E Hagni Wardoyo-Respiratory Tract Infections Blok Respirasi

8/12/2019 E Hagni Wardoyo-Respiratory Tract Infections Blok Respirasi

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Respiratory tract infectionE. Hagni Wardoyo

Clinical MicrobiologyMataram, 4 Juni 2014


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Anatomy


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Functional perspective

deliver air from the outside to the alveoli ALL THE TIME Increase the risk of microorganisms colonization and infectio

Anatomical barrier of infection

Normal biota barrier


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Anatomical barrier

nasal hair, mucociliary cells

coughing,

secretory immunoglobulin,

defensins,

phagocytic inflammatory cells


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Normal biota

The normal biota of the nasopharynx and oropharynx helpsthe host by preventing colonization by pathogenic organism

for the same nutrients

and the same receptor sites on host cells.

produce bacteriocins: bacterial products that are toxic to popathogens


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Normal biota stimulate natural immunesystem of the host

Preventscolonization

of pathogen

keeps the immunesystem primed fora rapid response

to invading

organisms

stimulates crosprotective

immune facto

known as natu

antibodies


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Normal biota bacteria usually present

Streptococcus mitisand other -hemolytic streptococci

Nongroup A -hemolyticstreptococci

Streptococcus pneumoniae

Streptococcus pyogenes

Streptococcus salivarius

Veillonellaspp.

Bacteroidesspp.

Fusobacteriumspp.

Prevotellaspp.

Porphyromonasspp.

Coagulase-negative staph

Neisseriaspp.

Nonhemolytic streptococ

Diphtheroids Micrococcusspp.

Eikenellaspp.

Capnocytophagaspp.


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Normal biota

bacteria occasionally present

Haemophilus influenzae

Haemophilus parainfluenzae

Peptostreptococcus

Actinomycetes

Staphylococcus aureus

Mycoplasma

Fungus and virus

Candida spp

Herpes simplex virus


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Normal biota shifting

Common normalbiota

Differentpharyngeal biota


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Detect microorganism: colonize or infec

Microorganismsisolated from the

pharynx

Colonization?Infection?


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Things to consider

Microorganism detection primary or possible pathogen?

A high-quality sample improve the clinical value of tculture results

A high-quality sample [i.e sputum] meaning minimizes contamination by oral biota

is collected before initiation of antibiotic

Interpretation of the result must be based on several factors Characteristics of the specimen

Which compatible clinical syndrome should be present

the presence of a potential pathogen is clinically relevant


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Selected Nonviral Pathogens in theRespiratory Tract

Primary Pathogens Streptococcus

pneumoniae

Group A -hemolyticstreptococci

Neisseriameningitidis

Neisseriagonorrhoeae

Bordetella pertussis

Mycobacteriumkansasii

Mycobacteriumtuberculosis

Legionellapneumophila

Toxin-producingCorynebacteriumdiphtheriae

Mycoplasmapneumoniae

Chlamydiatrachomatis

Chlamydophilapneumoniae

Pneumocystis jiroveci(carinii)

Possible Pathogens Acinetobacter spp.

Enterics and other gram-negative b

Fungi

Nocardiaspp.

Staphylococcus aureus

Haemophilus influenzae

-Hemolytic streptococci, nongrou

Moraxella catarrhalis

Anaerobes

Mycobacteriumspp.

Actinomycetes


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Case analysis 1

Microbiology diagnostic flow

few colonies

Staphylococcusaureus from a

sputum specimen

Quality of sputum

Low leukocyte, high

epithelial cells

Clinically relevant

Young man with

mild symptoms ofcoughing


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Case analysis 2

Microbiology diagnostic flow

heavy growth

coloniesStaphylococcus

aureus from a

sputum specimen

Quality of sputum

High leukocyte, low

epithelial cells

Clinically relevant

an elderly man with

post-influenzapneumonia


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Seasonal and Community Trends in Infe

Viral: seasonal infections of the respiratory tract

Mycoplasma pneumonia occur throughout the year, withouseasonal variability


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Microbial diagnostic flow


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Alur prosedur Lab MK

Pra-

analitik

Intra-

analitik

Pasca-

analitik

Mikrobiologi Klinik

Klinisi terkait Klinisi terkait

Konsensus prosedur laboratorium Mikrobiologi klinik-PAMKI 2


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Diagnosis mikrobiologi

Keterangan klinis pasien dapat mengarahkan jenis mikroorgyang diharapkan: bakteri, virus, jamur

Jika diagnosis menjurus pada bacterial Direct smeardiagnosis presumtif pemilihan antibiotika empi

pemilihan media pembenihan

Diferensiasi kolonisasi dan infeksi kualitas specimen

Proses pembenihan only strong suggested pathogen will highlygrowth expected

Identifikasi

Uji AST memerlukan pertumbuhan ulang pada media MHA dengankuman terstandar

TAT antara 36-72 jam


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Viral

Direct smear tidak aplikatif

Kultur virus (tidak rutin)

Memerlukan media telur, sel HeLa

Lama

Polymerase chain reaction (TAT 3-4 jam)

Lebih cepat dan sensitive Uji AST (tidak rutin)

Infeksi virus HIV


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Fungal

Direct smear

Hyphae

Filamen

Spora

Budding yeast

Kultur

Menggunakan media Saborroud agar

Pertumbuhan 1-2 minggu

Uji sensitivitas antifungal (tidak rutin)

Hanya pada infeksi jamur dimorfik atau yeast (Candida spp)


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Upper Respiratory TractInfections


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Case

Seorang anak laki-laki usia 4 tahun yang tidak menerima vak

rutin dibawa ke klinik dengan riwayat demam sejak 6 jam ylkesulitan menelan. Pemeriksaan fisik ditemukan stridor inspVisualisasi epiglottis dengan proteksi airway menunjukkan akemerahan dan edema


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Direct swab cultures of the epiglottis

Blood cultures


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d h l


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Proceed with culture

Id ifi i


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Identification

A ibi i ibili i


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Antibiotic susceptibility testing

T i k ih


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Terimakasih

CR Mahon, DC Lehman, G Manusellis. Textbook of Diagnost

Microbiology. 4th edition. 2011. WB Saunders. Missouri

Konsensus Mikrobiologi. 2005. Jakarta

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E Hagni Wardoyo-Respiratory Tract Infections Blok Respirasi