Pepy Dwi Endraswari, dr.

INFEKSI FUNGI
 Mikroba eukariot:
Fungi
Algae
Protozoa
Parasitic helminths

2
Peran fungi

decomposer
Sumber antibiotik
Membantu proses pembuatan makanan
Efek negatif: mycoses, produksi toxin, merusak
makanan

3
Kingdom Fungi
Terdiri dari >100,000 species dibagi menjadi 2
groups:
macroscopic fungi ( mushrooms)
microscopic fungi (molds, yeasts)
Dari >1oo,000 species yang ditemukan 100
spesies patogen bagi manusia.

4
Penyakit yang ditimbulkan oleh infeksi
fungi:
Penyakit yang ditimbulkan oleh infeksi
fungi:
Pokok Bahasan

Karakteristik fungi
Morfologi
Reproduksi
Nutrisi
Epidemiologi
Klasifikasi Fungi
Infeksi Fungi mycoses
1. Morfologi Fungi

Dinding sel: mengandung chitin

Membran sel: mengandung ergosterol
Mikroskopik: memiliki 2 macam morfologi:
yeast berbentuk bulat-oval
hyphae berbentuk filamen , disebut
juga:molds

Beberapa fungi mempunyai kedua fase

tersebut disebut sbg fungi dimorphic
merupakan karakteristik jamur patogen 8
Yeast
Unicellular fungi, nonfilamentous, typically
oval or spherical cells. Reproduce by
mitosis.
Yeasts are facultative anaerobes, which
allows them to grow in a variety of
environments.
When oxygen is available, they carry out aerobic respiration.
When oxygen is not available, they ferment carbohydrates to produce
ethanol and carbon dioxide.
Morfologi
yeast

10
Hyphae / Molds
Multicellular, filamentous fungi (Long filaments of cells
joined together)
Identified by physical appearance, colony
characteristics, and reproductive spores.
Hiphae:
Septate hyphae: Cells are divided by cross-walls (septa).
Coenocytic (Aseptate) hyphae: Long, continuous cells that are
not divided by septa.
Part of hiphae:
Vegetative Hypha: Portion that obtains nutrients.
Reproductive or Aerial Hypha: Portion connected with
reproduction.
Mycelium: Large, visible, filamentous mass made up of
many hyphae.
Morfologi hiphae/molds

12
Morfologi Hiphae / Molds
Mycelium: Large, Visible Mass of Hyphae
Dimorphic Fungi

Can exist as both multicellular fungi (molds) and

yeasts.
Many pathogenic species.
Mold form produces aerial and vegetative hyphae.
Yeast form reproduces by budding.

Dimorphism in pathogenic fungi typically depends

on temperature:
At 37oC: Yeast form.
At 25oC: Mold form.

Dimorphism in nonpathogenic fungi may depend

on other factors: Carbon dioxide concentration
 2. Reproduksi Fungi
Hiphae : form spores
asexual reproduction spores are formed through
budding or in conidia or sporangiospores
sexual reproduction spores are formed following
fusion of male & female strains & formation of sexual
structure
Yeast : Asexual reproduction by mitosis
Fission yeasts: Divide evenly to produce two new cells
Budding yeasts: Divide unevenly by budding
Budding yeasts can form pseudohypha, a short chain of undetached
cells.

16
Asexual mold spores

17
4 main divisions based on spore
type

1. Zygomycota (Conjugation Fungi)

2. Ascomycota (Sac Fungi)
3. Basidiomycota (Club Fungi)
4. Deuteromycota no sexual spores

18
I. Zygospores: Also known as
bread molds.

19
II. Ascospores

20
III. Basidospores

21
Nutrisi Fungi
heterotrophic
Mayoritas tidak membahayakan, hidup secara
saprofit pada tumbuhan atau hewan yang mati
Beberapa mrpkn parasit yang hidup pada jaringan
organisme lain infeksi jamur mycoses
growth temperature 20o-40oC

22
 INFEKSI JAMUR
(Mycoses)
Jamur Penyebab
Epidemiologi
Manifestasi klinik
Diagnosis
Mikrobiologi
Terapi
Mycoses

Merupakan infeksi kronis, karena

pertumbuhan jamur yang lambat
Klasifikasi:
1. Superficial mycoses
2. Cutaneus mycoses
3. Subcutaneus mycoses
4. Systemic mycoses
5. Opportunistic mycoses
 General Clinical Classification
of Pathogenic Fungi
Superficial Cutaneus Subcutaneus Sistemic Opportonistic
Pityriasis Tinea pedis Chromoblasto Aspergillosis Aspergillosis
versicolor Tinea mycosisi Blastomycosis Candidosis
Tinea niegra unguinum Sporothricosis Candidosis Cryptococcosis
Piedra Tinea corporis Mycetoma Coccidioidomyc Zygomycosis
Tinea cruris Phaeohypom osis
Tinea manus ycois Histoplasmosis Geothricosis
Tinea capitis Cryptococcosis Fusariosis
Tinea barbae Trichosporonosis
Geothrichosis Others
Paracoccidioido
mycosis
Zygomycosis
Fusariosis
Trichosporonsis
EPIDEMIOLOGI
How can you control a disease if
you dont know the source?
Factors to consider:
- Where do pathogens live in nature?
- How do they disseminate?
- What is the human portal of entry?
- Why is a human susceptible?
Epidemiologically we have three groups of
fungi:

1.) Dermatophytoses: man, animal, soil.

2.) Exogenously acquired: soil, air.
3.) Endogenous in origin: normal flora.

Lets look at the above three groups separately

Three groups (cont)

1.) Dermatophytoses:
 Dermatophytoses (cont)

Fungi which caused ringworms

These diseases are classified by the mode
transmission:
a.) Anthropophilic implies organisms that are
spread from man to man
e.g. Epidermophyton floccosum, Microsporum
audouinii, M. ferrugineum and several Trichophyton spp.
Dermatophytoses (cont)

b.) Geophilic are organisms that live in soil and

maybe transmitted to man by soil contact, e.g.
Microsporum gypseum (often causing tinea
barbae).

c.) Zoophilic are organisms which are transmitted

to man from animals other than man (dogs, cats,
cattle, etc.). Some zoophilic dermatophytes are
Microsporum canis, Trichophyton verrucosum and
two varieties of T. mentagrophytes.
Dermatophytoses (cont)

Mode and vehicle of transmission:

- Transmitted by contact with soil, infected

humans and infected animals.
- Transmission is with hyphae and/or spores in
soil or infected skin, nails or hair.
- In some cases fomite transmission is with
infected clothing.
2.) Exogenously acquired: soil & air

This includes all other mycoses (one major

exception: Opportunistic infection by candida
albicans).
Disease is acquired from one of two sources:

A.) Soil
Where fungi live forming hyphae and spores, they
enter the host via punctured wounds and trauma.
Spore size is not important. The following are
some examples of diseases that are acquired by
this mechanism.Example: Subcutaneus mycosis
(Sporothricosis, Mycetoma, Chromomycosis) , Mycotic
keratitis
Exogenously acquired:Subcutaneus
mycoses
Exogenously acquired:Sporotrichosis
Note hyphae and spores which live in
nature on plant material and are the
infectious particles.

This is the pathogenic phase which is

not infectious. It can be grown in
the laboratory at 35 C, i.e. the
fungus is dimorphic
Exogenously acquired:Mycotic
Keratitis

- Numerous fungi cause keratitis worldwide but mostly in tropical

or heavily agricultural areas. Spores and hyphae are implanted
onto eye following trauma.

Patient Penicillium, one of numerous soil

fungi causing this disease.
 B.) Air and lungs
These are fungi which grow in nature but produce airborne
infectious particles which have the correct size limitations to
enter the human lung.

Note that airborne particles greater than 6 microns cannot

enter the human lung.
 Air and lungs (cont)
Aspergillosis Organisms in environment, cannot eliminate
Histoplasmosis Spread from bird droppings, especially
blackbirds, chickens and bats
Cryptococcosis In pigeon droppings and near Eucalyptus
trees
Coccidioidomycosis in area characterized by little rainfall and
intense heat. Some evidence that the organism Coccidioides
immitis favors salty soils.
SporothricosisThe pulmonary form is caused by spores
entering the lungs from peat moss or other dusty forms of
organic matter.
Air and lung: Aspergillosis

Lung infarct (left), aspergilloma (right). Diseases initiated by spores

entering the lungs.

Aspergillus with infectious spores

(3-6 microns).
3.) Endogenously acquired
Candidiasis is the only major systemic mycosis that
is endogenous in origin. That means that the
numerous yeast species are part of mans normal
flora. This means that the key to infection is
predisposing factors,
e.g. 90 % of AIDS patients have candidiasis.
The only exception to being endogenous in origin is
STD candidiasis and nosocomial acquired
candidiasis, usually from hospital workers.
Today, candidiasis is the most important systemic
mycoses in the world.
Candidiasis (cont)
Dissemination or disease spread is with yeast cells and/or hyphae. The
hyphae looks distorted, thus it is sometimes called pseudohyphae.
The disease is worldwide and fatal in susceptible hosts.

Yeast cells and pseudohyphae seen in patients.

 Conclusions
1.) Most systemic mycoses are acquired from fungi which live
in soil on decaying vegetation.
2.) Fungi produce hyphae and spores which enter humans via
a punctured wound or, if less than 6 microns, can enter the
lungs.
3.) Dermatophytoses (ringworms) can be transmitted to man
from soil, animals and other men.
4.) Candidiasis is the only major mycosis that is endogenous in
origin.
5.) Most systemic mycoses are seen in patients that have
depressed immunity. This may be genetic or acquired.
CLINICAL MYCOLOGY
1. Superficial Mycoses

Infections of hair shafts and superficial

epidermal cells.
Prevalent in tropical climates.
1. Superficial mycosis
Definition: Infections of hair shafts and superficial
epidermal cells. Limited to the stratum corneum. No
Inflamation. Cosmetic problem.

Causative Clinical
Disease Incidence
organisms Manifestation
Pityriasis Malassezia
Hipopigmented
versicolor furfur Common
macule

Exophiala
Tinea nigra Rare black macules
werneckii
Trichosporon black nodule on
White piedra Common
beigelii hair shaft
creme-colored
Black piedra Piedraia hortae Rare nodules on hair
shaft
Clinical Manifestation
Diagnosis laboratorium
Spesimen: skin scrapping (kerokan kulit),
potongan rambut pengecatan dengan
KOH 10-20% diamati dibawah mikroskop

Terapi: obat antifungal topikal

2. Cutaneus Mycoses

Infeksi jamur pada jaringan

berkeratin (kulit, rambut dan
kuku)
Jamur mensekresi keratinase, suatu enzym
yang mendegradasi keratin.
Infeksi ditransmisikan melalui kontak
langsung dengan kulit, kuku atau rambut
yang terinfeksi.
Cutaneus mycoses

Disease Causative organisms Incidence

Dermatophytes
Dermatophytosis
(Microsporum,
Ringworm of the scalp, Common
Trichophyton,
glabrous skin and nails.
Epidermophyton)

Candidiasis of skin and Candida albicans

Common
and nails. and related species.
Dermatophytosis: Ringworm of the
scalp, glabrous skin and nails
Disease Symptoms

Tinea capitis ringworm lesion of scalp

Tinea corporis ringworm lesion of trunk, arms, legs

Tinea manus ringworm lesion of hand

Tinea cruris "jock itch" ringworm lesion of groin

Tinea pedis"athlete's foot" ringworm lesion of foot

Tinea unguium infection of nails

Ectothrix infection of hair shaft surface

Endothrix infection of hair shaft interior

Dermatophytosis: Clinical
Manifestation

Tinea Pedis: is transmitted

via the feet by
desquamated skin scales in
substrates like carpet and
matting
Dermatophytosis: Clinical
Manifestation

Tinea cruris Tinea barbae

Tinea Unguinum Tinea corporis

Dermatophytosis: Clinical Manifestation
Tinea Capitis: Exothrix, Endothrix, Favus

"Kerion" lesion caused by T. verrucosum Tinea capitis showing extensive

following contact with cattle. hair loss caused by M. canis.

Endothrix tinea capitis (left) caused by T. tonsurans and "black dot" tinea capitis
(right) caused by T. violaceum
Dermatophytosis:
Laboratoy Diagnosis
Spesimen: Skin Scrapings, nail scrapings and
epilated hairs

Method:
Direct Microscopy: KOH 10-20% and ink parker
Culture: Sabouraud's dextrose agar containing
cycloheximide incubated at 26-28C for 4 weeks
Microscopic & Culture

Skin scrapping: Endothrix: spore

Exothrix: spore
hiphae

Culture on SDA
3. Subcutaneus Mycoses

Infeksi jamur pada jaringan subkutan.

Disebabkan oleh jamur saprofit yang hidup
pada tanah atau tanaman.
Infeksi terjadi karena masuknya spora atau
micelium pada luka kulit.
Dapat menyebar melalui pembuluh limfe.
 3. Subcutaneus Mycoses
Causative Incide Clinical manifestation
Disease
organisms nce
Sporothrix Nodules and ulcers along
Sporotrichosis Rare
schenckii lymphatics at site of inoculation
Fonsecaea, Warty nodules that progress to
Chromoblastomycosis Phialophora, Rare "cauliflower-like" appearance at
Cladosporium etc. site of inoculation
Pseudallescheria, Draining sinus tracts at site of
Madurella, inoculation
Mycotic mycetoma Rare
Acremonium,
Exophiala etc.
Subcutaneus mycoses:
SPOROTRICHOSIS
Sinonim: Rose Garneners disease
Manifestasi klinis
Cutaneus sporotrichosis
Infeksi sistemik
 Sporotrichosis

Characteristic
lymphadenopathy.

Pewarnaan GMS pada

spesimen biopsi
Subcutaneus mycoses:
Chromoblastomycosis
Penyebab: Fonsecaea pedrosoi, Fonsecaea
compacta, Phialophora verrucosa,
Cladosporium carrionii
Manifestasi klinik:
Nodule verrucous atau plaque
Sering terjadi di daerah tropis yang lembab
Kebanyakan pada kaki, didahului dgn luka ( bisa
pada bagian tubuh lain)
Walaupun jarang, dapat menyerang otak
(menyebar secra hematogen)
 Chromomycosis

Etiologic agent showing dematiaceous

hyphae and spores

10-year old case

Subcutaneus mycoses:
MYCETOMA
Sinonim: Madura foot
Penyebab:
Jamur (Eumycotic mycetoma)
Kuman yang mirip jamur (Actinomycotic mycetoma)
Gx klinis:
infeksi subkutan yang membengkak seperti tumor dan
adanya sinus yang mengeluarkan nanah dan granul / grains
seperti butiran pasir yang mengandung kuman
Ditemukannya granule/grains sangat penting untuk
diagnosa
bbrp jamur/bakteri penyebab mycetoma dapat di isolasi
dari tanah/ pohon.
 Mycetomas

15-year old case of mycetoma

One of many etiologic agents .Note
hyphae and spores which live in
nature. Fusarium sp.
4. Systemic Mycoses
Menginfeksi jaringan/organ secara sistemik
Biasanya disebabkan jamur yang hidup di tanah.

Disease Causative organisms Incidence

Histoplasma capsulatum
Histoplasmosis Rare*
Histoplasma dubosii
Coccidioidomycosis Coccidioides immitis Rare*
Blastomycosis Blastomyces dermatitidis Rare*
Paracoccidioides
Paracoccidioidomycosis Rare*
brasiliensis
Sporotrichosis Sporothrix schenkii Rare
Penicilliosis marnefffei Penicillium marneffei Rare*

*more common in endemic areas.

Histoplasmosis

intracellular infection of the reticuloendothelial

system
caused by the inhalation of conidia from
Histoplasma capsulatum
Isolation:soil enriched with excreta from
chicken, starlings (burung jalak) and bats
(kelelawar).
Major endemic: River Valley in the U.S.A.
Two varieties of H. capsulatum: var. capsulatum
(common) and var. duboisii
HISTOPLASSMOSIS

Clinical manifestations:
95% of cases of histoplasmosis are
inapparent, subclinical or benign.
Five percent of the cases have chronic
progressive lung disease, chronic cutaneous
or systemic disease or an acute fulminating
fatal systemic disease.
All stages of this disease may mimic
tuberculosis.
Histoplasmosis
COCCIDIOIDOMYCOSIS

initially:a respiratory infection, resulting from

the inhalation of conidia,
resolves rapidly leaving the patient with a
strong specific immunity
in some individuals the disease may progress.
Coccidioidomycosis (cont)

Coccidioides immitis is a soil inhabiting

fungus endemic in south-western U.S.A.,
northern Mexico and various centres in
South America. Several cases have now
been diagnosed in Australia, all in patients
with a history of travel to endemic areas.
The organism Coccidioides immitis is found
in desert soils as shown here. The spores
are < 7 microns, become airborne, enter the
lungs and initiate disease.
fever, pleuritic chest pain, cough, malaise, headache,
myalgia, night sweats and loss of appetite. Many
patients also develop a mild, diffuse erythematous or
maculopapular rash on the trunk and limbs.
5-10% of patients that do develop symptoms are left with
pulmonary residual nodule or cavity that is usually
detected several months or years later.
5% of patients may develop metapulmonary dissemination
to the meninges, bones, joints and subcutaneous and
cutaneous tissues, within the first few weeks to months
after the onset of primary infection .
5. Opportunistic Mycoses

Adalah infeksi yang terjadi pada manusia/hewan dengan sistem

pertahanan tubuh yang menurun :
pasien AIDS, pasien kanker
Individu yg mendapat terapi antibiotik spektrum luas
neonatus / individu yang sangat tua
Diabetes melitus
Resipien organ transplan
Terapi steroid
Pada sistem imun yang baik tidak menyebabkan penyakit.
Penyebab: Flora normal ataupun fungi yang ada di lingkungan
5. Opportunistic Infection
Disease Causative organisms Incidence
Candida albicans and
Candidiasis Common
related species.
Cryptococcosis Cryptococcus neoformans Rare/Common
Aspergillosis Aspergillus fumigatus etc. Rare
Rhizopus, Mucor,
Zygomycosis
Rhizomucor, Rare
(Mucormycosis)
Absidia etc.
Pneumocystosis Pneumocystis carinii Rare
 Opportunistic mycoses:
Candidiasis

Candidiasis also called as Monoliasis,

Can infect Skin, Mucosa, or Internal Organs
Normal flora
Exist in Mouth, Gastrointestinal tract, Vagina, skin in 20 %
of normal Individuals.
Colonization increases with age,in pregnancy,
Hospitalization
Important etiological agent presenting as opportunistic
infection in Diabetus and HIV patients
Clinical Manifestation

1. Oropharyngeal candidiasis: including thrush, glossitis, stomatitis and angular

cheilitis (perleche).
2. Cutaneous candidiasis: including intertrigo, diaper candidiasis, paronychia and
onychomycosis.
3. Neonatal and congenital candidiasis:
4. Vulvovaginal candidiasis and balanitis:
5. Candidemia (Candida septicemia) and disseminated candidiasis,etc.
Laboratory diagnosis

Clinical specimen:
Skin scrapings,
Mucosal scrapping,
Vaginal secretions
Blood ans other body fluid

Method:
Direct mikroskopic
Cultures : on Sabouraud's Glucose agar
PCR
CRYPTOCOCCOSIS
 Morphology

A true yeast
Round 4 10 microns
Surrounded by Mucopolysaccharide capsule.
Negative staining with India Ink and Nigrosin
60% of the infected prove positive by India Ink
preparation on examination of CSF
 Life cycle of C.neofromans

Found in wild/Domesticated birds (Pigeon) and eucalyptus

tree.Pigeons carry C.neofromans, but do not get infected.
Pathogenesis

Enters through lungs - inhalation of

Basidiospores of C neoformans
Enters deep into lungs.
Self limiting in most cases,
Pulmonary infections can occur.
Present as discrete nodules - Cryptococcoma.
 Pathogenesis

Can infect normal humans

Abnormalities of T lymphocyte function
aggravates the clinical manifestations (In AIDS
3- 20% develop Cryptococcosis)
Clinical manifestation: Chronic meningitis ,
Meningo encephalitis ,head ache low grade
fever,Visual abnormalities ,Coma fatal
Can manifest with involvement of ,Skin,
mucosa,organs,Bones,and as Disseminated
form.
Can mimic like Tuberculosis
 Laboratory Diagnosis.

Mikroskopic: Indian ink staining, Gram staining

Kultur :Cultures on Sabouraud dextrose agar
Serologis: detection of Capsular antigen
Treatment

Immune competent - Antifungal drug

AIDS patients are not totally cured ,
Relapses are frequent with fatal outcome.

Prevention:

Avoid contact with Birds

ASPERGILLOSIS
Aspergillosis

In nature > 100 species of Aspergillosis exist,

Few are important as human pathogens
1 A.fumigatus
2 A.niger
3 A.flavus
4 A.terreus
5 A.nidulans
Fungal spores enters through
respiratory tract
Morphology

Khas: hifa dengan

spora yang khas
Conidiophores
terminates in a
swollen cell vesicle
surrounded by one or
two rows of cell (
Streigmata ) from
which chains of
asexual conidia are
produced
Pathogenesis - varied
clinical presentations
Allergic Aspergillosis Atopic individuals, with
elevated IgE levels
10-20% of Asthmatics react to A.fumigatus
Allergic alveoitis follows particularly heavy and
repeated exposure to larger number of spores

Maltsters Lung causes allergic alveolitis, who handle barley on

which A.claveus has sporulated during malting process
Pathogenesis

Aspergilloma A fungal
ball, fungus colonize
Preexisting
(Tuberculosis ) cavities
in the lung and form
compact ball of
Mycelium which is later
surrounded by dense
fibrous wall presents
with cough, sputum
production
Haemoptysis occurs
due to invasion of blood
vessels
 Pathogenesis
Invasive Aspergillosis
occurs in
immunocompromised
with underlying disease
A.fumigatus >>
Fungus invades blood
vessels, causes thrombosis
septic emboli
Can spread to Kidney and
heart.