Bacterial Infection

BPHAR4051- Therapeutics I
Hector Ayala
October 8, 2020
 Overview
Infection is the term used to indicate
the presence of an infectious agent in
an individual or population.

Infectious diseases are the invasion

of a host organism by microbes.

Microbes that cause illness are also

known as pathogens.
 Infection Progression of Bacteria

Initial infection

Incubation Period

Prodromal stage

Period of Illness

Period of Decline

Convalescence
 Infection Progression of Bacteria Cont’
● Incubation period: time between infection and
the appearance of signs and symptoms.
● Prodromal phase: mild, nonspecific symptoms
that signal onset of some diseases.
● Period of Illness: a person experiences typical
signs and symptoms of disease.
● Period of Decline: subsidence of symptoms.
● Recovery phase: symptoms have disappeared,
tissues heal, and the body regains strength.
 TYPES OF INFECTIOUS DISEASE
Infectious disease can be described as being:

By duration:
● Acute, chronic, sub-acute, latent, or as an in
apparent (subclinical) infection
By Location:
● Local, focal, or systemic
By Blood toxicity
● Septicemia, bacteremia, or toxemia
By timing
● A primary/ secondary infection,
super-infection, or a mixed infection.
 TYPES OF INFECTIOUS DISEASE Cont’
BY DURATION

Acute: develops and runs its course quickly.

● Examples: Strep throat (Group A Streptococcus)

● Body develops immunity

Chronic: develops more slowly and is usually less severe, but may
persist for a long, indefinite period of time (from months to years).

● Example: Tuberculosis (Myocardium tuberculosis)

Latent: characterized by periods of no symptoms between

outbreaks of illness. The illness never completely goes away.

● Examples: Syphilis, Tuberculosis, Typhoid Fever disease may return after dormancy
 TYPES OF INFECTIOUS DISEASE Cont’
BY LOCATION

Local: confined to a specific area of the body.

Example: Ear Infection

Systemic: a generalized illness that infects most of the body

with pathogens distributed widely in tissues. It affects the
entire body at once. Most bacterial infections are localized, but
may become systemic if the patient is immunocompromised.

Example: Gonorrhea, Syphilis (Disseminated Chronic Syphilis)

TYPES OF INFECTIOUS DISEASE Cont’

By timing

Primary – initial infection in a previously healthy person.

Secondary – infection that occur

 Upper Respiratory Bacterial Infections

ACUTE RHINOSINUSITIS
ACUTE RHINOSINUSITIS
 ACUTE RHINOSINUSITIS
Epidemiology

Acute rhinosinusitis is an extremely common URI,

accounting for 16 to 25 million physician visits
annually.

History and physical examination are the most

practical methods used to diagnose acute
rhinosinusitis, but the clinical presentation is
nonspecific. A limited computed tomography (CT)
scan provides the most definitive information for
diagnosing sinusitis.
 ACUTE RHINOSINUSITIS: EPIDEMIOLOGY
The most common bacterial pathogens
isolated from sinus aspirates in ADULTS are
1. S. pneumoniae (41%)
2. H. influenzae (35%),
3. Moraxella catarrhalis (4%).
4. Various streptococcal species and
anaerobes from oral flora (14% )
5. Staphylococcus aureus (3%).
59% of Acute maxillary sinusitis are caused
by Bacterial Infections.
The most common bacterial pathogens
isolated from sinus aspirates in CHILDREN
are:
1. S. pneumoniae (41%)
2. H. influenzae (19%)
3. M. catarrhalis (19%)
★ M. catarrhalis is isolated more frequently in children
less than 5 years of age
60% of Acute maxillary sinusitis are caused by
Bacterial Infections.
 ACUTE RHINOSINUSITIS: SIGNS AND
SYMPTOMS
Acute rhinosinusitis presents as:

● Tenderness, cough, sinus pressure,

nasal obstruction, headache,
postnasal drainage, discolored nasal
discharge, and sore throat.

Signs and symptoms of acute sinusitis are

nonspecific and also may occur with
allergic rhinitis and viral Upper Respiratory
Infections.
 ACUTE RHINOSINUSITIS:Diagnosis

It is not cost-effective to use

radiologic and invasive procedures
for the diagnosis of acute
rhinosinusitis in most patients.

So, History and Physical

Assessment is used to diagnose
and treat patients.
 ACUTE RHINOSINUSITIS: Treatment

First-line treatment is amoxicillin. Alternatives

include amoxicillin/clavulanate, selected oral
cephalosporins, newer macrolides, and
fluoroquinolones (adults only)

Five-day treatment regimens are as effective as

10-day regimens for some agents in children
older than 2 years of age (older than 6 years for
severe illness) and adults
 ACUTE RHINOSINUSITIS: Complications
Serious complications resulting from acute rhinosinusitis are uncommon.

Of patients requiring hospital admission for sinusitis, 3.7% had intracranial

infection.

The most common infectious complications included

● cerebral abscess
● Meningitis
● epidural abscess
● Subdural abscess.
● Other complications, including periorbital cellulitis
 ACUTE OTITIS MEDIA (AOM)

Otitis media is a group of inflammatory diseases

of the middle ear.
Types of Otitis Media
● Acute otitis media= less than 3 months
infection
● Otitis media with effusion (OME)= serous
discharge
● Chronic otitis media= more than 3 months
infection
 ACUTE OTITIS MEDIA (AOM)

Acute Otitis Media is extremely prevalent in

young children, occurring in most children at
least once within the first 6 years of life. Many of
these children also develop chronic OME, which
may be associated with hearing impairment and
learning disability. Care of otitis media is
estimated to account for over 24.5 million
physician office visits annually.
 ACUTE OTITIS MEDIA: Epidemiology
● As early as 6 months of age, 48% of infants experience at least one episode of
AOM.
● By 1 year of age, 62% to 79% of infants experience one or more episodes of otitis
media, and almost 20% have had three or more episodes.
● The frequency of at least one occurrence of otitis media further increases to 83%
to 92% by 2 to 3 years of age. The peak incidence for AOM is between the age of 6
months and 1 year.

The risk of AOM and OME appears to be higher in infants :

● Who are not breastfed (Lack of Passive Immunity)

● Low socioeconomic factors
● African-Americans that live in urban environments
● Exposed to secondhand smoke.
 ACUTE OTITIS MEDIA: Epidemiology

The pathogens involved in otitis media are

essentially the same as those involved in acute
rhinosinusitis.

● S. pneumoniae (30% to 47%)

● H. influenzae (14% to 35%)
● M. catarrhalis (less than 14%)

Penicillin-resistant S. pneumoniae is an
increasing problem in children with AOM,
particularly in children who attend day-care
centers.
 ACUTE OTITIS MEDIA: Signs and Symptoms

● AOM is characterized by acute onset of

ear pain, fever, and middle-ear effusion.
Ear pulling, crying, irritability, anorexia,
vomiting, and diarrhea are common in
young children.

These symptoms are nonspecific, though, as

up to 72% of children without AOM present
with these symptoms.
 ACUTE OTITIS MEDIA: Diagnosis

● The diagnosis of AOM is made on the basis of acute symptoms, middle ear
effusion, and middle ear inflammation. Techniques used to demonstrate
reduced tympanic membrane mobility are important to confirm diagnosis.
● The pneumatic otoscope introduces a puff of air while the movement of the
tympanic membrane is observed.
● Tympanometry: This is carried out using a small handheld instrument which is
used to measure air pressure changes in the ear, they can also be used to
determine if the eardrum has been ruptured.
 ACUTE OTITIS MEDIA:
Treatment
First-line treatment with amoxicillin is
recommended by consensus groups.
Alternatives are the same as listed for
acute rhinosinusitis
 ACUTE OTITIS
MEDIA:Complications
● tympanic membrane perforation,
cholesteatoma (middle ear cyst), ossicular
fixation or destruction, labyrinthitis, and
chronic otitis media.
● Additional complications include cervical
abscess, temporal osteomyelitis, facial
paralysis, mastoiditis, brain abscess,
meningitis, subdural or epidural abscess,
lateral sinus thrombosis, and
hydrocephalus.
 ACUTE OTITIS MEDIA: Why
Mostly Children?
Kids (especially in the first 2 to 4 years of life) get ear
infections more than adults do for several reasons:

● Their shorter, more horizontal eustachian tubes let

bacteria and viruses find their way into the middle
ear more easily. The tubes are also narrower, so
more likely to get blocked.
● Their adenoids, gland-like structures at the back of
the throat, are larger and can interfere with the
opening of the eustachian tubes.
● Lack of Immunity
 PHARYNGITIS
Acute pharyngitis (Sore Throat): is a sudden
painful inflammation of the pharynx, the back
portion of the throat that includes the posterior
third of the tongue, soft palate, and tonsils.
➢ Most cases of acute pharyngitis are
self-limited, and specific treatment is needed
only for pharyngitis caused by group A
-hemolytic streptococci (S. pyogenes). Rare
causes of bacterial pharyngitis that also
require treatment include Neisseria
gonorrhoeae, Francisella tularensis, Yersinia
pestis, and Corynebacterium diphtheriae.
 PHARYNGITIS: Epidemiology
The most important cause of pharyngitis or tonsillitis
in terms of the need for treatment and frequency of
occurrence is S. pyogenes. Acute bacterial
pharyngitis may also be caused by group C and G
streptococci, Arcanobacterium hemolyticum, and
possibly M. pneumoniae and Chlamydia pneumoniae.
● The presence of sore throat is associated with
more than 10% of primary care physician visits,
yet less than 20% of patients with a sore throat
actually visit a health-care provider.
● Nearly all common causes are self-limiting, with
symptoms lasting from 2 to 7 days.
 PHARYNGITIS: Signs and Symptoms

● Pain – Body, swallowing

● Dry cough
● Fever
● Vasodilation
● Edema
● Redness and swelling in the
tonsillar pillars, uvula, and soft
palate.
● A creamy exudate may be present in
the tonsillar pillars
● Lymph node enlargement
 PHARYNGITIS: Diagnosis
Laboratory Diagnosis (Throat Culture):
● The only reliable method of diagnosing GABHS infection is a throat culture or rapid
antigen detection test (RADT). A throat culture is performed by swabbing the
posterior pharynx and then plating the specimen on sheep blood agar, followed by
incubation for at least 18 to 24 hours.
Clinical Diagnosis (Physical Assessment):
● Pharyngitis is diagnosed by performing a
physical examination. They will review the
person's current symptoms and check their
throat, ears, and nose for signs of infection.
When an individual has clear signs of a viral
infection, the doctor will likely not perform
further testing.
 PHARYNGITIS: Treatment
According to the Centers for Disease Control and
Prevention (CDC), amoxicillin and penicillin are the
most commonly prescribed treatment . It’s important
that you take the entire course of antibiotics to
prevent the infection from returning or worsening.
An entire course of these antibiotics usually lasts 7
to 10 days.

❖ An alternative treatment is oral erythromycin,

but oral cephalosporins, newer macrolides, and
amoxicillin/clavulanate are also effective
 PHARYNGITIS: Complications
Complications of acute group A -hemolytic streptococcal pharyngitis can
be divided into suppurative complications, toxin-mediated complications,
and nonsuppurative complications.
❖ Suppurative
■ Sinusitis
■ Peritonsillar abscess
■ Retropharyngeal abscess
❖ Non-suppurative
■ Acute Rheumatic fever
■ Post-strep glomerulonephritis
■ Scarlet fever
■ Toxic shock
 ACUTE EPIGLOTTITIS

Acute epiglottitis is a very serious condition involving cellulitis and swelling of the epiglottis. Children with acute
epiglottis are at significant risk for acute airway obstruction and death if endotracheal intubation or emergency
tracheostomy is not performed.
 ACUTE EPIGLOTTITIS: Epidemiology

Acute epiglottitis is usually caused by infection with H influenzae type B. Fortunately, the availability and
widespread use of Haemophilus type B vaccine in children has almost eliminated acute epiglottitis, and
this topic will be discussed only briefly in this chapter. In addition to H. influenzae type B, acute epiglottitis
may be caused by S. pneumoniae, -hemolytic streptococci, S aureus, and aerobic gram-negative bacteria

Occur in immunocompromised individuals.

 ACUTE EPIGLOTTITIS: Treatment

Ceftriaxone is the antibiotic of choice (DOC) for epiglottitis. This agent is a third-generation
cephalosporin with broad-spectrum activity against gram-negative organisms, lower efficacy against
gram-positive organisms, and higher efficacy against resistant organisms
 Pneumonia: Overview

● Pneumonia is an infection in
one or both lungs.
● Pneumonia causes
inflammation in the alveoli.
● The alveoli are filled with fluid
or pus, making it difficult to
breathe.

Pneumonia is the inflammation and

consolidation of lung tissue due to
an infectious agent.
 Pneumonia: How is it caused?
● Most of the time, the body filters
organisms and xenobiotics.
● This keeps the lungs from
becoming infected.
● But microbes sometimes enter
the lungs and cause infections.

This is more likely to occur when:

1. immune system is weak.

2. microbe is very strong
(superbug)
3. body fails to filter the organisms.
 Types of Pneumonia

Anatomical Classification:
● Bronchopneumonia affects the lungs
in patches around bronchi
● Lobar pneumonia is an infection that
only involves a single lobe, or
section, of a lung.
● Interstitial pneumonia involves the
areas in between the alveoli
Types of Pneumonia: Bronchopneumonia
Types of Pneumonia: Lobar pneumonia
Types of Pneumonia: Interstitial pneumonia
 Types of Pneumonia

Clinical Classification:
● Community Acquired Pneumonia- pneumonia that is acquired outside the
hospital.
● Nosocomial Pneumonia- pneumonia that is acquired inside the hospital
● Nursing Home-Acquired Pneumonia- pneumonia occurring in a resident of
a long-term care facility or nursing home
● Aspiration Pneumonia and Lung Abscess- is a type of lung infection that is
due to a relatively large amount of material from the stomach or mouth
entering the lungs
 Pneumonia: Epidemiology

● In the United States, pneumonia is reported to be the sixth leading

cause of death, and the most common infectious cause of death.
● Approximately 5.6 million cases of Community Acquired Pneumonia
occur annually in the United States, with about a fourth of cases
requiring hospitalization (1.4 million).
● Pneumonia is the second most common hospital-acquired infection,
occurring in 0.5% to 3% of hospitalized patients.
● Pneumonia is the leading cause of death among nursing home
patients. Estimates of Nursing Home Acquired Pneumonia range from
0.3 to 2.5 cases per 1,000 days of resident care.
 Pneumonia: Epidemiology
The most common causative agent is
Streptococcus pneumoniae, which is responsible
for almost 50% of cases; 5 other common causes
are respiratory viruses (mainly influenza A) and
the atypical bacteria Chlamydophila pneumoniae
and Mycoplasma pneumoniae. Less common
bacterial causes are Haemophilus influenzae,
Staphylococcus aureus, Moraxella catarrhalis
and Legionella pneumophila.
 Pneumonia:
Pathology
Congestion:
● Presence of a proteinaceous
exudate and often of bacteria in
the alveoli.

Red Hepatization:
● Presence of erythrocytes in the
cellular intra-alveolar exudate.
● Neutrophils are also present
● Bacteria are occasionally seen in
cultures of alveolar specimens
collected.
 Pneumonia:
Pathology
Gray Hepatization:

● No new erythrocytes are

extravasating, and those already
present have been lysed and
degraded.
● Neutrophil is the predominant cell
● Fibrin deposition is abundant
● Bacteria have disappeared
● Corresponds with successful
containment of the infection and
improvement in gas exchange
 Pneumonia:
Pathology
Resolution:

● Macrophage is the dominant

cell type in the alveolar space
● Debris of neutrophils, bacteria,
and fibrin has been cleared
 Pneumonia: Risks Factors

The risks factors of Pneumonia Includes:

● Cigarette smoking
● Upper respiratory tract infections
● Alcohol addiction
● Corticosteroid therapy
● Old age
● Recent influenza infection
● Pre-existing lung disease
● Immunocompromised Patients
● Chronic Diseases
 Pneumonia: Prevention

● Smoking cessation
● Better Nutrition
● Respiratory hygiene measures
● Pneumococcal polysaccharide vaccine
● Inactivated influenza vaccine
● Live attenuated influenza vaccine
● Healthy lifestyle
 Pneumonia:
Diagnosis
The diagnosis of pneumonia
is usually based on clinical,
radiographic, and laboratory
findings. An accurate and
complete medical history
including pet exposure,
travel history, and
occupational exposures, and
a physical examination are
advised
 Pneumonia Complications

SLAP HER (please don’t)

● S - Septicaemia
● L - Lung abscess
● A - ARDS
● P - Parapneumonic effusions
● H - Hypotension
● E - Empyema
● R - Respiratory failure/ Renal failure
Urinary Tract System
 Urinary Tract Infection (UTI)

Urinary tract infection (UTI) is a term that is applied to a

variety of clinical conditions ranging from the asymptomatic
presence of bacteria in the urine to severe infection of the
kidney with resultant sepsis. UTI is one of the more common
medical problems.

UTI is an inflammatory response of the urothelium to bacterial

invasion that is usually associated with bacteriuria and
pyuria.

● The presence of bacteria in the urine is termed

bacteriuria
● Pyuria is the condition of urine containing white blood
cells or pus
 Urinary Tract Infection: Etiology

Enteric bacteria are the most common organisms

causing urinary tract infections. This is due to
the anatomic proximity of bowel flora to the
urethra, particularly in women. More important is
the pathogenicity specific to the urinary tract that
certain species of enteric organisms have
acquired. Such organisms are called
uropathogens for their ability to cause infection
even in the healthy host.
 Urinary Tract Infection: Epidemiology
● UTIs are responsible for over 7 million outpatient visits and 1 million
hospitalizations in the United States annually.
● As one of the most common infectious diseases, UTIs have a significant
financial and human public health impact. Each year, an estimated $1.6 billion
is spent in the United States diagnosing and treating acute bladder infections
in women alone.
● Such women will typically experience 6.1 days of symptoms and lose 1.2 days
of work or school. UTIs are also the most common hospital-acquired
infection, accounting for up to 40% of nosocomial infections.
● In the general population, 3.5% of individuals have asymptomatic bacteriuria.
 Urinary Tract Infection: Predisposing factor

1. Factor increasing urinary stasis: 3. Anatomic factor:

● Intrinsic obstruction due to stone on ● Congenital defect in genital tract leading
tumor in urinary tract. to obstruction
● Extrinsic obstruction due to tumor ● Fistula
and fibrosis.
● Shorter female urethra
● Urinary retention including
neurogenic bladder. ● Obesity
● Renal impairment. 4. Factor compromising immune
2. Foreign bodies: response:
● Urinary tract calculi ● Ageing
● Catheter ● HIV
● Urinary tract instrumentation
● Diabetes mellitus
 Urinary Tract Infection: Predisposing factor

Other:
● Pregnancy
● Multiple sex partner
● Poor personal hygiene
● Hypoestrogenic state
● Use of spermicidal agent and
contraceptive diaphragm (women)
 Urinary Tract Infection: Pathogenesis

Understanding of the mode of bacterial entry, host susceptibility factors,

and bacterial pathogenic factors is essential to tailoring appropriate
treatment for the diverse clinical manifestations of UTI.
There are 4 possible modes of bacterial entry into the genitourinary tract. It
is generally accepted that periurethral bacteria ascending into the urinary
tract causes most UTI. Most cases of pyelonephritis are caused by the
ascent of bacteria from the bladder, through the ureter and into the renal
parenchyma
 Urinary Tract Infection:
SIGNS AND SYMPTOMS
● Pain or burning during urination (dysuria)
● An increased urge to urinate (urinary urgency)
● The need to get up at night to urinate (nocturia)7
● Inability to hold your urine (urinary incontinence)
● Passing frequent, small amounts of urine
● Foul-smelling urine
● Cloudy urine caused by pus (pyuria)
● Bloody urine (hematuria)
● Pus discharge from the urethra
● Lower abdominal discomfort
● Pelvic pain in women
● Low-grade fever
● Fatigue
 Urinary Tract Infection: DIAGNOSIS

● History and physical examination

● Urinalysis obtain a midstream voided “ clean- catch” urine specimen.
● Urine for culture and severity
● Imaging studies of urinary tract (e.g IVP, cystoscopy)
 Urinary Tract Infection: Treatment
● Therapy with TMP/SMX or a fluoroquinolone is recommended for 3
days in healthy women with uncomplicated cystitis, 7 to 10 days for
pyelonephritis, and 7 to 14 days for complicated UTIs.
● Prostatitis treatment requires prolonged antimicrobial administration
with an agent that achieves good concentrations in prostatic fluid (e.g.,
fluoroquinolones).
● Recurrent uncomplicated UTIs may be managed with prophylactic or
self-initiated therapy
● Individualization of therapy is dictated by illness severity,
microbiological susceptibility, allergy history, drug interactions,
compliance potential, and cost.
Urinary Tract Infection: Prevention
 What are Antibiotics:

Antibiotics, also known as antibacterials, are medications that destroy or slow

down the growth of bacteria.
 ANTIBIOTICS’ Ideal Qualities
● kill or inhibit the growth of the bacteria
● cause no damage to the host (human
or pets)
● cause no allergic reaction to the host
● stable when stored in solid or liquid
dosage forms
● remain in specific tissues in the body
long enough to be effective
● kill the pathogens before they mutate
and become resistant to it.
 ANTIBIOTICS: Classification
According to bacterial spectrum of activity

● Narrow spectrum
● Broad spectrum

According to antimicrobial activity

● Bactericidal
● Bacteriostatic
 According to bacterial spectrum of activity
● Narrow spectrum antibiotics act against a limited group of
bacteria, either gram positive or gram negative.
For example: sodium fusidate only acts against staphylococcal
bacteria.
● Broad spectrum antibiotics act against gram positive and gram
negative bacteria.
For example: amoxicillin.
 Classification of Antibiotic based on
Antimicrobial Activity
“Bacteriostatic” means that the agent prevents the growth or
reproduction of bacteria.
● Bacteriostatic antibiotics limit the growth of bacteria by interfering
with bacterial protein production, DNA replication, or other aspects
of bacterial cellular metabolism.
● This group includes: tetracyclines, sulfonamides, spectinomycin,
trimethoprim, chloramphenicol, macrolides and lincosamides.
● They must work together with the immune system to remove the
microorganisms from the body. However, there is not always a
precise distinction between them and bactericidal antibiotics.
 Bactericidal

“Bactericidal” means that it kills bacteria.

Ways that bactericidal antibiotics kill bacteria are by:

● Inhibiting cell wall synthesis: Beta-lactam antibiotics (penicillin
derivatives (penams), cephalosporins
● Inhibiting bacterial enzymes or protein translation. Other bactericidal
agents include daptomycin, fluoroquinolones, metronidazole,
nitrofurantoin, co-trimoxazole and telithromycin.
● The antibiotic polymyxin B injures the plasma membrane of bacteria,
allowing their contents to leak out.
Bacteriostatic Bactericidal
● Inhibits the growth of ● Kills the bacteria
Bacteria
● Requires aid of host
defenses (immune syst.)
● Relapse can occur after
discontinuation of drug
Classification of Antibiotic based on MOA