Atypical Mycobacteria

dg dasar epidemiologi, mycobacteria dibagi :

1. M. tuberculosis komplek
- M. tuberculosis
- M. bovis
- M. africanum
2. Mycobacterium atypic
Nontuberculous mycobacteria /NTM
Mycobacteria other than tubercle bacilli /MOTT
3. M. leprae

Mycobacterium bovis
sumber : susu yg terkontaminasi
penetrasi :
- jaringan limfatik oropharynx
- mukosa gastrointestinal
pencegahan : pasteurisasi
Mycobacteriophaga : phaga 33D

Diagnosis lab
1. Mikroskopis : BTA
2. Kultur
lebih sukar diisolasi
dihambat gliserol
kurang aerotoleran
M. tuberculosis : niasin (+)
M. bovis
: niasin (-)
M. bovis dihambat TCH

niasin
(-)
(+)

Bacillus of Calmette-Guerin (BCG)

mutan M. bovis yg dilemahkan
dg cara subkultur berulang
pd glycerol-potato-bile medium
BCG digunakan untuk
1. Pencegahan tuberkulosis
vaksinasi intrakutan
2. imunoajuvan
seluler & humoral
regresi tumor

Mycobacterium atypic
banyak terdapat di lingkungan, flora normal
kulit, sal. napas, sal. cerna
potensial patogen pd mns :
- virulensi pd marmot
- isolasi berulang dari Px
Klinis = tuberkulosis
beda terapi uji kepekaan
Katalase heat stabil (68C)

Klasifikasi Mycobacterium atypic menurut Runyon

Dasar : kecepatan pertumbuhan & pigmentasi koloni
Inkubasi : 1 dibungkus aluminium foil, 1 tidak
Group I : Slow-growers (koloni 7 hr pd media
padat)
photochromogenic : pigmen + cahaya
II : Slow-growers
scotochromogenic : pigmen + tanpa cahaya
scotos (Yunani) : gelap
III : Slow-growers
nonphotochromogenic
IV : rapid growers (< 7hr)
pigmen karotenoid : gradasi warna kuning-merah

M. kansasii
Group I : slow grower, photochromogen
natural reservoir : tap water
Klinis : Pd Px peny. paru kronis (silikosis)
Diagnosis lab
1. Mikroskopis : BTA
2. Photochromogen
koloni halus
pigmen kuning-oranye
suhu optimal 37C

M. marinum
Group I : slow grower, photochromogen
saprofit di tanah, danau, pantai, ikan
Klinis : swimming pool granuloma
Diagnosis lab
1. Mikroskopis : BTA
2. Photochromogen
kuning-oranye-merah
3. Suhu optimal : 30-32C

niasin (+)

M. simiae
Group I :
slow grower
photochromogen
saprofit di water supply
Diagnosis lab
1. Mikroskopis : BTA
2. Photochromogen : kuning
3. Niacin +

kuning

M. schrofulaceum
Group II : slow grower, schotochromogen
sumber : produk peternakan yg terkontaminasi
Klinis : limfadenitis
Diagnosis lab :
1. Mikroskopis : BTA
2. Schotochromogen
pigmen kuning-oranye
suhu optimal 37C

M. xenopi
Group II : slow grower, schotochromogen
saprofit di air (saluran air panas/dingin)
Diagnosis lab :
1. Mikroskopis : BTA, gambaran mirip hyphae
2. Schotochromogen : kuning
3. Suhu optimal : 42-45C

M. avium-M. intracellulare
Group III : slow growers, nonphotochromogens
M. avium-M. intracellulare complex (MAC)
- ciri overlap, reservoir : natural water
- NTM terbanyak pd Px AIDS
specimen AIDS : darah
1. Mikroskopis
BTA, granula bipolar
2. t optimal : 37C
koloni halus, transparan

M. ulcerans
Group III : slow grower, nonphotochromogen
tropical skin disease (Afrika, Asia)
ulkus nekrosis , jarang terjadi granuloma
Diagnosis lab :
1. Mikroskopis : BTA
2. Suhu optimal : 30-33C
biochemically unreactive

M. fortuitum-M. chelonei complex

Group IV : rapid grower (< 7 hari)
kemungkinan komensal di kulit
penyebab infeksi nosokomial karena
iatrogenik pd Px immunocompremise

Mycobacterium :
1. M. tuberculosis komplek
M. tuberculosis
- growth rate slow
- pigmen (-)
- niasin (+)
- nitrat (+)
- katalase (-) pd 68C
- tidak dihambat TCH
M. bovis
- niasin (-)
- dihambat TCH
M. africanum : hanya ada di Afrika

2. Mycobacterium atypic :
I : Slow-growers, photochromogenic
M. kansasii : koloni halus
pigmen kuning-oranye, t opt. 37C
M. marinum : t optimal : 30-32C
M. simiae : niasin (+)
II : Slow-growers, scotochromogenic
M. schrofulaceum : scoto, t opt. 37C
M. xenopi : suhu optimal : 42-45C
III : Slow-growers, nonphotochromogenic
M. avium-M. intracellulare : koloni halus
M. ulcerans : 30C, biochemically unreactive
IV : rapid growers
M. fortuitum-M. chelonei complex (< 7 hari)

3. M. leprae
Belum bisa dikultur pada media buatan
Ket. tabel :
K : koloni kering, kasar
Hf : koloni halus, photochromogenic
Hs : koloni halus, scotochromogenic
H : koloni halus
N : niasin
Nt : nitrat
RG : rapid grower
K - : belum bisa dikultur di media buatan

M. tuberculosis
M. bovis
M. kansasii
M. marinum
M. simiae
M. schrofulaceum
M. xenopi
M. avium-intracellu.
M. ulcerans
M. fortuitum-chelo
M. leprae

K
K
Hf
Hf
Hf
Hs
Hs
H
H

37
37
37
30

N+
N-

Nt +

N+
37
42
37
30

RG
K-

TERIMA KASIH