Sie sind auf Seite 1von 59

Microbiology Examination for Respiratory Infection

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

Copyright © 2010 Pearson Education, Inc.


The Upper Respiratory System

 Nose
 Pharynx (throat)
 Middle ear
 Eustachian tubes

Copyright © 2010 Pearson Education, Inc.


Structures of Upper Respiratory System

Figure 24.1
Copyright © 2010 Pearson Education, Inc.
The Lower Respiratory System

 Larynx
 Trachea
 Bronchial tubes
 Alveoli
 Pleura

Copyright © 2010 Pearson Education, Inc.


Structures of Lower Respiratory System

Figure 24.2
Copyright © 2010 Pearson Education, Inc.
Normal Microbiota of Respiratory
System
 Suppress pathogens by competitive inhibition
in upper respiratory system
 Lower respiratory system is sterile

Copyright © 2010 Pearson Education, Inc.


Upper Respiratory System Diseases

 Pharyngitis
 Laryngitis
 Tonsillitis
 Sinusitis
 Epiglottitis: H. influenzae type b

Copyright © 2010 Pearson Education, Inc.


Streptococcal Pharyngitis

 Also called strep throat


 Streptococcus
pyogenes
 Resistant to
phagocytosis
 Streptokinases lyse
clots
 Streptolysins are
cytotoxic
 Diagnosis by enzyme
immunoassay (EIA)
tests
Figure 24.3
Copyright © 2010 Pearson Education, Inc.
 Swab of the pharynx and Tonsil :
Gram Stain : Gram Positive Cocci in chain
Culture on Blood Agar : Beta Hemolytic pin point
colony

Copyright © 2010 Pearson Education, Inc.


Scarlet Fever

 Streptococcus pyogenes
 Pharyngitis
 Erythrogenic toxin produced by lysogenized
S. pyogenes

Copyright © 2010 Pearson Education, Inc.


 Microbiology Diagnostic the same with Streptococcal
pharyngitis

Copyright © 2010 Pearson Education, Inc.


 DIPHTHERIA INFECTION

Copyright © 2010 Pearson Education, Inc.


 Swab from Nose, Pharynx and Under the lesion /
membrane
 Gram stain and Culture : Blood agar or Telurit Agar

Copyright © 2010 Pearson Education, Inc.


Diphtheria

 Corynebacterium diphtheriae: Gram-positive rod


 Diphtheria toxin produced by lysogenized C.
diphtheriae

Figure 24.4
Copyright © 2010 Pearson Education, Inc.
Diphtheria

 Diphtheria membrane: Fibrin, tissue, bacterial


cells

Figure 24.5
Copyright © 2010 Pearson Education, Inc.
 OTITIS MEDIA

Copyright © 2010 Pearson Education, Inc.


Otitis Media

 Etiologic Bacteria
 S. pneumoniae (35%)
 H. influenzae (20–30%)
 M. catarrhalis (10–15%)
 S. pyogenes (8–10%)
 S. aureus (1–2%)
 Incidence of S.
pneumoniae reduced
by vaccine

Figure 24.6
Copyright © 2010 Pearson Education, Inc.
The Common Cold

 Rhinoviruses (50%)
 Coronaviruses (15–20%)

Copyright © 2010 Pearson Education, Inc.


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

Copyright © 2010 Pearson Education, Inc.


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?
Copyright © 2010 Pearson Education, Inc.
LOWER RESPIRATORY INFECTION

Copyright © 2010 Pearson Education, Inc.


Lower Respiratory System Diseases

 Bacteria, viruses, and fungi cause


 Bronchitis
 Bronchiolitis
 Pneumonia

Copyright © 2010 Pearson Education, Inc.


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)
Figure 24.7
Copyright © 2010 Pearson Education, Inc.
Pertussis (Whooping Cough)

 Stage 1: Catarrhal stage, like common cold


 Stage 2: Paroxysmal stage—violent
coughing sieges
 Stage 3: Convalescence stage

Copyright © 2010 Pearson Education, Inc.


 Microbiology Lab for Pertussis infection :
 Swab from larynx or bronchial wash.
 Gram stain as guidance followed by Culture on
Bordet Gangou Agar.

Copyright © 2010 Pearson Education, Inc.


TUBERCULOSIS

Copyright © 2010 Pearson Education, Inc.


 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.

Copyright © 2010 Pearson Education, Inc.


Tuberculosis

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

Figure 24.8
Copyright © 2010 Pearson Education, Inc.
Tuberculosis

 M. bovis: <1% U.S. cases; not transmitted from


human to human
 M. avium-intracellulare complex infects people with
late-stage HIV infection

Copyright © 2010 Pearson Education, Inc.


Tuberculosis

Clinical Focus, p. 144


Copyright © 2010 Pearson Education, Inc.
Worldwide Distribution of Tuberculosis

Figure 24.11a
Copyright © 2010 Pearson Education, Inc.
U.S. Distribution of Tuberculosis

Figure 24.11b
Copyright © 2010 Pearson Education, Inc.
A Positive Tuberculin Skin Test

Figure 24.10
Copyright © 2010 Pearson Education, Inc.
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

Copyright © 2010 Pearson Education, Inc.


PNEUMONIA

Copyright © 2010 Pearson Education, Inc.


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

Copyright © 2010 Pearson Education, Inc.


Pneumococcal Pneumonia

 Streptococcus pneumoniae
 Gram-positive encapsulated diplococci

Figure 24.12
Copyright © 2010 Pearson Education, Inc.
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

Copyright © 2010 Pearson Education, Inc.


Haemophilus influenzae Pneumonia

 Sputum with specific color-metallic glance.


 Gram-negative coccobacillus
 Lab Diagnosis: Isolation; special media for
nutritional requirements ( Haemophylus Agar )

Copyright © 2010 Pearson Education, Inc.


Mycoplasmal Pneumonia

 Primary atypical
pneumonia; walking
pneumonia
 Mycoplasma
pneumoniae
 Pleomorphic,
wall-less bacteria
 Common in children
and young adults

Figure 24.13
Copyright © 2010 Pearson Education, Inc.
Mycoplasma pneumoniae

Figure 11.20
Copyright © 2010 Pearson Education, Inc.
Mycoplasmal Pneumonia

 Symptoms: Mild but persistent respiratory


symptoms; low fever, cough, headache
 Diagnosis: PCR and serological testing
 Treatment: Tetracyclines

Copyright © 2010 Pearson Education, Inc.


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

Clinical Focus, p. 691


Copyright © 2010 Pearson Education, Inc.
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

Copyright © 2010 Pearson Education, Inc.


Psittacosis (Ornithosis)

Figure 11.24a
Copyright © 2010 Pearson Education, Inc.
Chlamydial Pneumonia

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

Figure 11.24b
Copyright © 2010 Pearson Education, Inc.
Coxiella burnetii, the Cause of Q Fever

Figure 24.14
Copyright © 2010 Pearson Education, Inc.
Q Fever

 Symptoms: Mild respiratory disease lasting 1–2


weeks; occasional complications such as
endocarditis occur
 Diagnosis: Growth in cell culture
 Treatment: Doxycycline and chloroquine

Copyright © 2010 Pearson Education, Inc.


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

Copyright © 2010 Pearson Education, Inc.


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. Gram-
positive cocci in pairs
were cultured from a
blood sample.
 Can you identify
infections that could
cause these symptoms?

Copyright © 2010 Pearson Education, Inc.


Viral Pneumonia

 Viral pneumonia occurs as a complication of


influenza, measles, or chickenpox
 Viral etiology suspected if no other cause is
determined

Copyright © 2010 Pearson Education, Inc.


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

Copyright © 2010 Pearson Education, Inc.


The Influenza Virus

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

Figure 24.15
Copyright © 2010 Pearson Education, Inc.
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

Copyright © 2010 Pearson Education, Inc.


Influenza Serotypes

Type Antigenic Year Severity


Subtype
A H3N2 1889 Moderate
H1N1 1918 Severe
H2N2 1957 Severe
H3N2 1968 Moderate
H1N1 1977 Low
B None 1940 Moderate
C None 1947 Very mild

Copyright © 2010 Pearson Education, Inc.


Pneumocystis Pneumonia

 Causative agent: Pneumocystis jirovecii


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

Copyright © 2010 Pearson Education, Inc.


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
Copyright © 2010 Pearson Education, Inc.
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?

Copyright © 2010 Pearson Education, Inc.


THANK YOU / ARIGATO GO ZAI MAS … HAI

Copyright © 2010 Pearson Education, Inc.