Clinical Mycology

1. Clinical Mycology
in Indonesia
Fadel Muhammad Garishah, MD
Department of General Medicine

2. Clinical Mycology
 Applied sciences of the study of fungal infections

3. Medically Important Fungi
ent classesof innateimmunereceptors.Although not
formally proven, dectin-1 also seemsto mediatethe
recognition of Pneumocystiscarinii b-glucan, which is
involved in innateimmunity dictatetheprocessesof
host defence that are specific to the provoking
pathogen22
.
Box 2 | Fungal infections: morphogenesis and virulence
Opportunistic fungi
Budding yeast
Pseudohypha
Germ-tube
Hypha
Capsule
Conidia
Parent
yeast cell
Candida
albicans
Cryptococcus
neoformans
Aspergillus
umigatus
Paracoccidioides
brasiliensis
Histoplasma
capsulatum
Coccidiodes
immitis
Blastomyces
dermatitidis
25°C 37°C
Dimorphic fungi

4. Indonesia and Fungal Infections
 Tropical climate is suitable for the development of fungi
 Poverty associated low-level hygiene

5. Fungal
Corneal Ulcer
Tinea Capitis
Tinea Barbae
Otomycosis
Oral thrush
Tinea Faciei
Tinea Versicolor
Tinea Corporis
Tinea CrurisCandidiasis
Vaginalis
Onychomycosis
Tinea Pedis/
Athelte’s Foot
Tinea Intertriginosa
Tinea Imbricata

6. Systemic Fungal Infections
 Histoplasmosis
 Lung Aspergillosis
 Cryptococcosis

7. Subcutaneous Fungal Infections
 Chromomycosis
 Sporotrichosis
 Mycetoma
 Zygomycosis

8. Fungal Pathogens
 Dermatophytes
 Trichiphyton rubrum
 Epidermophyton
 Microsporum
 Candida species

9. Fungal Infections

10. Superficial Fungal Infections
Tinea Nigra Pityriasis versicolor
White Piedra
Black Piedra

11. Cutaneous
Tinea Skin Candidiasis
Nail Candidiasis
Oral Candidiasis

12. Subcutaneous
Sporotrichosis chromoblastomycosis
mycetoma Phaeohyphomyciosis

13. Systemic
Histoplasmosis
coccidioidomycosis
Paracoccidioidomycosis
Blastomycosis

14. Opportunistic
Cryptococcisis
Aspergillosis
Pneumocystis
Penicillinosis

15. Opportunistic
Mucormycosis
Hyalohyphomycosis

16. Antifungal Development

17. Type Dose Details
Polyenes : Disrupt cell membrane function
Amphotericin B 0,25-50 mg/kg IV 2-6 hr Systemic Mycosis
Nystatin 500.000 IU – 1000.000 IU TID Oral, Mucosal Candidasis
Azole Imidazole: Disrupt ergosterol synthesis
Ketoconazole 200-400 mg BID; 4-6
mg/kg/day
Miconazole 50 mg QD; Topical regiment
Clotrimazole 10 mg TID, Topical regiment 7-14 days
Azole Triazole
Fluconazole 100mg-400mg QD 14 days
Itraconazole 200mg-400mg QD/TID 3 months, depending on
infections
Voriconazole 4-6mg/kg/QD IV or 200mg
BID
Antifungals

18. Echinocandins: Disrupt cell wall synthesis
Caspofungin 50mg IV over 1 hr 14 days
Allylamines: Disrupt lanosterol synthesis
Terbinafine 250 mg QD 2-4 weeks
Inhibits Mitosis
Griseofulvin 125-500 mg QD 2 weeks – 6 months
depending on infections
Inhibits DNA Synthesis
Flucytosine 50-150mg/kg/D QID Synergistic with
Amphotericin B
Antifungals