BIOMEDIK

D E D E M A H D I YA H
DEFINITION

Microbiology is the study of microorganisms, a large and diverse group of

microscopic organisms that exist as single cells or cell clusters; it also
includes viruses, which are microscopic but not cellular.
They are responsible for cycling the chemical elements essential for life,
including carbon, nitrogen, sulfur, hydrogen, and oxygen; more
photosynthesis is carried out by microorganisms than by green plants.
VIRUS

virus is a set of genes, composed of either DNA or RNA, packaged in a

protein-containing coat.
The resulting particle is called a virion.
Viruses that infect humans are considered along with the general class of
animal viruses; viruses that infect bacteria are referred to as
bacteriophages, or phages for short.
 Viruses are complexes consisting of protein and an RNA or DNA genome.
They lack both cellular structure and independent metabolic processes.
They replicate solely by exploiting living cells based on the information in
the viral genome.
 Virus reproduction requires that a virus particle infect a cell and program
the cellular machinery to synthesize the constituents required for the
assembly of new virions.
The infected host cell may produce hundreds to hundreds of thousands of
new virions and usually dies
REPRODUKSI VIRUS
HUMAN HERPESVIRUS (HHV) 8

Pathogen, clinical picture. HHV 8 has recently been identified as a decisive

cofactor in induction of Kaposi sarcoma.
The classic, sporadic form of this malignancy was described in 1872 in the
Mediterranean area
It also occurs following organ transplantations and is a significant cause of
death in AIDS patients (12%).
Diagnosis. Antibody assay (EIA, IF, Western blot).
HUMAN HERPESVIRUS (HHV) 6

Pathogen, pathogenesis, clinical picture. HHV-6 was isolated in 1986 in

patients suffering from lymphoproliferative diseases and AIDS.
The virus shows T-cell tropism and is biologically related to the
cytomegalovirus.
HHV-6 exists in two variants, HHV-6A and HHV-6B.
The pathogenic implications of their reactivation have not yet been
described.
 HHV-6B is the causal pathogen in exanthema subitum(roseola infantum), a
disease that is nearly always harmless, characterized by sudden onset with
high fever and manifests as a typical exanthem in small children.
Diagnosis and epidemiology. HHV-6 can be cultured in stimulated umbilical
lymphocytes. Potentially useful diagnostic tools include antibody assay and
PCR.
POXVIRUS

Virus variola, yang termasuk genus Orthopoxvirus dan merupakan agen

penyebab cacar diberantas pada tahun 1980 setelah kampanye vaksinasi
WHO.
Virus vaccinia, digunakan pada akhir abad ke-18
oleh E. Jenner di Inggris sebagai virus vaksin untuk melindungi terhadap
penyakit cacar, sekarang digunakan sebagai vektor dalam biologi molekuler
 Virus molloscum kontagiosum hanya mempengaruhi manusia dan
menyebabkan tumor jinak.
Diagnosis. Orthopoxviruses and parapoxviruses: electron microscopy.
Molloscum contagiosum: histology.
Pathogens. The viruses of the pox group are the largest
viruses of all.
At 230x350 nm they are just within the resolution range
of light microscopes. They have a complex structure (Fig.
8.7) and are the only DNAviruses that replicate in a
defined area within the host-cell cytoplasm, a so-called
virus factory
HEPADNAVIRUSES: HEPATITIS B VIRUS
AND HEPATITIS D VIRUS
A hepatitis B virus (HBV) infection (see p. 385ff., replication) of the liver
cells results in expression of viral antigen on the cell surface, followed by
immunological cell damage with acute, possibly fulminant, chronic
persistent or chronic aggressive hepatitis.
Tahap akhir dapat menyebabkan sirosis hati atau hepatocellular karsinoma
 Diagnosis: antigen imunologi atau antibodi assay dalam serum pasien.
Antigen atau antibodi pola yang diamati memberikan wawasan dan
perjalanan penyakit.
Pencegahan: imunisasi aktif dengan permukaan HBV (HBs) antigen; pasca
pajanan bersamaan imunisasi pasif.
 Hepatitis B pathogen. The hepatitis B virus (HBV) is the main
representative of the family of hepadnaviruses,
Hepadnaviridae. The name of the family is an acronym of
the disease caused by the virus and its genomic type.
 Hepatitis D pathogen. A certain percentage of HBV-infected persons, which
varies geographically, are also infected by a second hepatitis virus
discovered at the end of the seventies in Italy, the delta agent or hepatitis
D virus (HDV).
It was originally thought to be a new HBV antigen. In fact, it is an
unclassified RNA virus that codes for the delta antigen.
Its capsid consists of HBs antigen, i.e., HBV-coded material. For this reason,
the virus can only replicate in persons infected with HBV (in this case the
helper virus).
 Patogenesis dan gambaran klinis. Masa inkubasi hepatitis B adalah empat
sampai 12 minggu, diikuti dengan fase akut infeksi, icteric, atau anicteric,
dengan durasi variabel dua sampai 12 minggu.
BAKTERI

Bacterial cells are between 0.3 and 5 lm in size.

They have three basic forms: cocci, straight rods, and curved or spiral rods.
The nucleoid consists of a very thin, long, circular DNA molecular double
strand that is not surrounded by a membrane.
 The cytoplasmic membrane harbors numerous proteins such as permeases,
cell wall synthesis enzymes, sensor proteins, secretion system proteins,
and, in aerobic bacteria, respiratory chain enzymes.
The cell wall of Gram-negative bacteria features a porous outer membrane
into the outer surface of which the lipopolysaccharide responsible for the
pathogenesis of Gram-negative infections is integrated.
 The cell wall of Gram-positive bacteria does not possess such an outer membrane.
Many bacteria have capsules made of polysaccharides that protect them from
phagocytosis.
Attachment pili or fimbriae facilitate adhesion to host cells.
Motile bacteria possess flagella.
Foreign body infections are caused by bacteria that form a biofilm on inert
surfaces.
Some bacteria produce spores, dormant forms that are highly resistant to
chemical and physical noxae
BACTERIAL FORM

Bacteria differ from other single-cell microorganisms in both their cell

structure and size, which varies from 0.35 m. Magnifications of 500
1000nmclose to the resolution limits of light microscopyare required to
obtain useful images of bacteria.
 Many pathogenic bacteria make use of extracellular enzymes to synthesize
a polymer that forms a layer around the cell: the capsule
The capsule protects bacterial cells from phagocytosis. The capsule of most
bacteria consists of a polysaccharide. The bacteria of a single species can
be classified in different capsular serovars (or serotypes) based on the fine
chemical structure of this polysaccharide.
A bacterial biofilmis a structured community of bacterial cells
embedded in a self-produced polymer matrix and attached to either
an inert surface or living tissue.
Such films can develop considerable thickness (mm). The bacteria
located deep within such a biofilm structure are effectively isolated
from immune system cells, antibodies, and antibiotics. The polymers
they secrete are frequently glycosides, from which the term
glycocalyx (glycoside cup) for the matrix is derived.
 Certain oral streptococci (S.mutans) bind to the proteins covering tooth
enamel, then proceed to build a glucan matrix out of sucrose. Other
bacteria then adhere to
The matrix to form plaque (Fig. 3.14), the precondition for destruction of the
enamel and formation of caries
THE PHYSIOLOGY OF METABOLISM AND
GROWTH IN BACTERIA
Human pathogenic bacteria are chemosynthetic and organotrophic (chemo-
organotrophic).
They derive energy from the breakdown of organic nutrients and use this
chemical energy both for resynthesis and secondary activities
Bacteria oxidize nutrient substrates by means of either respiration or
fermentation
GROWTH AND CULTURING OF
BACTERIA
 Bacteria possess two genetic structures: the chromosome and the plasmid.
Replication of this DNA molecule always starts at a certain point (the origin
of replication) and is semiconservative, that is, one strand in each of the
two resulting double strands is conserved.
The phases of transcription are promoter recognition, elongation, and
termination.
REPRODUKSI
PRINSIP TERAPI ANTIBIOTIK

Specific antibacterial therapy refers to treatment of infections with anti-

infective agents directed against the infecting pathogen.
The most important group of anti-infective agents are the antibiotics, which
are products of fungi and bacteria (Streptomycetes)
SPECTRUM OF ACTION

Each anti-infective agent has a certain spectrum of action, which is a range

of bacterial species showing natural sensitivity to the substance.
Some anti-infective agents have a narrow spectrum of action (e.g.,
vancomycin).
have broad spectra like tetracyclines, which affect all eubacteria.
EFIKASI

The efficacy of an anti-infective agent (syn. kinetics of action) defines the

way it affects a bacterial population
Two basic effects are differentiated:
bacteriostasis, i.e., reversible inhibition of growth, and irreversible
bactericidal activity
 Many substances can develop both forms of efficacy depending on their
concentration, the type of organism, and the growth phase.
Many of these drugs also have a postantibiotic effect (PAE) reflecting the
damage inflicted on a bacterial population.
 A bacteriostatic agent alone can never completely eliminate pathogenic
bacteria from the bodys tissues.
All of the bacteria from an infection focus cannot be eliminated without
support from the bodys immune defense system.
PHARMACOKINETICS

Pharmacokinetics covers the principles of absorption, distribution, and

elimination of pharmacons by the macroorganism
 The dosage and dosage interval recommendations for antibacterial therapy take into
account the widely differing pharmacokinetic parameters of the different anti-
infective agents, among them:
Absorption rate and specific absorption time
Volume of distribution
Protein binding
Serum (blood) concentration
Tissue concentration
Metabolization
Elimination
SIDE EFFECTS

Toxic effects. These effects arise from direct cell and tissue damage in the
macroorganism. Blood concentrations of some substances must therefore
be monitored during therapy if there is a risk of cumulation due to
inefficient elimination (examples: aminoglycosides, vancomycin).
Allergic reactions. See p. 108 for possible mechanisms (example: penicillin
allergy).
Biological side effects. Example: change in or elimination of normal flora,
RESISTANCE TESTS
BAKTERI YANG PATOGEN PADA
MANUSIA
Staphylococcus
S. epidermidis infeksi tubuh
S. saprophyticus infeksi saluran urin
S, aureus-> infeksi pd kulit
Streptococcus
S. pneumoniae infeksi sal. Pernafasan
S. agalactiae meningitis
Caused by S. pyogenes
 Clostridium perfringens gas gangren
Clostridium tetani (Tetanus)
Gardnerella vaginalis
GENETIKA MIKROBA

The science of genetics defines and analyzes heredity, or constancy and change in the vast
array of physiologic functions that form the properties of organisms.
The unit of heredity is the gene, a segment of DNA that carries in its nucleotide sequence
information for a specific biochemical or physiologic property.
The traditional approach to genetics has been to identify genes on the basis of their
contribution to phenotype, or the collective structural and physiologic properties of a cell or
an organism.
Plasmids were identified as small genetic elements capable of independent replication in
bacteria and yeasts.
Amplification of specific regions of DNA also can be achieved with bacterial enzymes using the
polymerase chain reaction (PCR) or other enzyme-based methods of nucleic acid
amplification (eg, transcription-mediated amplification).
 Genetic information is stored as a sequence of bases in deoxyribonucleic acid (DNA).
(In RNA bacteriophages [eg, Q, MS2] and some RNA viruses [eg, influenza and
reovirus], genetic information is stored as a sequence of bases in ribonucleic acid
[RNA].
Most DNA molecules are doublestranded, with complementary bases (A-T; G-C) paired
by hydrogen bonding in the center of the molecule
The orientation of the two DNA strands is described as antiparallel; one strand is
chemically oriented in a 5 to 3 direction, while its complementary strand runs 3 to 5.
The complementarity of the bases enables one strand (template strand) to provide
the information for copying or expression of information in the other strand (coding
strand;
 Each of the four bases is bonded to phospho- 2-deoxyribose to form a
nucleotide
The length of a DNA molecule is usually expressed in thousands of base
pairs, or kilobase pairs (kbp).
A small virus may contain a single DNA molecule of 5 kbp, whereas the
single DNA molecule that forms the Escherichia coli chromosome is 4639
kbp.
 Ribonucleic acid (RNA) most frequently occurs in single-stranded form. The base
uracil (U) serves in RNA the hybridization function that thymine (T) serves in DNA, so
the complementary bases that determine the structure of RNA are A-U and C-G.
The overall structure of single-stranded RNA molecules is determined by
hybridization between base sequences that form loops, with the result that single-
stranded RNA molecules assume a compact structure capable of expressing genetic
information contained in DNA.
The most general function of RNA is communication of DNA gene sequences in the
form of messenger RNA (mRNA) to ribosomes. The ribosomes, which contain
ribosomal RNA (rRNA) and proteins, translate this message into the primary
structure of proteins via aminoacyl- transfer RNAs (tRNAs).
 RNA molecules range in size from the small tRNAs, which contain fewer than 100
bases, to mRNAs, which may carry genetic messages extending to several thousand
bases.
Bacterial ribosomes contain three kinds of rRNA with respective sizes of 120, 1540, and
2900 bases and a number of proteins
A few RNA molecules have been shown to function as enzymes (ribozymes). For
example, the 23S RNA in the 50S ribosomal subunit (Figure 73) catalyzes the
formation of the peptide bond during protein synthesis.
Some small RNA molecules (sRNA) function as regulators by either binding near the 5
end of a mRNA, preventing ribosomes from translating that message, or by base
pairing directly with a strand of DNA near the promoter preventing transcription.
 Some bacterial species can invade higher organisms because they possess
specific genes for pathogenic determinants.
These genes are often clustered together in the DNA and are referred to as
pathogenicity islands.
Pathogenicity islands have a different G + C content from the rest of the
genome, are linked to tRNA genes, are flanked by direct repeats, and
contain diverse genes important for pathogenesisincluding adhesins,
invasins, and exotoxinsas well as those that are probably involved in
mobilization.
 Transposons are genetic elements that contain several kbp of DNA, including
the information necessary for their migration from one genetic locus to another.
Complex transposons carry genes for specialized functions such as antibiotic
resistance and are flanked by insertion sequences.
Viruses are capable of survival, but not growth, in the absence of a cell host.
Replication of the viral genome depends upon the metabolic energy and the
macromolecular synthetic machinery of the host.
Frequently, this form of genetic parasitism results in debilitation or death of the
host cell.
 REPLICATION Double-stranded DNA is synthesized by
semiconservative replication.
Transduction is phage-mediated genetic recombination in bacteria.
Direct uptake of donor DNA by recipient cells depends on their
competence for transformation. Natural occurrence of this property is
unusual among bacteria, and some of these strains are transformable
only in the presence of competence factors, produced only at a
specific point in the growth cycle.
Naturally competent transformable bacteria are found in several
genera and include Bacillus subtilis, Haemophilus influenzae, Neisseria
gonorrhoeae, and Streptococcus pneumoniae.
INFEKSI NOSOKOMIAL

Infeksi yang didapat seorang penderita yang sedang menjalani

perawatan di rumah sakit.
Infeksi Nosokomial dapat berasal dari :
- Dokter / Perawat Sakit / Carrier
- Penderita lain Sakit / Carrier
- Penderita sendiri Flora normal tubuh
- Lingkungan Alat / Bahan tercemar,
Ruangan.
Cara penularan sering terjadi
melalui :
- Pembedahan
- Catheter intravenous
- Catheter kandung kemih
- Cairan intravenous
- Endotracheal tube
- Respirator/Ventilator
 Faktor-faktor yang
menentukan terjadinya
Infeksi Nosokomial :

- Susceptibility penderita terhadap infeksi

- Besarnya paparan mikroba
- Cara pemaparan mikroba
Risiko terjadi Infeksi Nosokomial
meningkat karena :

- Pemakaian obat imunosupresan

- Tindakan bedah yang extensif
- Prosedur diagnostik dan terapeutik yang
intensif
- Penggunaan cairan intravenous
- Penggunaan antimikroba berspektrum
luas dan tidak rasional
 Kelompok mikroba penyebab
Infeksi Nosokomial :

- Mikroba patogen konvensional

- Mikroba patogen kondisional
- Mikroba patogen oportunistik
 Jenis mikroba penyebab Infeksi
Nosokomial :
- Bakteri Gram negatif yang sering :
- Pseudomonas aeruginosa
- Acinetobacter baumanni
- Klebsiella pneumoniae ESBL
- Escherichia coli ESBL
- Enterobacter spp.
- Proteus spp.
- Serratia spp.
- Legionella pneumophila
- Bakteri Gram positif yang
sering :
- Methicillin Resistant Staphylococcus
aureus (MRSA)
- Methicillin Resistant Staphylococcus
epidermidis (MRSE)
- Vancomycin Resistant Enterococcus
(VRE)
- Virus : Hepatitis B, Hepatitis C, HIV
- Jamur : Candida spp. , Aspergillus spp.
- Parasit : Malaria
Pemeriksaan untuk studi
epidemiologi (surveillance)
Infeksi Nosokomial dapat
dengan cara :

- Biotyping
- Serotyping
- Bacteriophage typing
- Molecular / DNA typing
- Antibiogram dan Resistogram
TERIMA KASIH