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Mengapa perlu belajar nonspore
forming anaerob bacteria?
Ciri-ciri infeksi anaerob?
 Disebabkan oleh mo endogen oportunistik, seringkali tidak menular
 Terjadi pada imunokompromise host, dengan PO2 jaringan yang rendah
 seringkali polimikroba
 Membentuk abses atau jaringan nekrotik
 Seringkali memerlukan antibiotik sepektrum luas
Tanda klinis infeksi anaerob
 Keadaan klinis yang memungkinkan infeksi anerob al: infeksi paru dengan disertai aspirasi,
infeksi setelah operasi abdomen, sepsis post abortion
 Discharge yang berbau busuk sekali
 Jaringan nekrotik, gangrene, membentuk pseudomembran
 Terbentuk gas pada jaringan atau discharge
 Tanda infeksi tetapi kultur rutin (anaerob) negatif
 Infeksi menyertai malignansi
 Infeksi yang berhubungan dengan penggunaan aminoglikosid
 Septic tromboplebitis
 Bakteremik dengan jaundice
 Infeksi karena gigitan atau tusukan
 Perubahan warna eksudat menjadi hitam
 Tampak granul sulfur pada discharge
 Gas gangrene
Faktor virulensi?
Broad Classes of Virulence Factors
Associated with Gram-Neg. Anaerobes
 Adhesins
 Protection from:
• Oxygen toxicity
• Phagocytosis
 Tissue Destruction
Anaerobic Gram-Neg. Virulence Factors
Anaerobic Gram-Negative Virulence
Factors (cont.)
Bagaimana menanganinya?
Stains gram-variable or gram-negative,
but not a gram-negative cell wall
Anaerobes (cont.)
Most Common
Sites of Anaerobic
Anaerobic Gram-Positive
Bacterial Infections

NOTE: Figure legend in text

indicates that each of these
organisms is a bacillus (i.e., rod-
shaped). This is INCORRECT.
Peptostreptococcus is, as the
name indicates, a coccus.
Diseases Associated with
Anaerobic Gram-Positive Bacilli
Actinomyces Infections
Gram Stain and Macroscopic
Colonies of Actinomyces

NOTE: Molar tooth appearance

of colonies on agar can help
remind us that the oral cavity is a
common niche for Actinomyces.
Sulfur Granule from Sinus Tract of
Actinomycotic Infection
Cervicofacial Actinomycosis

NOTE: Sinus tract originating in oral cavity has

made it’s way to the surface at the jawline.
 Non motil non sporing
 On Gram stain: Gram-Positive Bacilli, short and club shaped or
long, thin, beaded filaments, branched or unbranched.
 grow slowly, prolonged incubation, anaerob
 Some strains produce colonies on agar that resemble molar teeth.
 Diagnosis can be made by examining pus from draining sinuses,
sputum, or specimens of tissue for the presence of sulfur granules.
The granules are hard, lobulated, and composed of tissue and
bacterial filaments, which are club shaped at the periphery.
Specimens should be cultured anaerobically on appropriate media.
 Treatment: of penicillin (6–12 months). Clindamycin or
erythromycin is effective in penicillin-allergic patients, Surgical
excision and drainage may be required.

 normal microbiota of the skin, oral cavity, large intestine,

conjunctiva, and external ear canal. Propionibacterium acnes, often
considered an opportunistic pathogen, causes the disease acne
 Gram stain, Gram-Positive Bacilli, pleomorphic, showing curved,
clubbed, or pointed ends; long forms with beaded uneven staining;
and occasionally coccoid or spherical forms.
 P acnes is frequently a cause of postsurgical wound infections,
particularly those that involve insertion of devices, such as
prosthetic joint infections, particularly of the shoulder, central
nervous system shunt infections, osteomyelitis, endocarditis, and
 Because it is part of the normal skin microbiota, P acnes sometimes
contaminates blood or cerebrospinal fluid cultures that are obtained
by penetrating the skin. It is therefore important (but often
difficult) to differentiate a contaminated culture from one that is
positive and indicates infection.
Epidemiology of

Anaerobic Gram-Negative
Bacterial Infections
Anaerobic Gram-Negative Infections
Anaerobic Gram-Negative Infections (cont.)
Clinically Predominant Anaerobic Gram-Negatives
Epidemiology of
Bacteroides Gram Stain
Bacteroides Virulence Factors
B fragilis

 is a very important pathogen among the anaerobes that are part of the
normal microbiota (commensal in GIT)
 Treatment of the animals with both gentamicin and clindamycin, a drug
effective against Bacteroides species, prevents both the initial sepsis and
the later devel
 The capsular polysaccharides of Bacteroides are important virulence
 have lipopolysaccharides (endotoxins) but lack the lipopolysaccharide
structures with endotoxic activity (including β-hydroxymyristic acid)
 Specimen:Terutama pus
 Microscopy:
 Gram negative, non motile, non sporing, pleomorphic rod,
 Culture:kanamycin or neomycin blood agar produce grey, non hemolitic,
glistening colonies

 The most active drugs for treatment of anaerobic infections are clindamycin
and metronidazole, although clindamycin resistance among the B fragilis
group has increased in the past decade.
 Clindamycin is preferred for infections above the diaphragm.
 The carbapenem antibiotics, ertapenem, imipenem, meropenem, and
doripenem, have good activity against many anaerobes, and resistance is
still uncommon.
 Tigecycline, an agent that has FDA approval for the treatment of skin and
soft tissue and intra-abdominal infections, has good in vitro activity against
a variety of anaerobe species, including the B fragilis group