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Atypical Agents of Respiratory Infections
ERI DIAN MAHARSIBAG.MIKROBIOLOGI
FKUY
Teaching Objectives:
• Know the general morphology & physiology of the organism
• Know clinical symptoms• Know the mechanism
pathogenesis• Know the diagnostic• Know preventive procedures
Legionellae•Family : Legionellacae•>> species & >> serogroup•Patogen >>: L.pneumophyla•Gram (-),pleiomorphic rods•Obligate aerob•Capable of replication in alveolar macrophages
Legionella pneumophila• Naturally found in water,cooling towers,water
systems• Patient with chronic pulmonary disease are
@highest risk• L.pneumophila nosocomial infection• Disease: Legionnaires disease (severe pneumonia);
Pontiac fever (influenza- like illness)• Transmission: enviromental to man• not man to man• Diagnosis: • Gram staining:difficult• direct & indirect fluorescent antibody (IFA)• Culture: buffered charcoal yeast extract agar
(BCYE),grows after 3 days incubation.
Mycoplasma• Family : Mycoplasmataceae• Mycoplasma pneumoniae is the
most common type of atypical pneumoniae
• >> species of mycoplasmas but !! Human pathogens: M.pneumoniae
M.hominis M. genitalium Ureaplasma urealyticum
Organism Disease
M. pneumoniae Upper respiratory tract disease,tracheobronchitis, atypicalpneumonia, (chronic asthma??)
M. hominis Pyleonephritis, pelvicinflammatory disease,postpartum fever
M. genitalium Nongonococcal urethritis
U. urealyticum Nongonococcal urethritis,(pneumonia and chronic lungdisease in premature infants??)
Diseases Caused by Mycoplasma
BASIC• The smallest free-living bacteria but the
extremely smallest is Ureaplasma → T-strains (tiny strains)
• The smallest genome size→lack many metabolic pathways → require complex media for the isolation
• Mycoplasmas are facultative anaerobes ,except for M.pneumoniae obligate aerobe
• No cell wall → that distinguishes it from other bacteria → can assume multiple shapes
Pathogenesis
• Major virulence factors 1.M.pneumoniae : Adherence protein called P1
• 2.Toxic metabolic product: H202 dan superoxide
Diagnosis
• Early: clinical grounds• Laboratory diagnosis:• Microscopy Absence of a cell
wall→ not usefull• Culture (+) in 2-3 weeks
difficult → not usefull• Serology: CFT ELISA
Prevention
• NO VACCINE• Prevention: avoid close
contact
M. HOMINIS & U.UREALYTICUM
• M.hominis → pyelonefritis• U.urealyticum → NGU• Diagnosis: culture• Prevention : proper barrier
protection or abstinensia
Klebsiella pneumoniae
• Can cause pneumonia• >> but more commonly implicated in hospital-
acquired urinary tract and wound infections, particularly in people with weakened immune systems.
• Lobar pneumoniae often occur in the elderly,diabetics,&alcoholism
• Problem in hospitals because, because it can cause outbreaks
Klebsiella pneumoniae
• Gram (-),rods, capable aerobic/anaerobic,capsulated
• Capsule inhibit phagocytosis
Protocol Klebsiella pneumoniaeHow to distinguish enterobacteriae
Chlamydia pneumoniae /Chlamydophila pneumoniae
Property C.trachomatis C.psitacci C.pneumoniae
Host range >>>humans Birds, mamals,
human (rare)
Humans
Elementary body
morfology
Round Round Pearl-shaped
Inclusion morfology
Round,vacuoler Varible,dense Round,dense
Glycogen containing inclusions
yes no no
Plasmid DNA
yes yes no
Pathogenesis - C. pneumoniae
• Person to person spread via aerosolized droplet
• Pathogenesis:litlle known• Caused:
pneumonia,bronchitis,pharyngitis,&flu like syndrome
Diagnosis - C. pneumoniae
• Difficult• Often asymtomatic or unrecognized• Diagnosis: • Specimen:throat swab,nasopharyngeal
swab,bronchoalveolar lavage fluids,sputum→culture→PCR
• Serology: CFT (complement Fix test) → not specific• IFA using EB as Ag → more reliable
Coxiella burnetii • Query fever / Q fever
• Zoonosis
• Potensial bioterorism
• Basic: Obligate intracellular, gram negative,cocobacillus
• Transmiison: inhalation,unpasteurized milk,tissue fluids
• Risk individu: man who come into contact with infected
animals, esp placenta (veterinarians,farmers)
Coxiella burnetii• Smaller than ricketsiaa• In contrast to ricketsia: C.burnetii
can survive extracellular, however it can be grown only in lung cells
• The organism can exist in 2 antigenic states
• When isolated from animals, C.burnetii in a phase I form → highly infection
• When grown in cultured cells lines → a phase II form→ not infectious
Clinical symtoms• Acute Q fever• Flu like syndrome • Pneumonia & granulomatous hepatitis• Diagnosis: serologic: ↑ titer 4x of antibody to phase 2
(Ig M & Ig G)
• Chronic Q fever (> 6 bulan)• Endocarditis & meningoencephalitis• Diagnosis: ↑ titer 4x antibody to phase 1&2 (IgG &
IgM)
Borellia vincentii• Spirochetes,anaerobic,Gram (-)• Cause: Vincent’s disease/Vincent’s
angina• Risk factors such as stress, poor
diet and nutrition, tobacco usage, and already having a systematic disease
• Symptoms include foul breath, ulcers in the inter-dental papillae, ulcers on the gums that easily bleed,pharyngitis
Referensi
• DIAGNOSTIC MICROBIOLGY : BAILEY & SCOTT”S
• MIKROBIOLOGY KEDOKTERAN:JAWETZS,MELNIC,ADELBERG