Kuliah Jamur Paru Dr Wanto
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Transcript of 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