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LEGIONELLA

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Citoplasma

ADN

Pared celular

Membrana
celular

Ribosomas
Flagelo

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Caractersticas
Bacilos Gram
Tienen flagelos y fimbrias
Protena : MIP (potenciador infectividad
del Macrfago)
Legiolisina fosfolipasa C.

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Patogenia
Patgeno intracelular.
Ingresa por inhalacin fagosoma:
multiplicacin activa de bacteria
bronconeumona-neumona.
Otros. Rin, bazo, etc.

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Clnica
Infec. Subclnicas
Enf, Legionarios:L. Pneumophila
Fiebre de Pontiac
Infecciones extrapulmonares:
piel
Nefritis pericarditis
Absceso. Peritonieal.

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Epidemiologa
Microorganismo . ubicuos
- Relacionado al ambiente
- Factores de amplificacin,
- Mecanismos de diseminacin
- Factores de virulencia
- Susceptibilidad del husped

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Diagnstico
Mtodo directo
Deteccin de Ag por Inmunofluorescencia.
Deteccin de nucleicos.
Aislamiento: BCYE
Mtodo indirecto serolgicos
Inmunofluorencia . Indirecta Elisa.

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Rayos x de trax - Legionella


Rayos X normales

Consolidacin del
lbulo superior

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Tratamiento
Eritromicina
Rifampicina
Azitromicina
Claritromicina

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PSEUDOMONA
AURUGINOSA

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Morfologia
BACILOS GRAM NEGATIVOS 1-3, 0, 51 um
CAPA POLISACRIDA LIMO.
FLAGELO POLAR

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Determinantes de patogenecidad
FACTORES CELULARES

ACTIVIDAD BIOLGICA

Fimbrias (pili)

Adherencia al epitelio

Flagelo

Movilidad, invasividad

Polisacrido envoltura

Adherencia, toxicidad neutrfilos

Exopolisacrido mucoide
(alginato)

Adherencia, forma biopelicula, inhibe


fagocitosis, reduce actividad
antibiticos

LPS (lpido A)

Efecto endotoxina: fiebre, hipotensin,


leucopenia, shock

Antgeno O

Protege a la bacteria del complemento

Protenas shock trmico

Adaptacin al estrs bacteriano, la


ayuda a sobrevivir, induce respuesta
husped

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FACTORES EXTRACELULARES
Proteasas (elastasa,
proteasa alcalina).

Adherencia tisular, invasividad, necrosis,


degradan IgG e IgA

Exotoxina A

Bloquea sntesis proteica, necrosis tisular,


citotxica (macrfagos), invasividad,
leucocitosis. Induce formacin Ac. Anti-toxina
A.

Exoenzima SR

Necrosis pulmonar, invasividad, diseminacin


hemtica

Citotoxina

Toxicidad letal para leucocitos

Fosfolipasas

Efecto membrana, hemlisis, floggenas

Ferripioquelina (fpq)

Captacin de hierro

Pioverdina

Captacin de hierro

Piocianina

Lesiona epitelio, dificulta funcin ciliar, y


asociada fpq libera radicales OH

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Cuadros Clnicos
Infecciones del
tracto respiratorio

Endocarditis

Infecciones
menngeas

Infecciones
urinarias

Bacteriemias

Infecciones
gastrointestinales

Infecciones
osteoarticulares

Infecciones
cutneas

Infecciones
oculares

Infecciones ticas

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Diagnostico microbiolgico
Aislamiento

Identificacin

Tipado: serotipia, biotipia, genotipia

Sensibilidad de los antimicrobianos

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Tratamiento
Carboxipenicilinas

cefalosporinas de 3 y 4 generacin:

Ceftazidima cefepima ceppirona.

Batalactmico + aminoglicosido.

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Epidemiologa

UBICUO

OPORTUNISTA

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Profilaxis y control
1. En el hospital aislamiento
2. Higiene individual. Infeccin
endgena
3. Vigilancia y control de fmites
4. Comit de infecciones: supervisin
5. Vacunas: quemados

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KLEBSIELLA

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CARACTERISTICAS
Fermentan la
lactosa

Bacilos Gram-

Forman colonias
mucoides y
hmedas

Descarboxilan
lisina

No mviles

K. oxytoca

K. pneumoniae
Dos especies :

K. ozaenae
K.
rhinoscleromatis

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MECANISMOS DE
PATOGENICIDAD

Cpsula (K)

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KLEBSIELLA

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Enfermedades
K.
Neumoniae

K.
Azaenae

K.
Rhinoscleromatis

Neumona por aspiracin serotipos 1,2.


Dolor pleurtico. Esputo espeso y sanguinolente. Jalea de
grosella.
Resistente a muchos frmacos. Mortalidad ante 40-60%.
Infecciones Urinarias: Serotipo 8-9-19-24
Pielonefritis y cistitis.

Rinitis atrfica y ocena.


Rinitis atrfica: reas de metaplasia escamosa. Glndulas
atrficas.
Ocena: exudado verdoso maloliente.

Rinoscleroma
Inicia con catarro comn. Inflamacin granulomatosa de vas
nasales. Masas tumorales.
Estudio anatomopatolgico, muestra macrfagos espumosos.
Clulas gigantes y bacilos encapsulados.

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Tratamiento
Ciprofloxacina

TMP SM X
Cefalosporina antiseudomnica de
tercera generacin.
Rifampicina

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HELICOBACTER
PYLORI

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Morfologa y fisiologa
- Bacilo gram Negativo: curvo o Espiralado
- 0.51 um de ancho y 2,5-4 um de largo.
- Tiene 4-6 flagelos unipolares

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Especies del gnero Helicobacter


Gstricas
H. Pylori
H. Cinaedi
H. Heilmanii
H. Felis
H. Mustelae
H. Nemestrinae
H. acinonyx

No Gstricas
H. fennelliae

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Determinantes de Patogenicidad
Patogenia
Movilidad

Adhesinas

Ureasa

Citotoxina vacuolante
Otros: Protena CagA, dismutasa de
superxido, lipopolisacrido.

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lcera Duodenal
Carcinoma o
linfoma MALT

Colonizacin

Gastritis

lcera Gstrica

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Manifestaciones Clnicas
Gastritis aguda.
Intoxicacin
alimentaria

Gastritis Crnica
superficial difusa

Ulcera Gstrica o
Duodenal

Gastritis Crnica
Atrfica

Adenocarcinoma
Gstrico

Linfoma Gstrico

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GASTRITIS CRNICA

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GASTRITIS CRNICA

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GASTRITIS CRONICA ATRFICA

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GASTRITIS CRNICA ATRFICA

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Diagnstico

DIAGNSTICO ENDOSCPICO DIRECTO


Histolgico coloraciones especiales
Microbiolgico. Agar sangre, Agar chocolate, Agar Brucella.
PCR:
DIAGNSTICO ENDOSCPICO INDIRECTO
Prueba de la Ureasa
DIAGNSTICO NO ENDOSCPICO
Deteccin de anticuerpos contra H Pylori en suero o en
saliva.
- Urea Breath Test

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TEST FOR DIAGNOSIS OF HELICOBACTER PYLORI


Test

Sensitivity/Specifity
(%)

Cost ($)

Endoscopic Test Histology

95/80 99

50-100

Special Stains

90/99

200

Culture

60-90/100

150

Ureasa tests

90/95

10

Quantitative ELISA

85-90/85-90

500-100

Qualitative serum

90/90

10-15

Qualitative whole blood

85-90/90

10-15

95/95

280

95/95

60

Nonendoscopic Test
Antibody tests

Urea breath tests C-13


C-14

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Tratamiento
Antibacterianos, bismuto y
antiulceroso.

Epidemiologa

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