Professional Documents
Culture Documents
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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
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
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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
• 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
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
M gypseum
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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
CULTURE
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EPIDEMIOLOGI - CONTROL
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SUBCUTANEOUS MYCOSES
SPOROTHRIX SCHENCKII
Dimorphic fungi – in plant-wood
skin (traumatic)sporotrichosis: chronic granulamotous inf.
Spread along lymphatic draining the area
MORPHOLOGY - IDENTIFICATION
Self limited
Cutaneeous lymphatic form Potassium iodide Systemic
involment Amphotericin B (IV) / ketoconazole (PO)
EPIDEMIOLOGY - CONTROL
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CHROMOMYCOSIS
Caused by:
fungi : Petriellidium boydii, Madurella sp, Philospora sp,
Madurella mucetomatis, Aspergillu sp, Fusarium sp.
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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