awam
Kawalan dan pencegahan
1. Pengesanan & rawatan awal pesakit
TB
2. Kurangkan kesesakan (overcrowding)
3. Vaccination dgn Bacille Calmette-
Guerin (BCG)
4. Rawatan dgn isoniazid, streptomycin,
P-aminosalicylic acid, thiocetazone,
rifampicin, ethambutol, pyrozinamide
Kepentingan Mycobacterium leprae
dalam kesihatan awam
Mycobacterium leprae menyebabkan
Penyakit kusta.
(leprosy/Hansen disease)
Mengakibatkan kecacatan anggota
badan.
Not very infectious / contagious
Incubation period= 3-5 years
 Kepentingan Mycobacterium leprae
dalam kesihatan awam

Kawalan & pencegahan

1. Pengesanan & rawatan kes-kes
leprosy yang infectious.
2. Avoid living in crowded places.
3. Good personal hygiene.
4. Quarantin positive cases.
 Kepentingan Mycobacterium leprae
dalam kesihatan awam
Rawatan:-

Types of drugs Frequency Total

leprosy duration
Paucibacillary Rifampicin Monthly 6 months
Dapsone daily
Multibacillary Rifampicin Monthly 2 years
Daily
Dapsone Monthly
Daily
Clofazimine Monthly
daily
 Kepentingan Mycobacterium leprae
dalam kesihatan awam
Treatment of leprosy demands far more than
administration of antimicrobial agents. It is
often necessary to:-
a. Correct deformities
b. Prevent blindness & further damage to
anaesthetic extremities.
c. Treat reaction with anti-inflammatory
drugs.
d. Attend to patient’s social, psychological &
spiritual welfare.
 Pendiagnosan makmal
Mycobacterium tuberculosis
Pendiagnosan penyakit TB berdasarkan:
1. Simptom klinikal
2. Tanda2 penyakit melalui X-ray
3. Kehadiran acid-fast bacilli dalam
kahak
4. Pemencilan & idenfikasi & ujian
susceptibility kepada antimikrobial
5. Tuberculin Test.
 Tuberculin test
The tuberculin skin test measures
‘Delayed Type Hypersensitivity’ to
tuberculoprotein.
Perform by intradermal injection that
is read after 48-72 hrs.
Result:-
No induration = negative
Induration [10mm] = positive
 Pendiagnosan makmal
Mycobacterium tuberculosis
Sampel:-
Kahak
Urin
Darah
Cecair saraf tunjang (CSF)
Tissue biopsy dari hati, sum tulang,
nodus limfatik
any source suspected of being the site of
infection.
 Pendiagnosan makmal
Mycobacterium tuberculosis
Ujian makmal
1. Direct smear yg diwarna dgn Ziehl-
Neelsen stain:- acid fast bacilli
2. Kultur dlm media selektif Lowenstein-
Jensen; utk pemencilan & identifikasi
M.tuberculosis
-raised, dry ,creamy color colonies
3. Biochemical test: Niacin+ve
4. Sensitivity test:- isoniazid, streptomycin,
P-aminosalicylic acid, thiocetazone,
rifampicin, ethambutol, pyrozinamide
 Pendiagnosan makmal
Mycobacterium leprae
Sample: skin scrapping, sputum, nasal
swab, skin biopsy.
Microscopy: acid fast bacilli,
count the Bacteria Index
and
Morphological index.
Culture: only on the footpads of
armadillos