MICROBES IN RESPIRATORY SYSTEM

Oei Stefani ,MD FK UMM 2012

OVERVIEW

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Oei Stefani, MD

THE RESPIRATORY SYSTEM

A major portal of entry for infectious organisms It is divided into two tracts upper and lower.
The division is based on structures and functions in each part.

The two parts have different types of infection.

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Oei Stefani, MD

THE RESPIRATORY SYSTEM

The upper respiratory tract:
Nasal cavity, sinuses, pharynx, and larynx Infections are fairly common. Usually nothing more than an irritation

The lower respiratory tract:

Lungs and bronchi Infections are more dangerous. Can be very difficult to treat
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..PATHOGENS OF THE RESPIRATORY SYSTEM

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Oei Stefani, MD

PATHOGENS OF THE RESPIRATORY SYSTEM

Respiratory pathogens are easily transmitted from human to human. They circulate within a community. Infections spread easily. Some respiratory pathogens exist as part of the normal flora. Others are acquired from animal source, water, air etc Fungi are also a source of respiratory infection. Usually in immunocompromised patients Most dangerous are Aspergillus and Pneumocystis.
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..BACTERIA INFECTING THE RESPIRATORY SYSTEM

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Oei Stefani, MD

BACTERIAL INFECTIONS OF THE UPPER RESPIRATORY TRACT (URT)

Laryngitis & Epiglottitis Otitis media, mastoiditis, and sinusitis Pharyngitis Scarlet fever Diphtheria

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BACTERIAL INFECTIONS OF THE LOWER RESPIRATORY TRACT

1. 2. 3. 4. 5. 6. 7. 8. 9. Bacterial pneumonia Chlamydial pneumonia Mycoplasma pneumonia Tuberculosis Pertussis Inhalation anthrax Legionella pneumonia (Legionnaires disease) Q fever Psittacosis (Ornithosis)

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Oei Stefani, MD

STAPHYLOCOCCUS
Klasifikasi
Famili
Genus Spesies

: Micrococcaceae
: Staphylococcus : Staphylococcus aureus Staphylococcus epidermidis Staphylococcus saprophyticus

Morfologi
Kokus gram positif, gerak (-), spora (-), tersusun seperti buah anggur Kapsul (+) pada galur virulen
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........STAPHYLOCOCCUS
Sifat perbenihan
Aerob/anaerob fakultatif Mudah tumbuh pada medium sederhana Tahan terhadap NaCl 10% isolasi primer dengan Mannitol Salt Agar Suhu optimal 28-350C, pH 7,5 Katalase (+) Pigmen terbentuk pada suhu kamar

Metabolit bakteri
Katalase : mengubah H2O2H2O dan O2 Koagulase: free & bound coagulase, menyebabkan penggumpalan plasma Hialuronidase menghancurkanhialuronat acid pada kapsul Stafilokinase (fibrinolisin) Protease Lipase Fosfatase Deoksiribonuklease (Dnase)

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Oei Stefani, MD

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........STAPHYLOCOCCUS
Patogenesis & klinik
Merupakan flora normal kulit, saluran napas dan saluran cerna. 40-50% dari populasi membawa Staphylococcus aureus di hidung. Kemampuan patogenik disebabkan karena efek kobinasi faktor ekstraseluler, toksin dan daya invasi bakteri. Bakteri dapat menyebar secara hematogen/limfogen. Skin: folikulitis, furunkel, abses, karbunkel, impetigo, scalded skin Respiratory: pneumonia, empiema Bone: osteomielitis Gastrointestinal: enterokolitis, food poisoning Sistemik: sepsis Other organ: endokarditis, meningitis, brain abcess

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STREPTOCOCCUS
Klasifikasi
Famili Genus Spesies : Streptococcaceae : Streptococcus : S. pyogenes S. bovis S. agalactiae S. pneumoniae

Morfologi
Kokus gram positif, gerak (-), spora (-), tersusun seperti rantai Kapsul (+) pada beberapa spesies
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........ STREPTOCOCCUS Detection of bacteria type

Detected by Blood Agar Cultures Hemolytic Reactions: Blood agar is a solid growth medium that contains red blood cells. The medium is used to detect bacteria that produce enzymes to break apart the blood cells. This process is also termed hemolysis. The degree to which the blood cells are hemolyzed is used to distinguish bacteria from one another. Beta Hemolysis Complete Hemolysis Clear Zone Around Colonies on Blood Agar Alpha Hemolysis Incomplete Hemolysis Greenish Zone Around Colonies on Blood Agar Gamma Reaction: Absence of a Hemolytic Reaction No Change Around Stefani, MD on Blood Agar Colonies FK UMM 2012 Oei 14

........ STREPTOCOCCUS
Sifat perbenihan
Memerlukan enriched medium BAP Anaerob fakultatif dan anaerob mutlak Dapat membentuk L-form Katalase (-)

Toksin & enzim

Streptokinase (fibrinolisin) Streptodornase (DNase) Hialuronidasemenghancurkan hialuronat acid pada kapsul Hemolisin (streptolisin) Toksin piogenik dan eritrogenik dihubungkan dengan streptococcal toxic shock syndrome & scarlet fever

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........ STREPTOCOCCUS
Streptococcus pneumoniae (pneumokokus)
Merupakan flora normal saluran napas atas. Kuman diplokokus gram positif, bentuk seperti lanset, pada kultur tua mudah menjadi gram negatif. Galur yang virulen kapsul (+), koloni M (mukoid). Pada agar darah zona kehijauan (hemolisa parsial), lebih jelas pada agar darah coklat. Tumbuh lebih baik pada pCO2 5-10%. Mudah lisis dengan surface active agent misalnya garam empedu, sensitif terhadap optochin, virulen terhadap mencit. Bakteri masuk jaringan paru alveolidipenuhi fibrin dan sel darahperpadatan parudibersihkan oleh monositcairan direabsorpsikonvalesens Terapi: penisilin, eritromisin
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CORYNEBACTERIUM DIPHTHERIAE
Klasifikasi
Famili Genus Spesies : Corynebacteriaceae : Corynebacterium : C. Diphtheriae C. pseudodiphtheriae C. ulcerans C. xerosis

Morfologi
Batang langsing gram positif, gerak (-), spora (-), susunan khas membentuk huruf V,Y,L tulisan china Ujungnya menggelembung /club-shapped, berisi bahan makanan (Volutine granule) yang metakromatisBabes-Ernst bodies Granula metakromatis dapat dilihat dengan pewarnaan metakromasi: Neisser, Albert, Loeffler methylene blue
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........ CORYNEBACTERIUM DIPHTHERIAE

Sifat perbenihan

Resistensi &daya tahan

Anaerob fakultatif (namun Dibandingkan kuman tak pertumbuhan optimal diperoleh berspora lainnya, C.diphtheriase pada suasana aerob) lebih tahan terhadap pegaruh cahaya, pengeringan dan Media perbenihan untuk isolasi pembekuan primer: PAI (coagulated egg) dan Loeffler (coagulated serum) Dalam pseudomembran kering dapat hidup sampai 14 hari Media selektif: mengandung garam telurit Tellurite Blood Pemanasan: agar, membagi kuman mendidih mati dalam 1 menit C.diphtheriae menjadi tipe gravis, 580C mati dalam 10 menit mitis dan intermedius Mudah mati dengan desinfektans Suhu: 35-370C Waktu inkubasi 18-24 jam *tellurit menghambat pertumbuhan streptococcus dan diplococcus Oei Stefani, MD FK UMM 2012 18

........ CORYNEBACTERIUM DIPHTHERIAE

Patogenesis & klinik
Waktu inkubasi 1-7 hari Eksotosin menyebabkan reaksi keradangan, nekrosis jaringan, pseudomembranobstruksi saluran napas Eksotosin apat menyebar secara hematogen menuju jantung, saraf, ginjal

Terapi

causa eksotoksin ADS (Anti Difteri Serum) etiologi C.diphtheriae antibiotika penisilin, eritromisin
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BACILLUS ANTHRACIS
Klasifikasi
Genus Spesies : Bacillus : B.anthracis B.cereus

Morfologi
Batang lurus gram positif, gerak (-), spora (+) bulat lonjong letak di sentral diameter = diameter bakteri, susunan rantai/dua-dua Gambaran khas Bamboo appearance Kapsul (+) menyelimuti rantai Pewarnaan: gram positif, spora tidak tercat Pewarnaan khusus pewarnaan spora dari SCHAEFFER FULTON spora tercat hijau, vegetatif merah
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........ BACILLUS ANTHRACIS

Sifat perbenihan
Dapat tumbuh pada media NAP Suhu optimum 370C pH optimum 7,4 Koloni: besar 4-5 mm tepi koloni tidak rata dan berjumbai Plumouse colony/ caput medusae paa BAP: zona hemolisa negatif

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Oei Stefani, MD

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........ BACILLUS ANTHRACIS

Streptococcus pneumoniae (pneumokokus)
Merupakan flora normal saluran napas atas. Kuman diplokokus gram positif, bentuk seperti lanset, pada kultur tua mudah menjadi gram negatif. Galur yang virulen kapsul (+), koloni M (mukoid). Pada agar darah zona kehijauan (hemolisa parsial), lebih jelas pada agar darah coklat. Tumbuh lebih baik pada pCO2 5-10%. Mudah lisis dengan surface active agent misalnya garam empedu, sensitif terhadap optochin, virulen terhadap mencit. Bakteri masuk jaringan paru alveolidipenuhi fibrin dan sel darahperpadatan parudibersihkan oleh monositcairan direabsorpsikonvalesens Terapi: penisilin, eritromisin
FK UMM 2012 Oei Stefani, MD 22

MYCOBACTERIUM TUBERCULOSIS
Klasifikasi
Ordo : Actinomycetales Famili : Mycobacteriaceae Genus : Mycobacterium Spesies : M.tuberculosis M.leprae M.scrofulaceum

Morfologi
Bakteri tahan asam, batang langsing/sedikit bengkok, ujung tumpul, gerak (-), spora (-), kapsul (-) Dinding sel kompleks, sitoplasma terdaoat struktur yang mirip dengan mitokondria

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Oei Stefani, MD

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......MYCOBACTERIUM TUBERCULOSIS
Sifat perbenihan
Untuk pertumbuhan Mycobacterium membutuhkan fatty acid, amino acid, nitrogen&carbon, gliserol Suhu optimum 35-37oC Obligate aerob Inkubasi 10-14 hari, paling lama 4-6 minggu

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..VIRAL INFECTIONS OF THE LOWER RESPIRATORY TRACT

Majority of acute viral infections are in the lower respiratory tract and caused by: Influenza virus. Respiratory syncytial virus. Common characteristics of infection are: Short incubation period of 1 to 4 days. Transmission from person to person. Transmission can be direct or indirect. Direct through droplets Indirect through hand transfer of contaminated secretions
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INFLUENZA
Influenza virus is an orthomyxovirus. Virions are surrounded by an envelope. Genome is single-stranded RNA Allows a high rate of mutation Three major serotypes of virus: A, B, and C. Differences are based on antigens associated with the nucleoprotein. Direct droplet transmission most common method of spreading. Influenza is a significant health concern. Human virus can combine with an avian virus to produce a highly pathogenic virus. Humans are the hosts for influenza. Aquatic birds are the reservoir.
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INFLUENZA

Panel B: Dennis Kunkel

Microbiology: A Clinical Approach Garland Science

INFLUENZA: Pathogenesis
Influenza virus prefers the respiratory epithelium.
Viremia is rare.

Virus multiplies in the ciliated cells of lower respiratory tract.

Results in functional and structural abnormalities

Cellular synthesis of nucleic acids and proteins is shut down. Ciliated and mucus-producing epithelial cells are shed.
Substantial interference with clearance mechanisms Localized inflammation
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INFLUENZA: Pathogenesis
Three bacteria are common causes of superinfection. Streptococcus pneumoniae Haemophilus influenzae Staphylococcus aureus

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..INFLUENZA: Treatment
Two basic approaches Symptomatic care Anticipation of potential complications The best treatments are: Rest and fluid intake Conservative use of analgesics for myalgia and headache Cough suppressants.

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FUNGAL INFECTIONS OF THE RESPIRATORY SYSTEM

Two major factors govern the incidence and spread of fungal infection.
Ubiquity of the infectious organisms
Found in soil Resident flora

The adaptive immune response

Usually keeps these infections under control Immunocompromised patients at much greater risk

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ASPERGILLOSIS
Invasive aspergillosis shows a rapid progression to death. Typically seen in the immunocompromised. Particularly patients with leukemia or AIDS. Patients undergoing bone marrow transplantation. Also seen in individuals with preexisting pulmonary disease Chronic bronchitis, asthma, and tuberculosis Fungus produces extracellular proteases, phospholipases, and toxic metabolites.

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ASPERGILLOSIS
Caused by the fungus Aspergillus Widely distributed and found throughout world Dispersal is through inhalation of resistant conidia. Seen more and more in nosocomial infections associated with air-conditioning systems.

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..ASPERGILLOSIS: Pathogenesis
Colonization with Aspergillus leads to invasion of tissues. Invasion of lung tissue causes penetration of blood vessels. This causes hemoptysis and/or acute pneumonia. Pneumonia is accompanied by multifocal pulmonary infiltrates and high fever. Prognosis is grave. Mortality for invasive aspergillosis is 100%. Amphotericin B and itraconazole can be used but are usually ineffective.

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THANK YOU

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