1. Chronic Bronchitis Symptoms: @ Breathlessness, and wheezing @ Productive purulent cough, and Fever Diagnosis: @ Chest X-ray for to exclude lung neoplasm, pneumothorax, tuberculosis, and emphysema. @ Microscopy & culture of sputum to reveal pus cells, epithelial cells, and bacteria.

2. Chest X-ray: Chronic Bronchitis

3. Pathogens Causing Chronic Bronchitis: @ Streptococcus pneumoniae @ Haemophilus influenzae @ Moraxella catarrhalis @ Staphylococcus aureus @ Escherichia coli, Klebsiella @ Mycoplasma pneumoniae @ Influenza & Parainfluenza viruses, Rhinovirus, Coronavirus, Respiratory syncytial virus

4. EM: Haemophilus influenzae

5. Legionella pneumophila @ Gram negative rods poorly seen by microscopy @ Natural habitat: hot water systems, showers and air conditioning systems @ Has 36 species, commonest is L. pneumophila Symptoms: @ Fever, Dry cough, Pneumonia, Diarrhoea @ Transmitted by air conditioning & water. @ Legionella lives inside protozoa (amoebae) found in domestic water supplies.

6. EM: Legionella pneumophila

7. Lab. Diagnosis: @ Bronchoscopy samples are superior to sputum @ Immunofluorescence is less sensitive than culture to diagnose Legionella. @ Legionella antigens are detected in urine early in the infection. @ PCR to detect specific ribosomal RNA. @ Paired sera for antibody serology

8. Bronchoscopy

9. WHOOPING COUGH Presentation: @ Nasal discharge, pyrexia, Paroxysmal cough. @ Respiratory distress, apnea, Pneumonia Causes of whooping cough: @ Bordetella species: infects Man only @ Viruses: Respiratory syncytial virus, parainfluenza virus, adenovirus @ Mycoplasma pneumoniae.

10. WHOOPING COUGH

11. BORDETELLA @ Gram negative rods, non-motile, aerobic, catalase positive, oxidase positive, capsulated Bordetella Species: @ B. pertussis: Severe whooping cough. @ B. parapertussis: Mild whooping cough. @ B. bronchiseptica: Wound infections. Pathogensis: @ B. pertussis toxin damages the cilia of URT leading to whooping cough.

12. EM: B. pertussis

13. Laboratory Diagnosis of Bordetella: Specimens: @ Nasopharyngeal secretions collected by: # Pernasal swabs # Aspiration # Cough plates. Microscopy: @ Small, cocco-bacilli, Gram negative, capsulated, non-motile.

14. Pernasal swabs

15. Culture: @ Inoculate Bordet-Gengou medium, containing 20-30% blood. @ Inoculate the selective medium charcoal cephalexin blood agar (CCBA). @ Incubate up to 6 days at 37°C in moist aerobic atmosphere. @ Charcoal medium: Colonies small, shiny @ Bordet-Gengou : Colonies haemolytic and mucoid

16. * Charcoal cephalexin medium: Colonies small and shiny * Bordet-Gengou : Colonies haemolytic and mucoid

17. Identification: @ Slide agglutination tests using specific antisera. @ Fluorescent antibody staining. Transmission and Control: @ Transmitted by air-borne droplets. affecting infants and young children. @ Vaccination by an acellular, purified protein vaccine of the organism. Given as part the triple vaccine (DTP)

18. Triple DTP Vaccination

19. PNEUMONIA Symptoms of Typical pneumonia: @ Fever, rigors, productive cough @ Purulent sputum, chest pain Classification of pneumonia: @ Typical pneumonia: divided into * Community-acquired pneumonia * Hospital-acquired pneumonia @ Atypical pneumonia

20. Typical pneumonia

21. @ Causes of typical pneumonia: @ Community-acquired pneumonia, due to: # Strep. pneumoniae, Mycoplasma pneumoniae # H. influenzae, Moraxella catarrhalis, # Legionella phneumophila @ Hospital-acquired pneumonia, due to: # E. coli, Klebsiella, Ps. Aeruginosa, S.aureus # Bacteroides fragilis, Candida, Aspergillus, # Pneumocystis cranii

22. Staphylococcus aureus

23. Atypical Pneumonia @ Gives flu-like illness, dyspnoea, confusion. @ No productive cough, No high fever. Caused by: # Legionella pneumophila, Chlamydia pneumoniae #Coxiella burnetii, Mycoplasma pneumoniae, # Influenza A, B, C and Adenovirus Prevention of pneumonia: @ Capsular polysaccharide, polyvalent vaccine @ Given to immunosuppressed patients.

24. Coxiella burnetii

25. Laboratory Diagnosis of Strep. pneumoniae: @ Collect sputum, blood, CSF samples @ Gram-stained smear and culture. @ Alpha-hemolytic colonies on blood agar. @ Growth inhibited by bile and optochin. @ Quellung reaction (swelling of capsule with specific antiserum). @ Latex agglutination test for capsular antigen in CSF. @ Bile solubility @ Antigen detection in sputum specimens

26. Strep. pneumoniae: Optochin Sensitivity