E Hagni Wardoyo-Respiratory Tract Infections Blok Respirasi
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Transcript of 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