Download - Copy of Misetoma 1
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Mikologi kedokteran :
Ilmu yang mempelajari jamur yang menyebabkan penyakit pada manusia
Mikosis : penyakit yang disebabkan oleh jamur.
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Mikosis (Rippon dkk) :
1.Superfisialis : P. versicolor Piedra hitam /
putih
2. Cutaneous : Dermatofitosis ;
Microsporum sp, * Trichophyton
sp, *
Epidermophyton sp, ( kulit,
kuku,rambut ) * Candidiasis
( kulit, kuku membran mukosa )
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3. Subcutaneous : * Chromoblastomycosis * Mycetoma * Entomorphthoromycosis * Rhinosporidiosis * Lobomycosis * Sporotrichosis
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4.Systemic Pathogenic fungous
infections - Histoplasmosis - Blastomycosis - Paracoccidioidomycosis - Coccidioidomycosis Opportunistic fungous
infections - Cryptococcosis - Aspergillosis - Mucormycosis - Candidiasis (sistemik) - Pseudallescheriasis
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5. Mikosis lain (jarang) * Phaeohyphomycosis * Hypomycosis * algosis * Basidiomycosis
Biakan : jamur membentuk koloni 1. koloni filamen 2. koloni seperti ragi (Candida) 3. koloni ragi (Cryptococcus)
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Jamur dimorphic :
1.Biakan pada suhu kamar : koloni filamen
2.Biakan pada suhu 37℃ koloni ragi / spt ragi
1. Sporotrichum schenckii2. Histoplasma capsulatum3. Coccidioides immitis 4. Blastomyces dermatitidis5. Paracoccidioides brasiliensis
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Misetoma
Sinonim: madura foot, maduromikosis
eDefin
Definisi :
Kumpulan gejala yg disebabkan oleh infeksi jamur pada jaringan di bawah kulit, berupa pembengkakan, kelainan bentuk (deformitas) dan kantong abses dengan lubang fistel
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Distribusi geografik :
1. Daerah tropik (Indonesia)
2. Asia selatan
3. Amerika (Tropisubtropik
4. Sudan, Mexico (endemis)
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JAMUR PENYEBAB:
I. MISETOMA AKTINOMIKOTIK : GOL. SCHIZOMYCOPHYTA 1. Actinomyces 2. Nocardia 3. Streptomyces gram positive filamentous bac
II. MISETOMA MADUROMIKOTIK (Eumycotic mycetoma)
Gol. Eumycophyta 1. Madurella mycetoma 2. Pseudallescheria boydii mycetoma
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Granula butir butir jamur (grain) :
adalah gumpalan hifa.
Berwarna putih,kuning,hitam,
coklat,merah.
Jamur ditemukan di tanah & tum
buhan busuk
Cara infeksi : tusukan / trauma
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Jamur penyebab :
1.Misetoma dg granula hitam *Madurella mycetomatis (worldwide) *Madurella grisea (Africa,South&Central America) *Leptophaeria senegalensis ( Africa) *Pyrenochaeta romeroi ( Africa, South America)
2.Misetoma dg granula putih *Pseudallescheria boydii (Worldwide) *Acremonium sp (Africa, Middle East) *Noetestudina rosati ( Africa)
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3. Misetoma dg granula putih / kuning * Actinomadura madurae ( Worldwide)
* Nocardia asteroides ( Worldwide) * Nocardia brasiliensis (Central America)
4. Misetoma dg granula coklat / merah * Actinomadura pelletieri (Africa) * Streptomyces somaliensis (North Africa, Middle East )
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Morfologi :
I. Actinomadura madurae Syn: Actinomyces madurae Nocardia madurae Streptomyces madurae Jamur ini adalah Gram positive filamentous bacteria Menyebabkan : Mycetoma Actinomycosis / Madura foot
Makroskopis :
•Biakan dg agar Sabauraud’s•Putih-kuning, red or pink •Shiny, glabrous, waxy, wrinkled surface
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Mikroskopik :
1. Hifa bercabang, <= 1µm2. Spherical conidia3. Gram positive & non-acid-fast
Histopatologi :
* Tepi granula terdapat hifa (long fringes) dikelilingi eosinofil, forming clubs.
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II. Allescheria boydii :
Mycetoma / maduromycosis / madura foot
1. Makroskopis :
* Biakan dg agarSabouraud’s
* warna putih sp smooky grey
2. Mikroskopis :
* ovoid – pyriform conidia * diujung conidiaphore
Conidia di ujung conidiophore
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A. boydii :
3. Histopatologi : Bahan : pus + granula * horse-shoe shaped / oval. * eosinofil di perifer * hifa ber septum * ujung hifa melebar (form vesicle) * lebar hifa 2 – 4 mikron
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PEMBENGKAKAN :
ABSESDEFORMITYFISTUL
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Mycetoma pedis N. asteroides
Mycetoma pedisN. asteroides
Mycetoma asteroides
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* Misetoma laki > wanita t u umur 20 – 50 tahun * lesi disebabkan karena luka tusuk pada kulit benjolan kecil, keras dan tidak nyeri tekan* Tumbuh perlahan lahan ke otot / tulang deformity Bagian tengah lesi terjadi ulserasi dan keluar pus yang mengandung granula jamur
• Rasa gatal dan panas (+ infeksi sekunder)• Rasa sakit tidak ada• Proses berlangsung menahun.• Kaki (paling banyak), tumgkai, tangan bahu, bagian tubuh lain.
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Diagnosis :Bahan : 1. nanah
2. jaringan biopsi
Cara pemeriksaan :1. Sediaan langsung KOH 10%
--> Gumpalan hifa putih/kuning
2. Sediaan histopatologi ;
Jaringan granulasi + sarang rdg
3. Membedakan Nocardia dg penyebab
lain dipulas dg Ziehl-Neelsen
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Pengobatan :
1. misetoma aktinomikotik yg disebabkan
A. israelii , Nocardia, streptomyces antibiotik
Streptomisin, cotrimoxasole, dapson, rifampicin
3. Misetoma maduromikotik ekstirpasi jaringan ketokonazol, itrakonazolPrognosis : misetoma aktinomikotik > baik daripada misetoma maduromikotik