Download - Fungal Diarrhae
Mechanism of Diarrhea
1. Osmotic diarrhea
2. Secretory diarrhea
3. Inflammatory diarrhea
4. Abnormal gastrointestinal motility
• Viral • Norwalk • Rotavirus • Enteric adenovirus • Cytomegalovirus• Herpes simple virus
• Fungal • Candida Sp. • Histoplasma Sp.
Etiology of infectious diarrhea
Foodborne Illnesses Due to consumption of spoiled foods or foods
containg harmful microbes or their products Two categories of food poisoning
Food infections Consumption of living microorganisms
Food intoxications Consumption of microbial toxins rather than
the microbe Symptoms include nausea, vomiting, diarrhea,
fever, fatigue, and muscle cramps
Diare akibat jamur
Terjadi karena infeksi jamur atau toksin jamur atau infeksi oportunis
Beberapa jamur yang mengkontaminasi makanan :› Aspergillus flavus dan Apergillus parasitivus
yang mampu memproduksi mikotoksin› Penicillum martenssi memproduksi aflaktoksin.› Aspergillus achraceus dan Aspergillus melleus
memproduksi asam penisilat.› Mucor sering menyebabkan kerusakan
makanan, misalnya terjadinya pembusukan pada roti
Opportunistic Infection Defined
opportunistic infection
An infection by a microorganism that normally does not cause disease but pathogenic when the body's immune system is impaired and unable to fight off infection, as in AIDS, neutropenia, and congenital or iatrogenic host defense defects.
Opportunistic Infection Defined
Opportunistic Infection- an infection by a microorganism that normally does not cause disease but pathogenic when the body's immune system is impaired and unable to fight off infection› Prolonged Neutropenia- disseminated Candidiasis› Common Variable Immunodeficiency- recurrent
bacterial infections› Chronic liver disease- Vibrio infections› Advanced age, steroid use: disseminated Zoster› HIV/AIDS, BM/Solid organ transplants: CMV
Candida
Candida species are ubiquitous fungi found throughout the world as normal body flora.
Colonize the GI and GU found in hospital environment - food, air, floors and
personnel Candidiasis can range from superficial disorders
such as diaper rash to invasive, rapidly fatal infections in immunocompromised hosts.
Several clinically important species of Candida
Candida albicans is commonly responsible for candidiasis.
Others include: Candida tropicalis, Candida parapsilosis, Candida guilliermondi, and Torulopsis glabrata are also causative organisms
Speciation is important due to differential sensitivities of species to antifungal drugs
Infection with Candida
Candida is the cause of two major classes of disease Muco-cutaneous candidiasis
generally arises from overgrowth of normal flora organisms
Disseminated candidiasis organism invades tissue organism enters bloodstream from colonized
indwelling catheters or surgical wounds
Morphology Genus Candida - diverse group of yeasts
› Budding yeast, Gram stain - positive› ID based on biochemical tests and morphology
(corn meal agar) C. albicans Multiple forms
› Form yeast-like cells (blastoconidia), budding yeast, pseudohyphae and true hyphae (in tissue)
› Forms germ tubes (in presence of serum).
Pathogenesis of Candida infections
Most infections are endogenous› Candida is component of normal oral, GI, vaginal
flora
Pathogenic factors› Essential role of mucosal adherence› Alterations in micro-environment and/or microbial
flora predispose to symptomatic infection. › Germ tube formation, proteinases, phospholipases
may contribute to local invasion by C. albicans
Pathogenic factorsPatologis Faktor Virulensi
Mampu berkolonisasi Generation time pendek
Resisten terhadap lingkungan buruk (suhu dan pH)
Memiliki faktor adhesin (mannoprotein) sehingga memungkin menempel pada epitel dan endotel
Invasi jaringan Sekresi Litikenzim (proteinase, phospholipase)
Membentuk hifa
Persisten di jaringan (terhindar dari respon imun tubuh)
Perubahan fenotipAntigenik mimikri
Candida infections
Cutaneous infections - nails, diaper rash, Mucosal infections
› thrush (tongue, oral mucosa), pseudo-membrane; seen with inhaled steroids, cancer, HIV
› esophagitis in suppressed pts (mucosal invasion)› vulvovaginitis (discharge containing epithelial
cells, pseudohyphae, hyphae)
Candida infections Candidemia/disseminated candidiasis
› Candida spp are 4th leading cause of nosocomial bloodstream infections
› Antibiotics, iv catheters increase risk Antibiotics eliminate normal GI flora, permit
overgrowth of Candida and entry across damaged mucosa (memungkinkan juga candida menempel)
IVs provide entry through skin› Dissemination to kidney, brain, myocardium, eye is
common. Ocular candidiasis - white cotton ball-like lesions of
retina; can cause blindness
Candidiasis - Diagnosis
Specimen: feces Direct microscopic examination
› Important to demonstrate tissue invasion in mucosal infection; positive culture alone may be due to colonization
Culture› Candida spp grow well on standard media. › Candidemia readily detected with commercial blood
culture systems.
Hasil dikombinasikan dengan pemeriksaan klinis (Neutrophenia,dan lain-lain)
Candida: laboratory diagnosis Systemic candidiasis (eg, CNS, joint, blood) Cultures of cerebrospinal fluid (CSF), joint fluid, urine, or
surgical specimens may be obtained to identify candidal infections.
Blood culture is useful for diagnosing endocarditis and catheter-induced sepsis.
Urinalysis (UA) positive for Candida species may predict 38-80% of systemic candidiasis.
Blood culture is not helpful in diagnosing disseminated disease.
Debate among authorities exists regarding the specificity and sensitivity of antigen- and antibody-specific tests.