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Pepy Dwi Endraswari, dr.

Mikroba eukariot:
Fungi
Algae
Protozoa
Parasitic helminths

Peran fungi
decomposer
Sumber antibiotik
Membantu proses pembuatan

makanan
Efek negatif: mycoses, produksi toxin,
merusak makanan

Kingdom Fungi
Terdiri dari >100,000 species dibagi

menjadi 2 groups:
macroscopic fungi ( mushrooms)
microscopic fungi (molds, yeasts)

Dari >1oo,000 species yang

ditemukan 100 spesies patogen


bagi manusia.

Penyakit yang ditimbulkan oleh


infeksi fungi:

Penyakit yang ditimbulkan oleh


infeksi fungi:

Pokok Bahasan
Karakteristik fungi
Morfologi
Reproduksi
Nutrisi

Epidemiologi
Klasifikasi Fungi
Infeksi Fungi mycoses

1. Morfologi Fungi
Dinding sel: mengandung chitin
Membran sel: mengandung ergosterol
Mikroskopik: memiliki 2 macam morfologi:
yeast berbentuk bulat-oval
hyphae berbentuk filamen , disebut

juga:molds

Beberapa fungi mempunyai kedua fase

tersebut disebut sbg fungi dimorphic


merupakan karakteristik jamur patogen
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Yeast
Unicellular fungi, nonfilamentous,

typically oval or spherical cells.


Reproduce by mitosis.
Yeasts are facultative anaerobes,

which allows them to grow in a


variety of environments.
When oxygen is available, they carry out aerobic

respiration.
When oxygen is not available, they ferment

carbohydrates to produce ethanol and carbon dioxide.

Morfolog
i yeast

10

Hyphae / Molds
Multicellular, filamentous fungi (Long filaments of

cells joined together)


Identified by physical appearance, colony
characteristics, and reproductive spores.
Hiphae:

Septate hyphae: Cells are divided by cross-walls

(septa).
Coenocytic (Aseptate) hyphae: Long, continuous cells
that are not divided by septa.

Part of hiphae:
Vegetative Hypha: Portion that obtains nutrients.
Reproductive or Aerial Hypha: Portion connected with

reproduction.

Mycelium: Large, visible, filamentous mass made

up of many hyphae.

Morfologi hiphae/molds

12

Morfologi Hiphae / Molds

Mycelium: Large, Visible Mass of


Hyphae

Dimorphic Fungi
Can exist as both multicellular fungi

(molds) and yeasts.


Many pathogenic species.
Mold form produces aerial and vegetative hyphae.
Yeast form reproduces by budding.

Dimorphism in pathogenic fungi

typically depends on temperature:


At 37oC: Yeast form.
At 25oC: Mold form.

Dimorphism in nonpathogenic fungi may

depend on other factors: Carbon dioxide


concentration

2. Reproduksi Fungi
Hiphae : form spores
asexual reproduction spores are formed

through budding or in conidia or sporangiospores


sexual reproduction spores are formed
following fusion of male & female strains &
formation of sexual structure

Yeast : Asexual reproduction by mitosis


Fission yeasts: Divide evenly to produce two new cells
Budding yeasts: Divide unevenly by budding

Budding yeasts can form pseudohypha, a short chain


of undetached cells.

16

Asexual mold spores

17

4 main divisions based on


spore type
1. Zygomycota (Conjugation Fungi)
2. Ascomycota (Sac Fungi)
3. Basidiomycota (Club Fungi)
4. Deuteromycota no sexual spores

18

I. Zygospores:

Also known

as bread molds.

19

II. Ascospores

20

III. Basidospores

21

Nutrisi Fungi
heterotrophic
Mayoritas tidak membahayakan, hidup

secara saprofit pada tumbuhan atau


hewan yang mati
Beberapa mrpkn parasit yang hidup pada
jaringan organisme lain infeksi jamur
mycoses
growth temperature 20o-40oC

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INFEKSI JAMUR
(Mycoses)

Jamur Penyebab
Epidemiologi

Manifestasi klinik
Diagnosis
Mikrobiologi
Terapi

Mycoses
Merupakan infeksi kronis, karena

pertumbuhan jamur yang lambat


Klasifikasi:
1. Superficial mycoses
2. Cutaneus mycoses
3. Subcutaneus mycoses
4. Systemic mycoses
5. Opportunistic mycoses

General Clinical
Classification of
Pathogenic
Fungi
Superficia
Cutaneus Subcutan
Sistemic
l
Pityriasis
versicolor
Tinea
niegra
Piedra

eus
Tinea pedis
Tinea
unguinum
Tinea
corporis
Tinea cruris
Tinea
manus
Tinea
capitis
Tinea
barbae

Chromoblas
tomycosisi
Sporothrico
sis
Mycetoma
Phaeohypo
mycois

Aspergillosis
Blastomycosi
s
Candidosis
Coccidioidom
ycosis
Histoplasmos
is
Cryptococcos
is
Geothrichosi
s
Paracoccidioi
domycosis
Zygomycosis

Opportonisti
c
Aspergillosis
Candidosis
Cryptococcosis
Zygomycosis
Geothricosis
Fusariosis
Trichosporonosi
s
Others

How can you control a disease


if you dont know the source?

Factors to consider:
- Where do pathogens live in nature?
- How do they disseminate?
- What is the human portal of entry?
- Why is a human susceptible?

Epidemiologically we have three


groups of fungi:
1.) Dermatophytoses: man, animal, soil.
2.) Exogenously acquired: soil, air.
3.) Endogenous in origin: normal flora.

Lets look at the above three groups separately

Three groups (cont)

1.) Dermatophytoses:

Dermatophytoses (cont)
Fungi which caused ringworms
These diseases are classified by the mode
transmission:
a.) Anthropophilic implies organisms that
are spread from man to man
e.g.
Epidermophyton floccosum, Microsporum
audouinii, M. ferrugineum and
several Trichophyton spp.

Dermatophytoses (cont)
b.) Geophilic are organisms that live in soil
and maybe transmitted to man by soil
contact, e.g. Microsporum gypseum (often
causing tinea barbae).
c.) Zoophilic are organisms which are
transmitted to man from animals other than
man (dogs, cats, cattle, etc.). Some
zoophilic dermatophytes are Microsporum
canis, Trichophyton verrucosum and two
varieties of T. mentagrophytes.

Dermatophytoses (cont)

Mode and vehicle of


transmission:
- Transmitted by contact with soil,
infected humans and infected animals.
- Transmission is with hyphae and/or
spores in soil or infected skin, nails or
hair.
- In some cases fomite transmission is

2.)

Exogenously acquired: soil & air

This includes all other mycoses (one major


exception: Opportunistic infection by candida
albicans).
Disease is acquired from one of two sources:

A.) Soil
Where fungi live forming hyphae and spores,
they enter the host via punctured wounds
and trauma. Spore size is not important.
The following are some examples of diseases
that are acquired by this mechanism.Example:
Subcutaneus mycosis (Sporothricosis, Mycetoma,
Chromomycosis) , Mycotic keratitis

Exogenously
acquired:Subcutaneus
mycoses

Exogenously acquired:Sporotrichos
Note hyphae and spores which live
in nature on plant material and are
the infectious particles.

This is the pathogenic phase


which is not infectious. It can be
grown in the laboratory at 35 C,
i.e. the fungus is

dimorphic

Exogenously acquired:Mycotic
Keratitis
- Numerous fungi cause keratitis worldwide but mostly in
tropical or heavily agricultural areas. Spores and hyphae
are implanted onto eye following trauma.

Patient

Penicillium, one of numerous


soil fungi causing this disease.

B.) Air and lungs


These are fungi which grow in nature but produce
airborne infectious particles which have the correct size
limitations to enter the human lung.

Note that airborne particles greater than 6 microns


cannot enter the human lung.

Air and lungs (cont)


Aspergillosis Organisms in environment, cannot
eliminate
Histoplasmosis Spread from bird droppings,
especially blackbirds, chickens and bats
Cryptococcosis In pigeon droppings and near
Eucalyptus trees
Coccidioidomycosis in area characterized by little
rainfall and intense heat. Some evidence that the
organism Coccidioides immitis favors salty soils.
SporothricosisThe pulmonary form is caused by
spores entering the lungs from peat moss or other
dusty forms of organic matter.

Air and lung: Aspergillosis

Lung infarct (left), aspergilloma (right). Diseases initiated by


spores entering the lungs.

Aspergillus with infectious


spores
(3-6 microns).

3.) Endogenously
acquired
Candidiasis is the only major systemic
mycosis that is endogenous in origin. That
means that the numerous yeast species are
part of mans normal flora. This means that
the key to infection is predisposing factors,
e.g. 90 % of AIDS patients have candidiasis.
The only exception to being endogenous in
origin is STD candidiasis and nosocomial
acquired candidiasis, usually from hospital
workers.
Today, candidiasis is the most important
systemic mycoses in the world.

Candidiasis (cont)
Dissemination or disease spread is with yeast cells and/or
hyphae. The hyphae looks distorted, thus it is sometimes called
pseudohyphae.
The disease is worldwide and fatal in susceptible hosts.

Yeast cells and pseudohyphae seen in patients.

Conclusions
1.) Most systemic mycoses are acquired from fungi
which live in soil on decaying vegetation.
2.) Fungi produce hyphae and spores which enter
humans via a punctured wound or, if less than 6
microns, can enter the lungs.
3.) Dermatophytoses (ringworms) can be transmitted
to man from soil, animals and other men.
4.) Candidiasis is the only major mycosis that is
endogenous in origin.
5.) Most systemic mycoses are seen in patients that
have depressed immunity. This may be genetic or
acquired.

1. Superficial Mycoses
Infections of hair shafts and

superficial epidermal cells.


Prevalent in tropical climates.

1. Superficial mycosis
Definition: Infections of hair shafts and superficial
epidermal cells. Limited to the stratum corneum.
No Inflamation. Cosmetic problem.

Disease

Causative
organisms

Malassezia
Pityriasis vers furfur
icolor

Incidence

Clinical
Manifestatio
n

Common

Hipopigment
ed macule

Tinea nigra

Exophiala
werneckii

Rare

White piedra

Trichosporon
beigelii

Common

Black piedra

Piedraia

Rare

black
macules
black nodule
on hair shaft
cremecolored

Clinical Manifestation

Diagnosis laboratorium
Spesimen: skin scrapping (kerokan

kulit), potongan rambut


pengecatan dengan KOH 10-20%
diamati dibawah mikroskop

Terapi: obat antifungal topikal

2. Cutaneus Mycoses
Infeksi jamur pada jaringan

berkeratin (kulit, rambut dan


kuku)
Jamur mensekresi keratinase, suatu

enzym yang mendegradasi keratin.


Infeksi ditransmisikan melalui

kontak langsung dengan kulit, kuku


atau rambut yang terinfeksi.

Cutaneus mycoses
Disease

Causative
organisms

Incidence

Dermatophytes
(Microsporum,
DermatophytosisRi
Common
Trichophyton,
ngworm of the scal
Epidermophyton)
p,glabrous skin a
Candidiasis
of
Candida albicans
nd nails.
Common
skin andandnails. and related species.

Dermatophytosis: Ringworm of t
he scalp, glabrous skin and na
ils Disease
Symptoms
Tinea capitis
Tinea corporis
Tinea manus
Tinea cruris "jock
itch"
Tinea pedis"athlete's
foot"

ringworm lesion of scalp


ringworm lesion of trunk, arms,
legs
ringworm lesion of hand
ringworm lesion of groin
ringworm lesion of foot

Tinea unguium

infection of nails

Ectothrix

infection of hair shaft surface

Endothrix

infection of hair shaft interior

Dermatophytosis:
Clinical Manifestation

Tinea Pedis: is
transmitted via the
feet by desquamated
skin scales in
substrates like carpet
and matting

Dermatophytosis:
Clinical Manifestation

Tinea
cruris

Tinea Unguinum

Tinea barbae

Tinea corporis

Dermatophytosis: Clinical
Manifestation
Tinea Capitis: Exothrix, Endothrix,
Favus

"Kerion" lesion caused by T.


verrucosum following contact
with cattle.

Tinea capitis showing


extensive hair loss caused
by M. canis.

Endothrix tinea capitis (left) caused by T. tonsurans and


"black dot" tinea capitis (right) caused by T. violaceum

Dermatophytosis:

Laboratoy Diagnosis
Spesimen: Skin Scrapings, nail

scrapings and epilated hairs

Method:
Direct Microscopy: KOH 10-20% and ink

parker
Culture: Sabouraud's dextrose agar
containing cycloheximide incubated at 2628C for 4 weeks

Microscopic & Culture

Skin scrapping:
hiphae

Exothrix:
spore

Culture on SDA

Endothrix:
spore

3. Subcutaneus Mycoses
Infeksi jamur pada jaringan subkutan.
Disebabkan oleh jamur saprofit yang

hidup pada tanah atau tanaman.


Infeksi terjadi karena masuknya spora

atau micelium pada luka kulit.


Dapat menyebar melalui pembuluh

limfe.

3. Subcutaneus Mycoses
Disease

Causative
organisms

Sporotrichosis

Sporothrix
schenckii

Fonsecaea,
Chromoblastomyc Phialophora,
osis
Cladosporium
etc.
Mycotic
mycetoma

Pseudallescheri
a, Madurella,
Acremonium,
Exophiala etc.

Incid Clinical manifestation


ence
Rare

Nodules and ulcers along


lymphatics at site of
inoculation

Rare

Warty nodules that


progress to "cauliflowerlike" appearance at site of
inoculation

Rare

Draining sinus tracts at site


of inoculation

Subcutaneus mycoses:

SPOROTRICHOSIS
Sinonim: Rose Garneners disease
Manifestasi klinis

Cutaneus sporotrichosis
Infeksi sistemik

Sporotrichosis

Characteristic
lymphadenopathy.

Pewarnaan GMS
pada spesimen
biopsi

Subcutaneus mycoses:

Chromoblastomycosis
Penyebab: Fonsecaea pedrosoi,

Fonsecaea compacta, Phialophora


verrucosa, Cladosporium carrionii
Manifestasi klinik:
Nodule verrucous atau plaque
Sering terjadi di daerah tropis yang

lembab
Kebanyakan pada kaki, didahului dgn luka
( bisa pada bagian tubuh lain)
Walaupun jarang, dapat menyerang otak
(menyebar secra hematogen)

Chromomycosis

Etiologic agent showing


dematiaceous hyphae and spores
10-year old case

Subcutaneus mycoses:

MYCETOMA
Sinonim: Madura foot
Penyebab:
Jamur (Eumycotic mycetoma)
Kuman yang mirip jamur (Actinomycotic mycetoma)

Gx klinis:
infeksi subkutan yang membengkak seperti

tumor dan adanya sinus yang mengeluarkan


nanah dan granul / grains seperti butiran pasir
yang mengandung kuman
Ditemukannya granule/grains sangat penting
untuk diagnosa
bbrp jamur/bakteri penyebab mycetoma dapat
di isolasi dari tanah/ pohon.

Mycetomas

15-year old case of mycetoma

One of many etiologic


agents .Note hyphae and
spores which live in nature.
Fusarium sp.

4. Systemic Mycoses

Menginfeksi jaringan/organ secara sistemik

Biasanya disebabkan jamur yang hidup di tanah.

Disease

Causative
organisms

Incidence

Histoplasmosis

Histoplasma
capsulatum
Histoplasma dubosii

Rare*

Coccidioidomycosi
s

Coccidioides
immitis

Rare*

Blastomycosis

Blastomyces
dermatitidis

Rare*

Paracoccidioidomy Paracoccidioides
cosis
brasiliensis
*more common in endemic areas.
Sporotrichosis
Sporothrix schenkii

Rare*
Rare

Histoplasmosis
intracellular infection of the

reticuloendothelial system
caused by the inhalation of conidia from
Histoplasma capsulatum
Isolation:soil enriched with excreta from
chicken, starlings (burung jalak) and bats
(kelelawar).
Major endemic: River Valley in the U.S.A.
Two varieties of H. capsulatum: var.
capsulatum (common) and var. duboisii

HISTOPLASSMOSIS
Clinical manifestations:
95% of cases of histoplasmosis are

inapparent, subclinical or benign.


Five percent of the cases have chronic
progressive lung disease, chronic
cutaneous or systemic disease or an
acute fulminating fatal systemic
disease.
All stages of this disease may mimic
tuberculosis.

Histoplasmosis

COCCIDIOIDOMYCOSIS
initially:a respiratory infection,
resulting from the inhalation of
conidia,
resolves rapidly leaving the patient
with a strong specific immunity
in some individuals the disease may
progress.

Coccidioidomycosis (cont)

Coccidioides immitis is a soil inhabiting


fungus endemic in south-western
U.S.A., northern Mexico and various
centres in South America. Several
cases have now been diagnosed in
Australia, all in patients with a history
of travel to endemic areas.
The organism Coccidioides immitis is
found in desert soils as shown here.
The spores are < 7 microns, become
airborne, enter the lungs and initiate
disease.

fever, pleuritic chest pain, cough, malaise, headache,


myalgia, night sweats and loss of appetite. Many
patients also develop a mild, diffuse erythematous
or maculopapular rash on the trunk and limbs.
5-10% of patients that do develop symptoms are left
with pulmonary residual nodule or cavity that is
usually detected several months or years later.
5% of patients may develop metapulmonary
dissemination to the meninges, bones, joints and
subcutaneous and cutaneous tissues, within the
first few weeks to months after the onset of
primary infection .

5. Opportunistic Mycoses
Adalah infeksi yang terjadi pada manusia/hewan dengan

sistem pertahanan tubuh yang menurun :

pasien AIDS, pasien kanker


Individu yg mendapat terapi antibiotik spektrum
luas
neonatus / individu yang sangat tua

Diabetes melitus
Resipien organ transplan
Terapi steroid

Pada sistem imun yang baik tidak menyebabkan

penyakit.
Penyebab: Flora normal ataupun fungi yang ada di lingkungan

5. Opportunistic
Infection
Disease
Causative organisms

Incidence

Candidiasis

Candida albicansand
related species.

Common

Cryptococcosis

Cryptococcus
neoformans

Rare/Common

Aspergillosis

Aspergillus fumigatus
etc.

Rare

Zygomycosis
(Mucormycosis
)

Rhizopus, Mucor,
Rhizomucor,
Absidia etc.

Rare

Pneumocystosis Pneumocystis carinii

Rare

Opportunistic mycoses:

Candidiasis
Candidiasis also called as Monoliasis,
Can infect Skin, Mucosa, or Internal Organs
Normal flora

Exist in Mouth, Gastrointestinal tract, Vagina,


skin in 20 % of normal Individuals.
Colonization increases with age,in pregnancy,
Hospitalization
Important etiological agent presenting as
opportunistic infection in Diabetus and HIV
patients

Clinical Manifestation

1. Oropharyngeal candidiasis: including thrush, glossitis,


stomatitis and angular cheilitis (perleche).
2. Cutaneous candidiasis: including intertrigo, diaper
candidiasis, paronychia and onychomycosis.
3. Neonatal and congenital candidiasis:
4. Vulvovaginal candidiasis and balanitis:
5. Candidemia (Candida septicemia) and disseminated
candidiasis,etc.

Laboratory diagnosis
Clinical specimen:
Skin scrapings,
Mucosal scrapping,
Vaginal secretions
Blood ans other body fluid
Method:
Direct mikroskopic
Cultures : on Sabouraud's Glucose agar
PCR

Morphology
A true yeast
Round 4 10 microns
Surrounded by Mucopolysaccharide

capsule.
Negative staining with India Ink and
Nigrosin
60% of the infected prove positive by
India Ink preparation on examination of
CSF

Life cycle of
C.neofromans

Found in wild/Domesticated birds (Pigeon) and eucalyptus


tree.Pigeons carry C.neofromans, but do not get infected.

Pathogenesis
Enters through lungs - inhalation of

Basidiospores of C neoformans
Enters deep into lungs.
Self limiting in most cases,
Pulmonary infections can occur.
Present as discrete nodules Cryptococcoma.

Pathogenesis
Can infect normal humans
Abnormalities of T lymphocyte function

aggravates the clinical manifestations (In


AIDS 3- 20% develop Cryptococcosis)
Clinical manifestation: Chronic meningitis ,
Meningo encephalitis ,head ache low grade
fever,Visual abnormalities ,Coma fatal
Can manifest with involvement of ,Skin,
mucosa,organs,Bones,and as Disseminated
form.

Can mimic like Tuberculosis

Laboratory Diagnosis.
Mikroskopic: Indian ink staining, Gram

staining
Kultur :Cultures on Sabouraud
dextrose agar
Serologis: detection of Capsular antigen

Treatment
Immune competent - Antifungal drug
AIDS patients are not totally

cured , Relapses are frequent


with fatal outcome.

Prevention:
Avoid contact with Birds

Aspergillosis
In nature > 100 species of

Aspergillosis exist, Few are important


as human pathogens
1 A.fumigatus
2 A.niger
3 A.flavus
4 A.terreus
5 A.nidulans

Fungal spores enters through


respiratory tract

Morphology
Khas: hifa dengan

spora yang khas


Conidiophores
terminates in a
swollen cell
vesicle
surrounded by one
or two rows of cell
( Streigmata )
from which chains
of asexual conidia
are produced

Pathogenesis - varied
clinical presentations
Allergic Aspergillosis Atopic individuals,

with elevated IgE levels


10-20% of Asthmatics react to A.fumigatus
Allergic alveoitis follows particularly heavy
and repeated exposure to larger number of
spores
Maltsters Lung causes allergic alveolitis, who handle

barley on which A.claveus has sporulated during malting


process

Pathogenesis
Aspergilloma A

fungal ball, fungus


colonize Preexisting
(Tuberculosis )
cavities in the lung
and form compact
ball of Mycelium
which is later
surrounded by dense
fibrous wall presents
with cough, sputum
production
Haemoptysis occurs
due to invasion of
blood vessels

Invasive Aspergillosis

occurs in
immunocompromised
with underlying
disease
A.fumigatus >>
Fungus invades blood
vessels, causes
thrombosis septic
emboli
Can spread to Kidney
and heart.

Pathogenesis