Legionella Bordetella Haemophilus

8/9/2019 Legionella Bordetella Haemophilus

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1

PAMB 650 Medical MicrobiologyPAMB 650 Medical Microbiology

Lecture: 41Lecture: 41

Legionella Legionella ,, Bordetella Bordetella

andand Haemophilus Haemophilus

Gram Negative od! o" t#e e!$iratory %ractGram N

egative od! o" t#e e!$iratory %ract


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&rgani'ation o" Lecture&rgani'ation o" Lecture1(1( &vervie)&vervie)

*(*( &rgani!m! o" +linical m$ortance&rgani!m! o" +linical m$ortance

-(-( MicrobiologyMicrobiology

4(4( Public .ealt#Public .ealt#

5(5( Pat#ogenic Mec#ani!m!Pat#ogenic Mec#ani!m!6(6( +linical Pre!entation+linical Pre!entation


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LEGIONELLA LEGIONELLA


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LEGIONELLAE LEGIONELLAE

OverviewOverview /acultative intracellular $at#ogen/acultative intracellular $at#ogen Gram negative rodGram negative rod e uire! !$eciali'ed media to gro)e uire! !$eciali'ed media to gro) tain! $oorly )it# gram !taintain! $oorly )it# gram !tain %ran!mitted via contaminated aero!ol!%ran!mitted via contaminated aero!ol!

No $er!on to $er!on tran!mi!!ionNo $er!on to $er!on tran!mi!!ion


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** $ecie!$ecie! o" +linical m$ortanceo" +linical m$ortance Legionella Legionella

One genusOne genus 50 species50 species

of species implicated in human disease of species implicated in human disease Legionella pneumophila Legionella pneumophila

Causes ~ 90% of all cases of legionellosisCauses ~ 90% of all cases of legionellosis

Majority of all confirmed cases are caused y serogroups !"#Majority of all confirmed cases are caused y serogroups !"#

Legionella micdade Legionella micdade Most common afterMost common after L. pneumophila L. pneumophila


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Legionella micdadei Legionella micdadei

+aution:+aution: $his strain can stain ea&ly acid fast on primary$his strain can stain ea&ly acid fast on primary

isolation' ut loses this property hen gro n inisolation' ut loses this property hen gro n in(itro)(itro)

N&N& *+,-$.O/ 1.2 $O M3CO4-C$+*.-*+,-$.O/ 1.2 $O M3CO4-C$+*.-


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2ill not gro)2ill not gro) on !tandard #ee$ Blood Agaron !tandard #ee$ Blood Agar

Bu""ered +#arcoal 3ea!t tract Agar B+3 7Bu""ered +#arcoal 3ea!t tract A gar B+3 71(1( +y!teine+y!teine i! e!!ential "or gro)t#i! e!!ential "or gro)t#*(*( ronron i! e!!ential "or gro)t#i! e!!ential "or gro)t#

Gro)t# condition!:Gro)t# condition!:1(1( -5-5 00 ++*(*( -89 day!-89 day!

MicrobiologyMicrobiology


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+olony A$$earance:+olony A$$earance:

Ground gla!!Ground gla!! mall 18- mmmall 18- mm


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9

+ulture+ulture o"o" Legionella Legionella organi!m "romorgani!m "rom normallynormally!terile ti!!ue!terile ti!!ue

etection o"etection o" L. pneumophila L. pneumophila antigen in urineantigen in urine

eroconver!ioneroconver!ion : 4 "old or greater ri!e in !$eci"ic: 4 "old or greater ri!e in !$eci"ic

!erum antibody titer!erum antibody titer L. pneumophila L. pneumophila irect "luore!cent antibodyirect "luore!cent antibody /A7 !taining/A7 !taining

Laboratory iagno!i! o"Laboratory iagno!i! o"

Legionella Legionella


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10

Legionnaire!Legionnaire! di!ea!e8di!ea!e8

PublicPublic .ealt#.ealt#

isease " 6orld ideisease " 6orld ide poradicporadic +pidemic community"ac7uired pneumonia+pidemic community"ac7uired pneumonia

/osocomial infections /osocomial infections+8posure " 6ater" ased aerosols+8posure " 6ater" ased aerosols -ir conditioning cooling to ers-ir conditioning cooling to ers 6hirlpool spas6hirlpool spas auna or mister auna or mister

ur(i(al +n(ironmentur(i(al +n(ironment -moe ae-moe ae 4iofilms4iofilms


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11

Legionnaire;!Legionnaire;! di!ea!edi!ea!e ncubation $eriod *810 day!ncubation $eriod *810 day! $neumonia$neumonia 15895< mortality15895< mortality

eryt#romycineryt#romycin

Pontiac "everPontiac "ever ncubation $eriod 18* day!ncubation $eriod 18* day!

"lu8li=e"lu8li=e

milder no mortality7milder no mortality7 !el"8limiting!el"8limiting

** +linical Pre!entation!+linical Pre!entation!


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PA%.&G N &/PA%.&G N &/ LEGIONELLA LEGIONELLA

P#agocyto!i! into t#e monocyte!P#agocyto!i! into t#e monocyte!binding to com$lement rece$tor!binding to com$lement rece$tor!

n#ibition o" $#agoly!o!ome "u!ionn#ibition o" $#agoly!o!ome "u!ion e$lication )it#in t#e $#ago!omee$lication )it#in t#e $#ago!ome

Ly!i! o" t#e $#ago!ome lead! to a$o$to!i! andLy!i! o" t#e $#ago!ome lead! to a$o$to!i! and

relea!e o" t#e organi!mrelea!e o" t#e organi!m

%.1 cell! and /N8%.1 cell! and /N8 >>
http://medecinepharmacie.univ-fcomte.fr/bacterio_web/exa_microscopiques/bgn.htm


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Bordetella Bordetella
http://medecinepharmacie.univ-fcomte.fr/bacterio_web/exa_microscopiques/bgn.htmhttp://medecinepharmacie.univ-fcomte.fr/bacterio_web/exa_microscopiques/bgn.htmhttp://medecinepharmacie.univ-fcomte.fr/bacterio_web/exa_microscopiques/bgn.htm


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Bordetella pertussis Bordetella pertussis

trict aerobetrict aerobe

Gram negativeGram negative

mall +occobacillu! 8!ingly or in $air!mall +occobacillu! 8!ingly or in $air!

%ran!mi!!ion by aero!oli'ed dro$let!%ran!mi!!ion by aero!oli'ed dro$let!

Non8inva!iveNon8inva!ive

trictly #uman $at#ogentrictly #uman $at#ogen


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B. pertussis B. pertussis mall, tran!$arent #emolytic colonie! onmall, tran!$arent #emolytic colonie! on

Bordet8Gengou mediumBordet8Gengou medium


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iagno!i!iagno!i!

Ba!ed on !ym$tom!Ba!ed on !ym$tom!

+ulture o" re!$iratory !ecretion! on Bordet8+ulture o" re!$iratory !ecretion! on Bordet8

GengouGengou mediummedium irect "luore!cent antibody te!tingirect "luore!cent antibody te!ting

P+ P+

lide agglutinationlide agglutination


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Public .ealt# A!$ect! o"Public .ealt# A!$ect! o" B. B.

pertussis ( pertussis ( Whooping oughWhooping ough ! !


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August 2, 2010

WHOOPING COUGH EPIDEMIC GROWS HEALTH OFFICIALS URGE VACCINATION AND TIMELY DIAGNOSIS

As of July 27, the number of illnesses from the disease this year hadclimbed to 2,174, a six-fold increase from the 49 illnesses re!orted for thesame !eriod last year" #n addition, a $an %iego &ounty infant has becomethe se'enth to die from !ertussis this year"

()he !ertussis e!idemic is a sobering and tragic reminder that diseaseslong thought controlled can return *ith a 'engeance,+ orton said" ( e can!rotect oursel'es and the most 'ulnerable in our community by getting'accinated today"+


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%uring January--June in &alifornia1". /9 of cases *ere among infants aged months

too young to be fully immuni3ed2"&hildren aged 7 to 9 years and 10 to / years

10"1 cases and 9" cases !er 100,000, res!ecti'ely"

f 4 case re!orts1"105 61 " !atients *ere hos!itali3ed,2" 6 2"9 *ere months"

"#ncidence among is!anic infants 649"/ cases !er 100,000 *as higher thanamong other racial8ethnic !o!ulations"4"5 deaths *ere re!orted, all in !re'iously healthy is!anic infants aged 2 monthsat disease onset none had recei'ed any !ertussis-containing 'accines"

)he incidence of !ertussis is cyclical, *ith !ea:s occurring e'ery --5 years in the

;nited $tates 6 2 " )he last !ea: *as in 2005, *hen a!!roximately 25,000 cases

*ere re!orted nationally"

Morbidity and Morta ity W!!" y R!#ort $ MMWR)

%& y '( )*+* , -'$)./01+2
http://www.cdc.gov/mmwr/http://www.cdc.gov/mmwr/http://www.cdc.gov/mmwr/http://www.cdc.gov/mmwr/http://www.cdc.gov/mmwr/


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2ertussis -mong -dolescents and2ertussis -mong -dolescents and-dults-dults

isease often milder than in infants and childrenisease often milder than in infants and children .nfection may e asymptomatic' or may present.nfection may e asymptomatic' or may present

as classic pertussisas classic pertussis 2ersons ith mild disease may transmit the2ersons ith mild disease may transmit the

infectioninfection Older persons often source of infection forOlder persons often source of infection for

childrenchildren


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Pertu!!i!8 i!ea!ePertu!!i!8 i!ea!e

Primarily a to in8mediated di!ea!ePrimarily a to in8mediated di!ea!e

oto in! are controlled by central locu!oto in! are controlled by central locu! BvgA" BvgA" t)o8com$onent !ignal tran!duction !y!tem to !en!e t#et)o8com$onent !ignal tran!duction !y!tem to !en!e t#e

environment and regulate gene e $re!!ionenvironment and regulate gene e $re!!ion


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Pertu!!i!8 i!ea!ePertu!!i!8 i!ea!e

n"lammation inter"ere! )it# clearance o"n"lammation inter"ere! )it# clearance o"$ulmonary !ecretion!$ulmonary !ecretion! +oug# $rogre!!e! "rom mild catarr#al !tage7 to !ever+oug# $rogre!!e! "rom mild catarr#al !tage7 to !ever

$aro y!mal !tage7$aro y!mal !tage7

e!olve! !lo)lye!olve! !lo)ly

va!ion o" #o!t de"en!e!va!ion o" #o!t de"en!e! Pertu!!i! antigen! allo) eva!ion o" #o!t de"en!e!Pertu!!i! antigen! allo) eva!ion o" #o!t de"en!e!

Lym$#ocyto!i! $romoted but im$aired c#emota i!Lym$#ocyto!i! $romoted but im$aired c#emota i!


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Pertu!!i! Pat#ogene!i!Pertu!!i! Pat#ogene!i!

%)o8!tage $roce!! o" di!ea!e%)o8!tage $roce!! o" di!ea!e e!$iratory coloni'atione!$iratory coloni'ation

9810 day!9810 day!

N& !ym$tom!N& !ym$tom!

Po!itive culture! to)ard t#e end o" t#i! !tagePo!itive culture! to)ard t#e end o" t#i! !tage

%o in8mediated di!ea!e%o in8mediated di!ea!e


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+oloni'ation+oloni'ation

Attac#ment re uire! multi$le "actor!Attac#ment re uire! multi$le "actor!

Pertu!!i! %o inPertu!!i! %o in /ilamentou! #emagglutinin/ilamentou! #emagglutinin /imbriae/imbriae


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!)!) /ilamentou! #emagglutinin/ilamentou! #emagglutinina(a( ominant ad#e!inominant ad#e!inb(b( e uired "or trac#eal coloni'atione uired "or trac#eal coloni'ationc(c( .ig#ly immunogenic.ig#ly immunogenic

d(d( Primary com$onent o" acellular $ertu!!i! vaccine!Primary com$onent o" acellular $ertu!!i! vaccine! *(*( /imbriae/imbriae

a(a( e uired "or $er!i!tent trac#eal coloni'atione uired "or $er!i!tent trac#eal coloni'ation

b(b( +om$onent o" !ome acellular $ertu!!i! vaccine!+om$onent o" !ome acellular $ertu!!i! vaccine!c(c( e uired "or $rotective immunity to in"ectione uired "or $rotective immunity to in"ection

-dhesins-dhesins


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Bordetella pertussis Bordetella pertussis%o in!%o in!

??

// N% %&? N// N% %&? N


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y!temic e""ect! o" Pertu!!i! %o iny!temic e""ect! o" Pertu!!i! %o in

!)!) $ cell ,ymphocytosis ith mitogenicity$ cell ,ymphocytosis ith mitogenicity

:):) ;; insulin secretioninsulin secretion

) ;; .g+ production.g+ production

5)5) .mpaired phagocyte function.mpaired phagocyte function

#)#) - 2"ri osylates ? proteins- 2"ri osylates ? proteins

@)@) trong adju(anttrong adju(ant

A)A) 2rimary component of pertussis (accines2rimary component of pertussis (accines


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*( Adenylate cycla!e %o in*( Adenylate cycla!e %o in Calmodulin"acti(ated ithCalmodulin"acti(ated ith adenylate cyclase and hemolysinadenylate cyclase and hemolysin acti(ityacti(ity -cts as anti"inflammatory and antiphagocytic factor -cts as anti"inflammatory and antiphagocytic factor ecretedecreted in(asi(ein(asi(e to8into8in

calmodulin

B. pertussis

Adenylatecyclase toxin


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-(-( ermonecrotic to in N%7ermonecrotic to in N%7A(A( .eat8labile !ecreted to in.eat8labile !ecreted to inB(B( %ran!glutamina!e activity t#at act! on !mall G%Pa!e! o" t#e #o "amily%ran!glutamina!e activity t#at act! on !mall G%Pa!e! o" t#e #o "amily+(+( nduce! locali'ed necro!i!nduce! locali'ed necro!i!

F&"&i( A3 !t a 3 % 4io56!7 )**8 +9.:8+-;8+'0 doi:+*3+*'9,henoty!ic =odifications seen1"?eorgani3ation of

actin cytos:eletalfocal adhesionsstress fibers

2"Alterations in cell mor!hology

?ho

@%>

?ho

@%>

>olyaminated

% )

Bffectors

?ho

@)>

>olyaminated

&t#er %o in!:&t#er %o in!:


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4(4(

%rac#eal cytoto in%rac#eal cytoto in-)-) isaccharide"tetrapeptide monomeric y"product of peptidoglycan synthesisisaccharide"tetrapeptide monomeric y"product of peptidoglycan synthesis4) Causes damage to cilia' and loss of ciliated cells4) Causes damage to cilia' and loss of ciliated cellsC) .ncreased .,"! and nitric o8ide productionC) .ncreased .,"! and nitric o8ide production

5(5( %y$e !ecretion !y!tem%y$e !ecretion !y!tem-)-) -llo s-llo s Bordetella to translocate effector proteins directly into Bordetella to translocate effector proteins directly into host cellshost cells4)4) *e7uired for persistent tracheal coloni=ation*e7uired for persistent tracheal coloni=ationC)C) .nhi its host immune response.nhi its host immune response

)) .nduces necrotic cell death.nduces necrotic cell death

6(6( Li$o$oly!acc#aride LP 7Li$o$oly!acc#aride LP 7-)-) 2yrogenic2yrogenic4)4) MitogenicMitogenicC)C) -cti(ate and induce tumor necrosis factor production in macrophages-cti(ate and induce tumor necrosis factor production in macrophages

)) ,2 lac&s a repetiti(e O"antigenic structure,2 lac&s a repetiti(e O"antigenic structure

&t#er %o in!:&t#er %o in!:


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%reatment%reatment

ryt#romycinryt#romycin @accine@accine

=illed bacterial cell !u!$en!ion 8 %P vaccine=illed bacterial cell !u!$en!ion 8 %P vaccine @accine8 induced immunity )ane! a"ter "ive to@accine8 induced immunity )ane! a"ter "ive to

ten year!ten year! acellular vaccine! %aP7acellular vaccine! %aP7

Multicom$onent acellular vaccine!Multicom$onent acellular vaccine!


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.aemo$#ilu!.aemo$#ilu!


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&vervie)8 .aemo$#ilu!&vervie)8 .aemo$#ilu!

mallmall

Non8motileNon8motile

Gram8negative rod!Gram8negative rod! %ran!mitted via re!$iratory dro$let!, or%ran!mitted via re!$iratory dro$let!, or

direct contact )it# contaminated !ecretion!direct contact )it# contaminated !ecretion!

Normal "lora o" t#e #uman re!$iratoryNormal "lora o" t#e #uman re!$iratorytract and oral cavity(tract and oral cavity(


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Haemophilus Haemophilus !$ecie! o"!$ecie! o"clinical im$ortanceclinical im$ortance

1(1( H. in#luen$ae H. in#luen$ae88ty$e b i! an im$ortant #uman $at#ogenty$e b i! an im$ortant #uman $at#ogen

*(*( H. ducre%i H. ducre%i 88!e ually tran!mitted $at#ogen c#ancroid7!e ually tran!mitted $at#ogen c#ancroid7

-( &t#er-( &t#er Haemophilus Haemophilus are normal "loraare normal "lora88 H. parain#luen$ae & H. parain#luen$ae & $neumonia endocarditi!$neumonia endocarditi!

88 H. aphrophilus & H. aphrophilus & $neumonia endocarditi!$neumonia endocarditi!

88 H. aeg%ptius & H. aeg%ptius & $in= eye $urulent con unctiviti!7$in= eye $urulent con unctiviti!7


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i""erentiation o" $ecie!i""erentiation o" $ecie!

H!7o y>i>H!7o y>i>? Y? Y

Gro@t6Gro@t6Fa5tor Fa5tor


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Public .ealt# A!$ect!8Public .ealt# A!$ect!8 H. in#luen$ae H. in#luen$ae

%y$ing ba!ed on ca$!ule $oly!acc#aride a%y$ing ba!ed on ca$!ule $oly!acc#aride a C " C "

Polyribo!e8ribitol $#o!$#ate P P7 ca$!ule ty$e b7Polyribo!e8ribitol $#o!$#ate P P7 ca$!ule ty$e b7

Nonenca$!ulated nonty$eable7 organi!m! are $artNonenca$!ulated nonty$eable7 organi!m! are $arto" normal "lora o" t#e re!$iratory tracto" normal "lora o" t#e re!$iratory tract

D5< o" inva!ive di!ea!e cau!ed by ty$e bD5< o" inva!ive di!ea!e cau!ed by ty$e b


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Public .ealt# A!$ect!Public .ealt# A!$ect!

H. in#luen$ae H. in#luen$ae ty$e b incidence #a! "allenty$e b incidence #a! "allenDD< $o!t8vaccineDD< $o!t8vaccine

Pre8immuni'ationPre8immuni'ation eroty$e b )a! t#e mo!t common inva!iveeroty$e b )a! t#e mo!t common inva!ive

!$ecie!!$ecie!


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Po!t8immuni'ationPo!t8immuni'ation Mo!t ca!e! in unvaccinated or incom$letelyMo!t ca!e! in unvaccinated or incom$letely

vaccinated c#ildren(vaccinated c#ildren(

Non8enca$!ulated and !eroty$e " are t#e mo!tNon8enca$!ulated and !eroty$e " are t#e mo!t

commoncommon

+#ildren 8 Pneumonia and meningiti! le!! common+#ildren 8 Pneumonia and meningiti! le!! common

Mo!t in"ection! E*F-7 are currently attributed toMo!t in"ection! E*F-7 are currently attributed tononty$eable !train!(nonty$eable !train!(


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i!ea!e cau!ed byi!ea!e cau!ed by H. in#luen$ae H. in#luen$ae "erot%pe ' "erot%pe '

&linical =icrobiology ?e'ie*s, A!ril 2000, !" 02- 17, Col" 1 , o" 2


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nva!ive i!ea!e! $o!t8immuni'ationnva!ive i!ea!e! $o!t8immuni'ation

e$tic art#riti!e$tic art#riti!

&!teomyeliti!&!teomyeliti!

+elluliti!+elluliti! Pericarditi!Pericarditi!

Pneumonia 8 mo!t "re uent i! !eroty$e " Pneumonia 8 mo!t "re uent i! !eroty$e "

&titi! media&titi! media "treptococcus pneumoniae "treptococcus pneumoniae and t#en non8ty$eable .iand t#en non8ty$eable .i


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Pat#ogenic Mec#ani!m!Pat#ogenic Mec#ani!m!

H. in#luen$ae H. in#luen$ae Anti$#agocyticAnti$#agocytic $oly!acc#aride ca$!ule$oly!acc#aride ca$!ule i! t#ei! t#e

ma or $at#ogene!i! "actorma or $at#ogene!i! "actor

Li$o$oly!acc#aride li$id A com$onent "rom t#eLi$o$oly!acc#aride li$id A com$onent "rom t#ecell )all ma or role in non ca$!ule !train!7cell )all ma or role in non ca$!ule !train!7

All virulent !train! $roduceAll virulent !train! $roduce neuraminida!eneuraminida!e andandanan gA $rotea!egA $rotea!e

No e oto in!No e oto in!
http://medinfo.ufl.edu/year2/mmid/bms5300/images/d7128.jpg


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.ib con ugate vaccine P P ca$!ule7.ib con ugate vaccine P P ca$!ule7

%#e .ib con ugate vaccine doe! not $rotect%#e .ib con ugate vaccine doe! not $rotectagain!t nonty$eable !train!(again!t nonty$eable !train!(

Per!on! at ri!= "or inva!ivePer!on! at ri!= "or inva!ive H in#luen$ae H in#luen$ae di!ea!edi!ea!e A!$leniaA!$lenia

mmunocom$romi!edmmunocom$romi!ed

Pat#ogene!i! .o!t /actor!Pat#ogene!i! .o!t /actor!


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Public .ealt# A!$ect o" ot#erPublic .ealt# A!$ect o" ot#er Haemophilus Haemophilus !train!!train!

H. ducre%i H. ducre%i e ually tran!mitted di!ea!e 8 c#ancroide ually tran!mitted di!ea!e 8 c#ancroid

H. in#luen$ae H. in#luen$ae biogrou$biogrou$ aeg%ptiusaeg%ptius Bra'ilian Pur$uric /everBra'ilian Pur$uric /ever

H. aeg%ptius H. aeg%ptius

HH

$in= eyeI $urulent con unctiviti!7$in= eyeI $urulent con unctiviti!7

H. aphrophilus H. aphrophilus $neumonia$neumonia n"ective endocarditi!n"ective endocarditi!


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Haemophilus Haemophilus in#luen$aein#luen$ae biogrou$biogrou$ aeg%ptiusaeg%ptius

Bra'ilian $ur$uric "ever in c#ildrenBra'ilian $ur$uric "ever in c#ildren

.ig# "ever.ig# "ever eat# )it#in 4J #our!eat# )it#in 4J #our!


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Case StudyCase Study HistoryHistory

13 year old white male13 year old white male fully vaccinatedfully vaccinated cold-like symptoms and persistentcold-like symptoms and persistent

cough- 10 days durationcough- 10 days duration 2 weeks later2 weeks later

progressive coughing spells withprogressive coughing spells withinspiratory whoopinspiratory whoop

posttussive vomitingposttussive vomiting


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Case StudyCase Study

%e!t!%e!t! Na!o$#aryngeal !)ab!Na!o$#aryngeal !)ab!

Bordet8GengouBordet8Gengou mediummedium

Blood !am$le! "or !erologyBlood !am$le! "or !erology $o!itive gM and gA antibodie!$o!itive gM and gA antibodie!

%reatment%reatment

a'it#romycina'it#romycin


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Case StudyCase Study

HistoryHistory 4 month old white female4 month old white female 1 day history1 day history

10310300

fever, lethargy, irritability, stiff neckfever, lethargy, irritability, stiff neck TestsTests

Cerebral spinal uid cultureCerebral spinal uid culture !o@itale?8enric#ed!o@itale?8enric#ed c#ocolate agarc#ocolate a gar

Documents

Legionella Bordetella Haemophilus