MICROBIOLOGY – CARDIO/PULMONARY

BY MARTINEZ, VIERA & GUZMAN – AT STILL UNIVERSITY SCHOOL OF OSTEOPATHIC MEDICINE

ENDOCARDITIS CAUSING ORGANISMS
TYPE Features Disease Clinical diagnosis Pathogenesis
Strep. Viridians Gram + SUBACUTE ENDOCARDITIS, Catalase -, Facultative Extracellular dextran helps bind to heart
Dental carries, Brain or Liver anaerobe, α-hemolytic, valve
cocci abscesses Optochin Resistant
Staphylococcus Aureus Gram +,cocci,capsule, protein A in ACUTE ENDOCARDITIS, Coagulase +, Catalase +, β- Rapid growth, protein A (antiphagocytic),
the cell wall, yellow,creamy, Abcesses,pyogenic infections hemolytic, novobiocin enterotoxin (watery diarrhea), toxic shock
grapelike clusters on culture (endocarditis, osteomyelitis), sensitive, ferment mannitol syndrome toxin; exfoliation, α-
food poisoning, toxic shock toxin;coagulase
syndrome,scalded skin
syndrome *Most common cause of Endocarditis in IV
Drug Abusers
Staphylococcus Prosthetic Valve – first year
Epidermitis post op
Candida Albicans Yeast endogenous to our mucous Forms pseudohyphae and true Endocarditis  IV drug abusers
membrane normal flora hyphae (when it invades tissue)
Aggregatibacter species Gram -, rods, Facultative anaerobes Endocarditis--> A.
(new) actinomyecetecomitans, A.
aphrophilus
Cardiobacterium Gram -,rods, Facultative anaerobes, Subacute bacterial endocarditis
hominis
Rickettsiae Three Genera; Best visualized with Giemsa
Rickettsia,Ehrlichia,Coxiella--
>Obligate intracellular bacteria,
Arthropod borne (lice,ticks,
fleas,mites,
Rickettsia Rickettsi Obligate intracellular bacteria Rocky Moutain spotted fever; Weil-Felix reaction Invasion of endothelial lining, transmitted
vasculitis, rash spreads from (agglutination when patient's by Dermacentor ticks
extremities to thorax serum mixed with OX strain of
Proteus Vulgaris)

Coxiella burnetii Endospore; very unique to the Pneumonia Non Arthropod transmission;Aerosilized
Rickettsia family
Q fever
LOBAR PNEUMONIA
Bacteria Features
Streptococcus Pneumoniae Gram + diplococci; “Lancet
shaped”encapsulated,
Facultative anaerobe
Klebsiella Pneumoniae Gram – rod,
Encapsulated
Nonmotile
facultative anaerobe
BRONCHOPNEUMONIA
Staphylococcus Aureus Gram +,cocci, capsule,
protein A in the cell wall,
yellow, creamy, grapelike
clusters on culture
Haemophilus Influenzae Gram – coccobacillus
encapsulated facultative
anaerobe
Clinical diagnosis
α-hemolytic, Optochin and
Bile sensitive,
Quellung test positive,
catalase negative
Indole negative
Ferments lactose
Coagulase +, Catalase +, β-
hemolytic, novobiocin
sensitive, ferment mannitol
Grown on Chocolate agar,
Positive Quellung test; due
to capsule
Pathogenesis
Capsule
Rapid growth, protein A
(antiphagocytic),
enterotoxin (watery
diarrhea), toxic shock
syndrome toxin;
exfoliation, α-toxin;
coagulase, hemolysins
Leukocidins, penicillinase,
hyaluronidase,staphylokin
ase
Capsule,
Attachment pilli,
IgA protease
Characteristics Complications
The most common Lung abscess
bacterial pneumonia
etiology. Lobar pneumonia Empyema
Community acquired;
elderly or debilitated
patient, Otitis Media,
Meningitis
Red currant jelly sputum; Necrosis of
color due to O antigen. alveolar wall with
abscess formation
Broncho pneumonia
Most often seen in
alcoholics and diabetics
Broncho pneumonia Abscess formation
Most commonly in IVDA, or empyema not
elderly and hospitalized common
patients, chronic lung
disease, cystic fibrosis
MOST COMMON CAUSE OF EPIGLOTTITIS
…also causes: Broncho pneumonia, Meningitis
in infants and children, may occur in adults with
COPD
Legionella Pneumphila
Pseudomonas Aeruginosa
INTERSTITIAL PNEUMONIA – PRIMARY ATYPICAL
Mycoplasma Pneumoniae
Fried Egg Appearance
Respiratory Syncytial Virus (RSV)
Belongs to paramyxovirus family
Parainfluenza Virus
Belongs to paramyxovirus
family (others are Measles,
Gram - bacillus
Stains poorly
Charcoal Yeast Extract
Gram - rod; appears blue-
green, grape like odor
No cell wall
Subgrouping determined by
envelope F and G
glycoproteins.
Can survive on surfaces for
up to 6 hours.
the causative agents of nearly Infection limited to respiratory
40% of acute respiratory tract
infections in infants and children
(second to RSV).
Diagnosis:
Dieterle silver stain
Direct Fluorescent
Antibody (DFA)
****Nonspecific cold
agglutinins
“Fried egg appearance” on
culture
Transmitted via large
droplets, fomites, and
hands; enters through the
eyes and nose.
Infected cells (epithelium
specificity) form syncytia
(multinucleated cells).
Facultative Intracellular Infection through inhaled Pontiac fever
parasite, catalase and aerosol from stored water,
oxidase positive, produces most commonly from AC Legionnaires’
beta lactamases conditioners disease: Atypical
pneumonia
“Foamy Macrophage” TREATMENT:
AZITHROMYCIN OR
LEVOFLOXACIN
Capable of growing in Nosocomial pneumonia Focal hemorrhage
diesel or jet fuel, causes Immunocompromised and necrosis
corrosion
AIDS
Cystic fibrosis
Protein P1-adhesion to “Walking pneumonia” ; it Encephalitis
respiratory epithelium usally occurs in children
and young adults, may Erythema
occur in epidemics multiforme
TREATMENT:
DOXYCYCLINE
ARYTHROMYCIN
Reinfection occurs MOST common cause of Treatment:
throughout life with upper and lower RTI in Ribavirin
repeat milder infections infants/young children
limited to upper RT.
**MOST common cause of
Bronchiolitis
MOST COMMON CAUSE OF CROUP
ALSO CAUSES: Common Cold, bronchitis, and bronchopneumonial; usually
accompanied by a hoarse or "barking" cough, sometimes with a swollen
epiglottis
Mumps and RSV)
Influenza Is caused by influenza viruses
types A and B (but not C)
Belongs to orthomyxovirus transmitted by airborne droplets.
family
PNEUMOCYSTIS JIROVECI One of most important fungal
agent in AIDS patients
**Obligate Extracellur parasite
Does NOT contain ergosterol in
cell membrane.
Can NOT be cultivated, diagnosis
rely on microscopic examination.
FAMILY CHLAMYDIACEAE Obligate intracellular Gram-
negative bacteria; small, round-
to-ovoid.
The cell envelope consists of two
lipid bilayers (with LPS)>>> but
contains NO peptidoglycan, or
muramic acid.
c.pneumoniae (pear shaped)
FUNGI – DIMORPHIC
Histoplasma Capsulatum Inhalation of Histoplasma
capsulatum hyphae containing spores
from soils contaminated with bird
droppings or bat guano
Tissue form: Yeast
Enviornmental form: Hyphae
*Giemsa Stain Microconidia
Enveloped; -, ssRNA
MAJOR Surface Angtens for
Subtyping:
• Hemagglutinin
• Neuraminidase
Serotyping is based on the M and
NP proteins
Cysts of P. jiroveci in the lung;
SILVER STAIN*
Elementary bodies: metabolically
inactive, infectious forms.
Reticulate bodies: metabolically
active, noninfectious forms
Leading to infection of
macrophages and histocytes;
infection of reticuloendothelial
system
Replication:
• Cap-Snatching
• Synthesis of viral mRNA
and RNA genome occurs in
nucleus
Antigenic Variability:
• Antigenic Drift: occurs
every year
• Antigenic Shift: occurs
every 10-20years (only type
A)
Not transmitted person to person;
may be caused by activation of pre-
existing dormant cells in lung
Diagnosis: Silver-Staining Cyst in
Bronchial alveolar lavage fluids or
biopsy
Treatment:
Trimethoprim/Sulfamethoxazole
Chlamydophila pneumoniae:
Respiratory infections: atypical
pneumonia.
Occurs throughout the
Mississippi and Ohio River
valleys
Symptoms: common cold, pharyngitis,
tracheobronchitis, and bronchiolitis or
croup in children.
Mainly infection of lung tissue; 100%
fatal if untreated.
Pneumocystis Carrini
Pneumonia*interstitial Pneumonia
X-RAY: Patchy Infiltrative (ground
glass appearance)
Chlamydophila psittaci :
Respiratory infections: severe
bronchopneumonia with localized
infiltration of inflammatory cells,
necrosis, and hemorrhage.
Disease: Fungus Flu
Symptoms: flu-like, weight loss and
night sweats resemble TB.
Chronic infection in
immunocompromised individuals
leads to hepatosplenomegaly
Blastomyces Dermatitidis
Coccidioides Immitis
Paracoccidioides Brasiliensis
OPPORTUNISTIC MYCOSIS
Cryptococcus neoformans
Aspergillus fumigatus
V-SHAPED
More common in males than in
females or children.
Tissue Form: Broad Based Budding
Yeast
Environmental form: hypha with
conidia
Mold phase: Segmented
arthroconidia found in the
environment
Spherule filled with endospores,
typical structures formed in infected
tissues
= South American blastomycosis
an environmental yeast
**Encapsulated Yeast
Reproduces by budding
Present in soil contaminated with
bird excreta
filamentous mold in dust and soil.
Broad Based Budding Yeast (pic)
Possible chronic pulmonary
infection or disseminated infection
(meninges, soft tissues, joints, and
bone).
Endemic Region: Southwestern
U.S. – So. California(especially San
Joaquin Valley), Arizona, New
Mexico, Texas, Nevada
90% infected are males
surrounded by a huge
polysaccharide capsule ( major
virulence factor) in tissue
Yeasts inhaled into the alveoli and
begins to produce the
polysaccharide capsule
Aspergilloma: a mycelial ball
(cotton ball) formed in the lung
cavity; Hospital outbreak due to
construction reported.
**Hemoptysis
Aspergillus flavus (found growing
on peanuts) produce Aflatoxins B1
is a potent carcinogen.
Endemic Region:Mostly in Disease: Blastomycosis
South Central and South Acute and chronic pulmonary disease
Eastern U.S.
Disseminated Disease:
*Appears to be associated Progressive pulmonary disease may
with Rotton Wood occur with further dissemination to
skin, bone, and genitourinary tract.
Disease: Coccidiodmycosis (Valley
fever) caused by C. Immitis and
Coccidioides posadasii
influenza-like illness with fever, cough,
headaches, rash, and myalgias
Sperule
PARACOCCIDIOIDES AND PARACOCCIDIOIDOMYCOSIS
An asymptomatic to a subclinical, symptomatic or chronic infection.
Disseminated paracoccidioidomycosis affects: reticuloendothelial
system, skin, and mucous membranes (most common: mouth and
nose).
“Soap Bubble Lesion”  India ink preparation of CSF:
Mucoid Clear Capsule encapsulated yeast cells; diagnostic of
cryptococcus neoformans meningitis
Acute invasive aspergillosis (most
severe and fatal) results in the spread
from the lungs to brain, GI, etc.
Other primary infection site: eye, ear,
nose (pneumonia), and skin.
Treatment: Amphotericin B
Rhizopus and Rhizomucor
filamentous, found in soil, plants,
and decaying fruits
Restricted to burn, leukemia, DM
population.
Cause mucocutaneous and
rhinocerebral (fatal within a week)
infections, septic arthritis, dialysis-
associated peritonitis, renal
infections, gastritis, and pulmonary
infections.

RIGHT ANGLE BRANCH, NOT

SEGMENTED