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

Chest X-ray: Chronic Bronchitis

Pathogens Causing Chronic Streptococcus Haemophilus Moraxella Staphylococcus Escherichia coli, Mycoplasma Influenza & Parainfluenza viruses, Rhinovirus, Coronavirus, Respiratory syncytial virus

EM: Haemophilus influenzae

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

EM: Legionella pneumophila

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

Bronchoscopy

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

WHOOPING COUGH

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

EM: B. pertussis

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

Pernasal swabs

Inoculate Bordet-Gengou medium, containing 20-30% Inoculate the selective medium charcoal cephalexin blood agar Incubate up to 6 days at 37°C in moist aerobic Charcoal medium: Colonies small, Bordet-Gengou : Colonies haemolytic and mucoid

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

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

Triple DTP Vaccination

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

Typical pneumonia

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

Staphylococcus aureus

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

Coxiella burnetii

Laboratory Diagnosis of Strep. Collect sputum, blood, CSF Gram-stained smear and Alpha-hemolytic colonies on blood Growth inhibited by bile and Quellung reaction (swelling of capsule with specific Latex agglutination test for capsular antigen in Bile Antigen detection in sputum specimens

Strep. pneumoniae: Optochin Sensitivity