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DESCRIPTION
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Chlamydophila pneumoniae & Jamur penyebab infeksi pernafasan
Pratami Adityaningsari
Bag Mikrobiologi
Chlamydophila pneumoniae / Chlamydia pneumoniae
- obligate intracellular
- known as the Taiwan acute respiratory agent
(TWAR)
Kingdom : Bacteria
Phylum : Chlamydiae
Order : Chlamydiales
Family : Chlamydiaceae
Genus : Chlamydophila
Species : C. pneumoniae
3 species of Chlamydia :
C. trachomatis
C. psittaci
C. pneumoniae
The latter moved to a new genus : Chlamydophila
Chlamydophila psittaci & C. pneumoniae inf. of respiratory tract
Chlamydophila pneumoniae exists as an elementary body (EB) between hosts. The EB
travels from an infected person to the lungs of an uninfected person in small droplets and is
responsible for infection. Once in the lungs, the EB is taken up by cells in a pouch called an
endosome by a process called phagocytosis. However, the EB is not destroyed by fusion with
lysosomes, as is typical for phagocytosed material. Instead, it transforms into a reticulate
body and begins to replicate within the endosome. The reticulate bodies must use some of
the host's cellular metabolism to complete its replication. The reticulate bodies then convert
back to elementary bodies and are released back into the lung, often after causing the death
of the host cell. The EBs are thereafter able to infect new cells, either in the same organism
or in a new host.
Thus, the life cycle of C. pneumoniae is divided between the
elementary body, which is able to infect new hosts but can not
replicate, and the reticulate body, which replicates but is not
able to cause new infection.
(Chlamydia) pneumoniae in an epithelial cell in acute bronchitis: 1 - infected epitheliocyte,
2 - uninfected epitheliocytes, 3 - chlamydial inclusion bodies in cell, 4 - cell nuclei
C. pneumoniae less commonly causes several other illnesses, but can
cause meningoencephalitis, arthritis, myocarditis & Guillain –
Barre Syndrome
There is no vaccine to protect against Chlamydia pneumoniae.
Fungal Diseases of the Lower Respiratory System
Fungal Diseases may germinate in the lower respiratory tract.
The incidence of fungal diseases has been increasing in recent years.
The mycoses below can be treated with amphotericin B.
That fungal are :
Histoplasma capsulatum
Coccidioides immitis
Blastomyces dermatitidis.
Pneumocystis jiroveci (carinii).
Histoplasmosis
Histoplasma capsulatum causes a subclinical infection.
The disease is acquired by inhalation of airborne conidia.
Isolation of the fungus or identification of the fungus in tissue samples is
necessary for diagnosis.
Histoplasma capsulatum
Kingdom: Fungi
Phylum : Ascomycota
Subphylum: Ascomycotina
Class: Ascomycetes
Order: Onygenales
Family: Onygenaceae
Genus: Histoplasma
Caused by Histoplasma capsulatum
Variety duboisii
Not as severe of an infection
Variety capsulatum
Common cause of histoplasmosis
It grows in soil, particularly if the soil is heavily contaminated
with bird droppings, especially from starlings.
Although the birds are not infected, bats can be infected and can
excrete the organism in their guano
Infection occurs when airborne spores enter a host organism’s
respiratory tract
Inhaled spores are engulfed by macrophages and develop into yeast
forms.
In tissues, H. capsulatum occurs as an oval budding yeast inside
macrophages
The yeasts survive within the phagolysosome of the macrophage by
producing alkaline substances, such as bicarbonate and ammonia, that
raise the pH and thereby inactivate the degradative enzymes of the
phagolysosome
The organisms spread widely throughout the body; especially to the
liver and spleen, but most infections remain asymptomaric, and the
small grantdomatous foci heal by calcification.
Histoplasmosis first affects the lungs and can spread to other organs,
including the brain
1. Dormant Stage
2. Acute Stage
3. Chronic Stage
4. Systemic Stage (Disseminated Histoplasmosis)
Dormant Stage
No symptoms exist
Fungi survives in spore form within the lungs
Acute Stage
Characterized by short bursts of activity
Symptoms
Flu
Lung Issues
Cough
Chest pain (nyeri dada)
Inflammation of infected areas
Fever
Chills (menggigil)
Chronic Stage
Histoplasma capsulatum becomes established in the body
The fungus goes through alternations of activity and dormancy
Symptoms
Increase in frequency of previous symptoms
Shortness of breath
Excessive sweating (berkeringat)
Liver infection or spleen infection
Systemic Stage
Occurs as the fungus reaches all parts of the host organism,
including most organs and the central nervous system
Symptoms
Increase in frequency of previous symptoms
Skin and mouth sores (lidah kotor), including rashes
Joint and muscle pain (nyeri sendi & otot)
Headache
Neck stiffness (kaku kuduk)
Mikroskopik
Makroskopik
Detection
Lung X-Ray
Tissue Samples
Blood, Bone Marrow, Skin
Cultures
Blood, Sputum
Testing
Antigen Testing*
CD4 Count
oEarly Detection Saves Lives!
Antifungal Medications
Amphotericin B
Azoles
Fluconazole
Itraconazole
Ketonazole
Coccidioides immitis
Kingdom : Fungi
Division : Ascomycota
Class : Euascomycetes
Order : Onygenales
Family : Onygenaceae
Genus : Coccidioides
Disease
Coccidioides immitis causes coccidioidomycosis.
Properties C. immitis is a dimorphic fungus that exists as a
mold in soil and as a spherule in tissue
Patogenesis
In soil, it forms hyphae with alternating
arthrospores and empty cells.
Arthrospores are very light and are carried by the wind.
They can be inhaled and infect the lungs.
In the lungs, arthrospores form spherules that are large, have a
thick, doubly refractive wall, and are filled with endospores.
Upon rupture of the wall, endospores are released and differentiate
to form new spherules.
The organism can spread within a person by direct extension or via
the bloodstream.
Granulomatous lesions can occur in virtually any organ but are
found primarily in bones and the central nervous system
(meningitis)
Dissemination from the lungs to other organs occurs in people who
have a defect in cell-mediated immunity.
Mikroskopis
Makroskopis
Antifungi
amfoterisin B, ketokonazole, itrakonazole
In tissue specimens, spherules are seen microscopically.
Cultures on Sabouraud's agar incubated at 25 °C show hyphae with arthrospores
(Caution: Cultures are highly infectious; precautions against inhaling arthrospores must be taken.)
Coccidioidomycosis
Inhalation of the airborne arthrospores of Coccidioides immitis
Most cases are subclinical but predisposing factors such as fatigue
and poor nutrition can contribute to a progressive disease
Symptoms include chest pain, fever, coughing, and weight loss.
Life Cycle of Coccidioides immitis
Blastomyces dermatitidis
Kingdom : Fungi
Phylum : Ascomycota
Class : Euascomycetes
Order : Onygenales
Family : Onygenaceae
Genus : Blastomyces
Blastomycosis is a chronic granulomatous
and suppurative disease having a primary
pulmonary stage that is frequently followed
by dissemination to other body sites, chiefly
the skin and bone.
Aetiological Agent:
Blastomyces dermatitidis, a soil inhabiting
fungus.
Manifestasi klinik
The patient usually presents with cough, fever, night sweats, and
general weakness and may be thought to have tuberculosis.
The sputum may be blood stained and
purulent, again suggesting tuberculosis.
The cutaneous form of infection presents as
papules which progress to crusty ulceration
Skin lesions are often multiple and most
commonly appear on the face and limbs.
They are usually painless and may be mistaken for squamous cell
carcinoma
Atrophic scars develop where there have been old lesions.
Other lesions can occur in the mucous
membranes of the nose, mouth, larynx, and
vagina
Blastomycosis
Caused by Blastomyces dermatitidis.
The infection begins in the lungs and spreads to cause extensive abscesses.
Other Fungi Involved in Respiratory Disease
Occurs most often in immunosuppressed hosts.
Common causes:
Aspergillus
Rhizopus
Mucor
Aspergillus sp
Kingdom: Fungi
Phylum: Deuteromycota
Class: Eurotiomycetes
Order: Eurotiales
Family: Trichocomaceae
Genus: Aspergillus
Aspergilloma. (Fungus ball)
ABPA. (Hypersensitivity)
Aspergillus necrotizing bronchitis.
endo-bronchial mass, obstructive pneumonitis, collapse, hilar mass.
Invasive Pulmonary Aspergillosis.
Angioinvasive/ hemorrhagic infarcts.
Airway invasive-obstructing.
Faktor virulensi
binding to fibrinogen & laminin, secretion
elastase & protease, katalase
Gejala klinik
Clinical findings could be non-specific.
Some patients may remain asymptomatic.
Most frequent symptom is HEMOPTYSIS 75%.
Less commonly chest pain, dyspnea , malaise.
Wheezing and fever (could also be secondary to underlying disease, or
bacterial super infection of the cavity or aspergilloma itself).
Pneumocystis pneumonia
Caused by Pneumocystis jiroveci (carinii).
Pneumocystis jiroveci is an opportunistic pathogen that invades
immunosuppressed or cancer patients.
Untreated causes are usually fatal.