Bacillus anthracis

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Fotomikrograf B. anthracis (pewarnaan Gram)

Klasifikasi ilmiah Kerajaan: Filum: Kelas: Ordo: Familia: Genus: Spesies: Bakteria Firmicutes Bacilli Bacillales Bacillaceae Bacillus B. anthracis

Nama binomial Bacillus anthracis

Cohn 1872

Bacillus anthracis adalah bakterium Gram-positif berbentuk tangkai yang berukuran sekitar 1x6 mikrometer dan merupakan penyebab penyakit antraks. B. anthracis adalah bakterium pertama yang ditunjukkan dapat menyebabkan penyakit. Hal ini diperlihatkan oleh Robert Koch pada tahun 1877. Nama anthracis berasal dari bahasa Yunani anthrax ( ), yang berarti batu bara, merujuk kepada penghitaman kulit pada korban. Bakteria ini umumnya terdapat di tanah dalam bentuk spora, dan dapat hidup selama beberapa dekade dalam bentuk ini. Jika memasuki sejenis herbivora, bakteria ini akan mulai berkembang biak dalam hewan tersebut dan akhirnya membunuhnya, dan lalu terus

berkembang biak di bangkai hewan tersebut. Saat gizi-gizi hewan tersebut telah habis diserap, mereka berubah bentuk kembali ke bentuk spora. Bacillus anthracis mempunyai gen dan ciri-ciri yang menyerupai Bacillus cereus, sejenis bakterium yang biasa ditemukan dalam tanah di seluruh dunia, dan juga menyerupai Bacillus thuringiensis, pantogen kepada larva Lepidoptera.

Biakan Bacillus anthracis Diperoleh dari "http://id.wikipedia.org/wiki/Bacillus_anthracis"

Tuberkulosa
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Paru-paru penderita TBC melalui Sinar X Tuberkolosis atau TBC adalah infeksi karena bakteri Mycobacterium tuberculosis, yang dapat merusak paru-paru tapi dapat juga mengenai sistem saraf sentral (meningitis, sistem lymphatic, sistem sirkulasi (miliary TB), sistem genitourinary, tulang dan sendi. Indonesia berada dalam peringkat ketiga terburuk di dunia untuk jumlah penderita TBC. Setiap tahun muncul 500 ribu kasus baru dan lebih dari 140 ribu lainnya meninggal. Tanggal 24 Maret diperingati dunia sebagai "Hari TBC". Pada 24 Maret 1882, Robert Koch di Berlin, Jerman, mempresentasikan hasil penyebab tuberkulosa yang ditemukannya.

Daftar isi
[sembunyikan]

1 Jenis-jenis 2 Lihat juga 3 Referensi 4 Pranala luar

[sunting] Jenis-jenis

Tuberkulosa pernafasan, dikonfirmasi secara bakteriologik dan histologik Tuberkulosa pernafasan, tidak dikonfirmasi secara bakteriologik dan histologik Tuberkulosa pada sistem syaraf Tuberkulosa pada organ lainnya Tuberkulosa millier

[sunting] Lihat juga

Daftar korban Tuberkolosis terkenal Bacillus Calmette-Gurin (BCG) tes Heaf ATC kode J04 obat buat perawatan TBC Nontuberculous mycobacteria Mycobacterium bovis penyebab TBC di ternak Leprosy and Buruli Ulcer, penyakit lainnya yang disebabkan oleh mycobacteria lainnya

[sunting] Referensi
Core Curriculum on Tuberculosis: What the Clinician Should Know, 4th edition (2000). Division of Tuberculosis Elimination, Centers for Disease Control and Prevention (CDC). (Internet versionupdated Aug 2003). Joint Tuberculosis Committee of the British Thoracic Society. Control and prevention of tuberculosis in the United Kingdom: Code of Practice 2000. Thorax 2000;55:887-901 (fulltext). Thomas Dormandy (1999). The White Death: A History of Tuberculosis. ISBN 0814719279 HB - ISBN 1852853328 PB Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the World. Tracy Kidder, Random House 2000. ISBN 0812973011. A nonfiction account of treating TB in Haiti, Peru, and elsewhere. Ha SJ, Jeon BY, Youn JI, Kim SC, Cho SN, Sung YC. Protective effect of DNA vaccine during chemotherapy on reactivation and reinfection of Mycobacterium tuberculosis. Gene Ther. 2005 Feb 03; [Epub ahead of print] PMID 15690060

[sunting] Pranala luar

Organisasi World Health Organization Tuberculosis home page at World Health Organization - Strategy & Operations, Monitoring & Evaluation Division of Tuberculosis Elimination Centers for Disease Control and Prevention Fact sheets, data, and other resources The Stop TB Partnership international organization. World TB Day. The Tuberculosis Coalition for Technical Assistance - TBCTA The main purpose of TBCTA is to assist the U.S. Agency for International Development (USAID) and its local (public, private, NGO) partners to improve TB control programs and accelerate the implementation of the Directly Observed Treatment Short Course (DOTS) strategy. With other global TB partners, TBCTA contributes to accelerate the pace of DOTS expansion. Gerakan Terpadu Nasional Penanggulangan TBC - Stop TB Partnership Indonesia Sumber informasi penanggulangan TBC di Indonesia.

Heinrich Hermann Robert Koch

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Heinrich Hermann Robert Koch (11 Desember 1843 - 27 Mei 1910) adalah seorang dokter Jerman. Dia menjadi terkenal setelah penemuan anthrax bacillus (1877), tubercle bacillus (1882), dan kolera bacillus (1883) dan pengembangan postulat Koch. Dia diberikan Penghargaan Nobel dalam Fisiologi atau Kedokteran pada 1905 dan dianggap sebagai pendiri bakteriologi. Robert Koch dilahirkan di Clausthal, Jerman sebagai seorang anak pejabat pertambangan. Dia belajar medis dibawah Jacob Henle di Universitas Gottingen dan tamat pada 1866. Dia kemudian bekerja di Perang Perancis-Prusia dan kemudian menjadi opsir medis di distrik Wollstein. Bekerja dengan alat yang sangat terbatas, dia menjadi salah satu pendiri ilmu bakteriologi, satunya lagi adalah Louis Pasteur. Setelah Casimir Davaine menunjukkan transmisi langsung anthrax bacilus di antara sapi, Koch mempelajari anthrax lebih dekat lagi. Dia menemukan metode untuk memurnikan basilus dari sampel darah dan mengembangkan kultur murni. Dia menemukan bahwa, anthrax tidak dapat hidup di luar inang atau hospes dalam waktu yang lama, namun dapat membuat spora yang dapat bertahan lama. Spora-spora ini, tertanam dalam tanah, adalah penyebab dari merebaknya anthraks yang spontan dan tidak dapat dijelaskan. Dia mempublikasikan hasil penemuannya pada 1876 dan dihargai pekerjaan di "Kantor Kesehatan Istana" di Berlin pada 1880. Di Berlin, dia meningkatkan metode yang dia pakai di Wollstein, termasuk teknik pencemaran dan pemurnian, dan media pertumbuhan bakteri, termasuk piring agar dan

cawan petri (dinamakan setelah J.R. Petri), keduanya masih digunakan sampai sekarang. Dengan teknik-teknik tersebut, dia dapat menemukan bakteri yang menyebabkan tuberkulosis (Mycobacterium tuberculosis) pada 1882 (dia mengumumkan penemuannya pada 24 Maret). Tuberkolosis adalah penyebab dari satu dalam tujuh kematian di pertengahan abad ke-19. Pentingnya penemuannya meningkatkan taraf Koch menjadi setaraf dengan Louis Pasteur dalam riset bakteriologi. Pada 1883, Koch bekerja dengan tim riset dari Prancis di Alexandria, Mesir, mempelajari kolera. Koch mengidentifikasi bakterium vibrio yang menyebabkan kolera, meskipun dia tidak pernah membuktikannya dalam eksperimen. Pada 1885, dia menjadi profesor higinitas di Universitas Berlin, dan kemudian, pada 1891, direktur di Institut Penyakit Menular (Institute of Infectious Diseases) yang baru didirikan, dia mundur dari posisi tersebut pada 1904. Dia kemudian mulai berkeliling dunia, mempelajari penyakit ini di Afrika Selatan, India, dan Jawa. Kemungkinan sama pentingnya dengan penemuan tuberkolosis yang membuatnya dihargai penghargaan Nobel, adalah Postulat Koch, yang menyatakan bahwa untuk menandakan sebuah organisme sebagai penyebab penyakit, dia harus:

ditemukan dalam seluruh kasus penyakit yang diperiksa dipersiapkan dan mempertahankan dalam culture murni. mampu memproduksi infeksi asal, meskipn setelah beberapa generasi dalam culture dapat diambil dari hewan terinokulasi dan di"culture" lagi.

Tapi setelah kesuksesannya kualitas dari risetnya menurun (terutama setelah kegagalan obat penyembuhan TBC-nya tuberculin), meskipun muridnya yang menggunakan metodenya berhasil menemukan organisme yang bertanggung jawab atas diphtheria, typhoid, pneumonia, gonorrhoea, cerebrospinal meningitis, leprosi, wabah bubonik, tetanus, dan syphilis. Dia meninggal di Baden-Baden, Jerman.

Robert Koch Biography (1843-1910)

Nationality German Gender Male Occupation bacteriologist Robert Koch is considered to be one of the founders of the field of bacteriology. He pioneered principles and techniques in studying bacteria and discovered the specific agents that cause tuberculosis, cholera, and anthrax. For this he is also regarded as a founder of public health, aiding legislation and changing prevailing attitudes about hygiene to prevent

the spread of various infectious diseases. For his work on tuberculosis,he was awarded the Nobel Prize in 1905. Robert Heinrich Hermann Koch was born in a small town near Klausthal, Hanover, Germany, on December 11, 1843, to Hermann Koch, an administrator in the local mines, and Mathilde Julie Henriette Biewend, a daughter of a mine inspector. The Koch's had a total of thirteen children, two of whom died in infancy.Robert was the third son. Both parents were industrious and ambitious. Robert's father rose in the ranks of the mining industry, becoming the overseer ofall the local mines. His mother passed her love of nature on to Robert who, at an early age, collected various plants and insects. Before starting primary school in 1848, Robert taught himself to read and write. At the top of his class during his early school years, he had to repeat his final year. Nevertheless, he graduated in 1862 with good marks in the sciences and mathematics. A university education became available to Robert whenhis father was once again promoted and the family's finances improved. Robertdecided to study natural sciences at Gottingen University, close to his home. After two semesters, Koch transferred his field of study to medicine. He haddreams of becoming a physician on a ship. His father had traveled widely in Europe and passed a desire for travel on to his son. Although bacteriology wasnot taught then at the University, Koch would later credit his interest in that field to Jacob Henle , an anatomist who had published a theory of contagion in 1840. Many ideas about contagious diseases, particularly those of chemist and microbiologist Louis Pasteur , who was challenging the prevailing mythof spontaneous generation, were still being debated in universities in the 1860s. During Koch's fifth semester at medical school, Henle recruited him to participate in a research project on the structure of uterine nerves. The resultingessay won first prize. It was dedicated to his father and bore the Latin motto, Nunquam Otiosus, or Never idle. During his sixth semester, he assisted Georg Meissner at the Physiological Institute. There he studied the secretion of succinic acid in animals fed only on fat. Koch decided to experiment on himself, eating a half pound of butter each day. After five days, however, he was so sick that he limited his study to animals. The findings of this study eventually became Koch's dissertation. In January 1866, he finished the final exams for medical school and graduated with highest distinction. After finishing medical school, Koch held various positions; he worked as anassistant at a hospital in Hamburg, where he became familiar with cholera, and also as an assistant at a hospital for retarded children. In addition, he made several attempts to establish a private practice. In July, 1867, he married Emmy Adolfine Josephine Fraatz, a daughter of an official in his hometown.Their only child, Gertrude, was born in 1868. Koch finally succeeded in establishing a practice in the small town of Rakwitz where he settled with his family.

Shortly after moving to Rakwitz, the Franco-Prussian War broke out and Koch volunteered as a field hospital physician. In 1871, the citizens of Rakwitz petitioned Koch to return to their town. He responded, leaving the army to resume his practice, but he didn't stay long. He soon took the exams to qualify for district medical officer and in August 1872 was appointed to a vacant position at Wollstein, a small town near the Polish border. It was here that Koch's ambitions were finally able to flourish. Though he continued to see patients, Koch converted part of his office into a laboratory.He obtained a microscope and observed, at close range, the diseases his patients confronted him with. One such disease was anthrax, which is spread from animals to humans throughcontaminated wool, by eating uncooked meat, or by breathing in airborne spores emanating from contaminated products. Koch examined under the microscope the blood of infected sheep and saw specific microorganisms that confirmed a thesis put forth ten years earlier by biologist C. J. Davaine (1812-1882) thatanthrax was caused by a bacillus. But Koch was not content to simply verify the work of another. He attempted to culture, or grow, these bacilli in cattleblood so he could observe their life cycle, including their formation into spores and their germination. Koch performed scrupulous research both in vitroand in animals before showing his work to Ferdinand Cohn, a botanistat the University of Breslau. Cohn was impressed with the work and replicatedthe findings in his own laboratory. He published Koch's paper in 1876. In 1877, Koch published another paper that elucidated the techniques he had used to isolate Bacillus anthracis. He had dry-fixed bacterial cultures onto glass slides, then stained the cultures with dyes to better observe them, and photographed them through the microscope. It was only a matter of time that Koch's research eclipsed his practice. In 1880, he accepted an appointment as a government advisor with the Imperial Department of Health in Berlin. His task was to develop methods of isolating andcultivating disease-producing bacteria and to formulate strategies for preventing their spread. In 1881 he published a report advocating the importance of pure cultures in isolating disease-causing organisms and describing in detail how to obtain them. The methods and theory espoused in this paper are still considered fundamental to the field of modern bacteriology. Four basic criteria, now known as Koch's postulates , are essential for an organism to be identified as pathogenic, or disease-causing. First, the organism must be foundin the tissues of animals with the disease and not in disease-free animals.Second, the organism must be isolated from the diseased animal and grown in apure culture outside the body, or in vitro. Third, the cultured organism must be able to be transferred to a healthy animal, who will subsequently show signs of infection. And fourth, the organisms must be able to be isolated fromthe infected animal. While in Berlin, Koch became interested in tuberculosis, which he wasconvinced was infectious, and, therefore, caused by a bacterium. Several scientists had made similar claims but none had been verified. Many other scientists persisted in believing that tuberculosis was an inherited disease. In sixmonths, Koch succeeded in isolating a bacillus from tissues of humans and animals infected with tuberculosis. In 1882, he published a

paper declaring that this bacillus met his four conditions--that is, it was isolated from diseased animals, it was grown in a pure culture, it was transferred to a healthy animal who then developed the disease, and it was isolated from the animal infected by the cultured organism. When he presented his findings before the Physiological Society in Berlin on March 24, he held the audience spellbound, sological and thorough was his delivery of this important finding. This day has come to be known as the day modern bacteriology was born. In 1883, Koch's work on tuberculosis was interrupted by the Hygiene Exhibition in Berlin, which, as part of his duties with the health department, he helped organize. Later that year, he finally realized his dreams of travel when he was invited to head a delegation to Egypt where an outbreak of cholera had occurred. Louis Pasteur had hypothesized that cholera was caused by a microorganism; within three weeks, Koch had identified a commashapedorganism in the intestines of people who had died of cholera. However, when testing this organism against his four postulates, he found that the disease did not spread when injected into other animals. Undeterred, Koch proceeded toIndia where cholera was also a growing problem. There, he succeeded in finding the same organism in the intestines of the victims of cholera, and although he was still unable to induce the disease in experimental animals, he did identify the bacillus when he examined, under the microscope, water from the ponds used for drinking water. He remained convinced that this bacillus was the cause of cholera and that the key to prevention lay in improving hygiene and sanitation. Koch returned to Germany and from 1885-1890 was administrator and professor at Berlin University. He was highly praised for his work, though some high-ranking scientists and doctors continued to disagree with his conclusions. But Koch was an adept researcher, able to support each claim with his exacting methodology. In 1890, however, Koch faltered from his usual perfectionism and announced at the International Medical Congress in Berlin that he had found aninoculum that could prevent tuberculosis. He called this agent tuberculin. People flocked to Berlin in hopes of a cure and Koch was persuaded to keep theexact formulation of tuberculin a secret, in order to discourage imitations.Although optimistic reports had come out of the clinical trials Koch had setup, it soon became clear from autopsies that tuberculin was causing severe inflammation in many patients. In January 1891, under pressure from other scientists, Koch finally published the nature of the substance, but it was an uncharacteristically vague and misleading report which came under immediate criticism from his peers. Koch left Berlin for a time after this incident to recover from the professional setback. He also suffered from a personal scandal during this time, divorcing his wife in 1893 and immediately marrying an actress, Hedwig Freiberg, thirty years his junior. But the German government continued to support him throughout this time. An Institute for Infectious Diseases was established andKoch was named director. With a team of researchers, he continued his work with tuberculin, attempting to determine the ideal dose at which the agent could be the safest and most effective. The discovery that tuberculin was a valuable diagnostic tool (causing a reaction in those infected but none in those not infected), rather than a cure, helped restore Koch's reputation. In 1892 there was a cholera outbreak in Hamburg. Thousands of people died. Koch advocated strict sanitary conditions and

isolation of those found to be infected with the bacillus. Germany's senior hygienist, Max von Pettenkofer, was unconvinced that the bacillus alone could cause cholera. He sneered at Koch's ideas,going so far as to drink a freshly isolated culture. Several of his colleagues joined him in this demonstration. Two developed symptoms of cholera, Pettenkofer suffered from diarrhea, but no one died; Pettenkofer felt vindicated in his opposition to Koch. Nevertheless, Koch focused much of his energy on testing the water supply of Hamburg and Berlin and perfecting techniques for filtering drinking water to prevent the spread of the bacillus. In the following years, he gave the directorship of the Institute over to oneof his students so he could travel again. He went to India, New Guinea, Africa, and Italy, where he studied diseases such as the plague, malaria, rabies, and various unexplained fevers. In 1905, after returning to Berlin from Africa, he was awarded the Nobel Prize for physiologyand medicine for his work on tuberculosis. Subsequently, many other honors were awarded him recognizing not only his work on tuberculosis, but his more recent research on tropical diseases, including the Prussian Order Pour le Merits in 1906 and the Robert Koch medal in 1908. The Robert Koch Medal was established to honor the greatest living physicians, and the Robert Koch Foundation, established with generous grants from the German government and from theAmerican philanthropist, Andrew Carnegie (1835-1919), was founded to work toward the eradication of tuberculosis. Meanwhile, Koch settled back into the Institute where he supervised clinicaltrials and production of new tuberculins. He attempted to answer, once and for all, the question of whether tuberculosis in cattle was the same disease asit was in humans. Between 1882 and 1901 he had changed his mind on this question, coming to believe that bovine tuberculosis was not a danger to humans,as he had previously thought. He espoused his beliefs at conferences in the United States and Britain during a time when many governments were attemptinglarge-scale efforts to minimize the transmission of tuberculosis through meatand milk. Koch did not live to see this question answered. On April 9, 1910, three daysafter lecturing on tuberculosis at the Berlin Academy of Sciences, he suffered a heart attack from which he never fully recovered. He died at Baeden Baeden on May 27 at the age of 67. He was honored after death by the naming of the Institute after him. Koch's obituaries are full of admiration for his perseverance and his scrupulous scientific process. Yet underneath the praise there is an acceptance thatthese same qualities--so useful to science--produced in the man a stubborn arrogance and an inability to give credit to the work of others or to admit his own mistakes. His early work with tuberculin and his defense that bovine tuberculosis was not harmful to humans are examples of his mistakes. Nevertheless, his strong will proved to be remarkably productive for science. He neverleft laboratory findings in the laboratory. Rather, he insisted, albeit stubbornly at times, that what he found in the laboratory should make a differencein the world. In the first paper he wrote on tuberculosis, he stated his lifelong goal, which he clearly achieved: "I have undertaken my investigations in the interests of public health and I hope the greatest benefits will accruetherefrom."

Robert Koch, Dari Sinbad Si Pelaut Sampai Anthrax

Di akhir abad 19, ada dua penyakit yang paling banyak menimbulkan korban di Eropa: kolera dan TBC (tuberkulosis). Waktu itu kolera disebut juga King Cholera, karena nyaris tak seorang pun yang mampu menyembuhkannya. Sedangkan TBC dikenal dengan White Death, sebab penderita TBC biasa memuntahkan cairan putih begitu paru-paru semakin rusak. Dalam keadaan terjepit ini, Robert Koch muncul dengan beberapa temuannya yang mengesankan. Koch adalah seorang dokter Jerman yang berhasil mendalami selukbeluk bakteri, bahkan pada 1905 ia memenangkan Hadiah Nobel untuk kedokteran. Ia lahir di Hanover, Jerman pada 1843. Ia anak ketiga dari 13 bersaudara. Si kecil Robert sama sekali tak pernah menyimpan cita-cita bahwa suatu ketika ia akan menjadi dokter. Robert Koch selalu bermimpi akan mengunjungi tempat-tempat eksotik di dunia luar, sejauh rimba hitam di Afrika dan dataran es di Kutub Selatan. Keinginannya, ia ingin menjadi Sinbad Si Pelaut. Namun mimpi itu tak kesampaian. Satu-satunya hobi masa kecil yang masih terus bisa dipertahankan hingga dewasa, hanyalah kegemarannya bermain-main dengan kaca pembesar. Lulus dari seolah menengah, ia masuk ke fakultas kedokteran dan berkawan akrab dengan mikroskop. Ketika usianya menginjak 29 tahun, ia mulai melakukan penelitian yang mendalam mengenai kuman-kuman penyakit pada manusia dan hewan. Namun penyelidikannya tidak berhenti sampai di situ. Ia terus membuat terobosan besar. Untuk memudahkan pemantauannya mengenai kuman penyakit, ia memberikan warna pada makhluk-makhluk renik itu. Dengan cara itu, Robert Koch bisa memotret perkembangan hidup bakteri melalui lensa mikroskop. Sejak itu, ia memang membuat kemajuan luar biasa. Empat tahun kemudian ia berhasil menyibak siapa bakteri yang bertanggungjawab dalam tuberkulosis (TBC). Setahun berselang, ia pun muncul dengan termuannya yang baru. Ia tahu kuman penyebab kolera. Sebagai bukti penghargaan, Institut Penyakit-penyakit Menular di Berlin, 1891. Dari penelitiannya, Koch kemudian menyebarkan ide yang sampai sekarang tetap berlaku. Lingkungan yang lebih sehat dapat menghambat, bahkan mencegah penyebaran penyakit. Soalnya, polusi ikut mempercepat penyebaran kuman penyakit. Untuk mencegah penyebaran kolera, pasokan ait minum harus dibikin bersih. Selain itu, Koch juga punya pengalaman bagus dengan anthrax. Pada 1870 ia menemukan cara-cara kerja bakteri anthrax, bacillus anthracis, pada hewan-hewan ternak. Beberapa waktu kemudian, ia mengeluarkan anthrax dari tubuh binatang dan mengembangkannya di luar. Untuk meyakinkan dirinya, Koch menyuntikkan anthrax ke dalam tubuh binantang yang sehat.

Pada 1882, Koch berhasil memisahkan bacillus tuberculosis, bibit penyakit yang menimbulkan tuberkulosis (TBC). Pada 1890, Koch menemukan tuberculin yang dipercayainya sebagai obat TBC. Tuberculin sekarang dikenal sebagai senyawa yang dipakai untuk menunjukan bersih-tidaknya seseorang dari TBC. Koch meninggal pada 1910 setelah mendapat begitu banyak penghargaan. dari berbagai sumber/is

Tuberkulosis

Penyakit Lama dengan Kuman Makin Kuat

Sabtu, 24 Maret 2007 - 09:41 WIB

Siapa yang tidak tahu penyakit tuberkulosis? Gambaran orang bertubuh kurus batuk sampai terbungkuk-bungkuk dengan dahak bercampur darah sering kali menghiasi film dan sinetron Indonesia. Namun, belum semua tahu bagaimana tuberkulosis atau TB ditularkan, pencegahan, serta pengobatan yang seharusnya agar penyakit itu hilang dari peredaran. Hasil penelitian mengenai Knowledge, Attitude, Practice TB di Indonesia menunjukkan, 76 persen masyarakat tahu tentang TB dan 85 persen tahu bahwa TB dapat disembuhkan. Hanya 16 persen yang bisa menyebutkan tiga atau lebih gejala TB dan hanya 19 persen yang tahu bahwa obat TB bisa didapatkan secara gratis di puskesmas. Selain itu, ada pemahaman yang salah tentang penularan TB, yaitu melalui makanan, minuman, serta polusi. Tuberkulosis adalah suatu penyakit menular yang disebabkan oleh Mycobacterium tuberculosis. Kuman ini ditemukan oleh ilmuwan Jerman Robert Koch sekitar 100 tahun lalu. Seperti batuk pilek, kuman TB menular lewat percikan batuk, bersin, atau ludah penderita yang terlempar ke udara. Karena kuman terhirup lewat udara, demikian dituturkan dokter spesialis paru dari RS Persahabatan/FKUI Tjandra Yoga Aditama, sebagian besar (80 persen) TB terjadi di paru. Namun, kuman TB bisa juga menyerang organ tubuh lain, seperti usus, selaput otak (meningitis TB), tulang dan sendi, serta kulit. Menurut situs Organisasi Kesehatan Dunia (WHO), tidak semua orang yang terpapar kuman TB menjadi sakit. Jika daya tahan tubuhnya kuat, kuman menjadi tidak aktif. Saat daya tahan menurun kuman baru berkembang biak dan menyebabkan penyakit TB. Hanya 5-10 persen orang yang terinfeksi kuman TB? kecuali mereka yang terinfeksi HIV? menjadi sakit. Keberadaan kuman TB di tubuh yang tidak menimbulkan sakit disebut TB laten. Adapun orang yang menderita TB serta bisa menularkan ke orang lain disebut TB aktif. Orang dengan TB aktif harus segera ditemukan dan diobati agar tidak menyebarkan kuman ke anggota masyarakat lain. Penyakit TB biasanya menular pada anggota keluarga penderita, teman sekolah atau teman kerja. Oleh karena itu, mereka yang berada di ruangan tertutup dengan cahaya matahari dan pertukaran udara kurang bersama penderita TB aktif dalam waktu lama harus memperkuat daya tahan tubuh. Gejala Gejala TB antara lain batuk berdahak terus-menerus lebih dari dua pekan, demam, dahak bercampur darah, letih lesu, berat badan dan nafsu makan menurun drastis, nyeri dada dan sesak napas, serta berkeringat di malam hari tanpa melakukan kegiatan. Orang yang mengalami gejala seperti itu perlu segera memeriksakan diri ke puskesmas atau rumah sakit terdekat. Setiap orang bisa terkena TB. Selain orang yang berada dekat penderita dalam waktu lama, mereka

yang berisiko tinggi tertular adalah orang dengan daya tahan tubuh menurun, misalnya, terinfeksi HIV, diabetes, menjalani pengobatan kanker, pengobatan kortikosteroid. Mereka yang bekerja atau berada di fasilitas pelayanan dalam jangka waktu lama, misalnya, panti jompo, penjara, atau rumah sakit. Selain itu, orang- orang yang kurang gizi, pencandu alkohol, pengguna narkoba suntik, serta gelandangan. Untuk menentukan penyakit TB, mula-mula orang bisa menjalani tes Mantoux, yaitu penyuntikan tuberkulin di bawah kulit terluar, biasanya pada lengan. Dua atau tiga hari kemudian lengan akan diperiksa ada tidaknya benjolan untuk melihat faktor risiko tertular TB. Untuk memastikan, dilakukan foto rontgen paru, tes basil tahan asam (BTA) positif serta kultur kuman. Sejauh ini tes TB yang digunakan untuk pelayanan kesehatan secara luas adalah tes BTA positif. Namun, tes ini dari sisi teknologi kedokteran dinilai sudah kedaluwarsa karena tidak berubah sejak digunakan pertama kali oleh Robert Koch 100 tahun lalu, yaitu melihat ada tidaknya kuman dalam dahak lewat bantuan mikroskop. Sensitivitas tes ini hanya 40-60 persen. "Kuman baru bisa terlihat jika jumlahnya 5.000 per mililiter dahak," kata Tjandra. Karena itu, menurut Direktur Pengendalian Penyakit Menular Langsung Departemen Kesehatan Rosmini Day, mereka yang BTA negatif, tapi menunjukkan gejala klinis TB tetap diobati. Saat ini ada upaya untuk menemukan cara deteksi yang lebih maju dari BTA positif. Menurut Firdosi Mehta dari WHO, ada kelompok kerja di tingkat global yang sedang mengembangkan cara deteksi tersebut. Sejauh ini belum ditemukan cara yang cukup sensitif dan spesifik untuk digunakan dalam kegiatan pelayanan kesehatan yang luas. Diharapkan tahun 2010 cara deteksi yang lebih maju bisa diimplementasikan. Pencegahan Dalam situs American Lung Association, mereka yang terinfeksi kuman TB, tetapi tidak sakit bisa diberi terapi preventif. Terapi itu dengan minum isoniazid selama sekitar 9 bulan. Mereka yang sakit biasanya diobati dengan regimen yang terdiri dari 5-6 jenis obat selama 6-8 bulan, antara lain rifampisin, isoniazid, pirazinamid, etambutol, dan streptomisin. Karena obat memberikan efek samping yang tidak nyaman seperti pendengaran berkurang, bingung, mulut kering, biasanya penderita akan berhenti minum obat jika merasa sudah cukup sehat. Padahal, kuman masih belum terbasmi seluruhnya. Akibatnya, bisa terjadi kuman yang resistan terhadap obat. Untuk memastikan pengobatan berjalan semestinya, WHO merekomendasikan strategi pengobatan yang disebut directly observed treatment shortcourse (DOTS), yaitu penderita minum obat dengan diawasi oleh pengawas minum obat. Pengawas ini bisa anggota keluarga, petugas kesehatan, atau relawan. Kuman yang resistan terhadap obat, terutama isoniazid dan rifampisin, disebut kuman yang multidrug resistant (MDR). Menurut Tjandra, penderita MDR TB hanya bisa diobati dengan obat lini kedua seperti kuinolon, sikloserin, kanamisin, kapriomisin. Obat-obatan ini selain jumlahnya terbatas, mahal, perlu diberikan dalam waktu lama, efek sampingnya juga lebih besar. Isu yang paling menakutkan dalam hal TB saat ini, lanjut Tjandra, adalah extreme atau extensive drug resistant (XDR). Dalam hal ini kuman kebal terhadap tiga atau lebih jenis obat lini kedua. Sejauh ini belum ada obat TB lini ketiga. Suatu penelitian di Afrika Selatan menunjukkan 52 dari 53 penderita XDR yang HIV positif meninggal dunia dalam waktu 25 hari. Oleh karena itu, pengobatan lini pertama harus dipastikan untuk dilakukan secara benar. Jika terjadi MDR, hal ini diperkirakan 1,6 persen di Indonesia, atau bahkan XDR, beban penderita serta masyarakat akan makin besar. (ATK)

Robert Koch
AKA Robert Heinrich Hermann Koch Born: 11-Dec-1843 Birthplace: Clausthal-Zellerfeld, Germany Died: 27-May-1910 Location of death: Baden-Baden, Germany Cause of death: Heart Failure Remains: Cremated, Robert Koch Institute, Berlin, Germany Gender: Male Race or Ethnicity: White Sexual orientation: Straight Occupation: Doctor Nationality: Germany Executive summary: Discovered bacteria that causes tuberculosis Wife: Emmy Adolfine Fraats (m. 1866) Daughter: Gertrud (b. 1865) Wife: Hedwig Freiberg (m. 1893)