Mycosis Systemik Opportunistik & Pathogens

8/2/2019 Mycosis Systemik Opportunistik & Pathogens

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MYCOSIS SYSTEMIK OPPORTUNISTIK

DAN PATOGEN

Oleh :

Dr. dr. Hj. Efrida Warganegara, M.Kes., Sp.MK


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SYSTEMIC MYCOSIS : Pathogenic

Diseasea Agent

Blastomycosis Blastomycesdermatitidis

Histoplasmosis Histoplasmacapsulatum

Coccidioidomycosis Coccidioidesimmitis

Paracoccidioidomycosis Paracoccidoidesbrasiliansis


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BLASTOMYCOSIS= Notrh American Blastomycosis= Gilchists disease

Etiologic agent :Blastomyces dermatitidis, a dimorphic fungus that grows as mold at

room temperature and as a yeast at 35 - 370C

Epidemiology :

B. dermatitidis is saprophytic in nature & grows in the mold form insoil

or decaying wood associated with soil, has been isolated severaltimes, but repeated isolation from the same sites were not succesful

most of the cases have been found in Noth America, but alsoprevalent in Africa & has been reported in India, occurs most often inadult males

the lack of a specific skin test antigen has prevented the

determination of the prevalence of asymptomatic Blastomycosis inlarge population


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BLASTOMYCOSISCxlinical features :

the primary site of Blastomycisis is the lung, withmild infiltrat & few clinical symptoms

in severe disease, pulmonary infiltrate may be more

extensive & the patients will have fever, cough &weight lose, nodular pulmonary lesion may occur

some cases may progres to chronic disease withpulmonary fibrosis & the cavitation

the fungus may disseminate to any organ of thebody, mostly skin & bone

skin lesion are frequently a manifestationofdisseminated disease, with dry & scaly, extensive

granulomatous with vesicle or pustule


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BLASTOMYCOSIS

Laboratory diagnosis :

Direct microscopic examination :

wet mount : B. dermatitidis appear as alarge, thick-walled single-budding yeast ( 8- 18 um ), the bud has a wide base

histophatology : the yeast form is usuallyeasily fount in infected tissue, are bestdetected with PAS or GMS stain


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BLASTOMYCOSISLaboratory diagnosis :

Culture :

is the dimorphic fungus, that grows in the mycelial form(mold) at room temperature & as a yeast at 370C

the mold form grows slowly, became visible in 7 - 10days, the colony is usually white & cottony

the yeast-like colony grows on blood agar at 370C after 3- 4 days

Microscopic morpology :

the mold produces small, smooth walled conidia &attached to the conidiophores that arise directly from thehyphae

yaest are large, thick-walled, single-budding & the budhas a wide base (neck) the diagnostic

structure of B. dermatitidis


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BLASTOMYCOSIS

Serology :

ID test is the most reliable, CFT notdetect antibodies in all cases, will

cross-react with antibodies to H.

capsulatum

Treatment : Amphoterisin B,

Ketoconazole


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HISTOPLASMOSIS= reticuloendotheliosis= Darlings disease

Etiologic agent : Histoplasma capsulatum, adimorphic fungus, having a mold form at roomtemperature & yeast form at 370C

Epidemiology : H. capsulatum grows in soil, especially in soil

that esriched with bat or bird manure

often be isolated from old building/caves,where birds/chickens or bats have roosted

H. capsulatum grows in soil in the mycelialform & large number of conidia are produce

the disease is acquired by inhaling conidia &re orted from most area of the world


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HISTOPLASMOSISClinical features :

is primarily a pulmonary disease; when conidia are inhaled,infections is established in the lungs; the disease may be mild,

with few or no symptom (95%)

may be severe with lung infiltrates, from mild to extensive

primary pulmonary histoplasmosis progresses to chronicpulmonary disease in about 5 % of those with disease; ischaracterized by fibrosis & cavitation,

symptoms includes : cough, fever, chills & weight lose (resemblesto toberculosis, sarcoidosis, & other systemic fungal disease)

the most severe form of histoplasmosis is disseminated disease;the fungus invade any organs of body


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HISTOPLASMOSIS

Laboratory diagnosis :Direct microskopic examination : wet mount :

H. capsulatum may be seen in sputum, bronchialwashed, or in any body fluids as a small yeast, 4 -6 um

histopathology : the yeast form can be found intissue removed from the infected sites, ussuallyin the macrophage & in granulomas

GMS (gomori methenamine silver) stain shouldbe used ( the yeat dark-brown - black )


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HISTOPLASMOSISCulture :

colony morphology : H. capsulatum grows slowly in the mold form

when incubated at room temperature, appear in 7 - 10 days butconidia is not form until later; on SDA ( sabouraud dextrose agar )the colony Is ussually white & cottony

microscopic morphology :

two types of conidia are prodeced by H. capsulatum small,pyriform smoth-walled conidia (microconidia, 4 - 6 um ) and large,round, thick-waled tuberculated conidia

( macroconidia, 8 - 18 um ) the diagnostic conidia

to prove the identification of H. capsulatum, convert the mold form- yeast form; be done by transferring the mold colony to blood agar& incubate at 370C in 3 - 5 days the yeast colony will be white

brown


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HISTOPLASMOSIS

Serology :

antibodies to the fungus are produced within10 - 21 days after a person is infected by H.capsulatum

agglutination test, measures IgM antibodies, isa quantitative test

CFT, measures both IgM & IgG, is quantitativetest; ID test is a quantitative test

Treatment :

Amphotericin B, Ketoconazole


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COCCIDIOIDOMYCOSIS= valley fever

Etiologic agent : Coccidioides immitis, a biphasic fungal pathogen

Epidemiology :

C. immitis grows in semi-acrid, solid, is known to exist in North,Central, & South American, especially California; its inhaled into thealveoli, where it produces disease, either benign ( resembles flu ), or

acute, depending on many factors ( race; inoculum )Clinical features :

most is a benign disease, prodeces only mild symptoms; amongcertain races ( Filipinos, Black ), immunosupressed or the used ofcorticosteroids, disseminated may occur

there is no site of predilection for this organism; any body tissue maybecome infected


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COCCIDIOIDOMYCOSIS

Laboratory diagnosis :Direct microscopic examination :

wet mount : specimens in KOHmounts, C. immitis may be seen assporangia

( spherula ) filled with endospora histophatology : the sporangia stain

well with HE & PAS stain


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COCCIDIOIDOMYCOSISCulture :Never work with culture on the laboratory bench

OUTSIDE of a biohazard hood !

C. immitis is a biphasic fungal phatogen, grows at roomtemperature repidly producing a dirty gray-white colony;at maturity, the hyphae develops arthroconidia wich

enlarged & barrel-shaped; alternate cells emptythehyphae break easilly into separate artrhoconidia float inthe air spread by the wind

Serology : used as diagnostic & prognostic tools; includeCFT, latex aglutination, ID test

Treatment : Amphotericin B, Ketoconazol


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PARACOCCIDIOIDOMYCOSIS= South American blastomycosis

Etiologic agent :Paracoccidioidomycosisbrasiliaensis,

a dimorphic fungus that grows as mold at roomtemperature & as a yeast at 370C / in infected tissues

Epidemiology :

the saprophytic habitat of P. brasiliensis is not known;endemic mostly in South America

most cases of paracodioidomycosis are seen in adultmales; is rare in children

& adult women; appears to reflect a host-parasiterelasionship by sex hormones


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PARACOCCIDIOIDOMYCOSIS

Clinical features :

the primarily site of infection is the lung; disease may bebenign, primary pulmonary form or may disseminate toproduce acute & chronic, progresive disease, includes lymphnodes & skin

the primary benign form may ultimately results with someresidual interstitial fibrosis

acute & chronic, progresive paracoccidioidomycosis,disseminated from of the disease, most prequently recognizedon the basic of lesion on oropharynx & gingivae

progresive chronic pulmonary disease may involve all lobes ofthe lung; produce extensive fibrosis


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Direct microscipic examination :

wet mount : appears a large, yeast-like cells ( 30 -360 um ), budding with one or more buds (multiple buds ) with narrow necks

histophatology : in infected tissue appears aslarge cells, multiple buds, connected to the

parent cell by narrow necks, it has been called apilot wheel or mickey mouse


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Culture :

colony morphology : P. brasiliensis is a dimorphicfungus, grows slowly in the mycelial form at roomtemperature; readily convert to the yeast phase when

grown at 370C on enriched media

microscopic morphology : the mycelial form is thin,septate hyphae, conidia, chlamydospora & arthroconidiamay be formed; yeast phase cultures will demonstrateboth mycelial element & yeast; the yeast arecharacterized by large ( 30 um or more ); multiple-thin-walled buds, with narrow necks


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Serology : CFT & ID test have been

shown to be reliable; howevercross reactions may occur

Tretment : Ketoconazole,Amphotericin B, Sulfadiazine


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SYSTEMIC MYCOSES

SYSTEMIC MYCOSIS : Opportunistic

Disease Agents

Candidiasis Candida albicans; Candida sp.

Cryptococcosis Cryptococcus neoformans

Aspergillosis Aspergillus fumigatus;Aspergillus sp.

Zygomycosis Mucor, Rhizopus, Absidia


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SYSTEMIC MYCOSES

Pathogenic Opportunistic

Agent dimorphic fungus non-dimorphic fungus

Port dentre lung (per inhalation ) lung & others

Disease usually chronic usually acute

Patients could be healthy patients usually illpatient


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SYSTEMIC MYCOSESCANDIDIASIS = Candidosis

acute / chronic fungal infections, involving, the mouth,vagina, skin nails, bronchi / lung, alimentary tract,urinary tract, blood steam and less commonly, the heartor meningen

are caused by Candida albicans or other species

are predisposed by : extremes of age, wasting, &nutritional disease, excessive moisture, pregnancy,

diabetes, long-term antibiotics, & steroid use, indwellingcatheter, immunosupressed & AIDS

are generally treated with imidazoles, polyenes or both


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CANDIDIASISCandida albicans : is part of the normal flora of the skin, mucous

membranes & GI tract along with other Candidasp.

normal colonization must be distinguised frominfection

form elongated budding forms calledpseudohyphae, which are often seen in clinicalmaterial along with true hyphae, blastoconidia &yaest cells


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CANDIDIASIS

Clinical features : oral thrush is a yeast infectoins of the oral mucocutaneus

membranes

manifest as white curd-like patches in the oralcavity

occurs in premature infants; older infantsbeing treated with antibiotics,immunosuppressed patients, long-termantibiotics & AIDS patients


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CANDIDIASIS

Clinical features : Vulvovaginitis is a yeast infection of the vagina; manifest with a

thick yellow-white discharge, a burning

sensation, curd-like patches on the vaginalmucosa & inflamation of perineum

is predisposed by diabetes, antibiotic therapy,

oral contraceptive use & pregnancy may be trasmitted to sexual partner as balanitis

CANDIDIASIS


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CANDIDIASIS

Clinical features : Cutaneus candidiasis involves the nails ( onychomycosis; paronychis ), skin

folds ( intertriginosa ) or groin ( such as diaper rash )

may be eczematoid or vesicular / pustular; is

predisposed by moist condition

Clinical feature : alimetary tract disease :

is usually an extension of oral thrush & may includeesophagitis & ultimately the entire gastrintestinal tract

is found in patients with AIDS or otherimmunosuppressive disorder, particularly those patientson long-term antibiotics therapy


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CANDIDIASIS


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CANDIDIASISClinical feature :

Chronic mucocutaneus candidiasis

is a chronic, often disfiguring, infections of the epithelialsurfaces of the body

is diagnosed microscipically & by the lack of cellmediated immunity

Clinical feature :

Bronchopulmonary infections occurs in patient with chronic lung disease; its usually

manifested by persistent cough

CANDIDIASIS


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CANDIDIASISClinical feature :

Candidemia / blood borne infections occurs most commonly in patients with indwelling

catheter; these infections are manifested by fever,macronodular skin lesion & endopthalmitis

Clinical feature : Endocarditis

occurs in patient who have manipulated or damagedvalves, or in IV drug abusers

Clinical feature : Cerebrospinal infections

may occur in compromised patients

CANDIDIASIS


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CANDIDIASISLaboratory diagnosis :

direct microscopic examination : wet mount of the skin /nail scraping or exudate, demonstration of the presenceof pseudohyphae / hyphae, & yeast in the tissue

culture : of the specimens on to SDA at roomtemperature, Candida will grows as yaest-like colony

C. albicans be identified by :

* germ tube test -- yeast germination in serum at 370C

* culture on corn-meal-agar -- reveals chlamydospres

* culture on Eosin-methylen-blue-agar : reveals spidercolony

* fermentation test of : glucose, lactose, maltose,sacharose

serologic : high levels of Candida precipitins or antigens


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SYSTEMIC MYCOSES : Opportunistic

CRIPTOCOCCOSIS

include subacute or chronic fungal infectionsinvolving the lungs, meninges, or lesscommonly the skin, bones & other tissues

most commonly occur as cryptococcalmeningtis; often occuring in AIDS patients

is caused by Cryptococcus neoformans; yeastthat posseses an antigenic polysaccharidaecapsule

is associated with pigeon feces; considered tobe an opportunist in the present of underlyingdisease in patients with Hodgkins disease,leukomias; or leucocyte enzyme deficiency

disease

CRYPTOCOCCOSIS Busse Buschkes disease


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CRYPTOCOCCOSIS = Busse-Buschkes disease= European Blastomycosis

Clinical feature : pulmonary infections : are ussually

asymptomatic; & self resolving;

most common in pigeon breeder

meningitis ( most often ) or

meningoencephalitis occurs in AIDSpatients most commonly withheadache, ussually with fever,

followed by typical sign of meningitis

CRYPTOCOCCOSIS


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CRYPTOCOCCOSISLaboratory diagnosis :

microscopic examination : wet mount,demonstration of encapsulated yeast in CSFsediment in india-ink

detection of the capsular material in the CSF (the cryptococcal antigen ) by latex agglutinationtest

culture : in SDA ( Sabouraud dextrase agar )revealyeast colony

Treatment : Amphotericin B, 5- fluorocytosisn or

fluconazol


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ASPERGILLOSIS

caaused by Aspergillus fumigatus, an

opportunistic organism

is a ubiquitous filmentous fungus whose

airborne spores are contantly in the air

is recognized both in tissue & in culture by itscharacteristic septate hyphae with

dichotomous branching, produced conidial

heads with numerous conidia


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ASPERGILLOSIS

Clinical feature :Aspergilloma = fungus ball :

is a roughly spherical growth of

Aspergillus in pre existing lung cavities &

does not invade the lung tissue

occurs clinically as reccurent hemoptysis& diagnosed by radiologig method

Treatment : surgical ( lobectomy )

ASPERGILLOSIS


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ASPERGILLOSISClinical features : Invasive aspergillosis

occurs most commonly during severe neotropenic inleukemia & transplantm patients; most commonly occursas fever of unknown origin in patient with neutropenia

fewer than 500/mm3

& pneumonia

it may begin as sinusitis or lungs; it disseminate to anypart of the body, most frequently brain

is diagnosed by microscopy & culture of lung biopsymaterial

is trested with amphotericin B or intraconzole & has ahigh fatality rate


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ASPERGILLOSIS

Clinical features :Allergic bronchopulmonary -aspergillosis

is an allergic disease, in which theorganism colonies the mucous plugs form

in the lung, but does not invade lungtissue

is diagnosed by finding of high titer of IgE

antibodies

SYSTEMIC MYCOSES O t i ti


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ZYGOMYCOSIS = Mucormycosis + Phycomycosis

caused by the genera Rhizopus, Mucor & Absidia;non-septate fungi; phylum Zygomycota; grow repidly& predilection for invading blood vessels & the brain

Clinical features : thoracic infectoins

occur in leukemia & lymphoma patients

abdominal-pelvic infections occurs in malnourish

patients

cutaneus infections occurs in patients withleukemia30

ZYGOMYCOSIS


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ZYGOMYCOSISClinical features : Rhinocerebral infections

is the common form; occurs in patients with acidoticdiabetes

presents with facial swelling & blood tinged exudate inthe turbinate bones & eyes; lethargy & fixated pupil

is a fatal infections & spreads rapidly

must be diagnosed rapidly; ussually by a KOH mount of

necrotic tissue or exudate from the eye, nose, or ear

Treatment : control of diabetes; Surgical debridement;

amnphotericin B

Mycosis Systemik Opportunistik & Pathogens

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