PATHOGENS THAT

INVOLVE THE
RESPIRATORY TRACT
 I. BACTERIA
A. STREPTOCOCCUS PYOGENES
Characteristics:
- Group A Beta hemolytic
- Gram (+) cocci in chains
-facultative anaerobes
- Toxins and Enzymes:
1. Streptokinase 3. Erythrogenic toxin
2. Hyaluronidase 4. Streptolysin O
Disease:
Streptococcal Pharyngitis (“Strep Throat”)
> Clinical manifestations:
- Acute bacterial infection
- Sore throat, chills, fever, headache
- beefy red throat
- white patches of pus on pharyngeal
epithelium
- enlarged tonsils
- enlarged and tender cervical lymph nodes
- other manifestations: impetigo, scarlet
fever
Complications:
1. Rheumatic fever
-- fever, migratory polyarthritis,
carditis
-- 1-4 weeks after infection (usually
after pharyngitis)
2. Glomerulonephritis – hypertension,
edema of face and ankles, hematuria
-- 2-3 weeks after infection (skin
infection)
Reservoir: Humans
Incubation Period: 1 to 3 days
- Period of Communicability: 10 to 21 days (if untreated)
- <24 hours (if with antibiotic)
Transmission: human to human by direct contact
- aerosol droplets and secretions
- fomites
Diagnosis: Clinical s/sx, throat culture (gold standard)
- ASO titer (antistreptolysin O)
Treatment: Penicillin G Amoxicillin
Clindamycin Erythromycin
Cephalosphorin
Prevention and Control: personal hygiene and cleanliness
- Standard precaution
- prompt treatment of streptococcal infections
 B. STREPTOCOCCUS PNEUMONIAE
CHARACTERISTICS:
- Gram (+) cocci in pairs or short chains
- alpha hemolytic streptococci
- virulence factors
RESERVOIR: Humans
TRANSMISSION: Colonization of nasopharynx
- extensive close contact
DISEASE: Pneumonia and meningitis - common cause
in >5 yrs old and adults.
- Bacteremia and URTI (otitis, sinusitis)
DIAGNOSIS: Gram stain and culture, serologic test-
antigen identification
TREATMENT: Penicillin, Erythromycin
PREVENTION AND CONTROL: Vaccine
 C. NEISSERIA MENINGITIDIS
Characteristics: Gram (-) diplococci, capnophilic,
facultative anaerobe
--Virulence Factors:
a. Capsule
b. Endotoxin: Lipopolysaccharide (LPS)
c. IgA1 Protease - cleaves IgA in half
d. Can extract iron from transferring via a non-energy
mechanism
e. Pili adherence
Reservoir: Humans
Transmission: Nasopharyngeal carriers (10%)
Droplet respiratory secretions
Diseases:
1. Meningitis -- 6 months to 2 yrs. old
-- fever, stiff neck (nuchal rigidity), vomiting,
lethargy, altered mental status
-- petecchial rash
2. Septicemia (Meningococcemia)
-- fever, petecchial rash, hypotension
-- fulminant meningococcemia
-- death occurs within 6-8 hrs.
Diagnosis: Gram stain of blood or CSF
-- Culture: Thayer-Martin media (TM)
-- Latex Agglutination Test (LAT)
Treatment: Cephalosporin, Pen G,
Chloramphenicol
Prevention and Control: Respiratory isolation
Chemoprophylaxis: Rifampicin and
Ciprofloxacin
Polysaccharide Vaccine
 D. HAEMOPHILUS INFLUENZA TYPE B
Characteristics: Gram (-) coccobacilli
- non-motile, non-spore forming
- facultative anaerobe
- “blood loving”
- Requires:
1. X factor (Hematin)—heat stable
2. V factor (NAD)– heat labile
--Nicotinamide adenine dinucleotide (NAD)
- Types: a, b, c, d, e, f (most invasive type: b)
Diseases:
1. Meningitis - main cause in 6 mos - 3 y/o
2. Pneumonia - 2nd most common cause of CAP
3. Epiglottis 5. Sepsis
4. Septic arthritis 6. Cellulitis
7. Otitis media
Reservoir: Humans
Transmission: airborne, droplets spread
- direct contact with secretions, fomites
Diagnosis: Culture
- Agglutination assays
- immunoelectrophoresis
- ELISA (Enzyme-Linked Immunosorbent Assay)
Treatment:
- Ampicillin
-Amoxicillin
- Cephalosphorin
Prevention and Control: Rifampicin - to decrease
respiratory carriage
- HiB vaccine - between 2-15 months old
- avoid crowding
- handwashing, standard precaution
 E. BORDETELLA PERTUSSIS
Characteristics:
--Gram (-) coccobacilli
--non motile, obligate aerobes
--Virulence factors:
1. Pertussis toxin
2. Extracytoplasmic adenylate cyclase
3. Filamentous hemagglutinin (FHA)
- facilitates adherence to cilia of
respiratory system
4. Tracheal cytotoxin
- destroys cilia  impaired
clearance of bacteria & mucus.
Reservoir: humans
Transmission: Airborne via droplets produced by coughing
Incubation Period: 6-20 days
Disease: Pertussis (Whooping Cough)
Stages: 1. Catarrhal stage
- 1-2 weeks duration
- similar to upper respiratory tract infection
- low grade fever, runny nose, mild cough
- Most contagious Stage
2. Paroxysmal stage
- 2-10 weeks  severe, uncontrollable coughing
- cough ends in a high-pitched indrawn breath
(whoop)
3. Recovery or Convalescent Stage
- within 4 weeks
- patient no longer contagious
Diagnosis: Nasopharyngeal swab
- culture: Bordet-Gengou agar or Regan-
Lowe agar
- Nucleic acid and immunodiagnostic
procedures
Treatment:
-Erythromycin
-Doxycycline
-Azithromycin
Prevention and Control:
-Inactivated (heat-killed) pertussis vaccine
- Droplet Precautions
 F. CORYNEBACTERIUM DIPHTHERIAE
Characteristics:
- Gram (+) bacilli, facultative anaerobe
- non-spore forming, non-motile
- produce exotoxin (by bacteriophage)
- A subunit - blocks protein synthesis by inactivating
elongation factor (EF2)
- B subunit – provides entry into cardiac and neural
tissue
Reservoir: Humans
Incubation Period: 1-4 days to one week
Disease: DIPHTHERIA
- mild sore throat with fever
- swollen cervical lymph nodes (“bull neck”)
- Pseudomembrane forms on pharynx
- Myocarditis (10%) , neural involvement
Diagnosis:
- Nasopharyngeal and throat swab for culture
- Loeffler’s medium
- Cystine-tellurite medium (Tinsdale
medium)
- Schick test
- test for susceptible individuals
Treatment:
- Antitoxin
- Penicillin or Erythromycin
Prevention and Control:
- Diphtheria toxoid
- Patient isolation and disinfection of fomites
- Contact and droplet precautions
 G. MYCOBACTERIUM TUBERCULOSIS
Characteristics:
- acid fast, weakly gram (+)
- non motile, obligate anaerobe
-virulence factors:
1. Cord factor
2. Complex lipids (e.g. mycolic acid, wax D,
phosphatides)
Diseases:
1. Pulmonary TB (Primary Complex)
- often seen in children
- localized to the middle and lower lung zones
- GHON lesion/complex  small calcified nodules
2. Post-primary disease
- adult type or reactivation or secondary tuberculosis
- endogenous reactivation of latent infection
 - localized to apical and posterior segment or upper lobes
and superior segment of lower lobes
- fever, night sweats, malaise, weight loss, cough,
hemoptysis
3. Extrapulmonary TB
a. TB lymphadenitis - >2.5 % of cases
b. Pleural involvement (pleural effusion)
c. Genitourinary TB – 15% of cases
d. Skeletal TB (Pott’s disease) – 10%
e. TB meningitis -- 5%
f. GI TB
g. Pericardial TB
h. Miliary TB (disseminated TB)
Reservoir: Humans
Transmission: airborne, droplets
- prolonged direct contact with infected persons
- Bovine TB: infected cattle or ingestion of
contaminated milk
Incubation Period: 4 to 12 weeks
Diagnosis: demonstration of AFB in sputum specimen
- culture: Lowenstein- Jensen Media - 3-6 weeks
- DNA PCR (Polymerase Chain Reaction)
- PPD (Purified Protein Derivative) or Mantoux test
Treatment: Isoniazid (INH)
Rifampicin (RIF)
Directly Observed Therapy (DOT)
Pyrazinamide (PZA)
Ethambutol (EMB)
Streptomycin (STREP)
Prevention and Control:
- Isolation and treatment of infected individuals
- airborne precautions
- BCG vaccine (70-80% effective)
 H. MYCOPLASMA PNEUMONIAE
Characteristics: Gram (-) motile, facultative anaerobe
- no cell wall
- pleiomorphic bacteria
Reservoir: Humans
Incubation Period: 6 to 32 days
Transmission: droplet inhalation
- direct contact with infected person
- fomites
Disease: primary atypical pneumonia
- Clinical manifestations: headache, sore throat
- cough ( dry  productive)
- paucity of findings on chest examination is in
marked contrast to prominence of CXR infiltrates
Diagnosis: test for antibodies
- cold agglutinin
- complement fixation test
- sputum culture ---- “fried egg” colonies
Treatment: most cases are mild (10-14 days)
- Erythromycin
- Clarithromycin
-Azithromycin
- Tetracycline
Prevention and Control:
- avoidance of crowded living and sleeping quarters
- proper disposal of tissues and soiled articles
- handwashing
- - - droplet precautions
 II. VIRUSES
A. COMMON COLD, ACUTE VIRAL RHINITIS,
ACUTE CORYZA
Pathogen:
- Rhinovirus
- Adenovirus
- Coronavirus (also cause SARS)
- Respiratory Syncytial Virus (RSV)
- Influenza and Parainfluenza virus
Reservoir: Humans
Transmission:
- Respiratory secretions by way of hands and
fomites
- Direct contact with or inhalation of airborne
Incubation Period:
- 12 hours to 5 days (usually 48 hours)
- communicable period: 24 hours before onset
up to 5 days after onset
Disease:
- produces coryza (profuse discharge from
nostrils)
- runny eyes, sore throat, chilliness, malaise
Treatment: Supportive
Prevention and Control:
- Handwashing
- Sanitary disposal of oral and nasal discharges
- Avoid crowding and contact with infected
individuals
- Disinfect eating and drinking utensils
 B. INFLUENZA VIRUS
Characteristics:
- Orthomyxovirus
- RNA virus
- Influenza virus type A, B and C
- Type A --- severe symptoms associated
with epidemics and pandemics
- Type B --- less severe, localized outbreak
- Type C --- does not cause significant
disease
- Envelope contains: hemagglutinin (H) and
neuraminidase (N)
Reservoir:
- Primary: Humans
- Others: Pigs, ducks (avian)
Transmission:
- airborne spread
- direct contact with secretions
Incubation Period: 1-3 days
Disease: fever, chills, headache, myalgia, sore throat,
cough, nasal discharge
Diagnosis: Isolation of virus from pharyngeal or nasal
secretions
- Immunodiagnostic procedures
Treatment:
- supportive
- Amantadine
Prevention and Control:
- Yearly vaccination
- Good personal hygiene
- Avoid crowded areas during epidemics
- - - droplet precautions
 C. MUMPS VIRUS
Characteristics:
- Paramyxovirus
- RNA virus
Reservoir: Humans
Transmission:
- droplet spread, saliva and fomites
- direct contact with saliva of infected person
Incubation Period: 14- 18 days
- Communicable: 1-2 days before onset of parotitis to
5 days
- no longer contagious after 9 days
Disease:
- Parotitis ( 30-40 %)
- Unilateral or bilateral (2/3 bilateral)
- can occur singly or with other salivary glands
affected
Complications:
- CNS involvement
- aseptic meningitis – 50-60% of patients
- encephalitis --- < 0.002%
- Orchitis (testicular inflammation)
- 50% of post pubertal males
- sterility is rare
- Oophoritis (ovarian inflammation)
- 5% of post pubertal females
- Deafness (1 per 20,000 cases)
Diagnosis: isolation of virus from saliva, throat
swab, CSF, urine
- ELISA
Treatment: Supportive
Prevention and Control: live, attenuated mumps
vaccine
 III. FUNGI
A. CRYPTOCOCCUS NEOFORMANS
Characteristics: not dimorphic ( yeast form only)
Disease: Cryptococcosis
- Meningitis
- Pneumonia
- Skin lesions
Reservoir: pigeon droppings
Transmission: inhalation
Diagnosis: Biopsy and culture
Serology, skin tests
Treatment: Amphotericin B
Fluconazole
 B. OTHERS
Pathogens: Histoplasma capsulatum
Blastomyces dermatitidis
Coccidioides immitis
- Dimorphic ( yeast and mycelial forms)
Reservoir: bat droppings
Transmission: inhalation
Disease: Pneumonia
Treatment:
Itraconazole
Amphotericin B