Mikosis Paru

Mikosis paru
Dr Indah Rahmawati, Sp.P

FKIK UNSOED / RSMS Purwokerto
TROPMED, 2 September 2010
Inhalation of fungal
spores
DISEASE SPECTRUM
ALLERGY
Spores SINUSITIS
8 µm
ASPERGILLOMA
PULMONARY
ASPERGILLOSIS
2-4 µm
DISEMINATED
ASPERGILLOSIS
Diagnosis of respiratory
mycoses
 Presence of risk factors

 Clinical signs
 Laboratory
 Microscopy & Culture of sputum
and BAL
Serology - detection of antibodies
and fungal antigens
Detection of fungal DNA using PCR
Risk factors
• Usually in patients with

– Preexisting lung disease
– Hypersensitivity
– Immunosuppression
Jamur paru
• Aspergillosis
• Kandidiasis
• Histoplasmosis
• Kriptokokosis
• Blastomikosis
Aspergillosis
• Aspergillus flavus
• Aspergillus niger
• Aspergillus fumigatus
• Aspergillus clavatus
 inhalasi  paru
A. Flavus kacang tanah
• Aflatoxin (aspergillus flavus toxin)

• AFT B1 dan AFTB2  karsinogenik,
hepatotoksik, mutagenik,
immunosuppesif
• Banyak pada produk pertanian /
olahan / peternakan
Penyakit yang ditimbulkan
• Aflatoxikosis
• Aspergillosis :
Allergic Bronchopulmonary
Aspergillosis
Aspergillosis invasif
• Aspergilloma (Mycetoma)
( Bola jamur berisi mycelia )
Aspergilloma
• Usually in preexisting cavaties or

cyst
• Hemoptysis, a common symptom
and complication
• Progression more in HIV(+)
• Hemoptysis more in HIV(-)
Aspergilloma
• Typical finding : well-defined

homogeneous nodular opacity
within a cavity with air crescent
sign, may be movable.
• Atypical : focal thickening/
fronds/ sponge like opacity in
cavity
ASPERGILLOMA
ASPERGILLOMA
029
Hyphae of Aspergillus fumigatus
Candidiasis
• Candida infections are usually due to

impaired epithelial barrier functions
• Occur in all age groups  most
common in newborn / elderly
• The clinical manifestations may be
acute, subacute or chronic to
episodic
Clinical manifestations
• Oropharyngeal candidiasis
• Cutaneous candidiasis
• Vulvovaginal candidiasis and balanitis
• Chronic mucocutaneous candidiasis
• Neonatal and congenital candidiasis
• Oesophageal candidiasis
• Gastrointestinal candidiasis
• Pulmonary candidiasis
• Peritonitis
• Urinary tract candidiasis
• Meningitis
• Hepatic and hepatosplenic
candidiasis
• Endocarditis, myocarditis and
pericarditis
• Candidemia (Candida septicemia)

and disseminated candidiasis
• Ocular candidiasis
• Osteoarticular candidiasis
• Other forms of candidiasis
(cholecystitis, pancreatitis,
prostatitis, etc)
Clinical groups and / or predisposing
factors for invasive candidiasis
• Neutropenia (especially >7 days)

• Hematological malignancy
• Solid tumor malignancy
• Postsurgical intensive care patients
• Prolonged intravenous catheterization
• Broad-spectrum or multiple antibiotic therapy
• Diabetes mellitus
• Parental nutrition
• Severe burns
• Neonates
• Corticosteroid therapy
• Intravenous drug abuse
Pulmonary candidiasis
• Hematogenous dissemination causing a

diffuse pneumonia or by bronchial
extension in patients with oropharyngeal
candidiasis
• Aspiration of yeasts from the oral cavity
• Aspecific radiological and culture findings
 present at autopsy
• Histopathology can provide a definitive
diagnosis
LIDAH ANUS
KUKU JARI SPORA
Kriptokokosis
• The AIDS epidemic,

immunosuppressive agents by
increasing numbers of solid organ
transplant recipients
• Asymptomatic nodular disease to
severe acute respiratory distress
syndrome (ARDS)
• Classic symptoms of pneumonitis
(cough, fever, sputum production)
• Pleural symptoms may predominate
CRYPTOCOCCOSIS
Histoplasmosis
• Daerah sungai, iklim tropis

• Kotoran kelelawar / burung
• Batuk, demam, nyeri dada/sendi
• Ssm tlg, hepar, lien, sal cerna
• Disseminata  AIDS, ggn sistem
immun
• Diagnosis : jamur dalam sputum /
tempat lesi, Antibodi dalam darah
HISTOPLASMOSIS
Blastomikosis
• Banyak di Amerika tenggara /

barat
• Saluran napas, kulit, tulang,
sendi dan kelenjar prostat
• Gejala flu
Clinical
manifestations
• Asymptomatic infection occurs in at
least 50% of infected persons
• Symptomatic disease develops after
an incubation period of 30–45 days
• Acute pulmonary blastomycosis
mimics influenza or bacterial
pneumonia
Radiographic findings
• Alveolar infiltrates
• mass lesions that mimic
bronchogenic Carcinoma
• fibronodular interstitial
infiltrates
BLASTOMIKOSIS
Koksidioidomikosis
• Banyak di Amerika barat / selatan

• Saluran napas, tulang, sendi, kulit
dan selaput otak
• Diagnosis : jamur dalam sputum /
tempat lesi, Antibodi dalam darah
• The main symptoms are fever,

pleuritic chest pain, cough, malaise,
headache, myalgia, night sweats and
loss of appetite
• Clinical material: Skin scrapings,
sputum and bronchial washings,
cerebrospinal fluid, pleural fluid and
blood, bone marrow, urine and tissue
biopsies from various visceral organs
Terapi jamur paru
• Amphoterisin B
• Itraconazole
• Voriconazole

Mikosis Paru

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Mikosis paru

Dr Indah Rahmawati, Sp.P

 Presence of risk factors

• Usually in patients with

• Aflatoxin (aspergillus flavus toxin)

• Usually in preexisting cavaties or

• Typical finding : well-defined

• Candida infections are usually due to

• Candidemia (Candida septicemia)

• Neutropenia (especially >7 days)

• Hematogenous dissemination causing a

• The AIDS epidemic,

• Daerah sungai, iklim tropis

• Banyak di Amerika tenggara /

• Banyak di Amerika barat / selatan

• The main symptoms are fever,

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