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Updated
2007-03-11 15:18
Associated Diseases
Pathogen Associated Diseases Streptococcus pyogenes (Group A) Pharyngitis; Scarlet Fever; Rheumatic Fever (resp infxn); Acute Glomerulonephritis (skin or resp infxn) Haemophilus influenzae Children: URTI (epiglottitis, otitis media, sinusitis); Adults & children: Pneumonia, Meningitis Corynebacterium diphtheriae Diphtheria (grayish pseudomembranes over tonsils- airway obstruction, bull neck, laryngeal nerve palsy) SARS-CoV I: Fever Prodrome, II:Respiratory Phase dry cough, hypoxia pneumonia Bordetella pertussis Whooping Cough (cough w/ inspiratory whoop, "cough of 100 days") Moraxella catarrhalis URI: otitis media, sinusitis (#3), bronchitis (in those with COPD), conjuctivitis, Pneumonia (often secondary to influenza) Influenza virus (types A, B, C) Influenza (winter): epidemics (A), outbreaks (B), mild infxns (C) Rhinovirus common cold (coryza) in fall and winter Coronavirus 5-10% of common cold (coryza) Enterovirus summer cold Adenovirus URI: acute febrile pharyngitis, atypical pneumonia, epidemic kerato-conjunctivitis Respiratory Syncytial Virus (RSV) bronchiolitis symptoms, viral pneumonia, tracheobronchitis, Croup Parainfluenza virus Croup (barking cough, inspiratory stridor, winter peak), Pneumonia, URI Mumps virus Mumps: parotitis, oorchitis, meningitis Streptococcus pneumoniae (pneumococcus) Adults: Pneumonia, Meningitis; Children: Otitis Media; Sepsis Sinusitis Staphylococcus aureus Pneumonia (in addition to many other dz's), MRSA: Fulminant necrotising pneumonia Legionella pneumophila Atypical pneumonia: "Legionaire's dz" an atypical pneumonia characterized by high fever & nonproductive cough Klebsiella pneumoniae Pneumonia (currant jelly sputum often in alcoholics), Nosocomial Pneumonia Pseudomonas aeruginosa Nosocomial Pneumonia common in cystic fibrosis Burkholderia cepacia Fulminant pneumonia in cystic fibrosis patients Mycoplasma pneumoniae Atypical Pneumonia (peak age 10-15 yo) spread within families "Walking Pneumonia" Mycobacterium tuberculosis tuberculosis; assoc w/ poverty, crowding, HIV; granulomas Chlamydia Pneumoniae Atypical Pneumonia, Pharyngitis, Cough Mycobacterium aviumintracellulare complex (MAC) opportunistic infx associated late HIV w/ <50 CD4 Candida albicans Thrush, Esophagitis (as well as many other dz) Coccidioides immitis "Valley Fever," flu-like with pulmonary infiltrates, erythema nodosum Histoplama capsulatum Histoplasmosis: asymptomatic usually, diffuse pneumonia as opportunistic infx Blastomyces dermatitidis Blastomycosis: Primary pneumonia, dissemination Cryptococcus neoformans Cryptococcosis: self-limiting pneumonia, opportunistic meningitis Aspergillus fumigatus Lung infxns: Allergic aspergillosis, Farmer's Lung, Aspergilloma (Fungus Ball)
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Transmission
Pathogen Transmission Streptococcus pyogenes (Group A) respiratory; direct mucosal contact Haemophilus influenzae respiratory Corynebacterium diphtheriae respiratory; skin SARS-CoV respiratory Bordetella pertussis respiratory Moraxella catarrhalis normal respiratory flora Influenza virus (types A, B, C) respiratory & direct contact Rhinovirus respiratory & nasal secretions from hand to nose or eye Coronavirus hand to mucous membrane Enterovirus fecal oral Adenovirus respiratory, fecal oral Respiratory Syncytial Virus (RSV) secretions, fomites, nosocomial infection, reinfection Parainfluenza virus small aerosol particles Mumps virus respiratory Streptococcus pneumoniae (pneumococcus) normal flora of oropharynx Staphylococcus aureus ubiquitous in environment, normal flora Legionella pneumophila respiratory from environ water sources (air conditioners) Klebsiella pneumoniae aerosol, normal flora of large intestine Pseudomonas aeruginosa ubiquitous in moist environment Burkholderia cepacia ubiquitous in moist environment Mycoplasma pneumoniae respiratory (community acquired) Mycobacterium tuberculosis respiratory Chlamydia Pneumoniae respiratory Mycobacterium aviumintracellulare complex (MAC) ubiquitous in environment Candida albicans normal flora of GI, oral cavity, female genital tract Coccidioides immitis respiratory, inhaled arthrospores Histoplama capsulatum respiratory, inhaled microconidia spores Blastomyces dermatitidis respiratory, inhaled conidia Cryptococcus neoformans respiratory, inhaled yeast Aspergillus fumigatus ubiquitous in environment
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Microbe Characteristics/Virulence
Pathogen Microbe Characteristics/Virulence Streptococcus pyogenes (Group A) gram+ cocci, Beta hemolytic, Group A; Streptokinase, Hyaluronidase, Pyrogenic exotoxins (superantigens), Streptolysin O & S, Streptodornase Haemophilus influenzae small gram- rod; Polysacharide capsule type b, IgA protease, Adherence factors Corynebacterium diphtheriae club shaped gram+ rod arranged in palisades with metachromatic granules (Chinese characters); Diphtheria Toxin (AB) SARS-CoV Coronavirus family: ss+ RNA, linear, enveloped, helical Bordetella pertussis small encapsulated gram- rod; polysaccharide capsule, pili for attachment, Pertussis Toxin (does not invade) Moraxella catarrhalis gram- cocci, aerobic, oxidase+ catalase-; produces beta-lactamase Influenza virus (types A, B, C) Orthomyxovirus family: segmented ss- RNA, enveloped, linear; HA, NA Rhinovirus Picornavirus: ss+ RNA, linear, naked; acid-labile; prefers cold; ICAM-1 Coronavirus Coronavirus family: ss+ RNA, linear, enveloped, helical; club shaped surface spikes (peplomers) Enterovirus Picornavirus family: ss+ RNA, linear, maked; multiple serotypes Adenovirus Adenovirus family: ds DNA, nonsegmented, naked Respiratory Syncytial Virus (RSV) Paramyxovirus family: ss-RNA, linear, enveloped; F (fusion) & G (attachment) proteins: cell to cell transfer down respiratory tract causing necrosis of epithelium, edema, plugging, air trapping (resp dx of infancy and elderly) Parainfluenza virus Paramyxovirus family: ss-RNA, linear, enveloped; combined Hemagglutinin/neuraminidase Mumps virus Paramyxovirus family: ss-RNA, linear, enveloped; HA/NA, glycoprotein surfaces spikes Streptococcus pneumoniae (pneumococcus) gram+ cocci in pairs (diplococci); Alpha hemolytic Staphylococcus aureus gram+ cocci, nonmotile, non-spore forming, facultative anaerobes (grape like clusters); Protein A, enzymes, exotoxins Legionella pneumophila rod staining faintly gram- (can't see); beta lactamase Klebsiella pneumoniae gram- rod with VERY thick capsule; septic shock caused by endotoxins in cell wall Pseudomonas aeruginosa gram- rod, strict aerobe; flagella, pili, binding lectins, mucoid exopolysacharides, exoenzyme S Burkholderia cepacia gram- rod Mycoplasma pneumoniae no cell wall, pleomorphic, very small, polarized; no toxins but instead P1 protein that adheres and causes necrosis of resp tract Mycobacterium tuberculosis obligate aerobic bacilli; intracellular; virulence factor = cord factor, sulfolipids Chlamydia Pneumoniae obligate intracellular pathogen TWAR strain Mycobacterium aviumintracellulare complex (MAC) acid fast, slow growing Candida albicans single-celled yeast, "pseudohyphae"; proteinase that digests epith cells Coccidioides immitis dimorphic, forms spheruled filled with endospores that disseminate and induce granulomas Histoplama capsulatum dimorphic, multiplies within macrophages and forms granulomas Blastomyces dermatitidis dimorphic; round, double wall, single broad based yeast bud Cryptococcus neoformans yeast form only, single budding with thick capsule Aspergillus fumigatus mold form only, acute branching septate hyphae; very fast growing
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Diagnosis
Pathogen Diagnosis Streptococcus pyogenes (Group A) gram stain, Beta hemolytic culture but also bacitracin sensitive Haemophilus influenzae Special chocolate agar culture w/ factors X (hemin) & V (NAD) Corynebacterium diphtheriae morphology and metachromatic staining pattern on tellurite plate cultures or Loeffler's medium SARS-CoV RT-PCR & serological test Bordetella pertussis culture with Bordet-Gengou agar Moraxella catarrhalis non performed (?) Influenza virus (types A, B, C) clinical diagnosis; immunofluorescnent staining of viral culture Rhinovirus non performed Coronavirus non performed Enterovirus non performed Adenovirus non performed Respiratory Syncytial Virus (RSV) nasal wash specimens for culture; IFA, ELISA Parainfluenza virus viral isolation is "gold standard" Mumps virus non performed Streptococcus pneumoniae (pneumococcus) gram stain, Alpha hemolytic, does not grow culture in presence of bile or optochin Staphylococcus aureus grapelike clusters of cocci, coagulase+, catalase+ Legionella pneumophila culture, special agar, serology, fluorescent tests Klebsiella pneumoniae large on gram stain due to capsule, lactose-fermenting Pseudomonas aeruginosa gram stain, motile, ferments lactose Burkholderia cepacia "similar to P. aeruginosa" Mycoplasma pneumoniae no gram stain, cold agglutination test, slow special agar (fried eggs on culture) Mycobacterium tuberculosis acid-fast; grows with standard culture media; catalase- Chlamydia Pneumoniae doesn't gram stain Mycobacterium aviumintracellulare complex (MAC) acid-fast Candida albicans epithelium scrapins examed with KOH prep, Sabouraud's agar Germ Tube Test Positive Coccidioides immitis biopsy, Sabouraud's agar Histoplama capsulatum biopsy, Sabouraud's agar, Ag serology of urine Blastomyces dermatitidis biopsy Sabouraud's agar Cryptococcus neoformans culture, yeast cells in CSF when mixed on India ink stain, capsular antigen test Aspergillus fumigatus biopsy, culture, silver stains to ID
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Vaccines
Pathogen Vaccines Streptococcus pyogenes (Group A) none (over 70 serotypes) Haemophilus influenzae vaccine (capsular antigen) against type B Corynebacterium diphtheriae Diphtheria toxoid vaccine (part of DPT) SARS-CoV none Bordetella pertussis part of DPT vaccine Moraxella catarrhalis Vaccine under development Influenza virus (types A, B, C) inactivated trivalent annual vaccine, Intranasal vaccine for ages 5-49 (not immunosupp.) Rhinovirus none (over 100 serotypes) Coronavirus none Enterovirus none Adenovirus enteric-coated live nonattenuated vaccine for military Respiratory Syncytial Virus (RSV) none Parainfluenza virus none Mumps virus live, attenuated as part of MMR Streptococcus pneumoniae (pneumococcus) (over 65 yo or immunocompromised) w/23 of most common capsular antigens Staphylococcus aureus none Legionella pneumophila none Klebsiella pneumoniae none Pseudomonas aeruginosa none Burkholderia cepacia none Mycoplasma pneumoniae none Mycobacterium tuberculosis BCG (low efficacy) Chlamydia Pneumoniae none Mycobacterium aviumintracellulare complex (MAC) none Candida albicans none Coccidioides immitis none Histoplama capsulatum none Blastomyces dermatitidis none Cryptococcus neoformans none Aspergillus fumigatus none
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Treatment
Pathogen Treatment Streptococcus pyogenes (Group A) Penicillin Haemophilus influenzae URI: Ampicillin; Prophylaxis: Rifampin Corynebacterium diphtheriae antitoxin; Erythromycin SARS-CoV supportive, possible ventilation Bordetella pertussis Erythromycin, supportive therapy Moraxella catarrhalis Amoxicillin/clavulanate Influenza virus (types A, B, C) supportive; Uncoating inhibitors (inf. A only): Amantadine Rimantadine Neuraminidase inhibitors (Inf. A+B): Zanamivir, Oseltamivir phosphate Rhinovirus symptomatic, self-limited Coronavirus symptomatic, self-limited Enterovirus symptomatic, self-limited Adenovirus symptomatic Respiratory Syncytial Virus (RSV) supportive: oxygen, fluid control, steroids, ventilations; ribavirin (controversial) Parainfluenza virus supportive Mumps virus supportive Streptococcus pneumoniae (pneumococcus) Penicillin G Staphylococcus aureus Methicillin, Nafcilin (Penicillin resistant); MRSA (vancomysin or linezolid) Legionella pneumophila Macrolide antibiotics, Rifampin (resistant to beta lactam antibiotics) Klebsiella pneumoniae Treatment dilemmas due to high antibiotic resistance Pseudomonas aeruginosa 3rd generation cephalosporins Burkholderia cepacia 3rd generation cephalosporins Mycoplasma pneumoniae Erythromycin or Tetracyclin Mycobacterium tuberculosis multi-drug regimen (including INH, RIF, and pyrazinamide); Quantiferon (new) Chlamydia Pneumoniae Erythromycin Mycobacterium aviumintracellulare complex (MAC) extremely resistant, 4-8 drug combo Candida albicans Amphotericin B, fluctyosine, azoles, echinocandins Coccidioides immitis Amphotericin B, azoles Histoplama capsulatum Itraconazole, Fluconazole, Amphotericin B (if severe) Blastomyces dermatitidis Itraconazole, Ketoconazole, Amphotericin B Cryptococcus neoformans Amphotericin B, itraconazole Aspergillus fumigatus surgical removal of fungus ball Voriconazole Amphotericin Caspofungin
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Notes
Pathogen Notes Streptococcus pyogenes (Group A) Scarlet fever, Rheumatic fever, Glomeruloneph. Haemophilus influenzae epiglottitis, potential emergency! Corynebacterium diphtheriae "Chinese characters," gray pseudomemb. SARS-CoV first reported in Asia 2/2003 Bordetella pertussis cough of 100 days Moraxella catarrhalis otitis media, sinusitis Influenza virus (types A, B, C) genetic drift (epidemics), gentic shift (pandemics) Rhinovirus 50% of common colds Coronavirus diarrhea in infants Enterovirus summer colds Adenovirus outbreaks among millitary recruits Respiratory Syncytial Virus (RSV) annual outbreaks in babies, respiratory distress & tachypnea Parainfluenza virus stridor, potential emergency!, "seal bark" cough Mumps virus swollen parotid glands Streptococcus pneumoniae (pneumococcus) #1 community acquired pneumonia Staphylococcus aureus coagulase+ Legionella pneumophila air conditioners Klebsiella pneumoniae thick capsue, alcoholics via aspiration, "currant jelly" suptum Pseudomonas aeruginosa pneumonia in cystic fibrosis patients Burkholderia cepacia none Mycoplasma pneumoniae "walking" pneumonia, young adults, spread among families Mycobacterium tuberculosis PPD test, multi-drug resistance, chest X-ray, poverty Chlamydia Pneumoniae Excellent prognosis in young patients, 5-10% mortality in elderly Mycobacterium aviumintracellulare complex (MAC) opportunistic infx in HIV patients Candida albicans immunocompro. Coccidioides immitis deserts & SW US, Filipinos & Asians with predisposition Histoplama capsulatum Mississippi & Ohio River valleys, bat & bird droppings Blastomyces dermatitidis Central/Easter USA, soil with decay Cryptococcus neoformans Opportunistic infx in 10% of HIV patients, pigeon droppings Aspergillus fumigatus Fungus balls
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