Mikosis paru

Dr Indah Rahmawati, Sp.P

FKIK UNSOED / RSMS Purwokerto
TROPMED, 2 September 2010
 Inhalation of fungal
spores
DISEASE SPECTRUM

ALLERGY
Spores SINUSITIS
8 µm
ASPERGILLOMA

PULMONARY
ASPERGILLOSIS
2-4 µm
DISEMINATED
ASPERGILLOSIS
 Diagnosis of respiratory
mycoses

 Presence of risk factors

 Clinical signs
 Laboratory
 Microscopy & Culture of sputum
and BAL
Serology - detection of antibodies
and fungal antigens
Detection of fungal DNA using PCR
 Risk factors

• Usually in patients with

– Preexisting lung disease
– Hypersensitivity
– Immunosuppression
 Jamur paru

• Aspergillosis
• Kandidiasis
• Histoplasmosis
• Kriptokokosis
• Blastomikosis
 Aspergillosis

• Aspergillus flavus
• Aspergillus niger
• Aspergillus fumigatus
• Aspergillus clavatus
 inhalasi  paru
 A. Flavus kacang tanah

• Aflatoxin (aspergillus flavus toxin)

• AFT B1 dan AFTB2  karsinogenik,
hepatotoksik, mutagenik,
immunosuppesif
• Banyak pada produk pertanian /
olahan / peternakan
 Penyakit yang ditimbulkan

• Aflatoxikosis
• Aspergillosis :
Allergic Bronchopulmonary
Aspergillosis
Aspergillosis invasif
• Aspergilloma (Mycetoma)
( Bola jamur berisi mycelia )
 Aspergilloma

• Usually in preexisting cavaties or

cyst
• Hemoptysis, a common symptom
and complication
• Progression more in HIV(+)
• Hemoptysis more in HIV(-)
 Aspergilloma

• Typical finding : well-defined

homogeneous nodular opacity
within a cavity with air crescent
sign, may be movable.
• Atypical : focal thickening/
fronds/ sponge like opacity in
cavity
ASPERGILLOMA
ASPERGILLOMA

029
Hyphae of Aspergillus fumigatus
 Candidiasis

• Candida infections are usually due to

impaired epithelial barrier functions
• Occur in all age groups  most
common in newborn / elderly
• The clinical manifestations may be
acute, subacute or chronic to
episodic
 Clinical manifestations

• Oropharyngeal candidiasis
• Cutaneous candidiasis
• Vulvovaginal candidiasis and balanitis
• Chronic mucocutaneous candidiasis
• Neonatal and congenital candidiasis
• Oesophageal candidiasis
• Gastrointestinal candidiasis
 Clinical manifestations

• Pulmonary candidiasis
• Peritonitis
• Urinary tract candidiasis
• Meningitis
• Hepatic and hepatosplenic
candidiasis
• Endocarditis, myocarditis and
pericarditis
 Clinical manifestations

• Candidemia (Candida septicemia)

and disseminated candidiasis
• Ocular candidiasis
• Osteoarticular candidiasis
• Other forms of candidiasis
(cholecystitis, pancreatitis,
prostatitis, etc)
 Clinical groups and / or predisposing
factors for invasive candidiasis

• Neutropenia (especially >7 days)

• Hematological malignancy
• Solid tumor malignancy
• Postsurgical intensive care patients
• Prolonged intravenous catheterization
• Broad-spectrum or multiple antibiotic therapy
• Diabetes mellitus
• Parental nutrition
• Severe burns
• Neonates
• Corticosteroid therapy
• Intravenous drug abuse
 Pulmonary candidiasis

• Hematogenous dissemination causing a

diffuse pneumonia or by bronchial
extension in patients with oropharyngeal
candidiasis
• Aspiration of yeasts from the oral cavity
• Aspecific radiological and culture findings
 present at autopsy
• Histopathology can provide a definitive
diagnosis
LIDAH ANUS
KUKU JARI SPORA
 Kriptokokosis

• The AIDS epidemic,

immunosuppressive agents by
increasing numbers of solid organ
transplant recipients
• Asymptomatic nodular disease to
severe acute respiratory distress
syndrome (ARDS)
• Classic symptoms of pneumonitis
(cough, fever, sputum production)
• Pleural symptoms may predominate
CRYPTOCOCCOSIS
 Histoplasmosis

• Daerah sungai, iklim tropis

• Kotoran kelelawar / burung
• Batuk, demam, nyeri dada/sendi
• Ssm tlg, hepar, lien, sal cerna
• Disseminata  AIDS, ggn sistem
immun
• Diagnosis : jamur dalam sputum /
tempat lesi, Antibodi dalam darah
HISTOPLASMOSIS
 Blastomikosis

• Banyak di Amerika tenggara /

barat
• Saluran napas, kulit, tulang,
sendi dan kelenjar prostat
• Gejala flu
 Clinical
manifestations
• Asymptomatic infection occurs in at
least 50% of infected persons
• Symptomatic disease develops after
an incubation period of 30–45 days
• Acute pulmonary blastomycosis
mimics influenza or bacterial
pneumonia
 Radiographic findings

• Alveolar infiltrates
• mass lesions that mimic
bronchogenic Carcinoma
• fibronodular interstitial
infiltrates
BLASTOMIKOSIS
 Koksidioidomikosis

• Banyak di Amerika barat / selatan

• Saluran napas, tulang, sendi, kulit
dan selaput otak
• Diagnosis : jamur dalam sputum /
tempat lesi, Antibodi dalam darah
 Clinical manifestations

• The main symptoms are fever,

pleuritic chest pain, cough, malaise,
headache, myalgia, night sweats and
loss of appetite
• Clinical material: Skin scrapings,
sputum and bronchial washings,
cerebrospinal fluid, pleural fluid and
blood, bone marrow, urine and tissue
biopsies from various visceral organs
 Terapi jamur paru

• Amphoterisin B
• Itraconazole
• Voriconazole