Mycologie
Inhoud
1. INLEIDING ........................................................................................................................................................................................ 3
Celmembraan uit ......................................................................................................................................................................... 3
Soms symbiose Pathogene species:............................................................................................................................................. 3
1.1. Vermenigvuldiging bij fungi ................................................................................................................................................ 4
1.2. Klinisch belang van mycosen ............................................................................................................................................. 4
1.3. Diagnostiek in de mycologie .............................................................................................................................................. 4
Direct microscopisch onderzoek huidmycose (tinea) .................................................................................................................... 5
Staalafname: ............................................................................................................................................................................... 5
Kweekmethoden .............................................................................................................................................................................. 5
Macroscopisch uitzicht Microscopisch onderzoek ....................................................................................................................... 5
Huidmycosen .............................................................................................................................................................................. 5
Biochemische identificatie ........................................................................................................................................................... 6
Gisten: ......................................................................................................................................................................................... 6
Fungi: .......................................................................................................................................................................................... 6
Histo-pathologisch onderzoek .......................................................................................................................................................... 6
Biopt:........................................................................................................................................................................................... 6
1.3.2. Directe fluorescente assay............................................................................................................................................ 6
1.3.3. Serologie ...................................................................................................................................................................... 6
Moleculaire technieken .................................................................................................................................................................... 7
Gevoeligheidsbepalingen t.o.v. antimycotica .................................................................................................................................... 7
1.4. Behandeling van mycosen ................................................................................................................................................. 7
Azolen of Daktarin: ....................................................................................................................................................................... 7
2. Oppervlakkige mycosen ......................................................................................................................................................... 8
2.1. Dermatofytosen (tinea, ringworm) ..................................................................................................................................... 8
Verwekkers.................................................................................................................................................................................. 8
Schimmels:.................................................................................................................................................................................. 8
Geofielen: .................................................................................................................................................................................... 8
Zoöfielen:..................................................................................................................................................................................... 8
Antropofielen: .............................................................................................................................................................................. 8
Tinea: .......................................................................................................................................................................................... 8
Infectiebronnen ........................................................................................................................................................................... 8
Sporen en hyfen: .......................................................................................................................................................................... 8
Pathologie ................................................................................................................................................................................... 9
Tinea: .......................................................................................................................................................................................... 9
Soorten tinea: .............................................................................................................................................................................. 9
Labdiagnostiek ............................................................................................................................................................................ 9
Huidschilfers, nagelfragmenten: ................................................................................................................................................... 9
Haren: ......................................................................................................................................................................................... 9
2.2. Pytiriasis versicolor ..........................................................................................................................................................10
Verwekkers.................................................................................................................................................................................10
Pathologie ..................................................................................................................................................................................10
Labdiagnostiek ...........................................................................................................................................................................10
2.3. Oppervlakkige candidosen ...............................................................................................................................................10
Verwekkers.................................................................................................................................................................................10
1
, Pathologie ..................................................................................................................................................................................10
Symptomen: ...............................................................................................................................................................................11
Blijvende of recidiverende infecties van:.......................................................................................................................................11
Labdiagnostiek ...........................................................................................................................................................................11
Vers nat preparaat:......................................................................................................................................................................11
Uitstrijkpreparaat: .......................................................................................................................................................................11
3. Onderhuidse mycosen ..........................................................................................................................................................13
Verwekker: ..................................................................................................................................................................................13
Lokaal:........................................................................................................................................................................................13
3.1. Sporotrichose ..................................................................................................................................................................13
Pathologie ..................................................................................................................................................................................13
Verwekker ..................................................................................................................................................................................13
Labdiagnostiek ...........................................................................................................................................................................13
4. Diepe cosmopolitische mycosen...........................................................................................................................................15
4.1. Aspergillosen ...................................................................................................................................................................15
Verwekkers.................................................................................................................................................................................15
Pathologie ..................................................................................................................................................................................15
Labdiagnostiek ...........................................................................................................................................................................16
4.2. Mucormycose/zygomycose ..............................................................................................................................................17
Verwekkers.................................................................................................................................................................................17
Pathologie ..................................................................................................................................................................................17
Symptomen ................................................................................................................................................................................18
Risicofactoren ............................................................................................................................................................................18
Labdiagnostiek ...........................................................................................................................................................................18
4.3. Diepe candidosen ............................................................................................................................................................19
Verwekkers.................................................................................................................................................................................19
Ziektebeelden.............................................................................................................................................................................19
Labdiagnostiek ...........................................................................................................................................................................19
4.4. Cryptococcose .................................................................................................................................................................21
Verwekker ..................................................................................................................................................................................21
Pathologie ..................................................................................................................................................................................21
Labdiagnostiek ...........................................................................................................................................................................21
‘Bird seed agar’: ..........................................................................................................................................................................22
4.5. Pneumocystose ...............................................................................................................................................................23
Verwekker ..................................................................................................................................................................................23
Pathologie ..................................................................................................................................................................................23
Labdiagnostiek ...........................................................................................................................................................................23
5. EXOTISCHE DIEPE MYCOSEN ...............................................................................................................................................24
2
, 1. INLEIDING
Eukaryoten zonder chlorofyl
- Eencellig: gisten
- Meercellig: schimmel
o Hyfen: mycelium of thallus
▪ Coïnocytisch of apocytisch → sporen vormen
▪ Vegetatief of reproductief mycelium → voedingsstoffen uit bodem
Dimorfe fungi: zowel gistvorm als schimmelvorm ~ omstandigheden
(37/30°C) (25°C)
Celwand uit
- Chitine
- Hemicellulose
- Eiwitten
- Lipiden
- (GEEN peptidoglycaan)
Celmembraan uit
- Ergosterol
Vermenigvuldiging via sporen
- In een vruchtlichaam
- Op een schimmeldraad
- Op een cel
Heterotroof: organische stoffen van andere organismen om eigen organisch celmateriaal aan
te maken
Saprofytisch: kunnen leven op (dood) organisch materiaal
- Exosaprofieten: biotoop in de natuur en deze kan een infectiebron zijn naar de
mens
- Endosaprofiet: commensalen inwendig aanwezig bij de gastheer zoals bv.
Candida albicans
- Episaprofiet: leven op de huid zoals bv. Pytyrosporum ovale
Soms parasitair: dringen levende organismen binnen en leven ten koste van de gastheer
Soms symbiose Pathogene
species:
- Hypersensitiviteit: allergische reactie
- Mycotoxicosen: ziekte door consumptie van gecontamineerd voedsel met
schimmels die toxines produceren
o Aspergillus flavus → aflatoxine
o Claviceps purpurea → ergotalkaloïden
- Infectie
3
Inhoud
1. INLEIDING ........................................................................................................................................................................................ 3
Celmembraan uit ......................................................................................................................................................................... 3
Soms symbiose Pathogene species:............................................................................................................................................. 3
1.1. Vermenigvuldiging bij fungi ................................................................................................................................................ 4
1.2. Klinisch belang van mycosen ............................................................................................................................................. 4
1.3. Diagnostiek in de mycologie .............................................................................................................................................. 4
Direct microscopisch onderzoek huidmycose (tinea) .................................................................................................................... 5
Staalafname: ............................................................................................................................................................................... 5
Kweekmethoden .............................................................................................................................................................................. 5
Macroscopisch uitzicht Microscopisch onderzoek ....................................................................................................................... 5
Huidmycosen .............................................................................................................................................................................. 5
Biochemische identificatie ........................................................................................................................................................... 6
Gisten: ......................................................................................................................................................................................... 6
Fungi: .......................................................................................................................................................................................... 6
Histo-pathologisch onderzoek .......................................................................................................................................................... 6
Biopt:........................................................................................................................................................................................... 6
1.3.2. Directe fluorescente assay............................................................................................................................................ 6
1.3.3. Serologie ...................................................................................................................................................................... 6
Moleculaire technieken .................................................................................................................................................................... 7
Gevoeligheidsbepalingen t.o.v. antimycotica .................................................................................................................................... 7
1.4. Behandeling van mycosen ................................................................................................................................................. 7
Azolen of Daktarin: ....................................................................................................................................................................... 7
2. Oppervlakkige mycosen ......................................................................................................................................................... 8
2.1. Dermatofytosen (tinea, ringworm) ..................................................................................................................................... 8
Verwekkers.................................................................................................................................................................................. 8
Schimmels:.................................................................................................................................................................................. 8
Geofielen: .................................................................................................................................................................................... 8
Zoöfielen:..................................................................................................................................................................................... 8
Antropofielen: .............................................................................................................................................................................. 8
Tinea: .......................................................................................................................................................................................... 8
Infectiebronnen ........................................................................................................................................................................... 8
Sporen en hyfen: .......................................................................................................................................................................... 8
Pathologie ................................................................................................................................................................................... 9
Tinea: .......................................................................................................................................................................................... 9
Soorten tinea: .............................................................................................................................................................................. 9
Labdiagnostiek ............................................................................................................................................................................ 9
Huidschilfers, nagelfragmenten: ................................................................................................................................................... 9
Haren: ......................................................................................................................................................................................... 9
2.2. Pytiriasis versicolor ..........................................................................................................................................................10
Verwekkers.................................................................................................................................................................................10
Pathologie ..................................................................................................................................................................................10
Labdiagnostiek ...........................................................................................................................................................................10
2.3. Oppervlakkige candidosen ...............................................................................................................................................10
Verwekkers.................................................................................................................................................................................10
1
, Pathologie ..................................................................................................................................................................................10
Symptomen: ...............................................................................................................................................................................11
Blijvende of recidiverende infecties van:.......................................................................................................................................11
Labdiagnostiek ...........................................................................................................................................................................11
Vers nat preparaat:......................................................................................................................................................................11
Uitstrijkpreparaat: .......................................................................................................................................................................11
3. Onderhuidse mycosen ..........................................................................................................................................................13
Verwekker: ..................................................................................................................................................................................13
Lokaal:........................................................................................................................................................................................13
3.1. Sporotrichose ..................................................................................................................................................................13
Pathologie ..................................................................................................................................................................................13
Verwekker ..................................................................................................................................................................................13
Labdiagnostiek ...........................................................................................................................................................................13
4. Diepe cosmopolitische mycosen...........................................................................................................................................15
4.1. Aspergillosen ...................................................................................................................................................................15
Verwekkers.................................................................................................................................................................................15
Pathologie ..................................................................................................................................................................................15
Labdiagnostiek ...........................................................................................................................................................................16
4.2. Mucormycose/zygomycose ..............................................................................................................................................17
Verwekkers.................................................................................................................................................................................17
Pathologie ..................................................................................................................................................................................17
Symptomen ................................................................................................................................................................................18
Risicofactoren ............................................................................................................................................................................18
Labdiagnostiek ...........................................................................................................................................................................18
4.3. Diepe candidosen ............................................................................................................................................................19
Verwekkers.................................................................................................................................................................................19
Ziektebeelden.............................................................................................................................................................................19
Labdiagnostiek ...........................................................................................................................................................................19
4.4. Cryptococcose .................................................................................................................................................................21
Verwekker ..................................................................................................................................................................................21
Pathologie ..................................................................................................................................................................................21
Labdiagnostiek ...........................................................................................................................................................................21
‘Bird seed agar’: ..........................................................................................................................................................................22
4.5. Pneumocystose ...............................................................................................................................................................23
Verwekker ..................................................................................................................................................................................23
Pathologie ..................................................................................................................................................................................23
Labdiagnostiek ...........................................................................................................................................................................23
5. EXOTISCHE DIEPE MYCOSEN ...............................................................................................................................................24
2
, 1. INLEIDING
Eukaryoten zonder chlorofyl
- Eencellig: gisten
- Meercellig: schimmel
o Hyfen: mycelium of thallus
▪ Coïnocytisch of apocytisch → sporen vormen
▪ Vegetatief of reproductief mycelium → voedingsstoffen uit bodem
Dimorfe fungi: zowel gistvorm als schimmelvorm ~ omstandigheden
(37/30°C) (25°C)
Celwand uit
- Chitine
- Hemicellulose
- Eiwitten
- Lipiden
- (GEEN peptidoglycaan)
Celmembraan uit
- Ergosterol
Vermenigvuldiging via sporen
- In een vruchtlichaam
- Op een schimmeldraad
- Op een cel
Heterotroof: organische stoffen van andere organismen om eigen organisch celmateriaal aan
te maken
Saprofytisch: kunnen leven op (dood) organisch materiaal
- Exosaprofieten: biotoop in de natuur en deze kan een infectiebron zijn naar de
mens
- Endosaprofiet: commensalen inwendig aanwezig bij de gastheer zoals bv.
Candida albicans
- Episaprofiet: leven op de huid zoals bv. Pytyrosporum ovale
Soms parasitair: dringen levende organismen binnen en leven ten koste van de gastheer
Soms symbiose Pathogene
species:
- Hypersensitiviteit: allergische reactie
- Mycotoxicosen: ziekte door consumptie van gecontamineerd voedsel met
schimmels die toxines produceren
o Aspergillus flavus → aflatoxine
o Claviceps purpurea → ergotalkaloïden
- Infectie
3
