MICROBES IN RESPIRATORY SYSTEM

Oei Stefani ,MDFK UMM

2012

OVERVIEW

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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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…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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…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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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. Bacterial pneumonia2. Chlamydial pneumonia3. Mycoplasma pneumonia4. Tuberculosis5. Pertussis6. Inhalation anthrax7. Legionella pneumonia (Legionnaire’s disease)8. Q fever9. Psittacosis (Ornithosis)

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STAPHYLOCOCCUS

• Klasifikasi

Famili : Micrococcaceae

Genus : StaphylococcusSpesies : Staphylococcus aureus

Staphylococcus epidermidis Staphylococcus saprophyticus

• MorfologiKokus gram positif, gerak (-), spora (-), tersusun seperti

buah anggurKapsul (+) 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 H2O2→H2O

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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........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

• Terapi: penisillin dan derivatnya

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STREPTOCOCCUS

• KlasifikasiFamili : StreptococcaceaeGenus : StreptococcusSpesies : 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 CulturesHemolytic 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 Colonies on Blood Agar

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........ STREPTOCOCCUS

Sifat perbenihan• Memerlukan enriched medium →

BAP• Anaerob fakultatif dan anaerob

mutlak• Dapat membentuk L-form• Katalase (-)

Toksin & enzim• Streptokinase (fibrinolisin)• Streptodornase (DNase)• Hialuronidase→menghancurkan

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→ alveoli→dipenuhi fibrin dan sel darah→perpadatan paru→dibersihkan oleh monosit→cairan direabsorpsi→konvalesens

Terapi: penisilin, eritromisin

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CORYNEBACTERIUM DIPHTHERIAE

• KlasifikasiFamili : CorynebacteriaceaeGenus : CorynebacteriumSpesies : 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 metakromatis→Babes-Ernst bodies Granula metakromatis dapat dilihat dengan pewarnaan metakromasi:

Neisser, Albert, Loeffler methylene blue

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........ CORYNEBACTERIUM DIPHTHERIAE

Sifat perbenihan• Anaerob fakultatif (namun

pertumbuhan optimal diperoleh pada suasana aerob)

• Media perbenihan untuk isolasi primer: PAI (coagulated egg) dan Loeffler (coagulated serum)

• Media selektif: mengandung garam telurit →Tellurite Blood agar, membagi kuman C.diphtheriae menjadi tipe gravis, mitis dan intermedius

• Suhu: 35-370C• Waktu inkubasi 18-24 jam*tellurit menghambat pertumbuhan

streptococcus dan diplococcus

Resistensi &daya tahan• Dibandingkan kuman tak

berspora lainnya, C.diphtheriase lebih tahan terhadap pegaruh cahaya, pengeringan dan pembekuan

• Dalam pseudomembran kering dapat hidup sampai 14 hari

• Pemanasan:mendidih →mati dalam 1 menit580C →mati dalam 10 menit

• Mudah mati dengan desinfektans

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........ CORYNEBACTERIUM DIPHTHERIAE

Patogenesis & klinik• Waktu inkubasi 1-7 hari• Eksotosin menyebabkan reaksi

keradangan, nekrosis jaringan, pseudomembran→obstruksi 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

• KlasifikasiGenus : BacillusSpesies : 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 ϕ 4-5 mm

tepi koloni tidak rata dan berjumbai →Plumouse colony/ caput medusaepaa BAP: zona hemolisa negatif

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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→ alveoli→dipenuhi fibrin dan sel darah→perpadatan paru→dibersihkan oleh monosit→cairan direabsorpsi→konvalesens

Terapi: penisilin, eritromisin

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MYCOBACTERIUM TUBERCULOSIS

• KlasifikasiOrdo : ActinomycetalesFamili : MycobacteriaceaeGenus : MycobacteriumSpesies : M.tuberculosis

M.lepraeM.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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......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

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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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Microbiology: A Clinical Approach © Garland Science

……INFLUENZA

Panel B: © Dennis Kunkel

…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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