LAPORAN MIKROBIOLOGI II Isolasi dan Identifikasi Kelompok Bakteri Gram Positif serta Pengambilan dan Preparasi Sampel Mikrobiologi
Nama : Ellena Nur Fitriani NPM : 411112038 411112038
DIII Analis Kesehatan STIKES Jeneral A!hma "ani "ani #imahi 2013$2014
STAPHYLOCOCCUS ISOLASI DAN IDENI!IKASI STAPHYLOCOCCUS
I" Penda Penda#$l #$l$an $an Is%lasi Is%lasi aalah aalah men&am men&am'il 'il mi(r%%r mi(r%%r&ani &anisme sme )an& tera*at tera*at i alam an
menu menum' m'uh uh(a (ann nn)a )a ala alam m suat suatu u mei meium um 'uat 'uatan an++ Pr%s Pr%ses es *emi *emisa saha han n atau atau *emurnian ari mi(r%%r&anisme lain *erlu ila(u(an (arena semua *e(er,aan mi(r%'i%l%&is- misaln)a telaah an ienti.i(asi mi(r%%r&anisme- memerlu(an suatu suatu *%*ula *%*ulasi si )an& )an& han)a han)a teri teriri ri ari ari satu satu ma!am ma!am mi(r mi(r%%r %%r&a &ani nism smee sa,a sa,a /%l(-13+ a(t a(ter erii
'era 'erasa sall
ari ari
(ata (ata atin bacterium /,ama(bacterium /,ama(- bacteriabacteria-
aal aalah ah
(el%m*%( ter'an)a( ari %r&anisme hiu*+ Sehin&&a alam (ehiu*an sehari$ hari (ita serin& (ali 'erintera(si 'erintera(si en&an 'a(teri+ a(teri *ertama (ali itemu(an %leh Ant Anth%n) h%n) an ee eeu5en u5enh%e( h%e( *aa 1674 en&an en&an men&&un men&&una(an a(an mi(r%s( mi(r%s(%* %* 'uatann)a seniri /Pel!ar/Pel! ar- 2006+ Staphylococcus aalah aalah 'a(teri 'a(teri 'er'ent 'er'entu( u( 'ulat'ulat- 'iasan) 'iasan)aa 'er&er 'er&er%m'% %m'%ll se*erti 'uah an&&ur- 9ram *%siti.+ Saat ini tera*at (uran& le'ih 32 s*e!ies Staphylococcus namu namun n )an& )an& *ent *entin in& & se!a se!ara ra (lin (lini( i( 'a&i 'a&i manu manusi siaa aal aalah ah Staphy Staphyloc lococc occus us aure aureus, us, Staph Staphylo ylococc coccus us epider epidermid midis is a an saprophyticus saprophyticus /Pel!ar /Pel!ar- 2006+ Stap Staphy hylo loco cocc ccus us aure aureus us 'ersi.at
*at%&en
Staphylococcus
*aamanusia
)an& serin&
men)e'a'(an men)e'a'(an a'ses- in.e(si 'ernanah *aa 'a&ian (ulit atau an&&%ta 'aan)an& lain lain++
esi$ esi$le lesi si *aa *aa (uli (ulitt
%leh %leh (um (uman ini ini
meli meli*u *uti ti 'isu 'isull- (ar' (ar'un un(e (ell-
.urun(el-im*eti&% s'- namun S. aureus ,u&a aureus ,u&a a*at men)e'a'(an *neum%niae%ste%mielitis- en%!aritis an (era!unan ma(anan /Pel!ar- 2006+ an Staphylococcus saprophyticus umumn)a Staphyloco Staphylococcus ccus epidermidis epidermidis an a*at%&en a*at%&en ta*i alam alam (eaaan (eaaan tertentu tertentu S. epidermidis epidermidis a*at men)e'a'(an lesi *aa(ulit an en%!aritis sean&(an S. saproph saprophyticus yticus a*at men)e'a'(an in.e(si saluran (emih /Pel!ar- 2006+ II" II" Prin Prinsi sip p Prin Prinsi* si* ari ari is%la is%lasi si mi(r% mi(r%%r %r&a &anis nisme me aala aalah h memi memisah sah(an (an satu satu ,eni ,eniss mi(r%%r&anisme en&an mi(r%%r&anisme lainn)a )an& 'erasal ari !am*uran 'erma!am$ma!am mi(r%%r&anisme terse'ut+ terse 'ut+ III" III" $%$an %$an
Pra(ti Pra(ti(um (um )an& ila(u(a ila(u(an n i la'%rat% la'%rat%rium rium Mi(r%'a Mi(r%'a(ter (terium ium STIKES STIKES Jene Jeneral ral A!hma !hma "ani ini ini 'ertu, 'ertu,uan uan untu( untu( a*at a*at men&i men&is%l s%lasi asi serta serta a*at a*at men&ienti.i(asi men&ienti.i(asi s*esies 'a(teri Staphylococcus )an& Staphylococcus )an& i*eri(sa i*eri(sa ilihat ari !iri$ !iri *aa *emeri(saan mi(r%s(%*is- !iri$!iri *aa (%l%ni serta hasil ari u,i$u,i lan,utan )an& ila(u(an+ I&" I&" in%a$an P$staka Sta*h)l%!%!!us 'erasal ari (ata sta*h)l%s 'erarti (el%m*%( 'uah an&&ur an !%!!us 'erarti 'ulat+Kuman ini serin& itemu(an se'a&ai .l%ra n%rmal *aa (ulit an sela*ut lenir manusia+Paa tahun 1880 Pasteur men&enal men&is%lir mi!r% mi!r%!%! !%!!u !u )an& )an& mem' mem'ent entu( u( (el%m (el%m*%( *%(+P +Paa aa tahun tahun 1881 1881 ;)st% ;)st%n n 'erhas 'erhasil il men&is%lir mi!r%!%!!i ari a'!es+ Paa tahun 1884 <%sen'a!h untu( *ertama (alin (alin)a )a mem*el mem*ela,a a,ari ri Sta*h Sta*h)l )l%!% %!%!!u !!uss
se!ar se!araa
mena menalam lam sehin& sehin&&a &a 'erhas 'erhasil il
men&enal arietas aureus- al'us ari mi!r%!%!!us *)%&enes /Pel!ar- 2006+ Staphylococcus aalah Staphylococcus aalah sel &ram$*%siti. &ram$*%siti. 'er'entu( 'ulat- 'iasan)a tersusun alam ran&(aian ta( 'eraturan se*erti an&&ur+ a(teri ini muah tum'uh *aa 'er'a&ai *er'enihan an mem*un)ai meta'%lisme a(ti.- mera&i(an (ar'%hiratserta ser ta me men&h n&hasi asil( l(an an *i& *i&me men n )a )an& n& 'er 'erar aria iasi si a ari ri *ut *utih ih sam sam*ai *ai (un (unin in& & tua tua++ e'era* e' era*aa ia iantar ntaran) an)aa ter ter&%l &%l%n& %n& .l%r .l%raa n%rm n%rmal al *aa (uli (ulitt an sela sela*ut *ut mu( mu(%sa %sa manusia man usia lai lainn)a nn)a men men)e'a )e'a'(an '(an-- a'se a'sess- 'er' 'er'a&ai a&ai in. in.e(si e(si *i%& *i%&enen- an 'ah( 'ah(an an se*ti! se* ti!em emia ia )a )an& n& .at .atal al++ Staphylococcus *at *ath%&en h%&en seri serin& n& men men&hem &hem%lis %lisis is ara arahhmen&(%a men &(%a&ula &ulasi si *la *lasmasma- ser serta ta men& men&hasi hasil(an l(an 'er' 'er'a&ai a&ai eni enim m e(st e(strase raselule lulerr an t%(sin+ Suatu ,enis (era!unan ma(anan serin& ter,ai a(i'at enter%t%(sin tahan *anas )an& ihasil(an staphylococcus tert tertentu entu++ Staph Staphylococ ylococcus cus
!e*at men,ai
resis re sisten ten ter terha haa* a* 'an 'an)a )a( ( at ant antim imi(r i(r%'a %'a seh sehin& in&&a &a me menim nim'ul 'ul(an (an ma masal salah ah *en&%'atan )an& sulit /=%l(/=%l(- 13+
A+ Klas Klasi. i.i( i(as asii Staphylococcus /555+5i(i*eia+%r& Kin& Kin&%m %m Diisi%
: m%ner m%neraa : Firmi!utes
#lass
: a!illi
;rer
: Bacillales
Famil)
: Sthapylococcacae
9enus
: Staphyloccocus
S*esies
:
Staphylococcus aureus Staphylococcus citerus Staphylococcus albus Staphylococcus epidermidis Staphylococcus saprophyticus
+ M%r.%l%&i entu(: 'ulat- u(uran 1 mi(r%n+ Tia( mem'entu( s*%ra+ Tia( mem*un)ai .la&ela+ eta( sel satu sama lain )an& (ara(teristi( 'er&er%m'%l se*erti 'uah an&&ur+ Si.at (ara(teristi( ini i*a(ai se'a&ai *em'erian nama Sta*h)l%!%!!us+ Teta*i (aan&$(aan& aa )an& leta(n)a terse'ar atau ter*en!ar+ Pen&el%m*%(an ini a(an terlihat 'ai( *aa *en&amatan *enanaman alam meia *aat+ Pasan&an atau rantai *ene( le'ih serin& terlihat alam smear nanah an (ultur alam (alu+ Si.at *e5arnaan: *aa (ultur mua 'ersi.at 9ram />- sean& *aa (ultur tua 'ersi.at 9ram /$ /Ja5et- 16 K%l%ni mi!r%!%!!i tum'uh !e*at *aa meia a&ar *aa suhu n%rmal /370- an 'iasan)a 'er&aris ten&ah 1$2 mm setelah in(u'asi 24 ,am+ K%l%ni tai halus- 'asah- men%n,%l en&an te*i 'ulat an 'er5arna- )aitu *aa arietas al'us 'er5arna *utih- arietas !itreus 'er5arna (unin& ,ernih an arietas aureus 'er5arna (unin& emas /Ja5et- 16 #+ Fisi%l%&i an m%r.%l%&i Mi!r%!%!!i tum'uh *alin& 'ai( *aa suhu 220 ? 370+ @mumn)a a*at tum'uh alam lin&(un&an aer%' mau*un anaer%'+ Pr%u(si 5arna terlihat 'ai( *aa situasi aer%' an terlihat *alin& 'ai( *aa (ultur )an& tum'uh *aa suhu renah+ Pr%u(si t%(sin *aa semua strain terlihat *aa *enanaman alam meia seerhana )an& 'erisi asam$asam amin%- &aram &lu(%sa an .a(t%r *ertum'uhan )aitu thiamin an asam ni!%tinat+ Dalam &aris 'esarn)a strain aureus le'ih a(ti. meta'%lismen)a ari *aa strain al'us+ Dalam meia (alu )an& 'erisi e(str%sa- su(r%sa- malt%sa- an manit%l a(an ter,ai *eme!ahan (ar'%hirat men,ai asam tan*a &as /=%l(- 13+ D+ Pat%&enitas
Sta*h)l%!%!!us meru*a(an *en)e'a' ter,ain)a in.e(si )an& 'ersi.at *%%&eni(+ @ntu( *em'uatan (ultur a*at iam'il 'ahan ari *ernanahan (e!il- 'isul (e!il- 'isul 'esar- an a'!es i'er'a&ai 'a&ian tu'uh+ a(teri ini a*at masu( (e alam (ulit melalui .%li(el$.%li(el ram'ut- muara (elen,ar (erin&at an lu(a$lu(a (e!il+ Kemam*uan )an& men)e'a'(an *en)a(it ari sta*h)l%!%!!us aalah &a'un&an ari e.e( )an& itim'ul(an %leh *r%u($ *r%u( e(straseluler- a)a in.asi (uman an (emam*uan untu( 'er(em'an& 'ia( /Ja5et- 16+ Sta*h)l%!%!!us *at%&en mem*un)ai si.at se'a&ai 'eri(ut: • • •
Da*at men&hem%lisa eritr%sit Men&hasil(an (%a&ulasia*at mem'entu( *i&men /(unin& (eemasan Da*at meme!ah manit%l men,ai asam /An%nim- 2008+
Diantara
sta*h)l%!%!!us
)an&
mem*un)ai
(emam*uan
'esar
untu(
menim'ul(an *en)a(it ialah Sta*h)l%!%!!us aureus+ Sta*h)l%!%!!us n%n*at%&en 'ersi.at: • • • •
N%n hem%liti( Tia( men&hasil(an (%a&ulasi K%l%ni 'er5arna *utih Tia( meme!ah manit%l /An%nim- 2003+ In.e(si )an& itim'ul(an %leh Sta*h)l%!%!!us a*at meluas (e
,arin&an se(itarn)a- *erluasann)a a*at melalui arah atau lim.e- sehin&&a *ernanahan isitu 'ersi.at menahun- misaln)a sam*ai *aa sumsum sehin&&a ter,ai raan& sumsum tulan& /%ste%m)elitis+ Perluasan ini a*at sam*ai (e *aru$*aru- sela*ut %ta( an se'a&ain) /Ja5et- 16++
E+ =ariasi Suatu 'ia(an Staphylococcus men&anun& 'e'era*a 'a(teri tertentu )an& i'ea(an ari Se'a&ian 'esar *%*ulasi 'a(teri lainn)a alam *ena*ilan si.at$si.at (has (%l%ni enim-
reseistensi
/u(uran (%l%ni - *i&me- hem%lisis- *erlen&(a*an
terhaa*
%'at-
an
si.at
*at%&enn)a+
Se!ara
initr%-*enam*ilan (has se*erti ini i*e&aruhi %leh (%nisi *ertum'uhan+ ila
S. aureus )an& resisten terhaa* na.isilin i eram(an *aa suhu 370# iatas a&ar arah- ma(a satu ari 10
7
%r&anisame a(an menu,u(an resistensi
terhaa* na.isilin- 'ila 'a(teri terse'ut ieram *aa suhu 300# iatas a&ar$ a&ar )an& men&anun& 2$B C Na#l+- ma(a satu ari 10 3 %r&anisme menu,u(an resistensi terhaa* na.isilin /era- 2004+ F+ Stu(tur anti&en Staphylococcus men&anun& *%l%sa(aria an *r%tein )an& 'ersi.at anti&en )an& meru*a(an su'stansi *entin& ialm stu(tur inin& sel+ Pe*ti%&li(an- suatu *%limer *%lisa(aria )an& men&anun& su'unit$su'unit )an& teran&(ai- -meru*a(n e(s%s(elet%n (a(u *aa inin& sel+ Pe*ti%&li(an ihan!ur(an %leh asam (uat atau lis%im+ ali ini *entin& alm *ath%&enesis in.e(si- at ini men)e'a'(an
m%n%sit mem'uat interleu(in$1 /*ir%&en
en%&enan anti'%) %*s%ni( an at ini ,u&a a*at men,ai at (imia *enari( /(%m%atra(tan untu( leu(%sit *%lim%r.%nu(lir- mem*un)ai a(tiitas miti* en%t%(sin- men&hasil(an
.en%mena Sh5artman l%(al- am
men&a(ti.(an (%m*lemen /Jer%me- 2003+ Asam tei(%at- )an& meru*a(n *%limer &liser%l atau ri'%t%l .%s.at 'eri(atan en&an *e*ti%&li(an an men,ai 'ersi.at anti&eni!+ Anti'%) antitei(%at- )an& a*at iete(si en&an i.usi &el- a*at itemu(an *aa *enerita en%(aritis a(ti. )an& men)e'a'(an S. aureus /Jer%me- 2003+ Pr%tein A meru*a(n (%m*%nen innin& sel (e'an)a(an stain S. aureus )an& teri(at *aa 'a&ian F! m%le(ul I&9- (e!uali I&93+ a&ian Fa' *aa I&9 )an& teri(an *aa *r%tein A 'e'as unttu( 'eri(atan en&an anti&en s*esi.i(+ Pr%tein A meru*a(n rea&en *entin& alam munl%&i an te(n%l%&i ia&n%sis la'%lat%rium-- !%nt%hn)a-*r%tein A 'eri(atan en&an m%le(ul I&9 )an& iarah(an terhaa* anti&en 'a(teri tertentu a(an men&a&lutinasi 'a(teri )an& mem*un)ai anti&en itu /(%a&lutinasi /Jer%me- 2003+ e'era*a stain S. aureus mem*un)ai sim*ai )na& a*at men&ham'at .a&isitisis %leh leu(%sit *%l%m%r.%nu(lir- (e!uali (alau aa anti'%) s*esi.i(+ Ke'an)a(an stain S. aureus men*un)ai (%a&ulase- atau .a(t%r *en&&um*al *aa *ermu(aan inin& sel+(%a&ulase teri(at se!ara n%n enimti( ena& .i'rin%&en- sehin&&a 'a(teri terinte&rasi /Jer%me- 2003+
Ke&unaan tes ser%l%&i alm men&ienti.i(asi Staphylococcus ter'atas+ Penentuan ti*e .a&a iaar(an *aa lisis S. aureus %leh satu atau satu seri 'a(teri%.a&a (husus- hal ini ila(u(an i la'%lat%rium ru,u(a an i&una( untu( *enelitian e*iemi%l%&i! /Jer%me- 2003+ &"
Alat' Ba#an dan (ara Ker%a Alat) Alat$alat )an& i&una(an *aa *ra(ti(um ini antara lain !a5an *etri- lam*u
'unsen- mi(r%s(%*- %',e( &lass- %se- ra( ta'un& rea(si- serta ta'un& rea(si+ Ba#an) ahan$'ahan )an& i&una(an *aa *ra(ti(um ini antara lain 'ahan *emeri(saan 'eru*a sam*el n% Se- !a(ram anti'i%ti( n%%'i%sin- 2;2 3Cmeia a&ar arah- meia a&ar Mueller int%n- meia manit%l- meia &lu(%sameia MSA /Manit Salt a&ar- serta Na#l .isi%l%&is+ (ara ker%a ) Ienti.i(asi ila(u(an en&an !ara: *ari I ) 1+ a(u(an *emeri(saan mi(r%s(%*i( /direct preparat en&an *e5arnaan 9ram+ Amati hasiln)a i'a5ah mi(r%s(%* *er'esaran lensa %',e(ti. 100G en&an imersi %il+ 2+ Tanam(an P *aa lem*en& a&ar arah lalu in(u'asi se!ara aer%' *aa suhu 37H# selama 24 ,am+ 3+ Tanam(an *ula P *aa TS untu( !aan&an 'ila i*erlu(an *emeri(saan ulan&+
*ari II )
1+ Amati (%l%ni *aa lem*en& a&ar arah- (%l%ni Staphylococcus a(an tam*a( 'er'entu( 'ulat- iameter 2$4m- halus- li!in- men&(ilat an *in&&iran rata+ 2+ a(u(an *e5arnaan 9ram *aa (%l%ni tersan&(a- lalu amati i'a5ah mi(r%s(%*+ 3+ a(u(an u,i (atalase untu( mem'ea(an Staphylococcus strain (e!il en&an Streptococcus+ 4+ Dari (%l%ni a&ar arah- la(u(an u,i manit%l- &ula &lu(%sa serta u,i resistensi terhaa* n%%'i%sin+ (ara ker%a +%i Katalase )
Am'il (%l%ni 'a(teri an %les(an *aa %',e( &lass- (emuian tetesi 2;2 3C iatas %lesan terse'ut an amati aan)a &elem'un& &as *aa tetesan 2;2 menana(an
*%siti.+
/Staphylococcus
mem'eri(an
hasil
*%siti.
an
se'ali(n)a Streptococcus ne&ati.+ (ara $%i Manitol ) a+ Tanam(an 'a(teri *aa meia manit- lalu in(u'asi *aa suhu 37H# selama 24 ,am+ '+ Amati hasiln)a- hasil *%siti. a(an itanai en&an aan)a *eru'ahan 5arna meia ari un&u atau merah men,ai (unin&+ (ara $%i G$la Gl$kosa ) a+ Tanam(an 'a(teri *aa meia &lu(%sa- lalu in(u'asi *aa suhu 37H# selama 24 ,am+ '+ Amati hasiln)a- hasil *%siti. a(an itanai en&an aan)a *eru'ahan 5arna meia ari un&u atau merah men,ai (unin&+ (ara $%i Resistensi ter#adap No,obiosin ) a+ Seia(an lem*en& a&ar Mueller int%n+ uat sus*ensi 'a(teri *aa Na#l .isi%l%&i sa*ai ia*at (e(eruhan 0-B M! Farlan+ '+ Tanam(an sus*ensi 'a(teri terse'ut *aa lem*en& Mueller int%n en&an men&&una(an lii (a*as+ !+ eta((an !a(ram anti'i%ti( n%%'i%sin i atas *ermu(aan 'ia(an
&I"
terse'ut+ + In(u'asi(an selama 37H# selama 24 ,am+ Amati hasiln)a+ *ari III ) 1+ Amati hasil u,i manit%l 2+ Amati hasil u,i &lu(%sa 3+ Amati hasil u,i resistensi terhaa* n%%'i%sin 4+ a(u(an u,i (%a&ulasi *lasma *asil dan Pemba#asan Pra(ti(um ini ila(sana(an selama 3 hari )aitu imulai ari hari Senin- 02 Desem'er 2013 sam*ai en&an hari
*ari II 1+ M%r.%l%&i K%l%ni
#iri$!iri (%l%ni
entu( K%l%ni Diameter /mm arna Eleasi Permu(aan Pin&&iran Si.at
Meia A&ar Darah S. epidermidis S. aureus ulat ulat 1 mm 2 mm Putih #em'un& asah
MSA S. epidermmidis S. aureus ulat ulat
Putih #em'un& asah
0-3 mm
0-1 mm
Putih #em'un& asah
Putih #em'un& asah
Anhem%lisis em%lisis $ em%lisis 2+ asil *e5arnaan 9ram ari (%lini tersan&(a i meia AD entu( Susunan Si.at Tersan&(a
3+
N%+ 1+ 2+ 3+ 4+
: ulat : er&er%m'%l : 9ram *%siti. : Staphylococcus sp
asil @,i Katalase P%siti. /> *ari III Parameter *emeri(saan Plasma (%a&ulase 9ula manit%l 9ula &lu(%sa
$
aa &elem'un&
asil S+ e*iermiis Ne&ati. /$ Ne&ati. /$ P%siti. /> 22 mm /sensiti.
S+ aurreus P%siti. /> P%siti. /> P%siti. /> 20 mm /sensiti.
Pemba#asan erasar(an hasil *ra(ti(um )an& telah ila(u(an *aa sam*el Se
a*at i(etahui 'ah5a s*esies 'a(teri *aa sam*el terse'ut meru*a(an Staphylococcus epidermidis+ al terse'ut a*at ilihat ari semua hasil u,i )an& telah ila(ua(an+ Dari hasil u,i (atalase terlihat tera*at aan)a &elem'un&- hal terse'ut men&ini(asi(an 'ah5a sam*el terse'ut meru*a(an &enus Staphylococcus. @ntu( menetu(an s*esies ari sam*el terse'ut ila(u(an u,i lainn)a+ Ji(a ilihat ari m%r.%l%&i (%l%ni *aa AD an MSA tam*a( san&atlah sulit untu( mem'ea(an s*esies ari sam*el terse'ut- namun en&an u,i$u,i )an& ila(u(an selan,utn)a 'aru a*at i(etahui s*esies a*a
*aa sam*el terse'ut+ Dite&a((ann)a ia&n%sis 'ah5a sam*el terse'ut meru*a(an s*esies S. epidermidis aalah ilihat ari u,i &ula manit%l serta resistensi terhaa* n%%'i%sin- *aa u,i &ula manit%l en&an sam*el ini men&hasil(an hasil ne&ati. )an& a*at isim*ul(an 'u(an S.aureus- namun untu( mem'ea(an (emun&(inan sam*el terse'ut antara S. epidermidis en&an S. saprophyticus aalah ilihat ari hasil u,i resistensi terhaa* n%%'i%sinimana ,i(a sam*el )an& i*eri(sa aalah 'a(teri S. saprophyticus ma(a a(an men&hasil(an hasil )an& resisten sean&(an *aa *ra(ti(um (ali ini- sam*el )an& ileta((an anti'i%ti( n%%'i%sin men&hasil(an hasil )an& sensiti- hal terse'utlah )an& men&uat(an 'ah5a 'a(teri *aa sam*el terse'ut meru*a(an 'a(teri Staphylococcus epidermidis+ 9enus Staphylococcus teriri ari se(uran&n)a 30 s*esies+ Ti&a ,enis utama
)an&
*entin& se!ara (linis
aalah
Staphylococcus
aureus,
Staphylococcus epidermidis, Staphylococcus saprophyticus. Staphylococcus aureus meru*a(an 'entu( (%a&ulase *%siti.- hal ini mem'ea(an ari s*esies lain+ Staphylococcus aureus meru*a(an *ath%&en utama 'a&i manusia+ am*er setia* %ran& a(an men&alami 'e'era*a in.e(si Staphylococcus aureus se*an,an& hiu*n)a- 'erariasi alam 'eratn)a mulai ari (era!uan ma(anan atau in.e(si (ulit rin&an sam*ai in.e(si 'erat )an& men&an!am ,i5a+ Staphylococcus (%a&ulase$ne&ati. meru*a(an .l%ra n%n$mal manusia an (aan&$(aan& men)e'a'(an in.e(si- srin& (ali 'er(aitan en&an alat$alat )an& itanam- (hususn)a *aa *asien )an& san&at mua- tua an en&an .un&si imun )an& ter&an&&u+ Kuaran& le'ih 7B C ari in.e(si ini ise'a'(an %leh Staphylococcus (%a&ulase$ne&ati. a(i'at Staphylococcus epidermidisin.e(si a(i'at S.warneri, S. hominis, an s*esies lain )an& le'ih ,aran&+ Staphylococcus saprophyticus relatie serin& men)e'a'(an in.e(si saluran (emih *aa 5anita mua+ S*esies )an& *entin& 'a&i (e%(teran he5an /Ja5et- 16+ Staphylococcus muah tum'uh *aa (e'an)a(an *er'enihan 'a(teri alam (eaaan aer%'i! atau mi(r%aer%.ili(+ a(teri ini tum'uh *alin& !e*at *aa sushu 370 #- teta*i mem'entu( *i&men *ain& 'ai( *aa suhu (amar /20$ 2B0#+ K%l%ni *aa *er'enihan *aat 'er'entu( 'unar- halus- men%n,%l- an 'er(ilau+ S. aureus meme'entu( (%l%ni 'er5arna a'u$a'u sam*ai (unin& emas
tua+ K%l%ni S. epidermidis 'er5arna a'u$a'u sam*ai *utih *aa is%lasi *ertama 'an)a( (%l%ni mem'entu( *i&men han)a 'ila telah lama ieram(an+ Pi&men tia( ihasil(an *aa 'ia(an anaer%'i! atau *aa (alu+ er'a&ai tin&(atan hem%lissi ihasil(an Staphylococcus aureus an (aan&$(aan& %leh s*esies lain+ S*esies Pepto sterplococcus- )an& meru*a(an (%(us anaer%'se!ara m%r.%l%&i( miri* Staphylococcus /=%l(- 13+ Staphylococcus men&hasil(an (atalase- )an& mem'ea(an en&an Streptococcus. a(teri ini mera&i(an 'an)a( (ar'%hirat en&an lam'atmen&hasilan asam la(tat- teta*i tia( men&hasil(an &as+ A(tiitas *r%te%liti( san&at 'erariasi untu(
setia* strain+ Staphylococcus
)an& *ath%&en
men&hasil(an 'e'era*a at e(straseluler )an& a(an i'i!ara(an i'a5ah ini+ Staphylococcus relatie resisten terhaa* *en&erin&an - *anas- an terhaa* Na#l C teta*i muah iham'at %leh at$at (imia tertentu- se*erti he(sa(l%r%.en 3C /9erar- 182+ Ke*e(aan Staphylococcus terhaa* 'an)a( %'at antimi(r%'a 'er'ea$ 'ea+
*lasmi
an
men)e'a'(an %r&anism resisten tehaa* 'e'e'ra*a *enisislin /*enisilin 9am*isilin- ti(arsilin an %'at$%'at se,enis+ Plasmi i*niah(an melalui transu(si an mun&(in *ula melalui (%n,u&asi+ 2.
Kesimp$lan
teta* *e(a terhaa*
Dia&n%sa 'a(teri%l%&i(: Dari 'ahan *emeri(saan en&an n%m%r sam*el Se ia*at(an 'a(teri &III"
Staphylococcus epidermidis. Daftar P$staka An%nim+ 2003+ Bakteriologi Medik + Malan&+ FK @niersitas ra5i,a)a- Tim Ki(r%'i%l%&i FK @NI
I-"
Lampiran
9am'ar 1+ A&ar arah untu( u,i resistensi n%%'i%sin /(iri atas- a&ar arah untu( is%lasi /(anan atas- *re*rarat *e5arnaan 9ram /(iri 'a5ah- hasil is%lasi *aa a&ar arah /(anan 'a5ah+ Sum'er : D%(umentasi *ri'ai
9am'ar 2+ asil u,i (atalase *%siti. /(iri atas- hasil u,i resistensi n%%'i%sin /(anan atas- hasil u,i *lasma (%a&ulasi *%siti. /(iri 'a5ah- hasil is%lasi *aa MSA /(anan 'a5ah+ Sum'er : D%(umentasi *ri'ai ISOLASI DAN IDENI!IKASI STREPTOCOCCUS I" Penda#$l$an a(teri
'erasal ari (ata atin 'a!terium /,ama(- 'a!teria- aalah
(el%m*%( ter'an)a( ari %r&anisme hiu*+ Sehin&&a alam (ehiu*an sehari$ hari (ita serin& (ali 'erintera(si en&an 'a(teri+ a(teri *ertama (ali itemu(an %leh Anth%n) an eeu5enh%e( *aa 1674 en&an men&&una(an mi(r%s(%* 'uatann)a seniri+ a(teri a*at i'ea(an 'erasar(an 'entu(n)a )aitu: 1+ entu( #%!!us / 'ulat 2+ entu( asil / 'atan& 3+ entu( S*iral Di alam Mi(r%'a atau 'a(teri le'ih serin& itemu(an alam 'entu( (%l%ni an 'ersama$sama en&an mi(r%'a )an& lain+ ;leh (arena itu- alam mem*ela,arin)a- 'a(teri harus iam'il ari alam lalu iis%lasi(an alam suatu 'ia(an murni+ ia(an murni aalah 'ia(an )an& han)a 'erisi 1 ,enis 'a(teri /Pel!ar- 2006+ Dalam *en&is%lasian 'a(teri aa 'e'era*a ma!am !ara )aitu !ara *en&en!eran- !ara *enuan&an- !ara *en&&ese(an atau *en&&%resan- !ara *en)e'aran- !ara *en&u!ilan 1 sel- an !ara in%(ulasi *aa he5an /=%l(-13+
a(teri aalah ma(hlu( hiu* )an& san&at (e!il an han)a a*at ilihat en&an mi(r%s(%*+ Ini 'erarti *ula 'ah5a 'a(teri !u(u* ti*is sehin&&a tem'us !aha)a+ A(i'atn)a *aa mi(r%s(%* tia( tam*a( ,elas an su(ar untu( melihat 'a&ian$'a&iann)a+ Sehin&&a untu( men&atasi hal terse'ut ma(a *erlu ila(u(an
*en&e!atan
atau
*e5arnaan
*aa
tu'uh
'a(teri
terse'ut
/D5i,%se*utr%- 200B+ Streptococcus meru*a(an 'a(teri 9ram *%siti.- 'er'entu( !%!!ussusunan
se*erti
rantai-
memerlu(an
*en&a)a
se*erti
arah
untu(
*ertum'uhann)a+ Streptococcus i(lasi.i(asi(an 'erasar(an ti*e hem%liti( *aa a&ar arah /Pel!ar-2006+ Meia aalah suatu 'ahan atau susunan 'ahan )an& teriri ari nutrisi atau at$at ma(anan )an& i&una(an untu( menum'uh(an mi(r%'a /'a(teri+ Meia *ertum'uhan atau *em'ia(an i*erlu(an untu( mem*ela,ari si.at 'a(teri untu( a*at men&aa(an ienti.i(asi- eterminasi- atau i.erensiasi ,enis$,enis )an& itemu(an /=%l(-13+ Meium *em'ia(an )an& i&una(an untu( men&em'an&'ia((an 'a(teri i la'%rat%rium a*at i'ea(an men,ai ti&a )aitu meium *em'ia(an asarmeium *em'ia(an *en)u'ur- meium *em'ia(an sele(ti.- an !ara mena*at(an 'ia(an murni+ ia(an murni aalah 'ia(an )an& han)a 'erisi 1 ,enis 'a(teri /=%l(- 13+ Dalam *en&is%lasian 'a(teri aa 'e'era*a ma!am !ara )aitu !ara *en&en!eran- !ara *enuan&an- !ara *en&&ese(an atau *en&&%resan- !ara *en)e'aran- !ara *en&u!ilan 1 sel- an !ara in%(ulasi *aa he5an /Pel!ar2006+ II" Prinsip
Prinsi* ari is%lasi mi(r%%r&anisme aalah memisah(an satu ,enis mi(r%%r&anisme en&an mi(r%%r&anisme lainn)a )an& 'erasal ari !am*uran 'erma!am$ma!am mi(r%%r&anisme terse'ut+ III" $%$an Pra(ti(um )an& ila(u(an i la'%rat%rium Mi(r%'a(terium STIKES Jeneral A!hma "ani ini 'ertu,uan untu( a*at men&is%lasi serta a*at men&ienti.i(asi s*esies 'a(teri Streptococcus )an& i*eri(sa ilihat ari !iri$
!iri *aa *emeri(saan mi(r%s(%*is- !iri$!iri *aa (%l%ni serta hasil ari u,i$u,i lan,utan )an& ila(u(an+ I&" in%a$an P$staka Streptococcus meru*a(an 'a(teri 9ram *%siti.- 'er'entu( !%!!ussusunan
se*erti
rantai-
memerlu(an
*en&a)a
se*erti
arah
untu(
*ertum'uhann)a+ Streptococcus i(lasi.i(asi(an 'erasar(an ti*e hem%liti( *aa a&ar arah /isn%- 10+ erasar(an ti*e rea(si hem%lisis Streptococcus i'a&i men,ai 3 ti*e)aitu:
1+ Al.a $ hem%lisis em%lisis tia( sme*urna /hem%lisis se'a&ian- mam*u melisis(an eritr%sit
se'a&ian
atau
menestru(si
se'a&ian
eritr%sit
sehin&&a
men&hasil(an %na (ehi,auan i se(itar (%l%ni+ 2+ eta ? hem%lisis em%lisis sem*urna meru*a(an *eme!ahan sem*urna ari sel arah merah sehin&&a men&hasil(an %na ,ernih i se(itar (%l%ni+ 3+ 9amma ? hem%lisis Tia( hem%lisis /anhem%lisis- tia( menun,u((an
ter,ain)a
*eme!ahan eritr%sit i se(itar (%l%ni sehin&&a tia( tera*at %na i se(itar (%l%ni /%nan&- 1+ A+ M%r.%l%&i Stre*t%!%!!us teriri ari (%(us )an& 'eriameter 0-B O 1 m+ alam 'entu( rantai )an& (has- a&a( meman,an& *aa arah sum'uh rantai+ Stre*t%!%!!us
*ath%&en
,i(a
itanam
alam
*er'enihan !air atau
*aat+Stre*t%!%!!us men)e'a'(an in.e(si *aa manusia aalah &ram ne&atie+ Paa *er'enihan )an& 'aru (uman *%siti. &ram- teta*i 'ila *er'enihan telah 'erumur 'e'era*a hari a*at 'eru'ah men,ai ne&atie &ram+ Tia( mem'entu( s*%ra- (e!uali 'e'era*a strain )an& hiu*n)a sa*r%.iti( /Pel!ar- 2006+ + Si.at i%l%&i @mumn)a stre*t%!%!!us 'ersi.at anaer%* .a(ultati.+ an)a 'e'era*a ,enis
)an& 'ersi.at
anaer%*
%'li&ati.+
Paa
*er'enihan
'iasa
*ertum'uhann)a (uran& su'ur ,i(a (ealamn)a tia( itam'ah(an arah atau serum+ Kuman ini tum'uh 'ai( *aa * 7-4 $7-6- *aa suhu %*timum
370#+ @ntu( is%lasi *rimer han)a i *a(ai meia )an& men&anun& arah len&(a* serum atau transuat+ Dalam lem*en& a&ar arah )an& i in(u'asi *aa 370# setelah 18$ 24 ,am a(an stre*t%!%!!us mem'entu( (%l%ni (e!il (e a'u$a'uan- 'entu(n)a 'ulat- *in&&irann)a rata- *aa *ermu(aan meia(%l%ni tam*a( se'a&ai setiti( !airan+Stre*t%!%!!us mem'entu( 2 ma!am (%l%ni )aitu mu!%i an &l%ss)+ erasar(an si.at hem%liti(n)a *aa lem*en& a&ar arah- (uman ini i 'a&i alam : 1 em%lisis ti*e al.a- / streptococcus -iridians mem'entu( 5arna (ehi,au$ hi,auan an hem%lisis se'a&ian *aa (%l%nin)a+ 2 em%lisis ti*e 'eta- / streptococcus hemolyticus mem'entu( %na 'enin& ise(elilin& (%l%nin)a+ 3 em%lisis ti*e &amma-
/ streptococcus
anhemolyticus
tia(
men)e'a'(an hem%lisis /Ja5et- 16+ Strpetococcus 'eta hem%liti( &ru* A /S. pyogenes meru*a(an 'a(teri *en)e'a' utama in.e(si saluran *erna.asan- sean&(an &ru* meru*a(an .l%ra n%rmal mu(%sa a&ina an telah ter'u(ti se'a&ai *en)e'a' emam *ur*ularis-
(aan&$(aan&
men)e'a'(an
en%(aritis+ Streptococcus 'eta (el%m*%(
menin&itis #
ne%natal
men)e'a'(an
an
raan&
ten&&%r%(an /=%l(- 13+ #+ Klasi.i(asi Streptococcus pyogenes ialah 'a(teri 9ram$*%siti. 'entu( 'unar )an& tum'uhalam
rantai
*an,an&
an
meru*a(an
*en)e'a'
in.e(si
Stre*t%!%!!us 9ru* A+ Streptococcus pyogenes menam*a((an anti&en &ru* A i inin& seln)a an 'eta$hem%lisis saat i(ultur i *lat a&ar arah+ Streptococcus pyogenes (has mem*r%u(si%na 'eta$hem%lisis )an& 'esar- &an&&uan eritr%sit sem*urna an *ele*asan hem%&l%'in- sehin&&a (emuian
ise'ut Streptococcus 9ru* A /'eta$hem%lisis+Stre*t%!%!!us
'ersi.at (atalase$ne&ati. /#%)(enall- 17+ Klasi.i(asi ilmiah: Kin&%m:
a!teria
Filum
:
Fermi!utes
Kelas
:
a!illis
;r%
:
a!t%'a!illa!es
Famili
:
Stre*t%!%!!a!eae
9enus
:
Stre*t%!%!!us
S*esies :
Streptococcus pyogenes
D+ Stru(tur anti&en 1+ Kar'%hirat #+ at ini tera*at alam inin& sel al %leh lan!e.iel i*a(ai se'a&ai asar untu( mem'a&i stre*t%!%!!us alm &r%u*$&r%u* s*esi.i( ari A sam*ai T+si.at (has ari (ar'%hirat # se!ara ser%l%&i! i tun,u(an %leh suatu amin% se&ar+ 2+ Pr%tein M+ Pr%tein ini aa hu'un&ann)a en&an a(t%r irulensi (uman streptococcus gryp &- (er,an)a men&ham'at .a&%sit%sis+ terutama ihasil(an %leh (uman en&an (%l%ni ti*e mu(%i streptococcus+ 3+ Su'stansi anti&en ini i*er%leh ari en&an (uman en&an men&&una(an enim *r%te%liti(+ anti&en ini meran&san& *em'entu(an a&lutinin+ 4+ Pr%tein < anti&en < ti*e 20 tahan terhaa* tri*sin teta*i tia( tahan *e*sin an rusa( se!ara *erlahan$lahan %leh asam an *emanasan+ B+ Nu!le%*r%teine(strasi streptococcus en&an 'asa lemah - men&hasil(an suatu !am*uran )an& teriri *r%tein an su'stansi P )an& mun&(in meru*a(an 'a&ian ari 'aan sel (uman+ 6+ a(teri%.a&a+ Krause an M!#art) 'erhasil menemu(an 'a(eri%.a&a )an& a*at melisis(anti*e 1- 6- 12- 2B an streptococcus hemolyticus grup huan+ 7+ Meta'%lit 'a(teri 8+ T%(sin erit%&eni( t%(sin ini ntahan selama ,am *aa suhu 600#- teta*i alam air meniiha(an rusa( alam 5a(tu 1 ,am+ t%(sin ini meru*a(an *en)e'a' ter,ai rash *aa .e'ris s!arlatina+ + em%lisisin itr% streptococcus a*at men)e'a'(an ter,ain)a hem%lisi *aa sel arahmerah alam 'er'a&ai tara.+ Ji(a *en&han!uran sel arah merah ter,ai se!aralen&(a* en&an isertai *ele*asan hem%&l%'in- ma(a ise'ut 'eta hem%lisis+ Ji(a *en&han!uran sel arah merah tia( men,ai se!ar len&(a* en&an isertai *em'entu(an *i&men hi,au- ma(a ise'ut al.a hem%lisis+ 9amma
hem%lisis
(aan&$(aan&
i*a(ai
untu(
menun,u(an (uman )an& n%n hem%liti(+ 10+ NAase Enim ini terutama i'uat %leh streptococcus grup &- # an 9+
11+ 11+ Stre*t Stre*t%(in %(inase ase Enim Enim ini (er,an)a (er,an)a meru'ah meru'ah *lasmin *lasmin%&en %&en alam alam serum serum men,ai men,ai *lasmin *lasmin-)a -)aitu itu suatu suatu enim enim *r%te%l *r%te%liti( iti( )an& men&han men&han!ur( !ur(an an .i'rin an *r%tein lainn)a streptococcus lainn)a streptococcus++ 12+ Stre*t%%rnase: Stre*t%%rnase: Enim ini (er,an)a (er,an)a meme!ah DNA- terutama terutama i'uat %leh streptococcus &ru* A- # an 9+ 13+ ialur% ialur%nia niase: se: Enim Enim ini meme!ah meme!ah asam hialur%n hialur%nat at )an& meru*a(an meru*a(an (%m*%ne (%m*%nen n *entin& *entin& ari 'ahan 'ahan asar asar ,arin&an ,arin&an i(at+ i(at+ Aa Aa 'e'era*a 'e'era*a ,enis ,enis streptococcus &ru* A )an& )an& a*at a*at men&has men&hasil(a il(an n hialur%n hialur%nias iasee alam alam !airan !airan *er'enih *er'enihanan- ,enis ,enis ini tia( tia( mem'ent mem'entu( u( selu'un& selu'un& hialur%n hialur%nias iasee i'uat %leh streptococcus %leh streptococcus &ru* &ru* an 9+ 14+ Pr%teinase: Pr%teinase: Enim ini ia(ti.(an ia(ti.(an %leh sen)a5a sen)a5a sul.h)r)l sul.h)r)l *aa * B- B O 6- B+ Da la msuasana msuasana imana enim enim a*at ihasil( ihasil(an an en&an en&an 'ai(- ,ustru ,ustru se!ara lan&sun& men&a(i'at(an (erusa(an *aa *r%tein stre*t%(inase an hialur%niase+ 1B+ Am)lase+ Am)lase+ e'era*a e'era*a ,enis streptococcus ,enis streptococcus &ru* &ru* A mem'uat enim ini alam *er'enihan itam'ah(an *lasma manusia- te*un& (an,i &li(%&en an malt%se+ 16+ 16+ Ster Steras ase: e: eni enim m ini ini ,u&a ,u&a i'u i'uat at %leh %leh streptococcus &ru* A- terutama terutama 'e(er,a terhaa* su'strat su 'strat )an& 'eru*a 'eta na*til asetat+ 17+ K%l%ni 'entu( 'entu( + K%l%ni ini a*at tim'ul se!ara se!ara s*%ntan- teta*i (%l%ni (%l%ni ini a*at *ula tim'ul ,i(a (ealam *er'enihan itam'ah(an *enisilin atau E+
'asitrasin /J%nes- 18 7+ Sum' Sum'er er *enu *enula lara ran n Streptoco Streptococcus ccus pyogenes pyogenes aalah aalah *en)e'a' *en)e'a' 'an)a( 'an)a( *en)a(it *en)a(it *entin& *entin& manusia mulai ari in.e(si (ulit rin&an an&(al sam*ai *en)a(it sistemi( )an& men&an!am hiu*+ In.e(si 'iasan)a imulai i ten&&%r%(an atau (ulit+ #%nt%h #%nt%h rin&an rin&an in.e(si in.e(siStre Streptoco ptococcus ccus pyogenes pyogenes )aitu )aitu sa(it sa(it te(a( te(a( / stre stre* * thr%at thr%at l%(al l%(al an in.e(si in.e(si (ulit (ulit /im*eti /im*eti&%+ &%+Er)si*elas Er)si*elas an !ellulitis !ellulitis )an& )an& i!iri(a i!iri(an n en&an en&an *en)e'ar *en)e'aran an lateral lateral Streptococcus pyogenes i pyogenes i (ealaman la*isan (ulit /%)er- 186+ In.e(si ise'a'(an ise'a'(an %leh 'e'era*a 'e'era*a ,enisStreptococcus ,enis Streptococcus pyogenes )an& pyogenes )an& a*at a*at i(ai i(ait( t(an an en&an en&an rilis rilis /,enis /,enis 'aru 'aru t%(sin t%(sinra ra!u !un n 'a(ter 'a(teri+ i+ In.e( In.e(si si ten&&%r%(an ten&&%r%(an 'erhu'un&an 'erhu'un&an en&an rilis ini an men&a(i'at(an ,u&a *en)a(it emam emam 'erara 'erarah+ h+ In.e(si In.e(si t%Gi&eni t%Gi&eni!! Streptococcus pyogenes la pyogenes lainn) inn)aa a*at a*at
men&a(i'at(an stre*t%!%!!al t%Gi! sh%!( s)nr%mes)nr%me- )an& a*at men&an!am hiu* /%)er- 186+ F+ E*ie *iemi mi%l %l%& %&ii 1+ Se,umlah (uman streptococcus streptococcus misaln) misaln)aa- streptococcus -iridians an ente enter%! r%!%!! %!!usus- meru* meru*a(a a(an n se'a&i se'a&ian an ari ari .l%ra .l%ra n%rma n%rmall *aa *aa tu'uh tu'uh manusia+ 2+ Kuma Kuman$ n$(u (uma man n ini ini han) han)aa a(an a(an meni menim' m'ul ul(a (an n *en) *en)a( a(it it ,i(a ,i(a ter tera* a*at at iluar tem*at$tem*at i mana mere(a 'iasan)a 'eraa- misaln)a *aa (atu* (atu* ,antu ,antun&+ n&+ @ntu( @ntu( men!e men!e&ah &ah (emu (emun&( n&(in inan an ter,a ter,ain in)a )a hal hal ituituterut terutam amaa *aa *aa se5a(t se5a(tu u mela( mela(u(a u(an n tina tina(an (an$ti $tina na(an (an %*rati %*rati.. *aa *aa tra(tus tra(tus urinariu urinariuss imana imana serin& serin& men)e'a' men)e'a'(an (an ter,ai ter,ain)a n)a 'a(terem 'a(teremia ia tem*%rertem*%rer- *em'erian %'at$%'atan anti'i%ti(a anti'i%ti(a san&at i*erlu(an untu( men!e&a men!e&ah h atau atau unut( unut( *en&%'at *en&%'atan an ini terhaa* terhaa* in.e(si in.e(si streptococcus streptococcus 'eta hem%l)ti(us &ru* A *aa *enerita )an& i(etahui mem*un)ai (elaina (elainan n (atu* (atu* ,antun&+ ,antun&+ Sum'er Sum'er in.e(si in.e(si (uman (uman stre*t%! stre*t%!%!!u %!!uss a*at a*at 'erasal ari *enerita atau !arrier+ Penularann)a ter,ai se!ara r%*let ari tra(tus res*irat%rius atau ari (ulit+ 3+ #ara #ara !%ntr !%ntr%l %l ter*e ter*ent ntin& in& aa aalah lah Paa *enerita en&an in.e(si stre*t%!%!!us &ru* A *aa tra(tus • •
res*irat%rius atau*un (ulit harus i'eri(an anti'i%ti! se!ara intensi.+ Paa *enerit *eneritaa )an& *ernah mena*a mena*att seran&an seran&an emam emam rheuma rheuma
•
harus i'eri(an anti'i%ti(a alam %sis *r%.ila(sis+ @ntu( men!e&ah *en)e'aran stre*t%!%!!us a*at ila(u(an en&an !ara men!e&ah *en&%t%ran %leh e'u- entilasi )an& 'ai(- rin&an
uara- sinar ultrai%let- an *ema(aian aer%s%l /<%u..- 11+ 9+ Pen)a(it Pen)a(it )an& )an& itim itim'ul( 'ul(an an Streptoco Streptococcus ccus pyogenes pyogenes ,u&a ,u&a a*at a*at men)e men)e'a' 'a'(an (an *en)a *en)a(it (it alam alam 'entu( Sinr%m *%st$in.e!ti%us n%n$*)%&eni! /tia( ter(ait en&an multi multi*l *li(a i(asi si 'a(ter 'a(terii l%(al l%(al an *em'en *em'entu( tu(an an nanah nanah++ K%m* K%m*li li(as (asii )an& )an& i.asilitasi %leh (%nisi aut%immun ini ter&%l%n& ,aran& ter,ai+ #%nt%h ari (%m* (%m*li li(a (asi si ini ini )ait )aitu u ema emam m reum reumat ati( i( a(ut a(ut an an *%st *%st stre stre*t *t%! %!%! %!!a !all &l%merul &l%merul%ne* %ne*hrit hritis+ is+ Keua Keua (%nisi (%nisi ini mun!ul mun!ul 'e'era*a 'e'era*a min&&u min&&u setelah setelah in.e(si a5al stre*t%!%!!al+ Demam reumati( itanai en&an *eraan&an *aa seni an atau ,antun& lalu 'erlan,ut en&an sa(it te(a(+
9l%mer 9l%merul%n ul%ne*hr e*hriti itiss a(ut an *eraan&a *eraan&an n &l%meru &l%merulus lus *aa &in,al &in,al a*at a*at men&i(uti sa(it te(a( atau in.e(si (ulit /%)er- 186+ &" Alat Alat'' Ba#a Ba#an n dan dan (ara (ara Ker Ker%a %a Alat) Alat$alat )an& i&una(an *aa *ra(ti(um ini antara lain !a5an *etri- lam*u 'unsen- mi(r%s(%*- %',e( %', e( &lass- %se- ra( ta'un& rea(sir ea(si- serta ta'un& rea(si+ rea(s i+ Ba#an) ahan$'ahan ahan$'ahan )an& i&una(an *aa *ra(ti(um ini antara lain 'ahan *emeri(saan 'eru*a sam*el n% S*- !a(ram !a( ram anti'i%ti( 'asitrasin- 2;2 3C- meia a&ar arahmeia a&ar Mueller int%n- meia &lu(%sa- serta Na#l .isi%l%&is+ (ara ker%a) Ienti.i(asi Stre*t%!%!!us ila(u(an en&an !ara: *ari I) 1+ a(u(an *emeri(saan *emeri(saan mi(r%s(%*i( mi(r%s(%*i( *aa *aa P en&an *e5arnaan *e5arnaan 9ram+ 9ram+ Amati Amati i 'a5ah mi(r%s(%*+ 2+ Tanam nam P *aa *aa lem lem*en& *en& a&ar a&ar ara arahh- lalu lalu in(u in(u'a 'asi si 37H# 37H# sela selama ma 24 ,am ,am se!ara aer%'+ *ari II)
1+ Amati Amati m%r.%l m%r.%l%&i %&i an si.at si.at hem%li hem%liti ti( ( *aa *aa (%l%ni (%l%ni a&ar arah+ arah+ #iri (%l%ni (%l%ni Streptococcus 'entu( Streptococcus 'entu( (%l%ni : 'ulat 'ula t halus- u(uran (uran& ari 1 mm+ 2+ a(u a(u(a (an n *e5a *e5arn rnaa aan n 9ram 9ram *aa *aa (%l% (%l%ni ni ters tersan an&( &(aa an an amat amatii hasi hasiln ln)a )a i 'a5ah mi(r%s(%*+ 3+ a(u( a(u(an an u,i (ata (atala lase se-- amat amatii hasi hasiln ln) )a- Stre mem'eri(an (an hasil hasil Strept ptoc ococc occus us mem'eri ne&ati.+ 4+ Paa (%l% %l%ni Streptococcus 'eta Streptococcus 'eta hem%liti(he m%liti(- untu( untu ( men&etahui men&etahu i &ru* A la(u(an u,i resistensi terhaa* asitrasin+ B+ @ntu( @ntu( men&et men&etahui ahui 9ru* - la(u( la(u(an an #AMP #AMP test 6+ @ntu( @ntu( men&etah men&etahui ui 9ru* #- la(u(a la(u(an n u,i resisten resistensi si terhaa* terhaa* SQT SQT (ara +%i Katalase )
Am'il (%l%ni 'a(teri an %les(an *aa %',e( &lass- (emuian tetesi 2;2 3C iata iatass %lesa %lesan n terse' terse'ut ut an an amati amati aan) aan)aa &elem &elem'un 'un& & &as *aa *aa tetes tetesan an 2;2 menana menana(an (an *%siti.+ *%siti.+ /Streptococcus ne&a ne&ati ti.. an an se'a se'ali li(n (n)a )a Staphylococcus mem'eri(an hasil *%siti.+ (ara $%i Resistensi Basitrasin ) #ara (er,a sama en&an u,i n%%'i%sin teta*i meian)a i&anti a&ar arah an !a(ram anti'i%ti( men&&una(an 'asitrasin- emi(ian *ula haln)a en&an u,i resistensi terhaa* SQT+ *ari III ) ." Amati hasil u,i resistensi terhaa* 'asitrasin
&I"
*asil dan Pemba#asan Pra(ti(um ini ila(sana(an selama 3 hari )aitu imulai ari hari Senin- 02
Desem'er 2013 sam*ai en&an hari
*ari II ) entu( Susunan Si.at Tersan&(a
2+
:erantai :9ram *%siti. :Streptococcus sp
: ulat : erantai : 9ram *%siti. : Streptococcus sp
M%r.%l%&i (%l%ni
#iri$!iri (%l%ni
S. pyogenes ulat 0-B mm Putih #em'un& asah
A&ar arah S. -iridans ulat 1 mm itam #em'un& asah
entu( (%l%ni Diameter /mm arna Eleasi Permu(aan Pin&&irin Si.at hem%lisis 3+ asil u,i Katalase : Ne&ati. /$ tia( aa &elem'un& 4+ Penanaman *aa a&ar arah an &ula$&ula asil *enanaman *aa AD:
Ma(r%s(%*is entu( (%l%ni ulat Diameter /mm 0-8 mm arna Putih 'enin& Eleasi #em'un& Permu(aan asah Pin&&iran
S. / hemolotikus ulat 1 mm Putih #em'un& asah
P%siti. /> *ari III ) Pen&u,ian @,i resistensi terhaa* 'asitrasin #AMP test Pemba#asan
asil Aan)a %na /sensiti. $
Dari hasil *ra(ti(um )an& telah ila(u(an *aa ienti.i(asi ari sam*el n%m%r
S*
a*at
i(etahui
'ah5a
sam*el
terse'ut
meru(a*an 'a(teri
Streptococcus pyogenes+ al terse'ut a*at ilihat ari hasil ienti.i(asi *aa 'e'era*a u,i )an& ila(u(an+ Dari hasil *enanaman *aa A&ar arah ia*at(an (%l%ni 'er'entu( 'ulat- 'eriameter 0-8 mm- 'er5arna *utih 'enin&- memili(i eleasi !em'un&- *ermu(aan 'asah- *in&&irann)a rata serta memili(i si.at hem%lisis sem*urna+ Dari hasil terse'ut suah 'isa ite&a((an hasil ienti.i(asi en&an melihat si.at hem%lisisn)a )an& hem%lisis sem*urna- (arena han)a &%l%n&an 'a(teri Streptococcus em%lisis )an& a*at men&hem%lisis(an arah en&an sem*urna serta 'a(teri 9ram *%siti. )an& termasu( (ealam (el%m*%( 'a(teri Streptococcus hem%lisis aalah han)a Streptococcus pyogenes+ Jai ari hasil *enanaman *aa A&ar arah suah a*at ite&a((an s*esies ari sam*el terse'ut meru*a(an 'a(teri Streptococcus pyogenes- 5alau*un harus ila(u(an u,i lan,utan untu( memasti(an 'ah5a *aa sam*el terse'ut 'enar meru*a(an 'a(teri Streptococcus pyogenes+ Di alam *%*ulasi mi(r%'a tia( ter*isah seniri menurut ,enisn)a- teta*i teriri ari !am*uran
'er'a&ai ma!am
sel+
;leh
(arena itu- alam
mem*ela,arin)a- 'a(teri harus iam'il ari alam lalu iis%lasi(an alam suatu 'ia(an murni+ Di alam la'%rat%rium *%*ulasi 'a(teri ini a*at iis%lasi men,ai (ultur murni )an& teriri ari satu ,enis )an& a*at i*ela,ari m%r.%l%&i- si.at an (emam*uan 'i%(imia5in)a+ ia(an murni aalah 'ia(an )an& han)a 'erisi 1 ,enis 'a(teri /Pel!ar- 2006+ Aa 'er'a&ai !ara untu( men&is%lasi 'a(teri alam 'ia(an murni )aitu!ara *en&en!eran- !ara *enuan&an- !ara *en&&ese(an atau *en&&%resan- !ara *en)e'aran- !ara *en&u!ilan 1 sel- an !ara in%(ulasi *aa he5an+ Masin&$ masin& mem*un)ai (ele'ihan an (e(uran&an /Pel!ar- 2006+ #ara Pen&&%resan
#ara *en&&%resan 'ertu,uan 'ertu,uan untu( men&is%lasi mi(r%%r&anisme ari !am*urann)a atau merema,a(an (ultur (e alam meium 'aru+ Is%lasi 'a(teri en&an !ara ini ter'a&i men,ai ti&a )aitu &%resan sinam'un&- &%resan T- &%resan (uaran / streak 0uadrant + Ta*i )an& i&una(an )aitu &%resan T en&an !ara: a&i !a5an men,ai 3 'a&ian men&&una(an s*i%l mar(er+ •
Am'il 1 %se sus*ensi 'ahan )an& men&anun& 'a(teri atau !am*uran 'a(teri
•
se!ara ase*ti(+ In%(ulasi aerah 1 en&an strea( i&$a& Panas(an %se an tun&&u in&in- (emuian lan,ut(an strea( i&$a& *aa
•
aerah 2 / streak *aa &am'ar+ #a5an i*utar untu( mem*er%leh &%resan )an& •
sem*urna a(u(an hal )an& sama *aa aerah 3+ Meia is%lasi )an& i&una(an )aitu l%% A&ar Plate /AP+ #iri$!iri
(%l%ni )an& ia*at *aa meia terse'ut aalah K%l%ni (e!il$(e!il- *utih a'u$a'u 'ulat- ,ernih- sm%%th- sei(it !em'un&- haem%l)tis /aa %ne ,ernih ise(itar (%l%nin)a /%nan&- 182+ &II"
&III"
Kesimp$lan Dia&n%sa 'a(teri%l%&i( : Dari 'ahan *emeri(saan n%m%r S* ia*at(an 'a(teri Streptococcus pyogenes. Daftar p$staka isn% A+ 10+ The resur&en!e %. a!ute rheumati! .eer in the @nite States+ Ann
En&l J Me314:166B #%)(enall A+ 18+ #lassi.i!ati%n an ienti.i!ati%n %. the irians stre*t%!%!!i+ #lin Mi!r%'i%l re2:31B Ja5et- Melni!( an Ael'er&+ 16+ Mikrobiologi edokteran. Ja(arta : E9#+ J%nes KF- Fis!hetti =A+ 187+ i%l%&i!al an immun%!hemi!al ientit) %. M *r%tein %n &r%u* 9 stre*t%!%!!i 5ith M *r%tein %n &r%u* A stre*t%!%!!i+ In.e!t ImmunBB:B02 Pel!ar- M+J+ an E+#+S !han+ 2006+ Dasar$asar Mi(r%'i%l%&i /iter,emah(an %leh
I-"
Lampiran)
9am'ar 1+ A&ar arah untu( is%lasi /(iri atas- A&ar arah untu( u,i resistensi 'asitrasin /(anan atas- Pre*arat *e5arnaan 9ram /(iri 'a5ah- asil is%lasi *aa a&ar arah /(anan 'a5ah+ Sum'er : D%(umentasi *ri'ai
9am'ar 2+ asil u,i resistensi 'a!itrasin sensiti. /(iri atas- hasil u,i (atalase ne&ati. /(anan atas- hasil u,i &ula$&ula *%siti. /'a5ah+ Sum'er : D%(umentasi *ri'ai IDENI!IKASI DAN ISOLASI PNEUMOCOCCUS I"
Penda#$l$an Di alam Mi(r%'a atau 'a(teri le'ih serin& itemu(an alam 'entu( (%l%ni
an 'ersama$sama en&an mi(r%'a )an& lain+ ;leh (arena itu- alam mem*ela,arin)a- 'a(teri harus iam'il ari alam lalu iis%lasi(an alam suatu
'ia(an murni+ ia(an murni aalah 'ia(an )an& han)a 'erisi 1 ,enis 'a(teri /Pel!ar- 2006+ Dalam *en&is%lasian 'a(teri aa 'e'era*a ma!am !ara )aitu !ara *en&en!eran- !ara *enuan&an- !ara *en&&ese(an atau *en&&%resan- !ara *en)e'aran- !ara *en&u!ilan 1 sel- an !ara in%(ulasi *aa he5an /=%l(- 13+ a(teri aalah ma(hlu( hiu* )an& san&at (e!il an han)a a*at ilihat en&an mi(r%s(%*+ Ini 'erarti *ula 'ah5a 'a(teri !u(u* ti*is sehin&&a tem'us !aha)a+ A(i'atn)a *aa mi(r%s(%* tia( tam*a( ,elas an su(ar untu( melihat 'a&ian$'a&iann)a+ Sehin&&a untu( men&atasi hal terse'ut ma(a *erlu ila(u(an *en&e!atan atau *e5arnaan *aa tu'uh 'a(teri terse'ut /Pel!ar- 2006+ Pneum%(%(us /S+ Pneum%niae aalah i*l%(%(us &aram$*%siti.+ a(teri ini- )an& serin& 'er'entu( lanset atau tersusun alam 'entu( rantai- mem*un)ai sima*i *%lisa(aria )an& mem*ermuah *enentuan ti*e en&an antiserum s*esi.i(+ Pneum%(%(us muah ilisis(an %leh at a(ti. *ermu(aan- misaln)a &aram$&aram em*eu+ at a(ti. *ermu(aan mun&(in men&hilan&(an atau mn%na(ti.(an *en&aham'at aut%lisin inin& sel+ ;r&anisme ini aalah *en&huni n%rmal *aa saluran *erna*asan 'a&ian atas manusia an *at men)e'a'(an *neum%nia- sinusitis- %titis- 'r%n(itis- 'a(terimia- menin&hitisan *r%ses in.e(si lainn)a /%lan- 186+ Pneum%!%!!us meru*a(an 'a(teri 'entu( !%!!us- susunan i*l%!%!!us se*erti lan!et- 9ram *%siti.+ a(teri *neum%!%!!us a*at itemu(an i ten&&%r%(an- salia- an saluran *erna.asan ari 'e'era*a %ran&- terutama *aa carrier. Pneum%(%(us a*at iis%lasi ari aha(- arah an e(suat *enerita *neum%niae l%'aris- ari !airan %ta($sumsum tulan& 'ela(an& *enerita menin&itis an ari *enerita$*enerita %titis meia- *erit%nitis- en%(aritisan *en)a(it lainn)a+ Pneum%(%(us a*at i&%l%n&(an alam ti&a 'entu( 'esar 'erasar(an aa tia(n)a sim*ai- )aitu 'entu( M ? *neum%(%(us 'ersim*ai 'entu( S ? Pneum%(%(us tia( 'ersim*ai- an 'entu( < ? Pneum%(%(us )an& 'er'entu( (asar /rough+ entu( M meru*a(an *neum%(%(us )an& irulen + sim*ai Pneum%(%(us teriri atas *%lisa(aria )an& i(enal se'a&ai spesiic soluble substance /SSS an menetu(an irulensi 'a(teri an ti*e 'a(teri II"
terse'ut /%lan- 186+ Prinsip
Prinsi* ari is%lasi mi(r%%r&anisme aalah memisah(an satu ,enis mi(r%%r&anisme en&an mi(r%%r&anisme lainn)a )an& 'erasal ari !am*uran III"
'erma!am$ma!am mi(r%%r&anisme terse'ut+ $%$an Pra(ti(um )an& ila(u(an i la'%rat%rium Mi(r%'a(terium STIKES Jeneral A!hma "ani ini 'ertu,uan untu( a*at men&is%lasi serta a*at men&ienti.i(asi s*esies 'a(teri Pneumococcus )an& i*eri(sa ilihat ari !iri$ !iri *aa *emeri(saan mi(r%s(%*is- !iri$!iri *aa (%l%ni serta hasil ari u,i$u,i
lan,utan )an& ila(u(an+ I&" in%a$an P$staka Pneum%(%(us /S+ Pneum%niae aalah i*l%(%(us &aram$*%siti.+ a(teri ini- )an& serin& 'er'entu( lanset atau tersusun alam 'entu( rantai- mem*un)ai sim*ai *%lisa(aria )an& mem*ermuah *enentuan ti*e e&an antiserum s*esi.i(+ Pneum%(%(us muah ilisis(an %leh at a(ti. *ermu(aan- misaln)a &aram$&aram em*eu+ at a(ti. *ermu(aan mun&(in men&hilan&(an atau mn%na(ti.(an *en&aham'at aut%lisin inin& sel+ ;r&anisme ini aalah *en&huni n%rmal *aa saluran *erna*asan 'a&ian atas manusia an *at men)e'a'(an *neum%nia- sinusitis- %titis- 'r%n(itis- 'a(terimia- menin&itis- an *r%ses in.e(si lainn)a /inn- 2007+ A+ M%r.%l%&i an Ienti.i(asi 1 #iri Khas ;r&anisme : Di*l%(%(us 'er'entu( lanset- &ram$*%siti. )an& (has sern& terlihat alam 'ahan 'ia(an mua+ Paa aha( atau nanah- ,u&a terliahat (%(us tun&&al atau rantai+ Sema(in tua- %r&anisme ini !e*at men,ai &ram$ ne&ati. !enerun& melisis se!ara s*%ntan /=%l(- 13+ Aut%lisis *neum%(%(us san&at menin&(at 'ila aa at a(ti. *ermu(aan+ isis *neum%(%(us ter,ai alam'e'era*a menit 'ila em*eu sa*i /10C atau natrium e%(silat /2C itam'aha(an *aa 'ia(an (alu atau sus*ensi%r&anisme *aa * netral+ Stre*t%(%(us irians tia( men&alami lisis an muah i'ea(an ari ari *neum%(%(us+ Paa *er'enihan *aat- *ertum'uhan *neum%(%(us iham'at i se(itar !a(ram %*t%(in+ NN *etun,u( ienti.i(asi lainn)a: ham*ir semuan)a irulen 'a&i ti(us 'ila isunti((an intra*erit%neal an tes *em'en&(a(an sim*ai- atau rea(si Luellun& /=%l(- 13+
2 ia(an : Pneum%(%(us mem'entu( (%l%ni 'ulat (e!il- mula$mula 'er'entu( (u'ah an (emuian tim'ul le(u(an i ten&ah$ten&ahn)a en&an *in&&iran
)an&
menin&&i
an
α$hem%lisis
*aa
a&ar
arah+
Pertum'uahan 'a(teri itin&(at(an en&an B$10C #;2 /=%l(- 13+ 3 Si.at$si.at Pertum'uhan : Ke'an)a(an ener&i i*er%leh ari *era&ian &lu(%sa+ Ini ii(uti %leh *em'entu(an asam la(tat )an& !e*at- )an& mem'atasi *ertum'uhan+ ial *aa selan& (alu en&an 'asa- a(an ter,ai *ertum'uhan )an& masi. /=%l(- 13+ 4 =ariasi : ia(an *neum%(%(us men&anun& 'e'era*a %r&anisme )an& tia( a*at
mem'entu(
(%l%ni
(asar
teta*i
se'a&ian
'esar
'a(teri
men&ahasil(an *%lis(aaria an meme'entu( (%l%ni halus+ entu( (asar a(an 'an)a( itemu(an 'iala 'ia(an itum'uha(an *aa serum anti*%lisa(aria ti*e$s*esi.i( /Ja5et- 16+ Trans.%rmasi : ial suatu ti*e *neum%(%(us )an& tia( mem'uat sim*ai *%lis(aaria itum'uh(an alam e(stra( DNA ari ti*e *neum%(%(us )n& men&ahasil(an *%lis(aria sim*ai- a(an ter'entu( *neum%(%(us 'ersim*ai ari ti*e tera(hir+
+ Stru(tur Anti&en 1 Stru(tur (%m*%nen : P%lisa(aria sim*ai se!ara imun%l%&i( masin&$ masin& 'er'ea satu sama lain (uran& le'ih alam 80 ti*e+ P%lisa(aria aalah anti&en )an& terutam menim'ul(an res*%ns sel + 2
men&anun& anti'%i terhaa* le'ih ari 80 ti*e /%mniserummeru*a(an rea&en )an& 'ai( untu( meneta*(an se!ara te*at aan)a *neum(%(us alam aha( se&ar en&an men&&una(an mi(r%s(%* /P%5erl)- 186+ #+ Pat%&enesis 1 Ti*e *neum%(%(us : Paa %ran& e5asa- ti*e 1$8 men)e'a'(an (ira$(ira 7BC (asus *neum%nia *neum%(%(us an le'ih ari seten&ah (asus 'a(teremia *neum%(%(us )an& .atal *aa ana($ana(- ti*e 6- 14- 1- an 23 meru*a(an *en)e'a')an& *alin& serin&+ 2 Pen)e'a' *enta(it : Pneum%(%(us men)e'a'(an *en)a(it melalui (emam*uann)a 'er'ia( alam ,arin&an+ a(teri ini tia( men&hasil(an t%(sin )an& 'erma(ana+ =irulensi %r&anisme ise'a'(an %leh .un&si sim*ain)a- )an& men!e&ah atau men&hama'at *en&han!uran sel )an& 'ersim*ai %leh .a&%sit+ Serum )an& mn&anun& anti'%i terhaa* *%lis(aria ti*e$s*esi.i( a(an melinun&i terhaa* in.e(si+ ila serum ini ia's%r'si en&an *%lisa(aria ti*e$s*esi.i(- serum terse'ut a(an (ehilan&an a)a *elinun&ann)a+ e5an atau manusia )an& iimunisai en&an *%lisa(aria *neum%(%(us ti*e tertentu selan,utn)a imun terhaa* ti*e *neum%(%(us itu an mem*un)ai anti'%i *resi*itasi an %*s%nisasi untu( ti*e *%lisa(aria terse'ut+ 3 ilan&n)a Imunitas Alami : Karena 40$70C manusia *aa saat tertentu aalah *em'a5a *neum%(%(us irulen- sela*ut mu(%sa *erna*asan n%rmal
harus
mem*un)ai
imunitas
alami
)an&
(uat
terhaa*
*neum%(%(us+ Fa(t%r$.a(t%r )an& mun&(in menurun(an a)a tahan ini sehin&&a men)e'a'(an *reis*%sisi terhaa* in.e(si *neum%(%(us aalah se'a&ai 'eri(ut : a Kelainan saluran *erna*asan$In.e(si irus atauin.r(si lainn)a )an& merusa( *ermu(aan sel (elainan *enum*u(an lenir /misaln)a aler&i )an& melinun&i *neum%(%(us ari .a&%sit%sis %'stru(si 'r%n(us /misaln)a atele(tais an lu(a saluran *erna*asan a(i'at at iritan )an& merusa( .un&si mu(%siliaris+ ' Al(%h%l atau int%(si(asi %'at- )an& mene(an a(tiitas .a&%sit%sismene(an re.le(s 'atu(- an mem*ermuah as*irasi 'ena$'ena asin&+
! Kelainan inami(a sir(ulasi /misaln)a (%n&esti *aru$*aru an *a)ah ,antun&+ Malnutrisi- e'ilitas umum- anemia sel sa'it- hi*%s*lenisme- ne.r%sisatau e.isiensi (%m*lemen /Ja5et- 16+ D+ Pat%l%&i In.e(si *neum%(%(us men)e'a'(an melim*ahn)a !airan eema .i'rin%sa (e alam ale%li- ii(uti %leh sel$sel arah merah an leu(%sit- )an& men&a(i'at(an (%ns%liasi 'e'era*a 'e'era*a 'a&ian *aru$*aru+ an)a( *neum%(%(us itemu(an i seluruh e(suat- an 'a(teri ini men!a*ai aliran arah melalui rainase &etah 'enin& *aru$*aru+ Dinin& ale%li teta* n%rmal selama in.e(si+ Selan,utn)a- sel$sel m%n%nu(leus se!ara a(ti. mem.a&%sit%sis sisa$sisa- an .ase !air ini lam'at$laun ia's%r'si (em'ali+ Pneum%(%(us iam'il %leh sel .a&%sit an i!erna i alam sel /a&er- 10+ E+ Imunitas Imunitas terhaa* in.e(si *neum%(%(us aalah ti*e$s*esi.i( an 'er&antun& *aa anti'%i terhaa* *%lisa(aria sim*ai an *aa .un&si .a&%sit )an& utuh+ =a(sin a*at meran&san& *em'entu(an anti'%i terhaa* *%lisa(aria sim*ai /Sim'er(%..- 186+
F+ Pen&%'atan Karena *neum%(%(us sensiti. terhaa* 'an)a( %'at antimi(r%'a *en&%'atan ini 'iasan)a men&hasil(an *en)em'uhan )an& !e*at- an *eran res*%ns anti'%i tam*a(n)a 'an)a( 'er(uran&+ Penisislin aalah %'at *ilihan untu(*en)a(it ini+ A(hir$a(hir ini tim'ul resisitensi terhaa* 'e'era*a %'at *neum%(%(us )an& resisten terhaa* tetrasi(lin- eritr%misin an lin(%misin teah iis%lasi ari *enerita+ Pneum%(%(us )an& san&at resisten terhaa* *enisilin /(aar ham'atan minimum 4 unitm telah iis%lasi i Ne5 9uinea- an tem*at$tema*t lain serta menim'ul(an lea(an *en)a(it i rumah$rumah sa(it i A.ri(a Selatan+ e'era*a *neum%(%(us )an& a&a( resisten terhaa* *enislin 9 ari A.ri(a Selatan
*en&hasil β$ la(tamase+ Pneum%(%(us )an& resisten terhaa* *enisilin tia( 'an)a( menim'ul(an (esulitan *aa *neum%nia teta*i- *aa menin&hitis imana han)a sei(it %'at )an&a*at men!a*ai sususna sara. *usat- 'a(teri ini menimn'ul(an masalah *en&%'atan )an& sulit /Ja!%'s- 12+ &" Alat' Ba#an dan (ara ker%a Alat) Alat$alat )an& i&una(an *aa *ra(ti(um ini antara lain !a5an *etri- lam*u
'unsen- mi(r%s(%*- %',e( &lass- %se- ra( ta'un& rea(si- serta ta'un& rea(si+ Ba#an) ahan$'ahan )an& i&una(an *aa *ra(ti(um ini antara lain 'ahan *emeri(saan 'eru*a sam*el n% 12- meia a&ar arah- meia a&ar Mueller int%n- serta Na#l .isi%l%&is+
(ara ker%a) *ari I ) 1+ Mi(r%s(%*i( ahan *emeri(saan i!at en&an *e5arnaan 9ram an urri$9ins ma(a
hasiln)a : 9ram 9ram : P%siti. entu( : !%!!us l%n,un& se*erti lan!et Susunan : i*l%!%!!us *ari II )
urri$9ins Ka*sul : 'enin& a(teri : 'iru atar 'ela(an& : hitam
2+ Pem'ia(an : ahan *emeri(saan (uman tersan&(a itanam *aa meia a&ar arahin(u'asi *aa suhu 37H# selama 24 ,am+ asil 'ia(an *aa a&ar arah(%l%ni 'ulat$'ulat (e!il- iameter 1 mm- i se(itar (%l%ni tera*at &elan&&an& (ehi,auan /hem%i&esti+ *ari III ) Amati hasil 'ia(an *aa a&ar arah &I" *asil dan pemba#asan
Pra(ti(um ini ila(sana(an selama 2 hari )aitu imulai ari hari Senin- 0 Desem'er 2013 sam*ai en&an hari Selasa- 10 Desem'er 2013- en&an ia*at(an hasil se'a&ai 'eri(ut: *ari I asil ire!t *re*arat en&an *e5arnaan 9ram
entu( : !%!!us Susunan Si.at Tersan&(a
: i*l%!%!!us- m%n%!%!!us : 9ram *%siti. : Streptococcus sp
*ari II Pen&amatan hasil is%lasi: Tia( itemu(an aan)a *ertum'uhan *aa meia a&ar arah- ma(a is%lasi serta
ienti.i(asi ihenti(an+ Pemba#asan erasar(an hasil is%lasi an ienti.i(asi )an& ila(u(an *aa sam*el n% 12 tersan&(a Streptococccus sp tia( a*at ite&a((an ia&n%sis 'ah5a sam*el terse'ut meru*a(an Pneumococcus+ al terse'ut i(arena(an *aa sam*el tersan&(a )an& i is%lasi *aa meia a&ar arah tia( menun,u((an aan)a *ertum'uhan (%lini- hal terse'ut 'isa i(arena(an %leh 'e'era*a se'a'iantaran)a (arena sam*el tersan&(a )an& itanam(an *aa meia a&ar arah telah mati- (arena meia a&ar arah )an& 'u(an meru*a(an meia sele(ti. untu( (el%m*%( Pneumococcus sehin&&a tia( itemu(an aan)a *ertum'uhan- atau (arena 'a(teri (el%m*%( Pneumococcus harus itum'uh(an *aa meia enri!hment tertentu se*erti *aa meia a&ar !%lum'ia+ Seran&an *neum%nia *neum%(%(us 'iasan)a menaa(- en&an emammen&i&il- an n)eri *leura )an& n)ata+ Daha( miri* en&an e(suat ale%li men&anun& arah atau se*erti (arat+ Paa *ermulaan *en)a(it- (eti(a emam tin&&i tera*at 'a(teremia alam 10$20C+ Se'elum aan)a (em%tera*i *en)em'uhan imulai antara hari (e$B an hari (e$10 (arena *aa saat itu tim'ul anti'%i ti*e s*esi.i(+ An&a( (ematian men!a*ai 30C- 'er&antun& *aa usia an *en)a(it )an& menasarin)a+ Pneum%nia )an& isertai 'a(teremia
selalu men)e'a'a(an an&a(a (ematian )an& *alin& tin&&i+ #en&an tera*i antimi(r%'a- *en)a(it a*at sem'uh en&an !e*at 'ial %'at i'eri(an ari a5altim'uln)a (%ns%liasi a*at ihalan&i /inn- 2007+ Pneum%nia *neum%(%(us harus i'ea(an ari in.ar( *aru$*aruatele(tasis- ne%*lasma- *a)ah ,antun& (%n&esti. an *neum%nia )an& ise'a'(an %leh 'an)a( 'a(teri lainn)a+ Em*iema /nanah alam r%n&&a *leura aalah (%m*li(asi terserin& an memerlu(an as*irasi an rainase /a&er- 10+ Dari saluran *erna*asan- *neum%(%(us a*at men!a*ai tem*at$tem*at lain+ Sinus$sinus an telin&a *alin& serin& terseran&+ In.e(si (aan&$(aan& meluas ari mast%i sam*ai sela*ut %ta(+ a(teremia ari *neum%nia mem*un)ai ti&a (%m*li(asi )an& he'at /tria- )aitu menin&itis- en%(aritisan artritis s*eti(+ Den&an (em%tera*i ini- ,aran& ter,ai en%(aritis &II"
*neum%(%(us a(ut mau*un artritis /urman- 18B+ Kesimp$lan Dari hasil *ra(ti(um )an& telah ila(u(an ia*at(an 'ah5a *aa sam*el n% 12 memili(i 'entu( 'ulat- susunan i*l%!%!!us- serta 'ersi.ta 9ram *%siti.+ Namun- ienti.i(asi tia( ilan,ut(an i(arena(an hasil is%lasi *aa a&ar arah tia( menun,u((an aan)a *ertum'uhan (%l%ni- sehin&&a ienti.i(asi tia(
&III"
ilan,ut(an+ Daftar P$staka %lan 9 et al+ /186+ Pneum%!%!!al a!!ine e..i!a!) in sele!te *%*ulati%n in the @nite States+ Ann Intern Me104:1+ urman A- N%rr') <- Tr%ll.%rs + /18B+ Insasie *neum%!%!!al in.e!ti%ns+ In!ien!e- *reis*%sin& .a!t%rs- an *r%&n%sis+
inn- 5ashin&t%n- Jr+- Allen- ste*hen+- + Jana- E+ K%neman- 9ar) P+ Paul S+ an 9+5%%s+ 2007+ K%nemans: #%l%r Atlas an Tet'%%( %. Dia&n%sti! mi!r%'i%l%&)- 6th eiti%n+ i**i!%nt illiams R il(ins I-"
Lampiran
9am'ar 1+ asil is%lasi Pneumococcus *aa a&ar arah /(iri- hasil u,i resistensi en&an ;*t%!hin /(anan+ Sum'er : 9%%&le ima&es+!%m
IDENI!IKASI CORYNEBACTERIUM I"
Penda#$l$an Di alam *%*ulasi mi(r%'a tia( ter*isah seniri menurut ,enisn)a- teta*i
teriri
ari
!am*uran
'er'a&ai
ma!am
sel+ ;leh
(arena
itu-
alam
mem*ela,arin)a- 'a(teri harus iam'il ari alam lalu iis%lasi(an alam suatu 'ia(an murni+ Di alam la'%rat%rium *%*ulasi 'a(teri ini a*at iis%lasi men,ai (ultur murni )an& teriri ari satu ,enis )an& a*at i*ela,ari m%r.%l%&i- si.at
an (emam*uan 'i%(imia5in)a+ ia(an murni aalah 'ia(an )an& han)a 'erisi 1 ,enis 'a(teri /Pel!ar- 2006+ Aa 'er'a&ai !ara untu( men&is%lasi 'a(teri alam 'ia(an murni )aitu!ara *en&en!eran- !ara *enuan&an- !ara *en&&ese(an atau *en&&%resan- !ara *en)e'aran- !ara *en&u!ilan 1 sel- an !ara in%(ulasi *aa he5an+ Masin&$ masin& mem*un)ai (ele'ihan an (e(uran&an /alu)%- 2007+ K%l%ni$(%l%ni 'iasan)a men%n,%l ari *ermu(aan meium *em'ia(anan si.at *en%n,%lan ini a*at 'er'entu( titi($titi(- 'ulat- 'er'enan&- ta($teraturseru*a a(ar- an (um*aran+ Meia aalah suatu 'ahan atau susunan 'ahan )an& teriri ari nutrisi atau at$at ma(anan )an& i&una(an untu( menum'uh(an mi(r%'a /'a(teri+ Meia *ertum'uhan atau *em'ia(an i*erlu(an untu( mem*ela,ari si.at 'a(teri untu( a*at men&aa(an ienti.i(asi- eterminasi- atau i.erensiasi ,enis$,enis )an& itemu(an+ Meium *em'ia(an )an& i&una(an untu( men&em'an&'ia((an 'a(teri i la'%rat%rium a*at i'ea(an men,ai ti&a )aitu meium *em'ia(an asarmeium
*em'ia(an
*en)u'ur-
meium
*em'ia(an
sele(ti.-
an
!ara
mena*at(an 'ia(an murni+ ia(an murni aalah 'ia(an )an& han)a 'erisi 1 ,enis 'a(teri /Pel!ar- 2007+ Dalam *en&is%lasian 'a(teri aa 'e'era*a ma!am !ara )aitu !ara *en&en!eran- !ara *enuan&an- !ara *en&&ese(an atau *en&&%resan- !ara *en)e'aran- !ara *en&u!ilan 1 sel- an !ara in%(ulasi *aa he5an /Pel!ar2007+ a(teri 'atan& 9ram *%siti. )an& tia( mem'entu( s*%ra meru*a(an (el%m*%(
'a(teri
)an&
'erane(a
ra&am+
an)a(
an&&%ta
&enus
orynebacterium an s*esies anaer%'i(n)a- s*esies Propionibacterium- aalah an&&%ta .l%ra (ulit an sela*ut mu(%sa manusia )an& n%rmal+ K%rine'a(teria lainn)a tera*at *aa he5an an tum'uhan+ orynebacterium diphtheriae meru*a(an an&&%ta ter*entin& ari (el%m*%( ini- (arena a*at mem'uat e(s%t%(sin )an& san&at (uat )an& men)e'a'(an i.teria *aa manusia+ "isteria monocytogenes an rysipelothri rhusiopathiae terutama tera*at *aa he5an an se(ali$(ali men)e'a'(an *en)a(it 'erat *aa manusia /inn- 2007+ #%r)ne'a!terium meru*a(an 'a(teri 'eriameter 0+B$1 um an *an,an&n)a 'e'era*a mi!r%meter+ #iri (has 'a(teri ini aalah *em'en&(a(an
tia( teratur *aa salah satu u,un&n)a- )an& men&hasil(an 'entu( se*erti &aa II"
/=%l(- 16 Prinsip Prinsi* ari is%lasi mi(r%%r&anisme aalah memisah(an satu ,enis mi(r%%r&anisme en&an mi(r%%r&anisme lainn)a )an& 'erasal ari !am*uran
III"
'erma!am$ma!am mi(r%%r&anisme terse'ut+ $%$an Pra(ti(um )an& ila(u(an i la'%rat%rium Mi(r%'a(terium STIKES Jeneral A!hma "ani ini 'ertu,uan untu( a*at men&is%lasi serta a*at men&ienti.i(asi s*esies 'a(teri orynebacterium )an& i*eri(sa ilihat ari !iri$!iri *aa *emeri(saan mi(r%s(%*is- !iri$!iri *aa (%l%ni serta hasil ari u,i$
u,i lan,utan )an& ila(u(an+ I&" in%a$an P$staka A+ M%r.%l%&i an Ienti.i(asi 1+ #iri$!iri (has %r&anisme K%rine'a(teria 'eriameter 0+B$1 um an *an,an&n)a 'e'era*a mi!r%meter+ #iri (has 'a(teri ini aalah *em'en&(a(an tia( teratur *aa salah satu u,un&n)a- )an& men&hasil(an 'entu( se*erti &aa+ Di alam 'atan& tere'ut /serin& ie(at u,un& se!ara tia( 'eraturan terse'ar &ranula$&ranula )an& a*at i5arnai en&an ,elas en&an at 5arna aniline /&ranula meta(r%mati(
)an& men)e'a'(an 'atan& terse'ut
'er'entu( se*erti tas'ih+ Tia* (%rine'a(teria *aa seiaan )an& i5arnai !enerun& terleta( *arallel atau mem'entu( suut lan!i* satu sama lain+ Per!a'an&an ,aran& itemu(an alam 'ia(an /aint%n- 17+ 2+ ia(an Paa a&ar arah (%l%ni # i*theriae tam*a( (e!il- 'er&ranula- an 'er5arna (ela'u- en&an 'atas$'atas )an& tia( teratur- an memili(i aerah hem%lisis )an& (e!il+ Paa a&ar )an& men&anun& (alium telurit(%l%ni 'er5arna (ela'u sam*ai hitam se'a' telur%t ireu(si isalam sel / sta.il%(%(us an stre*t%(%(us a*at ,u&a mem'entu( (%l%ni hitam + Keti&a 'i%ar # i*htheria se!ara (has mem*un)ai &am'aran se'a&ai 'eri(t : &rais- mitis- intermeius+ =arian ini i(lasi.i(asi(an 'erasar(an !iri (has *ertum'uhan se*erti m%r.%l%&i (%l%ni- rea(si 'i%(imia- an 'er'a&ai *en)a(it )an& ise'a'(an %leh in.e(si+ San&at sei(it re.erensi la'%rat%rium )an& mem'eri(an !irri (has 'i%ar insien i.teri telah san&at menurun an hu'un&an 'er'a&ai *en)a(it en&an 'i%ar tia(
*entin& untu( (lini( atau *en&anturan (esehatan mas)ara(at terhaa* suatu (asus atau 5a'ah+ Ji(a i*erlu(an alam suatu 5a'ah- met%e imun%(imia an m%le(uler a*at i&una(an untu( men&&%l%n&(an s%lat diphteriae /aint%n- 17+ 3+ Si.at$si.at *ertum'uhan diphteriae an (%rine'a(teria lain tum'uh se!ara aer%' *aa se'a&ian 'esar *er'enihan la'%rat%rium+ Pr%*i%ni'a!terium- 'ersi.at anaer%'+ Paa *er'enihan serum %e..ler- (%rine'a(teria tum'uh ,auh le'ih muah ari*aa
(uman *at%&en *erna.asan lainn)a- an *aa
seiaan mi(r%s(%*i(- m%r.%l%&i %r&anisme tam*a( (has+ Kuman ini mem'entu( asam- teta*i tia( mem'entu( &as *aa 'e'era*a (ar'%hirat /aint%n- 17+ 4+ =ariasi an *eru'ahan K%rine'a(teria !enerun& men,ai *le%m%r. *aa m%r.%l%&i mi(r%s(%*i( an *aa m%r.%l%&i (%l%ni+ ila 'a(teri i.teria tia( t%(si&eni( iin.e(si %leh 'a(teri%.a&a ari 'a!teria t%(si&eni( tertentuturunan ari 'a(teri )an& terin.e(si a(an 'ersi.at lis%&eni( an t%(si&eni(an si.at ini (emuian a*at iturun(an+ ila 'a(teri i.teria t%(si&eni( i'ia( 'erturut$turut *aa anti serum s*esi.i( terhaa* .a&a tia( a(ti. )an& aa ialam seln)a- 'a(teri terse'ut !enerun& men,ai tia( t%(si&eni(+ Jai- *enam'han .a&a !enerun& menim'ul(an t%(si&enitas /*eru'ahan lis%&eni(+ Pem'entu(an t%(sin se'enarn)a mun&(in han)a ter,ai 'ila *r%.a&a lis%&eni( diphtheria terinu(si an melisis(an sel+ T%(si&enitas i(enali(an &en .a&a- sean&(an a)a inasi i(enali(an &en 'a(teri /aint%n- 17+ + Stru(tur Anti&en Telah itemu(an *er'eaan ser%l%&i! antar ti*e an alam tia* ti*e diphtheriae- teta*i tia( terseia (lasi.i((asi ser%l%&i! )an& memuas(an+ Tes$ tes ser%l%&i! umun)a tia( i*a(ai *aa ienti.i(asi+ T%(sin i.teria men&anun& *alin& sei(it em*at *enentu ant&eni( /Fari%- 13+ #+ Pat%&enesis Dalam (el%m*%( ini- 'a(teri *at%&en utama untu( manusia aalah diphtheriae tera*at alam saluran *erna.asan- alam lua($lu(a- atau *aa (ulit %ran& )an& terin.e(si atau %ran& n%rmal )an& mem'a5a 'a(teri+ a(teri ise'ar melalui r%*let atau (%nta( en&sn iniiu )an& *e(a 'a(teri
(emuian tum'uh *aa sela*ut mu(%sa atau (ulit )an& le!et- an 'a(teri )an& t%(si&eni( itu mulai men&hasil(an t%(sin /Dan- 188+ Semua diphtheriae )an& t%(si&eni( mam*u men&eluar(an e(s%t%(sin )an& menim'u(an *en)a(t )an& sama+ Pem'entu(an t%(sin ini in itr% terutama 'er&antun& *aa (aar 'esi+ Pem'entu(an t%(sin %*)imal *aa (aar 'esi 0-14 u&ml *er'enihan teta*i 'enar$'enar terte(an *aa 0-B u&ml+ .a!t%r lain )an& mem*en&aruhi tim'uln)a t%(sin in itr% aalah te(an %sm%ti!- (aar asam amin%- *- an terseian)a sum'er$sum'er (ar'%n an nitr%&en )an& !%!%(+ Fa!t%r$.a(t%r )an& men&atur *em'entu(an t%(sin ini in i% 'elum imen&erti 'etul /Dan- 188+ T%(sin i.teri aalah *%li*e*tia tia( tahan *anas / M 62+000 )an& a*at memati(an *aa %sis 0-1 u&ml+ ila i(atan isul.ie i*e!ah(anm%le(ul a*at ter'a&i men,ai ua .ra&men+ Fra&men / M se(itar 38+000 tia( mem*un)ai a(ti.itas seniri teta*i i*erlu(an untu( *eminahan .ra&men A (ealam sel+ Fra&men A men&ham'at *eman,an&an rantai *%li*e*tia asal(an aa ni(%tinami aenine inu(le%tia /NAD en&an men&henti(ann alti.itas .a!t%r *eman,an&an EF$2 /ahulu inama(an Trans.erase II+ Fa(t%r ini i*erlu(an untu( transl%(asi *%li*e*tiil$
diphtheria erosis pseudodiphtheriticum 2 pyogenes %
9lu(%sa 1 > > $ >
Malt%sa 1 > > $ >
hemolyticum' 1 Mem'entu( asam teta*i tia( mem'entu( &as
Su(r%sa 1 $ > $ >
@rease 1 $ $ > $
2
Ju&a inama(an homannii
D+ Pat%l%&i T%(sin i.teria ia's%r'si (ealam sela*ut mu(%sa an men)e'a'(an estru(si e*itel an res*%n *eraan&an su*er.i!ial+ E*itel )an& men&alami ne(r%sis tertanam alam e(suat .i'rin an sel$sel arah merah an *utihsehin&&a ter'entu( *seu%mem'ran )an& 'er5arna (ela'u )an& serin& mela*isi t%nsil- .arin& atau larin&+ Setia* usaha untu( mem'uan& *seu%mem'ran a(an merusa( (a*iler an men&a(i'at(an *erarahan+ Kelen,ar &etah 'enin& re&i%nal *aa leher mem'esar- an a*at ter,ai eema )an& n)ata i seluruh leher+ a(teri i.teria alam sela*ut terus men&hasil(an t%(sin se!ara a!ti.+ T%(sin ini ia's%r'si an men&a(i'at(an (erusa(an i tem*at)an& ,auh- (hususn)a e&enerasi *aren(im- in.iltrasi lema( an ne(r%sis %t%t ,antun&- hati- &in,al an arenal (aan&$(aan& ii(uti %leh *erarahan he'at+ T%(sin ,u&a men&a(i'at(an (erusa(an sara.- )an& serin& men&a(i'at(an *aralisis *alatum m%lle- %t%t$%t%t mata atau e(stremitas /#%llier- 17B+ Di.teria lu(a atau i.teria (ulit terutama ia*ati i aerah tr%*i!+ Suatu sela*ut a*at ter'entu(
*aa lu(a terin.e(si )an& tia( a*at sem'uh+
Namun- a's%r's t%(sin 'iasan)a sei(it an e.e( sistemi(n)a ta( 'erarti+ =irulensi 'a(teri i.teria ise'a'(an (arena (emam*uann)a untu( menim'ul(an
in.e(si-
tum'uh
!e*at
an
(emuian
en&an
!e*at
men&eluar(an t%(sin )an& ia's%r'si se!ara e.e(ti.+ diphteriae tia( *erlu men,ai t%(si&eni( untu( menim'ul(an in.e(si l%(al misaln)a i nas%.arin& atau (ulit teta*i strain )an& n%nt%(si&eni( tia( menim'ulan e.e( t%(si( l%(al mau*un sistemi(+ diphtheria tia( se!ara a(ti. men&inasi ,arin&an alam an *ra(tis tia( *ernah masu( *erearan arah /#%llier- 17B+ E+ K%rine'a(teria ain /Di.ter%i R Pr%*i%ni'a(teria an)a( s*esies orynebacteria an Propionibacteria lain )an& telah i(ait(an en&an *en)a(it *aa manusia+ orynebacterium eikeium /(%rine'a(teria &ru* JK men)e'a'(an *en)a(it *aa *asien en&an .un&si imun terte(an an hal ini *entin& (arena menim'ul(an in.e(si- termasu( 'a(teremia- )an& memili(i an&(a (ematian tin&&i an (arena 'a(teri ini resisten
terhaa*
'an)a(
%'at
antimi(r%'a
)an&
laim
i&una(an+
K%rine'a(teria lain telah i(ait(an en&an *en)a(it *aa manusia+ Se'a&ai !%nt%h- orynebacterium minutissimum men)e'a'(an eritrsma - suatu in.e(si su*er.i!ial *aa (ulit (etia( atau (ulit *u'is+ ;r&anisme mem'entu( .l%uresensi merah mua )an& teran& i'a5ah sinar ultra un&u *aa lesi (ulit an 'ila i'ia( *aa a&ar Mueller int%n /
/se'elumn)a
orynebacterium
haemolyticum menim'ul(an 'eta hem%lisis *aa a&ar arah+ a(teri ini (aan&$(aan&
i(ait(an
en&an .arin&itis an
a*at
tum'uh *aa
*er'enihan sele(ti. untu( stre*t%(%(us+ & haemolyticum aalah ne&atie (atalase- se*erti stre*t%(%(us &ru* A- an harus i'ea(an nelalui *e5arnaan 9ram se!ara m%r.%l%&i /'atan& atau (%(us an si.at$si.at (imian)a /<%ins(i- 11+ &" Alat' Ba#an dan (ara Ker%a Alat) Alat$alat )an& i&una(an *aa *ra(ti(um ini antara lain !a5an *etri- lam*u 'unsen- mi(r%s(%*- %',e( &lass- %se- ra( ta'un& rea(si- serta ta'un& rea(si+ Ba#an)
ahan$'ahan )an& i&una(an *aa *ra(ti(um ini antara lain 'ahan *emeri(saan 'eru*a sam*el n% 3- meia a&ar arah- meia a&ar Tellurit- meia &lu(%sameia la(t%sa- meia su(r%sa- meia malt%sa- serta Na#l .isi%l%&is+ (ara Ker%a) Ienti.i(asi orynebacterium ila(u(an en&an !ara: *ari I) 1+ a(u(an *emeri(saan mi(r%s(%*i( *aa P en&an *e5arnaan 9ram+ Amati i 'a5ah mi(r%s(%*+ 2+ Tanam P *aa lem*en& a&ar Tellurit- lalu in(u'asi 37H# selama 24 ,am se!ara aer%'+ *ari II ) ." Amati (%l%ni *aa lem*en& a&ar Tellurit- (%l%ni orynebacterium a(an
tam*a( 'er'entu( 'ulat- 'er5arna a'u$a'u- serta *in&&iran rata+ /" a(u(an *e5arnaan 9ram *aa (%l%ni tersan&(a- lalu amati i'a5ah mi(r%s(%*+ 0" Dari (%l%ni a&ar Telllurit- la(u(an u,i malt%sa- &ula &lu(%sa- u,i su(r%saserta u,i la(t%sa+ (ara $%i Maltosa ) a" Tanam(an 'a(teri *aa meia malt%sa- lalu in(u'asi *aa suhu 37H# selama 24 ,am+ b" Amati hasiln)a- hasil *%siti. a(an itanai en&an aan)a *eru'ahan 5arna meia ari un&u atau merah men,ai (unin&+ (ara $%i G$la Gl$kosa ) a" Tanam(an 'a(teri *aa meia &lu(%sa- lalu in(u'asi *aa suhu 37H# selama 24 ,am+ b" Amati hasiln)a- hasil *%siti. a(an itanai en&an aan)a *eru'ahan 5arna meia ari un&u atau merah men,ai (unin&+ (ara $%i Laktosa ) a" Tanam(an 'a(teri *aa meia la(t%sa- lalu in(u'asi *aa suhu 37H# selama 24 ,am+ b" Amati hasiln)a- hasil *%siti. a(an itanai en&an aan)a *eru'ahan 5arna meia ari un&u atau merah men,ai (unin&+ (ara $%i s$krosa ) a" Tanam(an 'a(teri *aa meia su(r%sa- lalu in(u'asi *aa suhu 37H# selama 24 ,am+ b" Amati hasiln)a- hasil *%siti. a(an itanai en&an aan)a *eru'ahan 5arna meia ari un&u atau merah men,ai (unin&+ *ari III) Amati hasil u,i malt%sa- &lu(%sa- su(r%sa- serta la(t%sa
&I" *asil dan Pemba#asan Pra(ti(um ini ila(sana(an selama 3 hari )aitu imulai ari hari Selasa- 10
Desem'er 2013 sam*ai en&an hari Kamis- 12 Desem'er 2013- en&an ia*at(an hasil se'a&ai 'eri(ut: *ari I) asil ire!t *re*arat en&an *e5arnaan 9ram entu(
: atan&
Susunan
: =- - K /se*erti huru. !ina
Si.at : 9ram *%siti. Tersan&(a : orynebacterium sp
*ari II) Pen&amatan hasil is%lasi
#iri$!iri (%l%ni entu( (%l%ni Diameter /mm arna Eleasi Permu(aan Pin&&iran Si.at hem%lisis *ari III) asil *enanaman *aa &ula$&ula a(t%sa *%siti. /> • 9lu(%sa ne&ati. /$ • Su(r%sa ne&ati. /$ • Malt%sa *%siti. /> •
Meia Tellurit ulat 1 m A'u$a'u #%neG asah Tia( rata $
Pemba#asan ) Dari hasil *ra(ti(um )an& telah ila(u(an *aa sam*el n% 3 setelah
ila(u(an *e5arnaan 9ram ia*at(an hasil 'a(teri terse'ut 'er'entu( 'atan&memili(i susunan se*erti huru. !ina- serta 'ersi.at 9ram *%siti.- an setelah i is%lasi *aa meia tellurit ia*at(an 'entu( (%l%ni 'ulat- 'er5arna a'u$a'userta memili(i *in&&iran tia( rata+ al terse'ut a*at men)ata(an 'ah5a *aa sam*el n% 3 tera*at 'a(teri tersan&(a #%r)ne'a!terium+ @ntu( melan,ut(an
ienti.i(asi ila(u(an u,i lan,utan *aa &ula$&ula )an& ia*at(an hasil: *aa meia la(t%sa />- *aa meia &lu(%sa /$- *aa meia su(r%sa /$- serta *aa meia malt%sa />- setelah hasil isama(an *aa ta'el ienti.i(asi s*esies orynebacterium en&an hasil se*erti )an& tlah ise'ut(an iatas- iu&a 'ah5a 'a(teri *aa n% sam*el 3 aalah 'a(teri orynebacterium durum+ Semua diphtheriae )an& t%(si&eni( mam*u men&eluar(an e(s%t%(sin )an& menim'u(an *en)a(t )an& sama+ Pem'entu(an t%(sin ini in itr% terutama 'er&antun& *aa (aar 'esi+ Pem'entu(an t%(sin %*)imal *aa (aar 'esi 0-14 u&ml *er'enihan teta*i 'enar$'enar terte(an *aa 0-B u&ml+ .a!t%r lain )an& mem*en&aruhi tim'uln)a t%(sin in itr% aalah te(an %sm%ti!- (aar asam amin%- *- an terseian)a sum'er$sum'er (ar'%n an nitr%&en )an& !%!%(+ Fa!t%r$.a(t%r )an& men&atur *em'entu(an t%(sin ini in i% 'elum imen&erti 'etul /=%l(-16+ T%(sin i.teri aalah *%li*e*tia tia( tahan *anas / M 62+000 )an& a*at memati(an *aa %sis 0-1 u&ml+ ila i(atan isul.ie i*e!ah(anm%le(ul a*at ter'a&i men,ai ua .ra&men+ Fra&men / M se(itar 38+000 tia( mem*un)ai a(ti.itas seniri teta*i i*erlu(an untu( *eminahan .ra&men A (ealam sel+ Fra&men A men&ham'at *eman,an&an rantai *%li*e*tia asal(an aa ni(%tinami aenine inu(le%tia /NAD en&an men&henti(ann alti.itas .a!t%r *eman,an&an EF$2 /ahulu inama(an Trans.erase II+ Fa(t%r ini i*erlu(an untu( transl%(asi *%li*e*tiil$
telah
menerima 2B0 unit antit%(sin i.teria intra*erit%neal 2 ,am se'elumn)a+
e5an )an& terlinun&i a(an mati alam 2$3 hari- sean&(an he5an )an& terlinun&i teta* hiu* 2+ Tes in itr% : se*%t%n& (ertas sarin& )an& ,enuh en&an antit%(sin ileta((an *aa lem*en& a&ar )an& men&anun& serum (ua 20C+ ia(an )an& ites terhaa* t%(si&enisitas i&%res(an *aa (ertas sarin&+ Setelah *en&eraman 48
,am-
antit%(sin
)an&
'eri.usi
arri
*%t%n&an
(ertas
telah
mem*resi*itasi(an t%(sin )an& 'eri.usi ari 'ia(an t%(si&eni( an men&hasil(an &aris$&aris raial )an& meman!ar ari *er*%t%n&an (ertas an *ertum'uhan 'a(teri+ 3+ Tes 'ia(an ,arin&an : T%(si&enisitas diphtheria a*at i*erlihat(an ena&an memasu(an 'a(teri (e alam a&ar )an& mela*isi 'ia(an sel sela*is+ T%(sin )an& ihasil(an a(an 'eri.usi (e alam sel i'a5ahn)a an &II"
&III"
mamati(an sel$sel terse'ut /Ja5et- 16+ Kesimp$lan Dari hasil is%lasi an ienti.i(asi *aa sam*el n% 3 i(etahui 'ah5a s*esies 'a(teri *aa sam*el terse'ut aalah orynebacterium durum+ Daftar p$staka aint%n D et al+ 17+ Immunit)'%. !hilren t% i*htheria- tetanus an *%li%m)elitis+r Me J1:8B4 #%llier
9am'ar 1+ asil is%lasi #%r)ne'a!terium *aa !%lum'ia a&ar /(iri+ Sum'er : &%%&le ima&es+ asil u,i &ula$&ula /(anan+ Sum'er : D%(umentasi *ri'ai+
IDENI!IKASI MYCOBACTERIUM TUBERCULOSIS I"
Penda#$l$an M)!%'a!teria aalah 'a(teri tahan asam /TA- *ertum'uhann)a *aa
meia aa 2 ma!am- )aitu )an& tum'uh !e*at an )an& tum'uh lam'at sean&(an *en&ertian meia alam 'ian& ilmu 'a(teri%l%&i aalah suatu su'strat 'ahan ma(anan )an& i*erlu(an untu( *ertum'uhan ,asa$,asa reni( /mi(r%%r&anisme + M)!%'a!teria )an& tum'uh !e*at *aa in(u'asi 37V#tum'uh alam 5a(tu 2$4 ha- sean&(an )an& tum'uh lam'at iatas 1B hari + M)!%'a!teria )an& tum'uh !e*at umumn)a termasu( (ealam (el%m*%( tia( *at%&en- 5alau*un iantaran)a aa )an& *at%&en a*%rtunis-sean&(an )an& tum'uh lam'at umumn)a termasu( (ealam (el%m*%( sa*r%.it an *at%&en terhaa* *enerita 'ah(an aa )an& %%n%sis + M)!%'a!teria 'isa 'erasal an a*at iis%lasi ari tanah- air- .aeses urine- susu- s*utumaha( an ,arin&an %r&an si*enerita /#%llin- 18B + Men&in&at asal sum'ern)a 'erariasi- suah tentu a(an men&anun& mi(r%%r&anisme lain se'a&ai (%ntaminan + Dalam 'ian& ilmu 'a(teri%l%&i te(ni( is%lasi M)!%'a!teria 'er'ea en&an te(ni( is%lasi 'a(teri lainn)a + an)a( s*esies ari M)!%'a!teria )an& tum'uhn)a lam'at sam*ai aa )an& memerlu(an 5a(tu 6 min&&u untu( 'isa tum'uh *aa meia- sehin&&a untu( men&is%lir a&enn)a- 'ahan sam*el harus i'e'as(an ari (%ntaminan + @ntu( mem'unuh (%ntaminan (hususn)a terhaa* ,amur an 'a(teri lainn)a )an& 'isa men&ham'at an menutu*i *ertum'uhan M)!%'a!teria i*a(ai 'ahan *em'unuh (%ntaminane(%ntaminan /#%rner- 18 +
Mycobacterium aalah 'a(teri 'er'entu( 'atan& lurus atau a&a( 'en&(%( )an& 'ersi.at tahan terhaa* *en&hilan&an at 5arna en&an asam$al(%h%l- atau ise'ut ,u&a 'a(teri tahan asam+ a(teri ini hiu* se!ara anaer%' an se!ara m%r.%l%&i tia( a*at i'ea(an satu sama lain+ @ntu( mem'ea(an s*esies Mycobacterium satu an )an& lainn)a haruslah ilihat ari si.at$si.at (%l%ni5a(tu *ertum'uhan- suhu *ertum'uhan- u,i 'i%(imia- u,i (e*e(aan terhaa* %'at$%'atan antitu'er(ul%sa an (hem%tera*eti(a- *er'eaan (e*e(aan terhaa* 'inatan& *er!%'aan- an *er!%'aan (e*e(aan (ulit terhaa* ,enis anti&en II"
Mycobacterium /inn- 2007+ Prinsip Prinsi* ari is%lasi mi(r%%r&anisme aalah memisah(an satu ,enis mi(r%%r&anisme en&an mi(r%%r&anisme lainn)a )an& 'erasal ari !am*uran
III"
'erma!am$ma!am mi(r%%r&anisme terse'ut+ $%$an Pra(ti(um )an& ila(u(an i la'%rat%rium Mi(r%'a(terium STIKES Jeneral A!hma "ani ini 'ertu,uan untu( a*at men&is%lasi serta a*at men&ienti.i(asi s*esies 'a(teri Mycobacterium )an& i*eri(sa ilihat ari !iri$ !iri *aa *emeri(saan mi(r%s(%*is- !iri$!iri *aa (%l%ni serta hasil ari u,i$u,i
lan,utan )an& ila(u(an+ I&" in%a$an P$staka A+ M%r.%l%&i an Ienti.i(asi 1+ #iri$!iri (has %r&anisme: Dalam ,arin&an- 'asil tu'er(el meru*a(an 'atan& ram*in& lurus 'eru(uran (ira$(ira 0-4G3m+ Paa *er'enihan 'uatan- terlihat 'entu( !%!!us an .ilamin+ M)!%'a!teria tia( a*at i(lasi.i(asi(an se'a&ai 9ram *%siti. atau 9ram ne&ati.+ Se(ali i5arnai en&an at 5arna 'asa5arna terse'ut tia( a*at ihilan&(an en&an al(%h%l- mes(i*un i'u'uhi i%ium+ asil tu'er(el )an& se'enarn)a itanai %leh si.at tahan$asam misaln)a- BC etilal(%h%l )an& men&anun& 3C asam hir%(l%ria /asam al(%h%l en&an !e*at a(an men&hilan& 5arna semua 'a(teri (e!uali m)!%'a!teria+ Si.attahan asam ini 'er&antun& *aa inte&ritas stru(tur selu'un& 'erlilin+ eknik pe1arnaan 2ie#l3 Nielsen i*er&una(an untu( ienti.i(asi 'a(teri tahan asam+ Paa aha(
atau
irisan
,arin&an
m)!%'a!teria
a*at
i*erlihat(an
(arena
mem'eri(an .l%uresensi (unin&$,in&&a setelah i5arnai en&an at 5arna .l%ur%(r%m /misaln)a aramin-r%amin /Ja5et- 16+ 2+ ia(an : Per'enihan untu( 'ia(an *rimer m)!%'a!teria se'ai(n)a meli*uti *er'enihan n%n sele(ti. an *er'enihan sele(ti.+ Per'enihan sele(ti. men&anun& anti'i%ti( untu( men!e&ah *ertum'uhan 'erle'ihan 'a(teri an ,amur+ Tera*at 3 .%rmulasi umum )an& a*at i&una(an untu( *er'enihan sele(ti. mau*un n%n sele(ti.+ 1 Per'enihan a&ar semi sinteti($
*er'enihan
ini
/misaln)a-
mile'r%%( 710 an 711 men&anun& &aram tertentu- itamin(%.a(t%r- asam %leat-al'umin- (atalase- &liser%l- &lu(%sa- an malasit hi,au *er'enihan 711men&anun& ,u&a hir%silat (asein+ Al'umin menetralisasi e.e(t%(si( an e.e( *en&ham'atan asam lema( alam 'ahan
atau
*er'enihan+
In%(ula
)an&
'esar
menim'ul(an
*ertum'uhan *aa *er'enihan alam 'e'era*a min&&u+ Karena in%(ula 'esar mun&(in memerlu(an *er'enihan ini ,ai mun&(in (uran& sensiti. ari*aa *er'enihan lain untu( is%lasi *rimer mi(%'a(teria+ Per'enihan a&ar
semisinteti(
i&una(an
untu(
*emantauan
m%r.%l%&i (%l%ni- untu( u,i (e*e(aan- an en&an *enam'ahan anti'i%ti(- se'a&ai *er'enihan )an& sele(ti.+ 2 Per'enihan telur te'al: *er'enihan ini /misaln)a- %5enstein$Jensen men&anun& &aram tertentu &liser%l- an su'satnsi %r&ani( (%m*le(s /misaln)a- telur se&ar atau (unin& telur- te*un& (entan&- an 'ahan$ 'ahan lain alam 'entu( (%m'inasi+ Malasit hi,au imasu(an untu( men&ham'at 'a(terilain+ In%(ula (e!il alam 'ahan )an& 'erasal ari *asien a(an tum'uh *aa *er'enihan ini alam 5a(tu 33$6 min&&u+ Den&an *enam'ahan anti'i%ti(- *er'enihan ini i&una(an se'a&ai *er'enihan sele(ti.+ 3 Per'enihan (alu: *er'enihan (alu /misaln)a Mile'r%%( 7 an 712 menu(un& *r%li.erasi in%(ula (e!il+ iasan)a- mi(%'a(teria tum'uh
alam
masaa-a(i'at
'entu(
!iri
(has
(el%m*%( hir%.%'i(
atau
se'a&ai
*ermu(aan
se(el%m*%( seln)a+
Ji(a
itam'ah(an T5eens /ester asam lema( )an& a*at larut alam air-
ini a(an mem'asah(an *ermu(aan- an (arena itumemuah(an *en&uraian *ertum'uhan alam *er'enihan !air+ Pertum'uhan serin&(ali le'ih !e*at i'anin&(an *aa *er'enihan (%m*le(s+ Per'enihan 712 en&an *enam'ahan anti'i%ti(- su*lemen- an asam
14
#$*almitat aalah asar untu( sistem 'ia(an A#TE# untu(
mi(%'a(teria+ Selama *ertum'uhan- mi(%'a(teria men&&una(an asam 14
#$*almitat- mele*as(an
14
#;2- )an& terete(si %leh mesin+ ia(an
*%siti. a*at iete(si en&an sistem ini alam 5a(tu (uran& ari 2 min&&u /Ja5et- 16+ 3+ Si.at$si.at *ertum'uhan : Mi(%'a(teria aalah aer%' %'li&at an mena*at ener&i ari %(siasi 'er'a&ai sen)a5a (ar'%n seerhana+ Kenai(an te(anan #;2 menin&(at(an *ertum'uhan+ A(ti.itas (imian)a tia( (has- an la,u *ertum'uhann)a le'ih lam'at ari*aa (e'an)a(an 'a(teri lain+ a(tu *en&&anaan 'asil tu'er(el aalah se(itar 18 ,am+ entu( sa.r%*it !enerun& tum'uh le'ih !e*at- 'er(em'an& 'ia( en&an 'ai( *aa suhu 22$23%- men&hasil(an le'ih 'an)a( *i&men an (uran& tahan asam ari*aa 'entu( )an& *at%&en /Alare- 184+ 4+
en&an
mum'unuh
se'a&ian
%r&anisme
lain
)an&
men&(%ntaminasi+ asil tu'er(el !u(u* resisten terhaa* *en&erin&an an a*at hiu* lama alam aha( )an& (erin& /arnes- 13 B+ =ariasi: =ariasi a*at ter,ai *aa 'entu( (%l%ni- *em'entu(an *i&men *r%u(si .a(t%r !%r- irulensi- suhu *ertum'uhan %*timal- an si.at$ si.at sel atau si.at *ertum'uhan lainn)a /Pel!ar- 2006+
6+ Pat%&enisitas Mi(%'a!teria : Tera*at *er'eaan )an& ,elas alam hal (emam*uan 'er'a&ai mi(%'a(teria untu( men)e'a'(an lesi *aa 'er'a&ai s*esies inan&+ Manusia an marm%t san&at rentan terhaa* in.e(si M tuberculosissean&(an un&&as an sa*i 'ersi.at resisten+ M tuberculosis an Mycobacterium bo-is sama$sama *at%&eni( terhaa* manusia+ Jalur in.e(si
/melalui
saluran
*erna.asan
atau
saluran
*en!ernaan
menentu(an *%la lesi+ Di ne&ara 'er(em'an& - M bo-is san&at ,aran& itemui+ e'era*a mi(%'a(terium ati*i( /misaln)a Mycobacterium kansasii men)e'a'(an *en)a(it manusia )an& tia( a*at i'ea(an ari tu'er(ul%sis 'a(teri lain /misaln)a Mycobacterium ortuitum han)a men)e'a'(an lesi *ermu(aan atau 'er*eran se'a&ai %*%rtunis /inn- 2007+ + @nsur$unsur asil Tu'er(el @nsur$unsur 'asil )an& ter!antum i'a5ah terutama itemu(an alam inin& sel+ Dinin& sel mi(%'a(terium a*at meran&san& hi*ersensitiitas ti*e lam'a)- mema!u (e(e'alan terhaa* in.e(si- anmen&&anti seluruh sel mi(%'a(teria
alam
a,uan
Freun+
Isi
sel
mi(%'a(teria
han)a
menim'ul(an rea(si hi*ersensitiitas ti*e lam'at *aa he5an )an& se'elumn)a telah isensitisasi+ 1 i*i: Mi(%'a(teria (a)a a(an li*i- men!a(u* asam mi(%lat /asam lema( rantai$*an,an& #78$#0- lilin- an .%s.atia+ Dalam sel- li*i se'a&ian 'esar teri(at *aa *r%tein an *%lisa(aria+ Di*e*tia muramil /ari *e*ti%&li(an )an& mem'entu( (%m*le(s en&an asam mi(%lat a*at men)e'a'(an *em'entu(an &ranul%ma .%s.%li*i meran&san& ne(r%sis (ase%sa+ i*i alam 'atas$'atas tertentu 'ertan&&un& ,a5a' terhaa* si.at tahan$asam 'a(teri+ Pen&hilan&an at ini en&an asam *anas merusa( si.at tahan$asam 'a(teri- )an& 'er&antun& *aa (eutuhan inin& sel an aan)a li*i tertentu+ Si.at tahan$asam 'a(teri ,u&a hilan& setelah s%ni(asi sel$sel mi(%'a(teria+ Analisis li*i en&an (r%mat%&ra.i &as menun,u(an *%la )an& mem'antu alam (lasi.i(asi 'er'a&ai s*esies+ Strain 'asil tu'er(el )an& irulen mem'entu( ser*entine !%rsimana 'asil tahan$asam tersusun alam rantai *aralel+ Pem'entu(an
!%r ini 'erhu'un&an en&an irulensi+ Suatu .a(t%r !%r /trehal%sa$ 6-6$imi(%lat telah ie(stra( ari 'asil irulen en&an *etr%leum eter+ Fa(t%r ini men&ham'at mi&rasi leu(%sit- men)e'a'(an &ranul%ma (r%nis- an a*at 'er*eran se'a&ai a,uan imun%l%&i(+ 2 Pr%tein : Setia* mi(%'a(teria men&anun& 'e'era*a *r%tein )an& a*at memi!urea(si tu'er(ulin+ ila isunti((an- *r%tein )an& teri(at *aa .ra(si lilin a*at meran&san& (e*e(aan terhaa* tu'er(ulin+ at terse'ut a*at *ula menim'ul(an *em'entu(an 'er'a&ai anti'%i+ 3 P%lisa(aria : Mi(%'a(teria men&anun& 'er'a&ai *%lisa(aria+ Peranann)a *aa *at%&enesis tu'er(ul%sis tia( ,elas+ at ini a*at men)e'a'(an hi*ersensitiitas ti*e !e*at an 'erla(u se'a&aianti&en 'ila 'erea(si en&an serum %ran& )an& terin.e(si /=%l(- 13+ #+ Pat%&enesis Mi(%'a(teria tia( men&hasil(an t%(sin+ ;r&anisme alam r%*let se'esar 1$B m terhiru* an men!a*ai ale%li+ ;r&anisme )an& irulen a(an meneta* an 'er(em'an& 'ia( serta 'erintera(si en&an inan& sehin&&a menim'ul(an *en)a(it+ asil tia( irulen )an& isunti((an /misaln)a #9 han)a a*at hiu* selama 'e'era*a 'ulan atau 'e'era*a tahun *aa inan& n%rmal+
men&hasil(an
(%l%ni )an&
li!in- halus-an
tia(
'er*i&mentasi+ Serin& itemu(an alam lin&(un&an an telah i'ia((an ari air- tanah- ma(anan- an he5an- termasu( 'urun&+ Pema*aran lin&(un&an a*at menim'ul(an (%l%nisasi MAI i saluran *erna*asan atau saluran *en!ernaan+ Ter,ai 'a(teremia sementara )an& ii(uti en&an inasi ,arin&an+ a(teremia )an& meneta* an *erluasan in.iltrasi ,arin&an menim'ul(an is.un&si %r&an+ Setia* %r&an a*at ter(ena+ Di *aru$*aru- serin& ter,ai n%sul- in.iltrasi )an& i.us- (aitas- an lesi en%'r%n(ial+ Mani.estasi lain aalah *eri(aritis- a'ses ,arin&an luna(- lesi (ulit- *em'esaran (elen,ar &etah 'enin&- in.e(si tulan&- an lesi susunan sara. *usat+ Pasien serin&(ali isertai &e,ala n%ns*esi.i( emam- 'er(erin&at malam- n)eri a'%men- iare an 'erat 'aan menurun+ Dia&n%sis i'uat en&an mem'ia((an MAI ari arah atau ,arin&an+ Tia( tera*at met%e u,i (e*e(aan)an& telah istanarisasi an tia( aa (%relasi )an& 'ai( antara hasil u,i (e*e(aan u,i (e*e(aan in itr%en&an &am'aran (lini(+ In.%rmasi ter'an)a( men&enai tera*i %'at atan& ari *er!%'aan (lini(+ 2+ Mycobacterium kansasii M kansasii aalah %r&anisme .%t%(r%m%&en )an& mem'utuh(an *er'enihan (%m*le(s untu( *ertum'uhan *aa suhu 37H#+ a(teri ini a*at menim'ul(an *en)a(it *aru$*aru an sistemi( )an& sulit i'ea(an ari tu'er(ul%sis- terutama *aa *enerita en&an res*%n imun )an& ter&an&&u+ Karena *e(a terhaa* ri.am*in- M kansasii serin& i%'ati en&an (%m'inasi ri.am*in- etam'ut%l- an is%niai en&an res*%n (lini( )an& 'ai(+ Sum'er in.e(si tia( ,elas- an *enularann)a renah atau tia( aa+
3+ Mycobacterium marinum an Mycobacterium ulcerans ;r&anisme ini tera*at alam air- *alin& 'ai( tum'uh *aa suhu renah /31H#- a*at men&in.e(si i(an- an a*at menim'ul(an lesi (ulit su*er.isisal /ul(us- &ranul%ma (%lam renan& *aa manusia+ E(sisi 'eahtetrasi(lin- ri.am*in- an etam'ut%l (aan&$(aan& e.e(ti.+ 4+ K%m*le(s M)!%'a!terium .%rtuitum$!hel%nae K%m*le(s ini aalah sa*r%.it- itemu(an *aa tanah an air- an tum'uh !e*at /3$6hari alam 'ia(an serta tia( meme'entu( *i&men+ Kaan&$(aan& %r&anisme ini a*at emnim'ul(an *en)a(it su*er.isisal an sistemi( *aa manusia+ Mycobacterium ortuitum a*at men&(%ntaminasi
(atu* 'a'i )an& i&una(an se'a&ai *r%stesis *aa *em'eahan ,antun& manusia+ ;r&anisme ini serin& resisten terhaa* %'at antimi(%'a(teri teta*i mun&(in *e(a terhaa* ami(asin- %(sisilin- se.%(sitin- eritr%misin- atau ri.am*isin /a)- 14+ &" Alat' Ba#an' dan (ara Ker%a Alat) Alat$alat )an& i&una(an *aa *ra(ti(um ini antara lain lam*u 'unsenmi(r%s(%*- *asir al(%h%l- %',e( &lass- serta %se+ Ba#an) ahan$'ahan )an& i&una(an *aa *ra(ti(um ini antara lain 'ahan *emeri(saan 'eru*a s*utum *asien teru&a men&ia* *en)a(it tu'er(ul%sis serta 'ahan *e5arnaan untu( mela(u(an *e5arnaan iehl$neelsen+ (ara Ker%a) ahan *emeri(saan i 'uat *re*arat (emuian i5arnai en&an iehl$Neelsen+ asiln)a aalah 'entu( 'atan& halus- 5arna 'a(teri merah /tahan asam en&an asar 'iru (aan&$(aan& 'er'utir atau 'er&ranula merah+ Pe5arnaan iehl$ Neelsen ila(u(an en&an !ara: 1+ Seiaan )an& telah i.i(sasi ituan&i en&an !ar'%l .u!hsin 2+ Di*anasi en&an a*i (e!il sehin&&a (eluar ua* (emuian 'iar(an selama B menit /*e5arna tia( '%leh meniih an men,ai (erin&- 'ila (eluar ua* a*i ian&(at 3+ Seiaan ituan&i en&an air 4+ Dituan&i en&an asam al(%h%l /#l 3C alam al(%h%l BC sam*ai 5arna !ar'%l .u!hsin hilan& B+ Dituan&i en&an meth)len 'lue 1C selama 1 menit 6+ Di!u!i en&an air (ran an (erin&(an 7+ Amati i'a5ati mi(r%s(%* en&an *er'esaran lensa %')e(ti. 100G- 'a(teri tahan asam a(an 'er5arna merah en&an latar 'ela(an& 'iru+ &I" *asil dan Pemba#asan Pra(ti(um ini ila(sana(an *aa hari Jumat- 13 Desem'er 2013- en&an ia*at(an hasil se'a&ai 'eri(ut: *asil pengamatan asil ire!t *re*arat en&an *e5arnaan iehl$Neelsen entu( : atan& Susunan:M%n%'asil-i*l%'asil-stre*t%'asil Si.at : *%siti. TA Tersan&(a: Mycobacterium tuberculosis
LP
.
/
0
4
5
6
7
8
9
.: ; LP
;BA
. / 0 4 5 6 7 8 9 .:
11 8 2 11 2 12
12 18 11 1 13 11
4 13 12 11 14
10 14 10 1 1
12 4 11 14 26
4 3 B 12 12
B 17 2 13 14
4 16 6 11 12
2 12 10 16
12 16 12 4 11
<$mla#
10 10 10 10 10
76 121 81 10B 13
5/
545
Pemba#asan
Dari hasil *e5arnaan en&an men&&una(an *e5arnaan iehl$Neelsen ia*at(an 'a(teri 'er5arna merah en&an latar 'ela(an& 'iru- )an& meru*a(an 'a(teri tahan asam en&an 'entu( 'atan&- memili(i susunan m%n%'asili*l%'asil serta stre*t%'asil- en&an tersan&(a Mycobacterium tuberculosis+ Tersan&(a 'a(teri Mycobacterium tuberculosis terse'ut lan&sun& ihitun& ari la*an& *anan& *ertama sam*ai la*an& *anan& *anan& )an& a*at men)im*ul(an hasil+ Dari *erhitun&an )an& telah ila(u(an ia*at(an 'atan& tahan asam se'an)a( B4B 'a(teri *aa B2 la*an& *anan&+ ahan *emeri(saan )an& 'eru*a sam*el terse'ut tia( ila(u(an ienti.i(asi lan,utan (arena en&an hasil *e5arnaan iehl$Neelsen suah a*at i(etahui 'ah5a 'a(teri *aa 'ahan *emeri(saan terse'ut suah meru*a(an 'a(teri tersan&(a Mycobacterium tuberculosis+ Ji(a in&in ila(u(an ienti.i(asi lan,utan san&at me'utuh(an 5a(tu )an& san&at lama untu( mela(u(an ienti.i(asi 'a(teri tersan&(a Mycobacterium tuberculosis (arena sam*ai saat ini 'elum aa met%e ienti.i(asi *aa Mycobacterium )an& !e*at /anun&- 182+ Ienti.i(asi Mycobacterium tuberkulosis
a*at ila(u(an en&an
men&&una(an 'ahan *emeri(saan 'eru*a s*utum ari *enerita )an& i!uri&ai menerita *en)a(it T+ Ienti.i(asi se!ara mi(r%s(%*is a*at ila(u(an en&an en&an *emeri(saan TA- s*utum i'uat seiaan a*us (emuian i5arnai men&&una(an *e5arna TA /)an& *alin& umun i&una(an aalah *e5arna eihl$ Neelsen+ Ienti.i(asi ila(u(an alam 100 la*an& *anan& mi(r%s(%* *er'esatan 1000 (ali+ asil *%siti. ila*%r(an se!ara (uantitati. en&an men&&una(an s(ala I@ATD an ;- se'a&ai 'eri(ut : Pen!atatan
Temuan
>>> >> > An&(a *asti
A*a'ila itemu(an le'ih ari 10 TAP minimal alam 20 P A*a'ila itemu(an 1$10 TAP minimal alam B0 P A*a'ila itemu(an 10$ TA100 P A*a'ila tera*at 1$ TAP /a*%ran ,umlah TA )an&
itemu(an Ne&ati. A*a'ila tia( itemu(an TA100P minimal alam 10 P Pemeri(saan mi(r%s(%*i( TA meru*a(an met%e )an& *alin& muah!e*at an murah untu( menentu(an ia&n%sis+ asil *e5arnaan TA a(an terlihat (uman 'er5arna merah an latar 'ela(an& 'er5arna 'iru+ asil *%siti. itentu(an %leh ,umlah (uman )an& itemu(an- sean&(an hasil ne&ati. 'elum tentu tia( aa (uman (arena ini 'isa ter,ai *aa sam*el )an& tia( re*resentati. /#%llin- 18B+ Pe5arnaan eihl$Neelsen meru*a(an *r%seur *e5arnaan tahan asam )an& *alin& tua )an& mens)arat(an 'ah5a *e5arna *rimer
(ar'%l .u(hsin
i*anasi am*ai 'erua* selama *r%ses *e5arnaan /Pel!ar- 2006+ Da)a mi(r%s(%* !aha)a 'isa san&at ter'atas untu( a*at menete(si ,umlah (uman )an& sei(it alam sam*el+ Den&an mi(r%s(%* .lu%resen!e a)a melihat i*er'esar sei(it en&an luas *anan& )an& le'ih 'esar (arena lensa %',e(ti. )an& le'ih 'esar an &am'ar )an& terlihat !u(u* ,elas (arena 'er.lu%resensi at 5arna auramin rh%amin /#%llin- 18B+ asil *%siti. se!ara mi(r%s(%*i( tentu sa,a tia( 'erarti ia&n%sa e*initi.+ arus i*asti(an en&an !ara *er'enihan(ultur atau melalui *er!%'aan he5an+ Sema(in 'an)a( (uman )an& itemu(an alam ienti.i(asi TA ma(a 'esat (emun&(inan ia*at(an aan)a (uman alam *aru$*aru+ asil ne&ati. mi(r%s(%*i( atau ,umlah Mi(%'a(teri )an& tera*at alam s*esimen )an& iam'il ari *asien san&at renah a*at i*er'ai(i untu( mem*er'esar an&(a ete(si- 'iasan)a ila(u(an *eme(atan s*esimen en&an sentri.u&asi+ S*esimen )an& (entar an liat se*erti s*utum- harus ien!er(an terle'ih ahulu a&ar *emeri(saan le'ih 'ai( /#%rner- 18+ In.e(si tu'er(ul%sis 'iasan)a ter,ai melalui e'u atau titi( !airan /r%*let )an& men&anun& (uman tu'er(ul%sis an masu( (e alam saluran *erna*asan+ Pen)a(itn)a tim'ul setelah (uman meneta* an 'er(em'an& 'ia( alam *aru$*aru atau (elen,ar &etah 'enin& re&i%nal+ Per(em'an&an *en)a(it
ter&antun& *aa %sis (uman )an& masu( serta a)a tahan an hi*ersensitiitas h%s*es /FK@I- 13+ Aa ua (elianan *at%l%&i )an& ter,ai a(i'at (uman tu'er(ul%sis- )aitu ti*e e(suati. an ti*e *r%u(ti.+ Ti*e e(suati. teriri ari in.lamasi )an& a(ut en&an eema- sel$sel le(%sit *%lim%r*%nu(lear an men)usul (emuian sel$sel m%n%sit )an& men&elilin&i 'asil tu'er(ul%sis+(elainan ini terlihat terutama *aa ,arin&an *aru an miri* *neum%niae 'a(teri+ Pen)em'uhan a*at ter,ai se!ara sem*urna sehin&&a seluruh e(suat ia's%r*si atau a*at 'er(em'an& men,ai ne(r%sis )an& luas atau 'eru'ah men,ai ti*e 2 /ti*e *r%u(ti.+ Dalam masa e(suat ini tes tu'er(ulin aalah *%siti. /a)- 14+ Kelainan ti*e *r%u(ti. a*a'ila suah matan& *r%sesn)a- lesi 'er'entu( &ranul%ma )an& (r%ni(- teriri ari 3 %na )aitu %na sentral /en&an sel ra(sa )an& 'erinti 'an)a( an men&anun& (uman tu'er(ul%sis %na ten&ah )an& teriri ari sel$sel e*itel%i )an& tersusun raial an %na luar )an& teriri ari .i'r%'las- lim.%sit an m%n%sit+ am'at laun %na luar a(an 'eru'ah men,ai .i'r%ti( an %na sentral a(an men&alami *er(e,uan+ Kelainan se*erti ini ise'ut tu'er(el+ Tu'er(el )an& 'er(e,u a*at *e!ah (e alam 'r%n(us an men,ai (aerna+ Kesem'uhan a*at ter,ai melalui *r%ses .i'r%sis atau *er(a*uran /Ja5et- 16+ Per,alanan (uman tu'er(ul%sis a*at lan&sun& melalui aliran lim.e- aliran arah- melalui 'r%n(us an tra(tus i&esti.us+ Paa mulan)a- (uman men,alar melalui saluran lim.e (e (elen,ar &etah 'enin&+ Selan,utn)a melaui u!tus th%ra!i!us masu( (e alam aliran arah an terus (e %r&an tu'uh+ Da*at *ula lan&sun& ari *r%ses *er(e,uan masu( (e ena terus (e aliran arah atau *r%ses *er(e,uan *e!ah (e 'r%n(us- ise'ar (e seluruh *aru$*aru atau tertelan (e tra(tus i&estius /inn- 2007+ Mycobacterium
tuberculosis
tum'uh
intra
sel
*aa
m%n%sit-
reti(ul%en%telial sel en&an sel ra(sa+ %(asi intra sel ini men)ulit(an *en&%'atan+ In.e(si *ertama 'iasan)a *aa ana(a$ana(- teta*i ,u&a a*at ter,ai *aa usia e5asa+ In.e(si *ertama a*at ter,ai imana sa,a i *aru$*aru teta*i 'iasan)a *aa 'asal *aru$*aru+
'aru ari luar+
Kesimp$lan erasar(an hasil *en&amatan )an& telah ila(u(an *aa *e5arnaan iehl$
Neelsen ia*at(an ,umlah TA se'an)a( B4B *aa B2 P+ Serta ia*at(an ,umlah 'a(teri W10 *aa 32 P+ Ma(a a*at isim*ul(an *aa sam*el terse'ut i(etahui 3> men&anun& Mycobacterium tuberculosis+ Serta ienti.i(asi ini &III"
tia( ilan,ut(an (arena mem'utuh(an 5a(tu )an& san&at lama+ Daftar P$staka Alare S- M!#a'e <+ 184+ EGtra*ulm%nar) tu'er!ul%sis reisite+ Mei!ine63:2B+ anun&- 9erar an K%es5ar%n%- En&&ar+ 182+ Mikrobiologi edokteran !ntuk "aboratorium dan linik. Ja(arta : PT+ 9rameia+ arnes PF- arr%5s SA+ 13+ Tu'er!ul%sis in the 10s+ ann Intern Me11:400+ #%llin #h- J +M + 9ran&e an M +D+ "ates 18B- ;r&anisati%n an *ra!ti!e in tu'er!ul%sis 'a!teri%l%&) + utter %ths %n%n + #%rner +A 18+ %in tu'er!ul%sis + Stanar ne!r%*s) an la'%rat%r) te!hniLues + #SI<; Par(ille =i!t%ria Australia + Ja5et- Melni!( an Ael'er&+ 16+ Mikrobiologi edokteran. Ja(arta : E9#+ Pel!ar- M+J+ an E+#+S+ #han+ 2006+ Dasar$asar Mi(r%'i%l%&i /iter,emah(an %leh
PENGAMBILAN DAN PREPARASI SAMPEL MIKROBIOLOGI
I"
Penda#$l$an asil suatu *emeri(saan mi(r%'i%l%&i( *aa umumn)a han)a menun,an&
ia&n%sa (lini(+ ila hasil *emeri(saan mi(r%'i%l%&i( aalah ne&ati.- hal ini tia( 'erarti 'ah5a ia&n%sa (lini( salah+ Ke&a&alan *en&asin&an (uman *en)e'a' *en)a(it a*at ise'a'(an %leh 'e'era*a .a(t%r+ Paa la'%rat%rium(e&a&alan terse'ut a*at ise'a'(an %leh tehni( atau !ara (er,a )an& salah+ a&i se%ran& *e(er,a la'%rat%rium )an& 'er*en&alaman hal emi(ian ,aran& se(ali ter,ai+ Ke&a&alan *emeri(saan mi(r%'i%l%&i( le'ih 'an)a( ter,ai (arena !ara *en&am'ilan an *en&iriman 'ahan *emeri(saan )an& salah + @mumn)a *en&am'ilan an *en&iriman 'ahan *emeri(saan irumah sa(it iserah(an *aa (ar)a5an$(ar)a5an )an& tia( mem*un)ai *en&etahuan asar tentan& s)arat$s)arat )an& i*erlu(an 'a&i *en&am'ilan 'ahan *emeri(saan mi(r%'i%l%&i( serta a(i'at$a(i'at )an& a*at tim'ul 'ila tia( ila(u(an rnenurut aturan se'enarn)a+ Dalam hal ini *entin& se(ali (er,a sama antara %(ter- *era5at an ahli la'%rat%rium untu( mena*at(an hasil *emeri(saan mi(r%'i%l%&i( )an& a*at i*er!a)a+ Pen&am'ilan 'ahan *emeri(saan harus ila(u(an *aa tem*at )an& (emun&(inan 'esar men&anun& (uman *en)e'a' *en)a(it+ Misaln)a *aa lu(a 'ernanah )an& ise'a'(an %leh (uman sta.il%(%(us 'ersi.at (%a&ulasa *%siti.+
ila 'ahan *emeri(saan
iam'il *a!ta *ermu(aan
sa,a- aa
(emun&(inan 'ah5a (uman ran& iasin&(an ialah sta.il%(%(us ran& (%mensal 'ersi.at (%a&ulasa ne&ati.- )an& 'iasa tera*at *aa (ulit+ Jumlah 'ahan *emeri(saan )an& iam'il harus !u(u* untu( a*at i*a(ai *aa *emeri(saan )an& i(ehena(i+ ahan *emeri(saan harus iterima alam suatu tem*at steril )an& )an& a*at itutu* en&an 'ai( an tia( '%!%r+ al ini *entin& untu( men!e&ah *en!emaran 'ahan *emeri(saan itu seniri an untu( melinun&i %ran&$%ran& )an& men&er,a(an 'ahan$'ahan terse'ut ari*aa (%nta( (uman *at%&en+ ;ran&$%ran& )an& men&er,a(an 'ahan *emeri(saan )an& men&anun& (uman *at%&en harus in&at a(an 'aha)a in.e(si 'ila (uran& hati$hati+
ahan *emeri(saan ari (lini( harus se&era i(irim (e la'%rat%rium untu( mena*at(an hasil )an& a*at i*er!a)a+ ila 'ahan *emeri(saan isim*an terlalu lama tentu sa,a (emun&(inan mena*at(an 'asil *%siti. ma(in 'er(uran&+ Misaln)a 'ahan tin,a )an& men&anun& Shi&ella- 'ila isim*an terlalu lama i rumah sa(it se'elum i'a5a (e la'%rat%rium- a(an men)ulit(an *en&asin&an Shi&ella terse'ut (arena teresa( %leh *ertum'uhan (uman$ (uman (%mensal+ II" Prinsip Aa hal$hal )an& men,ai *rinsi* asar )an& harus i*erhati(an *aa 5a(tu *en&am'ilan 'ahan untu( *emeri(saan mi(r%'i%l%&is )aitu : 1+ ahan *emeri(saan se'ai(n)a iam'il se'elum i'eri(an *en&%'atan en&an anti'i%ti(a atau at$at antimi(r%'a lain+ Ji(a 'ia(an i'eri(an ila(u(an setelah *em'erian tera*i anti'i%ti(a- *emeri(saan la'%rat%rium harus i'eri(an (eteran&an su*a)a ila(u(an tina(an$tina(an untu( men&hilan&(an *en&aruh anti'i%ti(a terse'ut- misaln)a *enam'ahan *enisilinase atau *en&en!eran 'ahan *emeri(saan+ 2+ ahan *emeri(saan harus iam'il *aa tem*at )an& iu&a *alin& 'an)a( men&anun& %r&anisme )an& itu,u en&an tin&(at *en!emaran )an& *alin& sei(it+ al ini terutama *entin& *aa *en&am'ilan 'ahan ari (elainan )an& men&anun& sat.il%(%(us (%a&ulasa *%siti.+ 3+ Fa(t%r *entin& lainn)a untu( (e'erhasilan *en&asin&an %r&anisme *en)e'a'n)a ialah staium *en)a(it *a!ta saat *en&am'ilan 'ahan untu( 'ia(an+ Kuman enteri( *at%&en 'er,umlah 'esar i alam tin,a *aa staium iare a(ut suatu in.e(si usus an *aa saat inilah (uman *alin& muah 4+ ahan *emeri(san harus !u(u* ,umlahn)a sehin&&a a*at i*eri(sa len&(a*- selain itu ,u&a harus isim*an alam 5aah )an& steril+ Aa 'er'aha)a 'a&i *ara *e(er,a la'%rat%rium a*a'ila aha( meleleh (eluar 5aahn)a atau 'ila tem*at *en&asin&an tin,a tern)ata '%!%r+ B+ Ji(a i*erlu(an *en&am'ilan aha( la&i- ma(a *enerita atau *em'antu *enerita harus i'eri(an *etun,u( ? *etun,u( )an& se(sama+ 6+ arus iatur a&ar 'ahan *emeri(saan a*at se&era i(irim(an (e la'%rat%rium+ Serin&(ali Shi&ella sulit iasin&(an ari 'ahan tin,a )an& isim*an terlalu lama irumahsa(it (arena *ertum'uhann)a tertutu* %leh
*ertum'uhan (uman (%mensal an an&(a (ematian Shi&ella )an& ma(in tin&&i+ 7+ a'%rat%rium harus i'eri(an (eteran&an (lini( )an& !u(u* untu( men&arah(an *ara ahli mi(r%'i%l%&i untu( memilih *er'enihan an !ara$ !ara *emeri(saan )an& *alin& sesuai+ Pentin& se(ali aan)a (er,asama )an& erat serta (%nsultasi )an& serin& antara %(ter (lini(- *er5a5at an mi(r%'i%l%&is+ 8+ @ntu( *en&um*ulan 'ahan *emeri(saan 'ia(an (uman anaer%' *erlu ta'un& )an& tertutu* &ana )an& iisi en&an &as (ar'%ni%(sia an nitr%&en )an& 'e'as %(si&en+ ahan *emeri(saan /nanah- eairan tu'uh atau 'ahan eairan lain isunti((an melalui tutu* (aret untu( men&hinari (%nta( en&an uara+ III" $%$an ) 1+ Mem*un)ai *en&etahuan asar untu( mela(u(an *en&am'ilan an *enan&anan !%nt%h u,i mi(r%'i%l%&i+ 2+ Memahami te(ni( *en&am'ilan !%nt%h )an& re*resentati. 3+ Mem*er(ira(an tehni( rutin asar untu( *en&am'ilan an *emeri(saan a5al 'ahan *emeri(saan+ I&" in%a$an P$staka Dalam suatu analisis mi(r%'i%l%&i- *en&am'ilan sam*el meru*a(an salah satu (un!i utama )an& san&at menu(un& (e'erhasilan suatu analisa- )aitu meminah(an sam*el atau (ultur 'a(terial ari satu tem*at (e tem*at )an& lain se!ara ase*tis /terhinar ari (%ntaminasi+ Pen&ertian sam*el aalah 'a&ian ari *%*ulasi )an& in&in iteliti+ Sam*el ian&&a* se'a&ai *er5a(ilan ari *%*ulasi )an& hasiln)a me5a(ili (eseluruhan &e,ala )an& iamati+ asil suatu *emeri(saan mi(r%'i%l%&i *aa umumn)a han)a menun,an& ia&n%sa (lini(+ Namun a*a'ila hasil *emeri(saan mi(r%'i%l%&i ne&ati.- hal terse'ut tia( 'erarti 'ah5a ter,ai (esalahan alam ia&n%sa (lini(+(esalahan alam *en&am'ilan mi(r%'a *en)e'a' *en)a(it a*at ise'a'(an %leh 'er'a&ai ma!am .a(t%r+ Paa la'%rat%rium- (e&a&alan terse'ut a*at ise'a'(an %leh te(ni( atau !ara (er,a )an& salah+ a&i se%ran& *e(er,a la'%rat%rium )an& 'er*en&alaman- (e,aian emi(in ,aran& se(ali ter,ai+ Ke&a&alan *emeri(saan mi(r%'i%l%&i le'ih 'an)a( ter,ai (arena !ara *en&am'ilan an *en&iriman 'ahan *emeri(saan )an& salah+ Dalam hal ini- *entin& se(ali (er,asama antar
%(ter- *era5at an analis (esehatan la'%rat%rium- untu( mena*at(an hasil *emeri(saan mi(r%'i%l%&i )an& a(urat an a*at i*er!a)a /inn- 2007+ A+ Sam*el ari Pemeri(saan Darah Darah alam (eaaan n%rmal tia( men&anun& mi(r%'a+ iasan)a mi(r%'a )an& itemu(an ialam arah 'erasal ari luar tu'uh atau ari 'a&ian$'a&ian tu'uh lain+ Pen!emaran mi(r%'a alam arah terutama 'erasal ari (ulit- (arena itu *en&am'ilan 'ahan *emeri(saan arah harus iahului en&an mem'ersih(an (ulit en&an 'ai( /aile)- 170+ Pr%ses *en&am'ilan arah ia5ali en&an i'ersih(ann)a (ulit en&an i%in 3-BC- a*a'ila tia( aa a*at men&&una(an antise*ti( lain se*erti al(%h%l 70C+ Jan&an mela(u(an *al*asi la&i untu( men!ari ena setelah (ulit i'ersih(an+ Jumlah arah )an& iam'il 'er&antun& *aa ,enis *emeri(saan an *aa ,enis mi(r%'a )an& iu&a aa i alam arah terse'ut+ *aa
Misaln)a- *aa in.e(si staphylococcus- ti*us a'%minalis atau
'a(terimia
a(ut
)an&
ise'a'(an
%leh pneumococcus atau
menin&%(%(us- ,umlah 'a(teri terse'ut *er ml arah !u(u* 'an)a(sehin&&a ,umlah arah )an& iam'il tia( *erlu terlalau 'ana)(+ Se'ali(n)a ,umlah 'a(teri 'asil 9ram$ne&ati. i alam arah san&at ,aran&- sehin&&a i*erlu(an ,umlah arah )an& !u(u* 'an)a( untu( a*at men&is%lasi 'a(teri terse'ut+ #ara lain )an& i&una(an untu( *emeri(saan ,asa reni( alam arah ialah *em'ia(an *aa lem*en& a&ar tuan&an an men&hitun& (%l%ni$(%l%ni (uman )an& tum'uh *aa lem*en& a&ar terse'ut+ Per'enihan )an& i&una(an ialah XTr)*ti!ase S%) A&arX atau Xeart in.usi%n A&arX+ ila ari 1 ml arah alam lem*en& a&ar tuan&an terse'ut ia*at(an 'e'era*a ,enis (uman tertentu- ma(a a*atlah ian&&a* 'ah5a (uman terse'ut i a*at alam arah *enerita an 'u(an (arena (e!emaran *a!ta 5a(tu *en&am 'ilan arah terse'ut /aile)- 170+ ila men&irim(an arah (e la'%rat%rium untu( *em'ia(an atau is%lasi- i*erlu(an se(itar (uran& le'ih 10 ml arah *asien )an& isim*an alam '%t%l atau ta'un& steril 'ersama anti(%a&ulann)a+ Pemeri(saan sam*el arah harus sese&era mun&(in ila(u(an (arena mi(r%'a alam arah a(an ter*en&aruh %leh sel$sel arah terse'ut- mau*un %leh at$at lain )an& tera*at i alam arah terse'ut- misaln)a *en&aruh ari anti'i%ti(+ ahan *emeri(saan arah )an& a(an iis%lasi en&an !ara ituan& *aa
lem*en& a&ar- ma(a harus i!am*ur en&an suatu anti(%a&ulan ,u&a+ iasan)a anti(%a&ulasi )an& a*at i&una(an aalah larutan natrium sitrat 2C se'an)a( 3 ml- he*arin 1 m& atau *%lianet%l sul.%nat+ @ntu( men!e&ah hasil *emeri(saan alse
*%siti. en&an men&is%lasi mi(r%'a )an&
se'enarn)a
tern)ata
namun
meru*a(an
mi(r%'a
hasil
*en!emaran(%ntaminasi ari sam*el *emeri(saan arah- ma(a *erlu i*erhati(an !ara$!ara *en&am'ilan an *en&iriman sam*el *emeri(saan terse'ut /lair- 170+ #ara *en&am'ilan arah: 1+ D a r ah ) a n & ia m ' il ' i a sa n ) a ar a h e na 2+ = % l u m e a r a h ) a n & i a m ' i l : a+ De5asa 10$20 ml '+ ana($ana( 1$B ml !+ 'a)i 1$3 ml 3+ Darah iam'il saat suhu 'aan nai(emam tin&&i+ 4+ a(terimia intermitten- iam'il 2$3 (ali- interal 24 ,am+ B+ Darah iam'il ari 2 tem*at )an& 'er'ea- )aitu *aa ena
len&an(anan an ena len&an (iri+ Karena 'isa sa,a hasil 'er'easehin&&a men&hinari .alse *%stitie.alse ne&atie+ 6 + D ar ah ( e mu i an i ma su (( an ( e al am ' %t %l ' er is i m e ia !air TS/Tr)*ti!ase S%) r%th an '%t%l i&%)an&(an iatas me,a a&ar ter!am*ur
rata+
Per'anin&an
meia
!air
TS:
Darah10:17 + K u l t u r l a i n : I / rain eart In.usi%n+ #ara *en)im*anan arah: 1 + P e n )i m * an a n : Y 2 4 , a m * a a su h u r ua n & + 2+ ila tia( memun&(in(an- &una(an meia trans*%rt 'eru*a St ua rt meium- Amies meium+ Meia trans*%rt 'er&una se'a&aian ti(%m*lemen /men!e&ah lisis sel an anti.a&%siti( /su*a)a (uman tia( men.a&%sit sel+ 3 + il a m e ia t ra ns *% rt t i a( t er s e ia - & u na (a n a nt i( % a& ul a n SPS/S %iu mP%lianit%l
Sul.%nat
0-0BC-
,an&an
men&&una(an
anti(%a&ulan lain (arena a*at mem'unuh ia'ilitas 'a(teri+ Fun&si
anti(%a&ulan SPS: Men&(%a&ulasi arah • Men&ham'at *ertum'uhan (uman • Men!e&ah .a&%sit%sis • Men!e&ah *en&a(ti.an (%m*lemen+ • #ara *en&iriman arah:
1 + P e n & i r i ma n : Y 2 , a m * a a s u h u ru a n & 2 + i l a t i a ( m e mu n & ( in ( a n - t er u s ( an e n & a n me i a trans*%rt /9erar- 182+ + Sam*el Pemeri(saan air (emih Air (emih meru*a(an 'ahan *emeri(saan )an& *alin& serin& i'ia((an alam la'%rat%rium+ #ara *en&am'ilan an *en&iriman 'ahan *emeri(saan ini ter&antun& *aa (eaaan *enerita an *aa *en)a(it )an& ierita+ In.e(si *aa *an&(al saluran (emih a(an men&hasil(an *ertum'uhan (uman i alam (anun& (emih+ Selain ari mi(r%%r&anisme (%mensal (ulit- air (emih 'iasan)a steril /9u*te- 10+ Mi(r%%r&anisme *at%&en )an& mun&(in aa ialah : 1. .coli 2. Proteus 3. itrobacter 4. Pseudomonas 5. Moraella 6. &dne bacter 7. Stailokokus 8. Streptokokus aecalis 9. Salmonella 10. Mycobacterium tuberkulosis 11. Serratia 12. Pro-identia 13. andida albicans 14. Stailokokus hemolyticus 15. Streotokokus hemolyticus 16. 6eisseria gonorrhoeae 17. &lkaligenes @ntu( 'ia(an )an& 'u(an itu,u(an *aa *en)a(it tu'er(ul%sis- iam'il air (emih *%rsi ten&ah )an& i(eluar(an- itam*un& i alam 5aah 'eru*a ta'lin& rea(si tertutu* (a*as )an& telah isteril(an alam %t%(la.+ @ntu( mena*at(an 'ahan *emeri(saan ari (anun& (emih a*at ila(u(an en&an men&&una(an (ateter- selain itu a*at *ula itaah air (emih ialam ta'lin& atau '%t%l steril+ ila 'ahan *emeri(saan air (emih iam'il se!ara emi(ian ma(a se'ai(n)a )an& i*eri(sa ialah *%rsi *erten&ahan ari air (emih terse'ut+ Misaln)a 'ila air (emih itam*un& alam ti&a ta'un& ma(a )an& i*eri(sa ialah ta'un& (eua+ Paa 5a(tu *en&am'ilan air (emih haruslah i*asti(an le'ih ahulu 'ah5a *enerita se(uran&$(uran&n)a 'elum 'er(emih alam 3 ,am tera(hir+ ila hasil 'ia(an air (emih
menun,u((an 100+000 (uman atau le'ih *er ml ma(a ini menana(an aan)a in.e(si /9erar- 182+ Paa 5anita air (emih a*at (e!emaran en&an (uman$(uman ari a&ina+ Fa!ia *ria air (emih a*at (e!emaran ari in.e(si *r%stat+ @ntu( men&hinari ini ma(a *erlu ila(u(an (ateterisasi air (emih+ Keru&ian (ateterisasi ialah 'ah5a en&an emi(ian (anun& (emih seniri a*at men&alami (e!emaran en&an (uman$(uman ari luar+ asil *em'ia(an air (emih en&an ,umlah (uman )an& san&at 'an)a( selain meman& ise'a'(an %leh suatu in.e(si- a*at *ula ise'a'(an %leh (arena (elam'atan alam mem'ia( 'ahan *emeri(saan terse'ut+ Air (emih harus i'ia( alam 5a(tu 30 menit setelah iam'il /9an- 170+ #+ Sam*el *emeri(saan aha( S*utum /aha( aalah 'ahan )an& i(eluar(an ari *aru an tra(ea melalui
mulut+ iasan)a ,u&a ise'ut en&an e!*e!t%rat%rian /D%rlan-
12+ S*utum- aha(- atau ria( aalah se(ret )an& i'atu((an an 'erasal ari ten&&%r%(an- hiun& atau mulut+ Per'eaan ini hena(n)a i,elas(an (e*aa *asien
)an& aha(n)a a(an i*eri(sa+S*utum )an& i(eluar(an
%leh se%ran& *asien hena(n)a a*at iealuasi sum'er- 5arna- %lumean (%nsistenn)a (arena (%nisi s*utum 'iasan)a mem*erlihat(an se!ara s*esi.i( *r%ses (e,aian *at%l%&i( *aa *em'entu(an s*utum itu seniri /Salle-161+ Pemeri(saan s*utum i*erlu(an ,i(a iu&a tera*at *en)a(it *aru$ *aru+ Mem'ran mu(%sa saluran *erna.asan 'eres*%ns terhaa* in.lamasi en&an
menin&(at(an
(eluaran
se(resi
)an&
serin&
men&anun&
mi(r%%r&anisme *en)e'a' *en)a(it /ur%n- 1B8+ S*utum 'er'ea en&an s*utum )an& 'er!am*ur en&an air liur+ #airan s*utum le'ih (ental an tia( tera*at &elem'un& 'usa i atasn)a+ S*utum iam'il ari saluran na.as 'a&ian 'a5ah sean&(an s*utum )an& 'er!am*ur air liur iam'il ari ten&&%r%(an /aile)- 170+ Pen&am'ilan s*utum se'ai(n)a ila(u(an *aa *a&i hari- imana (emun&(inan untu( mena*at s*utum 'a&ian alam le'ih 'esar+ a(tu )an& i*erlu(an untu( *en&am'ilan s*utum aalah 3 (ali *en&am'ilan s*utum alam 2 (ali (un,un&an- )aitu S*utum se5a(tu /S-
)aitu (eti(a *enerita *ertama (ali atan& S*utum *a&i /P- (ees%(an harin)a (eti(a *enerita atan& la&i en&an mem'a5a s*utum *a&i /s*utum *ertama setelah 'an&un tiur- S*utum se5a(tu /S- )aitu saat *enerita ti'a i la'%rat%rium- *enerita iminta men&eluar(an s*utumn)a la&i+ Pen&am'ilan s*utum *aa *asien tia( '%leh men)i(at &i&i+ A&ar s*utum muah i(eluar(an- ian,ur(an *asien men&%nsumsi air )an& 'an)a( *aa malam se'elum *en&am'ilan s*utum+ Se'elum men&eluar(an s*utum- *asien isuruh untu( 'er(umur$(umur en&an air an *asien harus mele*as &i&i *alsu /'ila aa+ S*utum iam'il ari 'atu((an *ertama /.irst !%u&h+ #ara mem'atu((an s*utum en&an Tari( na.as alam an (uat /en&an *erna.asan aa 'atu((an (uat s*utum ari 'r%n(us tra(ea mulut 5aah *enam*un&+ aah *enam*un& 'eru*a *%t steril 'ermulut 'esar an 'er*enutu* /S!re5 #a* Meium /lair- 170 Peri(sa s*utum )an& i'atu((an- 'ila tern)ata )an& i'atu((an aalah air liursalia- ma(a *asien harus men&ulan&i mem'atu((an s*utum+ Se'ai(n)a- *ilih s*utum )an& men&anun& unsur$unsur (husus se*erti : arah an unsur$unsur lain+ ila s*utum susah (eluar(an la(u(an *era5atan mulut Pera5atan mulut ila(u(an en&an %'at &l)seril &ua)a(%lat /eG*e!t%rant 200 m& atau en&an men&%nsumsi air teh manis saat malam se'elum *en&am'ilan s*utum /Ja5et- 16 Te(ni( lain untu( men&eluar(an s*utum 'ila s*utum ,u&a tia( 'isa iaha((an- s*utum a*at iam'il se!ara: a+ As*irasi transtra!heal /transtra!heal as*irasi atau !u!i transtra!heal+ Te(ni( untu( men&um*ul(an sam*el ari e(suat 'r%n(ial untu( *emeri(saan hist%l%&is an mi(r%'i%l%&i+ Se'uah ,arum imasu((an melalui (ulit i atasn)a tra(ea an melalui li&amentum (ri(%tir%i+ Se'uah (ateter imasu((an (e alam tra(ea an iterus(an (e tin&(at 'i.ur(asi tra(ea+ Ini(asi : In,e(si Transtra!heal ila(u(an untu( mem'l%(ir sara. larin& 'erulan& untu(
larin&%s(%*i ter,a&a- serat %*ti( an atau intu'asi
retr%&ra+ Pen&ha*usan tan&&a*an &a& re.le(s atau hem%inami( untu( larin&%s(%*i
atau
'r%n(%s(%*i+
Di&una(an
untu(
mem'antu
men&hinari =alsaa se*erti te&an& )an& a*at men&i(uti )an& lain Xter,a&aX intu'asi /*asien i'ius an entilasi s*%ntan+ '+ r%n!hial laa&e /r%n!h%ale%lar laa&e
r%n!h%ale%lar laa&e /A meru*a(an *r%seur meis imana 'r%n(%s(%* ile5at(an melalui mulut atau hiun& (e *aru$*aru an !airan )an& isem*r%t(an (e
'a&ian (e!il ari *aru$*aru+ iasan)a
ila(u(an untu( menia&n%sa *en)a(it *aru$ *aru+ Se!ara (hususumumn)a i&una(an untu( menia&n%sa in.e(si *aa %ran& en&an masalah sistem (e(e'alan tu'uh- *neum%nia *aa %ran& *aa entilat%r- 'e'era*a ,enis (an(er *aru$*aru- an ,arin&an *arut *aa *aru$*aru /*en)a(it *aru interstitial+ !ara *alin& umum untu( sam*el (%m*%nen !airan la*isan e*itel /EF
an untu( menentu(an
(%m*%sisi
an
*r%tein
saluran
uara
*aru-
serin&
i&una(an
alam *enelitian imun%l%&i se'a&ai sarana sel sam*lin& atau tin&(at *at%&en i *aru$*aru+ #%nt%h ini termasu( sel T an tin&(at *%*ulasi irus in.luena+ !+ un& 'i%*s) i%*si *aru aalah *r%seur untu( mena*at(an sam*el (e!il ,arin&an *aru$*aru untu( *emeri(saan+ Jarin&an 'iasan)a i*eri(sa i 'a5ah mi(r%s(%*- an a*at
i(irim (e la'%rat%rium mi(r%'i%l%&i
untu( (ultur+ Pemeri(saan mi(r%s(%*is ila(u(an %leh ahli *at%l%&i+ i%*si aalah *en&am'ilan ,arin&an tu'uh untu( la'%rat%rium+
Pemeri(saan
,arin&an
terse'ut
*emeri(saan
'ertu,uan
untu(
menete(si aan)a *en)a(it atau men!%!%((an ,arin&an %r&an se'elum mela(u(an trans*lantasi %r&an+
mi(r%'a )an& tum'uh !e*at- aha( harus iam'il *aa *a&i hari+ Pen&am'ilan aha( a*at *ula ila(u(an en&an !ara lan&sun& en&an mela(u(an as*irasi men&&una(an ,arum sunti(+- i'a5ah a&u atau liah (e alam 'atan& ten&&%r%(an+ Aa ,u&a )an& men&am'il 'ahan *emeri(saan en&an men&&una(an 'r%n(%s(%*- terutama untu( 'ahan *emeri(saan tu'er(ul%sa an ,amur+ Namun- en&an !ara ini masih aa *ula (emun&(inan ter(%ntaminasi %leh mi(r%'a lain )an& 'erasal ari mulut+ Namun- a*a'ila tia( mun&(in untu( se&era ila(u(an *emeri(saan-sam*el aha( a*at imasu((an (e lemari es ahulu untu( 1 sam*ai 3 ,am /9erar182+ D+ Sam*el Pemeri(saan Tin,a Paa umumn)a is%lasi mi(r%'a- termasu( irus ari sam*el tin,a a*at 'erasal ari tun,a *enerita )an& i(eluar(an se!ara alamiah atau a*usan *%r%s usus *enerita /re!tal s5a'+ asil )an& i*er%leh ari (eua *r%ses *en&am'ilan sam*el ini umumn)a sama+ Tin,a iam'il se!ara ase*ti( en&an men&&una(an sen%( *lasti( (e!il lalu imasu((an (e alam 5aah tertutu* ulir )an& (ea* air /&am'ar+ Sen%( ini i*er&una(an untu( meminah(an sei(it tin,a se!ara aman (ealam 5aah terse'ut+ Paa ana($ ana( (e!il 'iasan)a sulit untu( men&am'il tin,an)a- (arena itu iam'il en&an usa* u'ur /Xre!tal s5a'X+ Ji(a *aa suatu saat i*erlu(an 'ia(an tin,a sean&(an sean&(an *en&iriman tin,a (e la'%rat%rium mi(r%'i%l%&i( tia( a*at se&era ila(u(an- *erlu i*er&una(an *er'enihan trans*%r /air &aram &liser%l+ Ji(a iu&a *en)e'a'n)a ialah =i'ri% !h%lerae le'ih 'ai( i*er&una(an air *e*t%n al(ali+ @ntu( mena*at(an hasil )an& 'ai( alam is%lasi mi(r%'a *at%&en tin,a- se'ai(n)a i*ilih 'a&ian tin,a )an& 'erlenir+ Pem'ia(an 'ahan *emeri(saan ila(u(an *aa meium sele(ti. /aile)170+ E" Sam*el Pemeri(saan u(a In.e(si Paa in.e(si lu(a 'iasan)a eti%l%&)n)a ise'a'(an %leh : Aer%' : 1+ Sta.il%(%(us aureus 2+ Stre*t%(%(us hem%l)ti(us 3+ Pr%teus 4+ Pseu%m%nas B+ Kuman (%li.%rm Anaer%':
Tia( ers*%ra: 1+ Stre*t%(%(us 2+ a!ter%ies ers*%ra: 1+ #l%striium 5el!hii 2+ #l%striium tetani 'ers*%ra 3+ #l%striium se*ti!um 4+ #l%striium e*iemati%us Jamur 1+ #ania 2+ As*er&illus Sum'er in.e(si mun&(in e(s%&en /ari lin&(un&an atau en%&en /(uman (%mensal alam tu'uh+ u(a )an& ter'u(a mun&(in terin.e(si %leh 'e'era*a %r&anisme- teta*i lu(a tertutu* )an& tia( 'erlu'an& 'iasan)a terin.e(si %leh satu ,enis %r&anisme sa,a- misaln)a Sta.il%(%(us aureusStre*t%(%(us hem%l)ti!us an seterusn)a /Ja5et- 16+ Pen&am'ilan 'ahan : ahan *emeri(saan a*at itam*un& se!ara ase*ti( alam 5aah )an& steril+ ahan *emeri(saan 'eru*a nanah le'ih 'ai( ari*aa (a*as usa*+ Ji(a aa (er%*en& iatas lu(a - (u*aslah (er%*en& itu- lalu tem*el(an (a*as usa* *aa lu(a tai+ Ji(a a!ta a'ses- se%tlah en&an sem*erit steril- Ji(a iam'il en&an (a*as usa*- am'illah ua 'uah se(ali&us- satu untu( seiaan an satu untu( 'ia(an+ ahan *emeri(saan i(irim (e la'%rat%rium+ Mula$mula 'ahan ini i*eri(sa se!ara ma(r%s(%*i( terutama untu( melihat aan)a 5arna 'iru (ehi,auan /Pseu%m%nas an aan)a &as /#l%striium- Klesiella an E+!%li+ Seiaan i5arnai se!ara 9ram untu( melihat (umann)a 9ram *%siti. atau 9ram ne&ati.+ Pe5arnaan 9ram ,u&a mem'eri(an (eteran&an a*a(ah (uman terse'ut 'eru*a (%(us atau 'atan&+ Ji(a (%(us 9ram *%siti. tersusun 'er&er%m'%l ise'ut Sta.il%(%(us- ,i(a 'eru*a rantai ise'ut Stre*t%(%(us+ Kuman 'atan& 9ram *%siti. /'ers*%ra mun&(in #l%striium tetani atau #l%striium 5el!hii(uman 9ram ne&ati. mun&(in Pseu%m%nas- Pr%teus- Kle'siella- E+!%li an lain$lain /ur%n- 1B8+ ahan *emeri(saan i'ia((an *aa lem*en& a&ar arah /se!ara aer%' an anaer%' an *er'enihan a&in& re'us <%'erts%n /'ia(an anaer%'+ ahan aer%' a*at i'ia((an *aa lem*en& a&ar arah atau *er'enihan Ma!+#%n(e)+ K%l%ni )an& tum'uh i*eri(sa se!ara ma(r%s(%*i( an mi(r%s(%*i( :
1+ Sta.il%(%(us aureus menun,u((an (%l%ni 'er*i&men (unin& emashem%liti( ti*e 'eta i se(itar (%l%ni serta rea(si (atalase an (%a&ulasan)a *%siti.+ 2+ Stre*t%(%(us hem%l)ti!us- mem*un)ai (%l%ni halus- hem%lisis 'eta(atalasan)a ne&ati.- C termasu( (el%m*%( A+an!e.iel+ 3+ K%l%ni Pseu%m%nas 'e5arna hi,au (e'iruan+
*em'ia(an
se&era
i(er,a(an
*aa
*er'enihan a&in& re'us <%'erts%n atau *er'enihan ti%&li(%lat an lem*en& a&ar arah- Ji(a *em'ia(an harus tertuna- a*at i&una(an *er'enihan trans*%rt Stuart+ 1+ #l%striium 5el!hii iienti.i(asi 'erasar(an si.at$si.at m%r.%l%&iaan)a sim*ai an rea(si 'i%(imia5i /*em'e(uan 'er'usa *aa susu la(mus- rea(si Na&ler *%siti. !lan a(tiitas sa(ar%liti( (uat+ 2+ #l%striium tetani menun,u((an si.at (has )aitu 'entu(n)a se*erti *emu(ul &eneran&+ Disini *erlu i'u(ti(an aan)a *em'entu(an t%(sin an netralisasi %leh at antit%(sin )an& (has+ Pem'u(tian aan)a #l%striium tetani sa,a tia( 'e&itu *entin& se'a' serin& tera*at se'a&ai *en!emar lu(a )an& sa*r%.it /9u*te- 10+ F+ Sam*el Pemeri(saan @sa* Ten&&%r%( K%mensal )an& aa ialah Sta.il%(%(us al'us- Stre*t%(%(us iriansStre*t%(%(us
anhem%l)ti!us-
Di.ter%i-
a!t%'a!illus-
Neisseria
n%n*at%&en+ Sean&(an (uman )an& *at%&en ialah Sta.il%(%(us aureusStre*t%(%(us hem%l)ti!us- Di.teriae- +in.lueae-
%rrelia =in!enti-
%retella *ertussis an lain$lain /9an- 170+ @sa* ten&&%r%( iam'il en&an mulut *enerita ter'u(a le'ar an liah ite(an en&an 'atan& *ene(an liah+ arus iusaha(an a&ar han)a men&am'il 'ahan ari sela*ut lenir (er%n&(%n&an+ Mes(i*un tia( se&era
mem'eri(an in.%rmasi )an& i*erlu(an- teta*i serin& *%siti. untu( +in.luenae an harus i(er,a(an (arena meru*a(an !ara )an& ter'ai( untu( memasti(an ia&n%sis+ Ji(a aa sela*ut- terutama ,i(a iu&a menerita i.teria- 'a&ian sela*ut ini harus i'uan& terle'ih ahulu+ Pemeri(saan a5al ila(u(an en&an *e5arnaan 9ram- seiaan )an& i5arnai en&an (ar'%l .u(sin en!er untu( %rrelia in!enti an *e5amaan Al'ert untu( (uman i.teri+ Per'enihan )an& i*er&una(an ialah a&ar arahserum %e..ler an a&ar arah telurit /i.teri- a&ar !%(lat /+in.luenae an Neisseria menin&itiis- *er'enihan %ret 9en&%u untu( %retella *ertussis /ur%n- 1B8+ Pengiriman Ba#an Pemeriksaan
Ma(in !e*at 'ahan *emeri(saan ti'a i la'%rat%rium ma(in 'ai( hasil *emeri(saann)a+ ila i*erlu(an 5a(tu lama alam *en&iriman 'ahan *emeri(saan (e la'%rat%rium- ma(a haruslah 'ahan *emeri(saan terse'ut iin&in(an atau imasu((an (e alam suatu *er'enihan *en&a5et+ Aa (uman )an& tia( a*at iin&in(an (arena a(an mati- se*erti Niesseria menin&itiis+ Aa *ula ,asa reni(- se*erti (uman$(uman aner%'- )an& a(an mati 'ila 'er(%nta( en&an %(si&en+ Se'ali(n)a stre*t%(%(us hem%l%ti( *aa *en&usa* a(r%n (erin& alam (ant%n& *lasti( a*at tahan 2 sam*ai 3 hari+ Per'enihan *en&a5et se'ai(n)a i&una(an 'ila ,ara( antara *enerita an la'%rat%rium !u(u* ,auh+ Per'enihan *en&a5et )an& a*at i&una(an ialah *er'enihan Stuar atau *er'enihan #ar)$lair atau *er'enihan air *e*t%n lini+ @ntu( *en&iriman irus se'ai(n)a 'ahan *emeri(saan i'e(u(an en&an men&&una(an Xr) i!eX Pen&iriman !airan se'ai(n)a alam '%t%l Xs!re5$!a*X an i'un&(us 'erla*is$la*is untu( men!e&ah (erusa(an /ur%n- 1B8+ Suatu !ara *en&iriman 'ahan *emeri(saan irus tan*a men&&una(an Xr) i!eX an tan*a X.reee r)in&X telah itemu(an %leh 9AN an (a5an$(a5an alam tahun 16+ ahan )an& i(rim aalah 'ahan )an& men&anun& irus in.luena an !aran)a ialah se'a&ai 'eri(ut: ahan !airan alant%i( )an& men&anun& irus in.luena serta *enisilin 100 u& an stre*t%misi 100 u& *er ml imasu((an alam ta'un&$ta'un& *resi*itasi steril+ Ta'un&$ta'un& terse'ut itutu* en&an *ara.in- sehin&&a tia( '%!%r an a*at i(irim (e la'%rat%rium ir%l%&i(+ Ta'un&$ta'un& terse'ut tia( '%leh ter(ena sinar matahari lan&sun&
an a*at isim*an *aa suhu (amar /26V sam*ai 300V#+ Pen&iriman 'ahan *emeri(saan harus selalu isertai (eteran&an$(eteran&an se!u(u*n)a se*erti &"
)an& telah ise'ut se'elumn)a /9an- 170+ Kesimp$lan Pen&am'ilan an *en&iriman 'ahan *emeri(saan haus ila(u(an %leh %ran& )an& 'er(%m*eten an mem*un)ai *en&etahuan asar tentan& s)arat$ s)arat )an& i*erlu(an 'a&i *en&am'ilan 'ahan *emeri(saan mi(r%'il%&i( serta a(i'at$a(i'at )an& a*at tim'ul 'ila tia( ila(u(an menurut aturan se'enarn)a+ Dalam hal ini *entin& se(ali (er,a sama antara %(ter- *era5at an ahli la'%rat%rium- untu( mena*at(an hasil *emeri(saan mi(r%'i%l%&i( )an& a*at i*er!a)a+ Dalam *en&iriman 'ahan *emeri(saan hal$hal )an& harus i*erhati(an aalah: Ma(in !e*at 'ahan *emeri(saan sam*ai i la'%rat%rium hasil *emeri(saann)a a(an ma(in 'ai(+ ila *en&iriman 'ahan *emeri(saan lama ma(a 'ahan *emeri(saan terse'ut iin&in(an atau imasu((an (e alam suatu *er'enihan *en&a5et /meia trans*%rt en&an mem*erhati(an s)arat 'eri(ut : /1+(uman tersan&(a mam*u tum'u tum'uh alam meia terse'ut- /2 Kumar lain tia( a(an tum'uh 'erle'ihan+ al ini ise'a'(an (arena aa (uman )an& tia( a*at iin&in(an (arena a(an mati- se*erti neis+
&I" Daftar P$staka aile)- +<+ an S#;IT- E+9+- Dia&n%sti! Mi!r%'i%l%&)- Thir+E+- "un& Mei Pu'lishin&+- Tai*ei 170+ lair- J+E+- ennette- E++ an Truant- ,+P+- Manual %. #lini!al Mi!r%'i%l%&)illiams an il(ins #%+- altim%re- 170+ ur%n- K++- TeGt'%%( %. Mi!r%'i%l%&)- 4th Eiti%n- The Ma! Millan #%+ Ne5 "%r( 1B8 9erar %nan&- En&&ar S K%es5ar%n%- Mi!r%'i%l%&i Ke%(teran @ntu( a'%rat%rium an Klini(+ PT 9rameia 182 9an- K++- 9ani- K+S+- an Suhart%- A ne5 an sim*le meth% .%r senin& n%n .reee rie in.luenae is%lates ') mail 5ith%ut re.ri&erati%n- Ameri!an reie5 %.
9u*te S- Mi!r%'il%&) Dasar- Eisi (eti&a - inaru*a A(sara 10 Ja5et- Melni!( R Ael'er& : Mi!r%'i%l%&i Ke%(teran- Eisi 20- E9#-16+ Salle- A+J+- Funati%n Prin!i*les %. a!teri%l%&)- .i.th eiti%n- M! 9ra5 ill%%( #%m*an) In!+- Ne5 "%r(- 161 inn- ashin&t%n- Jr+- Allen- Ste*hen+- + Jana- E+ K%neman- 9ar) P+ Paul
