This document discusses two gram-negative bacteria - Haemophilus influenzae and Bordetella pertussis. H. influenzae can cause localized infections like ear infections or more invasive diseases like meningitis. It exists in both encapsulated and unencapsulated forms. B. pertussis causes whooping cough and is highly contagious, especially in infants and young children. It presents with mild upper respiratory symptoms initially followed by severe paroxysmal coughing. Both organisms require special growth factors and are diagnosed through microscopy, culture, serology or PCR of clinical samples. H. influenzae is treated with antibiotics like ceftriaxone or amoxicillin for different infections. B. pert

1. HaemophilusHaemophilus
&&
BordetellaBordetella
A. L. Samer FaisalA. L. Samer Faisal

2. Haemophilus influenzaeHaemophilus influenzae
 Gram negative Rods.Gram negative Rods.
 Range from coccobacillary to long filamentousRange from coccobacillary to long filamentous
forms.forms.
 Non – motileNon – motile
 AerobicAerobic
 Fastidious organismsFastidious organisms

3. Haemophilus influenzaeHaemophilus influenzae
 Humans are the only natural hostsHumans are the only natural hosts
 Transmission:Transmission: respiratory droplet spreadrespiratory droplet spread
 Peak Prevalence of Meningitis:Peak Prevalence of Meningitis: 6 – 126 – 12
monthsmonths
 The incidence of Hib fell by 95% in populationsThe incidence of Hib fell by 95% in populations
with high rates of vaccinationwith high rates of vaccination

4. Haemophilus influenzaeHaemophilus influenzae
Two main typesTwo main types::
 II The uncapsulated (untypable) strainsThe uncapsulated (untypable) strains
 IIII The encapsulated strainsThe encapsulated strains

5. CapsuleCapsule
 Polysaccharide in naturePolysaccharide in nature
 Six types : a, b, c, d, e and fSix types : a, b, c, d, e and f
 Type b is associated with most severe form ofType b is associated with most severe form of
diseasedisease
 Hib capsule is Polyribitol Phosphate (PRP)Hib capsule is Polyribitol Phosphate (PRP)

6. Haemophilus influenzaeHaemophilus influenzae
UnencapsulatedUnencapsulated
Responsible for localizedResponsible for localized
infections i.e.infections i.e.
 Otitis mediaOtitis media
 ConjuctivitisConjuctivitis
 BronchitisBronchitis
 SinusitisSinusitis
CapsulatedCapsulated
Responsible for InvasiveResponsible for Invasive
disease i.e.disease i.e.
 MeningitisMeningitis
 SepticaemiaSepticaemia
 EpiglottitisEpiglottitis
 PneumoniaPneumonia
 Septic arthritisSeptic arthritis
 CellulitisCellulitis

7. LABORATORY DIAGNOSISLABORATORY DIAGNOSIS
 Clinical SpecimensClinical Specimens
 Blood, sputum, CSF, Joint fluidBlood, sputum, CSF, Joint fluid
 MicroscopyMicroscopy
 Gram StainGram Stain
 Flourescent antibody stainFlourescent antibody stain
 CultureCulture
 Chocolate Agar (Factor V & X)Chocolate Agar (Factor V & X)
 SerologySerology
 Latex agglutination, Counter immunoelectrophoresisLatex agglutination, Counter immunoelectrophoresis
 PCRPCR

9. Growth requirements in VitroGrowth requirements in Vitro
 FactorFactor VV HeminHemin
 FactorFactor XX NADNAD
 Chocolate agar provide both these factorsChocolate agar provide both these factors
 Growth is enhanced in 5% CoGrowth is enhanced in 5% Co22

11. TREATMENTTREATMENT
 Meningitis – CeftriaxoneMeningitis – Ceftriaxone
 Otitis media & Sinusistis – Amoxycillin-Otitis media & Sinusistis – Amoxycillin-
clavulanate & Co-trimoxazoleclavulanate & Co-trimoxazole
PREVENTIONPREVENTION
 Vaccine against hemophilus type-b (Hib)Vaccine against hemophilus type-b (Hib)
 Age 2-15 monthsAge 2-15 months
 Conjugate vaccineConjugate vaccine
 RifampicinRifampicin

12. Haemophilus ducreyiHaemophilus ducreyi
 Causes a sexually transmitted infection calledCauses a sexually transmitted infection called
ChancroidChancroid
 Requires only Factor X for growthRequires only Factor X for growth

13. Bordetella pertussisBordetella pertussis
 Small CoccobacillarySmall Coccobacillary
 Gram negative rodGram negative rod
 CapsulatedCapsulated
 Causes Pertussis (Whooping Cough) – a highlyCauses Pertussis (Whooping Cough) – a highly
infectious disease in its early phaseinfectious disease in its early phase

14. Bordetella pertussisBordetella pertussis
 Pathogen only for humansPathogen only for humans
 Transmitted by airborne dropletsTransmitted by airborne droplets
 Highly contagiousHighly contagious
 Worldwide distributionWorldwide distribution
 Primarily infants & young childrenPrimarily infants & young children

15. • Typical Organisms
The organisms are minute, gram-negative coccobacilli
resembling H influenzae. A capsule is present.
• Culture
 Primary isolation of B pertussis requires enriched media.
 Bordet-Gengou medium (potato-blood-glycerol agar) that
contains penicillin G, 0.5 μg/mL, can be used.
 A charcoal-containing medium supplemented with horse
blood, cephalexin, and amphotericin B (Regan-Lowe) is
preferable because of the longer shelf life.
 The plates are incubated at 35–37°C for 3–7 days aerobically
in a moist environment.
 The small, faintly staining gram negative rods are identified
by immunofluorescence staining.
 B pertussis is non-motile.

16. • Growth Characteristics
 The organism is a strict aerobe.
 it is oxidase and catalase positive.
 but nitrate, citrate, and urea negative, the results
of which are useful for differentiating among
the other species of bordetellae.
 It does not require X and V factors on
subculture.

17. CLINICAL FEATURESCLINICAL FEATURES
 Acute tracheobronchitis in childrenAcute tracheobronchitis in children
 Mild upper respiratory tract symptomsMild upper respiratory tract symptoms
 Severe paroxysmal cough (1 to 4 weeks)Severe paroxysmal cough (1 to 4 weeks)
 Death due to pneumoniaDeath due to pneumonia
 In AdultsIn Adults
 Paroxysmal cough lasting weeks (100 day cough)Paroxysmal cough lasting weeks (100 day cough)
 Whoop is absentWhoop is absent

18. Laboratory DiagnosisLaboratory Diagnosis
 Clinical SpecimensClinical Specimens
 Nasopharyngeal swabNasopharyngeal swab
 MicroscopyMicroscopy
 Gram negative rodsGram negative rods
 Flourescent antibody stainingFlourescent antibody staining
 CultureCulture
 Bordet gengou medium (20-30% blood)Bordet gengou medium (20-30% blood)
 SerologySerology
 Agglutination with specific antiseraAgglutination with specific antisera
 PCRPCR

19. TREATMENTTREATMENT
 AntibioticAntibiotic
 ErythromycinErythromycin
 Supportive CareSupportive Care
 Oxygen TherapyOxygen Therapy
 Suction of mucusSuction of mucus

20. PREVENTIONPREVENTION
 VaccinesVaccines
 Acellular pertussis vaccineAcellular pertussis vaccine
 BoostrixBoostrix
 AdacelAdacel
 Killed VaccineKilled Vaccine
 Higher side effects (encephalopathy)Higher side effects (encephalopathy)
 AntibioticsAntibiotics
 ErythromycinErythromycin
 Un-immunized & exposedUn-immunized & exposed
 Immunized & < 4 yrs.Immunized & < 4 yrs.

21. QUESTIONS...???QUESTIONS...???