Agents of Respiratory disease

Dr.Vinita Kumari
Lecturer
Department of Pathology
JSMU
CORYNEBACTERIUM DIPHTHERIAE
• Gram positive rods appear
club shaped
• V-l shaped formations
(Chinese letter
arrangements)
• Beaded appearance
……….metachromatic,
polyphosphate
• Humans are natural host
• Transmitted by airborne
droplets
MYCOBACTERIUM TUBERCULOSIS
 Disease and epidemiology
• M. tuberculosis causes tuberculosis
• Prevalent world wide, particularly among low
income populations
• One of the top ten causes of death globally
• In 2019, around one million people fell ill with
tuberculosis
• According to the latest WHO estimations,
the incidence, prevalence and mortality of TB in
Pakistan are 230 per 100 000
Transmission of M. tuberculosis
• Humans are the natural
reservoirs
• M. bovis causes tb in
humans
• M.bovis is found in cow’s
milk and unpasteurized milk
causes gut tb in humans
• In developed countries, tb is
seen in
immunocompromised
individuals
Important properties of M. tuberculosis
• Acid fast bacteria
• Neither Gram positive nor Gram negative
• Slow growing ( doubling time is 18 hours)
• Culture take around 6-8 weeks to develop
• Obligate aerobe
• Causes disease in highly oxygenated areas s such as upper
lobes of lungs and kidneys
• Acid fast………. Long chains fatty acid (mycolic acid)
• Resistant to acids and alkalis…………….NaOH used in
clinical specimens
 Virulence factors
• Cord factor (trehalose
dimycolate) : primary
glycolipid found in cell wall,
toxic to leukocytes and
involve in granulomatous
inflammation
• Virulent strains grow in
serpentine manner
• Avirulent strains do not grow
in serpentine manner
• Proteins ….. Antigenic in PPD
skin test
 Pathogenesis
• Organisms infects macrophages and other
reticuloendothelial cells
• Organism survives and multiplies in a
phagosome
• Production of exported repetitive protein that
prevents the fusion of phagosmes with lysomes
• Two types of lesions
exudative lesions and granulomatous lesions
• Exudative lesions which consists of acute inflamm
response
• Granulomatous lesions consist of granuloma
 Immunity and hypersensitivity
• Resistance to the organism is mediated by CD4
positive T cells and macrophages
• No role of circulating antibodies
• Major role of activated macrophages by
interferon gamma
• Prior infection detection………………positive
tuberculin skin test, delayed hypersensitivity
• Induration on skin…..diameter measurement
 Tuberculin skin test
• Tuberculin skin test is said to be
positive :
• Induration of 15mm or more in
persons without risk factors
• Induration of 10mm or more in
persons with risk factors
• Induration of 5mm or more in
deficient cell mediated immunity
• Positive skin test shows previous
infection
• Gene Nramp…….natural
resistance to tuberculosis
 Clinical findings
• Fever, fatigue, night sweats and weight loss
• Tb can affect almost every part of body
• Symptoms depends upon the system involved
• Most common presentation is pulmonary tuberculosis
• Manifested by cough with hemoptysis
• Unilateral swollen non tender cervical lymphnodes……..scrofula
• Lymphadinitis…………….most common manifestation of
extrapulmonary tb
• Severity of disease depends upon…….immune status of the
person
• Erythema nodosum
• Miliary tuberculosis
• Tuberculosis meningitis
• Tuberculous osteomyelitis
• Gut tb
• Oropharyngeal tuberculosis
• Renal tuberculosis…………..sterile pyuria
• 90% infections are asymptomatic
 Laboratory diagnosis
• Zihel neelsen staining,
AFB smear
• Culture on LJ medium
• BACTEC Medium
• NAAT, Gene expert
 Prevention
• BCG, or bacille Calmette-Guerin, is a vaccine for
tuberculosis (TB) disease
• BCG vaccine has a documented protective effect
against meningitis and disseminated TB in children
• A single dose of BCG vaccine is administered
routinely at birth in Pakistan. The vaccine is
administered just beneath the skin. If the child
misses the dose at birth, it can be administered
later on as well
 BORDETELLA
• Small ,cocobacillary, encapsulated gram
negative rod.
• A pathogen only for humans.
• Transmitted by airborne droplets.
• Highly contagious disease.
• Occurs primarily in infants and young children.
• Attached to cillia of epithelial cells by a protein
on the pilli called filmentous hemagglutinin.
 PATHOGENESIS
 Pertussis toxin stimulates adenylate cyclase by
catalyzing the addition of adenosine
diphosphate ribose to the inhibitory subunit
of the G protein complex that results in
prolonged stimulation of adenylate cyclase
that cause a rise in AMP and cAMP dependent
proein kinase activity that results in edema of
the respiratory mucosa.
 CLINICAL FINDINGS
• Severe paroxysomal cough lasts for 1 to 4
weeks.
• Series of hacking coughs, with copious
amounts of mucus.
 LABORATORY DIAGNOSIS
• Nasopharyngeal swabs
• Bordet-Gengou medium used for this purpose.

• PCR highly specific and sensitive.

 TREATMENT AND PREVENTION
• Azithromycin.

• Acellualr vaccine containing purified proteins

from the organisms and a killed vaccine
containing inactivated pertussis organisms.