Infeksi Jamur pada

System Genital

Efrida Warganegara
 SYSTEMIC MYCOSES
SYSTEMIC MYCOSIS : Opportunistic

Disease Agents

 Candidiasis Candida albicans; Candida sp.

 Cryptococcosis Cryptococcus neoformans

 Aspergillosis Aspergillus fumigatus;

Aspergillus sp.

 Zygomycosis Mucor, Rhizopus, Absidia

 SYSTEMIC MYCOSES
Pathogenic Opportunistic

 Agent dimorphic fungus non-dimorphic fungus

 Port d’entre lung (per inhalation ) lung & others

 Disease usually chronic usually acute

 Patients could be healthy patients usually ill

patient
 SYSTEMIC MYCOSES
CANDIDIASIS = Candidosis

 acute / chronic fungal infections, involving, the mouth,

vagina, skin nails, bronchi / lung, alimentary tract, urinary
tract, blood steam and less commonly, the heart or
meningen

 are caused by Candida albicans or other species

 are predisposed by : extremes of age, wasting, &

nutritional disease, excessive moisture, pregnancy,
diabetes, long-term antibiotics, & steroid use, indwelling
catheter, immunosupressed & AIDS

 are generally treated with imidazoles, polyenes or both

 CANDIDIASIS
Candida albicans :

 is part of the normal flora of the skin, mucous

membranes & GI tract along with other Candida
sp.
 normal colonization must be distinguised from
infection
 form elongated “budding forms” called
pseudohyphae, which are often seen in clinical
material along with true hyphae, blastoconidia &
yaest cells
 CANDIDIASIS
Clinical features : Vulvovaginitis
 is a yeast infection of the vagina; manifest with a
thick yellow-white discharge, a burning sensation,
curd-like patches on the vaginal mucosa &
inflamation of perineum

 is predisposed by diabetes, antibiotic therapy, oral

contraceptive use & pregnancy

 may be trasmitted to sexual partner as balanitis

 2. Genital System Disease
b.Vulvovaginal Candidiasis (VVC)
Vulvovaginal Candidiasis (CCV)
 VVC is fungal infection, is the second most common cause
of vaginal symptom after BV
 Like BV, it seems to occur after a disruption of the normal
microbiota.
 Often involved not only the vagina, but the vulva as well as.
Symptom and Sign
 The most common - constant, intense itching and burning of
the vagina or vulva
 Typically – large amount of thick, clumpy whitish or whitish-
gray vaginal discharge
 Vaginal mucosa – usually red &somewhat swollen, and may
have patches of cottage cheese appearing clumps attached
to it
 2. Genital System Disease
b. Vulvovaginal Candidiasis (VVC)
Causative Agent
 VVC is caused by Candida albicans – a yeast (eucaryotic) that
is part of the normal microbiota of the vagina in about a
third of all women
Pathogenesis
 Normally, vaginal colonization by C. albicans causes no symptoms.
 The growth of the m.o. is usually limited by the immun system
and the normal vaginal lactobacilli that occupy the same niche
and compete for nutritients
 When the normal microbiota balance is disturbed – as occurs
during menstruation or pregnancy, or when using oral
contraceptives or antibiotics – C. albicans can multiply freely,
causing an inflammatory respons.
 The sign and symptom of VVC occur within about 10 days.
 2. Genital System Disease
b.Vulvovaginal Candidiasis (VVC)
Epidemiology
 Factor predispose to C.albicans – late pregnancy, poorly
controlled diabetes, and use of oral contraceptive or AB
 Hormon replacement therapy, may also increase the risk of
VVC
 The disease does not spread from person to person
Treatment and Prevention
 Intravaginal treatment with antifungal e.g. nystatin,
clotrimazole, or fluconazole is usually efective
 Fluconazole taken by mouth is generally safe and effective,
although it may cause side effects e.g. headache, &nausea..
 Self diagnosis and treatment with over the counter
medication – development drug resistant
 Prevention – minimizing use and duration antibacterial, and
effective treatment of underlying disease e.g. diabetes.
 CANDIDIASIS
Laboratory diagnosis :
 direct microscopic examination : wet mount of the skin /
nail scraping or exudate, demonstration of the presence of
pseudohyphae / hyphae, & yeast in the tissue
 culture : of the specimens on to SDA at room
temperature, Candida will grows as yaest-like colony
 C. albicans be identified by :
* germ tube test -- yeast germination in serum at 370C
* culture on corn-meal-agar -- reveals chlamydospres
* culture on Eosin-methylen-blue-agar : reveals spider
colony
* fermentation test of : glucose, lactose, maltose,
sacharose
 serologic : high levels of Candida precipitins or antigens
Bacterial Vaginosis
 2. Genital System Disease
a. Bacterial Vaginosis (BV)
 The genital tract is the portal of entery for many
infectious disease both non-sexuallly and
sexually transmitted.
 This section discusses some genital system
disease that are not generally transmitted
sexually
 BV is the most common vaginal disease of
women in their childbearing years.
 Term vaginosis raher than vaginitis, because
there are no inflammatory changes.
 BV in pregnant women and puts them at risk for
premature delivery
 2. Genital System Disease
a. Bacterial Vaginosis (BV)
Sign and Symptoms
 BV is characterized by a thin, grayish-
white, slightly bubbly vaginal discharge
that has a characteristic strong fishlike
smell
 The bacteria associated with BV may
spread to the uterus or fallopian tubes,
causing pelvic inflammatory disease (PID),
which can lead to sterility.
 About half of BV cases are a symptomatic
 2. Genital System Disease
a. Bacterial Vaginosis (BV)
Causative Agent
 Causes of BV are unknown
 Because cases show a significant decrease in vaginal
lactobacilli
 Condition that suppress lactobacilli or promote the
growth of other m.o. are though to play a causative role
 The discharge that characterizes BV contain large
number of bacteria, including :
* aerotolerant Gardnerella vaginalis
* anaerobic species of Mobiluncus sp. and Provetella sp.
* Mycoplasma sp.
* Aerobic streptococci
 these m.o. generally present in women with BV
 Gardnerella vaginalis
 G. vaginalis is a rod shaped
gram negative (variable)
facultative anaerob bacteria
 Increase in vagina with
decrease in Lactobacilly and
increase in anaerobes;
difficult to cultivate.
 More commonly causes
nonspesific vaginitis (bacterial
vaginosis) but can on
occasion cause NGU in males.
 2. Genital System Disease
a. Bacterial Vaginosis (BV)
Pathogenesis
 Women with BV 
* characteristik changes in the vagina, including a loss of
acidity of the vaginal secretion (N : pH 3,8-4,2)
* disruption of the normal microbiota
* substantial increase in the number of clue cells
(epithelial cells that have sloughed off the vaginal wall
and are coverred with bacteria)
* There is no inflammation unless another, concurrent
vaginal infection is present
* The strong fishy odor is caused by metabolic product of
the anaerobic bacteria and is used for diagnosis in the
whiff test
 2. Genital System Disease
a. Bacterial Vaginosis (BV)
Epidemiology
 The disease is most common among sexually active
women and sometimes occurs in children who have
been sexually abused
 Pregnant women are at increased risk of BV
 Women who wear thongs, douche, have multiple sex
partner, have sex with orher women, have a new sex
partner, or use an intrauterine devise (IUD) also have
an increased risk
 There is no proof that BV is sexually transmitted
 However, women with BV are at higher risk of getting
other STIs such as gonorrhea, HIV, or chlamydia.
 Virgin seldom get BV
2. Genital System Disease
a. Bacterial Vaginosis (BV)
Treatment and Prevention
 Respond quickly to treatment with antibiotics e.g.
metronidazole or clinadamycin  orally or
vaginally
 The disease can recur
 Treatment of BV is important in pregnant women
because BV may cause premature birth
 BV can prevent by abstinence, limiting the number
of sex partner, and avoiding douching and the use
of thongs.
 Treatment of the male sex partner of patient with
BV does not prevent recurrences
 Diagnosis
Three of the four criteria should be positive

 Thin homogenous discharge

 pH of discharge >4.5.
 Clue cells in saline wet mount or Gram
stain of vaginal discharge
 Mixture of vaginal discharge and 10%
KOH liberates an "amine-like" or "fishy"
odor.
Treatment
 Products like douches or deodorant sprays that
mask vaginal odor should not be used to treat
BV. Although they may temporarily eliminate
odor, they will not cure the condition.
 It is important to tell your patient not to douche
or use a feminine hygiene spray for a few days
before their appointment. These products may
actually hide important clues that can help in
diagnosing BV, and may make the condition
worse.
 Antibiotic therapy: metronidazole or clindamycin
for 7 days.
MYCOPLASMA & UREAPLASMA
1. Mycoplasma hominis
2. Mycoplasma genitalium
3. Ureaplasma urealyticum : is a
prokaryote that lacks a cell wall and
can be cultured in the lab. However,
this organism is often seen in normal
individuals and culturing the organism
has questionable value in diagnosing
NGU.
Ureaplasma urealyticum
 U. urealyticum and M. hominis colinize the
Genitourinary tract of sexually active men
and women
 Both organism are opportunisyic
pathogens and can be transmitted by
sexual contact
 Colonization occurs initialy during birth as
infeant passes through the birth canal,
increases after pubertas and increased
sexual activity
Ureaplasma urealyticum
 U. urealyticum : has been implicated as one of
the causes of NGU
 In women : appears to be an opportunistic
pathogen during pregnancy  cause of
chorioamnionitis  leads to premature labor
and delivery
 Stillbirths and perinatals death have been
associated with infection
 Congenital and neonatal pneumonia,
septcemia, and meningitis  have been
associated with infection of chorioamnion by
U.ueralyticum
 Therapy NGU : Tetracyclin, if allergy may be
take erythromycin, sexual partner also threated
 2. Genital System Disease
c. Staphylococcal Toxic Shock Syndrome
Toxic Shock Sydrome
 Late 1970s – children with Staphylococcal infection
 In 1980 became epidemic in young, healthy, menstruation women
who were using a brand og high-absorbency tampon that has
since been removed from the market
 Term Toxic Shock Syndrome – describe the sign and symptom of
the illness. Now, it is called Staphylococcus toxic shock syndrome
Sign and Symptom
 Is characteristic by the suddent development of high temperatur,
headache, muscle aches, bloodshot eyes, vomiting, diarrhea, a
sunburnlike rash, and confusion
 Typically, the skin peels about a week after the development of
the disease.
 Without treatment, the blood pressure can drop, leading to
multiorgan failure, coma, and sometimes death
 2. Genital System Disease
c. Staphylococcal Toxic Shock Syndrome
Causative Agent
 Is caused by strain of Staphylococcus aureus that produce toxic
shock syndrome toxin-1 (TSST-1) or other related exotoxin
Pathogenesis
 Tampon-associated toxic shock syndrome begin 2-3 days after the
start of menstruation when tampon are used.
 The staphylococci grow in the blood-soaked tampon.
 The bacteria rarely spread throughout the body, but as they
multiply they produce TSST-1 or other exotoxin
 Staphylococcal toxic shock syndrome results from absorption of
these toxin into the blood stream
 Toxin (superantigen) – activation of large number of helper Tcell
- leading a massive release of cytokines – drop in blood pressure
and multiorgan failure – the most dangerous of the potentially a
fatal illness
 2. Genital System Disease
c. Staphylococcal Toxic Shock Syndrome
Epidemiology
 Syndrome can occur : after infection of surgical wound,
infection childbirth, and others. Not spread from person
to person
 Increase the risk – using tampon; higher-absorbency
tampon may pose a greater risk; intravaginal
contraceptive sponges
Treatment and Prevention
 Staphylococcus TS Syndrome is a severe disease and
requires hospitalization
 Effectively treated with antibacterial, IV fluid, and other
measures to prevent shock and kidney damage
 Source of the infection should be removed if possible
 2. Genital System Disease
c. Staphylococcal Toxic Shock Syndrome
Treatment and Prevention (continued)
 Most people recover fully in 2-3 weeks, the disease can be
fatal within a few hours.
 Prevented by appropriate use of tampon, washing hand
before/ after inserting tampon, tampon with the lowest
practical absorbency, changing tampons about every 6
hours, using a pad instead of tampon while sleeping
 It is also important to avoid trauma to the vagina when
inserting tampons, to recoqnize the sign and symptom of
Staph.TSS , and remove any tampon immediately if
symptom occur
 Women who have had Staph.TSS previously should not
use tampon
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