INFEKSI FUNGI

1. Pepy Dwi Endraswari, dr. INFEKSI FUNGI

2. Mikrobaeukariot: • Fungi • Algae • Protozoa • Parasitic helminths

3. Peran fungi • decomposer • Sumber antibiotik • Membantu proses pembuatan makanan • Efek negatif: mycoses, produksi toxin, merusak makanan

4. 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.

5. Penyakit yang ditimbulkanolehinfeksi fungi:

6. Penyakit yang ditimbulkanolehinfeksi fungi:

7. PokokBahasan • Karakteristik fungi • Morfologi • Reproduksi • Nutrisi • Epidemiologi • Klasifikasi Fungi • Infeksi Fungi  mycoses

8. 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

9. 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.

10. Morfologi yeast

11. Hyphae / Molds • Multicellular, filamentous fungi (Long filaments of cells joined together) • Identified by physical appearance, colony characteristics, and reproductive spores. • Hiphae: • Septatehyphae: 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.

12. Morfologihiphae/molds

13. MorfologiHiphae / Molds

14. Mycelium: Large, Visible Mass of Hyphae

15. 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

16. 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.

17. Asexual mold spores

18. 4 main divisions based on spore type • Zygomycota (Conjugation Fungi) • Ascomycota (Sac Fungi) • Basidiomycota (Club Fungi) • Deuteromycota – no sexual spores

19. I. Zygospores: Also known as bread molds.

20. II. Ascospores

21. III. Basidospores

22. 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

23. INFEKSI JAMUR (Mycoses) • JamurPenyebab • Epidemiologi • Manifestasiklinik • Diagnosis Mikrobiologi • Terapi

24. Mycoses • Merupakaninfeksikronis, karenapertumbuhanjamur yang lambat • Klasifikasi: • Superficial mycoses • Cutaneus mycoses • Subcutaneus mycoses • Systemic mycoses • Opportunistic mycoses

25. General Clinical Classification of Pathogenic Fungi

26. Epidemiologi

27. How can you control a disease if you don’t know the source?

28. 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?

29. Epidemiologically we have three groups of fungi: 1.) Dermatophytoses: man, animal, soil. 2.) Exogenously acquired: soil, air. 3.) Endogenous in origin: normal flora. Let’s look at the above three groups separately

30. Three groups (con’t) 1.) Dermatophytoses:

31. Dermatophytoses (con’t) 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.

32. Dermatophytoses (con’t) 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.

33. Dermatophytoses (con’t) • 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 with infected clothing.

34. 2.) Exogenously acquired: soil & air  This includes all other mycoses (one major exception: Opportunistic infection by candidaalbicans). 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) , Mycotickeratitis

35. Exogenously acquired:Subcutaneus mycoses

36. Exogenously acquired:Sporotrichosis 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

37. 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. Penicillium, one of numerous soil fungi causing this disease. Patient

38. 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.

39. Air and lungs (con’t) • 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 Coccidioidesimmitis favors salty soils. • SporothricosisThe pulmonary form is caused by spores entering the lungs from peat moss or other dusty forms of organic matter.

40. Air and lung: Aspergillosis Lung infarct (left), aspergilloma (right). Diseases initiated by spores entering the lungs. Aspergillus with infectious spores (3-6 microns).

41. 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.

42. Candidiasis (con’t) 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.

43. 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.

44. Clinical Mycology

45. 1. Superficial Mycoses • Infections of hair shafts and superficial epidermal cells. • Prevalent in tropical climates.

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

47. Clinical Manifestation

48. Diagnosis laboratorium • Spesimen: skin scrapping (kerokan kulit), potongan rambut  pengecatan dengan KOH 10-20%  diamati dibawah mikroskop • Terapi: obat antifungal topikal

49. 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.

50. Cutaneus mycoses