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Respiratory Tract Infections Bacterial. Dr. Ross Davidson Rm 309, MacKenzie Building QE II HSC ph: 473-5520 [email protected] Respiratory Tract Infections. Pneumonia - community-acquired - hospital AECB (AE-COPD) Sinusitis Otitis media. RTIs.

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respiratory tract infections bacterial

Respiratory Tract InfectionsBacterial

Dr. Ross Davidson

Rm 309, MacKenzie Building

QE II HSC

ph: 473-5520

[email protected]

respiratory tract infections
Respiratory Tract Infections
  • Pneumonia - community-acquired - hospital
  • AECB (AE-COPD)
  • Sinusitis
  • Otitis media
slide3
RTIs
  • 1st lecture – Common bacterial causes
  • 2nd lecture – Mycobacteria & atypical pathogens
rti specimens
RTI - specimens
  • Sputum
  • BAL / bronch washing
  • Naso-pharyngeal aspirates
  • Endotracheal aspirates
  • Sinus aspirates
  • Tympanocentesis
respiratory tract infections common pathogens
Respiratory Tract InfectionsCommon Pathogens
  • Streptococcus pneumoniae
  • Haemophilus influenzae
  • Moraxella catarrhalis
  • Mycoplasma pneumoniae
  • Chlamydophyla pneumoniae
  • Legionella pneumophila
  • S.aureus
  • B.pertussis
  • Gram-negatives / anaerobes

Atypical Pathogens

community acquired pneumonia etiology
Community Acquired Pneumoniaetiology

S.pneumoniae

H.influenzae

Other

Anaerobes

L.pneumophilia

M.pneumoniae

C.pneumoniae

respiratory tract infections7
Respiratory Tract Infections
  • S.pneumoniae
  • Most common bacterial cause of RTIssmall gram positive diplococcialpha haemolytic, bile soluble, optochin Sgrowth often enhanced in CO2 atmospheremost are encapsulated (> 80 distinct types)
  • Colonizes the nasopharynx in 5-10% of adults and 20-40% of children
  • Incidence increases in winter months
respiratory tract infections8
Respiratory Tract Infections
  • Pathogenicity-adherence essential for colonization-capsule is important virulence factor - aids in escape from phagocytic cells
  • Predisposition to pneumococcal infection-defective Ab formation-insufficient numbers of PMNs-day-cares, military, prisons, shelters-chronic respiratory disease-infancy and aging-diabetes, alcoholism, liver disease
respiratory tract infections10
Respiratory Tract Infections
  • Pneumococcal vaccine23 different serotypesaccount for 90% of invasive strainsprotection wanes with time and age
  • Indications for vaccineadvanced age myelomasplenectomy alcoholismHIV / AIDs diabeteslymphoma
  • PREVNAR- conjugate vaccine - indicated for use in infants < 2 years of age
s pneumoniae
S.pneumoniae
  • Treatment- penicillins, cephalosporins, macrolides, fluoroquinolones
  • Choice of antibiotic - site of infection - co-morbidities - degree of illness - ambulatory / inpatient
respiratory tract infections12
Respiratory Tract Infections
  • Antibiotic resistance in S.pneumoniae- penicillin resistance is major concern - due to remodeling of the PBP- multi-drug resistance
penicillin resistance in s pneumoniae

oral / viridans

Streptococci

0.03 g/ml

S.pneumoniae

0.06 g/ml

0.12 g/ml

0.5 g/ml

Penicillin Resistance inS.pneumoniae

Minimum

Inhibitory Concentration

percentage of penicillin non susceptible s pneumoniae in canada 1988 2005
Percentage of Penicillin Non-Susceptible S. pneumoniae in Canada: 1988-2005

16

% Intermediate Resistance

14

% High-level Resistance

12

10

8

6

4

2

0

1988

1993

1995

1997

1999

2001

2003

2005

Low, D: Canadian Bacterial Surveillance Network, Nov , 2005

resistance in s pneumoniae

% Resistance

25

High Res

Intermediate Res

20

15

10

5

0

Pen-I

Cefprozil

TMP/SMX

Amoxicillin

Ceftriaxone

Cefuroxime

Gatifloxacin

Tetracycline

Moxifloxacin

Levofloxacin

Gemifloxacin

Erythromycin

Telithromycin

Resistance in S.pneumoniae
relationship between patient types pulmonary function and likely pathogens
Relationship Between Patient Types, Pulmonary Function, and Likely Pathogens

Viral, allergens, pollutants, cigarette smoke

M.pneumoniae, C.pneumoniae

H.influenzae, S.pneumoniae

FEV1 % Predicted

Enterobacteriaceae Pseudomonas spp Gram-negatives

Resistant organisms

Acute Bronchitis

Chronic Bronchitis

Simple

Complicated

Complicated

PLUS Risks

respiratory tract infections17
Respiratory Tract Infections
  • H.influenzae
  • Most common cause of AE-COPD-small gram negative bacilli-requires X and V factors for growth-will grow on “chocolate” agar (5% CO2)-may be encapsulated
  • Historically, type b (Hib) responsible for majority of invasive disease
  • Introduction of Hib vaccine >> very little Hib seen today
  • majority of mucosal disease due to non-encapsulated strains
respiratory tract infections18
Respiratory Tract Infections
  • Approx 20% produce -lactamase
  • < 2% have altered PBP
  • 2nd / 3rd generation cephalosporins effective
  • newer macrolides have some activity
  • fluoroquinolones very active, but contraindicated in children
respiratory tract infections19
Respiratory Tract Infections
  • Moraxella catarrhalissmall gram negative cocco-bacilliassociated with otitis media, sinusitis, AECBcarriage rate probably approaches 50%
  • 90% strains resistant to ampicillinwith exception of trimethoprim, predictably susceptible to most oral antibiotics
respiratory tract infections20
Respiratory Tract Infections
  • Bordetella pertussis
  • Causitive agent of pertussis
  • Small gram negative cocci-bacilli
  • Strictly aerobic, fastidious
  • Requires growth on media containing charcoal, blood, or starch
  • Bordet-Gengou(BG) or RL medium
respiratory tract infections21
Respiratory Tract Infections
  • Incubation period generally 7-10 days (range 4-21)
  • Classical course of disease:1. Catarrhal stage 1-2 weeks - symptoms non specific - low grade fever, mild cough, etc 2. Paroxysmal stage 1-6 weeks - paroxysmal cough, whoop, posttussive vomiting 3. convalescent stage 2-4 weeks - symptoms gradually decrease
respiratory tract infections22
Respiratory Tract Infections
  • Laboratory diagnosis
  • Naso-pharyngeal specimens best yield
  • - culture - PCR - DFA
  • Treatment - macrolides 1st choice
slide23
RTIs
  • Nosocomial pneumonia - ventilated patients at increased risk - gram negative bacteria / S.aureus
  • Nursing home pneumonia - similar etiology to CAP - greater incidence of anaerobes
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