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RESPIRATORY TRACT INFECTIONS (RTI)

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RTI

URTIs LRTIs
 Pharyngitis  Pneumonia
 Tuberculosis
 Laryngitis LOWER RESPIRATORY TRACT INFECTIONS
 Bronchitis
 Sinusitis (LRTI)
 Bronchiolitis
 Epiglotittis  Empyema
 Lung abscesses

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PNEUMONIA
 Definition: infection of the lung parenchyma
 OR
 Classification
 Acute pneumonia
 Community-acquired pneumonia (CAP)
 Chronic pneumonia
 Nosocomial pneumonia
 Healthcare-associated pneumonia (HCAP) –≥ 2 days hospitalization in
last 90 days OR nursing home/long-term facility resident
 Hospital-acquired pneumonia (HAP) - ≥ 48 hrs after admission
 Ventilator-associated pneumonia (VAP) – 48-72hrs after airway intubation
and start of mechanical ventilation

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PNEUMONIA PATHOGENS

 Acquisition of microbes Clinical Common bacteria

condition
 Aspiration – elderly, decreased consciousness
Acute pneumonia S.pneumoniae Enterobacteriaceae P.aeruginosa
 Inhalation S.aureus Legionella Mixed anaerobes
H.influenzae (aspiration)
 Rarely
Chronic M.tuberculosis, NTMs, Nocardia species
 Haematogenous pneumonia
 Extension from infected pleura or mediastinal space Lung abscess Mixed anaerobes S.aureus
Actinomyces spp Enterobacteriaceae
Nocardia spp P.aeruginosa

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COMMUNITY ACQUIRED PNEUMONIAS (CAP)

ASSOCIATIONS

Association Organism
Aspiration Gram negatives, oral anaerobes  S.pneumoniae, M.pneumoniae, H.influenzae
Lung abscess MRSA, oral anaerobes, fungal, M.tuberculosis, atypical mycobacteria
 Atypical pneumonia
Bat/bird droppings Histoplasma capsulatum
 M.pneumoniae
Birds Chlamydophila psittaci
Rabbits Francisella tularensis  L.pneumophila
Farm animals Coxiella burnetii  C.pneumoniae
HIV Pneumocystis jiroveci, Cryptococcus neoformans, Mycobacteria  C.psittaci
Cruise ships Legionella spp
 C.burnetii
Bioterrorism Brucella anthracis, Yersinia pestis, F.tularensis
 S.aureus

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RISK FACTORS - CAP COMMON BACTERIAL CAUSATIVE AGENTS

 Extremes of age 0-1 mnth E.coli, Group B Strep, L.monocytogenes

 Smoking
1-6 mnth C.trachomatis, S.aureus
 Chronic obstructive pulmonary disease (COPD)
6mnth – 5yrs Viruses
 Diabetes
5-15 yrs M.pneumoniae
 Cardiovascular disease
16-30 yrs M.pneumoniae, S.pneumoniae
 Recent anaesthesia/ intubation
Older adults S.pneumoniae, H.influenzae
 Immunosuppression – therapy, HIV

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HEALTHCARE ASSOCIATED PNEUMONIAS CHRONIC PNEUMONIAS

 Aspiration pneumonia – Gram negatives, oral anaerobes

 Hospital-acquired pneumonia  Bacterial causes
 Aerobic gram negatives – Enterobacteriaceae (E.coli)  M.tuberculosis
 S.aureus, S.pneumoniae  NTMs – M.avium complex, M.kansasii, etc
 Ventilator-associated pneumonia
 P.aeruginosa S.aureus  Fungal – Aspergillus, Cryptococcus, dimorphic fungi
 Enterobacteriaceae Haemophilus spp
 Acinetobacter spp

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BRONCHITIS

 Acute – commonly viral

 M.pneumoniae, C.pneumoniae, Bordetella pertussis – less
commonly
 Bronchiolitis – commonly viral
 Chronic – associated with smoking, pollution, exposure to
allergens
 H.influenzae, S.pneumoniae

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CLINICAL FEATURES

 Fever
 Lung abscesses
 Predisposing factors – alcohol and sedative use, seizures, strokes,  Cough
neuromuscular disease – association with aspiration  Sputum – purulent, blood-stained?
 Community-acquired: mixed anaerobes (Gram negatives and Gram
 Mycoplasma – productive cough is rare
positives)
 Hospital-acquired - S.aureus, P.aeruginosa, Klebsiella, Proteus
 ± Sharp chest pain on inspiration – pleural inflammation
 Others – mycobacteria (cavitary lung lesion), actinomyces, etc  Signs of systemic infection – myalgia, weakness, malaise
 Mental confusion – in the elderly

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MICROBIOLOGICAL DIAGNOSIS
 Specimen – sputum (expectorated or induced), bronchoalveolar
lavage (BAL), blood
 Gastric aspirate – for TB diagnosis  Use appropriate container for sputum
 Used for patients
 Unable to produce sputum  Make sure pt produces sputum NOT saliva
 Uncooperative (including small children)
 Too ill to expectorate
 Neutralization with sodium bicarbonate within 1 hour of
collection – if for M.tuberculosis culture

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SPUTUM SPECIMEN CONTAINER UNACCEPTABLE CONTAINERS

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SPUTUM: SPECIMEN QUALITY

 Describe sputum appearance – pus, blood, saliva, mucus Purulent Mucoid

• Sputum texture
• Thick – good quality
• Thin and watery – probably saliva

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SPUTUM: SPECIMEN QUALITY

Saliva or induced Bloodstained sputum  Wet preparation – look for pus cells
sputum

 Microscopy
 Gram stain – look for pus cells & bacteria
 Ziehl-Neelsen stain
 KOH
 Giemsa stain – for Y.pestis & Histoplasma

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SPUTUM VS SALIVA

https://www.brainkart.com/article/Lower-Respiratory-Tract-Infection_20810/

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 Culture specimen – media selection – BA & MacConkey (in air),

CBA (CO2)
 LJ if suspect TB

 Examine & report cultures

 Identify isolate + susceptibility testing

 Serological tests for some e.g. to detect S.pneumoniae antigen

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Reller L B et al. Clin Infect Dis. 2008;46:926-932

© 2008 by the Infectious Diseases Society of America

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NEGATIVE
TEST CONTROL

Mac
+ve -ve TEST
control control

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https://www.brainkart.com/article/Lower-Respiratory-Tract-Infection_20810/

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