5.2. ISPA - Bakteri 2 PDF

BACTERIAL INFECTION ON UPPER
RESPIRATION TRACT
Ike Irmawati P.A, MSi Med

Revised by eri dian
Mikrobiologi FK Yarsi
Haemophilus
Characteristics of Haemophilus
• Small, pleomorphic gram-negative
coccobacilli, non motile
• (+) cytochrome oxidase
• Growth in culture requires exogenous hemin
(oxidized ferroprotoporphyrin) (X factor)
and/or nicotinamide adenine dinucleotide
(NAD) (V factor)
Haemophilus: Natural Habitats
• Normal inhabitant of the upper respiratory,

gastrointestinal, and genital tracts of humans
except Haemophilus ducreyi (not normal
microbial flora)
Haemophilus species of clinical
importance
1. H. influenzae
-type b is an important human pathogen
2. H. ducreyi
-sexually transmitted pathogen (chancroid)
3. Other Haemophilus are normal flora

- H. parainfluenzae
- H. aphrophilus
- H. aegyptius
Haemophilus: Modes of Infection
• Encapsulated strains of Haemophilus
influenzae associated with invasive infection
caused by person-to-person spread of H.
influenzae due to inhalation of infectious
respiratory droplets
• Type b H. influenzae was most commonly
associated with disease prior to conjugate
vaccine but prevalence has declined with
advent of vaccination
Haemophilus: Types of Infectious Disease
Encapsulated (types a-f) strains of H.

influenzae produce invasive infection
(pneumonia, meningitis, epiglottitis, and
bacteremia)
Unencapsulated (non-typeable) strains of H.
influenzae cause otitis media in children, and
lower respiratory tract infections (acute
tracheobronchitis, pneumonia) in children and
adults
Haemophilus: Species Identification
• Preliminary findings: small faintly-staining

(with safranin) gram-negative coccobacillary
to filamentous rods that grow on chocolate
agar but not sheep blood agar (except H.
aphrophilus that with passage in culture grows
on both)
• X and V factor requirements determined using
X, V, and XV factor impregnated paper strips
on Mueller-Hinton agar
Haemophilus influenzae
Differentiation of Species
Growth
Hemolysis Factor
X V
H. influenzae - + +
H. aegyptius - + +
H. ducreyi - + -
H. parainfluenzae + - +
H. aphrophilus - - -
• Aerobic gram-negative bacteria

• Polysaccharide capsule
• Six different serotypes (a-f) of polysaccharide
capsule
• 95% of invasive disease caused
by type b
Haemophilus influenzae type b
Clinical Features*
Epiglottitis
17%
Meningitis
50%
Pneumonia
15%
Osteomyelitis
2%
Arthritis
8% Cellulitis Bacteremia
6% 2%
*prevaccination era
Epidemiology
• Reservoir Human
Asymptomatic carriers
• Transmission Respiratory droplets

• Antigenic Properties• Contains 3 Major
surface antigens
• 1 Capsular polysaccharide
• 2 Outer membrane proteins (OMP)
• 3 Lipopolysaccharides ( LPS )
Pathogenesis
• Organism colonizes nasopharynx

• In some persons organism invades
bloodstream and cause infection at distant
site
• Antecedent upper respiratory tract infection
may be a contributing factor
Pathogenic Mechanisms
• H. influenzae
◦ Antiphagocytic polysaccharide capsule is the
major pathogenesis factor
◦ Lipopolysaccharide lipid A component from the
cell wall (major role in non capsule strains)
◦ All virulent strains produce neuraminidase and an
IgA protease
◦ No exotoxins
Pathogenesis – Host Factors
Hib conjugate vaccine (Poliribitol phosphate ( PRP)

capsule)
The Hib conjugate vaccine does not protect
against nontypeable strains
Persons at risk for invasive H influenzae disease
◦ Asplenia
◦ Immunocompromised
Basis for the H.influenzae type B
vaccine
• The polysaccharide capsule of H.influenzae type B is and
represent its major virulence antiphagocitic factor. The
capsule contain ribose,ribitol,and phosphate,known
collectively as polyribitol phosphate (PRP). Phagocytosis and
complement-mediated activity are stimulated in the presence
of antibodies directed at the H.influenzae type B capsule.
• H.influenzae type B vaccine contain PRP antigens conjugated
to specific protein carriers.
H. influenzae serotype b:
diagnosis and treatment timeline
Incubation Signs or Infectiousness Lab Prophylaxis

symptoms Specimens
Exposure Onset*
Incubation period unknown Sudden Management of

(~ 2-4d) Onset sequelae
Infectious while organisms are present,

or until 24-48h of antimicrobial therapy
Specimens from sterile site, for culture (cerebrospinal

Immunize contacts aged <5y fluid, blood, pus, middle ear fluid). Gram Stain is
presumptive
Antimicrobial prophylaxis
*Invasive disease includes meningitis, epiglottitis, pneumonia, septic arthritis, and cellulitis (less commonly osteomyelitis and pericarditis).
Modified from Michigan Health Department http://www.michigan.gov/documents/mdch/2Hflu_Rev2008_231415_7.pdf
• IsoVitaleX-enriched chocolate
agar
• Requires 2 erythrocyte factors
for growth: X (hemin) and V
(NAD).
• X & V factors are released
following lysis of red blood cells
• 5% CO2 enhances growth
Satellite Phenomenon
H. influenzae
Grows near S. aureus on blood agar:

satellite phenomenon.
Satellite phenomenon
S.aureus
Public Health Aspects-
H. influenzae
• Typing based on capsule polysaccharide a → f
• Polyribose-ribitol phosphate (PRP) capsule
(type b)
• Nonencapsulated (nontypeable) organisms are
part of normal flora of the respiratory tract
• 95% of invasive disease caused by type b
Polysaccharide Conjugate Vaccines
• Stimulates T-dependent immunity

• Enhanced antibody production, especially in
young children
• Repeat doses elicit booster response
Moraxella
Gram negativ diplococci
• Neisseriaceae • Moraxellaceae
– Neisseria – Moraxella
– Kingella – Acinetobacter
– Eikenella
– Simonsiella
– Alysiella
Characteristics of Moraxella
• Gram-negative diplococci with adjacent sides

flattened
• Frequently appear as intracellular gram-
negative diplococci within polymorphonuclear
neutrophils
• Growth Moraxella catarrhalis occurs on both
sheep blood and chocolate agar
• Moraxella catarrhalis capnophilic (optimal
growth with 3-7% CO2)
• Moraxella rather than Branhamella accepted
taxonomically as the genus designation for M.
catarrhalis (family Moraxellaceae)
• Even though M. catarrhalis not a member of
the family Neisseriaceae, morphologic and
biochemical similarity to Neisseria allows
clinical laboratory identification of M.
catarrhalis with Neisseria species
Moraxella catarrhalis: Natural Habitats
Present in the upper respiratory tract of 1.5-5.4% of
healthy individuals, more commonly in children
(50.8%) and elderly adults (26.5%)
Moraxella catarrhalis: Types of Infectious
Disease
• Acute purulent exacerbation of chronic

bronchitis
• Causes 10-15% of episodes of otitis
media and sinusitis
• Rarely associated with systemic infection
(endocarditis, meningitits)
Moraxella catarrhalis: Modes of Infection
Oropharyngeal endogenous strains

spread into normally sterile regions of
the tracheobronchial tree, the middle
ear, and sinuses
Virulence factors:
Moraxella catarrhalis
• Endotoxin
• Pili
• Beta-lactamase
Laboratory Diagnosis:
Direct smear from an otitis media

sample showing intracellular
gram-negative diplococci
Laboratory Diagnosis:
• Colonies appear smooth with a grayish-

white color
• When colonies pushed with loop, they
“scoot” across media
Moraxella catarrhalis growing

on chocolate agar after 24 hours
of incubation
Laboratory Diagnosis :
Oxidase positive
Catarrhalis Disc
Positive= blue-gren
Produce beta- lactamase

Selected Biochemical Reactions for Identification of Neisseria
and Moraxella catarrhalis1
Glu Mal Lac Suc DNa BE

N. gon + – – – – –
N. men + + – – – –
N. lac + + + – – –
M. cat – – – – + +
1Glu=glucose, Mal=maltose, Lac=lactose, Suc=sucrose,
DNa=DNase, BE=butyrate esterase (indoxyl butyrate
substrate), N. gon=N. gonorrhoeae, N. men=N. meningitidis,
N. lac=N. lactamica, M. cat=Moraxella catarrhalis
Fusobacterium species
• anaerobic, non–spore-forming, gram-negative
bacilli
• Human infection usually results from F.
necrophorum subspecies funduliforme, but
infections with other species including F.
nucleatum, F.gonidiaformans, F. naviforme,
F.mortiferum, and F. varium have been
reported
Fusobacterium nucleatum
• Fusobacterium infections are most common in
adolescents and young adults, but infections,
including fatal cases of Lemierre disease, have
been reported in infants and young children
• Diagnosis: anaerobic blood culture

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BACTERIAL INFECTION ON UPPER

Ike Irmawati P.A, MSi Med

• Normal inhabitant of the upper respiratory,

3. Other Haemophilus are normal flora

Encapsulated (types a-f) strains of H.

• Preliminary findings: small faintly-staining

• Aerobic gram-negative bacteria

• Transmission Respiratory droplets

• Organism colonizes nasopharynx

Hib conjugate vaccine (Poliribitol phosphate ( PRP)

Incubation Signs or Infectiousness Lab Prophylaxis

Incubation period unknown Sudden Management of

Infectious while organisms are present,

Specimens from sterile site, for culture (cerebrospinal

Grows near S. aureus on blood agar:

• Stimulates T-dependent immunity

• Gram-negative diplococci with adjacent sides

• Acute purulent exacerbation of chronic

Oropharyngeal endogenous strains

Direct smear from an otitis media

• Colonies appear smooth with a grayish-

Moraxella catarrhalis growing

Produce beta- lactamase

Glu Mal Lac Suc DNa BE

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