Kuliah 1.pptx

Pratami Adityaningsari Bag Mikrobiologi

Chlamydophila pneumoniae / Chlamydia pneumoniae Kingdom : Bacteria Phylum :

Chlamydiae

Order

:

Chlamydiales

Family

:

Chlamydiaceae

Genus

:

Chlamydophila

Species :

C. pneumoniae

- obligate intracellular - known as the Taiwan acute respiratory agent (TWAR)

3 species of Chlamydia : C. trachomatis C. psittaci C. pneumoniae The latter  moved to a new genus : Chlamydophila Chlamydophila psittaci & C. pneumoniae  inf. of respiratory tract

Chlamydophila pneumoniae exists as an elementary body (EB) between hosts. The EB travels from an infected person to the lungs of an uninfected person in small droplets and is responsible for infection. Once in the lungs, the EB is taken up by cells in a pouch called an endosome by a process called

phagocytosis. However, the EB is not destroyed by fusion with lysosomes, as is typical for phagocytosed material. Instead, it transforms into a reticulate body and begins to replicate within the endosome. The reticulate

bodies must use some of the host's cellular metabolism to complete its replication. The reticulate bodies then convert back to elementary bodies and are released back into the lung, often after causing the death of the host cell. The EBs are thereafter able to infect new cells, either in the same organism or in a new host.

Thus, the life cycle of C. pneumoniae is divided between the elementary body, which is able to infect new hosts but can not replicate, and the

reticulate body, which replicates but is not able to cause new infection.

(Chlamydia) pneumoniae in an epithelial cell in acute bronchitis: 1 infected epitheliocyte, 2 - uninfected epitheliocytes, 3 - chlamydial inclusion bodies in cell, 4 - cell nuclei

C. pneumoniae less commonly causes several other illnesses, but can cause meningoencephalitis, arthritis, myocarditis & Guillain – Barre

Syndrome

There is no vaccine to protect against Chlamydia pneumoniae.

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Fungal Diseases of the Lower Respiratory System Fungal Diseases may germinate in the lower respiratory tract.  The incidence of fungal diseases has been increasing in recent years.  The mycoses below can be treated with amphotericin B. 

That fungal are : Histoplasma capsulatum Coccidioides immitis Blastomyces dermatitidis. Pneumocystis jiroveci (carinii).

Histoplasmosis  

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Histoplasma capsulatum causes a subclinical infection. The disease is acquired by inhalation of airborne conidia. Isolation of the fungus or identification of the fungus in tissue samples is necessary for diagnosis.

Histoplasma capsulatum  Kingdom: Fungi  Phylum : Ascomycota  Subphylum: Ascomycotina  Class: Ascomycetes  Order: Onygenales  Family: Onygenaceae  Genus: Histoplasma

Caused by Histoplasma capsulatum  Variety duboisii

 Not as severe of an infection  Variety capsulatum

 Common cause of histoplasmosis

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It grows in soil, particularly if the soil is heavily contaminated with bird droppings, especially from starlings. Although the birds are not infected, bats can be infected and can excrete the organism in their guano

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Infection occurs when airborne spores enter a host organism’s respiratory tract Inhaled spores are engulfed by macrophages and develop into yeast forms. In tissues, H. capsulatum occurs as an oval budding yeast inside macrophages

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The yeasts survive within the phagolysosome of the macrophage by producing alkaline substances, such as bicarbonate and ammonia, that raise the pH and thereby inactivate the degradative enzymes of the phagolysosome The organisms spread widely throughout the body; especially to the liver and spleen, but most infections remain asymptomaric, and the small grantdomatous foci heal by calcification.

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Histoplasmosis first affects the lungs and can spread to other organs, including the brain 1. 2. 3. 4.

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Dormant Stage Acute Stage Chronic Stage Systemic Stage (Disseminated Histoplasmosis)

Dormant Stage  

No symptoms exist Fungi survives in spore form within the lungs

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Acute Stage Characterized by short bursts of activity  Symptoms 

 Flu  Lung Issues

 Cough  Chest pain (nyeri dada)  Inflammation of infected areas  Fever  Chills (menggigil)

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Chronic Stage Histoplasma capsulatum becomes established in the body  The fungus goes through alternations of activity and dormancy Symptoms 

 Increase in frequency of previous symptoms

 Shortness of breath  Excessive sweating (berkeringat)  Liver infection or spleen infection

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Systemic Stage Occurs as the fungus reaches all parts of the host organism, including most organs and the central nervous system Symptoms 

 Increase in frequency of previous symptoms

 Skin and mouth sores (lidah kotor), including rashes  Joint and muscle pain (nyeri sendi & otot)  Headache  Neck stiffness (kaku kuduk)

Mikroskopik

Makroskopik

Detection  Lung X-Ray  Tissue Samples  

Cultures 

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Blood, Bone Marrow, Skin Blood, Sputum

Testing  

Antigen Testing* CD4 Count

Early Detection Saves Lives!

Antifungal Medications Amphotericin B  Azoles 

 Fluconazole  Itraconazole

 Ketonazole

Coccidioides immitis  Kingdom : Fungi  Division : Ascomycota  Class : Euascomycetes  Order : Onygenales  Family : Onygenaceae  Genus : Coccidioides

Disease Coccidioides immitis causes coccidioidomycosis.

Properties C. immitis is a dimorphic fungus that exists as a mold in soil and as a spherule in tissue

Patogenesis  In soil, it forms hyphae with alternating arthrospores and empty cells.  Arthrospores are very light and are carried by the wind.  They can be inhaled and infect the lungs.  In the lungs, arthrospores form spherules that are large, have a thick, doubly refractive wall, and are filled with endospores.

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Upon rupture of the wall, endospores are released and differentiate to form new spherules. The organism can spread within a person by direct extension or via the bloodstream. Granulomatous lesions can occur in virtually any organ but are found primarily in bones and the central nervous system (meningitis) Dissemination from the lungs to other organs occurs in people who have a defect in cellmediated immunity.

Mikroskopis

Makroskopis

Antifungi amfoterisin B, ketokonazole, itrakonazole

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In tissue specimens, spherules are seen microscopically. Cultures on Sabouraud's agar incubated at 25 °C show hyphae with arthrospores

(Caution: Cultures are highly infectious; precautions against inhaling arthrospores must be taken.)

Coccidioidomycosis 

Inhalation of the airborne arthrospores of Coccidioides immitis

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Most cases are subclinical but predisposing factors such as fatigue and poor nutrition can contribute to a progressive disease

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Symptoms include chest pain, fever, coughing, and weight loss.

Life Cycle of Coccidioides immitis

Blastomyces dermatitidis  Kingdom : Fungi  Phylum : Ascomycota  Class : Euascomycetes  Order : Onygenales  Family : Onygenaceae  Genus : Blastomyces

Blastomycosis is a chronic granulomatous and suppurative disease having a primary pulmonary stage that is frequently followed by dissemination to other body sites, chiefly the skin and bone. Aetiological Agent: Blastomyces dermatitidis, a soil inhabiting fungus.

Manifestasi klinik  The patient usually presents with cough, fever, night sweats, and general weakness and may be thought to have tuberculosis.  The sputum may be blood stained and purulent, again suggesting tuberculosis.  The cutaneous form of infection presents as papules which progress to crusty ulceration

Skin lesions are often multiple and most commonly appear on the face and limbs.  They are usually painless and may be mistaken for squamous cell carcinoma  Atrophic scars develop where there have been old lesions.  Other lesions can occur in the mucous membranes of the nose, mouth, larynx, and vagina 

Blastomycosis 

Caused by Blastomyces dermatitidis.

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The infection begins in the lungs and spreads to cause extensive abscesses.

Other Fungi Involved in Respiratory Disease 

Occurs most often in immunosuppressed hosts.

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Common causes:  Aspergillus  Rhizopus  Mucor

Aspergillus sp  Kingdom:  Phylum:  Class:  Order:  Family:  Genus:

Fungi Deuteromycota Eurotiomycetes Eurotiales Trichocomaceae Aspergillus

Aspergilloma. (Fungus ball)  ABPA. (Hypersensitivity)  Aspergillus necrotizing bronchitis. endo-bronchial mass, obstructive pneumonitis, collapse, hilar mass.  Invasive Pulmonary Aspergillosis. Angioinvasive/ hemorrhagic infarcts. Airway invasive-obstructing. 

Faktor virulensi binding to fibrinogen & laminin, secretion elastase & protease, katalase Gejala klinik Clinical findings could be non-specific.  Some patients may remain asymptomatic.  Most frequent symptom is HEMOPTYSIS 75%.  Less commonly chest pain, dyspnea , malaise.  Wheezing and fever (could also be secondary to underlying disease, or bacterial super infection of the cavity or aspergilloma itself).

Pneumocystis pneumonia 

Caused by Pneumocystis jiroveci (carinii).

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Pneumocystis jiroveci is an opportunistic pathogen that invades immunosuppressed or cancer patients.

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Untreated causes are usually fatal.