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Bacterial infection of respiratory tract system (Legionella (Lab (Culture,…
Bacterial infection of respiratory tract system
Lower respiratory tract infection
Duration
Chronic
Tuberculosis
Bacterial pneumonia
ไข้ ไอ หอบ
Typical pneumonia
Character
Abrupt onset
High fever with chills
Productive cough
Agents
Streptococcus pneumoniae
Haemophilus influenzae
Klebsiella pneumoniae
Atypical pneumonia
Character
Progressive onset
Fever
without chills
Dry cough
Myalgia ปวดเมื่อย
Agents
Mycoplasma
Legionella
Chlamydophila
Influenza virus
Adenovirus
Routes of infection
Airborne droplets
Aspiration
Bacteremia
Direct extension
Lab
Sputum culture and smear
Collection and transportation
Deep cough
Broncho-tracheal secretion (lower tract)
Within 2 hrs at room temp.
Blood culture
2 sets before antibiotics
Esp. Atypical
ในกรณีสงสัย bacteremia
Acute
Pneumonia
Hospital-acquired pneumonia (Nosocomial pneumonia)
Occuring 48 hrs or longer after hospitalization
Agents (contaminated in stool)
Klebsiella sp.
E.coli
Serratia marcescens (Enterobacteriaceae group)
Resistance
P. aeruginosa
Acinetobacter sp. (A.baum)
S.aureus
Anaerobic bact.
Community-acquired pneumonia (CAP)
Person-person tranmission
พวกลงท้ายด้วย
pneumoniae
H. Influenzae, Bordetella pertussis, S. aureus, M catarrhalis
Animal or environmental exposure
Legionella pneumophila
Bacillus antharcis
Burkholderia pseudomallei
Pasteurella multocida
Infected in the infant and young child
Group B strep
Onset in community or during 48 hrs of hospitalization
Mycoplasma
Claas
Mollicutes (soft skin)
No cell wall
Human pathogens
M. pneumoniae
Walking pneumonia
อาการไม่รุนแรง ไม่ต้อง admit
All ages (5-20 years)
Clinical
Flu-like
Low grade fever
Dry cough
Chronic หลายเดือน
Malaise ปวดเมื่อย
Character
Smallest free living
bact.
ผ่านกระดาษกรอง bact. ได้
Cell membrane
Cholesterol
ทำให้อยู่ใน env. ได้
A lot of
glycolipids
Cross react with human tissue
Autoimmune
Pleomorphic filaments
Pathogenesis
P1 protein (168 kD)
Adhere to sialoglycoprotein at base of cilia
Sequence homology
with
glycerophospholipids
Extrapulmonary complications
Hemolytic anemia
Pericarditis
Urticaria, erytherma nodosum
Arthritis
H2O2 and superoxide radicals
CARDS toxin
Induces hyperinflammation
Hoat defense
IgM > IgG and secretory IgA
Lab
Growth inhibition test
Susceptible to antiserum to M. pneumoniae
Hemadsorption test
Guinea pig
erythrocytes
M. pneumoniae จะ +ve (เกาะ
sialic acid
)
M. hominis
M. genitalium
M. fermentan
Lab
Culture
Gold std.
เพาะยาก growth ช้า
PPLO medium (modified hayflick)
20% horse serum
Source of cholesterol
25% yeasr extract
Source of amino acid
Penicillin
Inhibit gram +ve (normal flora)
Thallium acetate
Inhibit gram -ve (normal flora)
Within 2 hrs
Colonial morphology
Embedded colony, Fried egg colony
Dienes’s stain
ย้อมติด mycoplasma อื่น
ยกเว้น M. pneumoniae, bact., fungus
Treatment
First line
Macrolides
Azitheomycin
Clarithromycin
Erythromycin
Legionella
L. pneumonia serogroup 1
Habitat
Env. Water sources
Water cooling tower
Spas
ทนความร้อน
Shower water (ฝักบัว)
อยู่ร่วมกับ amoeba
Clinical
Legionnaires’s
disease
Pneumonia
Pontiac fever
Acute
Self limited
Transmission
Aerosols
No person to person
Pathogenesis
Intracellular pathogen
Phagocytosis into macrophages by blind to complement receptors
Legionella-containing vacuole (LCV)
สร้าง vacuole ล้อมปกป้องตัวเอง
Inhibit pahgosome-lysosome fusion
By type IV secretion system
Can proliferation in LCV
Dot/Icm genes
Lab
Direct fluorescent antibody (DFA)
Sensitivity ต่ำ
Lung biopsy
Silver impregnation
Non specific
Culture
Gold std.
Buffered charcoal yeast extract agar (BCYE)
With antibiotics เพื่อความ selective
Blue white autofluorescence
if L. pneumonia จะไม่เรืองแสงสีฟ้า
L. pneumonia require L-cysteine and iron salts for growth
Gram stain
0.05% basic fuchsin
ต้อง dilute 20 เท่าก่อนย้อม
gram negative bacilli
Ag detection in urine
สามารถ detect ได้ตั้งแต่เริ่มต้น
Ag อยู่หลายเดือนตรวจได้ว่าเคย infected ได้
Treatment
Macrolides (first line)