PARVOBACTERIA Mary Joyce Saborrido-Teoxon,MD FEU-NRMF Institute of Medicine Dept.

Of Microbiology & Parasitology

Diseases •Meningitis: H. influenzae; type b encapsulated strains. Vaccination effective Polyribitol capsule conjugated to protein months; 95% effective Spp. Otitis Media •Usually non typeable strains

DNA probe/ Culture -) •Ceftriaxone IM •Co-tri PO •Erythromycin PO •Healing 2 weeks X _ + _ _ V _ + + +

GENUS:

HAEMOPHILUS
•H. influenzae •H. aegypticus •H. aphrophilus •H. ducreyi •H. parainfluenzae •H. parahaemolyticus •H. haemolyticus

•Pertussis toxin (A and B component, OM protein toxin): ADP ribosylation of Gi (inhibiting negative regulator of adenyl cyclase) interferes with transfer of signals from cell surface to intracellular mediator system; Lymphocytosis promotion -activation → hypoglycemia •Increased histamine Disease •Whooping Cough (Pertussis) •Three stages after a 7-10 day incubation; contagious •(1-2 weeks) catarrhal: rhinorrhea, malaise, fever, sneezing •(2-4 weeks) paroxysmal: repetitive cough with whoops, vomiting; anoxia and severity of cough cause neurological damage and eye hemorrhages; organism present at beginning disappears •(>3 weeks) convalescence: less cough, secondary complications manifest: pneumonia, seizures, encephalopathy DIAGNOSIS:

H. aphrophilus H. haemolyticus H. parahaemolyticus H. parainfluenzae

Bronchitis •Exacerbations of acute bronchitis in smokers with COPD Pneumonia •1-24 months; smokers

GENUS:

● Haemophilus influenzae ●
Distinguishing Characteristics •Morphology: •Culture: Fastidious •Growth & Metabolism: X & V •Grows near S. aureus on BA = “Satellite” phenomenon Reservoir : •Human nasopharynx Transmission •Respiratory droplets, shared toys Pathogenesis •Polysaccharide capsule type b capsule is polyribitol phosphate acid type most important virulence factor •IgA protease is a mucosal colonizing factor Common cause of purulent meningitis Age Age Etiology < 2 mths 40% Group B strep 30% E. coli L. monocytogenes > 2 mths 60% H. influenza < 5 y.o. N. meningitidis 5 – 40 yrs 50% N. meningitidis >40 yrs 50% S. pneumoniae

Epiglottitis •Rare in vaccinated kids; seen in unvaccinated toddlers. H. influenzae was the major causative agent. Treatment •Cefotaxime or ceftriaxone for empirical therapy of meningitis. Check nasal carriage before releasing; use rifampin if still colonized. Prevention •Active: Conjugate capsular polysaccharideprotein vaccine •Passive: Ig (sickle cell dse., asplenia) •Rifampin reduces oropharynx colonization and prevents meningitis in unvaccinated, close contacts <2 years.

BORDETELLA

Small, Gram-negative, encapsulated coccobacilli Strict aerobes

● Bordetella pertussis ●
Distinguishing Characteristics •MORPHOLOGY: •GROWTH: Regan-Lowe or Bordet-Gengou media SOC: Saline nasal wash nasopharyngeal cultures Reservoir/Transmission •Human (vaccinated); respiratory droplet Pathogenesis •B. pertussis Is a Mucosal Surface Pathogen •Attachment to nasopharyngeal ciliated epithelial cells (Filamentous hemagglutinin)

ect immunofluorescence (DFA) on nasopharyngeal smear Treatment •Supportive care; hospitalization if <6 months, erythromycin Prevention •Vaccine: DTaP; immunity wanes 5-7 years •Babies born with little or no immunity (IgA) from mom – Erythromycin x 5 days

● Haemophilus aegypticus ●
-Weeks Bacillus

•Purulent Conjunctivitis

•Pertussis toxin (on outer membrane) aids in attachment to target recptor •Toxins damage respiratory epithelium. •Adenylate cyclase toxin: impairs leukocyte chemotaxis → inhibits phagocytosis and causes local edema •Tracheal cytotoxin: interferes with ciliary action; kill ciliated cells

● Bordetella parapertussis ● ● Bordetella bronchiseptica ●
-) bacilli RESERVOIR: RT of canines DISEASE: (in human) •Chronic RTI

•Topical Sulfonamides

● Haemophilus ducreyi ●
ease. Chancroid (genital ulcers): soft, painful chancre Slow to heal without treatment Open lesions increase transmission of HIV

EGBII; 8-15-11

GENUS: Small Gram-negative rods Facultative anaerobic Bipolar staining

PASTEURELLA

and regional lymph node enlargement and suppuration •Traumatic implantation while skinning rabbits → ulceroglandular disease •Aerosols (skinning rabbits) → pneumonia •Ingestion (of undercooked, infected meat or contaminated water) produces typhoidal tularemia. Pathogenesis •Facultative intracellular pathogen (localizes in reticuloendothelial cells) •Granulomatous response Disease •Tularemia •Endemic in every state of U.S. •Arkansas and Missouri highest Treatment •Streptomycin (DOC) •Gentamicin/ Tetracycline Prevention •Protect against tick bites, gloves while butchering rabbits •Live, attenuated vaccine for persons in high-risk occupations

Pathogenesis •Endotoxin •Facultative intracellular parasite (localizes in cells of reticuloendothelial system (RES) → septicemia •Granulomatous response with central necrosis Disease •Brucellosis (undulant fever) B. abortus: B. suis: B. melitensis: B. canis: •Acute Septicemias -104°F (often in afternoon) -like symptoms, including arthralgias, myalgia, back pain

Reservoir •U.S.: desert southwest, rodents, e.g., prairie dogs, chipmunks, squirrels, field mice, and voles Transmission •Wild rodents flea bite → sylvatic plague •Human-to-human transmission by respiratory droplets Pathogenesis •Coagulase-contaminated mouth parts of flea •Endotoxin •Two antigens (V and W) •Envelope antigen (F-1) inhibits phagocytosis Disease •Bubonic Plague uninfected human-coagulase rolecontaminated mouth parts Symptoms: Rapidly increasing fever Regional buboes Conjunctivitis untreated •Pneumonic Plague

● Pasteurella multocida ●
Distinguishing Characteristics •Small , encapsulated gram-negative rods Reservoir •Mouths of many animals, especially cats and dogs Transmission •Animal bites; particularly from cat bites Disease •Wound infection leading to cellulitis with lymphadenitis Pathogenesis •Endotoxin, capsule; spreads rapidly within skin, no exotoxins known Lab Diagnosis •Rarely cultured because routine prophylaxis is common. Treatment/Prevention •DOC: PEN G •Amoxicillin/clavulanate for cat bites. •Amoxicillin/Clavulanate is standard prophylaxis and treatment for most bites (human included), along with thorough cleaning

•Undulant Form: Milder, often a result of incomplete treatment •Chronic Form n one year)

GENUS: Gram-negative rods Zoonotic Facultative intracellular pathogen

BRUCELLA
Treatment: •DOC: Tetracycline + Gentamicin •Ampicillin

-10%

bubonic plague or inhalation of organisms from infected individual. Highly contagious! Treatment •Streptomycin with tetracycline •Strict quarantine for 72 hours after starting antibiotics Prevention •Animal control; avoid sick and dead animals. •Killed vaccine is available for high-risk occupations.

GENUS: Gram-negative small pleomophic rods Facultative intracellular pathogen

FRANCISELLA

● Brucella species ●
Distinguishing Characteristics •Small Gram-negative rods, aerobic •Facultative intracellular •Catalase (+); Oxidase (+) •Serological confirmation of disease of disease most common •Culture is hazardous. Reservoir •Domestic livestock Transmission •Unpasteurized dairy products •Direct contact with the animal, work in slaughterhouse

Prevention •Vaccinate animals •Pasteurize milk, especially goat milk.

● Francisella tularensis ●
Distinguishing Characteristics •Small Gram-negative rod •Serodiagnosis; culture is hazardous Reservoir •Many species of wild animals, especially rabbits, deer, and rodents Transmission •Tick bite (Dermacentor) → ulceroglandular disease, characterized by fever, ulcer at bite site,

GENUS: Gram-negative rod Enterobacteriaceae (oxidase negative)

YERSINIA

● Yersinia pestis ●
Distinguishing Characteristics •Small Gram-negative rods with bipolar staining (safety pin) •Facultative intracellular parasite •Coagulase + •Clinical specimens and cultures and hazardous •Serodiagnosis or direct immunofluorescence

EGBII; 8-15-11

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