MISCELLANEOUS GRAM-NEGATIVE BACILLI BordetellaWhooping cough FranciscellaTularemia...
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Transcript of MISCELLANEOUS GRAM-NEGATIVE BACILLI BordetellaWhooping cough FranciscellaTularemia...
MISCELLANEOUS GRAM-NEGATIVE BACILLI
Bordetella Whooping cough
Franciscella Tularemia
Brucella Brucellosis
Legionella Legionellosis
MISCELLANEOUS GRAM-NEGATIVE BACILLI
Bacteroides Intraabdominal infections
Fusobacterium Pleuropulmonary & CNS Infect.
Cardiobacterium Endocarditis
Eikenella Meningitis, endocarditis
Bordetella pertussis
Strictly aerobic bacilli
Transmitted by airborne droplets
Causes pertussis, or whooping cough
Binds to ciliated epithelial cells, proliferates, causes tissue damage
Bordetella pertussis
Pertussis toxinADP-ribosylates guanine nucleotide-binding proteins at the cell membraneInterferes with signal transduction by chemokine receptors
lymphocytes unable to enter lymphoid tissue increase in lymphocytes in the blood
(lymphocytosis)Mediates binding of the bacterium to ciliated cells
Adenylate cyclaseGuanine nucleotide-binding regulatory protein (stimulatory)
Guanine nucleotide-binding regulatory protein (inhibitory)
Bordetella pertussis
Adenylate cyclase toxin inhibitsleukocyte chemotaxis, phagocytosis and killingoxidative activity of alveolar macrophagescell lysis by NK cells
Tracheal cytotoxin inhibitsciliary movement in epithelial cells (ciliostasis)DNA synthesis
Bordetella pertussis
Filamentous hemagglutinin and Pertactin (P69 protein; 69kD) mediate attachment of B. pertussis to ciliated cells
Arginine-Glycine-Aspartic acid (RGD) sequence on these adhesins facilitates binding to glycoprotein integrins on ciliated respiratory cells
Bind to complement receptor 3 (CR3) on macrophages and facilitate phagocytosis
Bordetella pertussis
Catarrhal stage7-10 days after infectionresembles a common cold highest risk for transmission
production of bacteria is at a peak disease is not recognized as pertussis
Bordetella pertussis
Paroxysmal stage 1-2 weeks after the onset of the catarrhal stage repetitive coughs followed by an inspiratory whoop paroxysms end with vomiting and exhaustion
Bordetella pertussis
Convalescent stagediminished paroxysmal coughsecondary complications
pneumoniaencephalopathyseizures
Bordetella pertussis
B. pertussis constitutes a potential health hazard to pediatricians and dental professionals treating children
Bordetella pertussis
Treatment is supportiveErythromycin
Useful in prevention of disease in exposed, unimmunized individuals
Should be given to immunized children younger than 4 years who have been exposed(since vaccine-induced immunity is not fully
protective)
Bordetella pertussis
Fears of vaccine-related toxicityencephalopathy in 1/106 cases
Acellular vaccine composed of five antigens purified from the organism (inactivated pertussis toxin via 2 amino acid changes that eliminate its ADP-ribosylating activity but retains its antigenicity)
Combined with diphtheria and tetanus toxoids in 3 doses beginning at 2 months of age
Francisella tularensis
Very small (0.2 x 0.2-0.7 µm) coccobacillus
Survives in macrophages of the RESNot affected by humoral immunity
Causes tularemia (glandular fever, rabbit fever, tick fever)
Pathogenic strains have an anti-phagocytic capsule
Francisella tularensis
Very small (0.2 x 0.2-0.7 µm) coccobacillus
Survives in macrophages of the RESNot affected by humoral immunity
Causes tularemia (glandular fever, rabbit fever, tick fever)
Pathogenic strains have an anti-phagocytic capsule
Francisella tularensis
Spreads viatick bitescontact with an infected animalconsuming infected meat or waterinhalation of infected aerosols.
Highly infectiousExposure to 10 organisms by a tick bite, or 50 by aerosol can cause disease
Francisella tularensis
Abrupt onset of fever, chills, malaise and fatigue
Most common type is ulceroglandular, with skin ulcers and lymphadenopathy
Can be treated with streptomycin or gentamicin
Brucella
Small (0.5 x 0.6-1.5 µm), non-motile, non-encapsulated, strictly aerobic coccobacilli
”Biovars" of the species B. melitensis cause human brucellosis or undulent fever (Bang's disease)
Reside in the RES, and are sheltered from human immunity
Inhibit PMN degranulation
Transmitted to humans who have direct contact with animals or who consume unpasteurized milk or cheese
Initial subacute manifestations are malaise, chills, myalgias, arthralgias and non-productive cough
Fever is common and undulant (intermittent)
Granulomas in the liver, spleen and bone marrow; enlargement of the liver, spleen and lymph nodes
Brucella
Doxycycline
Doxycycline plus rifampin
Trimethoprim-sulfamethoxazolePregnant womenChildren under 8 years
Brucella
0.3-0.9 µm x 2-5 µmAerobic Appear as coccobacilli in tissuesFilamentous structures in culture
Legionella pneumophila detected only in 1976(does not stain well and does not grow on conventional media)
Legionella
C3b binds porin and facilitates uptake via CR3 complement receptor into alveolar macrophages
Inhibit phagosome-lysosome fusion
Tissue destruction due to the production of proteolytic enzymes, phosphatase, lipase and nuclease
Seen most often in individuals with compromised immune systems or pulmonary function
Legionella
Activated macrophages
No bacterial multiplication
Resting macrophages
Multiplying Legionella
Opsonization
Found in lakes, streams, air conditioning cooling towers and potable water systems (including dental unit water-lines)
Grow on dead organic matter (saprophytes)
Legionella
Legionnaire's disease
Abrupt onset of fever, chills, headache and non-productive cough A multi-organ disease, with abnormalities in the GI tract, CNS, liver and kidneys
Pulmonary function deteriorates if not treated
Legionella
Prevention
Reduce the microbial burden in the environmental sourcehyperchlorinationelevated temperatures(only moderately successful)
Legionella
Treatment
Macrolides: Erythromycin, azithromycin or clarithromycinQuinolones: Levofloxacin or gatifloxacinDoxycycline
ß-lactam antibiotics are ineffective because most strains produce ß-lactamases
Aminoglycosides, penicillins and cephalosporins cannot penetrate host cells, hence are ineffective
Legionella
Obligate anaerobic bacilli that colonize the oropharynx, GI tract and genital tract
The most common cause of serious anaerobic infections such as sepsis, peritonitis and abscesses
Its lipopolysaccharide has no endotoxin activityNo phosphate on lipid AFewer fatty acids
Bacteroides
B. melaninogenicus sub-species asaccharolyticus have been re-classified and include
Porphyromonas gingivalis (prominent in patients with periodontal disease)
Porphyromonas endodontalis (isolated from infected root canals in humans)
Bacteroides
Bacteroides fragilis constitutes only 1-2% of intestinal flora, but is the major cause of intraabdominal infections
The capsule prevents phagocytosis, and promotes abscess formation
Capsules mediate adhesion to peritoneal surfaces
Collagenase, hyaluronidase, neuraminidase, cause tissue destruction and IgG protease inactivates immunoglobulins
Bacteroides
Strains of Bacteroides fragilis that cause diarrheal disease (“enterotoxigenic” strains) produce a zinc metalloprotease
Causes F-actin rearrangement in intestinal epithelium
Resulting in chloride secretion & fluid loss
Bacteroides
B. fragilis is isolated invirtually all abdominal infectionsmore than 67% of suppurative (pus-forming) pelvic
infections15-20% of pleuropulmonary infections
B. melaninogenicus group is common in pleuropulmonary and CNS infections
Bacteroides
Treatment
Metronidazole (Flagyl)
Carbapenems (e.g. imipenem),
Resistance to clindamycin and tetracycline has developed in B. fragilis (mediated by transferrable plasmids)
Bacteroides
LPS stimulates leukocyte chemotaxis by activating the alternate pathway of complement (via C5a)
Fusobacterium are common in pleuropulmonary and CNS infections
Wolinella is a fusobacterium that populates the oropharynx
Fusobacterium
C. hominis is present in the respiratory tract of about 70% of healthy individuals
Most patients who develop C. hominis endocarditis have a history of dental disease or dental procedures before clinical symptoms developed, and pre-existing heart disease
Cardiobacterium
Enters the bloodstream from the oropharynx, adheres to the damaged heart tissue, and multiplies.
Complete recovery following appropriate antibiotic therapy (penicillin or ampicillin for 2-6 weeks)
Cardiobacterium
E. corrodens "corrodes" or form pits in agar
Facultatively anaerobic, gram-negative bacillus
A normal resident of the upper respiratory tract
Opportunistic pathogen: causes infections in immunocompromised patients and in patients with diseases or trauma to the oral cavity
Causes sinusitis, meningitis, brain abscesses, pneumonia, lung abscesses, and endocarditis
Eikenella