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Microbiology of Respiratory Infection II

Microbiology of Respiratory Infection II. Dr Michael Lockhart. Respiratory Infections. Infections of throat and pharynx Infections of middle ear and sinuses Infections of trachea and bronchi Infections of the lungs. Infections of throat and pharynx. Sore throat Diphtheria Candida/thrush

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Microbiology of Respiratory Infection II

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  1. Microbiology of Respiratory Infection II Dr Michael Lockhart

  2. Respiratory Infections • Infections of throat and pharynx • Infections of middle ear and sinuses • Infections of trachea and bronchi • Infections of the lungs

  3. Infections of throat and pharynx • Sore throat • Diphtheria • Candida/thrush • Vincent’s angina

  4. Infections of throat and pharynx • Diagnosis: • Well taken throat swab

  5. SORE THROAT

  6. Sore throat • VAST MAJORITY (OVER TWO THIRDS) - VIRAL • DO NOT NEED ANTIBIOTICS

  7. Bacterial sore throat • The most common BACTERIAL cause is Streptococcus pyogenes (also known as Group A streptococci) • Clinical: Acute follicular tonsillitis • Treatment:Penicillin

  8. Streptococcus pyogenes

  9. Streptococcal sore throat • Acute complications: • Peritonsillar abscess (quinsy) • Sinusitis/ otitis media • Scarlet fever

  10. QUINSY (PERITONSILLAR ABSCESS)

  11. Streptococcal sore throat • Late complications • Rheumatic fever • 3 weeks post sore throat • fever, arthritis and pancarditis • Glomerulonephritis • 1-3 weeks post sore throat • haematuria, albuminuria and oedema

  12. Diphtheria • Corynebacterium diphtheriae • Clinical: Severe sore throat with a grey white membrane across the pharynx. The organism produces a potent exotoxin which is cardiotoxic and neurotoxic.

  13. DIPHTHERIA

  14. DIPHTHERIA

  15. Diphtheria • Epidemiology : Rare, but increased in certain parts of the world eg Russia • Treatment: Antitoxin and Supportive and Penicillin/erythromycin

  16. Candida/Thrush • Candida albicans • Clinical: White patches on red, raw mucous membranes in throat/ mouth • Cause: endogenous • Treatment: Nystatin

  17. ORAL THRUSH

  18. Vincent’s angina • Mixture of organisms (Borrelia vincenti and Fusobacterium sp.) • Clinical:Foul smelling mouth and throat ulcers • Treatment: penicillin

  19. VINCENT’S ANGINA

  20. Respiratory Infections • Infections of throat and pharynx • Infections of middle ear and sinuses • Infections of trachea and bronchi • Infections of the lungs

  21. EAR

  22. OTITIS MEDIA

  23. Infections of middle ear and sinuses • Often viral with bacterial secondary infection • Most common bacteria: Haemophilus influenzae, Streptococcus pneumoniae and Streptococcus pyogenes. • Treat: Amoxycillin

  24. Respiratory Infections • Infections of throat and pharynx • Infections of middle ear and sinuses • Infections of trachea and bronchi • Infections of the lungs

  25. Infections of trachea and bronchi • Acute epiglottitis • Acute exacerbations of COPD • Cystic fibrosis • Pertussis (whooping cough)

  26. Acute epiglottitis • Haemophilus influenzae • Clinical: severe croup in children aged 2-7 years, may progress to respiratory obstruction and death.

  27. EPIGLOTTITIS

  28. EPIGLOTTITIS

  29. Acute epiglottitis • Microbiology of Haemophilus influenzae • Habitat - upper respiratory tract • Microscopy- small gram negative bacillus • Culture - Chocolate agar -small translucent colonies • Identify - “X and V test”; H influenzae requires both factors X and V to grow.

  30. Haemophilus influenzae

  31. Acute epiglottitis • Diagnosis: blood culture (?throat swab) • Treatment: ITU and ceftriaxone

  32. COPD • Acute exacerbations of COPD. • Exacerbations of this chronic condition are often associated with bacterial infection.

  33. Acute exacerbations of COPD • Often follow viral infection, or fall in atmospheric temperature with increase in humidity (often in winter) • Clinical: Patients present with increased breathlessness. The volume and purulence of sputum is increased.

  34. Acute exacerbations of COPD • The most common organisms associated are: • Haemophilus influenzae • Streptococcus pneumoniae • Moraxella catarrhalis • NB All three organisms are present in normal upper respiratory tract flora.

  35. Acute exacerbations of COPD • Treatment: • Give antibiotics if ↑sputum purulence. If no ↑sputum purulence then antibiotics not needed unless consolidation on CXR or signs of pneumonia. • 1ST LINE Amoxicillin 500mg tds 2ND LINE Doxycycline 200mg on day 1 then 100mg daily (5 days) • With time becomes increasingly difficult to treat, due to acquisition of more resistant organisms.

  36. Cystic fibrosis • Inherited defect • leads to abnormally viscid mucus which blocks tubular structures in many different organs including the lungs.

  37. Cystic fibrosis • Chronic respiratory infection is a major problem. • Causal bacteria: • Staphylococcus aureus and Haemophilus influenzae • Pseudomonas aeruginosa • Burkholderia cepacia

  38. Pertussis (whooping cough) • Bordetella pertussis • Clinical: Acute tracheobronchitis • cold like symptoms for two weeks • paroxysmal coughing (2 weeks) • repeated violent exhalations with severe inspiratory whoop, vomiting common • residual cough for month or more

  39. Pertussis (whooping cough) • Diagnosis: • pernasal swab (charcoal blood agar/ Bordet-Gengou medium) • serology • clinical ( by the stage of paroxysmal coughing organism numbers much reduced) • Treatment: most effective in the first 10 days of illness, also reduces spread to susceptible contacts • Vaccination

  40. Pernasal swab

  41. Respiratory Infections • Infections of throat and pharynx • Infections of middle ear and sinuses • Infections of trachea and bronchi • Infections of the lungs

  42. Infections of the lungs • Community acquired pneumonia • Nosocomial pneumonia • Legionnaires disease • Pneumocysitis carinii pneumonia (PCP) • Fungal chest infection • Tuberculosis

  43. Community acquired pneumonia • Clinical: cough, sputum production, dyspnoea, fever. • Chest x-ray with infiltrates. • Acquired in the community

  44. Community acquired pneumonia • Causative organisms: • Streptococcus pneumoniae 70% • Atypicals/viruses 20% • Staphylococcus aureus 4% • Other bacteria 1% • Haemophilus influenzae 5%

  45. Community acquired pneumonia • Streptococcus pneumoniae • Microbiology: • Microscopy - gram positive cocci • Culture - Alpha haemolytic colonies, typically “draughtsmen” ie with sunken centre. • Identify - “Optochin” sensitive • Treatment - generally penicillin sensitive

  46. Streptococcus pneumoniae

  47. Lobar pneumonia

  48. Community acquired pneumonia • “Atypicals” - old term for pneumonias not attributable to any of the common bacterial causes of pneumonia. • Refer to Dr McIntyre’s talk

  49. Community acquired pneumonia • Treatment , follow the Tayside Critical Care Pathway for the Management of Community-Acquired Pneumonia

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