ACTINOMYCES dan

NOCARDIA
KMB 231
Dr.Edhie Djohan Utama, SpMK
LAB. MIKROBIOLOGI FK USU
MEDAN

ORDO ACTINOMYCETALES

Mycobacteriaceae
Actinomycetaceae
Actinomyces
Arachnia
Nocardiaceae

Nocardia

Dermatophilaceae
Micromonosporaceae
Streptomycetaceae

ACTINOMYCES :
= Gram positip, tumbuh pelahan
membentuk filamen panjang yang
bercabang cabang.
= Beberapa genus filamennya
bersegmen, pleomorphic,
nonmotile.
= NonBTA (tidak tahan asam=nonacid fast)
= Sulfur granule dalam pus
= Strictly anaerobic

Morphology and Physiology:

Facultatively or strictly anaerobic Gram-positive
bacilli
Bacteria with fungi-like structures:

Form delicate filaments (often called hyphae or mycelia as

per the structures formed by the true fungi) and aerial
filaments which may branch, fragment into spores, or
become pigmented

Actinomyces actually means "ray fungus" in Greek

Actinomyces are true bacteria due to the lack of
mitochondria and a nuclear membrane, reproduction
by cell fission and susceptibility to penicillin but not
to antifungal chemothe-rapeutic agents
Actinomyces are morphologically similar to Nocardia
except that they Actinomyces are not acid-fast
Grow slowly in culture and cause infections that are
slow to develop and tend to be chronic

Epidemiology and Clinical Syndromes :

Normal flora of the upper respiratory, gastronintestinal and
femal genital tracts
Low virulence potential, only causing opportunistic disease
following disruption of mucosal barriers by trauma, surgery or
infection
Actinomycosis: May occur as acute pyogenic infection or
more commonly as a chronic infection that is both suppurative
and granulomatous
Characterized by multiple abscesses and interconnecting
sinus tracts that contain granules of microcolonies imbedded
in tissue elements

Microcolonies are macroscopic masses of filamentous

bacterial cells that are "cemented" together by calcium
phosphate known as sulfur granules due to their yellow or
orange appearance

Chronic suppuration results in granuloma formation and a

fibrotic "walling off" of the lesion

Ultimately resulting in bone involvement

Five major clinical forms of actinomycoses based on

site of infection: Cervicofacial actinomycosis
(most common form): associated with poor oral
hygiene, an invasive dental procedure or oral
trauma that is characterized by tissue swelling with
fibrosis and draining sinus tracts along the jawline
Thoracic actinomycosis: associated with
aspiration into the lungs and dissemination of the
organisms into surrounding tissues
Abdominal actinomycosis: associated with
abdominal surgery or intestinal trauma
Pelvic actinomycosis: primary infection associated
with intrauterine devices in women and secondary
infection associated with spread from abdominal
actinomycosis
Cerebral actinomycosis: associated with

Laboratory Identification:

Difficult to culture and identify because the

numbers of organisms are limited in affected
tissues and are sequestered in sulfur granules

Fastidious and slow growth (up to two weeks or

more)
Colonies have "molar tooth" appearance on agar
Granuloma: small growths of nodular
granulation tissue formed at sites of chronic
inflammation that are usually composed of
epithelioid cells, lymphocytes, multinucleated
giant cells, eosinophils, plasma cells that are
"walled off" by an area of fibrosis

Granulomatous: tending to form granulomas;

usually referring to diseases or pathogenic
microorganisms

Pertumbuhannya yg filamentous
dan membentuk koloni
bermycelium dan beberapa
menyebabkan penyakit yang
subcutaneous granulomatous
abscess
mirip infeksi jamur
sehingga disangka sebagai
fungi.

SPECIES ACTINOMYCES :

A. ISRAELII (strictly anaerob)

A. BOVIS
Lumpy Jaw pd
lembu
A. NAESLUNDII (aerob + CO2)
A. ODONTOLYTICUS
A. VISCOSUS (kultur primer anaerob)
ARACHNIA PROPIONICA

PENYEBAB PENYAKIT
ACTINO-MYCOSIS PADA
MANUSIA DAN BINATANG
pto

Diagnosis - examine pus for white or yellow

granules/Gram stain = filamentous/culture =
look for G+/identify by immunofluorescence

Sulfure Granule

KULTUR ACTINOMYCES
Kultur pada Brain heart infusion Agar
Diinkubasi pada keadaan anaerob
atau aerob plus CO2
Kultur diperiksa stlh 24 jam dan 5-7
hari.
Kultur pada thioglycolate broth akan
tumbuh pada dasar media seperti
gumpalan (fluffy balls)

Kebanyakan A. israelii membentuk koloni

kasar dan tumbuh pada dasar tabung
media cair menyerupai gumpalan
(clumps), strictly anaerobic

Pada media
padat koloni
seperti
jaringan
laba-laba
dalam 2-3
hari, lalu jadi
putih,
irreguler dan
koloni besar
menaik

ACTINOMYCES
=Tumbuhnya
lambat
sampai 2
minggu
= Gram positip,
sangat
pleomorphic,
irreguler,
clubshape,
bercabang
cabang/
nonmotile,

PATHOGENESIS ACTINOMYCES

Actinomyces kebanyakan berasal dari

tanah (soil), tetapi A.israelii dan
A.bovis tdk dijumpai di tanah A.israelii
sebagai flora normal di mulut, hidup
secara commensal dan tidak pathogen.
A.israelii bisa dikultur dari tonsil dan
bisa dijumpai pd scraping gusi dan
gigi.
Belum diketahui pasti kenapa
A.israelii jadi invasip tapi trauma
operasi gigi atau gigitan manusia bisa
actinomycosis

ACTINOMYCES

Jaringan terinfeksi timbul abscesss yang

berlubang lubang (turtuous sinus) dan
mengeluarkan discharge bernanah purulent
Pada lembu menyebabkan destruksi tulang
rahang (lumpy jaw) tapi pada manusia hal
ini jarang terjadi.
Ada tiga type : cervicofacial, thoracic dan
abdominal (paling sering cervicofacial)
Diagnose : sediaan pus atau sputum diperiksa adanya sulfur granule. Pada pewarnaan : Batang Gram positip, bercabang atau
tdk bercabang.

Three main sites of infection in humans:

1. Cervicofacial Form ("lumpy jaw") - The organisms are in
the pus either as single filaments or in the form of hard,
wedge-shaped or lobed "sulfur granules". The primary lesion
is generally present in the mandible or maxilla and probably
results by extension from damaged or traumatized regions
surrounding the teeth. The organism may spread from the
maxilla to the cranial bones, meninges or brain.
2. Thoracic Form - This form probably results from either
inhalation or aspiration of organisms from the tooth surfaces
or from material in the tonsillar crypts.
3. Abdominal Form - This form usually begins in the
appendix and may result from injected organisms.
Actinomycosis is being recognized in increasing incidence in
women using I.U.D. for birth control.

LUMPY
JAW
Pada lembu
menyebabkan
destruksi tulang
rahang (lumpy jaw)
tapi pada manusia
hal ini jarang
terjadi.

ACTINOMYCOSI
S
Paru-paru

Abdomen

Pireneum

Actinomycosis is a serious disease that may

lead to death.
These are always mixed polymicrobic infections,
usually with other anaerobes.
However, if diagnosed and treated early, the
lesions respond well to penicillin (drug of
choice)
Erythromycin or tetracycline may be substituted
in patients sensitive to penicillin.
Surgery is usually necessary to drain extensive
abscesses.
The yellow sulfur granules, characteristic of
this organism, can be seen with the naked eye.

PENGOBATAN

A.israelii peka terhadap PNC-G,

Erythromycin, Tetracyclin,
Chloramphenicol dan
Streptomycin.
PNC paling efektip secara klinis
Untuk mengeringkan abscess
dilakukan tindakan pembedahan
untuk mengeluarkan pus (resection
terhadap jaringan yg rusak)

NOCARDIA :
Nocardia diperoleh dari tanah (soil)
Dua species :

N.asteroid

dan
N.brasilienses patogen pada manusia

Nocardia ini BTA (acid fast),

menyerupai mycobacteria.
Reproduksi dengan fragmentasi
hyphae putus-putus menyerupai
bentuk batang atau sel coccoid.

Kultur NOCARDIA

Aerob, tumbuh pada suhu kamar 37 C dan

pada media sederhana (pada Sabaroud Agar
atau mineral salts medium)

Koloni pada Agar smooth, basah atau bisa

kasar dengan permukaannya velvet. (beludru),
koloni kering dan bisa pigmented.

Pada media cair tumbuh seperti lilin pada

permukaan media, filament bercabang cabang.

Species differentiated biochemically using

xanthine, tyrosine, casein hydrolysis.

Susceptible to antimicrobial drugs, esp.

sulfonamides. N. farcinica may exhibit multiple
drug resistance.

Nocardiosis

Diagnosis

Microscopic
appearance =
granules, filaments
Grow on appropriate
medium = 7-10 days
Gram positive, acidfast organisms

Biochemical tests
(casein hydrolysis +,
urea hydrolysis +,
tyrosine hydrolysis

NOCARDIA
Gram positip
dan acid fast
(BTA)

Patogenesis :

Pulmonary and Mycetoma

Pulmonary Nocardiosis :
Terjadi karena
menghirup organisme ini.
Penyebabnya :
N.asteroides, lesi
terpencar pencar di
paru-paru sehingga
menyerupai miliary
tuberculosis atau
histoplasmosis.

Chronis
subcutaneous
abscess
(Mycetoma)
Terjadi jika luka
kulit terkontaminasi
(tangan dan kaki).
Subcutaneous
Abscess khronis,
membesar secara
ekstensip merusak
jaringan
dan tulang.
Subcutaneous
Abscess
Timbul
sinus
sinus
khronis, membesar
dengan
pus
secara ekstensip
purulent, bisa

Timbul sinus sinus

dengan pus purulent,
bisa ditemukan sulfur
granule

PENGOBATAN :

Berbagai obat antimikroba bisa

digunakan, tetapi Sulfonamide
adalah yang paling efektip.
Trimethoprim-Sulfonamide lebih
baik lagi.
Amikin dan generasi ke-3
Cephalosporin juga baik.
Resection dan operasi drainage
perlu dilakukan.

lower jaw = abscess formation,

sinus tracts that reach the skin
Thoracic = aspiration into lung,
extension of cervicofacial,
hematogenous
Abdominal = trauma of intestine or
abdominal wall
Genital = intrauterine devices =
inflammation
Diagnosis - examine pus for white or
yellow granules/Gram stain =
filamentous/culture = look for
G+/identify by immunofluorescence