5.3 Patogenia Micotica
Transcript of 5.3 Patogenia Micotica
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Patogenia de los Hongos
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MECANISMOS DE ACCIÓN
PATÓGENA• Micetismo
•
Micotoxicosis
• Reacciones alérgicas
• Micosis
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Hábitat
Parásito Hospedero
Hongo
Micosis
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Factores del Hospedero
Estado inmunológicoEnfermedades subyacentesSexoEdadOcupación
Hábitos (alcoholismo, drogadicción))
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HabitatDistribución geográfica(temperatura, húmedad)
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CLASIFICACIÓN DE LAS MICOSIS
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MICOSIS SUPERFICIALES AFECTAN PIEL, MUCOSAS yFANERAS
• TRANSMISIBLES
•
RECIDIVANTES• NO DEJAN INMUNIDAD
• UNIVERSALES
• ENDÓGENAS O EXÓGENAS
EJS: PITIRIASIS VERSICOLOR, TIÑAS,PIE DE ATLETA, ONICOMICOSIS
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MICOSIS SUBCUTANEAS
• Afectan dermis, tejido celular
subcutáneo, músculos y a veces huesos
y articulaciones.
• No son transmisibles
• Puerta de entrada: traumatismo
•
Evolución lenta.• Agente etiológico en el suelo o los
vegetales.
EJS: ESPOROTRICOSIS, MICETOMAS
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MICOSIS PROFUNDAS
• Los agentes etiológicos están en el suelo
• Los esporos están en el aire
• Penetran por vía inhalatoria
• Primoinfección pulmonar
• Se propagan por vía linfática y hemática
• Dan una infección sistémica (afectan distintos
órganos)
• No son contagiosas
•
Son graves EJS: Histoplasmosis, Paracoccidioidomicosis
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• Inmunocomprometidos
• Agente etiológico: hongos de la microbiota
normal o del medio ambiente
• Fuente de infección endógena y exógena
MICOSIS OPORTUNISTAS
Ejs: Criptococosis, Candidiasis diseminada, Aspergilosis, Neumocistosis
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CANDIDOSIS O CANDIDIASISBUCAL
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Agente etiológico
Cand ida albicans
Candida tropicalis
Candida krusei Candida glabrata
Candida parapsilosis
Candida dubliniensis
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Hábitat
Microbiota normal de:
Cavidad bucal
Intestino
Vagina
Piel
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Fuente de infección
• Endógena: reservorio bucal
•
Exógena: la infección se puede adquirir deotras personas o de superficies y objetos.
Ej. Candidosis oral neonatal
Dermatitis del pañal
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• Capacidad de adherencia: Adhesinas
• Dimorfismo
• Tigmotropismo • Enzimas: proteinasas, fosfolipasas
• Formación de biopelículas o biofilm
• Mananos, mananoproteínas, glucanos
• Cambio fenotípico
Factores de virulencia de Cand ida spp .
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Adherencia
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DIMORFISMO
Candida albicans
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Factores de virulencia
•Morfogénesis: transición entre levaduras y formas
de seudohifas
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Tigmotropismo
Capitulo 23 de Liebana Ureña
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• Bicapa• Microcolonias
• Matriz extracelular – Agua (97%)
– Exopolisacáridos:
glucosa, manosa y galactosa – Proteínas, ac. nucleicos
• Canales de agua
[Douglas LJ. Trends Microbiol 2003]
BIOPELICULA DE CANDIDA
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Factores del hospederoCausas predisponentes
Generales Locales
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Causas predisponentes generales
Ruptura de la barrera cutáneo mucosa
Edad ( recién nacidos y ancianos)
Diabetes
Cambios hormonales
Corticoides
Antibióticos
Inmunosupresión por diferentes causas
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Prótesis
Dieta rica en hidratos de carbono
Mala higiene bucalLesiones en la mucosa
Tabaquismo
Hiposalivación
Causas predisponentes locales
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PRINCIPALES MECANISMOS DEDEFENSA
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CandidiasisSeudomembranosa Aguda
Queilitis Angular
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Diagnóstico
1. Examen microscópico directo
2. Cultivos
3. Identificación de especies
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1. Examen microscópico directo
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2. Cultivos
AgarSabouraud
CHROMagar ® Candida
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3. Microcultivo en Agar leche
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Micosis sistémicas endémicascon manifestaciones bucales
Histoplasmosis
Paracoccidioidomicosis
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Histoplasma capsulatum var. capsulatum
Fase saprofítica Fase parasitaria
Á
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Áreas endémicasH istoplasma capsulatum var capsulatum
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Mecanismos de virulencia
H istoplasma capsulatum
melanina
α1-3 glucano
Crecimiento intracelular
Aumento pH
fagolisosoma
Unión a receptores
CD11 y CD18
hierro
calcio
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Histoplasmosis
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Paracoccidioides brasiliensis
Fase saprofítica Fase parasitaria
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Areas endémicasParacoccidoides brasi l iensis
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Mecanismos de virulencia
Paracocc idioides brasi l iens is
α1-3 glucanoβ glucano
proteasas
O2
hierro
Receptor de laminina
Producción de melanina
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Paracoccidioidomicosis
Patogenia I Inmunidad innata
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Patogenia I Inmunidad innata
Elemento infectante
CONIDIOS Vía inhalatoria Alvéolo pulmonar
Fagocitosis
macrófagos y neutrófilos
Multiplicación y cambio afase levaduriforme
Células NK
Activación complemento
Migración a ganglioslinfáticos localesy órganos distales
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Patogenia II Respuesta inmune celular
IL 12
IFNγ
Linfocitos T helper
Formación del granuloma
2da semana
Respuesta TH1 Respuesta TH2
Producción deanticuerpos
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Diagnóstico
1. Examen microscópico directo
2. Cultivos a 28º y 37º C
3. Identificación de especies
4. Estudio histopatológico (biopsias)
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Histoplasmosis
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Paracoccidioidomicosis