Respimicro [recovered]

972 views

Published on

Published in: Health & Medicine
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
972
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
23
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Respimicro [recovered]

  1. 1. 24<br />Microbial Diseases of the Respiratory System<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  2. 2. upper respiratory system <br />The consists of the nose, pharynx, and associated structures, such as the middle ear and auditory tubes.<br />Coarse hairs in the nose<br />ciliated mucous membranes ( nose and throat )<br />Lymphoid tissue, tonsils, and adenoids<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  3. 3. lower respiratory system <br />consists of the larynx, trachea, bronchial tubes, and alveoli.<br />ciliary escalator<br />alveolar macrophages.<br />Respiratory mucus contains IgA antibodies.<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  4. 4. Normal Microbiota of the Respiratory System<br />The normal microbiota of the nasal cavity and throat can include pathogenic microorganisms.<br />The lower respiratory system is usually sterile because of the action of the ciliary escalator.<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  5. 5. Upper Respiratory System<br />Upper respiratory normal microbiota may include pathogens<br />Figure 24.1<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  6. 6. Microbial Diseases of the Upper Respiratory System<br />Laryngitis: S. pneumoniae, S. pyogenes, viruses<br />Tonsillitis: S. pneumoniae, S. pyogenes, viruses<br />Sinusitis: Bacteria<br />Epiglottitis: H. influenzaeHib vaccine<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  7. 7. Microbial Diseases of the Upper Respiratory System <br />These infections may be caused by several bacteria and viruses, often in combination.<br />Most respiratory tract infections are self-limiting.<br />H. influenzae type b can cause epiglottitis.<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  8. 8. Streptococcal Pharyngitis (Strep Throat)<br /> GAS- Streptococcus pyogenes<br />Resistant to phagocytosis<br />Streptokinaseslyse clots<br />Streptolysins are cytotoxic<br />Diagnosis by indirect agglutination/ EIA<br />Figure 24.3<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  9. 9. Streptococcal Pharyngitis (Strep Throat) <br />group A beta-hemolytic streptococci- Streptococcus pyogenes.<br />Symptoms of this infection are inflammation of the mucous membrane and fever; tonsillitis and otitis media may also occur.<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  10. 10. Streptococcal Pharyngitis (Strep Throat) <br />Rapid diagnosis is made by enzyme immunoassays.<br />Penicillin is used to treat streptococcal pharyngitis.<br />Immunity to streptococcal infections is type-specific.<br />Strep throat is usually transmitted by droplets.<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  11. 11. Scarlet Fever<br />Streptococcus pyogenes<br />Pharyngitis<br />Erythrogenic toxin produced by lysogenizedS. pyogenesby a phage.<br />Figure 24.4<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  12. 12. Scarlet Fever<br /> Strep throat, caused by an erythrogenic toxin-producing S. pyogenes, results in scarlet fever.<br />starts general malaise and swelling of neck<br />Symptoms include a red rash, high fever, and a SPOTTED STRABERRY like red, enlarged tongue.<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  13. 13. Diphtheria<br />Corynebacteriumdiphtheriae: Gram-positive rod pleomorphic club shape<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  14. 14. Diphtheria<br />Clinical <br />Start as sore throat and fever followed by general malaise and swelling of neck<br />Diphtheria (leather) tough grayish membrane of fibrin, dead tissue, and bacteria<br />Diphtheria toxin produced by lysogenizedC. diphtheriae (highly virulent toxin)<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  15. 15. Diphtheria<br />Figure 24.6<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  16. 16. Diphtheria<br /> <br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />Vao day nghe bai nay di ban http://nhattruongquang.0catch.com <br />
  17. 17. Diphtheria<br />A membrane can block the passage of air.<br />Exotoxin inhibits protein synthesis, and heart, kidney, or nerve damage may result (fatal)<br />minimal dissemination of the exotoxin in the bloodstream.<br />Antitoxin - neutralize the toxin<br />Antibiotics- Penicillin and Erythromycin can stop growth of the bacteria.<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  18. 18. Diphtheria<br />Prevented by DTaP and Td vaccine (Diphtheria toxoid)<br />Cutaneous diphtheria: Infected skin wound leads to slow healing ulcer<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  19. 19. MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  20. 20. A 15 y/o male patient have chief complaint of difficulty of breathing with associated throat pain, difficulty of swallowing and fever. Physical exam reveals inflamed pharyngeal area covered by grayish thick mucus that is adherent. Patient was noted to have an incomplete set of vaccination. Grams staining reveals gram positive bacilli with endospore.<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  21. 21. Corynebacteria (Genus Corynebacterium)<br /><ul><li>Aerobic or facultativelyanaerobic
  22. 22. Small, pleomorphic (club-shaped), gram-positive bacilli short chains (“V” or “Y” configurations) or in clumps resembling “Chinese letters”
  23. 23. Cells contain metachromaticgranules
  24. 24. Lipid-rich cell wall contains meso -diaminopimelicacid</li></li></ul><li>OTITIS MEDIA<br />infection of the middle ear, primarily in infants and young children<br />three manifestations<br /><ul><li>acute otitis media
  25. 25. chronic otitis media
  26. 26. otitis media with effusion</li></ul>A. Symptoms - fever, pain in the ear, dulled hearing. <br />
  27. 27. Otitis Media<br />S. pneumoniae (35%)<br />H. influenzae (20-30%)<br />M. catarrhalis (10-15%)<br />S. pyogenes (8-10%)<br />S. aureus (1-2%)<br />RSV<br />Affects 85% of children before age 3, and estimated 8 million cases/ year<br />Figure 24.7<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  28. 28. Otitis Media<br />Treated with broad-spectrum antibiotics Amoxicillin <br />Incidence of S. pneumoniae reduced by vaccine<br />Figure 24.7<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  29. 29. Otitis Media<br /> Earache, or otitis media, can occur as a complication of nose and throat infections.<br />Pus accumulation causes pressure on the eardrum causes inflammation and pain.<br />Often in children because of shorter and more horizontal eustachian tube<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  30. 30. B. DIAGNOSIS – <br /> 1. clinical presentation of fever and pain, especially following an URT infection such as a cold<br /> 2. otoscopic examination to see inflammation and/or fluid (pus); also loss of mobility with air pressure<br />
  31. 31. 6. <br /><ul><li>swelling and blockage
  32. 32. cyclic pattern of damage
  33. 33. discomfort - pressure and blocked nasal passages</li></li></ul><li>Common cold<br />Rhinoviruses (50%)<br />Coronaviruses (15-20%)<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  34. 34. The Common Cold <br />Any one of approximately 200 different viruses can cause the common cold; rhinoviruses cause about 50% of all colds.<br />Immunity is based on the ration of Ig A antibodies<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  35. 35. The Common Cold <br />Symptoms <br />Sneezing<br />nasal secretions<br />congestion.<br />Sinus infections, lower respiratory tract infections, laryngitis, and otitis media can occur as complications of a cold.<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  36. 36. The Common Cold <br />Colds are most often transmitted by indirect contact.<br />Rhinoviruses grow best slightly below body temperature.<br />The incidence of colds increases during cold weather<br />Antibodies are produced against the specific viruses.<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  37. 37. Microbial Diseases of the Lower Respiratory System<br />Bacteria, viruses, and fungi cause<br />Bronchitis<br />Bronchiolitis<br />Pneumonia<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  38. 38. Lower Respiratory System<br />The ciliary escalator keeps the lower respiratory system sterile.<br />Figure 24.2<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  39. 39. Pertussis (Whooping Cough)<br />Bordetellapertussis: Gram-negative coccobacillus<br />Capsule<br />Tracheal cytotoxin of cell wall damaged ciliated cells<br />Pertussistoxin produces systemic disease<br />Prevented by DTaP vaccine (acellularPertussis cell fragments)<br />Figure 24.8<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  40. 40. Epidemiology of Bordetellapertussis Infection<br /><ul><li>Man is only natural host; obligate parasites of man
  41. 41. Disease is highly communicable (highly infectious)
  42. 42. Children under one year at highest risk, but prevalence increasing in older children and adults </li></li></ul><li>Whooping cough<br />Inhalation of aerosols<br />Adhere to ciliated epithelial cells<br /> (FHA, Pili)<br />Toxin production<br />Damage to mucosal cells<br />(TCT, Ptx, Acase, LPS?)<br />Act on neurons<br />(Ptx, Acase, LPS)<br />Paroxysmal cough<br />
  43. 43. Whooping cough<br />Symptoms<br />Severe coughing, spasms, inspiratory whoop <br />Lymphocytosis<br />Stages of disease<br />Catarrhal -> Paroxysmal -> Convalescent<br />Spread--highlycontagious<br />Inhalation or direct contact with secretion<br />Usually self-limiting<br />Neurological sequelae<br />Secondary respiratory infections<br />Secondary aspiration pneumoniae<br />leading cause of death<br />
  44. 44. Pertussis (Whooping Cough)<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  45. 45. Pertussis (Whooping Cough)<br />.<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  46. 46. Clinical Progression of Pertussis<br />,<br />or death<br />Inflammation of respiratory mucosal memb.<br />Most infectious, but generally not yet diagnosed<br />
  47. 47. Laboratory Culture, Prevention & Treatment of Bordetella<br /><ul><li>Nonmotile
  48. 48. Fastidious and slow-growing
  49. 49. Requires nicotinamide and charcoal, starch, blood, or albumin
  50. 50. Requires prolonged growth
  51. 51. Isolated on modified Bordet-Gengouagar
  52. 52. Treatmentwith erythromycin</li></li></ul><li>Pertussis (Whooping Cough)<br /> Laboratory diagnosis is based on isolation of the bacteria on enrichment and selective media, followed by serological tests.<br />Regular immunization for children has decreased the incidence of pertussis.<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  53. 53. Tuberculosis<br />
  54. 54. Situationer<br />Leading causes of death world wide<br />Up to a half of world’s population infected, 95% in developing countries<br />8 million people get TB every year<br />(WHO fact sheet 2007)<br />
  55. 55. Philippines ranks 4th for # of TB cases worldwide, highest # per head in SEA<br />2/3 of Filipinos with TB<br />(DOH, 2007)<br />
  56. 56. Rex Karl S. Teoxon, R.N, M.D<br />46<br />PTB<br />Mycobacterium tubercle, acid fast bacilli<br />Airborne/droplets<br />Pott’s disease – thoracolumbar<br />Milliary TB – kidney, liver, lungs<br />
  57. 57. Rex Karl S. Teoxon, R.N, M.D<br />47<br />
  58. 58. Rex Karl S. Teoxon, R.N, M.D<br />48<br />
  59. 59. Morphology<br />Mycobacterium tuberculosis<br />Thin straight rods, 0.4 x 3 µm<br />Acid-fast organisms<br />
  60. 60. Mycobacterial cell wall components<br />Lipids (mycolic acids)<br />Proteins<br />Polysaccharides<br />
  61. 61. TB symptoms<br />Cough with two weeks or more<br />Sputum expectoration<br />Fever<br />Significant weight loss<br />Hemoptysis<br />Chest and/or back pains<br />
  62. 62. Rex Karl S. Teoxon, R.N, M.D<br />52<br />SIGNS AND SYMPTOMS<br />Wt loss, night sweats, low fever, non productive to productive cough, anorexia, Pleural effusion and hypoxemia, cervical lymphadenopathy<br />
  63. 63. Tuberculosis<br />Mycobacterium tuberculosis: Acid-fast rod; transmitted from human to human.<br />M. bovis: <1% U.S. cases, not transmitted from human to human.<br />M. avium-intracellulare complex infects people with late stage HIV infection.<br />Figure 24.9<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  64. 64. TuberculosisMycobacterium tuberculosis<br />Acid fast-lipid, wax<br />Slow growth (nutrient permeability)<br />Resist to detergent and common antibiotics<br />A leading cause of death by infectious disease <br />50% population infected, 3m death/yr<br />Reemergence in 1980 (AIDS, homeless, immigrants)<br />Diagnose<br />PPD test<br />Chest X-ray<br />Sputum smear (for acid-fast bacilli)<br />Sputum culture<br />
  65. 65. Diagnosis<br /><ul><li>Sputum culture
  66. 66. Slow, 13 hour generation time, takes weeks
  67. 67. Acid-fast staining
  68. 68. Skin test (PPD)
  69. 69. DNA hybridization
  70. 70. PCR (16s rRNA)
  71. 71. Bacteriophage</li></li></ul><li>Rex Karl S. Teoxon, R.N, M.D<br />56<br />PPD – ID<br />macrophages in skin take up Ag and deliver it to T cells<br /> T cells move to skin site, release lymphokines <br /> activate macrophages and in 48-72 hrs, skin becomes indurated<br /> - > 10 mm is (+) <br />
  72. 72. Rex Karl S. Teoxon, R.N, M.D<br />57<br />DIAGNOSIS<br />Chest x ray - cavitary lesion<br /> Sputum exam<br /> Sputum culture<br />
  73. 73. Stages of disease<br />Primary infection<br />Asymptomatic to flu-like<br />3-5% develop TB<br />Tubercle (granulomatous response)<br />Reactivation (active TB)<br /> Years later, 10% experience<br />LRT disease (pneumonia)<br />Disseminated miliary TB<br />Almost everywhere<br />AIDS and antibiotic resistance<br />
  74. 74. Stages of pathogenesis<br />Encounter - respiratory droplet<br />Entry - direct inhalation into LRT (ID=10)<br />SPREAD - alveoli, but can spread throughout body seeding many tissues<br />Multiplication<br />Grows in phagosome of macrophage<br />Strict aerobe<br />Very slow in culture (24 hr doubling time)<br />Evade defenses <br />Inhibits phagolysosomal fusion<br />
  75. 75. Tuberculosis <br />Tuberculosis is caused by Mycobacterium tuberculosis.<br />Large amounts of lipids in the cell wall account for the bacterium’s acid-fast characteristic as well as its resistance to dryingnd disinfectants.<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  76. 76. Tuberculosis <br />M. tuberculosis may be ingested by alveolar macrophages; if not killed, the bacteria reproduce in the macrophages.<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  77. 77. Tuberculosis <br />Lesions formed by M. tuberculosis are called tubercles<br />Dead macrophages and bacteria form the caseous lesion that might calcify and appear in an X ray as a Ghon’s complex.<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  78. 78. Tuberculosis <br />Liquefaction of the caseous lesion results in a tuberculous cavity in which M. tuberculosis can grow.<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  79. 79. Tuberculosis <br />New foci of infection can develop when a caseous lesion ruptures and releases bacteria into blood or lymph vessels; this is called miliary tuberculosis.<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  80. 80.
  81. 81. M. tuberculosis<br />Damage<br />Host response to bacteria (cell-mediated immunity)<br />Glycolipids (Freund adjuvant)<br />Spread to new hosts<br />Contagious by droplet, resistant to drying<br />Vaccine - BCG<br />Causes people to become PPD+, not very effective<br />Infect AIDS<br />Treatment<br />Unusual set of antibiotics (isoniazid, ethambutol, rifampin)<br />High mutation rate<br />
  82. 82. Tuberculosis <br />Miliary tuberculosis is characterized by weight loss, coughing, and loss of vigor.<br />Chemotherapy usually involves 3 or 4 drugs taken for at least 6 months; multidrug-resistant M. tuberculosis is becoming prevalent.<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  83. 83. Tuberculosis <br />Positive tuberculin skin test <br />an active case of TB<br />prior infection<br />vaccination <br />immunity to the disease<br />Induration and reddening at inoculation site within 48hours.<br />Most accurate- Mantoux test<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  84. 84. Tuberculosis <br />Laboratory diagnosis is based on the presence of acid-fast bacilli and isolation of the bacteria, which requires incubation (3-6weeks) of up to 8 weeks (Lowenstein-Jensen Agar)<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  85. 85. PPD Tuberculosis Skin Test Criteria<br />PPD = Purified Protein Derivative from M. tuberculosis<br />
  86. 86. MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  87. 87. MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  88. 88. MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  89. 89. Chest X-Ray of Patient with Active Pulmonary Tuberculosis<br />
  90. 90. Tuberculosis <br />Mycobacterium bovis<br />causes bovine tuberculosis <br />transmitted to humans by unpasteurized milk.<br />affect the bones or lymphatic system.<br />BCG vaccine -a live, avirulent culture of M. bovis<br />M. avium-intracellulare complex infects patients in the late stages of HIV<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  91. 91. Tuberculosis<br />Treatment of tuberculosis: Prolonged treatment with multiple antibiotics.<br />Vaccines: BCG, live, avirulent M. bovis; not widely used in United States.<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  92. 92. Tuberculosis<br />Figure 24.12<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  93. 93. Rex Karl S. Teoxon, R.N, M.D<br />78<br />MANAGEMENT<br />short course – 6-9 months <br />long course – 9-12 months<br />DOTS- direct observe treatment short course<br />Case finding<br />Home meds (members of the family)<br />Referrals<br />Follow-up short course – 6-9 months <br />long course – 9-12 months<br />
  94. 94. Rex Karl S. Teoxon, R.N, M.D<br />79<br />MANAGEMENT<br />Follow-up<br /> * 2 wks after medications – non communicable<br /> 3 successive (-) sputum - non communicable<br />rifampicin - prophylactic<br />
  95. 95. Rex Karl S. Teoxon, R.N, M.D<br />80<br />CATEGORIES OF TB<br />category I (new PTB) - (+) sputum<br />category II (relapse)<br />category III (PTB case) - (-) sputum<br />
  96. 96. Rex Karl S. Teoxon, R.N, M.D<br />81<br />TREATMENT:<br />CATEGORY 1 - NEW PTB, (+) SPUTUMGIVE RIPE 2 MONTHS, MAINTENANCE OF RI 4 MONTHS<br />CATEGORY 2 - PREVIOUSLY TREATED WITH RELAPSESGIVE RIPES 1ST 2 MONTHS, REPS 1 MONTH, MAINTENANCE RIE 5 MONTHS<br />CATEGORY 3 - NEW PTB (-) SPUTUM FOR 3XGIVE RIP 2 MONTHS, MAINTENACE RI 2 MONTHS<br />* IF RESISTANT TO DRUGS GIVE ADDITIONAL MONTH/S AS PRESCRIBED<br />
  97. 97. Rex Karl S. Teoxon, R.N, M.D<br />82<br />MDT side effects<br />r-orange urine<br />i-neuritis and hepatitis<br />p-hyperuricemia<br />e-impairment of vision<br />s-8th cranial nerve damage<br />
  98. 98. AFB SMEAR REPORTING GUIDELINE, DOH<br />NATIONAL TUBERCULOSIS CONTROL PROGRAM (2001)<br />Emilio M. Ramirez, MD<br />
  99. 99. National Tuberculosis Control Program (2001)<br />prevent transmission of tubercle bacilli to a healthy person<br />
  100. 100. Goal: Reduce TB mortality and prevalence through early case detection and treatment<br />Target: identify at least 70% of new smear (+) cases, cure at least 85% TB patients discovered<br />Strategy: DOTS (directly observed treatment short course chemotheapy)<br />
  101. 101. Sputum Collection Schedule forDIAGNOSIS<br />
  102. 102. Ideal sputum specimen?<br />MACROSCOPIC<br /><ul><li>Yellowish
  103. 103. Mucopurulent
  104. 104. Cheesy material</li></li></ul><li>When to collect another set of 3 sputum specimens?<br />When the diagnosis for the sputum microscopy examination is doubtful.<br />When the patient fails to complete his sputum collection within two weeks from the time of the previous collection.<br />
  105. 105. Ideal sputum specimen?<br />MICROSCOPIC<br /><ul><li>greater than 25 wbc/LPO, 5 wbc/OIO
  106. 106. Presence of alveolar macrophage, dust cells</li></li></ul><li>AFB STAINING<br />
  107. 107. DIRECT SMEAR EXAMINATION(Flow Chart)<br />SMEARING<br /> SPREADING<br /> DRYING<br /> FIXATION<br />STAINING<br /> INITIAL STAINING<br /> HEATING<br /> WASHING<br /> DECOLORIZATION<br /> WASHING<br /> COUNTER-STAINING<br /> WASHING<br /> DRYING<br />MICROSCOPIC OBSERVATION<br /> RECORDING & REPORTING<br />
  108. 108. DIRECT SMEAR PREPARATION<br />LABELING THE SLIDES<br />Write down the identification number of the sputum specimen on the end of a clean glass slide.<br />
  109. 109. SMEARING<br />SPREADING<br />With a coconut midrib, fish out one (1) loopful of purulent, solid particles of the sputum.<br />Spread the sputum evenly on the slide, approximately 2 x 3 cm <br /> in size. <br />
  110. 110. A Good Smear<br />Poor/too thick Good Poor/too thin<br />
  111. 111. SMEARING<br />DRYING<br />Allow the smear to dry completely at room temperature. <br /> Do not dry it under the sun or over the flame.<br />Place used midribs in a bottle with alcohol and sand mixture or Lysol, <br /> or in a plastic containers and burn them later.<br />
  112. 112. SMEARING<br />FIXATION<br />Fix the smear by passing it through the flame of an alcohol lamp 2 to 3 times, about 2-3 seconds each. <br /> Heat the back of smeared surface of the slide. Never scorch the smear.<br />
  113. 113. STAINING<br />FIXATION<br />Fix the smear by passing it through the flame of an alcohol lamp 2 to 3 times, about 2-3 seconds each. <br /> Heat the back of smeared surface of the slide. Never scorch the smear.<br />
  114. 114. STAINING<br />INITIAL STAINING<br />Arrange the slides on the staining bridge consecutively. <br />Pour carbol fuchsin solution covering the whole surface of the slide.<br />
  115. 115. STAINING<br />HEATING OF THE SLIDE<br />Heat the slide using an alcohol lamp or spirit cotton in a stick ‘till steam comes off from the stain.<br /> Do not boil and do not allow the stain to dry. Leave it for five minutes.<br />
  116. 116. STAINING<br />WASHING OF THE SLIDE<br />Tilt the slide to drain off excess stain.<br />Wash the staining solution off with a gentle stream of running water.<br />
  117. 117. STAINING<br />DECOLOURIZATION<br />Tilt the slide to drain off excess rinse water.<br />Cover the whole slide with 3% hydrochloric acid-ethanol and leave it until solution runs clear.<br />
  118. 118. Staining<br />WASHING OF THE SLIDE<br />Wash the slide with a gentle stream of running water.<br />Tilt the slide to drain off excess rinse water.<br />
  119. 119. Staining<br />COUNTERSTAINING<br />Pour 0.1% methylene blue to cover the whole surface of the smear and leave for 5-10 seconds.<br />Tilt the slide to drain off excess methylene blue.<br />
  120. 120. Staining<br />WASHING AND DRYING<br />Wash the slide with a gentle stream of running water.<br />Tilt and place the slide on the slide rack to dry in the air.<br /> Don’t place under the sun to dry.<br />
  121. 121. SMEAR READING<br />PROPER SCANNING<br /> Horizontal Scanning<br /> Vertical Scanning<br />IMPROPER SCANNING<br /> Zigzag Scanning<br />3 cm<br />
  122. 122. AFB OBSERVATION<br />Single/parallelform<br />Coccoid form<br />Clump form<br />Scratches on the slide<br />
  123. 123. MICROSCOPIC OBSERVATION OF AFB IN PROPERLY AND IMPROPERLY STAINED SMEAR<br />PROPER STAINING<br />INSUFFICIENT HEATING<br />UNDERDECOLORIZED<br />INTENSELY COUNTERSTAINED<br />
  124. 124. National Standard Reporting Scale (2001)<br />
  125. 125. INTERPRETATION OF LAB RESULTS<br />POSITIVE - if all or at least two of the three specimens are positive<br />NEGATIVE - if all (3) specimens are negative<br />DOUBTFUL - if one of the three specimens is positive <br /> (sputum examination should be repeated)<br />
  126. 126. Bacterial Pneumonias<br />Typical pneumonia is caused by S. pneumoniae.<br />Atypical pneumonias are caused by other microorganisms.<br />Lobar pneumonia<br />bronchopneumonia<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  127. 127. MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  128. 128. Pneumonias<br />Sign/ symptoms<br />High fever<br />DOB<br />Chest pain<br />Productive cough<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  129. 129. MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  130. 130. MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  131. 131. MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  132. 132. MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />Mortality within 30 days according to PSI risk class19<br />
  133. 133. Pneumomoccal Pneumonia<br />Streptococcus pneumoniae: Gram-positive encapsulated diplococci<br />Diagnosis is by culturing bacteria.<br />Penicillin <br />Fluoroquinolones<br /> is drug of choice.<br />Figure 24.13<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  134. 134. Pneumococcal pneumonia(Streptococcus pneumoniae)<br />Gram-positive diplococcus<br />Encapsulated (>80 serotypes)<br />Susceptible population<br />Elderly<br />Previously ill<br />Phagocytic dysfunction (e.g., asplenic, sickle cell)<br />Also cause meningitis, otitis media<br />Sensitive to optichin; autolysis by bile<br />
  135. 135. Pneumococcal Pneumonia<br />The bacteria can be identified <br />alpha-hemolysins, <br />inhibition by optochin, <br />bile solubility<br /> serological tests.<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  136. 136. 120<br />Identification<br />Not optochin sensitive<br />optochin sensitive<br />
  137. 137. Pneumococcal Pneumonia<br /> Symptoms <br />Fever<br />breathing difficulty<br />chest pain<br />rust-colored sputum.<br />A vaccine consists of purified capsular material from 23 serotypes of S. pneumoniae.<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  138. 138. Stages of pathogenesis<br />Encounter - humans only, by respiratory droplet<br />Entry - colonization of the oropharynx, aspiration into lung (pneumonia)<br />Spread (extracellular)<br />Pneumonia - blood culture can be positive<br />Meningitis - penetration of mucous membrane<br />Otitis media- eustachian tube to middle ear<br />Multiplication <br />Grows well in serous fluid in alveoli space<br />Evade defenses<br />Capsule--antiphagocytic<br />sIgA protease<br />
  139. 139. Haemophilus Influenzae Pneumonia<br />Gram-negative coccobacillus<br />Alcoholism, poor nutrition, cancer, or diabetes are predisposing factors.<br />Second-generation cephalosporins<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  140. 140. Mycoplasmal Pneumonia <br />Mycoplasmapneumoniae causes mycoplasmal pneumonia; it is an endemic disease.<br />Young adults and children<br />Symptoms persist for 3 weeks and longer (low fever, cough and headaches)<br />PRIMARY ATYPICAL/ WALKING PNEUMONIA<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  141. 141. Mycoplasmal Pneumonia <br />M. pneumoniae produces small “fried-egg” colonies after two weeks’ incubation on enriched media containing horse serum and yeast extract.<br /> Diagnosis is by PCR or serological tests.<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  142. 142. Atypical (walking) pneumoniaMycoplasma pneumonia<br />Lacks peptidoglycan<br />-lactam resistant<br />Disease primarily in young adults<br />Encounter - inhalation from human<br />Entry - restricted to mucosal surface<br />Terminal adhesin protein (P1)<br />Multiplication - require sterols<br />Damage<br />Inflammation<br />Damage and desquamation of ciliated epithelium<br />Treatments<br />Erythromycin, doxycycline, tetracyline<br />
  143. 143. Model for mycoplasma pathogenesis in the lungs<br />
  144. 144. Legionellosis<br />The disease is caused by the aerobic gram-negative rod Legionellapneumophila.<br />High fever 40.5C, cough and general pneumonia symptoms<br />The bacterium can grow in water, such as air-conditioning cooling towers, and then be disseminated in the air.<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  145. 145. Legionnaire's disease/Pontiac FeverLegionella pneumophila<br />Gram-negative rod<br />Stains irregularly<br />Silver stain<br />Disease<br />Pontiac Fever - flu-like in anyone (1968) <br />Fever muscular ache and cough(self limiting)<br />Legionnaire's disease - pneumonia<br />Primarily in middle aged to older men who heavy smoker and drinker or chronically ill<br />1976 American Legion Convention in Philadelphia ( toll 182 cases/29 death)<br />
  146. 146. L. pneumophila<br />
  147. 147. Legionellosis<br />This pneumonia does not appear to be transmitted from person to person.<br />Bacterial culture, FA tests, and DNA probes are used for laboratory diagnosis. <br />Prevention : Copper Ionizing procedure<br />Treatment : Erythromycin, some macrolides like Azithromycin<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  148. 148. Psittacosis (Ornithosis) <br />Chlamydophilapsittaci – gram negative intracellular bacteria and is transmitted by contact with contaminated droppings and exudates of fowl.<br />Elementary bodies allow the bacteria to survive outside a host.<br />s/sx: fever, headache , chills, some with delirium and disorientation<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  149. 149. Psittacosis (Ornithosis) <br />Commercial bird handlers are most susceptible to this disease.<br />The bacteria are isolated in embryonated eggs, mice, or cell culture; identification is based on FA staining.<br />Tx: Tetracycline<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  150. 150. Chlamydial Pneumonia <br />Chlamydophilapneumoniae causes pneumonia; it is transmitted from person to person.<br />Atherosclerosis-deposition of fats on arteries<br />s/sx resemble mycoplasma pneumonia<br />Tetracycline is used for treatment.<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  151. 151. Q Fever <br />Obligately parasitic, intracellular Coxiellaburnetii causes Q fever or X fever<br />The disease is usually transmitted to humans through unpasteurized milk or inhalation of aerosols in dairy barns, cattle tick bites<br />Laboratory diagnosis is made with the culture of bacteria in embryonated eggs or cell culture.<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  152. 152. Q Fever <br />Wide range of clinical symptoms<br />60% asymptomatic<br />s/sx: High fever, muscle ache, headache and coughing<br />Hepatitis and endocarditis (persist for months)<br />Tx: Doxycycline , Chloroquine<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  153. 153. Melioidosis <br />Melioidosis, glanders disease (horses) caused by Burkholderiapseudomallei<br />transmitted by inhalation, ingestion, or through puncture wounds. <br />Symptoms include pneumonia, sepsis, and encephalitis.<br />Tx: Ceftazidime<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  154. 154. MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  155. 155. MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  156. 156. Diagnostic <br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  157. 157. MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  158. 158. a. Streptococcus pneumoniae<br />
  159. 159. b. Haemophilusinfluenzae-<br />
  160. 160. c. Moraxellacatarrhalis-<br />
  161. 161. MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  162. 162. Viral Pneumonia<br /> A number of viruses can cause pneumonia as a complication of infections such as influenza.<br />The etiologies are not usually identified in a clinical laboratory because of the difficulty in isolating and identifying viruses.<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  163. 163. Respiratory Syncytial Virus (RSV) <br /> RSV is the most common cause of pneumonia in infants 2-6months<br />Life threatening- txRibavirin and Palizumab<br />Coughing, wheezing last more than a week, fever by bacterial infection<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  164. 164. Influenza<br />Hemagglutinin (H) spikes used for attachment to host cells.<br />Neuraminidase (N) spikes used to release virus from cell.<br />Figure 24.16<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  165. 165. Influenza<br />Antigenic shift<br />Changes in H and N spikes<br />Probably due to genetic recombination between different strains infecting the same cell<br />Antigenic drift<br />Mutations in genes encoding H or N spikes<br />May involve only 1 amino acid.<br />Allows virus to avoid mucosal IgA antibodies.<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  166. 166. Influenza Serotypes<br />A: Causes most epidemics, H3N2, H1N1, H2N2<br />B: Moderate, local outbreaks <br />C: Mild disease<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  167. 167. Influenza <br />Deaths during epidemic - secondary bacterial infections.<br />Multivalent vaccines for the elderly and other high-risk groups.<br />Amantadine and rimantadine are effective prophylactic and curative drugs<br />Zanamivir and oseltamivir<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  168. 168. 152<br />SARS<br />Coronavirus<br />Severe acute respiratory syndrome <br />IP: 2-7 days<br />MOT: respiratory droplet/person to person contact<br />
  169. 169. 153<br />RISK FACTORS<br />history of recent travel to China, Hong Kong, or Taiwan or close contact w/ ill persons with a hx of recent travel to such areas, OR<br />Is employed in an occupation at particular risk for SARS exposure, i.e. healthcare worker with direct patient contact or a worker in a laboratory that contains live SARS, OR<br />Is part of a cluster of cases of atypical pneumonia without an alternative diagnosis<br />
  170. 170. 154<br />SIGNS AND SYMPTOMS<br />fever, chills, rigors, myalgia, headache, diarrhea, sore throat, rhinorrhea<br />2-7 days after onset of illness - shortness of breath and/or dry cough<br />
  171. 171. 155<br />DIAGNOSIS<br />viral culture<br />PCR<br />serologic testing <br />Mgmt: supportive<br />
  172. 172. Rex Karl S. Teoxon, R.N, M.D<br />156<br />
  173. 173. Rex Karl S. Teoxon, R.N, M.D<br />157<br />
  174. 174. Rex Karl S. Teoxon, R.N, M.D<br />158<br />
  175. 175. MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  176. 176. Fungal Diseases of the Lower Respiratory System <br />Fungal spores are easily inhaled; they may germinate in the lower respiratory tract.<br />The incidence of fungal diseases has been increasing in recent years.<br />The mycoses in the sections below can be treated with amphotericin B.<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  177. 177. Histoplasmosis<br />Histoplasma capsulatum, dimorphic fungus<br />Figure 24.17<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  178. 178.  Histoplasmosis<br />Resembles Tuberculosis <br />Histoplasmacapsulatum causes a subclinical respiratory infection that only occasionally progresses to a severe, generalized disease.<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  179. 179. Histoplasmosis<br />Transmitted by airborne conidia from soil and thru bird droppings<br />Diagnosis by culturing fungus<br />Treatment: AmphotericinB or Itraconizole<br />Figure 24.18<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  180. 180. Coccidioidomycosis<br />Coccidioidesimmitis- dimorphic fungi<br />Figure 24.19<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  181. 181. Coccidioidomycosis  <br />Valley Fever or San Joaquin Fever<br />s/sx- fever, coughing and weigth loss<br />Most cases are subclinical, but when there are predisposing factors such as fatigue and poor nutrition, a progressive disease resembling tuberculosis can result.<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  182. 182. Coccidioidomycosis<br />Transmitted by airborne arthrospores<br />Diagnosis by serological tests or DNA probe<br />Treatment: AmphotericinB<br />Also Ketoconazole, Itraconazole<br />Figure 24.20<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  183. 183. Pneumocystis Pneumonia<br />Pneumocystis jiroveci (P. carinii) is found in healthy human lungs.<br />Pneumonia occurs in newly infected infants and immunosuppressed individuals.<br />Treatment: Timethoprim-sulfamethoxazole<br />Figure 24.22a<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  184. 184. Pneumocystis Pneumonia <br /> P. jiroveci causes disease in immunosuppressed patients.<br />Site - lining of alveoli<br />DOC Trimetophrim -Sulfamethoxazole<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  185. 185. Pneumocystis<br />Figure 24.21<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  186. 186. Blastomycosis<br />Blastomycesdermatitidis, dimorphic fungus<br />Found in soil<br />Can cause extensive tissue destruction, cutaneous lesions<br />Treatment: Amphotericin B<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  187. 187. Blastomycosis (North American Blastomycosis) <br />The infection begins in the lungs and can spread to cause extensive abscesses.<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  188. 188. Other Fungi Involved in Respiratory Disease<br /> Opportunistic fungi can cause respiratory disease in immunosuppressed hosts, especially when large numbers of spores are inhaled.<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />
  189. 189. Opportunistic Fungi Involved in Respiratory Disease<br />Aspergillus<br />Rhizopus<br />Mucor<br />Mucorindicus<br />Figures 12.2b, 12.4<br />MICROPARA- RESPIRATORY INFECTIONby Dr Sonnie Talavera<br />

×