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Infeksi Jamur pada Paru

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Histoplasmosis: Ohio Valley Fever

• Histoplasma capsulatum – most common true pathogen; causes histoplasmosis

• Distributed worldwide, most prevalent in eastern and central regions of US

• Grows in moist soil high in nitrogen content

• Inhaled conidia produce primary pulmonary infection that may progress to systemic involvement of a variety of organs and chronic lung disease.

• Amphotericin B, ketoconazole

PORTAL OF ENTRY

INHALATION

INOCULATION

(rare)

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Cause

• Spores

– trapped by macrophages

– germinate in lungs

• Infection spreads through body in blood stream

Acute Symptoms

Asymptomatic:

› No symptoms

› Most common

Symptomatic:

› Fever

› Chills/Sweats

› Cough

› Chest pain breathing

in

› Muscle Aches

› Loss of appetite

Chronic Symptoms

Chest pain

Shortness of breath

Cough

› May bring up blood

Weight loss

Fever

Excessive sweating

5% of those who are infected

› Chronic histoplasmosis

Disseminated Symptoms

Fevers

Headache

Pneumonia

Neck stiffness

› Swollen lymph nodes

Skin lesions

› Mouth and nose sores

Anemia

Weight loss:

› Diarrhea

› Loss of appetite

Infection of heart valves

Other Symptoms

• Enlarged

– Liver

– Spleen

– Adrenal gland

• Joint pain

• Rashes

• Skin nodules

– tender red lumps • erythema nodosum

Diagnosis

• Fungal culture

• Fungal stain

• Blood test

• Chest X-ray

– distinct markings on lungs

• CT scan

• Transbronchial biopsy

CLINICAL SPECIMENS

• SPUTUM

• BONE MARROW

• BIOPSY MATERIAL

• BRONCHIAL WASHINGS

• PERIPHERAL BLOOD

• GASTRIC WASHINGS

Identification

• 1. Microscopic observation

• 2. Conversion

• 3. DNA Probe

SEROLGICAL TEST

• COMPLEMENT FIXATION

– MYCELIAL FORM ANTIGEN

– YEAST FORM ANTIGEN

• IMMUNODIFFUSION

– H = ACUTE INFECTION

– M = PAST, PRESENT OR SKIN TEST

SEROLGICAL TESTS

• EIA detects antibody

• EIA to detect ANTIGEN

(systemic disease)

ECOLOGICAL ASSOCIATION

• Blackbird roosts

• Bats

• Bat guano

• Chicken houses

Treatment

Antifungal drugs

› IV

Amphotericin B (Fungizone IV, Abelcet)

› Oral

Itraconazole (Sporanox)

Ketoconazole

Prevention

• Minimize exposure to dust in contaminated environments

– Chicken coops

– Bat caves

• Wear breathing apparatus

– Masks

• Spray contaminated soil