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MYCOLOGY

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Introduction
• ± 70,000 spesise, 300 human infections
• Penyakit:
– Umumnya jinak,
– sulit diobati  mengancam jiwa
– meningkat:
• Penggunaan Obat: antibiotik, immunosuppressive
• Penurunan sistem imun

• Perananan:
– di tanah peranan degradasi senyawa organic
– industri, menghasilkan antibiotic
– Sebagian: pathogen, patogen oportunistik, kontaminan
– Flora normal
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Sifat Umum
• organisme eukariotik:
– Inti:
• kromosom > 1,
• terbungkus membrane inti,
– Sitoplasmanya:
• Mitokondria
• Ribosom tipe 80s.

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– Dinding sel rigid: chitine, glukan, khas:
ergosterol

– Heterotropik:
• tidak memiliki klorofil, tidak dapat mengolah
makanan sendiri  parasit
• Habitat:hidup di seluruh alam:
– Suhu tinggi (tropik)
– Kelembaban
– Oksigen
– Bahan organik

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KLASIFIKASI EUMYCETES (JAMUR SEJATI)

I. ASCOMYCETES Fusi
seksual dalam sacus / ascus – 4 – 8 spora  ascospore Aseksual
spore muncul ujung hifa  conidia Contoh.: Trichophyton,
Microsporum, Blastommyces

II. BASIDIOMYCETES
Fusi seksual disebut basidium  basidiospore Aseksual
spore muncul diujung hifa  conidia Contoh : Cryptococcus
neoformans

III. DEUTEROMYCETES – INPERFECT FUNGI


Proses seksual belum dapat diamati
Contoh : Epidermophyton, Sporothrix, Candida sp

IV. ZYGOMYCETES (MUCOR)


Mycelium tak bersepta, menghasilkan spora aseksual sporangium
Fusi seksual dalam keadaan istirahat, sel dinding tebal  zygospora
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Contoh : Rhizopus nigrans
Morfologi

1. Yeasts/ragi/khamir: uniseluler
2. Molds/kapang: multiseluler, hifa
3. Dimorphic fungi:
– in vivo, in vitro at 37°C : as yeasts
– in vitro at 25°C : as molds

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Mold/Kapang
• sel jamur berbentuk benang (filamnentous)
• dinding mengandung gugus sterol: ergosterol
• Sitoplasma: mengandung satu inti/lebih
• Antar sel dibatasi septa yang sering, atau tak bersepta,
inti menyebar (coenocytic)
• Hifa yang membentuk anyaman disebut miselium.
• Jenis hifa:
1. Hifa vegetatif: hifa yang masuk ke dalam substrat/media untuk
menyerap makanan.
2. Hifa aerial: hifa yang menonjol ke luar substrat.
3. Hifa reproduktif: hifa yang menghasilkan sel-sel reproduksi.

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Mold/Kapang, contoh:
• Dermatofita : penyakit kulit
• Kontaminan/patogen oportunistik:
– Aspergillus : aspergilosis
– Rhyzopus : zygomicosis
– Penicillium : penicilliosis

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Dimorphic Fungi

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Pathogenesis
• Kemampuan tumbuh pada 37°C
• Dermatophytes: Production of keratinase
• Bahan Antiphagocytic properties: kapsul pd
Cryptococcus neoformans
• Kemampuan Adherence (menempel)
• Faktor penyebar:
– Lokal: dermatophytes
– subcutaneous tissue
– sistemik:
• Infeksi paru
• Penyebaran hematogen
• Reaksi alergi
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Host Defenses
• Status kekebalan sangat penting
• Umumnya jamur mempunyai virulensi
rendah  infeksi oportunistik
• Sistem pertahanan:
– Nonspecific barriers
• Respon imun spesifik:
– Imunitas seluler: +++
– Imunitas humoral: ++
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FAKTOR RISIKO
• Penyakit yg menurunkan kekebalan: AIDS,
keganasan
• Obat-obatan penekan sistem imun:
sitostatika, kortikosteroid, pasien cangkok
jaringan
• Gangguan keseimbangan flora normal:
antibiotik jangka panjang, peralatan
terpasang (kateter, NS tube)

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Summary of Disease Mechanisms of Fungi

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Systemic
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Summary of Fungal infections

1. Superficial Fungal Infections


• Involve: only the outermost layers of the stratum corneum of the skin
(Phaeoannellomyces werneckii [syn. Exophiala werneckii] and M furfur)
or the cuticle of the hair shaft (Trichosporon beigelii and Piedraia
hortae)
• These infections usually constitute cosmetic problems
2. Dermatophyte Infections
• colonize skin, hair, and nails
• greater invasive properties, but they are limited to the keratinized
tissues
• They cause a wide spectrum of diseases: mild scaling disorder 
generalized and highly inflammatory

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3. Subcutaneous Mycoses
• Abundant in the environment
• have a low degree of infectivity
• access to the subcutaneous tissues through traumatic
implantation
• Histopathologic evidence indicates:
• producing proteolytic enzymes
• maintaining a facultative microaerophilic existence because of
the lowered redox potential of the damaged tissue
4. Systemic Mycoses
• 6 agents: Histoplasma capsulatum, Blastomyces dermatitidis,
Paracoccidioides brasiliensis, Coccidioides immitis, and
Penicillium marneffei are dimorphic. C immitis that forms
spherules
• primary site of infection is the respiratory tract
• C neoformans have shown that the acidic mucopolysaccharide
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Deep mycoses caused by:

1. primary pathogenic:
able to establish infection in a normal host
Agent : Blastomycosis dermatitidis, Coccidiodiodes immitis
Histoplasma capsulatum , Paracoccidioides
brasiliensis

2. opportunistic fungal pathogens: require a compromised host in


order to establish infection
Agent of Opportunistic Mycoses:
i. Candidiasis
ii. Aspergillosis
iii. Zygomycosis: Rhizopus, Rhizomucor, Absidia, Mucor
species, or other
members of the class of Zygomycetes
iv. Cryptococcosis
v. Phaeohyphomycosis
vi. Hyalohyphomycosis
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Actinomycetes
Funguslike Bacteria

• Actynomycosis : Actynomyces
• Nocardiosis : Nocardia

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Diagnosis
• Clinical presentation
• Microscopic examination: direct, biopsy
• Chest radiograph
• Serology

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Control
• Prevention:
– Maintenance of a "spore-free" environment
– Immunocompromised patients: management of
the underlying disease, prophylaxis therapy
• Treatment:
– Inhibitors of ergosterol biosynthesis: azoles,
allylamine, morpholine
– complexes with ergosterol: polyenes
– Inhibit DNA and RNA synthesis: 5-fluorocytosine
– Inhibit mitosis: griseofulvin

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SUPERFICIAL MYCOSIS

I. TINEA VERSICOLOR / PITYRIASIS VERSICOLOR


Malassezia furfur
mild infection – asymptomatic –Groth within stratum corneum of
cluster of sperical – short-thick skinned budding – hyphae
Chest-back-abdomen-neck –depigmented to brownish-red
Tx: 1% selenium sulfide/day/15 mnt/washed of

II. TINEA NIGRA


Exophiala wernecki
light brown to blakish macular –palmar-plantar stratum corneum
no scaling / reaction develops . Tx.:
III. PIEDRA
Piedra hortae  hard black nodule –around the scalp hair
Trichosporon cutaneum softer-white to like brown nodul
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axyllary-pubic-beard-scalp hair
CUTANEUS MYCOSIS

Superficial keratinized tissue : skin – hair – nail


Dermatophytes : Epidermophyton–Microsporum–Trichophyton
Keratine :Hyphae – arthroconidia
Culture : characteristic : coloni – conidia
Eped : Mediterranean : T schonleinii, Tropical : T rubrum
Cats – Dogs : M canis

MORPOLOGY - IDENTIFICATION

Trichophyton ( Arthroderma )
Microconidia dominant – Macroconidia rare
Formation according to species
T mentagrophytes – T rubrum – T tonsurans
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Trichophyton mentagrophytes Culture
: granular to powdery , grape-like
cluster-microconidia on terminal branches Cotony
strain : tear-drops microconidia

T rubrum
Colonies : red color Tear
drop shape microconidia along the side of hypha

T tonsurans
Coloni powdery
microconidia numerous and clavate – borne on short branches

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MICROSPORUM ( NANNIZZIA )
Macroconidia are predominant, large, rough-walled,
multicellular, spindle shape, on the end of hypha.
Infected skin and hair, rarely the nail

M canis

Thick-walled, 8-15 celled macroconidia, curved/hooked spiny tips


Infected hair  flourescence a bright green under Wood’s light

M gypseum

4-6 celled macroconidia

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Tinea korporis Tinea kruris

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Tinea imbrikata Tinea manum
Tinea pedis interdigitalis

Tinea
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pedis subakut Tinea pedis hiperkeratotik
DIAGNOSTIC LABORATORY TEST

SPECIMENS
Scrapings : skin-hair-nail . Mycrosporum 
flourescens under Wood’s light

MICROSCOPIC EXAMINATION

10-20 % potasium hydroxide, eva : 0 & 20 mnt


Trichophyton sp.  exothrix / endothrix

CULTURE

Sabouraud agar slant / 1-3 weeks / room temp. microscopic


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TREATMENT

Removed : infected & dead epithel / scalp / hair


Prevent reinfection : griseofulfin 1-4 weeks

Scalp inf.: Shampoos – miconazole cream – anti fungal

Body inf: miconazle cream–undecylenic acid cream–salicylic acid

Foot.inf.acute: KMNO4 1:5000  antifungal


Foot.inf.chronic: Cream antifungal (night) – powder (day)

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EPIDEMIOLOGI - CONTROL

Contact – skin , hair, hyphae (str.corneum), M canis (cats-dogs)


Babershope clippers, headrests – person to person

Control : Clenliness – sterilization instrument ( hot mineral oil)

Athlete.s foot: wear shoes chronic asymptomatic 


active (excesive heat / moisture / unsuitable footwear)
Inft.spreads: showers-dressing room

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SUBCUTANEOUS MYCOSES

Source : soil – decaying vegetation lesions iplantation


Extention lymphatic is slow except in Sporotrichosis

SPOROTHRIX SCHENCKII
Dimorphic fungi – in plant-wood
skin (traumatic)sporotrichosis: chronic granulamotous inf.
Spread along lymphatic draining the area

MORPHOLOGY - IDENTIFICATION

Rarelyseen in pus& tissue  small, round to cigar-shape,


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ANTIGENIC STRUCTURE
Heat-killed saline suspensions of culture (carbohydrat fractions)
 positive delayed skin test ( in infected human/animal ) A
variety antibodies are found in infected patients
(sometimes in normal individuals)

PATHOGENESIS – CLINICAL FINDING

Fungus -> skin (trauma) local lesions pustule, abscess / ulcer 


multiple subcutaneous nodule abscess occure along the lymphatics
 a little syst.illness  dessemination joint (debiletated patient)
 rarely  lung inf.

Histologically: chronic inflamaton and granulamas - necrosis

Organisme in tissue  spesiic immunoflourescence


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Sp schenckii (cotton blue)
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DIAGNOSTIC. LAB. TESTS

Pus / biopsy lesion  budding cell (rarely) Saboroud’s


agar conidia / yeast (37 C) – dimorphic fungi

Serology: agglutination yeast susp. / latect coated antigen


Not diagnostic
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TREATMENT

Self limited
Cutaneeous lymphatic form  Potassium iodide Systemic
involment Amphotericin B (IV) / ketoconazole (PO)

EPIDEMIOLOGY - CONTROL

S schenckii : in nature – plant, decaying wood, soil, inf.animal

Prevention of trauma in this occu[ations :


gardener, nursery worker, miners, contact with plant

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CHROMOMYCOSIS

Epidemiologi : Africa – Latin America


Skin of legs farmer worker

Slowly progresivegranulomatous infection of skin,couse by :


sp.black molds : Phialophora verrucosa , P(Fonsecaea) pedrosoi,
Clasdoporium carrionii

Fungi skin(trauma)months/yearslymphatic nodule


secondary infectionselephaniasis

Scraping / biopsy + KOH 10% round fungus cells

Cultured: Saboutoud’s agar  conidia

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MYCETOMA

Localized, swolle lesion with granuloma, draining from sinuses

Caused by:
fungi : Petriellidium boydii, Madurella sp, Philospora sp,
Madurella mucetomatis, Aspergillu sp, Fusarium sp.

Actinomycetes (filamentous bacteria):


Nocardia brasiliensis, Actinomadura madurae

Agent  subcutan tissue (foot, hand, back) by trauma


abscess  muscle / bone  chronic sinus Chronic –
untreated deeper & peripherily  deformity
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Dx.: characteristic morphological of granules

Tx.: Actinomycotic mycetomas : early with sulfonamides

Fungal mycetoma ; Tx ?  surgical

Epid.-control : cleaning wound – wearing shoes


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In The Name of Allah , Most Gracious, Most Merciful

By ( the token of ) time ( throught the Ages )

Verily Man is in Loss

Exept such as have Faith


and do righteous deeds
and ( join together ) in mutual teaching of Truth
and of Patience and Constancy

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ERYTHEMATHOUS CANDIDIASIS

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Germination of C. albicans

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Aspergillus Rhyzopus Penicillium

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Onikomikosis Onikomikosis Onikomikosis
proximal lateral & distal total distrofi

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Infeksi Candida
Dermatophytosis

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Penicilliosis

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Penicilliosis

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Aspergillosis (lanjutan)
• Foto toraks:
Infiltrat uni/bi-lateral (73%), kavitas (34%), noduler (14%)
Kavitas di lap. atas paru dapat  hemoptysis
Bentuk obstruksi: konsolidasi lap bawah difus bilateral
dan
atelektasis
• CT scan:
Nodul parenkim dengan halo di sekelilingnya dan kavitas

4/19/2018 Infiltrat dgn kavitas berdinding tebal