bacterial lobar pneumoniae

1. Bacterial Lobar Pneumonia
BY,
DR.SANGEETA PANIGRAHY
ASSISTANT PROFESSOR
GEMS MEDICAL COLLEGE AND HOSPITAL

2. typical (lobar)
• infection of the lung parenchyma and its alveoli.

3. Gram -positive
Gram-negative
Streptococcus pneumoniae
Staphylococcus aureus
H.Infulenza
Klebsiellae pneumoniae
others

4. Pneumococcal pneumonia
• Streptococcus pneumoniae (commonly referred to as pneumococcus)
is the leading cause

5. Virulence Factors

6. Clinical Manifestations
• Lobar pneumonia.
• Empyema and parapneumonic effusion.
• Invasive pneumococcal disease (IPD):

7. Risk Factors
• Children (<2 years).
• Splenectomy, sickle cell disease and other hemoglobinopathies.
• Underlying comorbid diseases.
• Viral URTI.

9. Specimen
Collection
sputum, cerebrospinal fluid (CSF), pleural fluid
lanceolate or flame-shaped gram-positive cocci (1 µm)
in pairs, surrounded by a clear halo (due to capsule)
Direct Smear
Microscopy
Antigen Detection
Capsular antigens: Detection of capsular antigens in CSF is
more sensitive than microscopy
C-antigens: Detection of C-polysaccharide antigen in urine by
immunochromatographic test (ICT)

11. Culture
• green zone of α-hemolysis, draughtsman-shaped or carrom coin-
shaped appearance.
• Chocolate agar: It produces greenish discoloration.

12. E: Properties of pneumococci: A. α-hemolytic draughtsman-shaped colonies on blood agar; B. Sensitive
to optochin;

13. Identification
Bile solubility
Optochin sensitivity:
Inulin fermentation:
Automated methods Molecular methods

14. Sensitive to optochin;

15. Typing of S. pneumoniae -Quellung or Neufeld
reaction

16. Molecular Methods
• Common genes targeted include: lytA (autolysin gene), ply
(pneumolysin) and psaA (pneumococcus surface antigen A)

17. Over all – streptococcus pneumoniae

19. Prevention and Vaccination
two vaccines available for pneumococcus:
23-valent pneumococcal
polysaccharide vaccine (PPSV23)
Pneumovax 23
pneumococcal conjugate vaccine
(PCV13)., Prevnar13
Less
immunogenic:
short-term
immunity
herd immunity
Does not provide
mucosal immunity,
More
immunogenic:
longer
immunity
No herd
immunity
Provides
mucosal
immunity

20. Schedule
After birth
Age ≥65 years:
Age 19–64 years:
6th, 10th and 14th week of age and booster at 15
months
Either PPSV23 only can be given or PCV13 followed
by PPSV23 can be given ≥1 year gap
underlying risk factors(Immunocompetent persons:.
Splenic dysfunction:, Immunocompromised persons

21. Haemophilus influenzae pneumonia
• Pfeiffer’s bacillus - Pfeiffer (1892).
• (Haemo means blood, philus means loving).
• H. ducreyi: chancroid, genital ulcer.
• H. aegyptius: It causes conjunctivitis and rashes .
• H. haemolyticus and H. parahaemolyticus.
• H. parainfluenzae:

23. virulence factors of H. influenzae are:

26. Direct Detection
Gram stain – GRAM NEGATIVE
PLEOMORPHIC Antigen detection

27. culture

28. • Special media such as Fildes agar and Levinthal’s agar; containing
factor X and V
• Haemophilus selective medium containing bacitracin

31. TREATMENT
• For invasive infections (type b), cephalosporins such as ceftriaxone,
cefotaxime (for 1–2 weeks) are the drug of choice
• Nontypeable strains are usually susceptible to quinolones
(levofloxacin) and macrolides (azithromycin).

32. Prophylaxis
• Hib Conjugate Vaccine.
• polyribosyl ribitol phosphate (PRP)
• DOSE - combination with DPT, hepatitis B (pentavalent vaccine) at 6,
10 and 14 weeks of birth.
• It is administered in IM route.

33. Staphylococcal pneumonia
Infant pneumonia
VAP in adults
Post-viral CAP
CA-MRSA:

34. gram-negative bacilli pneumonia
Non-fermenters
 Pseudomonas
aeruginosa,
 Acinetobacter,
Burkholderia cepacia
VAP
Enterobacteriaceae:
 Escherichia coli,
 Klebsiella pneumoniae, Enterobacter
species and
 Serratia marcescens

35. Klebsiella pneumoniae
• K. pneumoniae subspecies pneumoniae is the most pathogenic.
severe lobar pneumonia,
 urinary tract infections,
meningitis (neonates),
septicemia
nosocomial infections.

36. Laboratory Diagnosis

37. • ICUT tests: Indole test (negative), citrate test (positive), urease test
(positive) and TSI (triple sugar iron agar) test shows acid/acid, gas
present, H2 S absent.

38. TREATMENT
• Carbapenems, amikacin or β-lactam/β-lactamase inhibitor
combinations (BL/BLIs) such as piperacillin-tazobactam or
cefoperazone-sulbactam are usually used.
• Polymyxins or tigecycline are the next line antimicrobials, used for
carbapenem resistant isolates