PRESENTED BY SHAMIMA RAZIA BSc.

MLT III Year

MODERATOR Dr. RITU GARG ASSISTANT PROFESSOR MICROBIOLOGY, GMCH-32

GENERAL ANATOMY OF RESPIRATORY TRACT

NOSTRILS PHARYNX LARYNX TRACHEA BRONCHI

BRONCHIOLES
LUNGS ALVEOLI

RESPIRATORY TRACT INFECTION

Respiratory tract infection (RTI) includes infections of upper respiratory tract and lower respiratory tract

TYPES
Upper respiratory tract infection
Infection of middle ear

Lower respiratory tract infection

Infection of trachea and

and sinuses
Infection of throat and

bronchi
Infections of lungs

pharynx

PREDISPOSE TO RESPIRATORY TRACT INFECTION

Physical damage, e.g. smoking,etc. Loss of defence because of preexisting infectious

disease , immunosuppressive therapy, etc

Damage to respiratory tract by viral infection

ROUTES OF INFECTION: Infection is air borne

Talking, coughing and sneezing spread the infection

Air is a potential source of infectious agents for

respiratory infections

UPPER RESPIRATORY TRACT INFECTION

Infection of Ear and Sinuses
Acute otitis media Otitis externa Acute sinusitis

Infection of Throat and Pharynx

Tonsillitis Pharyngitis Sore throat Laryngitis Epiglottitis Peritonsillar abscess Oral thrush Vincents angina

LOWER RESPIRATORY TRACT INFECTION

Infection of Trachea and Bronchi Infection of Lungs

Bronchitis Bronchiolitis Bronchiectasis Tracheitis Tracheobronchitis

Pneumonia Lung abscess Empyema Respiratory tract

infection leads to septicemia and bacteramia

GENERAL SIGNS AND SYMPTOMS

Fever &chills Chest pain Malaise Nausea & vomiting Headache Painful cervical lymphadenopathy Tonsillitis and Pharyngitis Pain on swallowing

UPPER RESPIRATORY TRACT

The commonest respiratory infections are localized in

the oropharynx, nasopharynx and nasal cavity, causing sore throat, nasal discharge and often fever.
The upper respiratory tract is frequently involved in

wider or generalized infections such as whooping cough and measles, infections with mycoplasma pneumoniae, influenza, parainfluenza, adenovirus.
The potential bacterial pathogens commonly present

in the nasopharynx e.g. pneumococcus, H.influenzae, S.aureus and strep.pyogenes.

SORE THROAT
Definition :- Sore throat is a condition where the mucus membrane in the throat is inflamed because of an infection. Most common disease in young children caused by bacteria, virus and fungi.

PATHOGENESIS
Droplet inhalation
Portal of entry is respiratory tract

AGENTS
Streptococcus pyogenes(group A streptococcus) Corynebacterium diphtheriae

Beta hemolytic streptococci (group C and G)

Staphylococcus aureus

OTHER BACTERIAL THROAT INFECTIONS: Haemolytic streptococci other than strep. Pyognes are present in the throat as harmless commensals, but those are groups C & G occurring & B rarely cause pharyngitis.

VIRAL THROAT INFECTIONS:Epstein- Barr virus which cause an infectious mononucleosis , associated with throat lesions, enlarged lymph nodes, fever, abnormal LFT test.

NASAL, ORAL & SINUS INFECTIONS

The organisms infecting the nasal cavity are mainly the same as throat infections. Nasal swabs are more often taken to detect healthy carriers then to diagnose infections , deep nasal sawbs being taken for strep. pyogenes & diphtheria bacillus.

CLINICAL SYNDROME
Sinusitis

CAUSATIVE AGENTS
Strep.pneumoniae,

H.influenzae, strep.pyogenes, moraxella catarrhalis,S.aureus

Epiglottitis

H.influenzae type B

EAR INFECTION
Swabs are taken from the external auditorymeatus mainly in three suspected conditions acute otitis media, chronic suppurative otitis media & otitis externa.

ACUTE OTITIS MEDIA:- The organisms spreads to the

middle ear via the Eustachian tube from the nasopharynx.

 CHRONIC SUPPURATIVE OTITIS MEDIA:- when

the eardrum has been perforated in an acute attack of otitis meida and remains patent infections with the original pathogens may persist or repeated infection may be caused by secondary invaders such as S.aureus, coliform bacilli, pseudomonas & bacteroids.
OTITIS EXTERNA:- chronic inflammation of the skin

of the external meatus, with irritation & discharge, may be caused by bacteria, particutarly pseudomonas aeruginosa, coliform bacilli, & S.aureus or fungi, are candida & aspergillus.

LARYNGITIS
Definition:- Inflammation or irritation of the tissues of the larynx. Laryngitis causes a hoarse voice or the complete loss of the voice because of this irritation to the vocal folds or cords.

LARYNGITIS PATHOGENESIS
infection vocal overuse smoking and other inhaled irritants drinking of spirits contact with caustic or acidic substances (including

acid reflux from the stomach) allergic reaction direct trauma Pseudo membrane formation

LARYNGITIS AGENTS
Influenza viruses Rhinoviruses Adenoviruses Streptococcal infection

C. diphtheria

LOWER RESPIRATORY TRACT INFECTIONS

Trachea, bronchi & lungs are normally free from commensal

& potentially pathogenic bacteria but when their defeces are upset they are liable to be invaded by organism.
They are the site of primary infections witch various inhaled

pathogens, such as tubercle, whooping cough bacilli, influenzae viruses, mycoplasmaPneumoniae & chlamydias.

The commonest infections are acute tracheobronchitis, acute exacerbations of chronic bronchitis & pneumonias. Most cases the primary infection is caused by a virus e.g. rhinovirus, adenovirus, myxovirus.

CLINICAL SYNDROME Bronchitis, bronchiolitis

PNEUMONIA Community acquired

pneumonia

CAUSATIVE AGENTS Respiratory viruses, myco plasma pneumonias, chlamydia pneumonias, bordetella pertussis. Children:- resp. syncytial virus, parainfluenza virus, adeno virus, strep.pneumonia, H.influenza, Gp.B streptococci Adults:- S.pneumonia, Mycoplasma pneumonia, H.influenzae, S.aureus, GNB, Legionella spp.

CLINICAL SYNDROME Nosocomial pneumonia

Aspiration pneumonia

CAUSATIVE AGENTS GNB, Gram +ve org., anaerobes, Legionella spp. Mixed anaerobes & aerobes, anaerobes alone
Mycobacteria, fungi. Community acquired:-

Chronic pneumonia empyema

S.aureus, Strep.pneumoniae, Strep.pyogenes Nosocomial:- GNB

PNEUMONIA
Definition :-Inflammation of the Lungs with production of alveolar exudates. Inflammation and consolidation of the lung caused by microorganisms.

AGENTS
Streptococcus pneumoniae
Klebsiella pneumoniae Staphylococcus aureus

Mycoplasma pneumoniae

PNEUMONIA TRANSMISSION
Droplet inhalation

Aspiration of upper respiratory tract secretions

containing microorganisms Haematogenous or lymphatic dissemination Direct contact with respiratory secretions

BRONCHITIS
Definition:-Bronchitis is an inflammation of the bronchial tubes, or bronchi, that bring air into the lungs. Inflammation is a chemical reaction in the body that produces redness, swelling, and pain.

TYPES OF BRONCHITIS Acute bronchitis Chronic bronchitis

PATHOGENESIS Disturbed bronchial epithelium Excessive fluid accumulation Cough variable fever Sputum production

LABORATORY DIAGNOSIS

(I) SAMPLES : Throat swab, ear swab, nasal swabs are collected in

upper respiratory tract. Sputum is most commonly used in lower respiratory tract. Transtracheal aspirates Bronchial aspirates Pleural fluid Blood culture is used in case of pneumonia

COLLECTION THROAT SWAB: The swab should be rubbed with rotation over one tonsillar area The arch of the soft palate and uvula and finally the posterior pharyngeal wall The throat should be ensured good lighting The use of a disposable wooden spatula to pull outwards and depress the tongue Swab should be replaced in its tube with care not to soil the rim

SPUTUM
Collection in a disposable ,wide-mouthed, screw-

capped plastic container Collect the sputum before any antibiotic therapy is begun Patient to wait feels material coughed into his throat and then to spit it directly into opened container Sputum should be collected in sterile container to minimize containing with saliva Early morning sputum is more purulent

Bronchial swabs and aspirates

Bronchial collection may be done by transtracheal

puncture aspiration or by the use of protected swab passed through a bronchoscope into the bronchi Direct aspiration of secretion through a bronchoscope, e.g. by bronchial lavage

Bronchial swabs

aspirates machine

Blood Culture
In cases of suspected of pneumonia a sample of blood should be taken for culture before antiobiotics are given. Lung infections are commonly associated with bacteraemia. Culture from the blood a delicate pathogen whose growth is suppressed in cultures of sputum contaminated with salivary org.

TRANSPORT OF SPECIMENS
Upper respiratory tract infection, specimen is

collected using swab, it should be transported immediately to lab without delay. If delay is expected then specimen should be collected in a suitable transport media such as Ringer solution to keep the swab moist Sputum should also be transported immediately to avoid the death of delicate organism like H.influenzae If delay is suspected hold the specimen at 4 degree cellcious.

PROCESSING OF SPECIMEN
DIRECT EXAMINATION:
Gram stain

- Pus cells -Bacteria morphology, gram reaction - Budding yeast cell, hyphae - gram +ve stain should be cocci, diplococci or gram neg. bacilli

S.aureus

Ziehl Neelsen stain For mycobacterium tuberculosis. AFB STAIN

India ink preparation large polysaccharide capsule of Cryptococcus neoformans, pneumococci, Candida can be seen, but latex agglutination testing for capsular Ag is more sensitive.

POTASSIUM HYDROXIDE PREPARATION (KOH MOUNT)

Use of 20% KOH mount for demonstration of Candida albicans, aspergillus species, Cryptococcus neoformans.

Cryptococcus neoformans

Candida Albicans

Other stains are:

Direct wet mount and silver methenamine stain for

pneumocystis carinii Direct fluorescent antibody test for demonstration of antigen in specimen Electron microscopy for demonstration of Chlamydia and viruses

CULTURE Bacterial culture a loopful of specimen is inoculated on-: - Blood agar - Chocolate agar - MacConkey agar - Lowenstein Jensen medium{ if ZN is positive} - Brain heart infusion broth Plates are incubated at 37C in an incubator for 24 hrs. On Chocolate agar colonies are larger then ordinary blood agar. Accessory growth factors are added (factor X and V) in blood for Haemophilus.

PATHOGEN 1. Pneumococcus

BLOOD AGAR

BIOCHEMICAL TEST

splTESTS

5.Group b streptococci

Small, mucoid, a. Catalase Neg. a. India ink transparent colony b. Oxidase with alpha Neg. b. Quellungs rxn haemolytic. Further c. Bilesolubility inc. leads to +ve draughtsman or carom coin appearance of colonies. Blood agar with Satellitism streak of +ve Staph.aureus shows satellitism. Small, circular,and glistening with irregular edges Fried egg appearance eleks gel test Satellitism

2. H. influenzae

3. Corynebacterium diptheriae 4. Mycoplasma

Pseudomembrane detection Serological examination

Hemadsorption

PATHOGEN

BLOOD AGAR

BIOCHEMICAL TEST Catalase +ve Coagulase +ve

splTESTS

5.Staphylococcu Pin point colonies s aureus with beta haemolysis

Serology

eleks gel test

Fried egg appearance

 Then antibiotic sensitivity testing is done by -: Kirby Bauer disc diffusion method. Stoke method.

FUNGAL CULTURE
Inoculated on Sabouraud dextrose agar BHIA or BHIB Plates should be incubated at 37C & 22C. LCB is made from culture.

ANTIGEN DETECTION
Detection of antigen in specimen:

Capsular Ag of pneumococci can be detected by quellung reaction and latex agg. Test

H.influenzae and streptococcal Ag

detected by co agglutination test

SEROLOGY Serological test can be used for the detection of antibody such as CFT for Chlamydia sp., mycoplasma ELISA, RIA Indirect immunofluorescence test for phneumococci Immunoperoxidase test etc. These are used by diagnosis of RTI caused by viruses and bacteria

OTHER TECHNIQUES Newer tech. such as polymerase chain Reaction(PCR) can also be used for diagnosis of RTI

TREATMENT
1. Antibacterial agents are Ampicillin Amoxycillin Co-trimoxazole Erythromycin Penicillin 2. For anaerobes use metronidazole 3. Antituberculous drugs are used for M.tuberculosis 4. Antifungal agents used for fungal infections 5. Viral infections are self limited, so that no specific treatment is reqd.

THANK YOU
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