Opportunistic Mycoses

Transcription

1 CANDIDIASIS SOFYAN LUBIS DEPARTEMEN MIKROBIOLOGI FAK.KEDOKTERAN USU MEDAN 2009 Opportunistic Mycoses Opportunistic mycoses are fungal infections that do not normally cause disease in healthy people, but do cause disease in people with weakened immune defenses (immunocompromised people). Weakened immune function may occur due to inherited immunodeficiency diseases, drugs that suppress the immune system (cancer chemotherapy, corticosteroids, drugs to prevent organ transplant rejection), radiation therapy, infections (e.g., HIV), cancer, diabetes mellitus advanced age,and malnutrition. 1

2 Opportunistic Mycoses The most common infections are: CANDIDIASIS ASPERGILLOSIS CRYPTOCOCCOSIS ZYGOMYCOSIS PNEUMOCYSTIS JIROVECI ( P.carinii) Candida albicans widespread yeast infections can be short-lived, superficial skin irritations overwhelming, fatal systemic diseases budding cells of varying size that my form both elongate pseudohyphae & true hyphae forms off-white, pasty colony with a yeasty odor 2

3 Candida albicans Normal flora of oral cavity, genitalia, large intestine or skin of 20% of humans Account for 80% of nosocomial fungal infections Account for 30% of deaths from nosocomial infections Thrush occurs as a thick, white, adherent growth on the mucous membranes of mouth & throat Vulvovaginal yeast infection painful inflammatory condition of the female genital region that causes ulceration & whitish discharge Cutaneous candidiasis occurs in chronically moist areas of skin and burn patients Candida albicans Normal flora of oral cavity, genitalia, large intestine or skin of 20% of humans Account for 80% of nosocomial fungal infections Account for 30% of deaths from nosocomial infections 3

4 Candida albicans Thrush occurs as a thick, white, adherent growth on the mucous membranes of mouth & throat Vulvovaginal yeast infection painful inflammatory condition of the female genital region that causes ulceration & whitish discharge Cutaneous candidiasis occurs in chronically moist areas of skin and burn patients Candida albicans C. albicans is a member of the indigenous microbial flora of humans. 1. Found in the gastrointestinal tract, upper respiratory tract, buccal cavity, and vaginal tract. 2. Growth is normally suppressed by other microorganisms found in these areas. 3. Alterations of gastrointestinal flora by broad spectrum antibiotics or mucosal injury can lead to gastrointestinal tract invasion. 4. Skin and mucus membranes are normally an effective barrier but damage by introduction of catheters or intravascular devices can permit Candida to enter the bloodstream. In vitro (25 o C): mostly yeast; In vivo (37 o C): Yeast, hyphae and pseudohyphae 4

5 Candida albicans In vitro (25 o C): mostly yeast; In vivo (37 o C): Yeast, hyphae and pseudohyphae Candidiasis Vaginal candidiasis is the most common clinical infection. Local factors such as ph and glucose concentration (under hormonal control) are of prime importance in the occurrence of vaginal candidiasis. In mouth, normal saliva reduces adhesion (lactoferrin is also protective). Immune Response Hyphae are too big for phagocytosis but are damaged by PMNs and by extracellular mechanisms (myeloperoxidase and b- glucuronidase). Cytokine activated lymphocytes can inhibit growth of C. albicans. Resistance to invasive infection by Candida is mediated by phagocytes, complement and antibody, though cell-mediated immunity plays a major role. Patients with defects in phagocytosis function and myeloperoxidase deficiency are at risk for disseminated (even fatal) Candidiasis. 5

6 Candidiasis Vaginal candidiasis is the most common clinical infection. Local factors such as ph and glucose concentration (under hormonal control) are of prime importance in the occurrence of vaginal candidiasis. In mouth, normal saliva reduces adhesion (lactoferrin is also protective). Candidiasis, immune response Hyphae are too big for phagocytosis but are damaged by PMNs and by extracellular mechanisms (myeloperoxidase and b- glucuronidase). Cytokine activated lymphocytes can inhibit growth of C. albicans. Resistance to invasive infection by Candida is mediated by phagocytes, complement and antibody, though cellmediated immunity plays a major role. Patients with defects in phagocytosis function and myeloperoxidase deficiency are at risk for disseminated (even fatal) Candidiasis. 6

7 Candidiasis of skin, mucous membranes and nails Predisposing factors Infancy, pregnancy, old age Disorders of immune function, e.g., leukemia, corticosteroid therapy Chemotherapy, e.g., immunosuppressive, antibiotic Endocrine disease, e.g., diabetes mellitus Carcinoma 7

8 Candidiasis of skin, mucous membranes and nails Oropharyngeal candidiasis, including: THRUSH GLOSSITIS, STOMATITIS, AND ANGULAR CHEILITIS ( PERLECHE ) Candidiasis of skin, mucous membranes and nails 8

9 Candida albicans Candidiasis Thrush Vaginal 9

10 Opportunistic Infection by Candida albicans in an AIDS Patient Source: Atlas of Clinical Oral Pathology, 1999 Candidiasis of skin, mucous membranes and nails Cutaneous candidiasis, including : intertrigo, diaper candidiasis, paronychia,and onychomycosis 10

11 Candidiasis of skin, mucous membranes and nails 11

12 Tinea unguium Tinea pedis Candida albicans infection of the nails Source: Microbiology Perspectives,

13 Candidiasis Vaginal candidiasis is the most common clinical infection. Local factors such as ph and glucose concentration (under hormonal control) are of prime importance in the occurrence of vaginal candidiasis. In mouth: normal saliva reduces adhesion (lactoferrin is also protective). Candidiasis of skin, mucous membranes and nails Vulvovaginal candidiasis and balanitis: vaginal discharge, dysuria, erythematous oral contraceptive, pregnancy 13

14 Candidiasis Thrush Cutaneous Risk factors for Candidiasis Post-operative status Cytotoxic cancer chemotherapy Antibiotic therapy Burns Drug abuse Gastrointestinal damage. 14

15 Chronic mucocutaneous candidiasis Chronic mucocutaneous candidiasis (CMC) is the label given to a group of overlapping syndromes that have in common a clinical pattern of persistent, severe, and diffuse cutaneous candidal infections. These infections affect the skin, nails and mucous membranes. Immunologic studies of patients with CMC often reveal defects related to cell-mediated immunity, but the defects themselves vary widely. Chronic mucocutaneous candidiasis Chronic mucocutaneous candidiasis (CMC) is the label given to a group of overlapping syndromes that have in common a clinical pattern of persistent, severe, and diffuse cutaneous candidal infections. These infections affect the skin, nails and mucous membranes. Immunologic studies of patients with CMC often reveal defects related to cell-mediated immunity, but the defects themselves vary widely. 15

16 Mucutaneous candidiasis: response to fluconazole Transfusion of a Candida-specific transfer factor has been reported to be very successful (remission for > 10 years) when combined with antifungal therapy. The availability of effective oral agents, especially the azole antimicotics, has dramatically changed the life of patients living with CMC. Candida albicans 16

17 Lab diagnosis of C.albicans: 1. Germ tube test 2. Pembentukan khlamidospora di cornmeal agar 3. Di medium EMB Levine : membentuk koloni seperti kaki laba-laba 4. Fermentasi sugars 5. Assimilasi sugars Candidiasis 17

18 Chlamydospores of C.albicans Vulvovaginitis of children The vagina is close to the anus and the vulva lacks the protective labial fat and pubic hair of an adult. Also, children often have poor personal hygiene. Children with vulvovaginitis may complain of pain, itching, and burning around the vagina; a vaginal discharge; and pain when urinating. Causes of vulvovaginitis in children include: bacteria or fungus, pinworm, contact irritants, skin diseases, and and foreign body. 18

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