1. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings PowerPoint ® Lecture Slide Presentation prepared by Christine L. Case M I C R O B I O L O G Y a n i n t r o d u c t i o n ninth edition TORTORA  FUNKE  CASE Part A 24 Microbial Diseases of the Respiratory System

2. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Microbial Diseases of the Upper Respiratory System  Laryngitis: S. pneumoniae, S. pyogenes, viruses  Sore throat  Tonsillitis: S. pneumoniae, S. pyogenes, viruses  Affects speaking ability  Sinusitis: Bacteria  nasal discharge, blocked passage causes headache  Epiglottitis: H. influenzae  Swelling dangerous

3. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Upper Respiratory System  Upper respiratory normal microbiota may include pathogens. Inhale several microbes Figure 24.1

4. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Bacterial diseases of upper respiratory  Airborne pathogens make their first contact with mucous membranes and many respiratory or systemic diseases initiate infections here.

5. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Streptococcal Pharyngitis (Strep Throat)  Streptococcus pyogenes  No longer culture throat  swabs, now use enzyme immunoassay (faster)  Sym: Local inflam & fever, tonsillitis & ear infections  could also occur  Trans: respiratory secretions Figure 24.3

6. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Scarlet Fever  Streptococcus pyogenes  When strep throat produces erythrogenic (redding) toxins  Sym: Strawberry tongue, fever, peeled sunburn skin, enlarged red tongue Pandemic 1830-1880, more virulent strain Figure 24.4

7. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Diphtheria (Greek word leather)  Corynebacterium diphtheriae  Leading infections killer of children until 1935  Sym: Sore throat, fever, malaise, neck swelling, tough pseudomembrane in back of throat  Prevented by DTaP and Td vaccine (Diphtheria toxoid which cause the body to make antibodies)  Trans: Airborn droplets  Cutaneous diphtheria: Infected skin wound leads to slow healing ulcer

8. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Diphtheria Figure 24.6

9. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Otitis Media (earache)  S. pneumoniae (35%)  H. influenzae (20-30%)  M. catarrhalis (10-15%)  S. pyogenes (8-10%)  S. aureus (1-2%)  Painful, pathogens form pus putting pressure on eardrum, common in children  Treated with broad-spectrum antibiotics  S. pneumoniae reduced by vaccine, routine Figure 24.7

10. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Viral diseases of respiratory system  Most prevalent disease of humans is the viral disease affecting the upper respiratory system.

11. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Common cold  200 different viruses can cause the common cold  Rhinoviruses (50%)  Coronaviruses (15-20%)  Accumulate immunity with age  Sym: sneezing, nasal secretions, congestion, infection can spread to throat, respiratory, ear  Trans: possible airborn or topical  Antibodies are produced against specific viruses

12. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Diseases of the Lower Respiratory System  Bacteria, viruses, and fungi cause  Bronchitis/Bronchiolitis- H influenzae  Pneumonia= severe complications of bronchitis where the alveoli become involved

13. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Lower Respiratory System  The ciliary escalator keeps the lower respiratory system sterile. Figure 24.2

14. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Bacterial Diseases of lower respiratory system  Pertussis (whooping cough)  TB  Melioidosis  Bacterial Pneumonias  Pneumococcal  Haemophilus influenzae  Mycoplasmal  Legionellosis  Psittacosis  Chlamydial  Q fever

15. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Pertussis (Whooping Cough) (per=thoroughly, tusses=cough )  Bordetella pertussis:  Attaches to the cillia in the throat (red), preventing mucus movement & toxins enter the bloodstream  Sym: cold-like (nasal discharge & sneezing  Trans: airborne droplets  DTaP vaccine (acellular Pertussis cell) Figure 24.8

16. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Tuberculosis  Mycobacterium tuberculosis: trans: from human to human by inhalation  Filamentous, red-stained funguslike  growth= name  Sym: unaware until immune defenses fail, weight loss, coughing (up blood)  Lesions are called tubercles can show on Xray Figure 24.9

17. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Tuberculosis  Factors affecting host resistances levels:  Other illness, malnutrition, overcrowding, stress  Treatment of tuberculosis: Prolonged treatment with multiple antibiotics.  Vaccines: BCG, live culture of avirulent M. bovis; not widely used in US only recommended for children at high risk who have negative skin tests.  M. bovis causes bovine TB and can be transmitted by drinking unpasteurized milk

18. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Tuberculosis  Diagnosis: Tuberculin skin test screening  Positive reaction means current, previous infection or vaccination  Followed by X ray or CT, acid-fast staining of sputum, culturing bacteria (could take 8 weeks) Figure 24.11

19. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Pneumonia  Term applied to many pulmonary infections, most are caused by bacteria  Also named for the portions of the lower respiratory tract they affect:  Lobar  Broncho  pleurisy

20. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Pneumomoccal Pneumonia  Streptococcus pneumoniae: forms in pairs, the genus formerly named diplococcus, gram pos  Infected alveoli, interferes  with oxygen uptake  Sym: high fever, breathing  problems, chest pain, rust  colored sputum  Trans: many carriers, virulence based on carriers’ resistance, which can be lowered by stress Figure 24.13

21. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Haemophilus Influenzae Pneumonia  Resembles pneumococcal pneumonia yet gram neg  More susceptible if presence of alcoholism, poor nutrition, cancer, or diabetes are predisposing factors.

22. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Mycoplasmal Pneumonia  Mycoplasma pneumoniae:  Also called primary atypical or walking pneumonia.  Sym: Low grade fever, cough, headache persist for 3 weeks or longer  Lack cell walls, do not grow under normal conditions therefore appears to be viral pneumonia  20% of pneumonia in young adults and children. Figure 24.14

23. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Mycoplasmal Pneumonia Figure 11.20a–b Colonies form a fried egg appearance, take 3 or more weeks to grow, and are microscopic

24. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Legionellosis  Legionella pneumophila  1976 deaths occurred among members of American Legion attending a meeting  Sym: High fever, cough  Transmitted by inhaling aerosolized water from whirlpool spas, air conditioners, cooling towers, and supermarket vegetable misters.

25. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Psittacosis (Ornithosis)  Chlamydophila psittaci: parakeets, parrots, other fowl  Transmitted to humans by elementary bodies (infectious stage) from bird droppings.  Sym: Fever, headache, chills

26. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Chlamydial Pneumonia  Chlamydophila pneumoniae  Transmitted: respiratory route  Outbreaks on college campuses  Mild respiratory

27. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Q Fever (query) or X Fever  Coxiella burnetti, parasitic, intracellular is the exception to surviving airborne transmission  Transmit: to cattle via tick bites then shed in milk, feces, and urine. To humans unpasteurized milk or inhalation of aerosols in dairy barns (during calving), or meat & hide processing plants  In the absence of obvious cause the affliction was labeled Q for query (?)

28. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Melioidosis  Burkholderia pseudomallei  Melis (distemper of asses) eidos (resemblance) resembled bacterium causing glanders in horses  Sym: Pneumonia, soft tissue abscesses that resemble necrotizing fascititis, sepsis, encephalitis  Transmission inhalation or puncture wound

29. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Bacterial Pneumonia DiseasePathogenReservoir Pneumococcal pneumona Streptococcus pneumoniae Humans Haemophilus influenzae Humans Mycoplasma pneumoniaMycoplasma pneumoniaeHumans LegionellosisLegionella pneumophilaWater Psittacosis (ornithosis)Chlamydophila psittaciBirds Chlamydial pneumoniaChlamydophila pneumoniae Humans

30. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Viral diseases of Lower Respiratory For a virus to reach the lower respiratory system it must pass defenses designed to trap and destroy.

31. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Severe Acute Respiratory syndrome (SARS) China 2002, spread worldwide 2003 New variety of coronavirus Symptoms: fever, malaise, muscle aches, dry cough, difficulty in breathing, chills, headache, diarrhea Transmit: person to person contact No treatment

32. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Viral Pneumonia  Viral pneumonia as a complication of influenza, measles, or chickenpox.

33. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Respiratory Syncytial Virus (RSV)  Common cause of pneumonia in infants; 2-6 months  4,500 deaths annually  Can be life-threatening pneumonia in elderly where easily misdiagnosed as influenza  Causes cell fusion (syncytium= giant cell) in culture.  Symptoms: Coughing, wheezing  Natural immunity is poor against RSV, a globulin product is on the market, vaccines are being clinically tested

34. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Influenza  Sym: Chills, fever, headache, and muscle aches (no intestinal symptoms) deaths are usually from secondary bacterial infections  Vaccine for high-risk individuals.  NOT caused by H. influenzae

35. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Influenza  Hemagglutinin (H) Neuraminidase (N) spikes u sed to ID the variation H1, H2,….H15, N1….N9 Figure 24.16

36. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Influenza  Antigenic shift  Changes in H and N spikes  Probably due to genetic recombination between different strains infecting the same cell  1918 (20 million world wide) Spanish Flu  Swine (can be infected by both human and bird viruses), ducks, chickens of Chinese farms under suspicion as “mixing vessel” animals while migratory birds spread the virus

37. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Influenza Vaccines  Not been possible to make a vaccine for influenza that gives long-term immunity.  Inactivated intramuscular vaccine  Attenuated, nasal drops vaccine  Guillain-Barre’, possible post vaccine complication  Directed at 3 most important strains that season  70-90% effective for duration of 3 years  Antiviral meds if taken within 30 hours of symptoms

38. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Fungal disease of Lower Respiratory  Spores disseminated through the air

39. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Histoplasmosis  Histoplasma capsulatum,  Resembles TB, may spread to blood and lymph causing lesions in any organ  Transmitted by airborne conidia from soil, grows in moist soil rich in nitrogen from bird or bat guano  Sym: poorly defined Figure 24.17

40. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Coccidioidomycosis  Transmitted by airborne arthrospores  Valley fever or San Joaquin fever  Sym: chest pain, coughing, fever, weight loss Figure 24.20

41. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Pneumocystis Pneumonia  Pneumocystis jiroveci is found in  healthy human lungs,  Undetermined if protist or fungi  occurs in newly infected infants and AIDS or cancer patients.  Was uncommon disease until 1993, it became the primary indicator of AIDS Figure 24.22a

42. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Blastomycosis  Blastomyces dermatitidis  Found in soil  Sym: Infection in lungs, can spread & cause extensive tissue destruction with abcesses

43. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Mucor indicus Opportunistic Fungi Involved in Respiratory Disease  Aspergillus, Rhizopus, Mucor  Compost piles, decay  Impaired immunity, cancer, diabetes Figures 12.2b, 12.4