K - 12 Candidiasis...
Transcript of K - 12 Candidiasis...
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CANDIDIASISCANDIDIASIS
SOFYAN LUBISDEPARTEMEN MIKROBIOLOGI
FAK.KEDOKTERAN USUMEDAN
2009
Opportunistic MycosesOpportunistic 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.
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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
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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
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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 (25o C): mostly
yeast;
In vivo (37o C): Yeast,
hyphae and pseudohyphae
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Candida albicans
In vitro (25o C): mostly yeast;
In vivo (37o C): Yeast, hyphae and pseudohyphae
CandidiasisVaginal 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 ResponseHyphae 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.
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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 cell-
mediated immunity plays a major role.
Patients with defects in phagocytosis function and
myeloperoxidase deficiency are at risk for disseminated
(even fatal) Candidiasis.
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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
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Candidiasis of skin, mucous
membranes and nails
Oropharyngeal candidiasis, including:
� THRUSH
� GLOSSITIS,
� STOMATITIS, AND
� ANGULAR CHEILITIS ( PERLECHE )
Candidiasis of skin, mucous
membranes and nails
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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
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Tinea unguium
Tinea pedis
Source: Microbiology Perspectives, 1999.
Candida albicans infection of the
nails
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CandidiasisVaginal 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
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Candidiasis
Cutaneous
Thrush
Risk factors for Candidiasis
Post-operative status
Cytotoxic cancer
chemotherapy
Antibiotic therapy
Burns
Drug abuse
Gastrointestinal damage.
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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.
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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
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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
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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.