MICROBIAL DISEASES OF THE

RESPIRATORY TRACT
Marvi G. Dulnuan Niog, MD, FPSP, MPH

Objectives
Review of the structure and function of the
respiratory system (RS).
Enumerate normal microbiota of the RS.
Discuss microbial diseases of the upper RS.
Discuss microbial diseases of the lower RS.
Identify the common causes of bacterial
pneumonia.

Structure & Function of the Respiratory System

Functions:
Filtration,
Warming,
Moistening
Sound Production

Functions:
Speech & Other
respiratory sounds,
Maintenance of pH
Gas Exchange

Normal Biota of the Respiratory Tract

Upper Respiratory Tract
Location

Organism

Nasal
Membranes

Staphylococcus epidermidis, Corynebacterium spp. (about 20% of population).

Staphylococcus aureus, Neisseria spp.

Sinuses

Normally sterile

Pharynx

Non-hemolytic streptocooci , Streprococcus pneumoniae, Nesisseria spp.,

Heamophilus influenza, Candida spp.

Defense
Presence of the predominant normal microbiota suppress
growth of pathogenic organisms.
Coughing reflex
Mucociliary escalators

Normal Biota of the Respiratory Tract

Lower Respiratory Tract

- Nearly sterile

Defense
- No cilia or mucus
- Alveolar macrophages present

DISEASES OF
UPPER RESPIRATORY TRACT

Diseases of the Upper Respiratory Tract

Infection

Common Organisms

BACTERIAL DISEASES
Epiglottitis

Haemophilus influenzae

Pharyngitis,
Laryngitis, Tonsillitis

Streptococcus spp.
Streptocoocus pyogenes
Corynebacterium diphtheriae

Otitis MEDIA

Styaphylococcus aureus (1-2%),

Streptococcus pneumoniae (35%)
Haemophilus pneumoniae (20-30%)
Moraxella cattarrhalis (10-15%)
Streptococcus pyogenes (8-10%)

Sinusitis

VIRAL DISEASES

Common Cold
FUNGAL DISEASES

Coronavirus, Rhinovirus
Candida spp.
Rhinosporidium spp., Aspergillus spp.

Diseases of the Upper Respiratory Tract

PHYRINGITIS

Streptococcus pyogenes
Most common pathogen isolated in the
tonsillo-pharyngeal area
Sore throat

Belongs to Group A streptococci (GAS)

Diseases of the Upper Respiratory Tract

Streptococcus pyogenes
Pathogenesis:
Metabolism

Virulence

Toxins

1. Streptolysin O 1. M protein
1. Erythrogenic
a. oxygen labile
(70 types)
or pyrogenic
a. adherence
b. antigenic
toxin
factor
2. Streptolysin S
b anti2. Toxic shock
phagocytic
a. oxygen
syndrome
stable
c. antigenic
toxin
b. non-antigenic 2. Lipoteichoic
acid
-adherence
factor
3. Streptokinase
4.
Hyaluronidas
e
5. DNAase
6. Anti-C5a

Pathology

Toxin-related
1. Scarlet fever
2. Toxic shock syndrome
Direct Invasion
1. Pharyngitis
2. Skin infection
a. Folliculitis c. Impetigo
b. Cellulitis d. Necrotizing
fasciitis
Antibody-mediated
1. Rheumatic fever
a. Myocarditis d. Chorea
b. Fever
e. Rash
c. Arthritis f. Subcutaneous
nodules
2. Acute glomerulonephritis

Diseases of the Upper Respiratory Tract

Streptococcus pyogenes
Morphologic characteristic:
Gram Positive cocci
Lancefield Group A Streptococci
Beta hemolytic on BAP
Non-motile, non-sporeforming
Gram Stain

Biochemical characteristic:
Catalase negative
PYR Hydrolysis positive
Sensitive to Bacitracin & Vancomycin
Resistant to optochin
BAP

Diseases of the Upper Respiratory Tract

Streptococcus pyogenes

Diagnosis
Culture on BAP and CAP
Blood and throat swab
Serologic
1. Anti-streptolysin O (ASO) titer > 160 Units
2. C-Reactive proteins (CRP)
3. Erythrocyte Sedimentation Rate (ESR)

Treatment
Penicillin
Erythromycin

Diseases of the Upper Respiratory Tract

DIPTHERIA

Corynebacterium diphtheria
Causes diptheria
Common among children
Characteristic tough grayish membrane
that form in the tonsils andoro-paharynx
pseudo-membrane obstruction

Diseases of the Upper Respiratory Tract

Corynebacterium diptheriae

Also known as Kleb-loefflers bacillus

Sometimes called diptheroids
Non-motile and facultative anaerobe

Diseases of the Upper Respiratory Tract

Corynebacterium diphtheria

Pathogenesis
Release toxin that
inhibits protein
synthesis
Component A
ADP ribosyl
transferase
Component B
Pseudomembrane

Diseases of the Upper Respiratory Tract

Corynebacterium diptheriae

Diagnosis
Culture and isolation
Media

Colony Reaction

Blood Agar Plate (BAP)

Non-hemolytic whitegray colonies

Cystine tellurite agar

Gray black after 48 hrs.

May be both large and small and flat or convex

Tinsdales agar

Dark brown to black with brown to black halos

Loeffler agar (coagulated serum)

OR
Pais agar (coagulated egg)

Pleomorphic appearance, arranged side by side

Display metachromatic granules
Babes-Ernst granules

Diseases of the Upper Respiratory Tract

Corynebacterium diptheriae

Morphology
Gram stain
Gram positive rod, pleomorphic, club-shaped
picket-fence palisaded or Chinese characters

Diseases of the Upper Respiratory Tract

Corynebacterium diptheriae

Management and Treatment

Anti-toxin remains the only specific
method of treatment.
Antimicrobials
Penicillin
Macrolide

Vaccine for prevention

DPT (Diptheria, Polio and Tetanus

Diseases of the Upper Respiratory Tract

THE COMMON COLD

Viruses:
Rhinoviruses (50%)
Coronaviruses (15 20%)
Other viruses (10%)

DISEASES OF
LOWER RESPIRATORY TRACT

Diseases of the Lower Respiratory Tract

BRONCHITIS
BRONCHIOLITIS
PNEUMONIA

CAUSES OF PNEUMONIA

Gram Negative Bacilli:

Related to the Respiratory System
3 important genera
1. Haemophilus
2. Legionella
3. Bordetella

Haemophilus spp.

Group of small, gram-negative, pleomorphic

bacteria

Normal microbiota of mucous membranes

Haemophilus spp.

Encapsulated
Non motile
No toxins
Growth requirements
Hematin (Factor X) from blood
NAD (Factor V) from yeast extract or Staphylococcus aureus

Haemophilus influenzae

Pfeiffers Bacillus
Infects only humans
Transmission:
- via respiratory route

Haemophilus influenzae

Virulence factors
1. Capsule 6 types
type B most virulent
polyribitol ribose phosphate (PRP)
2. IgA1 protease

No Toxin

Haemophilus influenzae

Clinical Presentation
1. Meningitis 95% by type B
most common cause of
meningitis in aged < 2 y.o.
(5 months to 5 years in the US)
2. Acute epiglotitis
3. Pneumonia
4. Septic arthritis in infants
5. Sepsis (usually in aspleenic px)
6. Others: otitis media, sinusitis

Haemophilus influenzae

Laboratory Diagnosis
1. Gram stain
- gram negative short
rods or coccobacilli

Haemophilus influenzae

2. Culture
- Requires both X
and V factors
i. Chocolate agar Plate (CAP)

Haemophilus influenzae

ii. Blood Agar Plate next to a streak of betahemolytic Staph (Staphylococcus aureus )
- Satellite phenomenon

Haemophilus influenzae

iii. Mueller-Hinton Agar that has been fortified with both

X-factor and V-factor

Haemophilus influenzae
3. Quellang reaction
4. Biochemical tests:
Catalase positive
Ferments glucose

Non - hemolytic

5. Serologic tests detect capsular PLS

type polyribitol phosphate
ex. FAT, ELISA, LPAT

Haemophilus influenzae

Mortality rate for untreated H.influenzae meningitis = 90%

Treatment
1. Ampicillin (25% producr B-lactamase)
2. 3rd Gen. Cephalosporins (Cefotaxime)
Prevention and Control
1. Prompt diagnosis
2. Immunization with type b conjugate vaccine (3 doses at 2,4 & 6 months
of age or 2 doses at 2 and 4 months of age
3. Booster at 12 and 15 months
4. Prophylaxis for high risk patients - Rifampicin

Legionella spp.

Gram negative aerobic bacilli

Associated with environmental water sources
- airconditioner
- water air cooling systems

Legionella spp.

Important species
1. Legionella pneumophila
Legionnaires Pneumonia
Pontiac Fever

2. Legionella micdadei
Pittsburg pneumonia

Legionella pneumophila

Transmission
Respiratory system

Laboratory Diagnosis
1. Stains
i. Gram stain stains faintly
noted be
intracellular
organisms

Legionella pneumophila

ii. Dieterle Silver Stain

iii. Immunofluoresacence

Legionella pneumophila

2. Culture and Isolation

- Does not grow on ordinary media

- Requires high concentration of Iron and Cysteine

Legionella pneumophila

Culture media
i. Buffered Charcoal Yeast Extract Agar (BCYE)
- supplemented with L cyteine, ferric salt and alpha
ketoglutarate
ii. Chocolate agar
iii. Freeley-Gorman Medium (brown pigment)
3. Serologic test

Bordetella spp.

Strictly aerobic
Non fermentative
Small gram negative coccobacilli

Bordetella spp.

Growth requirements:
- Nitotinic acid
- Cysteine
- usually methionine
Also added to the medium remove excess fatty acids
blood, charcoal, starch or ion exchange resins

Bordetella spp.

Clinically important species

1. Bordetella pertussis Whooping cough
2. Bordetella parapertussis
3. Bordetella bronchiseptica Kennel cough in
dogs

Bordetella pertussis

Causes Whooping Cough

phases: 1. Catarrhal phase (1-2 weeks)

- patient is highly infective
- susceptible to antibiotic

2. Paroxysmal phase (2 -10 weeks)

- antibiotic not effective

Bordetella pertussis

Virulence factors
1. Capsule
2. Beta lactamase producing
3. Pili (Filamentous hemagglutinin)
4. Toxins
- Pertussis toxin
- Tracheal cytotoxin

Bordetella pertussis
Laboratory Diagnosis
* With associated lymphocytosis
1.1. Gram stain
- Gram negative coccobacilli

Bordetella pertussis

1. 2. Direct examination of smears stained with fourescein

conjugated monoclonal or polyclonal antibodies

Bordetella pertussis
2. Culture
usually isolated from the nasopharyngeal swabs
during paroxysms
should be incubated in a humid environment at
350C without CO2

slow grower; should be held for 7 to 12 days

Bordetella pertussis

Culture Media:

i. Regan Lowe
ii. Bordet Gengou
Composed of: Potato
20 30 % blood
Glycerol

Bordetella pertussis

Colonies:
- Small round and shiny
- may give the
appearance of
drop of mercury

Differentiation of Gram negative Rods Related to

the Respiratory Tract
Organism

Reservoir

Main Disease

Treatment

Haemophilus influenzae

Man only (Obligate

human parasite)
* Transmitted via
respiratory tract

Meningitis
Pneumonia, Sinusitis
Otitis Media

1. 2nd or 3rd generation

cephalosporin
2. Vaccine HiB
3. Passive immunization

Legionella pneumophila

Ubiquitous in man
and natural
water
environments
1. Airconditioners
2. Cooling towers

Legionnaires
Disease/ Pontiac
fever

1. Erythromycin
2. Rifampin

Bordetella pertussis

Man: highly
contagious
*Transmitted via
respiratory tract

Whooping cough

1. Erythromycin
2. Vaccine: DPT
3. Treat household contacts
with erythromycin