MICROBIAL DISEASES OF THE

RESPIRATORY SYSTEM
 INTRODUCTION
• RESPIRATORY SYSTEM EXCHANGES GASES BETWEEN THE
ATMOSPHERE AND THE BLOOD

IT IS DIVIDED INTO TWO MAIN PARTS:

• UPPER RESPIRATORY SYSTEM
• LOWER RESPIRATORY SYSTEM
STRUCTURES OF THE UPPER RESPIRATORY SYSTEM
STRUCTURES OF THE LOWER RESPIRATORY
SYSTEM:

(There are also various protective components such as the ciliated mucous membrane,
alveolar macrophages and secretory antibodies.
 NORMAL MICROBIOTA OF THE RESPIRATORY SYSTEM

UPPER RESPIRATORY SYSTEM LOWER RESPIRATORY SYSTEM

• Colonized by many microorganisms • Typically microorganisms are not present

• Normal microbiota limit growth of pathogens
• Normal microbiota may be opportunistic pathogens
 Bacterial Diseases of the Upper Respiratory System, Sinuses, and Ears

STREPTOCOCCAL RESPIRATORY DISEASES

Signs and Symptoms

• Sore throat and difficulty swallowing

• May progress to scarlet or rheumatic fever

• Caused by group A streptococci (S. pyogenes

 Bacterial Diseases of the Upper Respiratory System, Sinuses, and Ears

STREPTOCOCCAL RESPIRATORY DISEASES

Pathogenesis
• Occurs when normal microbiota are depleted, large inoculum is introduced, or adaptive immunity is
impaired

Epidemiology
• Spread via respiratory droplets
• Occurs most often in winter and spring

Diagnosis, Treatment and Prevention

• Often confused with viral pharyngitis
• Penicillin
Bacterial Diseases of the Upper Respiratory System, Sinuses, and Ears

DIPHTHERIA

Signs and symptoms

• Presence of pseudomembrane that can obstruct airways.

• Caused by Corynebacterium diphtheriae (C. diphtheriae)
• C. diphtheriae produces diphtheria toxin - which prevents
polypeptide synthesis and causes cell death
 Bacterial Diseases of the Upper Respiratory System, Sinuses, and Ears

DIPHTHERIA

Pathogenesis and Epidemiology

• Spread via respiratory droplets or skin contact
• Symptomatic in immunocompromised or nonimmuned individuals

Diagnosis, Treatment and Prevention

• Diagnosis based on presence of a pseudomembrane
• Treat with antitoxin and antibiotics
• Immunization is an effective prevention
 Bacterial Diseases of the Upper Respiratory System, Sinuses, and Ears

Signs and symptoms

• Sinusitis causes pain and pressure of the affected sinus
accompanied by malaise
• Otitis media results in severe pain in the ears
• Caused by various respiratory system and auditory tube
damage

SINUSITIS AND OTITIS

MEDIA
 Viral Diseases of the Upper Respiratory System

Pathogenesis and Epidemiology

• Bacteria in the pharynx spread to the sinuses via the throat
• Sinusitis is more common in adults
• Otitis media is more common in children

Diagnosis, Treatment and Prevention

• Symptoms often diagnostic
SINUSITIS AND OTITIS • No known way to prevent sinusitis
MEDIA
 Viral Diseases of the Upper Respiratory System

COMMON COLD
Rhinovirus Signs and symptoms
• Sneezing, runny nose, congestion, sore throat, malaise and
cough
• Pathogens and virulence factors (Enteroviruses, rhinoviruses
are the most common cause)

Pathogenesis
• Cold viruses replicate in and then kill infected cells.
 Viral Diseases of the Upper Respiratory System

COMMON COLD
Rhinovirus Epidemiology
• Rhinoviruses are highly infective
• Spread by coughing/sneezing, fomites or person-to-person
contact

Diagnosis, treatment, and prevention

• Signs and symptoms are usually diagnostic
• Pleconaril can reduce duration of symptoms
• Hand antisepsis is important preventive measure
 BACTERIAL DISEASES OF THE LOWER
RESPIRATORY SYSTEM
• Lower respiratory organs are usually axenic
• Bacterial infection of the lower respiratory system can cause life-threatening illness
 Bacterial Diseases of the Lower Respiratory System

BACTERIAL PNEUMONIAS

• Lung inflammation accompanied by fluid-filled alveoli and bronchioles

• Described by affected region or organism causing the disease
• Bacterial pneumonias are the most serious and the most frequent in adults
 Bacterial Diseases of the Lower Respiratory System

PNEUMOCCOCAL PNEUMONIA

Signs and symptoms

• Short, rapid breathing; rust-colored sputum
• Caused by Streptococcus pneumoniae

Pathogenesis and Epidemiology

• Infection occurs by inhalation of bacteria
• Bacterial replication causes damage to the lungs

Diagnosis, treatment, and prevention

• Penicillin is the drug choice for treatment
• Vaccination is method of prevention
 Bacterial Diseases of the Lower Respiratory System

PRIMARY ATYPICAL (MYCOPLASMAL) PNEUMONIA

Signs and symptoms

• Include fever, malaise, sore throat, excessive sweating
• Caused by Mycoplasma pneumoniae

Epidemiology
• Bacteria is spread through nasal secretions

Diagnosis, treatment, and prevention

• Treated with tetracycline and erythromycin
• Prevention is difficult since infected individuals may be asymptomatic
Bacterial Diseases of the Lower Respiratory System

KLEBSIELLA PNEUMONIA

Signs and symptoms

• Pneumonia symptoms combined with a thick, bloody sputum
• Caused by Klebsiella pneumoniae

Pathogenesis and Epidemiology

• Immunocompromised individuals are at greatest rick for infection.

Diagnosis, treatment, and prevention

• Treated with antimicrobials
• Prevention involves good aseptic technique by health care workers
 Bacterial Diseases of the Lower Respiratory System

OTHER BACTERIAL PNEUMONIAS

• Haemophilus influenzae and Staphylococcus

A disease similar to pneumococcal pneumonia

• Yersinia pestis
Causes pneumonia called pneumonic plague

• Chlamydophila psittaci
Causative agent of ornithosis
• Disease of birds that can be transmitted to humans

• Chlamydophila pneumoniae
Causes pneumonia, bronchitis and sinusitis
 Bacterial Diseases of the Lower Respiratory System
LEGIONNAIRES' DISEASE
Signs and symptoms
• Typical pneumonia symptoms
• Pulmonary function can rapidly decrease
• Caused by Legionella pneumophila

Pathogenesis and Epidemiology

• L. penumophila kills human cells (causes tissue damage and
inflammation
• Legionella survives in domestic water resources
• The elderly, smokers and immunocompromised individuals are at
risk for infection
Diagnosis, treatment, and prevention
• Diagnosed with fluorescent antibody staining or serology
• Quinolones or macrolides are the preferred treatment
• Control by reducing bacterial presence in water
 Bacterial Diseases of the Lower Respiratory System
TUBERCULOSIS

Signs and symptoms

• Symptoms are not always initially apparent
• Caused by Mycobacterium tuberculosis

Pathogenesis
• M. tuberculosis remains viable for long time in aerosol drops
• Three types of tuberculosis; (Primary tuberculosis, Secondary
tuberculosis, Disseminated tuberculosis)

Epidemiology
• Immunocompromised individuals are most at risk
• Tuberculosis is leading killer of HIV+ individuals
 Bacterial Diseases of the Lower Respiratory System

TUBERCULOSIS

Diagnosis, treatment, and prevention

• Tuberculin skin test identifies exposure to tuberculosis
• Chest x-rays can identify tubercles in the lungs
• Drug-resistant stains of M. tuberculosis have emerged
• BCG vaccine available where tuberculosis is common
Bacterial Diseases of the Lower Respiratory System

PERTUSSIS (WHOOPING COUGH)

Signs and symptoms

• Initially cold-like, then characteristic cough develops
• Caused by Bordetella pertussis

Pathogenesis and Epidemiology

• Pertussis progresses through for phases: (Incubation, catarrhal,
paroxysmal, and convalescent)
• Highly contagious
• Bacteria spread through the air in airborne droplets

Diagnosis, treatment, and prevention

• Symptoms are usually diagnostic
• Treatment is primarily supportive
• Prevention is with the DTaP vaccine
Bacterial Diseases of the Lower Respiratory System

INHALATION ANTHRAX
Signs and symptoms
• Initially resembles a cold or flu
• Progresses to severe coughing, lethargy, shock and death
• Caused by Bacillus anthrasis

Pathogenesis and Epidemiology

• Anthrax is not spread from person to person
• Acquired by contact or inhalation of endospores

Diagnosis, treatment, and prevention

• Diagnosis is based on identification of bacteria in sputum
• Early and aggressive antimicrobial treatment necessary
• Anthrax vaccine
 Bacterial Diseases of the Lower Respiratory System
INFLUENZA

Signs and symptoms

• Sudden fever, pharyngitis, congestion, cough, myalgia
• Influenza virus types A and B are the causative agents

Pathogenesis and Epidemiology

• Symptoms produced by the immune response to the virus
• Flu patients are susceptible to secondary bacterial infections
• Virus causes damage to the lung epithelium
• Transmitted via inhalation of viruses or by self-inoculation
• Complications occur most often in the elderly, children, and
individuals with chronic diseases
 Bacterial Diseases of the Lower Respiratory System

INFLUENZA

Diagnosis, treatment, and prevention

• Signs and symptoms during a community-wide outbreak are often
diagnostic
• Treatment involves supportive care to relieve symptoms
• Oseltamivir and zanamivir can be administered early in infection
• Prevent by immunization with a multivalent vaccine
 Bacterial Diseases of the Lower Respiratory System

SEVERE ACUTE RESPIRATORY SYNDROME (SARS)

Signs and symptoms

• High fever, shortness of breath, and difficulty breathing
• Later develop dry cough and pneumonia
• Caused by a coronavirus called SARS virus

Pathogenesis and Epidemiology

• SARS virus spreads via respiratory droplets

Diagnosis, treatment, and prevention

• Diagnosis based on signs and symptoms of SARS
• Treatment is supportive care
 Bacterial Diseases of the Lower Respiratory System
RESPIRATORY SYNCYTIAL VIRUS INFECTION
Most common childhood respiratory disease

Signs and symptoms

• Fever, runny nose, and coughing in babies or immunocompromised individu
• Mild cold-like symptoms in older children and adults
• Caused by Respiratory syncytial virus (RSV)

Pathogenesis and Epidemiology

• Virus causes syncytia to form in the lungs
• Immune response to RSV further damages the lungs
• Transmission occurs via close contact with infected persons

Diagnosis, treatment, and prevention

• Diagnosis made by immunoassay
• Supportive treatment for young children
• Prevention includes aseptic technique of health care and day
care employees
 Bacterial Diseases of the Lower Respiratory System

HANTAVIRUS PULMONARY SYNDROME (HPS)

Signs and symptoms
• Symptoms progress to cough, shock, and labored breathing
• Caused by hantavirus
• Transmitted from mice via inhalation

Pathogenesis and Epidemiology

• Infection causes widespread inflammation leading to shock
• Human disease more likely as mouse population increases
• Person-to-person contact does not occur

Diagnosis, treatment, and prevention

• Diagnosis made is based on characteristic symptoms
• No specific treatment is available
• Prevention requires control of rodents
 Mycoses of the Lower Respiratory System

COCCIDIODOMYCOSIS

Signs and symptoms

• Resembles pneumonia or tuberculosis
• Can become systemic in immunocompromised persons
• Caused by Coccidioides immitis

Pathogenesis and Epidemiology

• Arthroconidia from the soil enter the body through inhalation
• Almost exclusively in Southern US and Northern Mexico

Diagnosis, treatment, and prevention

• Diagnosed by presence of spherules in clinical specimes
• Treat with ampothericin B
• Protective masks can prevent exposure to arthroconidia
Mycoses of the Lower Respiratory System

COCCIDIODOMYCOSIS
 Mycoses of the Lower Respiratory System

BLASTOMYCOSIS

Pathogenesis and Epidemiology

• Enters body through inhalation of dust carrying fungal spores
• Incidence of human infection is increasing

Diagnosis, treatment, and prevention

• Diagnosis is based on fungus identification in clinical samples
• Treated with amphotericin B
• Relapse common in AIDS+ patients
 Mycoses of the Lower Respiratory System

HISTOPLASMOSIS

Signs and symptoms

• Asymptomatic in most cases
• Symptomatic infection causes coughing with bloody sputum or skin lesions
• Caused by Histoplasmosis capsulatum

Pathogenesis and Epidemiology

• Humans inhale airborne spores from the soil
• Prevalent in the eastern US

Diagnosis, treatment, and prevention

• Diagnosis is based on fungus identification in clinical samples
• Infections in immunocompetent individuals typically resolve without treatment
Mycoses of the Lower Respiratory System

HISTOPLASMOSIS
 Mycoses of the Lower Respiratory System

PNEUMOCYSTIS PNEUMONIA (PCP)

Signs and symptoms

• Difficulty breathing, anemia, hypoxia, and fever
• caused by Pneumocystis jirovecii

Pathogenesis and Epidemiology

• Transmitted by inhalation of droplets containing fungus
• Common diseases in AIDS+ patients

Diagnosis, treatment, and prevention

• Diagnosis is based on clinical and microscopic findings
• Treat with trimethoprim and sulfamethoxazole
• Impossible to prevent infection with P. jirovecii
 Mycoses of the Lower Respiratory System

PNEUMOCYSTIS PNEUMONIA (PCP)

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