kuliah jamur paru dr wanto

7/25/2019 Kuliah Jamur Paru Dr Wanto

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DIAGNOSIS &

PENGOBATAN DINIMIKOSIS PARU

NGATWANTO

departemen Pulmonologi dan ilmu Kedokteran RespirasiFKIK UNSOEDRS !ARGONO


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COLONIZATION-INVASIONCOLONIZATION-INVASION

Initial situation integument damage in"asion


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GI tractGI tract

MODEL FOR INVASIVE CANDIDIASISBlijlevens, Donnelly, De Pauw. Brit J Haematol

2002;117:259!"

insult

in#ur$

translocation

infection

Antibiotics

Anti-cancer

sele%tion

Normal

commensalflora

DiseaseDisease

Central venous catheter

Candidaspeciesspecies


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Problems in diagnosis

Symptoms & signs: chronic cough, fever,malaise, dyspnea, wheezing, hemoptysis,

resemble those of other pulmonary

disorders physical findings: nonspecific

chest X-ray features of the majority of

respiratory fungal infections mimic

other lung diseases have limited value

in predicting the causative organism


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Host factors

Clinical features

+

iagnosis of Pulmonary !ycosis

Mycology:*serologic exam*direct smear*culture:sputum

tissue

*symptoms&signsphysical findings

chest X-ray features


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MycologyClinicalfeatures

Hostfactors

+ +

Probable=

= ProvenMycology

Clinicalfeatures

Hostfactors

+ +

tissue

MycologyHostfactors

Negativeor

Not done

Clinical

features

+Host

factors

Negativeor

Not done =

=

Possible

iagnosis of Pulmonary !ycosis

+

++

+


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"andida pneumonia Invasive Aspergillosis

Heart & Lung 1998;27(1): 63 - 66

AJR 1982;138: 645 648


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"linical

&

#maging

Studies

in

#nvasive

$spergillosis

&ig' resolution (T)'alo sign or %res%ent

sign in neutropeni% orallogeinei% &S(T

Ot're imaging o* lung+

,rain+ sinus Ot'er-ise une.plained

*e"er and/or lo%als$mptoms inimmunosupressi0edpatientsprobabili

t

resolution


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%adiologic iagnosis

Lancet 2005;366 !0!3-25" alo of low attenuation

surrounding a nodular lesion

is an early finding ininvasive pulmonary aspergillosis

$n air-crescent is also suggest-ive of

invasive aspergillosis but it is a late

finding


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"hest X-ray picture: "ryptococcal Pulmonary #nfection

Radi!g" 199#;175: 725 728


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"hest X-ray picture: "ryptococcosisSolitary or multiple pulmonary nodules,

subpleural, with mild pleural effusion'

"avitation is uncommon'

A 1232445

6 17324458


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Problems

in diagnosis

Sputum, blood

(ronchoscopy, bronchial

washing, tissue biopsy orneedle

aspiration

)ine needle aspiration

biopsy

*ransthoracic needle

aspiration biopsy *ransbronchial

lung biopsy

Procedures

to obtainspecimens

from respir-

atory organsfor mycologic

investigations


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#$+S*#" *.S*S

)% #/$S#/. P01!$%2 !2"S#S

cultureculturehistologyhistology

antigenantigenantibodyantibodyenolaseenolasemannanmannan

PCRPCR

1-3--D-glucan1-3--D-glucan

C-Reactive Protein (CRP),C-Reactive Protein (CRP),

rocalcitonin (PC!),rocalcitonin (PC!),

interleu"in-# ($%-#)interleu"in-# ($%-#)

spe%i9%it$spe%i9%it$ *re:uen%$o*o%%u

rren%e


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!ycology iagnosis of

#nvasive $spergillosis


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3' .mpiric therapy

$ntifungal therapy

is given based onpatients ris4 factors,

sign of infection arepresent,

but the etiologyis not clear

5' efinitive *herapy

#nfection signs are present

fungal infection diagnosis is

proven by histopathology

e6amination 7fungemia8specificity 9;,D-? mgA4gAdaywith oral ;-flucytosine 7?>>mgA4g

day8

- "onsolidation, ?> w4sfluconazole 5>>mg daily


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%ang4uman

Hunci diagnosis dini mi4osis paru ialahwaspada a4an 4emung4inan 4eberadaanpenya4it ini'

Iaspadai berbagai fa4tor pejamuyang memung4in4an invasi jamur

iagnosis mi4osis paru bolehpossible, probable dan proven


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%ang4uman

Pengobatan dini 7profila4sis, empiri4,preemptif8 sudah dapat dimulai pada 4asus

dengan diagnosis

possiblemau punprobable Pilihan obat antijamur 7$8 harus

mempertimbang4an spesies jamur yang

tersering ditemu4an pada pasien dgnfa4tor pejamu tertentu'


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%ang4uman

Seraya mewaspadi 4emung4inan spesiesjamur yg resisten, $ go-longan azol,

terutama vori4onazol dan flu4onazol

adalah pilihan pertama untu4 mi4osisparu'

o4ter spesialis paru harus mampu

memanfaat4an $ lain sepertie4ino4andin dan amfoterisin

kuliah jamur paru dr wanto

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