infeksi jamur oportunistik

8/12/2019 infeksi jamur oportunistik

1/27

OPPORTUNISTIC FUNGALINFECTIONS


2/27

MYCOSES4. ENDEMIC (PRIMARY,

SYSTEMIC):

Histoplasma capsulatum,Coccidioides immitis,

Blastomyces dermatitidis,Paracoccidioides brasiliensis


3/27

MYCOSES5.OPPORTUNISTIC

endogenous

- Candida(differentspecies)

- Pneumocystis carinii (?)


4/27

MYCOSES5.OPPORTUNISTIC

exogenous

- Cryptococcus neoformans- Aspergillus (differentspecies)

- Zygomycetes

- MANY OTHER FUNGI


5/27

Candida albicans and otherCandida species

Harmless inhabitants of

the skin and mucousmembranes of all humans

Normal immune system

keeps candida on bodysurfaces


6/27


7/27

MAIN DEFENSE MECHANISMSAGAINST CANDIDA II.

phagocytosis

killing, mostly inpolymorphonuclear cells,

less in macrophages T-cells (CD4)


8/27

THE MOST IMPORTANT RISKFACTORS

1. Neutropenia

2. Diabetes mellitus

3. AIDS

4. SCID

5. Myeloperoxidase defects

6. Broad-spectrum antibiotics


9/27

THE MOST IMPORTANTRISK FACTORS

7. Indwelling catethers

8. Major surgery

9. Organ transplantation

10. Neonates

11. Severity of any illness

12. Intravenous drug addicts


10/27

CLINICAL FORMS OFCANDIDIASIS

1. Cutaneous andmucosal

candidiasis


11/27

CLINICAL FORMS OFCANDIDIASIS

2. Invasive (systemic,disseminated,

hematogenous)candidiasis


12/27

INVASIVE CANDIDIASIS

Usually begins withcandidemia(but in only

about 50% of casescandidemia can be proven)

If phagocytic system isnormal, invasive infectionstops here


13/27

INVASIVE CANDIDIASIS

If phagocytic system iscompromised, infection

spreads to many organsand causes focalinfection in these organs

mortality of candidemiais 30-40%


14/27

DIAGNOSIS OF INVASIVECANDIDIASIS

Gram stain and isolationfrom blood, CSF or

peritoneal fluid isolation and/or pathology

positive of organ involved other tests are of lower

significance for the diagnosis


15/27

EPIDEMIOLOGY

Although candidiasis isendogenous in most cases,

cross infectionsaredescribed, especially in

intensive care unitpatients.


16/27

Pneumocystis carinii

Present in lungsof many

mammals, includinghumans, in persistent butharmless infection


17/27

Pneumocystis carinii

Main defense mechanismis T-cell mediated

causes interstitialpneumonitis incompromised patients

treatment and prevention:cotrimoxasoleor pentamidine


18/27

Cryptococcus neoformans

Occurs worldwide in soil andin bird droppings

Prominent feature: thickpolysaccharide capsule,

which causes evasion fromphagocytosis


19/27

MAIN DEFENSEMECHANISMS AND

PATHOGENESIS

T-cells responsible fordefense

Cryptococcus reaches

humans by inhalationofaerosolized yeast cells


20/27

CHRONIC MENINGITIS INAIDS-PATIENTS

The most important clinicalsyndrome

treatment: amphotericinB+/-flucytosine

recurrence prevention:fluconazole


21/27

EPIDEMIOLOGY OFCRYPTOCOCCOSIS

Infection is alwaysexogenous, is not

transmitted from human

to human


22/27

Aspergillusspecies

Aspergilli are worldwideoccurring saprophytes,

living in soil and on plants;they have small conidia

that form aerosols


23/27

Main defense mechanism isphagocytosis

Main risk factors arehematological malignancy,bone marrow transplantationand corticosteroid therapy


24/27


25/27

ZYGOMYCETES

Zygomycetes are ubiquitoussaprophytes

main host defense isphagocytosis

main risk factors are diabetes,hematological malignancies,corticosteroid therapy


26/27

Major clinical syndrome is:

Rhinocerebral mucormycosis(infection of nasal passages,

sinuses, eyes, cranial bonesand brain)

Treatment: surgery andamphotericin BPrognosis: very poor


27/27

OPPORTUNISTIC FUNGALINFECTIONS ARE:

difficult to diagnose

difficult to treat

difficult to prevent

more and more frequent

a great challenge for afuture work in all fields

Documents

infeksi jamur oportunistik