MICROBIAL AGENTS OF

RESPIRATORY TRACT
INFECTIONS
Depart. of Microbiologi Medical
Fac. Hasanuddin University
2005

Agents of Respiratory Tract

Infections
Respiratory tract Infection agents:
bacteria,
viruses
fungi
parasites

MAJOR INFECTIOUS AGENTS OF

UPPER RESPIRATORY DISEASE
DISEASES
Rhinitis

VIRUSES
Rhinoviruses,
adenoviruses,
coronaviruses,
parainfluenza viruses,
influenza viruses,
respiratory syncytial
virus, some coxsacki A
viruses

BACTERIA &
FUNGI
Rare

Streptococcus
Pharyngitis Adenoviruses, parapyogenes,
or tonsilitis influenza viruses,
influenza viruses, rhino- Corynebacterium
influenza viruses, rhinoviruses, coxsacki A &
B virus, herpes simplex
virus, Epstein-Barr virus

Corynebacterium
diphtheriae.
Neisseria
gonorrhoae

MAJOR INFECTIOUS AGENTS OF

UPPER RESPIRATORY DISEASE
DISEASES
Stomatitis

VIRUSES
Herpes
simplex virus,
some
coxsacki A
viruses

None
Peritonsilar
or
retropharyngi
al abscess

BACTERIA & FUNGI

Candida species,
Fusobacterium species,
spirochetes

Group A Streptococci
(most common), oral
anaerobes such as
Fusobacterium sp.,
Staphylococcus aureus,
Hemophilus influenzae
(usually in infants)

MAJOR CAUSES OF ACUTE MIDDLE

RESPIRATORY TRACT DISEASES
SYNDROME

VIRUSES

Epiglotitis Rare

Laryngitis Parainfluenza
and croup viruses, influenza
virus, adenovirus,

virus, adenovirus,
occasionally
respiratory
syncytial virus,
rhinoviruses,
corona viruses,
echoviruses.

BACTERIA
Haemophilus
influen-zae,
Streptococcus
pneumoniae,
Corynebacterium
diphtheriae,
Neisseria
meningitidis
Rare

MAJOR CAUSES OF ACUTE MIDDLE

RESPIRATORY TRACT DISEASES
SYNDROME

VIRUSES

BACTERIA

Laryngotracheitis Same as laryngitis

and laryngoand croup
tracheobronchitis

Haemophilus
influ-enzae,
Staphylococcus
aureus

Bronchitis

Bordetella
pertussis. H.
influenzae, Mycopasma
pneumoniae,
Chlamydia
pneumoniae

Parainfluenza
viruses, Influenza
viruses, respiratory
syncytial virus,
adenovirus,
measles

MAJOR CAUSES OF LOWER

RESPIRATORY TRACT DISEASES
SYNDROME

VIRUSES

Acute Pneumonia Influenza,

parainfluenza,
ade-novirus, r.
syncytial virus
(infants)

COMMON
BACTERIA
Streptococ.
pneumoniae,
Staphylococ.
Aureus, H.
influenza,
Enterobacteriaceae,
Legionella, mix
anaerobes,
Pseudomonas
aeroginosa

FUNGI

OTHER AGENTS

Candida
albicans,
Aspergillus sp.

Mycoplasma
pneumoniae,
Pneumocysti tis
carinini,
Chlamydia
trachomatis
(infants),
Chlamydia
pneumoniae

MAJOR CAUSES OF LOWER RESPIRATORY

TRACT DISEASES
SYNDROME

VIRUSES

COMMON BACTERIA

FUNGI

Chronic
pneumonia

Rare

Mycobact.
Tuberculosis, other
mycobacteria Nocardia

Coccidoides
immitis,
Blastomyces
dermatitidis,
Histoplasma
capsulaatum,
Cryptococcus
neoformans

Lung abscess

None

Mixed anaerobes,
Actinomycetes
Nocardia, S. aureus,
Ente-robacteriaceae P.
aeroginosa

Aspergillus
species

Empyema

None

Mixed anaerobes, S.
aureus, S.
pneumooniae,
Enterobacteriaceae P.
aeroginosa

OTHER
AGENTS

Paragonimud
westermani

Entamoeba
histoytica

TRANSMISSION
Endogenous : organ to organ
Direct
In-direct: - hematogenous
- lymphogenous

Exogenous: man to man

Direct contact: droplet
Air borne transmissiaon

AIR BORNE
TRANSMISSION
PORT THE
ENTRY
Mucous of
Resp. tract

HOST
Patients
Carriers

AGENTS
ROUTES
Direct
Air borne

Bacteria
Virus
Fungi

SOURCES
Droplet
Air

PORT THE
OUTLET
Mucous of
Resp. tract
Skin lesion

RESERVOIRS
Droplet
Sputum
Pus
Ulcus exudates

PREDISPOSING FACTORS
Age,
Immunity dissorder,
Difficulty in clearing upper
respiratory secretions,
Alcoholics, drug abusers,
Unconsciousness, decreased
laryngeal reflexes.

Haemophilus influenzae

CLASSIFICATION
Genera: Haemophilus
Species: H. influenzae, H. haemolyticus; H.
paraphrohaemolyticus; H. segnis; H.
aphrophilus; H. ducrey, H. aegyptius, H.
paraprophilus
strain H. influenzae: 6 major serotypes (a to f)
- non-capsulated (R strain) 50-80% upper
respiratory tract Pat. oportunistic
- type b: strain capsulated (S strain) 2-4%

pathogen.
- type a and c-f: capsulated (1-2%) rarely
incriminated as pathogens

CHARATERISTIC OF
H. influaenzae
Small, short rod
(coccobacilllus),
pleomorphic
Gram-negative,
non-sporeforming
Non-motile

Mostly noncapsulated, some

with capusule
(polisakharida).
Facultative anaerob
Fastidious:
need X and V
factors

VIRULENCE FACTORS
Capsular polysaccharaidesanti fagositic
Membrane lipopoligosaccharides-adhesion in host
cells
IgA protease-inactivation IgA
secretory

PATHOGENESIS
Portal of entry : upper respiratory
tract nasopharinx.
H influenzae type b penetrates
nasopharengial epithelium either
dissiminates hematogenously or
spread directly to meninges.

CLINICAL MANIFESTATIONS
Meningitis
Otitis media and sinusitis (young children).
Acute bacterial epiglottitis (Children 2-5 yr)
Cellulitis (face and neck).
Bacteriemia Systemic infection (capsulated
strain) meningitis or septic arthritis.
Respiratory disease
Chronic bronchitis
Pneumonia

EPIDEMIOLOGY
a. Reservoirs
- H. influenzae strictly human pathogen.
- Human carrier: non-capsulated H.
influenzae :
. 60-90% healthy children , 35% adults.
- 2% healthy children are asymptomatic
carrier H. influenzae type b.
b. Transmission: inhalation of infected
droplet. Close contact favors transmission.

EPIDEMIOLOGY
c. Incidence.
Frequency of invasive infection
related to age, but infection during 2
moths of age rare (protective by
mother immunity).
d. Susceptibility
Host-factors contributing to disease
suscep tibility : 2nd humoral immune
deficiency, sickle disease & chronic
pulmonary infection.

LABORATORY DIAGNOSIS
Specimens
Upper resp. tract
infection: blood
Nasopharynx swabs:
only for carrier.
Lower Resp. tract
infection: sputum,
Other infection:
cerebrospinal fluids

Laboratory
1. Gram-stain of
sputum and CSF.
2. Culture.
3. Particel
agglutination test.

Legionella pneumophila

CLASSIFICATION
Family Legionellaceae
Genera Legionella
Species: L. pneumophila, L.
micdadei, L. bozemanii, L. gormanii,
L. dumoffii, L. jordanis, L.
longbeachae,
L. wadsworthii, dan L. oakridgensis.

GENERAL PROPERTIES
thin, pleomorphic, Gram negatif tods
difficult to stain with conventional
staining ,
flagellated, motile
produces catalase and -laktamase
fastidious,
microaerophilic

VIRULENCE FACTORS
Adhesion
Ability to survive
intracelullary:
a. a peptide toxin inhibits a
respiratory burst
b. Produce catalase during the
respiratory burst (H2O2 from
phagocyte cell -- non-active)
c. Unidentified factors

CINICAL MANIFESTATION
Incubation periods: 2-10 days.
Legionnaires diseases:
pneumonia fever, chill, headache, cough
Pontiac fever : flue like
syndrome

EPIDEMIOLOGY
A. Distribution
Worldwide.
Exist in a wide range of physical and
chemical habits, mostly aquatic.
Found in water cooling tower, AC system,
shower heads, and faucet

B. Transmission
Aquired through inhalation of airborne
aerolized microorganisms.
No evidence of person to person
transmission.

EPIDEMIOLOGY
C. Susceptibility
Several predisposing factors: including
generalized immunosuppression and
condition that decrease local defenses in
lung (chronic diseases, smoking)
D. Incidence:
Exposure and subclinical infection
rather frequent app. 20% of older US
populations are sero-positive

LABORATORY DIAGNOSIS
A. Specimens
Tissue biopsy

B. Examinations
Microscopic examination of sputum and
tissue
Isolation & identification
DNA Identification
Serological test

Bordetella pertussis

CLASSIFICATION
Genera Bordetella
Species:
B. pertussis,
B. parapertussis,
B. bronchoseptica.

GENERAL PROPERTIES
small coccobacil , Gramnegative
capsulated, non-spora
strict aerobe
fastidious : need growth
factors

PATHOGEN FACTORS

Adhesin
Toxins

Pertussis Toxin :
Hipersensitivity cells to stimuli.
Susceptibility to anaphylaxis .
Insulin synthesis ,
Leucocytosis

Adenylate cylase-like toxin intracellulary

cAMP & inhibits hemotaxis.
Tracheal cytotoxin damage tracheal
epithelium characyteristic cough .

PATHOGENESIS
Locally on upper respiratory tract,
Most symptoms direct related to
mucosal destruction
Systemic effects: cause by either
diffusion of pertussis toxin or by
cross-reactive immune reaction.

CLINICAL MANIFESTION
Pertussis: 3 phase:
Catarrhal phase
Paroxysmal phase: 6 weeks or
more
Convalescence phase: 1-3
weeks

EPIDEMIOLOGY
1. Reservoir
There is no animal reservoir B. pertussis
strictly human pathogen
2. Transmission: person to person by inhalation of
droplet with bacteria
3. Insidence
- Pertussis : cause significant morbidity and
mortality.
- With intensive immunization program
insidence.
4. Susceptibility
- Affects mostly infants & particularly during the
first 6 months of life
- Morbidity & mortality rates are higher in girls.

LABORATORY DIAGNOSIS
Specimens
Cough-plate
Serum

Lab examinations
Isolation & identificartion
Direct
immunoflourescence
methods: fast diagnosis.
Enzyme immunoassay
(EIA)

Streptococcus pneumoniae
(PNEUMOCOCCUS)

CHARACTERISTIC OF
Strept. pneumoniae
Ovoid or lancet-shape cocci,
Paired Gram-positive,
Catalase negative
-hemolytic
Capsulated (polysaccharide)
Facultative anaerob, microaerobic
Bile soluble
Optochin-sensitive

CLASSIFICATION

lacks group-specific cell wall antigen

can not be classified using Lancefield
system
Polysaccharide capsule : antigenic
83 sero-types

VIRULENCE FACTORS
Polysaccharide capsul
IgA protease

CLINICAL MANIFESTATIONS
Str pneumoniae leading cause of
bacterial pneumoniae in adults and
children
Other infections :
otitis media,
meningitis,
sinusitis,
bronchitis.

PREDISPOSING FACTORS

Impaired immune response

Viral induced-immunosuppression
and viral-induced tissue alteration
Loss of splenic function

EPIDEMIOLOGY
Str. pneumoniae:
human pathogen,
no animal reservoir .
Transmission:
Person to person contact
inhalation of contaminated droplets

LABORATORY DIAGNOSIS
Specimen :
Sputum,
Blood,
Cerebro-spnal fluids
Pemeriksaan:
Rapid diagnostic
tests: particle
agglutination test.
Isolation

Confirmation:
1. Optochin sensitivity
testing: inhibited by
optochin.
2. Bile solubility testing
soluble in bile
3. Tes Quellung

QUELLUNG TEST

Neisseria meningitidis
(Meningococci)

CLASSIFICATION
Family: Neisseriaceae,
Genera: Neisseria
Species:
Patogen: N. gonorrhoae (gonococci) dan
N. meningitidis (meningococci), khas
intraseluler. Normal flora: extracellular: N.
lactamica, N. sicca, N. subflava, N. mucosa,
N. flavascens, N. cinerea, M. catarrhalis.
Identification: biochemial reaction.

GENERAL CHARACTERISTIC OF
NEISSERIA
Gram-negative cocci
Kidney-bean shape. often seen as diplococci
Capsulated and piliated
Aerobic, oxidase-positive,
Complex growth requirement.

VIRULENCE FACTORS
Adhesian factors: pili
Capsule polysaccharide:
antiphagocytic .
Lipopolysaccharide (LPS, endotoxin) :
10 times more potent than other
endotoxin
IgA proteases : protect bacteria
against the effect of secretory IgA

CLINICAL MANIFESTATION
Febril illnesss
Meningitis
Acute meningococcemia:
a. skin purpura, necrosis, gangren of the
digits.
b. Hipertention, multiple organ failure &
septic shock
Pharyngitis, pneumonia.

LABORATORY DIAGNOSIS
Specimen: Blood or cerebrospinal fluids
Nasopharyngeal swab : only for carrier tracking.
Bacterial diagnosis:
1. Gram preparation
2. Isolation
Serology
latex-agglutination test or hemagglutination
test

Mycoplasma pneumoniae

CLASSIFICATION
Orde: Mycoplasmatales
Family: Mycoplasmataceae
Genera: Mycoplasma & Ureaplasma
Species :
1. Mycoplasma pneumoniae
2. Mycoplasma genitalium,
3. Mycoplasma hominis
Species Ureaplasma:
Ureaplasma urealyticum

MYCOPLASMA PROPERTIES
Pleomorphic, small cells
Lack cell wall & do not stain with conventional
bacteriologic stains.
Smallest bacteria can grow in vitro,
fastidious; grow slowly on complex, enriched media.
Fried egg colonies
M. pneumoniae grow aerobically, other species are
facultative anaerobes.
Species can be easily differentiated by metabolic
characteristics.

PATHOGENESIS OF
M. pneumoniae
M. pneumoniae : primerily a pathogen of the
respiratory tract. Once its reached the bronchi,
adhesion to ciliatic mucosal epithelial cells.
The central nervus system (CNS), myocardium,
skin, joints, and blood may also be affected.
Transmission : Man to man by respiratory tract
secretion.

CLINICAL MANIFESTATIONS

Incubation period: 15-25 days.

Clinical diseases: pneumonia,
tracheobronchitis, pharyngitis, or otitis
media.
Pneumonia not as serious as other bacterial
pneumoniae, the patient often remain
ambulatory atypical or working
pneumonia: non-productive cough.

LABORATORY DIAGNOSIS
Specimens
Larinx or pharinx
swabs, sputum,
inflama-sion exudates,
nose secret , urethral
and genital secretions.
Microbiological diagnosis
1. Microscopically:
Preparation smear from
colony methalic
blue in alcohols or
fluoresence staining.

2. Isolation
3. Serology testing
cold-agglutinin Ab
Other antibodies :
Complement-fixing
Ab
IgM Ab