Damanhour University Faculty of Pharmacy

Department of Microbiology and Immunology

Course Name: GENERAL MICROBIOLOGY

Course Code: PM2201

Bacteria causing respiratory tract infections

Student Name: Ziad Mohammed Mahmoud

Student ID: 2171
Level: 2nd year general

Submission Date: 9/6/2020

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Abstract

In 2014 a study in the South-East Region revealed that 34.60% of deaths were due to
respiratory tract infections. Respiratory tract infections could be divided into upper
respiratory tract infections and lower respiratory infections. Lower respiratory
infections of bacterial source are the main bacterial infections while upper respiratory
tract infections are mainly due to viral pathogens. This article reviews the major
bacterial pathogens in the respiratory tract. . Staphylococcus aureus is a normal
component in the upper respiratory flora contributing to about 30% of it. Infection of
skin and soft tissue by Staphylococcus aureus is very common but not as serious as the
lower respiratory infection due to S. aureus which is linked with high mortality rate.
Young infants who gets ill by staphylococcal pneumonia are usually in high risk of
death. Streptococcus pneumoniae are mainly in the nasopharynx. By this way,
pneumococci may go directly through the airway towards the lower respiratory tract,
resulting in a number of pneumonia cases. Haemophilus influenzae is also a major
cause of a variety of respiratory diseases. But it is of low risk if compared to some other
pathogens; such as Mycobacterium tuberculosis and Streptococcus pneumoniae.
Remarkably, the Pseudomonas aeruginosa also may results in serious chronic
infections that can last for months to decades. For example, Pseudomonas aeruginosa
can cause the genetic disease cystic fibrosis (CF).

Introduction

Respiratory tract infections are widely distributing and they are the most common
infections in humanity. These infections are of two kinds: upper respiratory tract
infections and lower respiratory tract infections (LRTIs). Mostly, those infections are
not noticed by patients because they are usually not severe and sometimes self-limiting.
In a recent study in the South-East Region it was reported that about 34.60% of deaths
was due to respiratory tract infection. Lower respiratory tract infections (LRTIs) are
between the common causes of death in the world. There is a bigger problem in the
developing countries since they are complex infections and need a specific treatment.

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There is a number of diseases which could be called “Lower respiratory tract

infections”. These diseases have a lot of differences in their pathogenesis, clinical
symptoms, epidemiologies, and results. The causes and symptoms of those diseases
vary with factors as age, gender, weather, the type of population, and many other
factors. Gram positive Bacteria such as Staph. Aureus, Strept.pneumonia as well as
Gram-negative Klebsiella, Haemophilus influenzae, Acinetobacter Pseudomonas were
all proven to cause Lower respiratory tract infections. Upper respiratory infections are
of viral source mainly. Exceptions are only for Epiglottitis and laryngotracheitis.
Although upper respiratory infections of bacterial source are not common they are very
dangerous. Upper respiratory infections are mainly caused by Haemophilus influenzae
type b. Also Streptococcus pyogenes is real source of infection. (1), (2)

Main body of manuscript

Respiratory tract infections are of two kinds: upper respiratory tract infections (URTIs)
and lower respiratory tract infections (LRTIs). The main pathogens in the lower
respiratory tract are the gram-positive Staphylococcus aureus, Streptococcus
pneumonia, etc. as well as the gram-negative Haemophilus influenzae, Pseudomonas,
Acinetobacter and Klebsiella. (1)

Staphylococcus aureus

Lower respiratory infection caused by Staphylococcus aureus is not a usual disease.

Still, those less frequent infections are linked with more death. Staphylococcus aureus
is a normal component in the upper respiratory flora contributing to about 30% of it.
Infection of skin and soft tissue by Staphylococcus aureus is very common but not as
serious as the lower respiratory infection due to S. aureus which is linked with high
mortality rate. Historically young infants who gets ill by staphylococcal pneumonia are
usually in high risk of death. In the United States, the main cause of hospitals infection
is the S. aureus, usually the USA300 strains of MRSA. This led to a huge number of
pneumonia cases. In some study in Detroit, high mortality and morbidity rate has been
linked with Staphylococcal pneumonia reaching about 37%, much more than the
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normal rate. This high rate is thought to be related to weak defense mechanisms.
Although there is a low number of strains of Staphylococcus aureus in the world, a real
serious evolution and adaptation of these biofilms responding selective pressures and
irrational antimicrobial use. For example the USA300 lineage of MRSA is spreading
widely in In the United States. (3)

Streptococcus pneumonia

2,000,000 deaths was reported at one year caused by pneumococcal infections.

Streptococcus pneumoniae which is called (the pneumococcus) is considered the main
pathogen responsible of for community-acquired pneumonia. Pneumococcal
pneumonia incidence is very high especially when it comes to late age and other
comorbidity factors. Streptococcus pneumoniae are mainly in the nasopharynx. By this
way, pneumococci may go directly through the airway towards the lower respiratory
tract, resulting in a number of pneumonia cases. Also Streptococcus pneumoniae may
reach the sinus and middle ears, resulting in many infections. Sometimes, bacteremia
occurs if Streptococcus pneumonia reaches the blood. Meningitis cases may happen if
bacteria reaches the meninges through blood or local infection. (4)

Haemophilus influenzae

Haemophilus influenzae is also a major cause of a variety of respiratory diseases. But

it is of low risk if compared to some other pathogens; such as Mycobacterium
tuberculosis and Streptococcus pneumoniae. Haemophilus influenzae can cause
infection to both blood and the respiratory tract. It is a normal organism in the
nasopharynx of most normal people. Haemophilus influenzae could be divided into
many serotypes according to the polysaccharide capsule. Respiratory infections are
normally caused by the non-serotypes (NTHi). Many mechanisms were evolved by
Haemophilus influenzae to counter the host defense. One of these mechanism is its
ability to penetrate local tissue. Virulence factors of this bacterium as well as bad host
immunity will lead to the spread of this bacterium through the upper airway to the
bronchi of the lung. As a result, many problems appear. For example airway
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 General Microbiology (2201)

inflammation may occur especially in chronic obstructive pulmonary disease (COPD).

Treatment of only the respiratory tract infection with Haemophilus influenzae is not a
full solution. Infection and inflammation will not stop by this way. A better
understanding of the virulence factors and the host’s immunity will lead to better
results with treatment. (5)

Pseudomonas aeruginosa

Pseudomonas aeruginosa (PA) is a widely distributing Gram-negative bacterium

nearly everywhere. Luckily, it is easily removed by most host defenses. Still, serious
infections such as acute pneumonia or even bacteremia may occur in immune
compromised hosts. Remarkably, the Pseudomonas aeruginosa also may results in
serious chronic infections that can last for months to decades. For example,
Pseudomonas aeruginosa can cause the genetic disease cystic fibrosis (CF). A complex
interaction between pathogen and host occurs resulting in this genetic cystic fibrosis
(CF). Special virulence factors and weak host defense paly together to cause (CF). PA
has a special extraordinary genome (>6 Mb). This big genome have codes that is
responsible for dealing with environmental signals. Also these genes results in some
virulence factors, metabolism and resistance mechanisms. This unique genome gives
PA the ability to adapt pretty much everywhere. (8)

Streptococcus pyogenes

Streptococcus pyogenes or group A streptococcus, is a pathogen which causes

localized illness, such as pharyngitis and skin lesions. S. pyogenes can
asymptomatically colonize humans and may cause invasive diseases such as
bacteremia, pneumonia, necrotizing fasciitis, and streptococcal toxic shock syndrome.
S. pyogenes accounts for 2-5% of cases of bacterial pneumonia in the early 20th
century. Fatality of pneumonia due to S. pyogenes decreased to a low level after the
advent of antibiotics. Sporadic outbreaks of S. pyogenes infection have been reported
mainly in military camps, and S. pyogenes rarely causes pneumonia in general.
However, an outbreak of S. pyogenes pneumonia occurred at a US military camp in
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2002. This outbreak ended after intramuscular benzathine penicillin or oral

azithromycin administration. (7)

Escherichia coli

Respiratory tract infections are rarely caused by Escherichia coli. It is rarely the most
abundant facultative anaerobic bacterium in the normal human intestine. Its presence
is clearly associated with infections of the gastrointestinal tract, urogenital tract, and
peritoneum and occasionally with infections at distant loci after bacteremia. However,
it is rarely associated with pulmonary infections. Risk factors to get infected include
chronic illness, particularly diabetes mellitus, renal disorders and alcoholism. This
organism causes acute infection in patients with chronic bronchitis in rare cases.
Pulmonary Infection with pathogen usually results after bacteremia from either the
gastrointestinal or urinary tract. Also aspiration may be the mode of entry of E. coli
into the diseased lung. (9)

Conclusions

Although respiratory tract infections are common they are not dangerous for most
cases. Still they are one of the main death causes. The main pathogens in the
respiratory tract are the gram-positive Staphylococcus aureus, Streptococcus
pneumonia, etc. as well as the gram-negative Haemophilus influenzae, Pseudomonas,
Acinetobacter and Klebsiella. Streptococcus pneumonia is very pathogenic in the lower
respiratory tract considered the main pathogen responsible of for community-acquired
pneumonia. Pseudomonas aeruginosa as well as Haemophilus influenzae are not
strong pathogens except in case of weak host defenses. Streptococcus pyogenes danger
ended after intramuscular benzathine penicillin and oral azithromycin administration.

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