Fungi Diarrhae

Titiek 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

Acute

Pseudodiarrhea

Chronic

Acute Diarrhea

Infectious

Non infectious

Bacteria
Parasites
Enteroadherant E.coli
Giardia Cryptosporidia
Parasite

Viruses

Bacteria
Helminths

Etiology of infectious diarrhea

Viral
Norwalk
Rotavirus
Enteric adenovirus
Cytomegalovirus
Herpes simple virus
Fungal
Candida Sp.
Histoplasma Sp.

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 factors
Patologis

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 fenotip
Antigenik 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 3880% 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.