BACTERIA AS ETIOLOGIC AGENT IN RESPIRATORY TRACT INFECTION

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

RESPIRATORY TRACT AS OPEN ENDED TRACT PRONE TO BE INFECTED BY MANY KIND MICRO-ORGANISMS
Bacteria Virus Fungi & Yeast Parasites

PROBLEM RELATED TO BACTERIAL RESPIRATORY INFECTION

Heavily contaminated specimen Inhibited growth of bacteria Mixed infection Masked / under diagnosed anaerobic Difficult to find definitive responsible bacteria

BACTERIA REPORTED THAT CAN CAUSE RESPIRATORY TARCT INFECTON

Mycobacterium tuberculosis Streptococcus pneumoniae Klebsiella pneumoniae Staphylococcus aureus Haemophylus influenzae Pseudomonas aeruginosa Mycoplasma pneumoniae Moraxella catarrhalis Legionella pneumophila Coxiella burnetii Staphylococcus epidermidis Chlamydia pneuminae Acinetobacter Sp.

Epidemiologically different spectrum / prevalence

Developed or Developing Community or Hospital based Population Density Urban or Rural Economic and Social Status Health Services accessibility

Dr. M.Djamil Hospital Respiratory Infection Report 2009 (In-patient )

Altogether 1317 ( sputum ) samples Various Suspected Clinical Diagnoses
Pneumniae COPD Brochopneumoniae Pulmonary absces Asthma Bronchial Empyema Bronchiectasi. Acute bronchitis Chronic bronchitis Pleural effusion etc.

Bacteria detected
Klebsiella pneumoniae Staphylococcus aureus Streptococus pneumoniae Pseudomonas aeruginosa Staphylococcus epidermidis Streptococcus alpha haemolyticus Klebsiella Sp. Enterobacter aerogenes Others 32 % 19 % 15 % 14 % 3% 3% 1% 1% 12 %

How about other bacteria

Legionella pneumophyla ? Heaemophylus influenzae ? Acinetobacter Sp ? Moraxella catarrhalis ?

No data
No reagent available Special procedure No Clinical Clue No Clinical Requirement

Microbiology Examination for Respiratory Infection

Clinical Specimen
Sputum ( Mostly / frequent) Pharyngeal & laryngeal Swab. Broncho-alveolar Lavage/wash . Pleural effusion.

Sputum
For Lower Respiratory infection. Should from bronchus or bronchioles, not saliva. Heavily contaminated- need processing. 3 Early morning sputum for AFB. Polymicrobial.

Microbiology Examination for Sputum

Gram staining ( Absolutely ) AFB. Culture : Enrichment medium eg : Blood Agar. Specific purpose : Lowenstein Jenssen ( MTB). Sabourraud Agar ( Mold and Yeast) Chocolate Agar (H.influenzae) . Sensitivity Test.

Pharyngeal & Laryngeal Swab

For Upper respiratory Infection. Carefully obtained not touch the tongue. Swab post part of pharynx and Tonsil. Special precaution on Diphthery case. Laryngeal swab need expertise/ rare. Less contaminated bacteria compare with sputum.

Microbiology Examination for Swab

Gram stain ( Must ). Culture : Blood Agar Specific Agar : Tellurit Agar ( Diphthery). Chocolate Agar ( N. Gonorrhoe). Sabouraud Agar ( Mold & Yeast ). . Sensitivity Test

Broncho-Alveolar Lavage/Wash
Specialized expertise. Specific indication. Mostly for difficult case. Less contaminated bacteria. Be ware for anaerobic bacteria.

Microbiology Examination for BAL

Gram Stain ( Must ). Culture : Blood Agar Special Agar: Lowenstein Jenssen for MTB. Etc. . Sensitivity Test.

Pleural Effusion
Specific case. Specialized /Expertise. Mostly for Difficult case Pulmonary TB. Anaerobic infection. Postive it means infection. Microbiology Examination the same as other pulmonary specimen.

TERIMA KASIH