You are on page 1of 63

Infectious Agents Related to

Respiratory Tract Infection

Department of Microbiology and Parasitology


Faculty of Medicine
Universitas Padjadjaran
Respiratory tract

 Anatomically direct contact


with the physical environment
and exposed to airborne
microorganisms

 A wide range of organisms can


infect the respiratory tract,
including viruses, bacteria,
fungal, and parasites.

 Each years, children acquire 2-5


and adults acquire 1-2 URTI.
Respiratory Infections are the Most Common
Reason for Office Visits
180
161

100
Number of Office Visits

80
73
(millions)

60 55

35
40
26

20

0
Respiratory Hypertension Gastrointestinal Diabetes Depression
Infections Disorders

IMS America NDTI (National Disease Therapeutics Index) 2001.


Mehrotra A. Health Affairs 2008 Sep-Oct;27(5):1272-82.
Burden of Acute Respiratory Tract Infections

• Significant time away from school and work


• Significant healthcare expenditures for clinic
visits, hospitalization and medications
• Mortality rare except for community-acquired
pneumonia in persons with comorbidities
Host-Parasites Relationships
Beneficial effects of the Normal Flora
1. Synthesize and excrete vitamins.
2. Prevent colonization by pathogens. Competing for
attachment sites or for essential nutrients or ”available ecologic niches”
3. May antagonize other bacteria. Production of substance
(fatty acid, bacteriocin, colicin) which inhibit or kill nonindigenous species.
4. Stimulate the development of certain tissues  ex.
“well developed lymphatic tissue”
5. Stimulate the production of “natural antibodies”.
Harmful effects of the Normal Flora
1. Competition for nutrients.
2. Induction of a low grade toxemia.
3. The normal flora may be agents of disease
(endogenous disease) if reach a site or tissue where they cannot
restricted or tolerated by host defenses.
4. Transfer to susceptible hosts .
The Pattern of Host-Microbes relationships

8
From the Host perspective ……………

• Contact – Microbes adhere to exposed body surfaces


• Infection (colonization) – is simply the establishment of
microbes on or within host which can be short lived or
persistent which result in only low harm to host (Mandell, 2015)
• Infectious disease – an infection that causes damage or
disruption to tissues and organs which result in clinical sign
and symptom

9
From the agents perspective………………..
• Microbes that engage in mutual or commensal associations = normal
(resident) flora, indigenous flora, microbiota
• Pathogenicity - the ability of a microbe to cause disease
– True pathogens – capable of causing disease in healthy persons
with normal immune defenses (Influenza virus, plague bacillus,
malarial protozoan, N. gonorrhoeae, S. typhi, GAS, V. cholera,
pathogenic E.coli)
– Opportunistic pathogens – cause disease when the host’s
defenses are compromised or when they grow in part of the body
that is not natural to them (Pseudomonas sp., S.aureus, Candida
albicans, most of normal flora)
• The Virulence factor - structure or characteristic that contributes to
the ability of a microbe to cause disease
• Severity of the disease depends on the virulence factor
10
The Spectrum of Resident Flora of Respiratory Tract
Types of Resident Microorganisms
Common Residents Oral streptococci*
Neisseria spp., Branhamella or Moraxella
Corynebacteria spp*
Bacteroides
Anaerobic cocci (Veilonella)
Fusiform bacteria**
Candida albicans**
Streptococcus mutans
Haemophillus influenza
Occasional Residents Streptococcus pyogenes
Streptococcus pneumoniae
Neisseria meningitidis
Uncommon Residents Corynebacterium diphteriae
Klebsiella pneumoniae
Pseudomonas
Escherichia coli
C.albicans
Residents in latent state in tissues Pneumocystis jiroveci
Mycobactium tuberculosis
Cytomegalovirus (CMV)
Herpes simplex virus
Epstein-Barr virus
Major microbial Flora of the Upper Respiratory Tract
Organisms Oral cavity Nasopharynx, Epiglottis, Paranasal sinus,
Tonsil larynx Middle ear
Gram-positive cocci
Coagulase-negative staphylococci NF NF UP
Staphylococcus aureus CC UP UP
Pneumococci (S.pneumoniae) CC UP CP
Group A streptococci CC,CP UP CP
Groups C and G streptococci NF,CC,UP*
Other streptococci NF NF,CC
Gram-positive bacilli
Diphteroids NF NF
Corynebacterium diphtheriae UC,UP UP
Arcanobacterium haemoyticum
Gram-negative coccobacilli
Haemophilus influenzae CC,UP CP CP
Other Haemophilus spesies NF NF
Gram-negative cocci
Neisseria meningitidis CC,UP
Neisseria gonorrhoeae UC,UP
Other neisseria spesies NF NF UP
Moraxella catarrhalis NF NF CP
Major microbial Flora of the Upper Respiratory Tract
Organisms Oral cavity Nasopharynx, Epiglottis, Paranasal sinus,
Tonsil larynx Middle ear
Gram-positive anaerobes
Anaerobic streptococci NF NF UP*
Anaerobic diphtheroids NF NF
Actinomyces spesies NF,UP
Gram-negative bacilli
Enterobacteriaceae UC UC UP
Pseudomonas aeruginosa UC UC
Gram-negative anaerobes
Prevotella spesies NF,UP UP*
Fusobacterium spesies NF,UP UP*
Veilonella spesies NF
Mycobacterium
Mycobacterium tuberculosis UP UP UP UP
Spirochetes
Borrelia spesies NF,UP NF,UP
Treponema pallidum UP UP
Fungi
Candida albicans NF NF,UP
Aspergillus spesies UP
Mucor spesies UP
Major microbial Flora of the Upper Respiratory Tract
Organisms Oral cavity Nasopharynx, Epiglottis, Paranasal sinus,
Tonsil larynx Middle ear
Chlamydophila (Chlamydia)
Chlamydophila pneumoniae UP
Mycoplasma
Mycoplasma pneumoniae UC,UP UP UC,UP
Viruses
Epstein-Barr virus CP,CC
Herpes simplex virus CC,CP UP
Influenza virus CP CP
Parainfluenza virus CP CP
Adenovirus CP,UC CP
Coxsackievirus CP CP
Rhinovirus CP CP,UC CP
Respiratory syncytial virus CP CP
Human metapenumovirus CP CP
Figure 1. A diagram showing common causes of infection and the
resulting diseases in the respiratory tract
Upper Respiratory Tract infection URTI

Generalization about URTI

 Many microorganisms are restricted to the surface


epithelium, but other spread through other parts of the
body before returning to the respiratory tract, oropharynx,
and salivary glands.

 Two group of microbes can be distinguished: ‘professional’


and secondary invanders
Types of Respiratory Tract Infection
Types Microorganisms Consequences
Restricted to surface Common cold virus Local spread
Influenza virus Local (mucosal) defenses important
Streptococci in throat Adaptive (immune) response sometimes too late
Chlamidya to be important in recovery
Diphteria Short incubation period (days)
Pertussis
Candida albicans (thrush)
Spread through Measles, mumps, rubella Little or no lession at entry site
body EBV, CMV Microbe spreads through body , returns to surface
Chlamydophila psittaci for final multiplication and shedding, e.g salivary
Q fever gland (mumps, EBV, CMV), respiratory tract
cryptococcosis (measles)
Adaptive immune respons important in recovery
Longer incubation period (weeks)
Respiratory Invanders – Professional or Secondary
Type Requirement Examples
Professional Adhesion to normal mucosa (in Respiratory virus (influenza , rhinovirus)
invanders (infect spite of mucociliary system) Streptococcus pyogenes (throat)
healthy respiratory Streptococcus pneumoniae
tract) Mycoplasma pneumoniae
Chlamydia (psittacosis, chlamydial conjunctivitis and
pneumoniae, trachoma)
Ability to interfere with cilia Bordetella pertussis, M. pneumoniae, Strept.
pneumoniae (pneumolysin)
Ability to resist destruction in Corynebacterium diphteriae (toxin), Strept.
alveolar macrophage pneumoniae (pneumolysin)
Secondary invanders Initiation infection and damaged Staphylococcus aureus, Streptococcus pneumoniae,
(infect when host by respiratory virus (e.g pneumonia complicating influenza
defenses impaired) influenza virus)
Local defenses impaired (e.g cystic Staphylococcus aureus, Pseudomonas
fibrosis),
Chronic bronchitis, local foreign H.influenzae, Streptococcus pneumoniae, Pneumocystis
body or tumor depressed jiroveci, CMV, M.tuberculosis
immune response (e.g AIDS,
neoplastic dusease)
Depressed resistance (e.g elderly,
Streptococcus pneumoniae, Staphylococcus aureus,
alcoholisms, renal or hepatic
H.influenzae
disease)
The Dynamic of URTI
Viruses Aerobic bacteria
• Direct synergy • S.pneumonia Anaerobic bacteria
• Anatomy • H.influenzae • Pierocetta
•  Immunity • M.catarrhalis • Fusobaceria
•  Adherence • Others • Peptostreptococcus
• Paralysis cillia

Pathology changes

A secondary bacterial infection

Symptoms resolve

Regeneration of the cells

2 5 7 14 30
TABEL 1. Common Agents of Respiratory Infections
Clinical Illness Bacteria Viruses Fungi Other Comment

Upper Respiratory Airway


Common cold Rare Rhinovirus Rare Rare  Common cold is caused by a multitude of
(Rhinitis, coryza) Coronavirus organisms
Parainfluenza vi.  About 90% of cases are due to viruses
Adenoviruses
 Most common cause is Rhinovirus
RSV
Influenza vi.
Acute S.pneumonia Rhinovirus Rare Rare  Viral is most frequent cause of acute
Rhinosinusitis H.influenzae Parainfluenza vi. rhinosinusitis
M.catarrhalis Adenovirus  Only ± 2% of adult and 10% of children of
Influenza vi. viral sinusitis is complicated by acute
bacterial sinusitis (ABS)
 Community-acquired ABS: S. pneumoniae
and ntHI.
 Hospital-acquired ABS : more likely gram-
negative.
 ABS usually self limited (75 % resolving
without treatment).
 However, untreated ABS are at risk of
intracranial and orbital complications as
well as chronic sinus disease.
 Maximum medicamentosa therapy: a.b +
sinus irigation + topical steroid
TABEL 1. Common Agents of Respiratory Infections
Clinical Illness Bacteria Viruses Fungi Other Comment

Upper Respiratory Airway


Chronic Anaerobic strept . Aspergillus Certain  Usually polymicrobial infection
Rhinosinusitis Prevotella spp. Mucor parasites  Anaerobic organisms account 51%
(CRS) S.Aureus Rhizopus spp
Candida  S.aureus has been cultured as many as 33%
Enteric Gram-
negative bacilli.  Aspergillus, Mucor, Rhizopus spp produce
Pseudomonas invasive CRS
Alternaria  Hypersensitivity reaction to airborne fungi
Nocardia contribute to some case CRS
Legionella  In immunocompromized : Candida,
Atypical Alternaria, Nocardia, Legionella, and
mycobacteria. atypical mycobact, also parasites.
Otitis Externa S.epidermidis Rare Rare  Skin flora are major e/ agents
(OE) S.aureus  A diffuse acute OE (Swimmer's ear) may be
Diphtheroids caused by P. aeruginosa, along with other
P.acnes skin flora
P.aeruginosa  Malignant OE (severe necrotizing) usually
caused by P. aeruginosa.
TABEL 1. Common Agents of Respiratory Infections
Clinical Illness Bacteria Viruses Fungi Comment

Upper Respiratory Airway


Otitis Media S. pneumoniae Respiratory Rare  Usually polymicrobial infection.
H.influenzae viruses
 M. pneumoniae (rare) has been reported to cause
M.catarrhalis hemorrhagic bullous myringitis.
M.pneumonia
 Respiratory viruses may play a role but this remains
uncertain.
Pharyngitis S.pyogenes See table 4 C.albi  90% in adults and 60–75% of sore throats in children are
(Sore throat) Group C and G cans caused by viruses.
and Tonsilitis streptococci  GAS-pharyngitis accounts for 25-40% cases in children
N.Gonorrhoea and 10-25% in adults.
Meningococci  Delaying th/of strep throat, increases the chances of
H.influenzae potentially severe post-streptococcal complications.,
C.diphteriae included ARF, AGN, and local or systemic septic.
M.pneumonia
 Post streptococcal AGN is rarely the consequence of
M.hominis (type 1)
GAS-pharyngitis. No evidence that a.b might prevent
Mixed anaerobs the occurrence of AGN.
 Antibiotic is justified only in patient with GAS-
pharyngitis and have not proved effective in
management of non-streptococcal pharyngitis.
 The efficacy of a.b in cases of GAS-pharyngitis is rapid
disappearance of symptoms, the eradication or
decreased dissemination of GAS, and the prevention of
ARF demonstrated by penicillin G.
TABEL 1. Common Agents of Respiratory Infections
Clinical Illness Bacteria Viruses Fungi Other Comment

Respiratory Airway
Epiglotitis H.influenzae type b Rare Rare Rare  H.influenzae type b is the most common
(Hib) cause, particularly in children age 2 to 5.
 Some cases of epiglotitis in adults may be of
viral origin
 A viral URTI may precede infection with H
influenzae in episodes of epiglottitis
 Once H influenzae type b infection starts,
bacteremia is usually present.
 H.influenzae type b is isolated from the blood
or epiglottis therefore a blood culture should
always be performed.
Tracheolaryngi H.influenzae type b Parainfluenza v Rare Rare  Parainfluenza v. are most common causes.
tis (Croup) S.pyogenes (GABHS) RSV  More serious bacterial infections.
C.diphtheriae Adenoviruses
M.pneumoniae Influenza v  A history of preceding cold-like symptoms is
Enteroviruses typical of laryngotracheitis.
 Sputum or pharyngeal swabs cultures may be
used to isolate pathogens.
 Serologic studies to various viruses are helpful
for retrospective diagnosis.
COMMON COLD

Investigate for : bacterial complication : AOM, ABS


bacterial complication risk factor

Non-complicated Non-complicated common cold + risk factors of Common cold with


common cold bacterial complication bacterial complication

Inform parents/patients of clinical signs indicative of bacterial


complication Antibiotic treatment

Grade A

Professional concensus
Symptomatic treatment Symptomatic treatment +
follow up
In case of secondary
bacterial complication
Abnormal persistence or worsening of symptoms under
symptomatic treatment

Re-assessment
TABEL 2. Some Infectious Agents that Cause the Common Cold

Agents Human Serotypes


Myxoviruses
Influenza A, B, C
Parainfluenza 1, 2, 3, 4
Respiratory syncytial virus 1 (posibbly 2)
Human metapneumovirus 1 (possibly more)
Coronavirus 1
Picornaviruses
Rhinoviruses (most common cause) > 100 types
Coxsackie virus A 24
Coxsackie virus B 6
Echoviruses 31 (only types 11, 20, and 25 may cause
respiratory illnesses)
Adenoviruses 34 (types 1, 2, 3, 5, 7, 14, and 21 are
responsible for respiratory illnesses)
Mycoplasma pneumoniae 1
TABLE 3. Causes and Percentage of Cases of Community-Acquired ABS

Microorganism Percentage of Cases Comment


Haemophilus influenzae, 35%
nontypeable
Streptococcus pneumoniae 34%
Anaerobic bacteria 6% Anaerobic and polymicrobial
infections are much more
common in chronic
rhinosinusitis
Gram-negative bacteria 4% More common in hospital-
acquired rhinosinusitis
Staphylococcus aureus 4%
Moraxella catarrhalis 2% More common in children
*Streptococcus pyogenes 2%

The bacteria listed in Table 2 cause over 70% of the infections of the paranasal sinuses.
TABLE 4. Some Viral Causes of Pharyngitis

Virus Associated Disorder or Symptom Occurrence in Pharyngitis


Rhinovirus Common cold Common

Coronavirus Common cold Common

Adenovirus Pharyngoconjunctival fever and acute Common in military recruits and


respiratory disease boarding schools
Herpes simplex virus types 1 and 2 Gingivostomatitis Common

Parainfluenza virus Cold and croup Common in children

Coxsackie virus type A Herpangina (high fever, vomiting, diarrhea, Common


abdominal pain) and hand-foot-and-mouth
disease
Influenza A and B viruses Influenza Common during flu season

Respiratory syncytial virus Bronchiolitis and croup Common in children

Epstein-Barr virus Infectious mononucleosis Common in adolescents during winter

Cytomegalovirus (CMV) CMV mononucleosis Less common

Human immunodeficiency Primary HIV infection Infrequent (homosexual males and


virus (HIV) heterosexual females at highest risk)
Strategies for diagnosis of acute pharyngitis
infections
 Primarily directed at identifying S. pyogenes pharyngitis as well
as avoiding unnecessary treatment of acute viral pharyngitis.
 Only microbiological test are reliable to confirm the diagnosis
of GAS-Pharyngitis (Grade A). The best means of determining
etiologic agent is to swab the patient’s throat, culture on blood
agar plates, and demonstrate the growth of beta-hemolytic
colonies that are catalase (-), gram (+) cocci and sensitive to
bacitracin
 S. pyogenes rapid antigen detection tests (RADT) are available
and used clinically (strong recommended). The sensitivity ranges
from 77-95%, and spesificity ranges from 86-100%.
Predictive value of clinical and epidemiologic
features
 Throat cultures are not necessary for proper diagnosis of
all cases of pharyngitis.

 If a patient has clinical and epidemiologic features highly


suggestive of a viral etiology, further testing is not
needed.

 If clinical and epidemiologic features highly suggestive of


a bacterial etiology, further testing (e.g., cultures or
RADT) is needed.
TABEL 5. Clinical and epidemiologic features

Epidemiologic findings suggestive of S. pyogenes as the


etiologic agent
 Patient aged 5–15 years
 Children < 18 y.o are more likely to develop S. pyogenes pharyngitis, and
develop suppurative and non suppurative complications.
 History of exposure
 Sudden onset of signs and symptoms
Clinical findings suggestive of S. pyogenes as the etiologic
agent
 Sore throat, fever, headache, nausea, vomiting, and abdominal pain
 Inflammation of pharynx and tonsil
 Patchy discrete exudates
 Tender, enlarged anterior cervical node
Features suggestive of a virus as the etiologic agent
 Conjunctivitis, coryza, cough, diarrhea
PHARYNGITIS
Clinical and epidemiological sign of GAS-Pharyngitis

Positive Negative Symptomatic treatment

Rapid Antigen Test


Positive Negative

Yes Acute Rheumatic Fever No


Antibiotics treatment Risk Factors

Symptomatic treatment
Positive Culture Negative
S. pyogenes (Group A) (Family Streptococcaceae)
General characteristics
- Occurs in single, pairs, or chained Gram (+) coccus
- Facultative anaerobe, attaches to epithelial surface via the
lipoteichoic acid portion of pili

Attributes of pathogenesis
- M protein
- Hyaluronic acid capsule (promotes invasiveness)
- Erythrogenic toxin (causes rash)
- Hemolysins : streptolysin S & O
- Other enzyme :
- Streptokinase (enhances tissue penetration)
- Hyaluronidase (solubilises tissue ground substance)
Lower Respiratory Tract infection URTI
Pneumonia
• A major killer in both developed and developing
countries
• Accounts for more deaths than other infectious
diseases
• Mortality rates vary but can be as high as 25%
• A major cause of death in children in developing
countries
• Microbiological criteria are specific for predicting the
cause of pneumonia
Classification of pneumonia
• Community-acquired
• Hospital-acquired
• Aspiration and anaerobic
• Pneumonia in immunocompromised
• AIDS-related
• Geographically restricted
• Recurrent
MICROBIOLOGICAL CAUSES (%) OF COMMUNITY ACQUIRED
PNEUMONIA FROM HOSPITAL BASED STUDIES (N=3,000)

CAP Severe CAP


• No cause found 36 33
• Pneumococcus 25 27
• Influenza virus 8 2.3
• Legionella spp*. 7 17
• Haem. Influenzae 5 5
• Other viruses 5 8
• Psittacosis/Q fever 3 2
• Gram neg. bacilli 2.7 2
• Staph aureus* 2 5
Community-Acquired Pneumonia
Microbiology and Proportion of Deaths in Adults

Microbial Agent Proportion of Hospital Admissions Deaths


S. pneumoniae 20-60% 66%
H. influenzae 3-10% 7%
S. aureus 3-5% 6%
Gram Negative Rods 3-10% 3%
Miscellaneous Bacteria 3-5% 9%
“Atypical” Bacteria 10-20% 6%
Legionella spp. 2-8% 5%
Mycoplasma spp. 1-6% 1%
C. pneumoniae 4-6% <1%
Viral (including influenza) 2-15% <1%
Aspiration 6-10% ND
Some investigation for diagnosis pneumonia

• Non-invasive:
– Blood count, urea, albumin, LFT’s, sputum gram,
chest X-ray, CT scan
– Culture of sputum, blood, pleural fluid
– Serology: pneumococcal, Legionella antigen
• Invasive: induced sputum, bronchoscopy,
open lung biopsy
Streptococcus pneumoniae

General characteristics
• Part of normal flora oropharynx in 40-70% human
• Gram (+), α-hemolytic, lancet-shaped diplococcus
• Possesses a group-specific carbohydrate
• Possesses a type-specific polysaccharide capsule, >>80
different antigenic type, differentiated by swelling of the
capsule test
• Should be DD/ from non pathogenic S. viridans, by optochin,
bile solubility test, inulin test

Attributes of pathogenesis
• is attributed to the antiphagocytic capacity of the capsule
• Little evidence exist for production of toxin
Clinical Disease

 Pneumococcal pneumonia, facilitated by disturbance of


normal defense barrier of RT
 In 50-70% untreated cases, recovery is associated with
appearance of anticapsular antibody
 Two third of death : 5 days of infection
 D/ by culture of sputum
 OM & septicemia occurs in << 2 months infant
 Leading cause of bacterial meningitis

Treatment & Control


• Penicillin or other sensitive antibiotics
• For prevention of IPD : vaccine 7 types
Atypical Pneumonia
– Mycoplasma pneumoniae - most common
– Legionella sp. (Legionnaire's disease)
– Francisella tularensis (tularemia)
– Bacillus anthracis (anthrax)
– Chlamydia psittaci (psittacosis)
– Chlamydia trachomatis
– Chlamydia pneumoniae
– Coxiella burnetii (Q fever)
Mycoplasma pneumoniae
General characteristics
– is smallest and simplest of the self-replicating
prokaryotes
– lacks a cell wall
– requires cholesterol
– is only mucous membrane pathogen
Attributes of pathogenesis
– Possess a LPS different from that Gr (-) bacteria
– Glycolipid fraction, release H2O2
Clinical manifestation
– Causes primary atypical pneumonia (5 to 15 y.o)
– 1/3 of all cases of pneumonia in teenagers
Laboratory Diagnosis

1. Identification
a. Based on clinical presentation and serology
b. Culture on PPLO agar, “fried egg” appearance
c. Giemsa stain : small pleomorphic bacteria
d. DNA probes
2. Clinical specimen
a. Acute - Convalescent sera : CFT & cold agglutination
reaction
b. Nasopharyngeal secretion

Control
1. Treatment : tetracycline or erythromycin
2. Prevention, re-infection are common
Legionella pneumophila

General characteristics
– poorly stained, Gram negative rod, longer filament
– staining Dieterle’s silver stain
– facultative, intracellular organism
– has high density of cellular branched fatty acid
– catalase (+), most strain are weakly oxidase (+)
– hydrolyzes hippurate
– stream bacterium that contaminates air-conditioning
cooling tower
– frequently harbored by bacteria

Classification
– classified in new family and genus aquatic organisms
– major causative agent of legionaire’s disease
Attributes of pathogenesis
– grows intracellularly and fail to activate the alternate
C pathway
– produces cytotoxin, β-lactamase, endotoxin

Clinical Disease
– Pneumonia (legionaire’s disease)
– Pontiac’s fever
VIRUSES THAT CAUSE COMMUNTIY
ACQUIRED PNEUMONIA
INFLUENZA VIRUS

influenza virus A
influenza virus B,
much lesser extent influenza virus C
Influenza virus Genom
P1 81-94kD Polymerase RNA2
P2 RNA3
P3 RNA1
Na 60kD Neuraminidase RNA6
NP 53kD Nucleoprotein RNA5
H1 58kD Hemaglutinin1 RNA4
H2 28kD Hemaglutinin2 RNA7
MP 25kD Matrix protein
NS1 23kD Non structural RNA8
NS2 11kD
 Type A :
– Human, avian, mammals (horse, seal, pig)
– Sub-type
– Epidemic and pandemic
– Mutation:
Antigenic drift
Antigenic shift
 TYPE B:
– Only human, no animal reservoir
– No sub-type
– Only epidemic
– So far no shifts have been recorded
 Type C:
– much lesser extent influenza virus C
Viral proteins
The internal antigens
 M1 and NP proteins are the type-specific proteins (type-
specific antigens)
 used to determine whether a particular virus is A, B or C
 The external antigens
 HA and NA show more variation and are the subtype and
strain-specific antigens
Haemagglutinin (H 1-15)
Neuraminidase (N 1-9)
 used to determine the particular strain of influenza A
responsible for an outbreak
 HA involved in attachment and membrane fusion in
the endosome of the infected cell
Antigenic drift
– Antigenic drift is due to mutation
– Antibodies to the HA protein are the most
important in protection, although those to NA also
play a role
– Both proteins undergo antigenic drift (i.e.
accumulate mutations) and after a few years may
have accumulated sufficient changes that an
individual immune to the original strain is not
immune to the drifted one
– Antigenic drift results in sporadic outbreaks and
limited epidemics
Antigenic shift
– Antigenic shift is due to reassortment
– In the case of influenza A, antigenic shift
periodically occurs
– Apparently "new" HA and/or NA are found in the
circulating viral strains.
– There is little immunity (particularly if both proteins
change, or if new HA is present) and an
epidemic/pandemic is seen
Pandemic influenza H1N1
• An acute respiratory illness
• Sudden onset of: fever (>38oC), headache,
cough, sore throat, muscle aches, pneumonia
• Transmitted by respiratory droplets from
coughing, sneezing, and from “infected”
surfaces.
Underlying diseases with an increased risk
of severe influenza
• Chronic lung, liver, CNS, conditions,
• Immunosuppression
• Diabetes mellitus
• Asthma
• Age <5 years or >65 years
• Severely obese (BMI 40 or more)
• Pregnancy
• haemoglobinopathies
Preventing the spread of pandemic (swine)
influenza
• Wash hands with soap and water
• Avoid unnecessary contact with cases
• Avoid touching eyes, nose , mouth
• Cover mouth and nose with tissue
• Patients admitted to hospital who have a confirmed
diagnosis will be nursed in a negative pressure room
• HCW’s wear protective clothing
Treatment and prevention of pandemic
influenza H1N1
• Oseltamivir treatment of severe cases
• Can also be considered as antiviral prophylaxis
in selected high risk patients
• Should be used prudently because of risk of
drug resistance
• Vaccine about to be issued, will include
provision for health care workers
OTHER VIRAL CAUSES

• Respiratory syncytial virus (RSV)


• Parainfluenza viruses
• Enteroviruses
• (Cytomegalovirus)
Severe Acute Respiratory Syndrome (SARS)

 Identified in Guangdong Province, China, in


November 2002
 Rapidly spread to Hong Kong, South East Asia,
North America..The World
 By the end of outbreak in June 2003 more
than 8,000 cases had occurred with >800
deaths
 Person to person transmission demonstrated
• A type of viral pneumonia (corona virus) , with
symptoms including fever, a dry cough, dyspnea
(shortness of breath), headache, and hypoxaemia
(low blood oxygen concentration).
• Typical laboratory findings include lymphopaenia and
mildly elevated aminotransferase levels (indicating
liver damage).
• Death may result from progressive respiratory failure
due to alveolar damage.

You might also like