1. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings PowerPoint ® Lecture Slide Presentation prepared by Christine L. Case Microbiology B.E Pruitt & Jane J. Stein AN INTRODUCTION EIGHTH EDITION TORTORA FUNKE CASE Medical Microbiology Ch. 16 Respiratory tract infections

2. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Microbial Diseases of the Upper Respiratory System Laryngitis: S. pneumoniae, S. pyogenes, viruses Tonsillitis: S. pneumoniae, S. pyogenes, viruses Sinusitis: Bacteria Epiglottitis: H. influenzae

3. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Upper respiratory normal microbiota may include pathogens Upper Respiratory System Figure 24.1

4. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Streptococcal pharyngitis (Strep throat) Figure 24.3 Streptococcus pyogenes Resistant to phagocytosis Streptokinases lyse clots Streptolysins are cytotoxic Diagnosis by indirect agglutination

5. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Streptococcus pyogenes Pharyngitis Erythrogenic toxin produced by lysogenized S. pyogenes Scarlet Fever Figure 24.4

6. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Corynebacterium diphtheriae: Gram-positive rod Diphtheria membrane of fibrin, dead tissue, and bacteria Diphtheria toxin produced by lysogenized C. diphtheriae Prevented by DTaP and Td vaccine (Diphtheria toxoid) Cutaneous diphtheria: Infected skin wound leads to slow healing ulcer Diphtheria

7. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Figure 24.6 Diphtheria

8. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Otitis Media S. pneumoniae (35%) H. influenzae (20-30%) M. catarrhalis (10-15%) S. pyogenes (8-10%) S. aureus (1-2%) Treated with broad-spectrum antibiotics Incidence of S. pneumoniae reduced by vaccine

9. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Otitis Media Figure 25.7

10. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Rhinoviruses (50%) Coronaviruses (15-20%) Rhinoviruses attached to ICAM-1 on nasal mucosa Common cold

11. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Bacteria, viruses, & fungi cause: Bronchitis Bronchiolitis Pneumonia Microbial Diseases of the Lower Respiratory System

12. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Lower Respiratory System The ciliary escalator keeps the lower respiratory system sterile. Figure 24.2

13. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Pertussis (Whooping Cough) Figure 24.8 Bordetella pertussis: Gram-negative coccobacillus Capsule Tracheal cytotoxin of cell wall damaged ciliated cells Pertussis toxin Prevented by DTaP vaccine (acellular Pertussis cell fragments)

14. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Stage 1: Catarrhal stage, like common cold Stage 2: Paroxysmal stage: Violent coughing sieges Stage 3: Convalescence stage Pertussis (Whooping Cough)

15. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Tuberculosis Figure 24.9 Mycobacterium tuberculosis: Acid-fast rod. Transmitted from human to human M. bovis: <1% U.S. cases, not transmitted from human to human M. avium-intracellulare complex infects people with late stage HIV infection

16. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Treatment of Tuberculosis: Prolonged treatment with multiple antibiotics Vaccines: BCG, live, avirulent M. bovis. Not widely used in U.S. Tuberculosis

17. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Tuberculosis Figure 24.11 Diagnosis: Tuberculin skin test screening + = current or previous infection Followed by X-ray or CT, acid-fast staining of sputum, culturing bacteria

18. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Pneumomoccal Pneumonia Figure 24.13 Streptococcus pneumoniae: Gram-positive encapsulated diplococci Diagnosis by culturing bacteria Penicillin is drug of choice „Lancet-shaped“

19. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Pneumomoccal Pneumonia α-hemolysis Optochin

20. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Gram-negative coccobacillus Alcoholism, poor nutrition, cancer, or diabetes are predisposing factors Second-generation cephalosporins Haemophilus influenzae Pneumonia

21. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Mycoplasmal Pneumonia Figure 24.14 Mycoplasma pneumoniae: pleomorphic, wall- less bacteria Also called primary atypical pneumonia and walking pneumonia Common in children and young adults Diagnosis by PCR or by IgM antibodies

22. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Mycoplasmal Pneumonia Figure 11.19a, b

23. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Legionella pneumophila: Gram-negative rod L. pneumophila is found in water Transmitted by inhaling aerosols, not transmitted from human to human Diagnosis: culturing bacteria Treatment: Erythromycin Legionellosis

24. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Chlamydia psittaci: gram-negative intracellular bacterium Transmitted by elementary bodies from bird dropping to humans Reorganizes into reticulate body after being phagocytized Diagnosis: culturing bacteria in eggs or cell culture Treatment: Tetracycline Psittacosis (Ornithosis)

25. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Chlamydia pneumoniae Transmitted from human to human Diagnosis by FA test Treatment: Tetracycline Chlamydial Pneumonia

26. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Viral pneumonia as a complication of influenza, measles, chickenpox Viral etiology suspected if no cause determined Respiratory Syncytial Virus (RSV) Common in infants; 4500 deaths annually Causes cell fusion (syncytium) in cell culture Symptoms: coughing Diagnosis by serologic test for viruses and antibodies Treatment: Ribavirin Viral Pneumonia

27. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Chills, fever, headache, muscle aches (no intestinal symptoms) 1% mortality due to secondary bacterial infections Treatment: Amantadine Vaccine for high-risk individuals Influenza

28. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Hemagglutinin (H) spikes used for attachment to host cells Neuraminidase (N) spikes used to release virus from cell Influenza

29. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Influenza Figure 24.16

30. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Antigenic shift Changes in H and N spikes Probably due to genetic recombination between different strains infecting the same cell Antigenic drift Mutations in genes encoding H or N spikes May involve only 1 amino acid Allows virus to avoid mucosal IgA antibodies Influenza

31. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings A: causes most epidemics, H 3 N 2, H 1 N 1, H 2 N 2 B: moderate, local outbreaks C: mild disease Influenza serotypes

32. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Pneumocystis Pneumonia Figure 24.22 Pneumocystis jiroveci (P. carinii) found in healthy human lungs Pneumonia occurs in newly infected infants & immunosuppressed individuals Treatment: Timethoprim- sulfamethoxazole

33. Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings Aspergillus Rhizopus Mucor Opportunistic fungi involved in respiratory disease: Mucor rouxii Figure 12.2b, 12.4