INFEKSI PADA KLIEN DENGAN

IMMUNOCOMPROMISED

Kelompok 7

PENDAHULUANThe human body has a complex system of protective mechanisms to prevent infection, involving both the adaptive (cellular and humoral) immune system and the innate defense system (e.g. skin, mucous membranes).

PENGERTIAN Compromised hosts are people who have one or more defects in their body's natural defenses against

microbial invaders. Consequently they are much more liable to suffer

from severe and life-threatening infections

TERBAGI DUA KELOMPOK Defects, accidental or intentional, in the

body's innate defense mechanisms; Deficiencies in the adaptive immune

response.

GANGGUAN SISTEM IMUN Primary immunodeficiency

- Inherited or occurs by exposure in utero to environmental factors or by other unknown mechanisms. chronic granulomatous disease (Congenital defects in phagocytic cells )

- Rare , and varies in severity depending upon the type of defect

- Immunoglobulin deficiency

GANGGUAN SISTEM IMUN Secondary or acquired immunodeficiency

- Due to an underlying disease state) or occurs as a result of treatment for a disease.

- Malnutrition is a common and the most important cause of acquired immunodeficiency

- Treatment of disease can also cause immunosuppression

INFEKSI KLIEN IMUNOCOMPROMISED KARENA FAKTOR FISIK

Infeksi luka bakarThe most important pathogens in burn wounds are: - Pseudomonas aeruginosa and other Gram-

negative rods- Staphylococcus aureus- Streptococcus pyogenes;- other streptococci;- enterococci

INFEKSI KLIEN IMUNOCOMPROMISED KARENA FAKTOR FISIK

Traumatic injury and surgical wound infections- Staph. aureus is the most important cause of

surgical wound infection - Catheter-associated infection of the urinary tract is

common - Staphylococci are the most common cause of

intravenous and peritoneal dialysis catheter infections

INFEKSI KLIEN IMUNOCOMPROMISED KARENA FAKTOR FISIK

Infections of plastic devices in situ Staph. epidermidis is the most common cause of prosthetic valve and joint infections

Infections due to compromised clearance mechanisms Stasis predisposes to infection, and in health the body functions to prevent stasis

INFECTIONS ASSOCIATED WITH SECONDARY ADAPTIVE IMMUNODEFICIENCY

Hematologic malignancy and bone marrow transplant infectionsA lack of circulating neutrophils following bone marrow failure predisposes to infection, Gram-negative rods such as Escherichia coli and P. aeruginosa, Staph. epidermidis dan fungi

Solid organ transplant infections Most infections occur within 3-4 months of transplantation

AIDS infections The clinical definition of AIDS includes the presence of one or more opportunistic infections

OTHER IMPORTANT OPPORTUNIST PATHOGENS

A. Fungi Candida is the most common fungal pathogen in compromised patients , manisfestasi beragam tergantung area :- Chronic mucocutaneous candidiasis- Oropharyngeal and esophageal candidiasis- Gastrointestinal candidiasis- Disseminated candidiasis

FUNGI Cryptococcus neoformans

- Most common in people with impaired cell-mediated immunity

- An opportunistic yeast with a worldwide distribution.

- Cause infection in the immunocompetent host, - Infection is seen more frequently in people with

impaired cell-mediated immunity.

FUNGI Histoplasma capsulatum

- Infection may occur years after exposure- Highly infectious fungus that causes an acute but benign

pulmonary infection in healthy people- Produce a chronic progressive disseminated disease.- Endemic only in tropical parts of the world and notably

in the so-called 'histo belt' of the central USA, particularly in the Ohio and Mississippi river valleys.

- The natural habitat of the organism is the soil. - Transmitted by the airborne route and the fungal spores

are deposited in the alveoli, from whence the fungus spreads via the lymphatics to the regional lymph nodes.

FUNGI Aspergillus spp

- Usually a fatal disease in diseases of the lung- Cause of invasive disease in compromised patients- Usually in profoundly neutropenic patients or those

receiving high dose corticosteroids). - Found in soil, but have a worldwide distribution- Infection is spread by the airborne route, and the

lung is the site of invasion in almost every case

FUNGI Pneumocystis jiroveci (formerly P.

carinii)- Causes symptomatic disease in people with deficient

cellular immunity - An atypical fungus which appears to be widespread,- High incidence of P. jiroveci pneumonia in patients

receiving immunosuppressive therapy to prevent transplant rejection and in people with HIV.

- Very rare to find Pneumocystis infection in any other site in the body

OTHER IMPORTANT OPPORTUNIST PATHOGENS

BACTERIA Nocardia asteroides

Uncommon opportunist pathogen with a worldwide distribution contain two pathogenic genera, Actinomyces and Nocardia

Mycobacterium aviumIntracellulare disease is often a terminal event in AIDS This includes disseminated infection with Mycobacterium tuberculosis and Mycobacterium avium-intracellulare (Mycobacterium avium complex or MAC

OTHER IMPORTANT OPPORTUNIST PATHOGENS

PROTOZOA AND HELMINTHS Cryptosporidium and Isospora belli

- Cause severe diarrhea in AIDS - Protozoan parasite that causes human disease- Well known to veterinarians as an animal

pathogen

PROTOZOA AND HELMINTHS

Strongyloides stercoralis - Immunosuppression may lead to

reactivation of dormant parasitic- Roundworm that remains dormant

for years following initial infection, - May be reactivated to produce

massive autoinfection in the immunosuppressed patient

OTHER IMPORTANT OPPORTUNIST PATHOGENS

VIRUSES EBV infection

- Associated with the development of Hodgkin's disease,

- Non-Hodgkin's lymphomas in individuals with HIV infection,

- Post-transplantation lymphoproliferative disease

- Smooth-muscle tumors in immunosuppressed children

VIRUSES

Adenovirus infectionPrimary and reactivated adenovirus infections can result in disseminated disease in immunocompromised hosts, in particular pediatric and adult bone marrow transplant recipients.

VIRUSES Hepatitis B infection

Hepatitis B virus infection has an immunopathological basis, with jaundice occurring after cytotoxic T cells have lysed the hepatitis B surface-antigen-bearing hepatocytes

VIRUSES Polyoma viruses

BK or JC viruses, acquired via the respiratory tract and latent in the kidney, are often detected in the urine of bone marrow transplant recipients