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INFECTIONS
Ania Kurniawati PD, dr. Mkes
Bagian Mikrobiologi FK-UNJANI
PLEUROPULMONARY
INFECTIONS
Etiology:
Pyogenic cocci: Strept. Pneumoniae/Pneumococcus
Strept. Pyogenes
Staph. Aureus
Gram negative: Klebsiella pneumoniae
rod
Escherichia coli
Proteus
Haemophilus influenzae
Pseudomonas aeruginosa
atypical
Mycoplasma pneumoniae
pneumonia Legionella pneumophila
Pneumococcus causing 80% of all
bacterialpneumonia
Pneumococcal Pneumonia
General characteristic `Strept. pneumonia
is a gram positive, shaped diplococcus
is differentiated from other streptococci by:
sensitivity
to optochin; bile
fermentation of inulin
possesses a type specific polysacharide capsule
with more than 80 different antigenic types
is part of the normal oropharynyeal flora in 4070% of human beings
Tipe
hemolisis
Hari 3
(alpha)
S.pneumonia
e
-Tes Optokhin (+)
(Beta)
S.
hemolyticus /
S.viridans
Tes
basitrasi
n
Sensitif
Grup A
(Gamma)
Tidak ada
tes khusus
Clinical Manifestations
prodromal symptoms: rhinorrhea; pharyaqitis; cough
abrupt occurrence of fever ( 1020 F ) pleuritic chest
pain, chills.
the sputum is typically rusty in color do to
alveolar hemorrhage
necrosis of the lung tissue rarely occur pneumococcus do not posses necrotizing extracellural
enzyme
destruction of lung tissue by leucogtic proteases is
apparently prevented by protease inhibitor
-1anti trypsin
-2 macro globalin
Diagnosis
Confirmation of the etiologic agent may require
treatment: penicillin
prevention: Polyvalent vaccine
Streptococcus Pyogenes
Pneumonia (group A - hemol Strep.)
Attribute of Pathogenicity
Clinical Disease
1. Streptococcal pharyngitis
2. Scarlet fever
3. Post infectious disease :
- rheumatic fever
- GNA
4. Skin infection : impetigo, cellullitis,
erisipelas,
fascitis.
Streptococcus Pyogenes
Pneumonia
less than 5% of bacterial pneumonia
Staphylococcal
Pneumonia
A. General caracteristic of S. aureus
Gram (+), cluster-forming coccus
Nonmotile, nonsporeforming facultative
anaerobe
Fermentation of glucose produces mainly
lactic acid
Ferments mannitol (distinguishes from
S.epidermidis)
Catalase (+)
Coagulase (+)
Normal flora of human : nasal
B. Clasification
1. Staph. are catalase (+) whereas
Strept.
()
2. S. aureus (-hemolytic and coagulase
(+) is distinguished from the coagulase
(-) Staph., which are nonhemolytic.
C. Virulens factors :
1. Surface protein
2. Invasins (leukosidin, kinase, hyaluronidase)
3. Surface factors (carotenoids, catalase
production)
4. Immunological disguises (Protein A,
coagulase, clotting factor)
5. Membrane-damaging toxins (hemolysins,
leukotoxin, leukocidin)
6. Exotoxins (TSST, ExfoliatinToksin)
Staphylococcal Pneumonia
occurs in:
among hospitalized patient
person who inject unsterile materials into their vein
Clinical manifestations:
hospital
Clinical manifestation
usually acute infections
common symptoms:
lung
Diagnosis:
culture from blood ( 25% positive ), pleural
abuot 50%
die
Treatment:
Diagnosis
smears of sputum: gram-negative bacilli & PMN
culture: require special attention
counterimmuno electrophoresis
Treatment:
ampicillin
chloramphenicol
Mycoplasma pneumonia
Etiology: mycoplasma pneumonia
formerly: Eaton agent
PPLO
are the smallest free living organism capable of
replicating in cell.free-media
they lack of cell wall
= L from bacteria
Mycoplasma pneumonia
is an acute infection of the lower respiration tract
person
M.pneumoniae attaches to neuraminic acid
surfaces
attachment may be mediated by glycoprotein
Clinical Manifestation:
cause primary atypical pneumonia
slow outset of fever; headache, malaise, not
productive cough
over several weeks; interstitial or broncho
Attribute of pathogenicity:
1. posses a LPS, different from that of
gram.negative bacteria
2. has a glycolipid traction that may play
Laboratory Diagnosis:
clinical specimens includes:
nasopharyngeal secretion
acute & convalescence sera
CFT
cold aglutinin reaction
culture is performed on PPLO agar
tetracycline
Legionellosis = legionnairs`
disease & Pontiac fever
is an acut bacterial infections of humans
caused by member of the genus legionela:
Etiology:
genus legionella are faintly staining; thin
pleomorphic gram negative bacilli
do not grow on most commonly used
bacteriologic media
can be stained with:
Attributes of pathogenicity
grow intra cellular
produce : cytotoxine
-lactamase
endotoxin
Clinical Manifestations:
Legionairs` disease:
is acquired by innhalation of organism from
environmental sources
predominantly in middle age & elder men is
most
common in smokers in the present of an organ
transplant T-cell defect & chronic lung disease
has abroad range of manifestations from a mild
to
fulminant multisystem disease
Clinical Manifestations:
Pontiac fever
is an acute; self limited, febrile illness
incubation periode: 5-66 hours ( x : 36 h )
starts abruptly:
diffuse myalgia, headache, fever, tachipneu;
tachicardia
Diagnosis
definitive diagnosis requires isolation of the organism
from clinical specimens
is often diagnosis by direct fluorescent antibody
staining or by demonstration of dieterle` silver stain
may be grown and identified on buffered charcoal
yeast extract agar ( CYE agar )
may also be identified by an increase in antibody titer
Treatment: erythromycin
rifampin ( immunocompromised patient)
Prevention: decotaminated of cooling towers;
shower head; rebulicer with hyperchloriration
desinfectants or heat