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Microbiology Examination for Respiratory Infection

Dr Abdul Aziz Djamal MSc.DTM&H.SpMK(K)

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The Upper Respiratory System

Nose
Pharynx (throat)
Middle ear
Eustachian tubes

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Structures of Upper Respiratory System

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Figure 24.1

The Lower Respiratory System

Larynx
Trachea
Bronchial tubes
Alveoli
Pleura

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Structures of Lower Respiratory System

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Figure 24.2

Normal Microbiota of Respiratory


System
Suppress pathogens by competitive
inhibition in upper respiratory system
Lower respiratory system is sterile

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Upper Respiratory System Diseases

Pharyngitis
Laryngitis
Tonsillitis
Sinusitis
Epiglottitis: H. influenzae type b

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Streptococcal Pharyngitis
Also called strep throat
Streptococcus
pyogenes
Resistant to
phagocytosis
Streptokinases lyse
clots
Streptolysins are
cytotoxic
Diagnosis by enzyme
immunoassay (EIA)
tests
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Figure 24.3

Swab of the pharynx and Tonsil :


Gram Stain : Gram Positive Cocci in chain
Culture on Blood Agar : Beta Hemolytic pin point
colony

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Scarlet Fever
Streptococcus pyogenes
Pharyngitis
Erythrogenic toxin produced by lysogenized
S. pyogenes

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Microbiology Diagnostic the same with Streptococcal


pharyngitis

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DIPHTHERIA INFECTION

Swab from Nose, Pharynx and Under the lesion /


membrane
Gram stain and Culture : Blood agar or Telurit Agar

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Diphtheria
Corynebacterium diphtheriae: Gram-positive rod
Diphtheria toxin produced by lysogenized C.
diphtheriae

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Figure 24.4

Diphtheria
Diphtheria membrane: Fibrin, tissue, bacterial
cells

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Figure 24.5

OTITIS MEDIA

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Otitis Media

Etiologic Bacteria
S. pneumoniae (35%)
H. influenzae (2030%)
M. catarrhalis (1015%)
S. pyogenes (810%)
S. aureus (12%)
Incidence of S.
pneumoniae reduced
by vaccine

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Figure 24.6

The Common Cold


Rhinoviruses (50%)
Coronaviruses (1520%)

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Microbiology examination :
Gram stain as guidance from the swab or parentecis
of the fluid.
Followed by appropriate Culture of the suspected
bacteria.

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Diseases in Focus: Diseases of the


Upper Respiratory System
A patient presents
with fever and a red,
sore throat. Later, a
grayish membrane
appears in the throat.
Gram-positive rods
were cultured from
the membrane.
Can you identify
infections that could
cause these
symptoms?
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LOWER RESPIRATORY INFECTION

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Lower Respiratory System Diseases


Bacteria, viruses, and fungi cause
Bronchitis
Bronchiolitis
Pneumonia

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Pertussis (Whooping Cough)


Bordetella pertussis
Gram-negative
coccobacillus

Capsule
Tracheal cytotoxin of
cell wall damaged
ciliated cells
Pertussis toxin
Prevented by DTaP
vaccine (acellular
Pertussis cell
fragments)
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Figure 24.7

Pertussis (Whooping Cough)


Stage 1: Catarrhal stage, like common cold
Stage 2: Paroxysmal stageviolent
coughing sieges
Stage 3: Convalescence stage

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Microbiology Lab for Pertussis infection :


Swab from larynx or bronchial wash.
Gram stain as guidance followed by Culture on
Bordet Gangou Agar.

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TUBERCULOSIS

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Microbiology Lab examination;


Sputum ( 3 times early morning or SPS DOTS
Program ).
Acid Fast Staining / Ziehl Nielson or Kinyoum
Gabbet.
Fluorescent Microscope / Rhodamin.
Culture : Lowenstein Jensen or MGIT.
Molecular.

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Tuberculosis
Mycobacterium tuberculosis
Acid-fast rod; transmitted from human to human

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Figure 24.8

Tuberculosis
M. bovis: <1% U.S. cases; not transmitted from
human to human
M. avium-intracellulare complex infects people with
late-stage HIV infection

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Tuberculosis

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Clinical Focus, p. 144

Worldwide Distribution of Tuberculosis

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Figure 24.11a

U.S. Distribution of Tuberculosis

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Figure 24.11b

A Positive Tuberculin Skin Test

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Figure 24.10

Diagnosis of Tuberculosis
Tuberculin skin test screening
Positive reaction means current or previous
infection
Followed by X-ray or CT exam, acid-fast staining
of sputum, culturing of bacteria

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PNEUMONIA

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Microbiology Lab Examination.


Sputum
Gram stain followed by Blood culture : Tiny colony
with alpha hemolyticus. Confirm with optochin disc.

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Pneumococcal Pneumonia
Streptococcus pneumoniae
Gram-positive encapsulated diplococci

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Figure 24.12

Pneumococcal Pneumonia
Symptoms: Infected alveoli of lung fill with
fluids; interferes with oxygen uptake
Diagnosis: Optochin-inhibition test or bile
solubility test; serological typing of bacteria
Prevention: Pneumococcal vaccine

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Haemophilus influenzae Pneumonia


Sputum with specific color-metallic glance.
Gram-negative coccobacillus
Lab Diagnosis: Isolation; special media for
nutritional requirements ( Haemophylus Agar )

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Mycoplasmal Pneumonia
Primary atypical
pneumonia; walking
pneumonia
Mycoplasma
pneumoniae
Pleomorphic,
wall-less bacteria

Common in children
and young adults

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Figure 24.13

Mycoplasma pneumoniae

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Figure 11.20

Mycoplasmal Pneumonia
Symptoms: Mild but persistent respiratory
symptoms; low fever, cough, headache
Diagnosis: PCR and serological testing
Treatment: Tetracyclines

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Legionellosis
Sputum :
Gram stain and Culture
on Specific Agar
Legionella pneumophila
Gram-negative rod

Found in water
Transmitted by inhaling
aerosols ec. AC and not
transmitted from human
to human
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Clinical Focus, p. 691

Psittacosis (Ornithosis)
Sputum :
Gram stain and culture on appropriate media
( hard to grow ) and Serology
Chlamydophila psittaci
Gram-negative intracellular bacterium

Transmitted to humans by elementary bodies from


bird droppings
Reorganizes into reticulate body after being
phagocytized

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Psittacosis (Ornithosis)

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Figure 11.24a

Chlamydial Pneumonia
Sputum :
Gram stain and Serology
Chlamydophila pneumoniae
Transmitted from human to human

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Figure 11.24b

Coxiella burnetii, the Cause of Q Fever

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Figure 24.14

Q Fever
Symptoms: Mild respiratory disease lasting 12
weeks; occasional complications such as
endocarditis occur
Diagnosis: Growth in cell culture
Treatment: Doxycycline and chloroquine

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Melioidosis
Causative agent: by Burkholderia pseudomallei
Reservoir: Soil
Mainly in southeast Asia and northern Australia
Symptoms: Pneumonia, or tissue abscesses and
severe sepsis
Diagnosis: Bacterial culture
Treatment: Ceftazidime

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Diseases in Focus:
Common Bacterial Pneumonias

A 27-year-old man with a


history of asthma was
hospitalized with a 4-day
history of progressive
cough and 2 days of
spiking fevers. Grampositive cocci in pairs
were cultured from a
blood sample.
Can you identify
infections that could
cause these symptoms?

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Viral Pneumonia
Viral pneumonia occurs as a complication of
influenza, measles, or chickenpox
Viral etiology suspected if no other cause is
determined

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Respiratory Syncytial Virus (RSV)


Common in infants; 4500 deaths annually
Causes cell fusion (syncytium) in cell culture
Symptoms: Pneumonia in infants
Diagnosis: Serological test for viruses and
antibodies
Treatment: Ribavirin, palivizumab

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The Influenza Virus


Hemagglutinin (HA)
spikes used for
attachment to host
cells
Neuraminidase (NA)
spikes used to
release virus from
cell

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Figure 24.15

The Influenza Virus


Antigenic shift
Changes in HA and NA spikes
Probably due to genetic recombination between different
strains infecting the same cell

Antigenic drift
Point mutations in genes encoding HA or NA spikes
May involve only 1 amino acid
Allows virus to avoid mucosal IgA antibodies

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Influenza Serotypes
Type

Antigenic
Subtype

Year

Severity

H3N2
H1N1
H2N2
H3N2
H1N1

1889
1918
1957
1968
1977

Moderate
Severe
Severe
Moderate
Low

None

1940

Moderate

None

1947

Very mild

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Pneumocystis Pneumonia

Causative agent: Pneumocystis jirovecii


Reservoir: Unknown; possibly humans or soil
Symptoms: Pneumonia
Diagnosis: Microscopy
Treatment: Trimethoprim

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Other Fungi Involved in Respiratory


Disease
Sputum :
Gram satin followed by Culture on Sabouraud Agar
Systemic
Predisposing factors:
Immunocompromised state
Cancer
Diabetes

Aspergillus fumigatus
Mucor
Rhizopus
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Diseases in Focus: Diseases of the


Lower Respiratory System
A worker was hospitalized
for acute respiratory illness.
He had been near a colony
of bats. The mass was
surgically removed.
Microscopic examination of
the mass revealed ovoid
yeast cells.
Can you identify infections
that could cause these
symptoms?

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THANK YOU / ARIGATO GO ZAI MAS HAI

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