MICROBIAL DISEASES OF THE RESPIRATORY SYSTEM

Microbial Diseases of the Upper Respiratory System

 Anatomical Defenses
1. Nose
- coarse hairs
- mucous secreting cells and cilia
2. Throat
- ciliated mucous membrane
- traps dust and organism
- ciliated cells moves dust towards the mouth
3. Lymphoid tissues (tonsils)
 Normal Microbiota of the upper respiratory system:
- S. epidermidis Streptococcus
S. aureus H. influenzae
Corynebacterium
- Upper respiratory normal microbiota may include pathogens
- normal microbiota suppresses the growth of pathogens by competing with nutrients &
by secreting inhibitory substances.
Transmission:
1. Droplet infection ( respiratory secretion)
2. Unpasteurized milk
Signs & symptoms:
1. Fever
2. Local inflammation
3. Enlarged & tender lymph nodes of the neck
4. Otitis media

Diagnosis:
1. Culture from throat swab
2. Agglutination diagnostic tests
Treatment:
Penicillin

Scarlet Fever
 Streptococcus pyogenes
- lysogenized by a bacteriophage
- produces Erythrogenic toxin
- causes Pharyngitis
Signs & symptoms:
1. Fever
2. Pinkish Red Skin Rash
- Hypersensitivity of the skin to the toxin
3. Spotted , “ Strawberry tongue”
Diphtheria
 Corybacterium diptheriae
- Gram (+), non- endospore forming rod, immobile, straight or curved
- Pleomorphic, “ Club-shaped”, "Chinese characters"
- Klebs-Löffler bacillus
- produces an Exotoxin ( Diphtheria toxin )
Mode of transmission:
1. Droplet infection (Resistant to drying)
2. Cutaneous contact
Signs & Symptoms:
1. Fever
2. Sore throat
3. Malaise
4. Swelling of the neck “Bull neck”
- Tough grayish membrane that forms in the throat that contains fibrin, dead tissue and
bacteria
- Blocks passage of air to the lungs
5. Cutaneous diphtheria - Infects skin wound/ lesions
- Slow healing ulcerations covered by a gray membrane

Prevention:
DPT ( Diptheria Pertussis
Tetanus)
Treatment:
Penicillin and Erythromycin
- controls the growth of
bacteria
- does not neutralize toxin
Antibiotic + Diptheria antitoxin

OTITIS MEDIA
 Complication of colds or infections of the nose and throat
 Common in childhood
 Pus-formation in the eardrum causing it to be inflamed and painful
 Common pathogens: S. pneumoniae (35%)
H. influenzae (20-30%)
M. catarrhalis (10-15%)
S. pyogenes (8-10%)
S. aureus (1-2%)
Treatment:
broad-spectrum antibiotics Amoxicillin
Incidence of S. pneumoniae reduced by vaccine

VIRAL DISEASES OF UPPER RESPIRATORY SYSTEM

COMMON COLD
 Rhinoviruses – 50%
Coronavirus – 15-20%
Other viruses – 10%
 Immunity to cold viruses accumulate during our lifetime
  Decrease incidence of cold as age increases
 200 agents cause colds 113 serotypes of rhinovirus
 Vaccination is impractical
Mode of transmission:
1. Droplet infection
2. Fomites - viruses can be found in door knobs, telephone, cards, handkerchief etc.

• A single virus can cause colds

Signs & symptoms:
1. Sneezing
2. excessive nasal secretion
3. congestion
Treatment:
Antibodies are of no use
Supportive
BACTERIAL DISEASES OF THE LOWER RESPIRATORY SYSTEM
Lower Respiratory System
The Ciliary escalator keeps the lower respiratory system sterile.

 Bacteria, viruses, & fungi cause:

Bronchitis
Bronchiolitis
Pneumonia

BACTERIAL DISEASES OF THE LOWER

RESPIRATORY SYSTEM
PERTUSSIS (WHOOPING COUGH)
 Bordetella pertussis
- Gram-negative coccobacillus
- Gram-negative, aerobic coccobacillus
- Capsule
 Humans are its only host.
 Spread by coughing and by nasal drops
 Incubation period is 7-14 days.
 Occurs most with children under the age of one
 Children with faded immunity, normally around the age 11 through 18.
 Attaches to the ciliated cells in the trachea impeding their action and destroying the cells.
 Toxins:
1. Tracheal Cytotoxin – found on its cell wall
- damages ciliated cells
2. Pertussis Toxin - enters bloodstream and causes the symptoms.
 Stages:
1. Catarrhal stage
- Mild respiratory infection symptoms
- coughing, sneezing, and runny nose
- Most contagious
- One to two weeks
2. Paroxysmal stage
- Prolonged bouts of cough
- Accumulation of mucus due to damaged cilia
- Infected person desperately attempts to cough off mucus
- Gasping of air in between cough
causes Whooping sound.
 - Can result to broken ribs
- Occurs several times a day for 1-6wks
- Coughing fits may be followed by vomiting
- Vomiting induced by coughing can lead to malnutrition and dehydration
- triggered by yawning, laughing , ,stretching or yelling
3. Convalescence stage
- over one to two months

Complications :
*In infants:
- irreversible damage to the brain (Hypoxia)
- High mortality
* Pneumonia
Encephalitis
Secondary bacterial superinfections
Diagnosis:
- symptoms are non-specific hence usually not diagnosed until the appearance of the
characteristic cough.
- Culture of throat swab
- PCR (polymerase chain reaction)
- immunofluorescence
Prevention:
- DPT
Treatment:
- An effective antibiotic (Erythromycin or Azithromycin)
- Close contacts : Antibiotics as prophylaxis
BACTERIAL PNEUMONIAS

 Types of bacterial pneumonia:

Gram positive
- Streptococcus pneumoniae
- most common cause in all age groups except in infants
 - Staphylococcus aureus
Gram negative
- seen less frequently
- Haemophilus influenzae, Klebsiella pneumoniae, Escherichia coli, Pseudomonas
aeruginosa, Moraxella catarrhalis
* These bacteria often live in the gut & enter the lungs when contents of the gut (vomit) are
inhaled.
Atypical
- commonly affect teenagers and young adults
- less severe
Atypical
Coxiella burnetti, Chlamydophila pneumoniae, Mycoplasma pneumoniae, Legionella pneumophila.
Community-acquired pneumonia (CAP)
- Pneumonia in a person who has not recently been hospitalized
- most common type of pneumonia
- causes of CAP vary depending on a person’s age
(CAP contnd.)
- Streptococcus pneumoniae
- most common cause
Viruses
Atypical bacteria
Haemophilus influenzae
Hospital-acquired pneumonia
- Nosocomial pneumonia
- Acquired during or after hospitalization for another illness or procedure with onset at
least 72 hrs after admission.
Hospital-acquired pneumonia
- Seen in 5% of patients admitted for other causes.
- tends to be more deadly than community-acquired pneumonia
- Risk factors :
Mechanical ventilation
Prolonged malnutrition
Underlying heart and lung diseases
Decreased amounts of stomach acid
Immune disturbances
 Other types of pneumonia:
Severe acute respiratory syndrome (SARS)
- SARS coronavirus
Eosinophilic pneumonia
- infection with a parasite
- invasion of the lung by eosinophils
Chemical pneumonia
- Chemical pneumonitis
- Chemical toxicants such as pesticides
Aspiration pneumonia
- Aspiration pneumonitis
- aspirating foreign objects which are usually oral or gastric contents while eating or
after reflux or vomiting which results in bronchopneumonia
- the lung inflammation that results is not an infection but can contribute to one since
the material aspirated may contain anaerobic bacteria.
Aspiration pneumonia
- leading cause of death among hospital and nursing home patients
 Laboratory examinations for pneumonia:
1. Chest x-ray - areas of opacity (seen as white)
- consolidation.
* Pneumonia is not always seen
on x-rays either because the disease is
only in its initial stages, or because it
involves a part of the lung not easily
seen by x-ray.
 2. Chest CT (Computed Tomography)
- reveal pneumonia that is not seen on chest x-ray
3. Sputum Cultures
- two to three days
- to confirm that the infection is sensitive to an antibiotic
4. Complete Blood Count (CBC)
- a high white blood cell count
 Complications:
* Complications are more frequently associated with bacterial pneumonia than with viral
pneumonia.
1. Respiratory Failure
- by triggering (ARDS) lungs quickly fill with fluid and become very stiff
stiffness, combined with severe difficulties extracting oxygen due to the alveolar fluid  need for
mechanical ventilation
2. Sepsis and septic shock
- when microorganisms enter the bloodstream and the immune system
responds by secreting cytokines.
- can cause liver, kidney, and heart damage
3. Pleural effusion
- microorganisms infecting the lung will cause fluid to build up in the space that
surrounds the lung.

4. Empysema- microorganisms present in the pleural

cavity produces a pus – filled fluid.
5. Lung abscess - bacteria in the lung will form a pocket
of infected fluid

Pneumomoccal Pneumonia
 Streptococcus pneumoniae:
- Gram-positive, encapsulated, diplococci
- also called Pneumococcus.
- causes illness in children younger than 2 years old and adults 65 years of age or older.
- elderly are especially at risk of getting seriously ill and dying from this disease
 High risk individuals include those with the following conditions:
- Chronic heart, lung, or liver disease
- Sickle cell anemia
- with HIV infection, AIDS.
- People who have had organ transplant
- taking medicines that lower their resistance to infection
 Transmission of pneumococcal pneumonia:
- Droplet infection (Inhalation)
- Between people who are ill or who carry the bacteria in their throat.
- Common for people especially children, to carry the bacteria in their throats without
being sick.
 Pneumococcal pneumonia symptoms:
- may begin suddenly
 - severe shaking chill which is usually followed
by: High fever
Cough
Shortness of breath (Dyspnea)
Rapid breathing (Tacypnea)
Chest pains
 Other symptoms may include :
Nausea, Vomiting , Headache , Tiredness , Muscle aches
 Pneumococcal pneumonia diagnosis:
Symptoms, Physical exam, Lab tests , Chest x-ray
 Treatment:
- Penicillin is the drug of choice
- Amoxicillin and Erythromycin
- Vancomycin or Cephalosporin
• Fever - aspirin or acetaminophen
• Supplemental oxygen
• Intravenous fluids
• Plenty of rest and take increased amounts of fluids
• Coughing - helps to clear the lungs of fluid
• Prevention:
- Pneumococcal vaccine
- for children and adults
- 65 years old or older
- serious long-term health problem
- resistance to infection is lowered
- babies and children younger than
2 yrs old
Haemophilus influenzae Pneumonia
 Haemophilus influenzae (Pfeiffer's bacillus)
- small, pleomorphic, gram - negative coccobacillus, some strains posses a
polysaccharide capsule Haemophilus influenzae type b, or Hib
- meningitis and pneumonia. age of onset : Preschool (3 month – above 3yrs) peak at 3-12
months
 Predisposing factors:
- Alcoholism
- Poor nutrition
- Cancer
- Diabetes
- Immunocompromised
Transmission :
- Direct contact
- Inhalation of respiratory tract droplets
 PATHOGENESIS:
Invades the nasopharyngeal mucosa  Spreads to the lower respiratory tract  Invades and
destroys the mucous membranes  Interstitial lesions
 Lung findings:
epithelium of the smaller airways and lung
interstitium show PMN or lymphatic invasion
with inflammation, hemorrhagic edema and
and extensive destruction.
CLINICAL FEATURES:
I. Prodrome - Nasopharyngeal II.Pneumonia
- insidious onset with prolonged course (weeks)
Fever
Cough +/- productive
Pleuritic chest pain
Respiratory distress
Complications:
Bacteremia Cellulitis
Epiglottitis Meningitis
 Pericarditis Pyarthrosis
Empysema Pleural effusion
Diagnosis:
Chest X-Ray - lobar consolidation
- disseminated interstitial infiltration
Culture & Staining:
- samples include
sputum throat swab, nasopharyngeal secretions, tracheal aspirate, pleural fluid, blood
Treatment:
Antibiotics – Cefuroxime
Manage complications
Intubation/ventilation
Treat underlying illnesses
Mycoplasmal Pneumonia
 Mycoplasma pneumoniae:
- Pleomorphic, wall-less bacteria
- Primary Atypical Pneumonia or “ Walking Pneumonia”
- Common in children and young adults

Symptoms:
- Mild to moderate in severity that patient
may remain ambulatory throughout the illness
Diagnosis:
- PCR or by IgM antibodies
Treatment:
- Second generation Macrolide
- Second generation Quinolones

Legionelliosis / Legionnaire’s Disease

 Legionella pneumophila
- thin, pleomorphic, flagellated Gram-negative rod
- First recognized after a 1976 outbreak among a group of elderly men attending an
American Legion convention in Philadelphia, Pennsylvania.
 Pathology:
- can only be acquired from an environmental source (Water)
- Transmitted by inhaling aerosols
- infection never occurs between humans or humans and animals
- do not inhabit the upper respiratory tract but go directly to the lungs.
Symptoms:
- mild cough , low fever to rapidly progressive pneumonia, coma, and death.
Diagnosis:
- Culture
Treatment:
- Erythromycin
Chlamydial Pneumonia
 Chlamydia pneumoniae
- now known as Chlamydophila
pneumoniae
- small bacterium that undergoes several
transformations during its lifecycle
- Transmitted from human to human
(Droplet infection)
 Causes Pharyngitis, Bronchitis and atypical pneumonia[
 Elderly and debilitated patients
Symptoms and diagnosis:
- indistinguishable from other causes of pneumonia
Treatment and prognosis:
- Macrolide, Quinolone
 - Prognosis is excellent
Viral Pneumonia
 Viral pneumonia
- pneumonia caused by a virus
- a complication of influenza, measles & chickenpox
- Viral etiology suspected if no cause determined
- Most common cause of pneumonia in children
- Droplet infection
 Symptoms :
- Different viruses cause different symptoms.
- Fever, Non-productive cough, Rhinitis, and systemic symptoms (e.g. myalgia,
headache).
* Viruses also make the body more susceptible to bacterial infection; for this reason, bacterial
pneumonia often complicates viral pneumonia.
 Viruses that commonly cause pneumonia include:
Influenza virus A and B
Respiratory syncytial virus (RSV)
Adenoviruses (in military recruits)
Human parainfluenza viruses (in children)
Herpes simplex virus (HSV), mainly in newborns
Varicella-zoster virus (VZV)
Diagnosis:
- serologic test for viruses

Treatment:
- largely supportive
- Ribavirin.