Skin Disease and Fungi

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Skin Disease and Fungi

  1. 1. #M10 drg. Suryono, PhD SKIN DISEASES & FUNGI Immunity AgainstFungi Manusiamemilikitingkatimunitasyang tinggiterhadapjamur.Kebanyakaninfeksi disebabkanolehjamurtergolonginfeksiringandandapathilangdengansendirinya.Karena: 1. 2. 3. 4. 5. 6. 7. yang Asamlemakdalamkulit, pH kulit, permukaanmukosa, Cairantubuh, Epitelsel yang mengalamiregenerasi Flora normal, Transferrin, Silia (rambuthalus) padasaluranpernapasan What Happen When Fungi Do Pass The Resistance Barriers Of The Human Body? Infeksiberdasarkantingkatjaringan yang terinfeksi: a. Superficial mycoses Infeksipadalapisanterluarkulitdanrambut b. Cutaneous mycoses Infeksi yang lebihdalamsampaikelapisan epidermis, misalnyapenyakitinvasiverambutdan kuku c. Subcutaneous mycoses Infeksi yang melibatkan dermis, subkutan,ototdan fascia.Infeksiinikronisdandiindikasikandengan trauma padakulit.Infeksiinisulitdiobatidanmungkinmemerlukanintervensipembedahan Skin Anatomy DEDICATED FOR MOLAR PSPDG UMY 2012
  2. 2. #M10 drg. Suryono, PhD Fungal Infections (Mycoses) Principal tissue sites of deep mycoses in comparison to those of the superficial, cutaneous, and subcutaneous mycoses Portals of entry of pathogenic and opportunistic fungi causing deep mycoses Superficial Mycoses Disease Etiological Agent Symptoms Identification Of Organism Pityriasisve rsicolor Malassezia furfur hypopigmente d macules "Spaghetti and meatballs" appearance of organims in skin scrapings. Tineanigra Exophialawernecki i black macules Black, 2-celled oval yeast in skin scrapings Black piedra Piedraiahortai black nodule on hair shaft black nodule on hair shaft composed of spore sacs and spores White piedra Trichosporombeig elii creme-colored nodules on hair shaft white nodule on hair shaft composed of mycelia that fragment into arthrospores DEDICATED FOR MOLAR PSPDG UMY 2012
  3. 3. #M10 drg. Suryono, PhD PityriasisVersicolor Keluhankulit yang umumdenganpenampilan patch yang tidakberwarnaterutamapada dada danpunggung. Istilah“pityriasis”digunakanuntukmendeskripsikankondisidimanaskala patch samaseperti bran. Sedangkan“versicolor”digunakanuntukmenggambarkanwarna-warna yang muncul.Terkadangpenyakitinidisebut“Tineaversicolor”meskipun kata “tinea”secaralangsungdimaksudkanuntukinfeksidenganjamurdermatrofit. Clinical Features • Pityriasisversicolormenyerangbagiantenggorokan, leher, dan/ataulengan, jarangterdapatpadabagian lain tubuh. Patch berwarna pink, coklattembagaataulebihpucatdaripadakulit di sekitarnyadansedikitgatal. Patch pucatbiasanyapadakulit yang lebihgelap, kondisiinidikenaldenganPityriasisversicoloralbadancenderungtidakgatal. Terkadang patch bersisikdanberwarnacoklta, kemudianmenjaditidakbersisikdanberwarnaputih. • A yellow-green fluorescence dapatdiamatidenganWood's light(long wave ultraviolet A) padadaerah yang terinfeksi. • Pityriasisversicolorseringterjadi di daerahpanas, beriklimlembabataupadaseseorang yang berkeringatbanyak, sehingga bias kambuhpadasetiapmusimpanas. Pityriasisversicolortidakmunculpada area yang terkenasinarmataharilangsung. Patch Putih Persistent Pale Marks Hypopigmented Macules Black Nodule On Hair Shaft Patch Coklat DEDICATED FOR MOLAR PSPDG UMY 2012
  4. 4. #M10 drg. Suryono, PhD Creme-Colored Nodules On Hair Shaft M. furfur Superficial dermatophytes M. furfur skin scraping with calcifluor stain. Observe the detail of the fungal features with this technique that stains the fungal elements green-white. Hypopigmentedtineaversicolor Hypopigmentedtineaversicolor Hypopigmentedtineaversicolor. Small, pale macules coalesce into larger patches on this patient's neck. Glossary • Dermatophyte ; A type of fungus that causes diseases of the skin, including tinea or ringworm. • KOH ;The chemical formula for potassium hydroxide, which is used to perform the KOH test. The tests is also called a potassium hydroxide preparation. • Thrush ; A disease of the mouth, caused by and characterized by a whitish growth and ulcers. It can be diagnosed with the KOH test. DEDICATED FOR MOLAR PSPDG UMY 2012
  5. 5. #M10 • drg. Suryono, PhD Tinea ; A superficial infection of the skin, hair, or nails, caused by a fungus and commonly known as ringworm. Ring Worm Ring Worm Dermatomycosis (ringworm) of hair follicles Patient with ringworm on the arm, or Tineacorporis due to Trichophytonmentagrophytes Ringworm, stained preparation, Macroconidia ofMicrosporumcanis Ringworm, stained preparation, Macroconidiaof Microsporumcanis Cutaneous Mycoses Infeksi yang lebihdalamkelapisan epidermis, contohnyapenyakit invasive rambutdan kuku.Penyakitiniterbataspadalapisan keratin di kulit, rambut, dan kuku.Tidaksepertisuperficial mycoses, host dariresponimundapatdiaktifkan, menghasilkanperubahanpatalogispadalapisan yang lebihdalampadakulit.Organisme yang menyebabkanpenyakitiniadalahDermatophytes.PenyakitiniseringdisebutdenganingwormatauTinea.S emuapenyakittersebutdisebabkanolehMicrosporum, Trichophyton, danEpidermophyton, yang terdiridari 41 spesies. DEDICATED FOR MOLAR PSPDG UMY 2012
  6. 6. #M10 drg. Suryono, PhD Microsporum Disease Trichophyton Symptoms Epidermophyton Identification Of Organism Tineacapitis Ringworm of scalp Presence/absence and shape of micro- and macroconidia in scrapings of lesion, KOH mount Ringworm of trunk, arms, legs Presence/absence and shape of micro- and macroconidia in scrapings of lesion, KOH mount Ringworm of hand Presence/absence and shape of micro- and macroconidia in scrapings of lesion, KOH mount Ringworm of groin "jock itch" Presence/absence and shape of micro- and macroconidia in scrapings of lesion, KOH mount Tineacorporis Tineamanuum Tineacruris DEDICATED FOR MOLAR PSPDG UMY 2012
  7. 7. #M10 drg. Suryono, PhD Tineapedis Ringworm of foot "athlete's foot Presence/absence and shape of micro- and macroconidia in scrapings of lesion, KOH mount Infection of nails Presence/absence and shape of micro- and macroconidia in scrapings of lesion, KOH mount Infection of hair shaft surface Mycelium and spores on hair shaft Infection of hair shaft interior Mycelium and spores in hair shaft Tineaunguium Ectothrix Endothrix Subcutaneous Mycoses Infeksiinimelibatkan dermis, jaringansubkutan, otot, fascia.Infeksiinikronisdandiindikasikandengan padakulit.Infeksiinisulitdiobatidanmungkinmembutuhkanintervensipembedahan. dan trauma Jenis-jenissubcutaneous mycoses: 1. Chromoblastomycosis Ditandaidenganlesiverrucoidpadakulit (biasanyapadaekstremitasbawah) darihasilpemeriksaanhistologismenunjukkansel multiform (denganseptationstegaklurus) disebutdengan"copper pennies" yang merupakancirikhasdariinfeksiini. 2. Mycetoma Infeksisubkutansupuratifdangranulomatosamikosis yang merusaktulang contiguous, tendon, danototrangka.Mycetomadicirikandenganadanyasaluran sinus keringdaributirankecil yang berpigmentetapiterlihatjelassebagaibutiran yang ekstrusi. 3. Sporotrichosis DEDICATED FOR MOLAR PSPDG UMY 2012
  8. 8. #M10 drg. Suryono, PhD Disease Etiological Agent Symptoms Id Of Organism Nodules and ulcers along lymphatics and at site of inoculation Yeast in tissue; mold at rm temp with "rosette pattern" Fonsecaeapedrosoi or compacta, Wangielladermatitidis Warty nodules that progress to "cauliflower-like" appearance a inoculation site. Copper-colored spherical yeasts called "Medlar bodies" in tissue Pseudallescheriaboydii, Madurellagrisea or mycetomatis Draining sinus tracts at site of inoculation White, brown, yellow or black granules in exudate that are fungal colonies Sporotrichosis Sporothrixschenckii 1. yeast 2. mold Chromoblastomycosis Mycetoma Systemic Mycoses Infeksi yang berasaldariparu-parudandapatmenyebarkebanyak system organ.Organismeiniadalahorganismeinherenvirulen, kecualiCryptococcus adalahjamurdimorfik. Opportunistic Mycoses • Infeksipadapasiendengandefisiensiimun, contohnya: DM,terapi immunosuppressive, keganasan • Candidiasis (Candida albicancs)tumbuhsepertikrimpadapermukaantubuhcontohnya, mulut, kulit, vagina. Budding yeast. Berbentukpseudohyphaepadajaringan, grem tube dalam serum • Aspergillosis(Aspergillusniger) AIDS, perubahan DEDICATED FOR MOLAR PSPDG UMY 2012 flora normal,
  9. 9. #M10 drg. Suryono, PhD Oral Candidiasis • Synonyms: Candidosis, Thrush, Moniliasis • Infeksi opportunistic yang disebabkanolehjamurObiquitous, saprophytic dari genus Candida yang mencakup 8 jenisjamur, yang paling umumCandida albicans • Candidiasis is usually limited to the skin and mucous membranes. • Common clinical types of mucocutaneous candidiasis include: a. b. c. d. e. • oropharyngeal (affecting the oral cavity and/or pharynx) vulvovaginal (affecting the vaginal and vulvar mucosa) paronychial (affecting the nail beds and folds) interdigital (usually affecting the skin in between the fingers) intertriginous (affecting the skin of the submammary areas or the groin and/or scrotum) infeksiCandidiasis, sistemikdan invasive dapatterjadikhususnyapadapasiendengan immunosuppression berat. Saluranpencernaan, trakea, paru-paru, hati, ginjal, dan system sarafpusatberpotensialuntukterkenainfeksiCandidiasis yang nantinyaakannerakibat septicemia, meningitis, hepatosplenic, dan endocarditis Epidemiology Oral candidiasis disebabkan palingdominanolehCandida albicans, meskipunCandidajenis lain jugaterlibatpadainfeksitersebut.Candidamerupakanbagiandari flora normal mulutyaitusekitar30% 50%daripopulasi. Dan dapatmenyebabkaninfeksi opportunistic pada oral cavity denganberbagaijenis factor predisposisi yang lain. Etiology and Pathogenesis Factor yang menyebabkanCandidiasis: 1. The immune status of the host 2. The oral mucosal environment 3. The particular strain ofCandida albicans (thehyphal form is usually associated with pathogenic infection). Specific Conditions That May Predispose A Patient To Develop Oral Candidiasis 1. Factors that alter the immune status of the host: • Blood dyscrasias or advanced malignancy • Old age/Infancy • Radiation therapy/Chemotherapy • HIV infection or other immunodeficiency disorders • Endocrine abnormalities: DEDICATED FOR MOLAR PSPDG UMY 2012
  10. 10. #M10 drg. Suryono, PhD • Diabetes mellitus • Hypothyroidism or Hypoparathyroidism • Pregnancy • Corticosteroid therapy/Hypoadrenalism 2. Factors that alter the oral mucosal environment: • Xerostomia • Antibiotic therapy • Poor oral or denture hygiene • Malnutrition/Gastrointestinal malabsorption • Iron, folic acid, or vitamin deficiencies • Acidic saliva/Carbohydrate-rich diets • Heavy smoking • Oral epithelial dysplasia Clinical Presentation AndTreatment I. (Acute) Pseudomembranous Candidiasis • Pseudomembranous candidiasis is the most common form of oral candidiasis. • The most common sites include buccal mucosa, dorsal tongue, and palate. • Most frequent etiologies include antibiotic therapy or immunosuppression. • It appears as soft, creamy white to yellow, elevated plaques, that are easily wiped off affected oral tissues and leave an erythematous, eroded, or ulcerated surface which may be tender. Rationale for Treatment: Topical vs. Systemic Drugs • Topical antifungals are usually the drug of choice for uncomplicated, localized candidiasis in patients with normal immune function. • Systemic antifungals are usually indicated in cases of disseminated disease and/or in immunocompromised patients. • Duration of therapy: Medication should be continued for at least 48 hours after the disappearance of clinical signs of candidiasis along with complete healing and the absence of mucosal erythema. Some sources recommend drug therapy should be continued for 10-14 days regardless of the disappearance of clinical signs of candidiasis. DEDICATED FOR MOLAR PSPDG UMY 2012
  11. 11. #M10 drg. Suryono, PhD II. Chronic Hyperplastic Candidiasis • The most common sites are the anterior buccal mucosa along the occlusal line, and laterodorsal surfaces of the tongue. • The etiology may be idiopathic or associated with immunosuppression. • The most common appearance is that of asymptomatic white plaques or papules (sometimes against an erythematous background) that are adherent and do not scrape off. • Some sources believe that hyperplastic candidiasis may have the ability to promote the development of oral epithelial carcinogenesis. Treatment of hyperplastic candidiasis: • Use topical or systemic medications as was recommended for pseudomembranous candidiasis III. Chronic Atrophic (Erythematous) Candidiasis • The most common site is the hard palate under a denture, but atrophic candidiasis may also be found on the dorsal tongue and other mucosal surfaces. • The most common etiology is poor denture hygiene, and/or continuous denture insertion, but it may also be caused by immunosuppression, xerostomia, or antibiotic therapy. • The most common appearance is that of a red patch or velvet textured plaque. When atrophic candidiasis occurs on the hard palate in association with a denture, it is frequently associated with papillary hyperplasia. • Patients may complain of a burning sensation associated with this type of candidiasis • It is important to remember to treat both the denture (if present) and the oral tissues. (The denture will act as a reservoir for the Candida and reinfect the tissues if they are not treated concurrently). IV. Median Rhomboid Glossitis • Median rhomboid glossitis is a form of chronic atrophic candidiasis characterized by an asymptomatic, elongated, erythematous patch of atrophic mucosa of the posterior middorsal surface of the tongue due to a chronic Candida infection. (In the past, median rhomboid glossitis was thought to be a developmental defect resulting from a failure of the tuberculumimpar to retract before fusion of the lateral processes of the tongue). • A concurrent "kissing lesion" of the palate is sometimes noted. • Specific predisposing etiologic factor(s) for median rhomboid glossitis have not been clearly established. DEDICATED FOR MOLAR PSPDG UMY 2012
  12. 12. #M10 drg. Suryono, PhD V. Angular Cheilitis (Perleche) • Clinical appearance is that of red, eroded, fissured lesions which occur bilaterally in the commissures of the lips and are frequently irritated and painful. • The most common etiology is loss of vertical occlusal dimension, but it may also be associated with immunosuppression. Diagnosis • The diagnosis of oral candidiasis is most frequently made on the basis of clinical appearance along with exfoliative cytology examination. This involves the histologic examination of intraoral scrapings which have been smeared microscope glass slides. A 10% - 20% potassium hydroxide preparation ("KOH prep") can be used for immediate microscopic identification of yeast cell forms. Alternatively, the slide containing the cytologic smear can be sprayed with a cytologic fixative and stained using PAS (Periodic acid - Schiff) stain prior to microscopic examination. Candida Alhamdulillah selesaijugangeditmateri SUPER yang satuini.Maafyatemantemannggabisamaksimal translate semuanya. Banyak (banget) kakaa –oa Anyway, hope you guys can understand the main point of this Candidiasis lecture  Oke, adasatuquotenihdariomAristotelesyang mungkinbisabikin kalian lebihsemangat. Here is … “Pendidikanmempunyaiakar yang pahit, tapibuahnyamanis” SemangatHaphap!! DEDICATED FOR MOLAR PSPDG UMY 2012

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