INFEKSI JAMUR
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Transcript of INFEKSI JAMUR
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INFEKSI JAMUR
Rosmarini Estri Sih Hananti
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Infeksi jamur
Dermatofitosis
Pityriasis versicolor
Kandidosis kutis
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DERMATOFITOSIS
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Dermatofitosis
Dermatofita : organisme yg berkemampuan utk
menempel pd keratin dan menggunakan sbg
sumber nutrien utk berkolonisasi (str korneum,
rambut, kuku, tmsk jar tanduk binatang)
Infeksi o/ dermatofita dermatofitosis
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Epidemiologi
Jamur superfisial dibagi berdsr habitat dan bentuk infeksi
Geofilik :
Tanah
Menginfeksi manusia
Mll kontak lgs dari tanah
Dpt hidup di selimut dan alat pertanian slm 1 thn (spora)
Inflamatif
Microsprosum gypseum
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Zoofilik
Binatang, tp dpt transmisi ke manusia
Microsporum canis (anjing, kucing)
Transmisi mll kontak lgs dan tdk lgs (rmbt binatang yg
menempel di pakaian)
Biasanya mengenai kulit kepala, jenggot, wajah,
tangan (expose area)
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Anthropofilik
Manusia
Kontak langsung
Bervariasi antara asimptomatis - inflamasi jelas
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Prosedur diagnostik
Rambut
Dicabut KOH 10-20% ectothrix ato endothrix
Ectothrix : arthrokonidia mengelilingi rambut
(M.canis, M.audoninii)
Endothrix : arthrokonidia berada dalam rambut
(T.tonsurans)
Wood lamp : dpt melihat yg ectothrix
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Kulit dan kuku
Kulit dikerok, kuku di potong KOH 10-20% (kulit
10 menit, kuku 20-30 menit)
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Patogenesis
3 tahapan :
Adherence to keratinocytes
Penetration through and between cells
Development of a host response
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Adherence
Arthroconidia yg kebal thd sinar UV, kelembaban & temperatur yg bervariasi, kompetisi dg flora N, sphingosines (keratinosit), asam lemak (gl sebasea) fungistatik
Post pubertas produksi meningkat kejadian menurun
Penetration
Stlh menempel penetrasi lbh cpt dr deskuamasi
Dibantu o/ enzime proteinase, lipase, musinolitik (nutrisi utk jamur)
Trauma & maserasi membantu
Fungal mannan (dinding sel dermatofita) menurunkan proliferasi keratinosit
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Development of a host response
Derajat inflamasi dipengaruhi status imun dan
organismenya
Dermatofita f.kemotaksis
Hipersensitivitas tipe IV
Pdrt dgn inf primer inflamasi minimal (trichophytin (-))
Dermatophytid reaction timbul krn rx alergi, KOH (-),
berupa eritema nodosum, papul folikularis, vesikular id,
letak jauh dr sumber inf
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TINEA CAPITIS
Mengenai kepala & berhub dg rambut
Disbbkn o/ Trichophyton & Microsporum (M.canis, T.tonsurans)
Ada 3 tipe
Non inflammatory (“grey patch”)
Ectothrix anthropophilic (M.canis, M.audouinii)
Inflamasi minimal
Rambut yg terkena berwarna abu2 dan mudah patah
Tampak lesi hiperkeratotik, bts tegas, berskuama, “wheat
field”, biasa mngenai bag occiput
Lampu wood hijau
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Tipe inflammatory
Disbbkn o/ zoophilic, geophilic, ectothrix anthrophopilic
Inflamasinya (pustular folliculitis-kerion) rx hipersensitivitas
Kerion boggy, rambut mudah putus, orifisium folikel membasah krn pus
Gatal, kdg nyeri, limfadenopati, demam
Lampu wood (-)
“Black dot”
Antrophopilic endothrix (T.tonsurans, T.violaceum)
Inflamasi plg minimal, rambut patah (black dot)
Skuama difus-pustular folliculitis atau furuncle like – kerion
Lampu wood (-)
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Differential diagnosis
Dermatitis seboroik
Psoriasis
Impetigo
Dermatitis atopik
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TINEA CORPORIS
Mengenai kulit kecuali telapak tangan, kaki dan selangkang
Disbbkan antrophopilic atau zoophilic
Predisposisi : suhu lembab, pakaian oklusif berhub frekuensi & erupsi berat
Lesi klasik : makula eritematus batas jelas, tepi polisiklik, aktif (papul, vesikula), sembuh di tengah (central healing) tertutup skuama
Granuloma majocchi : T.rubrum, pd kaki yg dicukur berupa papul folikuler, >>wanita
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TINEA IMBRIKATA
Bentuk tinea korporis karena T.concentricum dan terdapatnya terbatas didaerah tertentu
Khas polisiklik
Makulopapulo skuamous
Tersusun cincin konsentris
Meluas keseluruh badan
Stratum korneum terlepas dan tepinya bebas menghadap tengah
Kepekaan T concentricum dipengaruhi gen autosomal resesif
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Differential diagnosis
Erythema annulare centrifugum
Dermatitis numularis
Granuloma annulare
Morbus hansen
Psoriasis
Pityriasis rosea
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TINEA CRURIS
Mengenai selangkang, pubis, perianal dan perineum
Makula eritematus batas jelas, tepi polisiklik, aktif
(papul, vesikula), sembuh di tengah (central healing)
tertutup skuama
Gejala klinis : Gatal, nyeri jk tjd maserasi atau infx
sekunder
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Differential diagnosis
Psoriasis
Dermatitis seboroik
Candidiasis
Eritrasma
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TINEA PEDIS DAN TINEA MANUS
Mengenai kaki (pedis), palmar & interdigital (manus)
Ada 4 tipe
Tipe kronik intertriginosa (interdigital)
Bnyk mengenai kaki
Mulai skuama, erosi, eritem di interdigital & subdigital kaki, tu/ 3 jari lateral.
Dpt meluas ke daerah telapak kaki atau instep, jrg dorsum
Oklusif & co-infeksi maserasi, pruritus, malodor (athlete’s foot)
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Tipe kronik hiperkeratotik
Skuama difus terbatas pd telapak kaki (lateral & medial),
bilateral moccasin type
T.rubrum >> vesikel skuama kolaret dg eritem
bervariasi
Biasanya disertai unilateral t.manum (2 feet-1 hand
syndrome)
T.manum meluas ke punggung tangan spt t.corporis
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Tipe vesikobulosa
Disbbkan T.mentagrophytes
Berupa vesikel (>3mm) atau bula pd tepi dan telapak kaki
Tipe akut ulseratif
Disbbkan T.mentagrophytes
Sering co-infx dgn gram negative berupa vesikopustul dan area luas yg purulen
dpt disertai selulitis, limfangitis, limfadenopati, demam
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DIFFERENTIAL DIAGNOSIS
INTERDIGITAL
Candidiasis
Eritrasma
HIPERKERATOTIK
Keratoderma
Dishidrosis
VESIKOBULOSA
Palmoplantar pustulosis
Pyoderma
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Tinea Unguium
Disbbkan :
T.rubrum, T.mentagrophytes, T.tonsurans, E.floccosum
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Ada 3 bentuk klinis
Distal subungual onychomycosis
Proximal subungual onychomycosis
White superficial onychomycosis
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Distal subungual onychomycosis (DSO)
Bentuk yg tersering
Tampak :
Diskromia unguium ( perubahan warna kuku )
Onikolisis ( lepasnya lempeng kuku dan dasar kuku )
Hipertropia unguium ( penebalan lempeng kuku )
Subungual hiperkeratosis /debris
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Proximal subungual onychomycosis (PSO)
>> disbbkan T.rubrum & T. megninii
Gejala klinis pada proksimal kuku. Banyak ditemukan pada
penderita AIDS, penerima transplantasi organ penyakit
jaringan ikat
Subungual hiperkeratosis, proximal onikolisis
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White superficial onychomycosis (WSO)
Disbbkn o/ T.mentagrophytes
Tampak bercak putih hingga kuning yg jelas pd
permukaan kuku
Permukaan menjd kasar dan rapuh
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Differential diagnosis
Psoriasis
Liken planus
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TINEA INKOGNITO
Infeksi dermatofit yg
berubah karena
kortikosteroid sistemik
atau topikal yg diberikan
karena kelainan yg telah
ada atau salah diagnosis
tinea
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Penatalaksanaan (tergantung luas & lokasi)
Topikal :
Gol azole : Ketokonazole 2%, mikonazole 2%
Gol alilamine : terbinafine
Ciclopirox 8% lacquer T unguium
Selenium sulfida, zinc pitirionin, ketokonazole shampo T.
capitis
Sistemik
Griseofulvin 0,5-1 gr/hr (dws), 0,25-0,5 gr/hr atau 10-25
mg/kgbb/hr(anak)
Golongan azol : ketokonazole, fluconazole, itraconazole
Terbinafine
2 - 4 mgg utk tinea corporis, cruris, pedis, manus
2 bulan utk tinea unguium pd jari tangan, 3 bulan pd jari kaki
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PITYRIASIS VERSICOLOR
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Pityriasis versikolor
Etiologi : Malassezia furfur
Epidemiologi : bnyk ditemukan di daerah tropis
Patogenesis :
M. furfur merup flora normal di kulit faktor
endogen (def imun krn penggunaan kortikosteroid,
kontrasepsi oral), eksogen ( suhu, kelembaban
udara, keringat) menjd patologis
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Gejala klinis
Makula hipopigmentasi atau hiperpigmentasi
berskuama tipis
Predileksi : dada, punggung, perut, ekstremitas
Ragi M.furfur dpt memfilter sinar matahari shg
menghambat tanning
Jg mensintesis pityriacitrin yg dpt mengabsorsi sinar
ultraviolet hiperpigmentasi
Azelaic acid (dicarboxilic acid) hmbt tirosinase
dan hancurkan melanosithipopigmentasi
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Penegakan diagnosis
Klinis
Pemx lab : KOH parker tampak spagheti meatball
(hifa pendek dan spora bulat berkelompok)
Lampu wood : kuning keemasan
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Diagnosis banding
Vitiligo
Pityriasis alba
Morbus hansen
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terapi
Topikal : selenium sulfide, ketokonazole shampo
(15-30 menit sblm mandi), gol azole lain
Sistemik : ketokonazole 1x200mg 10 hari
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KANDIDOSIS KUTIS
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Etiologi & epidemiologi
Disebabkan oleh spesies Candida, tersering
Candida albicans
Menyerang semua umur, baik laki-laki maupun
perempuan
Faktor predisposisi :
Obesitas
Oclusive dressing
DM
Occupational
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Kandidosis kutis
Kandidosis intertriginosa
Candida Paronikia
Onikomikosis
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Gejala klinis kandidosis intertriginosa
Keluhan gatal
Klinis akan tampak eritematous, di daerah
intertriginosa dengan maserasi yg dikelilingi lesi
satelit (vesikopustul)
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Gejala klinis candida paronikia
Infeksi pd lipatan kuku atau kutikula
Klinis : tampak eritema dan oedema dan cairan
purulen, tebal, pus putih kekuningan, membentuk
kantung yg mungkin menyebabkan infeksi kuku
Tdpt keluhan : nyeri
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Gejala klinis onikomikosis
Diskromi (brownish or green discoloration)
Onikolisis (terlepasnya nail plate)
Transverse depression pd nail plate (Beau lines)
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Penegakan diagnosis
Klinis
Pemx lab : KOH 10 %
Kultur pd Sabaroud agar
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Diagnosis banding
KANDIDOSIS INTERTRIGINOSA
Tinea cruris
Eritrasma
Psoriasis inverse
ONIKOMIKOSIS
Tinea unguium
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Penatalaksanaan
Edukasi
Meminimalkan pekerjaan yg berhub dgn kelembaban
Topikal : golongan azole (mikonazole, ketokonazole,
imidazole), nistatin
Sistemik : gol azole (ketokonazole) selama 5 - 7
hari