Anda di halaman 1dari 23

Atypical Agents of

Respiratory Infections
ERI DIAN MAHARSI
BAG.MIKROBIOLOGI
FKUY
Teaching Objectives:
Know the general
morphology & physiology of
the organism
Know clinical symptoms
Know the mechanism
pathogenesis
Know the diagnostic
Know preventive procedures
Legionellae
Family : Legionellacae
>> species & >> serogroup
Patogen >>: L.pneumophyla
Gram (-),pleiomorphic rods
Obligate aerob
Capable of replication in
alveolar macrophages



Legionella pneumophila
Naturally found in water,cooling
towers,water systems
Patient with chronic pulmonary disease are
@highest risk
L.pneumophila nosocomial infection
Disease: Legionnaires disease (severe
pneumonia); Pontiac fever (influenza- like
illness)
Transmission: enviromental to man
not man to man
Diagnosis:
Gram staining:difficult
direct & indirect fluorescent antibody (IFA)
Culture: buffered charcoal yeast extract agar
(BCYE),grows after 3 days incubation.


Mycoplasma
Family : Mycoplasmataceae
Mycoplasma pneumoniae is the
most common type of atypical
pneumoniae
>> species of mycoplasmas but !!
Human pathogens: M.pneumoniae
M.hominis
M. genitalium
Ureaplasma urealyticum
Organism Disease
M. pneumoniae Upper respiratory tract disease,
tracheobronchitis, atypical
pneumonia, (chronic asthma??)
M. hominis Pyleonephritis, pelvic
inflammatory disease,
postpartum fever
M. genitalium Nongonococcal urethritis
U. urealyticum Nongonococcal urethritis,
(pneumonia and chronic lung
disease in premature infants??)
Diseases Caused by Mycoplasma
BASIC
The smallest free-living bacteria but the
extremely smallest is Ureaplasma T-
strains (tiny strains)
The smallest genome sizelack many
metabolic pathways require complex
media for the isolation
Mycoplasmas are facultative anaerobes
,except for M.pneumoniae obligate aerobe
No cell wall that distinguishes it from
other bacteria can assume multiple
shapes


Pathogenesis
Major virulence factors
1.M.pneumoniae : Adherence
protein called P1
2.Toxic metabolic product: H202
dan superoxide

Diagnosis
Early: clinical grounds
Laboratory diagnosis:
Microscopy Absence of a cell
wall not usefull
Culture (+) in 2-3 weeks
difficult not usefull
Serology: CFT
ELISA
Prevention
NO VACCINE
Prevention: avoid close
contact
M. HOMINIS & U.UREALYTICUM
M.hominis pyelonefritis
U.urealyticum NGU
Diagnosis: culture
Prevention : proper barrier
protection or abstinensia
Klebsiella pneumoniae


Can cause pneumonia
>> but more commonly implicated in hospital-
acquired urinary tract and wound infections,
particularly in people with weakened immune
systems.
Lobar pneumoniae often occur in the
elderly,diabetics,&alcoholism
Problem in hospitals because, because it can
cause outbreaks



Klebsiella pneumoniae
Gram (-),rods, capable
aerobic/anaerobic,capsulated
Capsule inhibit phagocytosis
Protocol Klebsiella pneumoniae
How to distinguish enterobacteriae
Chlamydia pneumoniae /Chlamydophila pneumoniae
Property C.trachomatis C.psitacci C.pneumoniae
Host range >>>humans Birds,
mamals,
human (rare)
Humans
Elementary
body
morfology
Round Round Pearl-shaped
Inclusion
morfology
Round,vacuoler Varible,dense Round,dense
Glycogen
containing
inclusions
yes no

no
Plasmid
DNA
yes

yes

no
Pathogenesis - C. pneumoniae
Person to person spread
via aerosolized droplet
Pathogenesis:litlle known
Caused:
pneumonia,bronchitis,pha
ryngitis,&flu like
syndrome

Diagnosis - C. pneumoniae
Difficult
Often asymtomatic or unrecognized
Diagnosis:
Specimen:throat swab,nasopharyngeal
swab,bronchoalveolar lavage
fluids,sputumculturePCR
Serology: CFT (complement Fix test) not specific
IFA using EB as Ag more reliable


Coxiella burnetii
Query fever / Q fever
Zoonosis
Potensial bioterorism
Basic: Obligate intracellular, gram negative,cocobacillus
Transmiison: inhalation,unpasteurized milk,tissue fluids
Risk individu: man who come into contact with infected
animals, esp placenta (veterinarians,farmers)
Coxiella burnetii
Smaller than ricketsiaa
In contrast to ricketsia: C.burnetii
can survive extracellular, however
it can be grown only in lung cells
The organism can exist in 2
antigenic states
When isolated from animals,
C.burnetii in a phase I form
highly infection
When grown in cultured cells lines
a phase II form not infectious
Clinical symtoms
Acute Q fever
Flu like syndrome
Pneumonia & granulomatous hepatitis
Diagnosis: serologic: titer 4x of antibody to phase 2
(Ig M & Ig G)

Chronic Q fever (> 6 bulan)
Endocarditis & meningoencephalitis
Diagnosis: titer 4x antibody to phase 1&2 (IgG &
IgM)

Borellia vincentii
Spirochetes,anaerobic,Gram (-)
Cause: Vincents disease/Vincents
angina
Risk factors such as stress, poor
diet and nutrition, tobacco usage,
and already having a systematic
disease
Symptoms include foul breath,
ulcers in the inter-dental papillae,
ulcers on the gums that easily
bleed,pharyngitis
Referensi
DIAGNOSTIC
MICROBIOLGY : BAILEY &
SCOTTS

MIKROBIOLOGY
KEDOKTERAN:JAWETZS,M
ELNIC,ADELBERG