Lower Respiratory Tract
-lungs are axenic [no normal flora]
-Pneumonia: described by location, pathogen or way contracted [anything that effects lung tissue]
-Pleurisy [inflammation of serous membranes]

Pneumococcal Pneumonia
Pneumococcal Pneumonia
-most common bacterial pneumonia [80% of cases]
-Causative Agent: Streptococcus pneumoniae: G+, encapsulated, diplococci
-Capsules: protects it from macrophages

Signs & Symptoms
Signs & Symptoms
-cough, fever, congestion [main symptoms], chest pain, rust tinged sputum
-breathing becomes shallow and rapid
-skin becomes dusky due to poor oxygenation
-consolidation [air passage way can become blocked with inflamed cells, difficult breathing, labored breathing] may occur

Recovery
Recovery is usually complete
-most strains do not cause permanent damage to lung tissue

Complications
-pleural effusions [build up of fluid in the lungs and reduce the air flow, caused labored breathing and pain]
-septicemia
-endocarditis [inflammation of the lining of the heart]
-meningitis

Epidemiology
-75% of healthy individuals carry encapsulated strain in their throat
-bacterial rarely reach lung
-risk of pneumonia rises when cilia destroyed
-gram stain of sputum used for diagnosis [G+]
-pneumococci confirmed with quelling reaction [if you treat with anti-vascular antibodies and it will swell]

Bacterial Inflammation Response
Bacteria that reach alveoli cause inflammation response
-adhesions
-capsule
-phosphorylocholine in cell wall
-pneumolysis [cytotoxin
-IGA proteases

Prevention & Treatment
Prevention
-Pneumococcal vaccine
Treatment
-antibiotics successful if given early
Penicillin [some resistance]
-Erythromycin, Cephalosporin and Chloramphenicol

Klebsiella Pneumonia
-leading cause of nosocomial pneumonia
-Causative Agent: Klebsiella pneumoniae: G-, encapsulated, bacillus, produce mucoid colonies

Signs & Symptoms
-typical pneumonia symptoms combined with a thick, bloody sputum and recurrent chills
Organism causes tissue death
-leads to formation abscess in lung or other tissues
-endotoxin can trigger shock and disseminated intravascular coagulation

Epidemiology
-endogenous
-difficult for K. pneumoniae to infect lungs of healthy persons
-leading causes of nosocomial death
-also causes UTI, meningitis and wound infections
-diagnosed with chest x-ray and sputum culture

Prevention
-no vaccine available
-employ good aseptic techniques

Treatment
Antimicrobial treatment limited
-Cephalosporin combined with an
-tissue daminoglycosideamage and release of endotoxin can cause permanent damage to lungs
-high fatalities even with treatment

Mycoplasmal Pneumonia
Mycoplasmal Pneumonia
“walking pneumonia”
-leading pneumonia in children
-Causative Agent: Mycoplasma pneumonia
-small, pleomorphic, G+, no cell wall, prominent capsule

Signs & Symptoms
Onset is gradual
-1 to 4 week incubation period
First symptoms include:
-fever, headache, muscle pain fatigue, sore throat and excessive sweating
-atypical for pneumonia
-persistent dry cough for several weeks

Organism attaches to receptors on epithelium
-adhesion protein
-interferes with cilia, cells die and slough off
-capsule protects if from phagocytosis
-inflammation initiates thickening of bronchial and alveolar walls: causes difficulty in breathing

Epidemiology
Epidemiology
-spread through aerosol droplets: survival for long periods in secretions
-grow slowly in culture: 2-6 weeks for “fried egg” colonies to appear
-diagnosis difficult: serological tests required

Prevention and Treatment
No practical prevention
-avoid crowding in schools and military facilities
-aseptic techniques
Antibiotic treatment
-Penicillins are ineffectual [WHY?]
-antibiotics of chioce are Tetracycline and Erythromycin

Pertussis
Pertussis
-whooping cough
-Causative Agent: Bordetella pertussis
-small, G-, encapsulated, coccobacillus

Signs & Symptoms
Catarrhal Stage: cold symptoms [1-2 weeks]
Paroxysmal Stage: sever coughing [2-4 weeks]
-coughing followed by characteristic “whoop”
-may cause vessels in eyes to rupture
-cyanosis [bluish color turing of skin bc of lack of oxygen]
-vomiting, diarrhea and seizure may occur
Convalescent Phase: persistent cough [months]

Pathogen enters
Pathogen enters respiratory tract and attaches to ciliated cells
Produces 2 forms of adhesions:
-colonizes upper and lower respiratory tract
Produces numerous toxin products:
-mucus secretion increases and cilia action decreases
-cough reflex is only mechanism for clearing secretions
-decreased blood flow and WBC activity

Epidemiology
-spreads via infected respiratory droplets
-highly contagious
-most infectious during runny nose period
-classically disease of infants
-often overlooked as a persistent cold in adults
-high risk of secondary infections
[diagnosis: antibody tests]

Prevention and Treatment
Immunization:
-combined with Diphtheria and tetanus toxoids
Treatment:
-primarily supportive
-Erythromycin may reduce infectivity if given early

Tuberculosis
Tuberculosis
TB, Consumption
-Causative Agent: Mycobacterium tuberculosis
-G+, acid fast, slender bacillus, cord factor [acts like a toxin]

Signs & Symptoms
-chronic illness
Initial symptoms:
-minor cough and mild fever
Progressive symptoms:
-fatigue, night sweats, weight loss, chest pain and labored breathing
-chronic productive cough: sputum often bloody

3 Types of Tuberculosis
Primary TB: initial case of tuberculosis disease
Secondary TB: reactivated
Disseminated TB: tuberculosis involving multiple systems

Primary TB
-transmitted through respiratory droplets
-pathogens taken up by alveolar macrophages: fusion of phagosome with lysosomes prevented
-pathogen replicates inside macrophages slowly killing them
-intense immune reaction occurs: WBCs surround infected cells and release inflammatory chemicals

Primary TB [continued]
Primary TB [continued]
-other body cells deposit collagen fibers
-macrophages and lung cells form tubercle
-infected cells die producing caseous [cheesy] necrosis
-body may deposit calcium around tubercles: Ghon complex

Secondary TB
-tubercle ruptures and reestablishes active infection
-more common in immunosuppressed
-leading killer of HIV+ individuals

Disseminated TB
-some macrophages carry pathogen through blood and lymph to other sites of body
-bone marrow, spleen, kidneys, spinal cord and brain

Secondary and Disseminated pathways of TB
Secondary and Disseminated pathways of TB

Epidemiology
-1/3 of world population infected
-annual mortality of ~2 million [4 ppl a minute die]
-estimated 10 million Americans infected: rate highest among non-white, elderly poor people
-small infecting does: as little as ten inhaled organisms, not very virulent but high mortality

Tuberculin Test
Tuberculin Test
-tuberculosis antigen injected under skin
-injection site become red and firm if positive
-positive test does not indicate active disease
-definitive tests include sputum samples and chest x-rays

Prevention
-vaccination used in other parts of the world
-prophylactic antibacterial treatment for exposed individuals

Treatment
Antibiotic treatment
-Rifampin, Isoniazid, Streptomycin and Ethambutol
MDR [Multi Drug Resistant] strains
-XDR [Extensively Resistant Strands] resistant to Rifampin and Isoniazid and other drugs
-therapy lasts up to 6 months, DOTS [Directly Observed Treatment Short course] system

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