ACID FAST BACTERIA

Acid-fast stain bacterias:

1. Myobacterium
2. Nocardia
3. Rhodococcus
4. Gordonia

General characteristics:
Non-motile
Spore forming
Aerob

NAME CHARACTERISTICS PATHOGENICITY TRANSMISSION DIAGNOSIS & MANIFESTATION TREATMENT

Mycobacterium Acid-fast Intracellular pathogen Close person to person Anamnesis: INH (Isonicotinyl-hydrazin 
tuberculosis Mycolic-acid cell walls  in alveolar contactdroplet -Malaise isoniazid  INH  H)
DNA have 61%-70% G-C macrophage  lifelong -Weight loss Ethambutol
infection Increased risk: -Night sweat Rifampisin
Lipid-rich cell wall: -Homeless person -Blood-streaked sputum 4R3H3
-Acid fast M. tuberculosis enters -drug-alocoholic
-Detergent resistant respiration airways  -HIV Pem penunjang: IMMUNOPROPHYLAXIS
-Common antibiotic phagocytized by -prison/jail - Radiology: Patchy di upper M. bovis yang dilemahkan
resistance alveolar macrophage lobe (aerob bgt)
-Antigenic  stimulasi BUT 1) fusion of - (+) skin reactivity (Tuberculin) PREVENTION
respon imun seluler phagosome with pakai PPD, pakai 5 tuberculin Chemoprophylaxis (given when
-Purified protein lysosome is prevented, unit (TU) disuntikkan we have to do something with
derivative (PPD) specific because blocking of EEA intradermal High Risk of TB)
dx for tuberculin test 1 ; 2) phagosome able - lab detection of 2x seminggu INH 6-9 bulan
to fuse with Mycobacterium
intracellular vesicle, so Pyrazinamide, ethambutol,
nutrition + replication EXTRAPULMONARY levofloxacin selama 6-12 bulan.
tetap jalan  bacteria -spread to lymph nodes 
able to evade immune blood stream during initial Active: mendatangi Sungai
system + replication  phase of multiplication Rangas, meminta sputum
in response to Passive: sosialisasi TB
inflammation, People with BCG (Bacille-
macrophage secrete IL- Calmette-Guerin), positif
12, TNF alpha  tuberkulinnya
recruitment of T-cell
and NK TH-1  IFN- Microscopy:
gamma  infected ZN
macrophage are Fluorescence (auramine,
activated  Final rhodamine dyes)
product: GRANULOMA Molecular probes
(lingkaran yang Nucleic acid based test (mahal)
mengelilingi bakteri Tb
agar tdk menyebar) Kultur:
3 days sputum (PPP)
Isi Granuloma:
Central core (tdd Media:
alveolar macrophage, -Egg based: Loewenstein
epithelial cell, Langhans Jensen
Giant Cell) -Agar-based: Middlebrook
7H10, 7H11 +casein
 Dense wall: hydrolisate (defined salt,
macrophage CD4, CD8, vitamins, cofactors, oleic acid,
NK albumin, catalase, glycerols)
-Broth cultures: Middlebrook
7H9 dan 7H12.
MODS (microscopic
observation drug
susceptibility), using light
microscope

Identification:
Pakai secA genes

Mycobacterium Ditemukan oleh Hansen Lepra suka tempat Person-to-person Tidak bisa dikultur Rifampisin + Dapson
leprosy (Morbus-Hansen) dingin (kulit, saraf contact: droplet (Pausibasiler) 6 bulan
superf, hidung, paru, inhalation, skin contact Tuberculoid leprosy
laring, mata, biji palir) to respiration/skin (pausibasiler): reaksi imun Rifampisin + Dapson +
secrete kuat, tidak parah (macrophage Clofazimine (Lepromatous) 12
aktif, ada bacterial clearance, bulan
Armadillo (trenggiling di hanya macula hipopigmentasi),
Texas dan Mexico) bisa anaesthesia, batas tegas,
terinfeksi, no peripheral nerve damage,
transmission. sensory loss, nervus membesar
HistoPA: infiltrasi sel limfosit di
sekitar epitel
Sel langhans
Tidak ada bakteri yang
terdeteksi (non-infective)

Lepromatous: antibody kuat,

tapi ada defek pada respon
 seluler thd antigen lepra,
manifesnya parah karena no
bacterial clearance.
Ditemukan Sel T-suppressor.
Ridley-jopling classification
HistoPA: makrofag yang foamy,
dgn sedikit limfosit
Tidak ada sel Langhans
Banyak BTA (so fucking much
infective)
Mycobacterium Suka pada 41 derajat Ingestion of Mycobacterium avium Claritromycin/Azithromycin +
avium complex celcius, membntuk koloni contaminated water/ (subspecies paratuberculosis) Ethambutol + Rifampin : AIDS
(MAC) Terbagi yang soft smooth food (maximum) menyebabkan
menjadi 2: nonpigmented, Inhalation of infectious Chronic granulomatous Chemoprophylaxis: untuk CD4
Mycobacterium ubiquitous aerosols (minimum role enteritis a. k. a nya kurang dari 50 cell/mm3
avium of transmission) Johne disease
(subspecies Pada manusia: Crohn disease Claritromycin/Azithromycin +
paratuberculosis) Rifabutin  toxic
Mycobacterium Riwayat terkena Pneumocystis
avium jirovecii rentan
intracellulare HAART mengurangi insiden
(MAI) MAC pada AIDS

slow Manifestation:
1. Menyerupai cavitary TB
2. Berbentuk infiltrate di
middle-lobe (patchy,
nodular, associated with
bronchiectasis)  Lady-
windermere syndrome
 3. Solitary pulmonary
nodule
Disseminated: terminal stage
dari AIDS, CD4 menurun
Rapid growing M. abscessus Infeksi oportunistik Trauma, iatrogenic ? Susceptible with penicillin, tapi
Mycobacterium M. chelonae pada infection (cathether, resisten OAT
M. fortuitum immunocompromised = balut luka contaminated, Imipenem
M. immunogenum umum prosthetic device) Amikacine
M. mucogenicum Meningkat pada pasien Clarithromycine
hospitalized
Talak tambahan:
Iatrogenic infection - surgical
debridement

Nocardia Very ubiquitous Faktor terpenting Toksin eksogen metabolik DIAGNOSIS: Poorly stained by TMP-SMX (trimethoprime dan
pathogenicity: dan hemolisin (role nya Gram. And looked as Gram sulfametoxazole) 
Awalnya dikira fungus tapi kemampuan untuk tidak penting) negative sometimes immunocompromised+++ di
dia punya cell wall berisi kabur dari fagosit, bisa bawah ini
asam mikolat hidup di makrofag Habitat: Soil rich with Media: Buffered-Charcoal Yeast Amikacin
(tuberculostearic acid) (caranya sama dengan organic matter Extract Imipenem
50-62 karbon MTb), deactivate
suasana asamnya LAB: Sputum
150 spesies phagosome
Bisa tumbuh di semua media
Bentuk filamentous with Mencegah acid (merakyat, blusukan, calon
branches, aerial hyphae phosphatase-mediated presiden bakteri yang sangat
(bulu-bulu) killing bakteri, HIDUP NOCARDIA!!!)

GRAM + Infeksi eksogen (bukan Immunocompetent, tapi

flora normal); gangguan pulmonary, maka
Aerobic obligate rentan
 Morphology mirip CLINICAL: bronchopulmonary
Actinomyces, makanya disease (cough, fever, dyspnea)
dilakukan test BTA, BTA + Jika pada immunocompromised
bisa jadi disseminate
Catalase (+) (penyebaran) ke saraf dll

Infection cutaneous: Mycetoma

(infeksi kronis, bengkak, dan
tidak nyeri), lymphocutaneus
infection (ulserasi sepanjang
limfatik), cellulitis, abscess
Other weakly Basil  coccus Rhodococcus equi: tidak Rhodococcus equi
Mycobacterium Rhodococcus equi jhanya pada hewan, juga Tumbuh di media Broth;
(intracelullar dan bisa di immunocompromised 4 jam pertama tampil Seperti
Rhodococcus hidup di makrofag) batang
equi Mucoid Stlh 18 jam menjadi coccus
Tumbuhnya lambat
Gordonia Gordonia awalnya
disamakan dengan Invasive pulmonary disease,
Tsukamurella Rhodococcus diseminasi ke distal organ

Gordonia infeksi pulmonary

dan cutaneous
Penggunaan IV kateter.

Penggunaan kateter
(Tsukamurella)
Runyon classification for non-tuberculosis mycobacterium (NTM):
1. Slow growing photo chromogen (warna kekuningan di bawah matahari) Cth: kansasii, marinum
2. Slow growing scotochromogen. Cth: gordonae
3. Slow growing non-pigmented
4. Rapidly growing (alkali treatment)
Slow growing lebih bahaya?