Encina, Neil Gabriel M.

2F
Comparative Microbiology: Upper Respiratory Tract Infection, Pneumonia

INFECTION/ ETIOLOGY KEY FEATURES/ DIAGNOSIS TREATMENT PREVENTION

INTOXICATION MANIFESTATIONS
INFECTIONS OF
THE UPPER
RESPIRATORY
TRACT
- Myxoviruses - nasal stuffiness Diagnosis of the common cold is Supportive therapy to ease the patient’s Handwashing and disinfecting contaminated
1. Common cold Influenza - sneezing dependent on the patient’s discomfort, including zinc acetate objects can help to avoid acquiring the common
Parainfluenza - headache symptoms, localization of the lozenges and nasal gel containing zinc cold as well as avoiding contact with others during
Respiratory disease process, time of year, and gluconate. the cold season.
syncytial virus 1 Moderate to severe cases afebrile course.
Human - General malaise Large doses of vitamin
metapneumoviru - lacrimation Laboratory culture of the viruses C may shorten the duration of the illness
s - sore throat and serologic testing is rarely and decrease the severity of symptoms
- Coronoviruses - slight fever performed. of the common cold.
- Picorna viruses - anorexia
Rhinoviruses
Coxsackievirus A If organisms enter the trachea and
Coxsackievirus B bronchi:
Echoviruses - A tracheobronchitis develops and
- Adenoviruses there may be a cough and a feeling
- Mycoplasma of substernal discomfort.
pneumoniae

2. Acute Rhinovirus Mucosal inflammation of both the Four signs and symptoms that Symptomatic treatment ■ Avoiding jumping in water without plugging the
rhinosinusitis Parainfluenza virus nose and the paranasal sinuses. appear to be most helpful in nose.
Respiratory syncytial diagnosing a patient with acute ■ Increase oral hydration with liberal use ■ Have septal deviations and polyps or foreign
virus Adenovirus Sneezing bacterial rhinosinusitis are of nasal saline and steam to promote bodies surgically
rhinorrhea drainage. removed.
2 most common Nasal congestion (1) purulent nasal discharge; ■ Antipyretics, analgesics (e.g., ■ Practice proper dental management.
causes of community- Postnasal drip (2) maxillary tooth or facial pain acetaminophen), and decongestants
acquired acute Aural fullness (especially unilateral) (e.g., oxymetazoline, phenylephrine, and
bacterial rhinosinusitis: Facial pressure (3) unilateral maxillary sinus naphazoline) may be needed for fever,
1. Streptococcus Headache tenderness headache, and facial pain.
pneumoniae Sore throat (4) worsening symptoms after initial ■ Mucolytics (e.g., guaifenesin) are
2. Haemophilus Cough improvement. helpful for thinning thick nasal secretions
influenzae. Fever and especially for postnasal drip.
Myalgia
Antibiotic treatment
 - Amoxicillin or cefdinir. If the patient is
allergic to -lactam antibiotics,
trimethoprim-sulfamethoxazole or
azithromycin can be prescribed.

3. Pharyngitis Bacterial: Fever Swab the patient’s throat, culture Viral pharyngitis Adenovirus vaccine
S pyogenes Sore throat the sample on blood agar plates, - analgesics (e.g., acetaminophen); -
Edema and demonstrate the growth of warm saline gargles Patients should be
Viral: Hyperemia of the tonsils and beta-hemolytic colonies that are - Fluids to avoid dehydration should be encouraged to limit contact with uninfected persons
Rhinovirus pharyngeal catalase-negative, gram-positive encouraged
Coronavirus walls cocci and are sensitive to bacitracin
Adenovirus
Herpes simplex virus Patients with S pyogenes Rapid antigen detection tests S pyogenes pharyngitis
types 1 and 2 pharyngitis: - Penicillin
Parainfluenza virus - fever and severe pain upon - Erythromycin
Coxsackievirus A swallowing (generally of sudden
Influenza A and B onset).
viruses - Headache, nausea and vomiting,
Respiratory syncytial and abdominal pain
virus - tonsillopharyngeal erythema, with
Epstein-Barr virus or without
Cytomegalovirus exudate, and tender, enlarged
(CMV) anterior cervical lymph nodes
HIV (lymphadenitis).
- beefy red and swollen
uvula; petechiae on the palate
excoriated nares
(usually in children)
- scarlatiniform rash
4. Diphtheria Corynebacterium - pharyngeal pain, formation of a The oropharynx should be A patient with diphtheria should be Active immunization with the DTaP vaccine for
diphtheriae pseudomembrane seen on the swabbed and samples cultured for hospitalized, placed in isolation, and children and the DT vaccine for adults will serve as
tonsils and back of the oropharynx, C diphtheriae. immediately treated with antiserum to the protection from diphtheria.
- regional lymphadenopathy (“bull toxin.
neck” edema of the surrounding The C diphtheriae strain isolated by
tissues, fetid breath, low-grade fever, culture should be assayed for The most urgent task is giving the
and cough. diphtheria toxin production antiserum to neutralize the toxic effects
- Airway obstruction, tachypnea, using the Elek test of the diphtheria toxin.
stridor, and cyanosis (immunodiffusion assay) or by
polymerase chain reaction (PCR). The second most urgent task is
antimicrobial treatment with penicillin or
erythromycin.

The patient should also be given

 diphtheria vaccine to ensure immunity to
the disease.

INFECTION/ ETIOLOGY KEY FEATURES/ DIAGNOSIS TREATMENT PREVENTION

INTOXICATION MANIFESTATIONS
1. Pneumonia a. Typical - - Flu-like symptoms or an upper - Chest radiographs showing new a. Viral pneumonia - For influenza A - There are two vaccines that can be given to
Streptococcus respiratory tract infection consolidations or infiltrates are and B: zanamivir or oseltamivir adults to help prevent
pneumoniae definitive in helping to establish a pneumoni:
- A patient with pneumonia will diagnosis of pneumonia b. Community acquired; not 1. S pneumoniae vaccine
b. Interstitial frequently continue hospitalized - Azithromycin or 2. influenza vaccine
(atypical) to have symptoms of upper - Gram stain of sputum from a clarithromycin or fluoroquinolones with
-Mycoplasma respiratory tract infection and patient with suspected pneumonia enhanced activity against S pneumoniae - Chemoprophylaxis to prevent
pneumoniae develop respiratory symptoms that can be helpful in presumptive influenza infections is helpful in preventing
are indicative of a lower determination of the cause of the c. Community acquired; hospitalized - secondary bacterial
c. Chronic - respiratory tract infection—cough, pneumonia Cephalexin erythromycin or azithromycin pneumonia
Mycobacterium dyspnea, sputum production, or fluoroquinolones with enhanced
tuberculosis and tachycardia - Additional laboratory tests that activity against Streptococcus - The conjugated S pneumoniae heptavalent
can aid in establishing a pneumoniae vaccine is important
d. Fungal - -Pneumonia is even more likely to be definitive diagnosis in preventing infection with this organism in young
Blastomyces the d. Hospital acquired (nosocomial) - To children.
dermatitidis diagnosis if the patient also has a ■ Culture of the sputum. cover coliforms, S pneumoniae, and
fever ■ Culture of blood samples for anaerobes: Imipenem or meropenem or - The conjugated H influenzae type b (Hib)
e. Aspiration bacteria, fungi, or viruses. piperacillin P jiroveci pneumonia can be vaccine prevents childhood infections with H
(community -Auscultatory findings that may ■ Serology to detect antibodies treated with influenzae
acquired) - Oral include abnormal breath sounds, produced against the pathogen or trimethoprim/sulfamethoxazole Yeast
anaerobes or S dullness to percussion, as a result of infection with the infections can be treated with - Respiratory syncytial virus infections can be
pneumoniae wheezes, and crackles (rales) pathogen (e.g., cold agglutinins for amphotericin B prevented in premature infants, neutropenic
M pneumoniae; detection of infants, or in infants with various comorbidities with
f. Aspiration (hospital antibodies to the capsule of S e. Aspiration pneumonia and lung a periodic injection of respiratory syncytial virus
acquired) - Oral pneumoniae). abscess - Clindamycin immune globulin or humanized mouse
anaerobes, gram- ■ Antigen tests to detect certain monoclonal antibody (palivizumab).
negative enterics, or antigens produced by the pathogen f. Chronic pneumonia with fever, night
Staphylococcus aureus (e.g., polysaccharide testing for S sweats, and weight loss - Pulmonary
pneumoniae and H influenzae). tuberculosis: isoniazid + rifampin +
■ Skin tests to detect delayed-type pyrazinamide
hypersensitivity reactions to certain Primary pneumonia due in
pathogens (e.g., M tuberculosis: coccidioidomycosis and
Mantoux test, B dermatitidis, H histoplasmosis treatment is not
capsulatum, C immitis). usually recommended; if symptoms
■ Polymerase chain reaction (PCR) do not resolve within several weeks to
performed on sputum samples to 2 months, treat with itraconazole; for
 rapidly determine the cause of the severe disease, treat with
pneumonia (e.g., tuberculosis). amphotericin B
■ Urinalysis for Legionella antigens.

REFERENCE: THE BIG PICTURE: MEDICAL MICROBIOLOGY, NEAL R. CHAMBERLAIN PAGES 127 - 165