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Resp Bacterial Flashcards

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1
Q

Bacterial Resp infections (strep)

A
  • Gram (+) cocci in chains or pairs
  • Catalase (-) anaerobic
  • Serology: Lancefield grouping (A-G) based on carb Ag in cell wall
  • Also grouped by M-protein KEY Ag to provoke immune response
  • A-Hemolytic: Green-partial hemolysis
  • Pneumoniae (optochin sensitive)
  • Viridans (optochin resistant)
  • B-Hemolytic: Clear-complete hemo
  • Pyogenes A (bacitracin sensitive)
  • Agalactiae B (bacitracin resistant)
  • Y-Hemolytic: No hemolysis
  • Enterococcus (Faecalis/Faecium)
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2
Q

Strep tests

A
  • Catalase Test:
  • Superoxide dismutase splitrs O2+H2O2 into catalase & peroxidase
  • Enzyme that splits Hydrogen peroxide into Water & O2
  • Hydrogen peroxide by-product of resp & is LETHAL in excess
  • Catalase degrades hydrogen peroxide in cell before it can get to excess
  • Result=H2O2 in Free O2 (bubbles/water)
  • PYR (Pyrrogutamyl aminopeptidase):
  • Filter paper= L-pyrrolidonyl-β-naphthylamide (PYR). Bacterial pyrrolidonyl peptidase hydrolizes PYR=Color change
  • ex. Strep Group A(+) & S.pneumoniae (-)
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3
Q

Strep pyogenes (GAS) General

A
  • Gram (+) catalase (-)
  • Beta hemolytic in blood agar
  • Bacitracin sensitive & Group A/PYR(+)
  • Reservoir: Human upper resp & skin
  • Transmission: Resp droplet & P to P HIGH frequency in Winter-Spring
  • Pharyngitis in children 5-15
  • Capsule: Hyaluronic acid (anti-phago)
  • M-protein: Ag variation used for serotype
  • Binds to Fc region on IgG/IgA (anti-phag)
  • Binds to collagen, fibronogen, plasminogen
  • F-protein BINDS to fibronectin=Camo
  • Hemolysins: Strep S & O (toxic)
  • C5A peptidase: inactivates C5a
  • Streptokinase: Lyses blood clots
  • Streptodornases: DNAse
  • Pytogenic exotoxins-Super Ags
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4
Q

GAS M protein Structure

A
  • N terminal: Type specific sequence variation
  • Conserved Region:
  • Ag cross reacting domain w/human tissue
  • Binds to human tissue
  • Carb group Ag=Lancefield grouping common to certain types
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5
Q

Strep GAS Clinical Outline

A
  • Pyogenic infections=Local infections
  • Pharyngitis
  • Otitis media
  • Pneumonia
  • Toxin mediated:
  • Scarlet fever
  • Toxic shock smdrome
  • Fascitis
  • Immune mediated=Untreated pyogenic
  • Rheumatic fever
  • Glomerulonephritis
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6
Q

Strep GAS Pharyngitis

A
  • Pyogenic/Local infection
  • Sudden onset no more than 3-5 days
  • Sore throat, Fever, Headache
  • Inflammation of pharynx/Tonsils
  • Patchy exudates (not always)
  • Palatal petechiae
  • Tender & enlarged Ant cervical nodes
  • Seen in winter or early spring
  • NO COUGH
  • Diagnosis: Beta-hemolytic agar, bacitracin sensitive, Catalase (-), Gram (+) cocci in chains
  • Lancefield-Group A
  • Rapid strep (10-15min) Ag detection-ELISA
  • Throat swab (monoclonal Ab to detect the strep group A cap polysac)
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7
Q

Strep GAS Scarlet Fever

A
  • Associated with Pharyngitis if left untreated=Immune mediated
  • Streptococcal pyrogenic exotoxin=Super Ag causes outbreak
  • Diffuse erythromatous rash ALL over body
  • Fever
  • Strawberry Tongue
  • Skin desquamation=Peeling @ toes/fingers
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8
Q

Strep GAS Rheumatic Fever

A
  • Immune mediated inflammation in heart, Joints, Blood vessels, & subcutaneous
  • Type 2 hypersensitivity (Ab binds to Ag on cell surface NOT free floating)
  • Immune cross reactive w/Mprotein=Mol mimicry
  • Rheumatogenic Strains=1,3, 6, 18
  • Appear 2-4 weeks after pharyngitis
  • Fever, migratory polyarthritis, Erythema marginatum (Rash), Subcutaneous nodules (elbows,knees, wrists)
  • Carditis (damage to heart tissue)-Assoc w/subcutaneous nodules
  • Chorea (Nerve damage) uncontrollable movement of limbs/face
  • Diagnosis: Ab against Steptolsin O (ASO)-Hemolysins used to ID in Titer
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9
Q

Strep GAS Glomerulonephritis

A
  • Ag/Ab complex deposition (Type 3) on glomerular basement membrane
  • Triggers inflammatory Rxn->tissue damage w/impairment of kidney function
  • Localized skin infection & pharyngitis follows
  • Takes 10-15 days after skin infection
  • Symptoms:
  • Hypertension
  • Edema
  • Hematuria (smoky unrine)
  • Proteinuria
  • Diagnosis: History of skin/throat infections
  • Serology-Anti-ASO & Anti-DNase
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10
Q

Jones Criteria RF

A
  • Diagnostic= 1 required & 2 major OR 1 required & 1 major w/2 minor
  • Required: Strep infection
  • ASO/Strep Ab
  • Strep group A throat culture
  • Recent scarlet fever
  • Anti-DNA-B
  • Anti-Hyaluronidase
  • Major: Cariditis (mitral valve), Polyarthritis (3 days per joint w/3 weeks total), Chorea, Erythema, Subcutaneous Nodules
  • Minor:
  • Fever
  • Arthralgia
  • History of RF or RHD
  • Elevated Acute phase rxns (ESR, CRP, Leukocytosis)
  • Prolonged PR interval
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11
Q

Strep Pyogenes (GAS) Treatment

A
  • All treatment given after (+) Rapid Ag detection test or Strep culture
  • Penicillin G
  • Macrolides for Penicillin Allx-Azithromycin & Erythromycin
  • Prevention: NO vaccine
  • Early treatment of Pharyngitis helps prevent RF
  • Pts recovered from RF given monthly dose of Penicillin to prevent further infection-
    • Strep
    • Recurrence of RF
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12
Q

Strep Pneumoniae-General

A
  • Gram (+) encapsulated, Lancet-shaped (elongated) paired w/cocci (short chains)
  • Alpha hemolytic (stains green)
  • Optochin & Bile sensitive
  • Autolysis-Releases virulence factors
  • NO lancefield type due to lack of carb in cellwall
  • Reservoir: Humans nasopharyngeal more common children
  • Transmission: resp droplets & aspiration of normal flora
  • High risk: Children & elderly
  • Pts w/history of previous viral RT infection
    • Ex. Post-influenza, asthma
  • Alcoholics & smokers
  • Chronic pulm disease pts
  • Congestive heart failure
  • Asplenic/Splenectomy pts
  • <u><strong>Trauma/Meningitis</strong></u>=<em><strong>CSF leakage to nose</strong></em>
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13
Q

Strep Pneumoniae-Pathogenesis

A
  • Polysaccharide capsule=Anti-phagocytic (90 serotypes)-Vaccines
  • IgA proteases: Disrupts IgA activity
  • Pneumolysin-O: Alpha-hemo is Cytotoxin destroys ciliated epi cells (pulm)
  • Teichoic acid & peptidoglycan: Activate alternative complement (inflammation)
  • Phosphrylcholine: Unique to SP=Cell wall component
  • Binds to receptors of platelets activating factor (found on many cells)
  • Bacteria “hide” phagocytes=Spread infection
  • Pneumococcal pneum(typical)-most common cause for Community/Nosocomial
  • Aburtpt onset, fever, chills, rigors, cough w/rusty sputum-Lobular pneumonia
  • Otitis Media most common disease
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14
Q

Strep Pneumoniae-Diagnosis

A
  • Lab Specimen: Aspirate from sinus or Middle ear, CSF, blood
  • Gram stain: (+) diplococci & capsule
  • Quellung test: Capsular swelling applying specific Ab (like gram stain BUT w/Ab)
  • Culture: Alpha-hemolysis on Blood agar w/Optochin sensitive
  • Bile solubility: Addition of Bile to culture=killing of cell (less turbid=clear)
  • PCR/Latex particle agglutination: mainly used for meningitis
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15
Q

Strep Pneumoniae-Treatment

A
  • Penicillin/Erythromycin for most strains w/increasing resistance to penicillin
  • Resistance is NOT due to beta-lactasmase BUT mutation to penicillin binding proteins
  • Ceftriaxone or Vanomycin used as alt
  • Pneumo capsular vaccines used 2 types:
  • Adult PPV: 23 T-cell independent polysac Ags recommended for elderly over 65 (short lived immune response)
  • Pediatric PPV: 13 T-cell dependent conj diphtheria toxin for children under 5 (long lived immune response)
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16
Q

Haemophilus Influenza-General

A
  • Type B most VIRULENT type causes:
  • Localized infections in URT & LRT
  • Bacteremia (bacteria in blood)
  • **Meningitis **
  • Flora=Otitis media, Sinusnitis, pneumonia
  • Gram (-) pleomorphic Rod w/pink stain
  • Grow on chocalate agar or on Blood agar w/Strep aureus that lysis RBCs=Satellite Growth
  • Coccobacilli encapsulated w/diff types
  • Requires growth factors - **Ten(hemin) & five(NAD) **
  • Reservoir: Humans ONLY nasopharynx capsular type B & non-typable strains COMMON (Flora)
  • High Risk: Anyone-Unvaccinated children 2-4 or children w/severe infections
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17
Q

Haemophilus Influenza-Virulence factors

A
  • Polysaccharide capsule: Type B capsule made of polyribose-ribitol phosphatase (PRP)
  • IgA protease-Stops IgA
  • Endotoxin: Lipo-oligosacc (LOS) similar to Neisseria=Adherence, toxic to ciliated cells, Induce inflammation
  • Diseases:
  • Otitis media <strong>(2nd common next to <u>strep pneumo</u>) </strong>seen w/conjunctivitis
  • Sinusitis
  • Lower resp tract infection
  • Invasive disease=<strong>Meningitis & Epiglottitis</strong>
  • Children 2-4 yrs most affected-Milder in adults
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18
Q

Haemophilus Influenza-Epiglottitis

A
  • Acute onset, fever, sore throat
  • Dysphagia
  • Dysphonia=Hoarseness
  • Drooling
  • Distress=Breathing problem
  • Stridor=High pitched sound on inspiration
  • Muffled voice
  • Pharynx inflammed=Beefy cherry red, stiff, Swollen epiglottis
  • Diagnosis: Lateral X-ray of neck=Thumb sign
  • Laryngoscopy before intubation
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19
Q

Haemophilus Influenza-Treatment

A
  • Diagnosis: culture tiny colonies=Gray on chocolate agar or streak around Staph aureus=Satellite growth
  • Ag Detection-Latex agglutination-Rapid PRP capsular Ag for H.Influenza type B ONLY
  • Treatment: Suspected epiglottis is considered hospital emergency
  • Supportive treatment: Cricothyrotomy (between thyroid&ciricoid)
  • Antibiotics: Broad spectrum cephalosporin (Severe) & amoxicillin/Doxycycline (mild)
  • Prevention: Hib vaccine-for type B capsular polysaccharide-conj diphtheria or tetanus used to make it
    • Vaccine reduces carrier rate
  • Chemoprophylaxis(admin of meds to help minimize spread): Rifampin eliminates carriers in HIGH risk groups by type B
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20
Q

Corynebacterium diphtheriae-General

A
  • Pleomorphic, gram (+) rods, w/clubbed ends (Coryneform)
  • Arranged in pairs (V & L shapes)
  • Formation of granules (volutin-stain red w/methyl blue) beaded appearance
  • Reservoir: Human ONLY in nasopharynx, URT, GI, Skin-Normally harmless (flora)
  • Aquires toxin gene from phage=lysogenized carriers
  • Transmission: Resp or P to P spread of lysogenized bacteria
  • High Risk: Unvaccinated, Crowded, CHILDREN
  • Clinical: Diphetheria & skin infections
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21
Q

Corynebacterium diphtheriae-Virulence factor

Study These Flashcards
A
  • DT-A/B exotoxin (Secreted or released)
  • Inhibits Protein synthesis VIA ADP ribosylation/inactivation of EF-2
  • Carried by Phage B-Lysogenized corynebacteria
  • Binds to heparin-binding epidermal growth factor found on Heart/nerve cells
  • DT-3 parts 1. receptor binding region, 2.Translocation region (transmembrane), 3.catalytic region(A-unit)
  • Regulation via DTxR (Fe dependent repressor protein) on chromosome=responds to tissue Fe lvls
    • Low lvls = Toxin made
    • High lvls = Toxin Repressed
22
Q

Corynebacterium diphtheriae-Clinical

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A
  • Incubation time: 2-6 days (fever, dyspnea)
  • Local inflammation: Characterized by fibrinous exudate (tough, adherent-gray/green/black) pseudomembrane over tonsils
  • Exudate filled w/neutrophils, necrotic epithelial cells, erythrocytes, & bacteria w/fibrin mesh
  • Difficult to detach w/o damaging underlying tissue <strong>(bleeds occur when attempted)</strong>
  • Located @ pharynx = More severe due obstruction to air flow
  • Bull neck appearance-enlarged Ant cervical lymph nodes w/edema of soft tissues
  • Skin diphtheria-Skin ulcer if bacteria enters through skin <strong>(non-healing ulcer)</strong>
23
Q

Corynebacterium diphtheriae-Clinical complications

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A
  • Toxin carried to other organs-Heart, liver, kidney = necrosis
  • Myocarditis-Arrhythmias & circulatory collapse
  • Nerve weakness/paralysis: Cranial nerves
  • Paralysis of muscles of soft palate & pharynx=Lead to regurg of fluids through nose
  • Difficulties w/vision, speech, swallowing or movement of legs & arms
  • Swelling/congestion of pharyngeal/tonsilar area w/white exudate
  • Perforation of soft palate-Late effect
  • Skin lesions-More common & present in tropics
24
Q

Corynebacterium diphtheriae-Treatment

Study These Flashcards
A
  • Poor specificity on microscopy NOT all strains produce toxin
  • Culture=isolate organism w/3 medias
  • Cystine-Potassium tellurite (selective NO gram (-) & flora/Grey-Black colonies 24-48hrs)
  • Blood agar (small gray irreg zone & small zone of hemolysis)
  • Loeffer’s serum <u>(granule formation/Stain metachromic-inorganic polyphos)</u>
  • Toxin test for production-Elek test=ouchterlony (<u>bind to Ab to form immune complex</u>) Lines cross same Or PCR
  • Treatment: Early admin of diphtheria antitoxin (passive immunity)
  • Penicillin or erythromycin
  • Resp Support
  • Prevention: DPT (diphtheria, pertussis, tetanus) vaccine followed by boosters
25
Bordetella Pertussis-General
* Gram negative coccobacillus-capsulated * ***Strict aerobic***-requires enriched media _(Bordet-Gengou)_ * **_Resistant to penicillin-_**Added to medias to make it selective * **_Reservoir-_** Humans only * **_Transmission-_**Aerosol/Direct contact * **_High Risk-_**Unvaccinated children-Increasing in adults * **_Pathogenesis-_**adheres & multiplies rapidly on epi surface of trachea/bronchi * ***Interferes w/ciliary action***
26
Bordetella Pertussis-Adhesins (virulence)
* **_Adhesins:_** * FHA **_(filamentous hemagglutinin_**) & pertactin * **_Both bind to:_** * ***Integrins on ciliated cells*** * CR3 on macrophages=***induce phagocytosis*** w/o initiating oxidative death * **_Result=_**Intracellular growth in macrophages w/protection from humoral immunity= ***COUGH*** * It ***does NOT invade*** rather it liberates internal toxins that irritate surface cells. * **_Secondary invaders:_** staph, H.Influenza lead to bacterial pneumonia
27
Bordetella Pertussis-Virulence factors
* Pertussis Toxin (Ptx)-Ab type toxin * **_ADP ribosylation of G protein=Increase cAMP lvls_** * Increased resp secretion/mucus made * Inhibits signal transduction by cytokine receptors * Interfere signals from cell surface receptors to intracellular mediator sustems * Interfere w/chemotaxis of lymph/neutophils & phagocytosis _(increase WBC)_ * **_Tracheal cytotoxin (peptidoclygan)_** * Interferes w/DNA synth, kills clilated resp cells * **_Adenylate cyclase toxin/hemolysin:_** Secreted by bacteria, absorbed by host cells, & activated to convert ATP to cAMP * **_Impairs chemotaxis=Inhibit phagocytosis_**
28
Bordetella Pertussis-Clinical
* Incubation 7-10 days ***NO symptoms*** * **_Catarrhal:_** 1-2 weeks=Inflammation mucous membranes nose and throat * ***Highly contagious*** * ***Best time to culture*** * **_Paroxysmal:_** 2-4 weeks=destruction of ciliated epithelium, ***impairment of mucous clearing***, whooping w/series of coughs vomiting, leukocytosis "sudden attacks" * **_Convalescent:_** 3-4 weeks (+)=***secondary complications lack of oxygen supply:*** Pneumonia, seizures, encephalopathy & diminished cough (recovering) * Possible stage for ***super infection***
29
Bordetella Pertussis-Diagnosis
* **_Microscopy:_** Fluorescent Ab on aspirated specimens (false + high) * **_Specimen:_** Calcium alginate swabs * **_Culture:_** Not very sensitive * ***Bordet Gengou*** _(Potato/Blood/glycerol agar w/High amount of blood 20-30%)_ * Nicotinic acid + to support growth * charcoal & Starch + to remove FA * **_Molecular method_**: PCR * **_Serology_**: ELISA-titers against pertussis to Hemagglutinin using acute/Convalescent serum _(blood from recovering pt)_
30
Bordetella Pertussis-Treatment
* **_Macrolides:_** Erythromycin or Azithromycin for early stage * Treatment of dehydration & Low O2 for l***ate stage-Steroids*** for babies/elderly * **_Prevention & control:_** * **_DPT vaccine (diphteria, pertussis, tetanus)_** * Whole cell inactivated=80-85% effective w/SE * **_DaPT vaccine-Multivalent acellular vaccine effective w/less SE_** * Made up of several purified proteins, pertussis, hemagglutinin, peractin, fimbriae ***(contains @ least 2)-Booster needed*** * Main immunogen is pertussis-engineered by intro ***2 AA to inactivate enzyme*** activity * **_Erythromycin prophylaxis-_**in young children prevent relaspse-In catarrhal stage shorten length/severity
31
Moraxella Catarrhalis-General
* Large # of gram(-) rod/bean shaped cocci attached or residing ***w/in PMNs*** in sputum * ***Neisseriaceae family***=Oxidase +(cyto C-electron transfer chain) * ***Does NOT*** ferment ***glucose, maltose, sucrose*** * **_Reservoir:_** ***Pharyngeal flora*** in children/adults * **_High Risk:_** Children/elderly & may be combo infection w/other pathogen=***Lower resp tract infection*** * **_Clinical:_** Otitis media, sinusitis=***Children*** & Bronchitis, pneumonia=***Elderly*** * **_Diagnosis-_**Gram stain * **_Treatment-_*****Beta lactamase(+)***=Penicillin resistant * ***Ampicillin/Clavulanate***(Augmentin-***beta inhibitor***) 2nd or 3rd gen cephalosporins
32
Klebsiella Pneumoniae (General)
* ***Gram (-) rods,*** Faculative anaerobe * ***Lactose fermenter on MacConkey *** * ***Enteronacteriaciae=***Non-motile, ***Oxidase*** _(cyto-c) _& Indole _(reduction of trytophane)_ negative * High ***Mucoid colonies*** due to LARGE cap * **_Reservior:_** Part of normal flora GI & URT * **_Transmission_**: endogenous, aspiration/inhalation of resp droplets. * **_High risk:_** Chonic lung disease, alcoholism, diabetes, resp equipment (MEN) * **_Virulence:_** ***Capsule-Antiphago*** * Endotoxin(LPS)= Inflammation leads to Septic shock
33
Klebsiella Pneumoniae (Clinical)
* **_Presents:_** Typical pneumonia (productive)=***hospital/community*** * Upper lobes w/50% mortality * Necrotic destruction of alveolar spaces=***Cavity formation*** * Sputum ***THICK & Blood tinged jelly*** * **_Complications_**: Septicemia **_(bacteria in blood)_** or UTI * **_Diagnosis:_** Sputum w/gram stain _(BIG CAPSULES)_ * Pink colonies on ***MacConkey-Lactose *** * **_Treatment:_** Antibiotic resistance, even ***vancomycin resistance***
34
Pseudomonas Aeruginosa (General)
* Gram (-) rod i***n pairs,*** Oxidase (+) ***non-fermenter (aerobic)*** * **_Makes pigments:_** * Pyocyanin (blue * Pyoverdin (yellow/green) * Some strains have Cap, slime layer, mucoid colonies * ***Fruity grape-like oder*** * Beta Hemolytic * **_Reservoir_**: ***Uniquitous (everywhere)-***moist/wet sources, AC towers, Respirators, soil, disinfectant sol=***Requires minimal nutrition*** * Normal flora in some people * **_High risk:_** ***Oppurtunistic:*** immunocomprimised (COPD, CF) hospitalized pts, Mech ventilation, or Pts on Broad spec antibio
35
Pseudomonas Aeruginosa (Pathogenesis)
* Several virulence factors, adhesions, toxin, exoenzymes * **_Adhesins=_**Pili, LPS, capsule * **_Exotoxin A=_**A-B exo in single protein-***ADP ribosyltransferase reacts w/EF-2***=Inhibit protein synthesis (diphtheria toxin) * **_Pigments:_** Pyocyanin (blue) activates ***O2 radicals (ROI) attracts WBCs-Destruction of tissues*** * **_Phopholipase=_**Digests lecithin leads to cell lysis * Capsule/slime layer=***Creates Biofilm*** (some strains) * Most common cause of nosocomial pneumonia can be fatal _(necrotizing bronchopneumonia)_
36
Pseudomonas Aeruginosa (Clinical)
* Virulence facts must ***work TOGETHER*** to cause disease * **_Typical pneumonia:_** Tracheobronchitis w/pneumonia=**Necrotizing** * Biofilm formation found in ***CF pts*** * Comprimised neutrophils fail to clear bacteria=Population grows * ***Exo toxin A produced*** once pop reaches ***quarum sensing*** (biofilm)=slimey mucous * **_Bacteremia/Endocarditis:_** Leads to shock * Otitis media & externa (swimmer's ear) * **_Skin:_** Burn wounds or Folliculitis (hot tub) * **_Eye infection_**: Trauma (contact lens) * **_UTI:_** Hospital w/catheters
37
Pseudomonas Aeruginosa (Diagnosis)
* Culture on blood agar or enteric **_MacConkey=_**Grey colonies (non-lactose) * **_Oxidase (+)_**=Presence of Cyto C (remove electrons) * On ***colorles media*** makes ***Blue, green-yellow*** * ***Mucoid colonies=Frutiy order*** * **_Treat:_** Multidrug resistant due ***inherent resistance*** * ***Combo of antibiotics-***Anti-pseudomonal beta lactams + aminoglycosides or fluorquinolones * **_Prevention:_** Hospital control \* ***CL- of Hot tubs***
38
Burkholderia Cepacia
* ***Nine species** * * Gram (-) bacilli, aerobic non-fermenter, Oxidase (+) * Does NOT product diffusible pigments * **_Reservoir:_** Moist envrioments like Pseudomonas * Transmission: Inhalation * **_High Risk:_** Oppurtunistic pathogen (CPD, CF, Chronic granulomatous disease) * Weak & NOT pathogenic in healthy people * Typical pneumonia & UTI in catherized pts * **_Diagnosis:_** isolated from sputum/catheters put in Blood agar or w/***polymyxin for which it is resistant *** * **_Treat:_** less resistant to Antibiotics - ***Trimethoprium sulfa*** * Prevent by ***cleaning resp equipment*** BUT it is ubiquitous=hard to control
39
Acinetobater Baumannii
* Gram(-) coccobacilli (small rods), ***Non-motile*** * Aerobic (oxidase negative) & ***Highly resistant to antibio*** _(some are completely Immune)_ * **_Reservoir:_** Ubiquitous (pseudomonas)-***VERY resitant to enviroment dryness*** * Normal ***flora oropharyngeal*** * **_Transmission:_** Inhalation, ***trauma to skin***, Hospital setting * **_High Risk: Opportunistic-Pts_** * w/resp vent * Catherized pts **_(urine dialysis)_** * Surgery or trauma * Broad spectrum antibiotics * Presents as typical pneumonia, UTI, septecemia, ***Infections in aged & ICU pts*** * ***Soft tissue infections***=Gun shot wound ***(Iraq Bacillus)***
40
Legionella Pneumophilia (Legionnaire's disease)
* Gram (-) bacilli (pleomorphic) ***HARD*** to stain-***Silver impregnation*** * Fastidious growth ***(Needs nutrition) Cysteince/Iron*** * ***Special medium-BCYE*** (buffered charcoal yeast extract agar)-***Charcoal neutralize FAs*** * **_Reservoir:_** Aquatic, ***Survives in amoebae***(Natural water), cooling towers, Showers, water misters, hot tubs, decorative fountains. * Resistant to Cl- Can grow @ 45 C * **_Transmission:_** inhalation of aerosol & water ***NO person to person*** * **_High risk:_** Middle age or older=immunocomprimised _(alcoholics, smokers, COPD, diabetes, transplant pts)_
41
Legionella Pneumophilia (Pathogenesis)
* Faculative intracellular of ***alveolar macrophage, monocytes, & epithelial*** * C3B deposition facilitate phagocytosis * ***NO fusion*** of phagosome/lysosome=***Avoid intracellular killing*** (survive inside macrophage) * Infected macrophage-Make inflammatory cytokines=***Robust inflammatory response*** * **_Diagnosis:_** Direct fluorescent Ab or silver staining * Culture on BCYE w/cysteine&iron * **_Urine Ag Test:_** ***BEST method*** specific for LPS Ag * **_Ab Rxn:_** ELISA or indirect fluorescent Ab test = Lvl of 1:128 or more (+)
42
Legionella Pneumophilia (Clinical)
* **_Pontiac Fever: Flu-like symptoms_** * Incubation time=1/2 dats & lasts 2/5 days * Fever, chills, myalgia, malaise, headache * ***No pneumonia*** * Possible ***Hypersensitivity rxn*** * No Antibiotic treatment * **_Legion Disease: Atypical pneumonia_** * Incubation time=2/10 days * Male middle age (smoking, drinking, underlying pulm disease) * ***Sever Toxic pneumonia***-Rapid onset w/flu-like symptoms, high fever, chest pain ***DRY cough*** * ***Patchy interstitial infiltration*** w/tendency to develop into conslidation w/micro-abcess * Progress to ***multi-organ failure*** * Mortality 75% in immunocomprimised
43
Legionella Pneumophilia (treatment)
* Antibiotic must be able to ***penetrate HUMAN cells*** * **_Macrolides-_**Azithromycin or Clarithromycin * **_Fluoroquinolones_**-Cipro or Levo * **_Control-_** * ID Source & eliminate * Hyperchlorination & elevated water temp * ***Replace shower heads*** * Stop water mists on vegetables * ***Copper-silver ionization*** of water supply
44
Mycoplasma Pneumoniae (general)
* ***Cell-wall less=Pleomorphic*** * Sterol in cell membrane * ***Smallest free living organism*** (extracellular) * Requires cholesterol in culture * Lives in Human Resp Tract * Infected by aerosol spread w/in Close people - Incucation 1-4 weeks * **_High Risk:_** Teenagers/Young adults * Outbreaks occur in ***military & colleges*** * **_Adhesion_**: Surface P1 binds to sialic acid on ciliated resp epi cells * **_Tissue damage:_** Produce hydrogen peroxide-Superoxide radicals & cytolytic enzymes=***Killing cells/Destroying ciliary action***
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Mycoplasma Pneumoniae (Clinical)
* Incubation time 2-3 weeks * Pharyngitis * ***Tracheobronchitis-***Low grade fever w/Dry cough * ***Pneumonia-Atypical-***walking w/low grade fever, patchy broncho-Dry cough * **_Complications:_** ***Hemolytic anemia & Neurologic*** Due to MP binds to sialic acid glycoproteins on RBCs * **_Treatment: Beta-lactam antibios_** * Tetracycline, erythromycin & quinolones * ***Mulberry colonies or Fried egg colonies***
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Mycoplasma Pneumoniae (diagnosis)
* Specimen from bronchial washings ***(NO sputum produced)*** * Mulberry colony on ***A8 agar*** enriched media w/animal serum (cholesterol) & antibios to inhibit bacteria=***Grow SLOW up to 6 weeks*** * **_Cold aggutinin-_**IgM Ab bind to Ag on erythrocytes of O blood @ 4 C * Can be preformed ***@ bed side takes mins*** * For children under 12 not a good test * **_Serology-_**ELISA 4 fold increase (1:128) detect Ab against P1 Ag
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Chlamydiaceae (general)
* Under another family Clamydiopilia (Psittaci & Pneumoniae)-***Non-STD*** * ***"Energy Parasites"-***Use ATP produced by host cell * ***Obligate intracellular parasites*** w/o host cell ATP they cannot make their own * Cannot grow w/o culture-Has cell wall BUT lacks ***muramic acid (sugar acid)*** * NO Gram stain * **_Biphasic growth cycle:_** * ***Elementary body=***Infectous stage (metab inactive comes from outside-In) * ***Reticulate Body=***Metab active-replicate inside cell & convery EB to RB-Lyse cell
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Chlamydophilia Pneumoniae (general)
* **_Reservoir:_** Human RT * **_High risk:_** most cases are asymptomatic or ***present w/Pharyngitis** * * Elderly * **_Pathogenesis: Intracellular growth infects-_** * Macrophages * Endothelial cells * Coronary artery * Smooth muscle * **_Presents:_** * Pharyngitis * Sinusitis * Bronchitis * Atypical pneumonia (mycoplasma) * Linked to ***atherosclerosis,*** Alzheimer's, asthma, & reactive arthritis
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Chlamydophilia Pneumoniae (Diagnosis)
* Difficult to diagnose * **_Culture:_** Grow on ***HE-p2 cell line*** (not common) * ***DFA staining*** to detect ***inclusion bodies (stain green)*** * **_Serology: Best method-_**Microimmunofluorescence or comp fix test * Detect IgM or ***2x increase of IgG*** * **_Treat:_** Reaccurance of symptoms tends to happen so ***2-3 weeks treatment recommended*** * Doxycycline, fluoroquinolones, erythromycin
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Chlamydophilia psittaci
* **_Reservoir:_** Birds ***(farmhand working on turkey farm)*** present in tissue, feces, urine of bird ***(sick/healthy)*** * **_Transmission:_** Aero via dust w/resp secretions/handling of avian feces * ***NO person to person*** * **_Pathogenesis:_** Parrot fever/Ornithosis * Atypical pneumonia * Bronchitis/Pharyngitis/Sinusitis * Severe cases spread to ***Multi system*** * **_Diagnosis_**: Serology 4x increase comp fixation or micro immuno * **_Treatment:_** Doxycycline, macrolides, fluoroquinolones * Treat imported ***birds w/chlortetracycline***
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Bacillus Anthracis (general)
* ***Large gram (+) spore forming bacilli*** * Chain formation * Aerobic spore former-***Poly glutamic acid capsule*** **_(not a protein=NO gram stain)_** * **_Reservoir:_** Ubiquitous around the world (soils/animals) * **_Transmission:_** Disease of ***herbivores aquire pathogen by grazing *** * Humans infected by contact w/animals * **_Entry-_**injured skin, inhalation, ingestion * **_High risk:_** Farm hands, vets, tanners, taxidermists * **_Diagnosis:_** Resp secretions, Pus on skin, or Blood * **_Culture:_** Blood agar-non/hemo w/white-grey rough colonies ***(rounded glass appearance)*** * ***PCR best diagnosis***
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Bacillus Anthracis (Clinical)
* **_Virulence:_** * Poly-glutamate cap (non-phago) * ***Anthrax:*** A-B toxin coded by genes on plasmids * PA (protective Ag), EF (edema Ag), LF (lethal factor) * ***PA=Binding unit-entry*** _(bind multi-system)_ * ***EF=Adenylate cyclase increase*** cAMP=edema * ***LF=Zn dependent protease*** inhibits kinases-Cell death * **_Skin:_** entry through wound, black necrotic center w/raised edematous edges * **_GI:_** RARE in humans, High mortality * **_Inhalation(wool sorter's):_** incubation ***2+ months***, alveolar macrophage engulf spores-***carry to mediastinal lymph*** * Massive chest edema, hemorrhagic ***(widened mediastinum),*** bacteremia/toxemia=***Cyanosis-shock-death w/in 3 days*** (meningeal symtptoms)

Microbio-2 (20 decks)

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