Fungi DiarrhaeTitiek Djannatun

Bagian Mikrobiologi FKUY

Mechanism of Diarrhea

1. Osmotic diarrhea

2. Secretory diarrhea

3. Inflammatory diarrhea

4. Abnormal gastrointestinal motility

Clinical approach to diarrhea

Diarrhea Pseudodiarrhea

Acute Chronic

Infectious Non infectious

Acute Diarrhea

Parasite Viruses Bacteria

Bacteria Enteroadherant E.coli Giardia

Parasites Cryptosporidia

Helminths

• 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).

Morphology

(in tissue) in response to 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 albicans

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.