A. Klebsiella spKlebsiella sp scientific classification: Kingdom: Bacteria Phylum: Proteobacteria Class: Gamma proteobacteria Order: Enterobacteriales Family: Enterobacteriaceae Genus: Klebsiella Species: - Klebsiella pneumoniaKlebsiella oxytoca,, Klebsiella ozaena, Klebsiella rhinoscleromatis

 Morphology and properties of the bacteria Klebsiella spBacteria are gram (-), short rod-shaped, has a size of 0.5 to 1.5 x 1.2 ТЕ. This bacterium has a capsule, but does not form spores. Klebsiella unable to move because they do not have flagella but capable of fermenting carbohydrates to form acids and gases.Klebsiella species show mucoid growth, a large polysaccharide capsule and not motile. They usually give a positive test result for lysine decarboxylase and citrate. Klebsiella Voges-Proskauer reaction gives a positiveCulture nature or culture of Klebsiella sp on EMB and Mac Conkey medium to red colonies. Then on solid media grew mucoid colonies (24 hours). Easily cultured in simple media (bouillon order) with a colony of gray and white glossy surfaces.
 Antigen typeKlebsiella has the structure of the antigen. Members of the genus Klebsiella usually reveal two types of antigens on their cell surface, namely:ТЗ O antigen is the outer portion of the cell wall lipopolysaccharide and polysaccharide composed of repeating units. Some of the O-specific polysaccharide containing a unique sugar. O antigen is resistant to heat and alcohol and is usually detected by bacterial agglutination. Antibodies against the O antigen is IgM.ТЗ K antigen is the outermost part of the O antigens in some, but not in the Enterobacteriaceae. Some of the K antigen is a polysaccharide and the other protein.
Klebsiella pneumoniae enzymeKlebsiella bacteria have urease enzyme and the enzyme citrate permiase. Klebsiella enzyme is also capable of producing ESBL (Extended Spectrum Beta lactamase) which can paralyze the action of various types of antibiotics. This leads to resistant bacteria and difficult disabled.Resistance to antibiotics in the following manner:(1) Drug inactivation by degradation or modification enzymes such as beta and vamino lactamaces glycoside transferases,(2) Change target drug
 (3) The emergence of a bypass pathway that is not inhibited by the drug(4) Reduced membrane permeability for drug
 (5) Drug efflux from cells.

CHAPTER IIISI

Lower respiratory tract infection remains a major problem in the health field, both in developing countries and that has been developed. SEAMIC Health Statistics data from 2001 influenza and pneumonia is the leading cause of death in Indonesia number 6, number 9 in Brunei, Malaysia's number 7, number 3 in Singapore, the number 6 in Thailand and number 3 in Vietnam. 1999 WHO report states that the cause of death due to infectious diseases in the world is an acute respiratory tract infection including pneumonia and influenza. The incidence of pneumonia community in America is 12 cases per 1000 people per year and is the leading cause of death due to infection in adults in the country. The death rate from pneumonia in the United States is 10%.In the United States by any cause invasive pneumonia found only 50%. Cause of pneumonia is difficult to find and may take several days to get results, whereas pneumonia can cause death if not treated immediately, then the initial treatment of pneumonia are given antibiotics empirically.Household Survey of Health Department of Health in 2001, lower respiratory tract infection disease ranks second as a cause of death in Indonesia. In the SMF in 2001 Friendship Dr Lung infection is also the main pulmonary disease, 58% among ambulatory patients are cases of infection and 11.6% of cases nontuberkulosis, in patients hospitalized cases of infection 58.8% and 14.6% of cases nontuberkulosis . In Dr H. Adam Malik Medan 53.8% and 28.6% of cases of infection including an infection nontuberkulosis. In hospitals Dr. Surabaya Soetomo the data obtained about 180 community pneumonia with mortality rates between 20-35%. Pneumonia ranks fourth community and the ten most illnesses are treated per year.




Klebsiella pneumoniae was first discovered by Carl Friedlander. Carl Friedlander is a pathological and microbiological findings from Germany, which helps the bacteria that causes pneumonia in 1882. Carl Friedlander is the person who first identified the bacterium Klebsiella pneumoniae from the lungs of people who died of pneumonia. Because of his services, Klebsiella pneumoniae are often called the bakery Friedlander.Klebsiella pneumoniae is a Gram negative rod-shaped (bacillus). Klebsiella pneumonia bacteria classified as unable to perform the movement (non motile). Based on their need for oxygen, Klebsiella pneumoniae is an aerobic facultative bacteria. Klebsiella pneumoniae can ferment lactose. In the test with indole, Klebsiella pneumoniae will show negative results. Klebsiella pneumoniae can reduce nitrate. Klebsiella pneumoniae is found in the mouth, skin, and sal gut, but the natural habitat of Klebsiella pneumoniae is on the ground.Klebsiella pneumoniae can cause pneumonia. Pneumonia is an acute infection of the lung tissue (alveoli). Pneumonia caused by Klebsiella pneumoniae pneumonia can be community or community acquired pnuemonia. Community or community acquired pneumonia is pneumococcal pnuemonia in getting from the community. The new strain of Klebsiella pneumoniae can cause pneumonia or hospitality nosomikal acquired pneumonia, which means the disease is in peumonia get when patients are in hospitals or health centers. Klebsiella pneumonia generally attacks people with weak immune system, such as alcoholics, people with diabetes and those with chronic lung disease.
A. Pathogenicity of bacteria Klebsiella pneumoniaeThrough the upper respiratory tract bacteria into the lung tissue, tissue destruction occurs, forming the purulent and necrotic lung parenchyma, there was a lung abscess, bronchiectasis, bacteria enter the bloodstream, septicemia, liver abscess.- The capsules have the ability to defend the organism against phagocytosis and killing by normal serum- A capsulated strain is more virulent than encapsulated strains (in animals)- There are no toxins in addition to endotoxin that contributes to opportunistic infectionsKlebsiella pneumoniae strains that produce enterotoxins exist (has been isolated from patients with tropical sprue) is similar to the ST toxin (heat resistant) and LT (heat-labile enterotoxin) of E. coli, the ability to produce toxin is mediated by the Klebsiella pneumoniae plasmid. Cause pneumonia can infect other places besides the respiratory tract.These bacteria often lead to urinary tract due to nosocomial infection, meningitis, and pneumonia in patients with diabetes mellitus or alcohol addicts. Symptoms of pneumonia caused by bacteria in the form of acute symptoms of fever, malaise (lethargy), and a dry cough and the cough becomes productive and produce bloody sputum and purulent (pus). If the disease continues to happen abscess of lung tissue necrosis, and vibrosis bronchiectasi lungs.
2. Mode of transmission of the bacteria Klebsiella pnemoniaeKlebsiella pneumoniae causes lung disease gives the appearance of swelling of the lungs so that the left and right lobe of the lung are not the same; fever (chills), cough (bronchitis), thickening of the mucosal wall, and bloody sputum.Modes of transmission (infection) of Klebsiella pneumoniae in hospitalized patients can be through three ways, namely:A. Or oropharyngeal aspiration of gastric fluid containing colonies of pathogenic bacteria.2. Hematogenous spread of bacteria into the lungs3. Airborne transmission by aerosols or droplets containing microbes.3. Clinical symptomsThe symptoms of Klebsiella pneumoniae-infected person is breathing fast and shortness of breath, because suddenly inflamed lung. Frequency limit of fast breathing is breathing 50 times per minute or more in children aged 2 months to less than 1 year, and 40 times per minute or more in children aged 1 year to less than 5 years. Serious pneumonia characterized by coughing or (accompanied) difficulty breathing, shortness of breath or withdrawal of the chest wall into the bottom of (severe chest indrawing) in children aged 2 months to less than 5 years. In this age group is also known as very severe pneumonia, with symptoms of cough, difficulty breathing accompanied by symptoms of central cyanosis and can not drink. Meanwhile, for children under 2 months, severe pneumonia characterized by a frequency of 60 times per minute or more or (accompanied) strong withdrawal on the chest wall into the bottom of, cough, changes in sputum characteristics, body temperature over 38 ТК C. Other symptoms, ie when the physical examination found bronchial breath sounds, and leukocyte bronkhi more than 10,000 or less than 4500/uL.In elderly patients or patients with a low immune response, symptoms of atypical pneumonia, which is a non-respiratory symptoms such as dizziness, worsening of pre-existing illness and fainting. Increased respiratory rate is usually rapid and rare fever.
4. TreatmentSeveral types of Klebsiella pneumonia can be treated with antibiotics, especially antibiotics containing beta-lactam ring.Examples of such antibiotics are ampicillin, carbenicillin, amoxiciline, etc.. From the survey results revealed that Klebsiella pneumonia had a sensitivity of 98.4% for meropenem, 98.2% for imipenem, 92.5% for chloramphenicol, 80% to ciprofloxacin, and 2% to ampicillin. New strains and Klebsiella pneumoniae resistant to different types of antibiotics and is still doing research to find the right drug to inhibit the activity or even kill the bacteria.


5. Laboratory DiagnosisOn laboratory examinations are an increasing number of leukocyte, usually more than 10.000/ТЕl sometimes reach 30.000/ТЕl, and the type of leukocyte count and left shift are an increase in LED. To determine the etiologic diagnosis required examination of sputum, blood culture and serology.
CHAPTER IIICLOSING
Conclusion:
 Klebsiella pneumoniae is a Gram negative rod-shaped (bacillus). Klebsiella pneumoniae bacteria are classified as unable to perform the movement (non motile). Based on their need for oxygen, Klebsiella pneumoniae is an aerobic facultative bacteria. These bacteria can ferment lactose. In the test with indole, Klebsiella pneumoniae would have a negative but it can reduce nitrate.Klebsiella pneumoniae can cause pneumonia. Pneumonia itself is the process of acute infection of the lung tissue (alveoli). Klebsiella pneumoniae causes lung disease gives the appearance of swelling of the lungs so that the left and right lobe of the lung are not the same; fever (chills), cough (bronchitis), thickening of the mucosal wall, and bloody sputum.In the laboratory tests can be carried out a survey Aanthal Leukocytes and LED, and can do the examination of sputum, blood culture, and serology.