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Diseases of the Respiratory Tract

Microbiology presentation.
by

Rachel Wilson

on 24 April 2014

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Transcript of Diseases of the Respiratory Tract

Diphtheria
Bacterial infection of the upper respiratory tract. Characterized by sore throat, fever and pseudo membrane on the tonsils, pharynx and nostrils. The membrane then blocks airways which can suffocate those infected if serious enough, or just have them struggle to breathe.
Pharyngitis
Pharyngitis is characterized as inflammation of the throat in which the host experiences pain and swelling. The range of pain and symptoms the host feels are dependent on the causative agent.
Sinusitis
Tuberculosis
Tuberculosis (TB) is caused by a bacterium called
Mycobacterium tuberculosis
. The bacteria usually attack the lungs, but TB bacteria can attack any part of the body such as the kidney, spine, and brain. If not treated properly, TB disease can be fatal.
Influenza
The influenza virus, commonly known as the flu, is an infectious disease of birds and mammals caused by RNA viruses. Commonly confused with a cold, the flu is a much more severe disease and caused by a different virus
Infections of the Respiratory Tract
Causes
TB is spread through the air from one person to another. The TB bacteria are put into the air when a person with TB disease of the lungs or throat coughs, sneezes, speaks, or sings. People nearby may breathe in these bacteria and become infected. The resulting lung infection is called primary TB

A.K.A. The Sinus Infection
Introduction
Upper Respiratory Tract
Parts Include:
-The Nose or Nostrils
-Nasal Cavity
-Sinuses (4)
-Frontal Sinus
-Ethmoid Sinus
-Maxillary Sinus
-Sphenoid Sinus
-Oral Cavity
-Pharynx
-Epiglottis
-Larynx
Lower Respiratory Tract
Parts Include:
-Trachea
-The Lungs
-The Bronchi
-Bronchioles
-Alveoli
The functions of the respiratory system are:
1) Gas exchange between carbon dioxide and oxygen
2) Supplying oxygen to the heart and blood streams

Rhinitis
A.K.A. The Common Cold

Acute Otitis Media
A.K.A. The Ear Infection
Whooping Cough
Respiratory Syncytial Virus Infection
Pneumonia
Rhinitis is characterized by its symptoms of sneezing, scratchy throat, headache, sinus throbbing, and a runny nose.
Much like the common cold that starts out with runny nose, congestion and a fever, then 1-2 weeks, severe coughing begins.
Most people recover from primary TB infection without further evidence of the disease. The infection may stay inactive (dormant) for years. However, in some people it can reactivate.

Most people who develop symptoms of a TB infection first became infected in the past. In some cases, the disease becomes active within weeks after the primary infection.
Bordetella Pertussis is a very small, gram- negative rod. Strictly aerobic and fastidious because it has specific nutrient requirements for a successful culture.
TB is NOT spread by
•shaking someone’s hand
•sharing food or drink
•touching bed linens or toilet seats
•sharing toothbrushes
•kissing

TB bacteria can live in the body without making you sick. In most people who breathe in TB bacteria and become infected, the body is able to fight the bacteria to stop them from growing. People with latent TB infection do not feel sick and do not have any symptoms. People with latent TB infection are not infectious and cannot spread TB bacteria to others. However, if TB bacteria become active in the body and multiply, the person will go from having latent TB infection to being sick with TB disease.
The causative agent for Rhinitis is difficult to locate EXACTLY because Rhinitis can be caused by
approximately 200 viruses.



TB bacteria become active if the immune system can't stop them from growing. When TB bacteria are active (multiplying in your body), this is called TB disease. People with TB disease are sick. They may also be able to spread the bacteria to people they spend time with every day.

Many people who have latent TB infection never develop TB disease. Some people develop TB disease soon after becoming infected (within weeks) before their immune system can fight the TB bacteria. Other people may get sick years later when their immune system becomes weak for another reason.
TB Latent
sweating at night
pain in the chest
coughing up blood or sputum
weakness or fatigue
a bad cough that lasts 3 weeks or longer
weight loss
no appetite
chills
fever
No known place of origin. First outbreaks were described in 16th century, but the first culture wasn't isolated until 1906 by Juler Bordet and Octave Gengou. Wasn't made into a vaccine until the 1920's by Dr. Louis W. Sauer.
TB Disease
However, the most common type of virus that leads to Rhinitis is the group called the rhinoviruses. Of the group of rhinoviruses, there are 99 serotypes.
Serotype: a group of organisms, microorganisms,
or cells distinguished by their shared specific antigens
**There is no treatment for Rhinitis.**
**There is only treatment for Rhinitis symptoms**
Treatment
-Sinusitis is an inflammatory condition of any of the four sinuses in the skull
-Most often caused by allergies, infections, or structural problems in the nose.
-Such as narrow passageways or a deviated septum
Since this is a bacterial infection, it can be treated with antibiotics. The most commonly used antibiotic is Erythromycin, used for 2 weeks. Does wonders when used after first notice of infection. Skipping doses could possibly result in relapse of the infection, or the infection becoming resistant to the antibiotic.
Symptoms
On March 24, 1882, Dr. Robert Koch announced the discovery of
Mycobacterium tuberculosis
. During this time, TB killed one out of every seven people living in the United States and Europe.
Respiratory virus that infects the lungs and breathing passages. Can commonly cause Bronchiolitis or pneumonia in children under 1 years old.
Bacterial:
-Nasal Congestion
-Pressure above the nose or in the forehead
-An occasional headache or toothache
-Facial swelling
-Tenderness
-Discharge
Opaque, green or yellow discharge from the nose and/or mouth
Allergies:
-Discharge:
-Usually clear
-Itchy, watery eyes

Caused by the RSV virus that enters through orifice's of your body, such as the eyes, nose, or mouth.
Sinusitis Causative Agents
Tuberculosis, once called "consumption" and "white plague," is an ancient disease that may have always been with us. Evidence of tubercular decay found in the skulls and spines of Egyptian mummies, tell us that TB has been plaguing humans for at least 4,000 years. Hippocrates, the ancient Greek physician, noted that "phthisis" (consumption) was the most widespread and fatal disease of his time.
Any number of bacteria that are normal biota in the upper respiratory tract may cause sinus infections.
The most common bacteria that cause the infections are:

-
Streptococcus pneumoniae
-Streptococcus pyogenes
-Staphylococcus aureus
-Haemophilus influenza
Today, the cornerstone for any treatment of tuberculosis is still multidrug therapy. At least two drugs are given at the same time to prevent the emergence of drug resistance. Sometimes patients are treated with up to four different antibacterial drugs, and for periods of a minumum of 6 to 24 months.
Treatment
TB can occur outside the lungs, which is known as extrapulmonary TB.

Extrapulmonary TB is more common in
people with a weakened immune system, particularly people with an HIV infection. You are also more likely to develop extrapulmonary TB if you have previously been infected with TB but haven't had any symptoms (a latent TB infection).
Extrapulmonary TB
Multidrug-resistant TB (MDR TB) is caused by an organism that is resistant to at least isoniazid and rifampin, the two most potent TB drugs. These drugs are used to treat all persons with TB disease.
First isolated in 1956 from a chimpanzee who was showing symptoms of a respiratory illness.
MDR and XDR
Most common cause off lower respiratory tract infections. 2/3 of infants become infected within the first year. 90% are infected before age 2.
Extensively drug resistant TB (XDR TB) is a rare type of MDR TB that is resistant to isoniazid and rifampin, plus any fluoroquinolone and at least one of three injectable second-line drugs (i.e., amikacin, kanamycin, or capreomycin).
People suspected of having TB disease should be referred for a medical evaluation, which will include

Medical history,
Physical examination,
Test for TB infection (TB skin test or TB blood test),
Chest radiograph (X-ray), and
Appropriate laboratory tests

Diagnosis of TB

Biota of the Respiratory System
Pneumonia is an infection in one or both of your lungs. Many small germs, such as bacteria, viruses, and fungi, can cause pneumonia. Pneumonia is not a single disease. It can have more than 30 different causes. Understanding the cause of pneumonia is important because pneumonia treatment depends on its cause.
Many small germs can cause pneumonia. There are five main causes of pneumonia:

Bacteria
Viruses
Mycoplasmas
Other infectious agents, such as fungi - including pneumocystis
Various chemicals
What Causes Pneumonia
When the germs that cause pneumonia reach your lungs, the lungs' air sacs (alveoli) become inflamed and fill up with fluid and pus. This causes the symptoms of pneumonia, such as a cough, fever, chills, and trouble breathing.

When you have pneumonia, oxygen has trouble reaching your blood. If there is too little oxygen in your blood, your body cells can't work properly. Because of this and infection spreading through the body, pneumonia can cause death.
How Does Pneumonia Affect the Body
Pneumonia affects your lungs in two ways. Lobar pneumonia affects a section (lobe) of a lung. Bronchial pneumonia (or bronchopneumonia) affects patches throughout both lungs.
Two ways?
Bacterial Pneumonia
Bacterial pneumonia can attack anyone, at any age.

Bacterial pneumonia can occur on its own or develop after you've had a cold or the flu.

People at greatest risk for bacterial pneumonia include people recovering from surgery, people with respiratory diseases or viral infections and people who have weakened immune systems.
If your body's defenses are weakened—by illness, old age, malnutrition, or impaired immunity—the pneumonia bacteria, which can live in healthy throats, can multiply and work their way into the lungs. The infection can quickly spread through the bloodstream and invade the entire body.
Dozens of different types of bacteria can cause pneumonia.

The most common cause of bacterial pneumonia in adults is
Streptococcus pneumoniae
(pneumococcus), but there is a vaccine available for this form of pneumonia.
Atypical pneumonia, often called walking pneumonia, is caused by bacteria such as
Legionella pneumophila, Mycoplasma pneumoniae, and Chlamydophila pneumoniae.

Pneumocystis jiroveci
pneumonia is sometimes seen in people whose immune system is impaired (due to AIDS or certain medications that suppress the immune system).
Other bacteria that can cause pneumonia include
Staphylococcus aureus, Moraxella catarrhalis, Streptococcus pyogenes, Neisseria meningitidis, Klebsiella pneumoniae,
and
Haemophilus influenzae.
Bacteria Pneumonia
Most respiratory viruses attack the upper respiratory tract, but some cause pneumonia, especially in children. Most of these pneumonias are not serious and last a short time but others can be severe.

Viral pneumonia caused by the influenza virus may be severe and sometimes fatal. The virus invades the lungs and multiplies; however, there are almost no physical signs of lung tissue becoming filled with fluid. This pneumonia is most serious in people who have pre-existing heart or lung disease and pregnant women.

In extreme cases, the patient has a desperate need for air and extreme breathlessness. Viral pneumonias may be complicated by an invasion of bacteria, with all the typical symptoms of bacterial pneumonia.
Viral Pneumonia
Mycoplasms are the smallest free-living agents of disease in humankind. They are not classified as to whether they are bacteria or viruses, but they have traits of both.

Mycoplasms cause a mild and widespread pneumonia. They affect all age groups, but occur most often in older children and young adults.
Mycoplasm Pneumonia
Tuberculosis can cause pneumonia (
tuberculosis pneumonia
). It is a very serious lung infection and extremely dangerous unless treated early.

Pneumocystis carinii
pneumonia (PCP) is caused by an organism believed to be a fungus. PCP may be the first sign of illness in many persons with AIDS.

PCP can be successfully treated in many cases. It may recur a few months later, but treatment can help to prevent or delay recurrence.

Other less common pneumonias may be quite serious and occur more often. Various special pneumonias are caused by the inhalation of food, liquid, gases or dust, and by fungi.

Rickettsia (also considered an organism somewhere between viruses and bacteria) cause Rocky Mountain spotted fever, Q fever, typhus and psittacosis, diseases that may have mild or severe effects on the lungs.
Other Types
Prevention
Influenza Vaccine

Pneumococcal Vaccine
WASH YOUR HANDS
The normal biota of the respiratory system are:
Because the respiratory system is constantly in contact with the external environment, it harbors a larger amount of commensal normal biota than most of the other body systems.
The normal biota, however, are generally limited to the upper respiratory tract.

Some of the normal biota are also known to cause some serious diseases.
-Streptococcus pyogenes
-Haemophilus influenzae
-Streptococcus pneumoniae
-Neisseria meningitidis
-Staphylococcus areus
-Moraxella
species
-Corynebacterium,
as well as other miscellaneous diptheroids
-Candida albicans,
as well as other types of yeast
Influenza is an acute respiratory disease. Symptoms include fever, headache, myalgia, lethargy, coryza, sore throat and cough. Infections in children, particularly type A and B (H1N1) may also be associated with gastrointestinal symptoms such as nausea, vomiting and diarrhea

Most symptoms resolve within two to seven days although the cough may persist longer. Complications of influenza include middle ear infections, secondary bacterial pneumonia and exacerbation of underlying chronic health conditions.
Symptoms
Diagnosis
A clinical diagnosis can be confirmed by culture or antigen testing of appropriate respiratory specimens such as
nasopharyngeal aspirate
or nose and throat swabs, taken within five days of onset. Or it can be confirmed by serology performed on blood specimens taken during the acute and convalescent stages.
It is suspected that more microbial biota will be discovered in the Human Microbiome Project as microbiologists figure out and catalog the genetic sequences as well as how to culture the species of biota in a laboratory setting.
Most human infections are caused by either type A or B influenza viruses. Type A has been associated with widespread epidemics and pandemics, while type B has been infrequently associated with regional epidemics, and type C is only rarely associated with human infection.
Easy as ABC
Rest until the flu is fully resolved, especially if the illness has been severe

Fluids — Drink enough fluids so that you do not become dehydrated.

Acetaminophen (such as Tylenol® and other brands) can relieve fever, headache, and muscle aches.

Antibiotics

Antiviral Treatment
Treatment
Get the flu vaccine each year due to high mutation rate of the virus.

Practice good hygiene and personal health habits.

Cover your mouth when while sneezing and wash your hands regularly as the virus spreads through aerosols.
Prevention
What does the ear have to do with the respiratory tract?
-When viruses spread from either Rhinitis or Sinusitis, they can get into the fluid filled eustachian tube and cause it to become inflamed, constricting the already small space, causing fluid backup as the bacterium or virus mutiplies in the fluid.
The eustachian tube is located in the middle ear which is not known to have any biota even though bacteria can travel through the eustachian tube.
Symptoms in adults include:

-Fullness or pain in the ear
-Loss of hearing

Symptoms in children include:

-Irritability
-Fussiness
-Difficulty sleeping, eating or hearing
Causative Agents
Many viruses can cause Acute Otitis Media, but the most common causative agents are:

-
Streptococcus pneumoniae
-
Haemophilus influenza
S. pneumoniae
appears in pairs of elongated, gram-positive cocci joined end to end.
Brief History
H. influenzae
was the main cause for ear infections until a childhhod vaccine was presented for all diseases affiliated with the bacterium
H. influenzae
in the 1980's.

It has now been found that ear infections are caused by more than one bacteria and/or virus working collaboratively.
Prevention

-There is a vaccine (Prevnar) against
S. pneumoniae
and has been recommended for children since 2000.
-There also other vaccines available, such as Pneumovax, which primarily targets the older population for prevention of other pneumococcal pneumonia.
Treatment

-Until the late 1900's, broad spectrum antibiotics were regularly prescribed for Otitis Media. When it was discovered that this was producing antibiotic resistant bacterial biota, the treatment method was reexamined.
-The newly recommended treatment with uncomplicated Otitis Media is "watchful waiting" in cases where the patient has a fever lower than 104 degrees F. This allows the body 72 monitored hours to try to clear up the disease on its own before using antibiotics and other forms of treatment.
-Other forms of treatment include:
-Placing small tubes through the tympanic membrane to keep fluid out when inflammation occurs
-Viral sore throats are generally mild and can sometimes lead to hoarseness.
-Sore throats caused by group A streptococci are generally more painful than those caused by viruses and are more likely to cause more symptoms
Symptoms
Clinical signs and symptoms of the types of Pharyngitis are:

-Reddened mucosa
-Swollen tonsils
-White pockets of inflammatory products on the walls of the throat.
-Swollen mucous membranes, affecting speech and swollowing.
-Foul-smelling breath
Causative Agents
-
Streptococcus pyogenes
-
Fusobacterium necrophorum
F. necrophorum
causes the host to have a severe sore throat which have appeared most recently in adolescents and young adults around the country. It can cause serious infections in the bloodstream and other organs which can lead to a condition called Lemierre's syndrome. It is believed that this disease did not previously exist because
F. necrophorum
was killed by antibiotics. There are currently no rapid tests for this bacterium and it is now somewhat resistant to antibiotics.
S. Pyogenes
, however, is a gram-positive coccus that grows in chains. It does not form spores, it is nonmotile and forms capsules and slime layers. It is a facultative anaerobe that ferments a variety of sugars. It thrives in the presence of oxygen.

Untreated presence of streptococcal throat infections can lead to other serious complications such as:
-Scarlet Fever
-Rheumatic Fever
-Glomerulonephritis
-Necrotizing Fasciitis (In very rare cases)
Scarlet Fever
Rheumatic Fever
Glomerulonephritis
Necrotizing Fasciitis
Virulence Factors
Prevention
Treatment
Scarlet fever is classified as a the result of infection with an
S. pyogenes
strain that is, itself, infected with a bacteriophage. It is characterized by a sandpaper like rash, most often located on the neck, chest, elbows and inner thighs, with a high fever.
Rheumatic fever is thought to be caused by an immunologic cross between the streptococcal M protein and the heart muscle(s). It tends to occur about 3 weeks after pharyngitis has subsided. Symptoms include arthritis in multiple joints and the appearance of nodules over bony surfaces right under the skin. Can be avoided if the original streptococcal infection is treated with antibiotics.
Glomerulonephritis is thought to be the result of streptococcal proteins that participate in the forming of antigens and antibodies which are deposited in the basement membrane of the glomeruli of the kidney. It is characterized as nephritis because it appears as swelling in the hands and feet combined with low urine output, blood in the urine, increased blood pressure, and sometimes heart failure
Necrotizing fasciitis is a rare consequence of a streptococcal infection when the skin or tissue goes through a process of death, most often due to toxicity of the bacteria in the skin or tissue. Acts very similarly like Impetigo.
Fusobacterium necrophorum:

-Endotoxin
-Leukotoxin

Streptococcus pyogenes:

-Hemolysins
-Streptolysin O (SLO)
-Streptolysin S (SLS)
-Lipoteichoic Acid (LTA)
-M Protein
-Hyaluronic Acid Capsule
-Superantigens
-No vaccine exists for group A streptococci, although there is research being done to resolve that.
-There is a vaccine for rheumatic fever
-WASH YOUR HANDS. It's the best way to prevent all of this.
-The antibiotic of choice for Streptococcus pyogenes is penicillin.
-Group A streptococci have become resistant to erythromycin.
-In patients with penicillian allergies, cephalexin is usually prescribed.
Treatment
Various Bacteria
-Broad-spectrum antibiotics

Various Fungi
-Physical removal of the fungus
-In severe cases, antifungals are used
Symptoms
Symptoms
Fever, Cough, Tachypnea, Cyanosis, Wheezing, Rales. Runny Nose, Shortness in breath, and decreased appetite and activity.
Causative Agent
Single Stranded RNA Paramyxovirus, in the same family as Influenza, Rubella and Measles.
Prevention and treatment
Usually goes away on their own in 10-14 days, if not a broncho dilators may be used to treat infection and to help in breathing. Ribavirin or corticosteroids are given in case of serious infection.
For prevention use common sense. Wash your hands, stay clear of sick people, cover your mouth when you sneeze of cough, disinfect anything that has been touched by someone with RSV
First showed in 1613 Spain, which began an epidemic. Known as the year of strangulation.

1890, first isolated and used to immunize guinea pigs, by Shibasuburo Kitasato and Emil Von Behrig.

1895 immunizations shots were starting to be produced.

The United States only has one or two cases reported each year as of the 2000's

Fever, chills, fatigue, sore throat, cough, difficult and painful swallowing, difficulty breathing, heart arrhythmia's, bloodstained nasal discharge and inflammation of the pharynx and tonsils marked by a gray-ish patches
Brief History
Symptoms
Causative agents
The only bacteria that causes Diptheria is:

-
Corynebacterium diphtheriae
-Gram-positive and club shaped
Treatment
Prevention
Can be easily prevented through a series of vaccinations.
-
DTaP
: Diphtheria toxiod vaccine. A series of mixed vaccinations that also takes care of tetanus and acellular pertussis. Adults and adolescents should receive boosters.
Antitoxin with penicillin or erythromycin.
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