BAB I PENDAHULUAN

I.

1.

LATAR BELAKANG

Bakteri, dari kata bacterium (jamak, bacteria), adalah kelompok raksasa dari organisme hidup. Mereka sangatlah kecil (mikroskopik) dan kebanyakan uniseluler (bersel tunggal), dengan struktur sel yang relatif sederhana tanpa nukleus/inti sel, cytoskeleton, dan organel lain seperti mitokondria dan kloroplas. Penyakit yang disebabkan oleh bakteri merupakan suatu penyakit yang paling banyak diderita oleh masyarakat dunia. Penyebab infeksi ini bisa bermacam-macam dan salah satunya adalah bakteri. Ada berbagai macam bakteri yang bisa menyebabkan infeksi pada mata dan kulit, diantaranya Chlamydia trachomatis, Propionibacterium acnes, Pseudomonas aeruginosa, Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pyogenes.

I.

2.

RUMUSAN MASALAH

Jenis bakteri apa saja yang dapat menimbulkan patogen pada mata dan kulit.

Morfologi dan fisiologi bakteri yang menimbulkan patogen pada mata dan kulit.

Cara pencegahan dan pengobatan penyakit yang disebabkan bakteri patogen pada mata dan kulit.

I.

3.

TUJUAN PENULISAN

1

Penulisan makalah ini bertujuan untuk memberikan informasi ilmiah kepada sesama mahasiswa farmasi khususnya dan masyarakat secara umum tentang jenis-jenis bakteri penyebab infeksi pada mata kulit. Selain itu juga diharapkan adanya pengembangan untuk pengobatan penyakit berdasarkan informasi yang terdapat dalam makalah.

I.

4.

METODE PENULISAN

Metode penulisan yang digunakan dalam menyusun makalah ini adalah metode pustaka dan studi literatur. Dengan metode ini, penulis mencari dan mengumpulkan informasi penting yang sesuai dengan topik penulisan dari berbagai sumber seperti beberapa buku, artikel dan website atau situs-situs internet yang terkait.

I.

5.

SISTEMATIKA PENULISAN

Sistematika penulisan makalah ini terdiri dari tiga bab, yaitu Bab I: Pendahuluan, terdiri atas Latar Belakang, Rumusan Masalah, Tujuan Penulisan, Metode Penulisan, dan Sistematika Penulisan. Bab II: Pembahasan, serta Bab III: Penutup, yang terdiri atas Kesimpulan dan Saran.

BAB II PEMBAHASAN

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add6e7bde7f7d6ffffd6ffffadd6e7add6e7b5deefbde7f7bde7f77ba5a dcef7ffdeffffceefffd6ffffd6f7ffceefffb5dee7c6efffbde7f7bde7f794c6 d673a5b594c6d694c6ce8cb5c6a5cedea5ceded6ffffd6ffffdeffffd6ffff e7ffffd6ffffdeffffbde7efbddee7b5d6deadd6de9cc6ce9cbdce9cbdcea dd6deb5d6e7b5deefbde7efcef7ffceefffd6f7ffc6e7f7b5deefadd6e7b5 dee7b5deefc6eff7c6efffcef7ffb5deef94b5c65a7b8c73949cadced6ad cede7b9cad5a7b8c5a7b8c94b5bdb5d6e7e7ffffdeffffd6ffffadd6e7a5 cedeaddee7add6e773a5ad8cbdc6c6efffd6ffffb5e7f7d6ffff9cc6d6ad deefaddee79cced6c6f7ffaddee7addee7bde7ff94bdcea5cee7739cad4 a7b8c39637b94bdd68cb5ce6b94ada5cee79cc6de426b84426b84214 a63426b7b7ba5bdbde7ffa5cee784adc67ba5bd8cb5ce8cb5ceb5deef ceefff426b7b42637bc6efffcef7ff9ccedeb5deef94c6d6638c9c6b8ca57 b9cad527b8c94b5c6739cad2142525a8c94a5ceded6ffffadd6e7add6 e77394a57394a584a5ad5273849cbdce94bdce6b94a5739cad638c9c 8cb5c6cef7ff9cc6d6527b8c7ba5b5638c9c739cad7ba5bd6b94a5295 a6b0031426b94a59cc6d65a84947394ad8cb5c694bdce5a84948cb5c 684adbdc6eff7d6ffffd6ffffc6efff8cbdc6a5cedeadd6e78cb5bda5ced 69cbdcea5c6d6b5deefb5dee7c6e7f7c6e7f7bddeefb5dee7adcede84a db56b94a58cb5c6a5cedec6efffadcedea5cedebde7f7add6e7527b8c5 a84949cc6d68cbdce94c6ce6b949c103942527b84739ca584a5b59cc6 d6a5cedeb5deefb5deefc6efffcef7ffadd6e7add6e7add6e7add6efb5d eef9cc6d68cbdc6bdeff7cef7ffadd6e7add6e7bde7f794bdce9cc6d6ad d6e7d6ffffceffffa5cee7cef7ff94c6de9ccedea5cedeaddee7a5cedecef7 ff8cb5c69cc6d65a8494739ca57ba5ad8cb5bd9cbdc684adb56b949c9 cbdcA. Gambaran Umum Chlamydia trachomatis adalah salah satu dari tiga spesies bakteri dalam genus Chlamydia, famili Chlamydiaceae, kelas Chlamydiae, filum Chlamydiae,

domain Bacteria. C. trachomatis adalah agen chlamydial pertama yang ditemukan dalam tubuh manusia. Bakteri ini pertama kali diidentifikasi tahun 1907. Infeksi Chlamydia trachomatis sering tidak menimbulkan gejala dan sangat beresiko bila terjadi pada ibu-ibu karena dapat menyebabkan kehamilan ekyopik, intertelitas dan abortus. WHO memperkirakan 4 juta kasus baru pada ibu-ibu terinfeksi oleh Chlamydia trachomatis dan 50.000 diantaranya mengalami intertilitas,kehamilan ektopik dan abortus. Mekanisme terjadinya infeksi C.trachomatis telah dipelajari banyak peneliti, dimana MOMP (Major Outr Membrane Protein) merupakan suatu target penting untuk mencegah respons imun dari host, seperti neuralizing factor dan sel T. B. Klasifikasi Ilmiah Kingdom : Bacteria Filum : Chlamydiae Ordo : Chlamydiales Famili : Chlamydiaceae Genus : Chlamydia Spesies: Chlamydia trachomati C. Struktur

a.

Dasar badan (EB) EBS adalah bentuk menular dengan ukuran kecil (0,3-0,4 m) dari klamidia tersebut. Mereka memiliki membran luar kaku yang luas yang tertutup oleh ikatan disulfida. Karena membran luar mereka kaku,

43

mereka tahan terhadap kondisi lingkungan yang dihadapi ketika klamidia berada di luar sel host eukariotik mereka. Mereka mengikat tubuh dasar sebagai reseptor pada sel inang dan memulai infeksi. Kebanyakan klamidia menginfeksi sel epitel kolumnar, tapi beberapa juga dapat menginfeksi makrofag. b. Retikular tubuh (RB) RBS adalah bentuk intraselular non-infeksius dari dari klamidia tersebut. RB adalah bentuk replikasi metabolik aktif klamidia tersebut. RB memiliki membran yang rapuh yang tidak memiliki ikatan disulfida yang luas seperti yang dimiliki EBS. D. Siklus hidup

Siklus hidup C. trachomatis terdiri dari dua tahap, tubuh dasar dan retikular tubuh. Tubuh dasar adalah bentuk penyebaran dan analog dengan spora sebuah. Hal ini sekitar 0,3 mm dalam diameter dan menginduksi endositosis sendiri atas paparan target sel. Ini adalah bentuk yang mencegah fusi phagolysosomal sehingga memungkinkan untuk bertahan hidup intraseluler. Setelah di dalam endosome, glikogen dihasilkan menyebabkan tubuh dasar untuk "tumbuh" ke bentuk vegetatif, yang retikular tubuh. Formulir ini membelah melalui fisi biner di sekitar 2-3 jam per generasi. Ini memiliki masa inkubasi 7-21 hari di host. Tidak berisi dinding sel dan (ketika diwarnai dengan yodium) terdeteksi sebagai inklusi di dalam sel. Setelah divisi, yang retikular mengubah tubuh kembali ke bentuk dasar dan dilepaskan oleh sel oleh eksositosis. Satu phagolysosome biasanya menghasilkan 100-1000 tubuh dasar. EBS mengikat pada reseptor pada sel yang rentan dan diinternalisasikan oleh endositosis dan / atau oleh fagositosis. Dalam sel inang endosome yang EBS mereorganisasi dan menjadi RBS. Klamidia menghambat fusi dari endosome dengan lisosom dan dengan demikian tidak membunuh intraseluler. Seluruh siklus hidup intraseluler dari klamidia terjadi dalam endosome. RBS45

mereplikasi oleh fisi biner dan mereorganisasi ke EBS. Pemasukan yang dihasilkan mungkin berisi 100-500 progeni Akhirnya sel-sel dan melisiskan inklusi (C. psittaci) atau inklusi dicetak oleh endositosis terbalik (C. trachomatis dan C. pneumoniae) E. Epidemiologi a. Infeksi Okular C. trachomatis (biovar: trachoma) ditemukan di seluruh dunia terutama di daerah yang rentan dengan kemiskinan dan kepadatan penduduk. Diperkirakan 500 juta orang terinfeksi di seluruh dunia dan 7 - 9 juta orang buta . C. trachomatis (biovar: trachoma) adalah endemik di Afrika, Timur Tengah, India dan Asia Tenggara. Di Amerika Serikat, penduduk asli Amerika yang paling sering terinfeksi. Infeksi terjadi paling sering pada anak-anak. Organisme ini dapat ditularkan melalui tetesan, tangan, pakaian terkontaminasi, lalat, dan oleh bagian melalui jalan lahir terinfeksi. b. Infeksi Saluran Genital

Trachomatis (biovar: trachoma) adalah yang paling umum yang menularkan penyakit menular seksual bakteri di Amerika Serikat (4 juta kasus baru setiap tahun) dan 50 juta kasus baru terjadi di seluruh dunia setiap tahunnya. Tingkat infeksi tertinggi terjadi di Afrika dan Amerika Asli dengan kejadian puncak pada akhir umur belasan atau awal dua puluhan tahun.

C. trachomatis (biovar: LGV) adalah penyakit menular seksual yang terjadi secara sporadis di Amerika Serikat tetapi lebih lazim di Afrika, Asia dan Amerika Selatan. Manusia adalah hospes yang umum. Perkiraan jumlah kasus adalah 300-500 kasus per tahun di Amerika Serikat dengan homoseksual laki-laki menjadi reservoir utama dari penyakit ini.

F. Patologi C. trachomatis nonsilia menginfeksi sel epitel kolumnar. Merangsang organisme menginfiltrasi sel polymorphonuclear dan limfosit yang

menyebabkan pembentukan folikel limfoid dan perubahan fibrosis. Manifestasi klinis akibat dari kerusakan sel dan respon peradangan host. Infeksi tidak merangsang kekebalan jangka panjang dan hasil reinfeksi dalam respon inflamasi dan kerusakan jaringan berikutnya. C.trachomatis adalah agen penyebab trachoma, penyakit oculogential, radang paru-paru bayi dan venereum lymphogranuloma (LGV). a. Biovars - C. trachomatis memiliki kisaran inang yang terbatas dan hanya menginfeksi sel epitel manusia (satu strain dapat menginfeksi tikus). Spesies ini dibagi menjadi tiga biovars (varian biologi): trachoma, LGV dan pneumonitis mouse. b. Serovars - Biovars manusia telah lebih lanjut dibagi ke beberapa serovars (varian serologi; setara dengan serotipe) yang berbeda dalam protein utama mereka membran luar dan yang berhubungan dengan penyakit yang berbeda.

Tabel 1 Serovar A B Ba C Penyakit Trachoma Distribusi Asia and Afrika

47

Penyakit mata dan kelaminKonjungtivitis

D-K

Uretritis Cervicitis Sistem Respirtaory: Bayi pneumonia

Seluruh dunia

LGV1 LGV2 LGV3

Lymphogranuloma venerium (LGV)

Seluruh dunia

G. Gejala Klinis a. Trakhoma Infeksi kronis atau reinfeksi berulang dengan C. trachomatis (biovar: trachoma) menyebabkan inflamasi dan pembentukan folikel yang melibatkan seluruh konjungtiva. Parut pada konjungtiva penyebab balik dalam dari kelopak mata dan bekas luka akhirnya, pembentukan ulkus dan pembuluh darah di kornea, menyebabkan kebutaan. The trachoma, nama berasal dari 'trakhus' berarti kasar yang menjadi ciri penampilan konjungtiva. Pembengkakan pada jaringan juga mengganggu aliran air mata yang merupakan mekanisme pertahanan yang penting antibakteri. Jadi, infeksi bakteri sekunder terjadi. b. Inklusi Konjungtivitis Inklusi konjungtivitis disebabkan oleh C. trachomatis (biovar: trachoma) yang berhubungan dengan infeksi kelamin (serovars D - K). Infeksi ini ditandai dengan debit mukopurulen, infiltrat kornea dan vaskularisasi kornea sesekali. Dalam kasus-kasus kronis jaringan parut kornea dapat terjadi. Pada neonatus hasil infeksi dari bagian melalui saluran lahir yang terinfeksi dan menjadi jelas setelah 5 - 12 hari. Telinga infeksi dan rhinitis dapat menyertai penyakit mata. c. Pneumonia Bayi Bayi yang terinfeksi dengan C. trachomatis (biovar: trachoma; serovars: D -

K)

pada

saat

lahir

bisa

mengembangkan

pneumonia.

Anak-anak

mengembangkan gejala mengi dan batuk tapi tidak demam. Penyakit ini sering didahului oleh konjungtivitis neonatorum. d.Okular Lymphogranuloma Venereum Infeksi dengan serovars LGV dari C. trachomatis (biovar: LGV) dapat menyebabkan konjungtivitis oculoglandular. Selain konjungtivitis, pasien juga memiliki limfadenopati terkait. e. Infeksi Urogenital Pada wanita, infeksi biasanya (80%) tanpa gejala, tetapi gejala dapat mencakup servisitis, uretritis, dan salpingitis. Demam postpartum pada ibu yang terinfeksi adalah umum. Prematur pengiriman dan tingkat peningkatan kehamilan ektopik karena salpingitis dapat terjadi. Di Amerika Serikat, kehamilan tuba merupakan penyebab utama trimester pertama kematian terkait kehamilan. Pada pria, infeksi biasanya (75%) tanpa gejala. f. Sindrom Reiter Sindrom Reiter merupakan triad gejala yang mencakup konjungtivitis, polyarthritis dan peradangan alat kelamin. Penyakit ini berhubungan dengan HLA-B27. Sekitar 50-65% pasien memiliki infeksi C. trachomatis akut pada awal artritis dan lebih besar dari 80% memiliki bukti serologis untuk infeksi C. trachomatis. Lain infeksi (Shigellosis atau Enterocolitica Yersinia) juga telah dikaitkan dengan sindrom Reiter. g. Venereum Lymphogranuloma (C. trachomatis biovar: LGV) Lesi primer LGV adalah lesi vesikular kecil tanpa rasa sakit dan tidak mencolok yang muncul di situs infeksi, sering penis atau vagina. Pasien juga mungkin mengalami demam, sakit kepala dan nyeri. H. Diagnosis1. Sitologi - Pemeriksaan sel diwarnai untuk mengorek keberadaan badan

inklusi (Angka 2 dan 3) telah digunakan untuk diagnosis namun metode ini tidak sensitif seperti metode lain.2. Kultur - Kultur adalah metode yang paling spesifik untuk diagnosis

infeksi C. trachomatis. Spesimen ditambahkan ke kultur sel rentan dan

49

sel yang terinfeksi diperiksa untuk adanya inklusi-pewarnaan yodium pada tubuh. Noda yodium menginklusi glikogen dalam tubuh. Kehadiran inklusi pewarnaan yodium-tubuh yang spesifik untuk C. trachomatis sejak masuknya tubuh spesies lain dari klamidia tidak mengandung glikogen dan noda dengan yodium.3. Deteksi Antigen - immunofluorescence langsung dan kit LPS ELISA

yang mendeteksi kelompok tertentu atau strain-spesifik protein membran luar yang tersedia untuk diagnosis. Tidak sama baiknya dengan kultur, terutama dengan sampel yang mengandung beberapa organisme (misalnya pasien asimtomatik).4. Serologi - Serologis tes untuk diagnosis adalah nilai terbatas pada

orang dewasa, sejak uji tidak membedakan antara infeksi sekarang dan masa lalu. Deteksi antibodi IgM titer tinggi adalah indikasi infeksi baru. Deteksi antibodi IgM pada infeksi neonatal berguna.5. Probe Asam Nukleat - Tiga tes baru berdasarkan probe asam nukleat

yang tersedia. Tes ini sensitif dan spesifik dan dapat menggantikan kultur sebagai metode pilihan.6. Tes Non Kultur

Fluorescent Uji Antibodi Monoklonal: mendeteksi baik protein membran utama luar atau LPS Enzim Immunoassay: mendeteksi produk yang berwarna dikonversi oleh enzim terkait dengan antibodi DNA Probe: menggunakan DNA komplementer urutan spesifik RNA ribosom Chlamydia Rapid Test: menggunakan antibodi terhadap LPS Tes Esterase Leukosit: mendeteksi enzim yang dihasilkan oleh leukosit yang mengandung bakteri dalam urin

I. Pengobatan dan Pencegahan a. Doxycycline adalah antibiotik pilihan karena digunakan untuk pengobatan dalam jangka waktu yang panjang, dapat diminum dengan makanan dan harganya relatif murah. Namun, tetrasiklin, kloramfenikol, rifampisin, dan fluroquinones

juga dapat digunakan. Wanita hamil disarankan untuk mengambil eritromisin untuk infeksi. Baru-baru ini, azitromisin telah terbukti sebagai terapi dosis tunggal yang efektif. Oleh karena itu, ini akan meningkatkan kepatuhan pasien, tetapi lebih mahal dibandingkan dengan antibiotik lainnya. b. Penting untuk dicatat bahwa pasangan seks harus terlibat dalam rezim perawatan juga.

II. 2. Propionibacterium acnes

A. Gambaran Umum Propionibacterium acnes adalah Gram-positif yang paling umum, non-spora, batang anaerobik dijumpai dalam spesimen klinis. P.acnes biasanya tumbuh sebagai anaerob obligat. Memiliki kemampuan untuk memproduksi asam propionat dan katalase bersama dengan indol, nitrat, atau keduanya indol dan nitrat. B. Klasifikasi Ilmiah Kingdom : Bakteri Filum : Actinobacteria Ordo : Actinomycetales Famili : Propionibacteriaceae Genus : Propionibacterium Spesies: Propionibacterium acnes C. Struktur

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Sel Gram Bentuk Koloni Endospora Gerak Salinitas + Batang Tunggal Tidak Tidak

Lingkungan Oxygen Req. Habitat Suhu Opt.

NonHostAnaerobik 370C halofilik associated

Patogen di: Manusia Penyakit: Jerawat D. Siklus hidup 01000900000382f30100000059f3010000000400000003010800050000000b020000 0000050000000c021d012d01030000001e000400000007010400040000000701040 059f30100410b2000cc001c012c01000000001c012c0100000000280000002c01000 01c010000010018000000000070e6030000000000000000000000000000000000ffff fffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff fffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff fffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff fffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff fffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff ffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff7fff fffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff fffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff fffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff fffffffffffffffffffffffffffffffffffffffffffffffff7fffffffffff7fffffffffff7fffffffffff7fffffffffff7 fffffffffff7fffffffffff7fffffffffff7fffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff 7fffffffffffffffffffff7fffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff fffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff fffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff fffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff fffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff fffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff fffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff fffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff fffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff fffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff fffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff fffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff fffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff fffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff fffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff fffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff

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