kuliah 1

Chlamydophila pneumoniae & Jamur penyebab infeksi pernafasan

Pratami Adityaningsari

Bag Mikrobiologi

Chlamydophila pneumoniae / Chlamydia pneumoniae

- obligate intracellular

- known as the Taiwan acute respiratory agent

(TWAR)

Kingdom : Bacteria

Phylum : Chlamydiae

Order : Chlamydiales

Family : Chlamydiaceae

Genus : Chlamydophila

Species : C. pneumoniae

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.

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

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

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

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

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.

Histoplasmosis first affects the lungs and can spread to other organs,

including the brain

1. Dormant Stage

2. Acute Stage

3. Chronic Stage

4. Systemic Stage (Disseminated Histoplasmosis)

Dormant Stage

No symptoms exist

Fungi survives in spore form within the lungs

Acute Stage

Characterized by short bursts of activity

Symptoms

Flu

Lung Issues

Cough

Chest pain (nyeri dada)

Inflammation of infected areas

Fever

Chills (menggigil)

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

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

Blood, Bone Marrow, Skin

Cultures

Blood, Sputum

Testing

Antigen Testing*

CD4 Count

oEarly 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.

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 cell-mediated immunity.

Mikroskopis

Makroskopis

Antifungi

amfoterisin B, ketokonazole, itrakonazole

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

Most cases are subclinical but predisposing factors such as fatigue

and poor nutrition can contribute to a progressive disease

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.

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

Other Fungi Involved in Respiratory Disease

Occurs most often in immunosuppressed hosts.

Common causes:

Aspergillus

Rhizopus

Mucor

Aspergillus sp

Kingdom: Fungi

Phylum: Deuteromycota

Class: Eurotiomycetes

Order: Eurotiales

Family: Trichocomaceae

Genus: 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).

Pneumocystis jiroveci is an opportunistic pathogen that invades

immunosuppressed or cancer patients.

Untreated causes are usually fatal.