PENDAHULUANThe human body has a complex system ofprotective mechanisms to preventinfection, involving both the adaptive(cellular and humoral) immune system andthe innate defense system (e.g.skin, mucous membranes).
TERBAGI DUA KELOMPOK Defects, accidental or intentional, in the bodys innate defense mechanisms; Deficiencies in the adaptive immune response.
GANGGUAN SISTEM IMUN Primary immunodeficiency - Inherited or occurs by exposure in utero to environmental factors or by other unknown mechanisms. chronic granulomatous disease (Congenital defects in phagocytic cells ) - Rare , and varies in severity depending upon the type of defect - Immunoglobulin deficiency
GANGGUAN SISTEM IMUN Secondary or acquired immunodeficiency - Due to an underlying disease state) or occurs as a result of treatment for a disease. - Malnutrition is a common and the most important cause of acquired immunodeficiency - Treatment of disease can also cause immunosuppression
INFEKSI KLIEN IMUNOCOMPROMISED KARENA FAKTOR FISIK Infeksi luka bakar The most important pathogens in burn wounds are: - Pseudomonas aeruginosa and other Gram- negative rods - Staphylococcus aureus - Streptococcus pyogenes; - other streptococci; - enterococci
INFEKSI KLIEN IMUNOCOMPROMISED KARENA FAKTOR FISIK Traumatic injury and surgical wound infections - Staph. aureus is the most important cause of surgical wound infection - Catheter-associated infection of the urinary tract is common - Staphylococci are the most common cause of intravenous and peritoneal dialysis catheter infections
INFEKSI KLIEN IMUNOCOMPROMISED KARENA FAKTOR FISIK Infections of plastic devices in situ Staph. epidermidis is the most common cause of prosthetic valve and joint infections Infections due to compromised clearance mechanisms Stasis predisposes to infection, and in health the body functions to prevent stasis
INFECTIONS ASSOCIATED WITH SECONDARY ADAPTIVE IMMUNODEFICIENCY Hematologic malignancy and bone marrow transplant infections A lack of circulating neutrophils following bone marrow failure predisposes to infection, Gram-negative rods such as Escherichia coli and P. aeruginosa, Staph. epidermidis dan fungi Solid organ transplant infections Most infections occur within 3-4 months of transplantation AIDS infections The clinical definition of AIDS includes the presence of one or more opportunistic infections
OTHER IMPORTANT OPPORTUNIST PATHOGENSA. Fungi Candida is the most common fungal pathogen in compromised patients , manisfestasi beragam tergantung area : - Chronic mucocutaneous candidiasis - Oropharyngeal and esophageal candidiasis - Gastrointestinal candidiasis - Disseminated candidiasis
FUNGI Cryptococcus neoformans - Most common in people with impaired cell-mediated immunity - An opportunistic yeast with a worldwide distribution. - Cause infection in the immunocompetent host, - Infection is seen more frequently in people with impaired cell-mediated immunity.
FUNGI Histoplasma capsulatum - Infection may occur years after exposure - Highly infectious fungus that causes an acute but benign pulmonary infection in healthy people - Produce a chronic progressive disseminated disease. - Endemic only in tropical parts of the world and notably in the so-called histo belt of the central USA, particularly in the Ohio and Mississippi river valleys. - The natural habitat of the organism is the soil. - Transmitted by the airborne route and the fungal spores are deposited in the alveoli, from whence the fungus spreads via the lymphatics to the regional lymph nodes.
FUNGI Aspergillus spp - Usually a fatal disease in diseases of the lung - Cause of invasive disease in compromised patients - Usually in profoundly neutropenic patients or those receiving high dose corticosteroids). - Found in soil, but have a worldwide distribution - Infection is spread by the airborne route, and the lung is the site of invasion in almost every case
FUNGI Pneumocystis jiroveci (formerly P. carinii) - Causes symptomatic disease in people with deficient cellular immunity - An atypical fungus which appears to be widespread, - High incidence of P. jiroveci pneumonia in patients receiving immunosuppressive therapy to prevent transplant rejection and in people with HIV. - Very rare to find Pneumocystis infection in any other site in the body
OTHER IMPORTANT OPPORTUNIST PATHOGENS BACTERIA Nocardia asteroides Uncommon opportunist pathogen with a worldwide distribution contain two pathogenic genera, Actinomyces and Nocardia Mycobacterium avium Intracellulare disease is often a terminal event in AIDS This includes disseminated infection with Mycobacterium tuberculosis and Mycobacterium avium-intracellulare (Mycobacterium avium complex or MAC
OTHER IMPORTANT OPPORTUNIST PATHOGENS PROTOZOA AND HELMINTHS Cryptosporidium and Isospora belli - Cause severe diarrhea in AIDS - Protozoan parasite that causes human disease - Well known to veterinarians as an animal pathogen
PROTOZOA AND HELMINTHS Strongyloides stercoralis - Immunosuppression may lead to reactivation of dormant parasitic - Roundworm that remains dormant for years following initial infection, - May be reactivated to produce massive autoinfection in the immunosuppressed patient
OTHER IMPORTANT OPPORTUNIST PATHOGENS VIRUSES EBV infection - Associated with the development of Hodgkins disease, - Non-Hodgkins lymphomas in individuals with HIV infection, - Post-transplantation lymphoproliferative disease - Smooth-muscle tumors in immunosuppressed children
VIRUSES Adenovirus infection Primary and reactivated adenovirus infections can result in disseminated disease in immunocompromised hosts, in particular pediatric and adult bone marrow transplant recipients.
VIRUSES HepatitisB infection Hepatitis B virus infection has an immunopathological basis, with jaundice occurring after cytotoxic T cells have lysed the hepatitis B surface-antigen- bearing hepatocytes
VIRUSES Polyoma viruses BK or JC viruses, acquired via the respiratory tract and latent in the kidney, are often detected in the urine of bone marrow transplant recipients