PARVOBACTERIA Mary Joyce Saborrido-Teoxon,MD FEU-NRMF Institute of Medicine Dept.

Of Microbiology & Parasitology

Diseases Meningitis: H. influenzae; type b encapsulated strains. Vaccination effective Polyribitol capsule conjugated to protein months; 95% effective Spp. Otitis Media Usually non typeable strains

DNA probe/ Culture -) Ceftriaxone IM Co-tri PO Erythromycin PO Healing 2 weeks X _ + _ _ V _ + + +

GENUS:

HAEMOPHILUS
H. influenzae H. aegypticus H. aphrophilus H. ducreyi H. parainfluenzae H. parahaemolyticus H. haemolyticus

Pertussis toxin (A and B component, OM protein toxin): ADP ribosylation of Gi (inhibiting negative regulator of adenyl cyclase) interferes with transfer of signals from cell surface to intracellular mediator system; Lymphocytosis promotion -activation hypoglycemia Increased histamine Disease Whooping Cough (Pertussis) Three stages after a 7-10 day incubation; contagious (1-2 weeks) catarrhal: rhinorrhea, malaise, fever, sneezing (2-4 weeks) paroxysmal: repetitive cough with whoops, vomiting; anoxia and severity of cough cause neurological damage and eye hemorrhages; organism present at beginning disappears (>3 weeks) convalescence: less cough, secondary complications manifest: pneumonia, seizures, encephalopathy DIAGNOSIS:

H. aphrophilus H. haemolyticus H. parahaemolyticus H. parainfluenzae

Bronchitis Exacerbations of acute bronchitis in smokers with COPD Pneumonia 1-24 months; smokers

GENUS:

Haemophilus influenzae
Distinguishing Characteristics Morphology: Culture: Fastidious Growth & Metabolism: X & V Grows near S. aureus on BA = Satellite phenomenon Reservoir : Human nasopharynx Transmission Respiratory droplets, shared toys Pathogenesis Polysaccharide capsule type b capsule is polyribitol phosphate acid type most important virulence factor IgA protease is a mucosal colonizing factor Common cause of purulent meningitis Age Age Etiology < 2 mths 40% Group B strep 30% E. coli L. monocytogenes > 2 mths 60% H. influenza < 5 y.o. N. meningitidis 5 40 yrs 50% N. meningitidis >40 yrs 50% S. pneumoniae

Epiglottitis Rare in vaccinated kids; seen in unvaccinated toddlers. H. influenzae was the major causative agent. Treatment Cefotaxime or ceftriaxone for empirical therapy of meningitis. Check nasal carriage before releasing; use rifampin if still colonized. Prevention Active: Conjugate capsular polysaccharideprotein vaccine Passive: Ig (sickle cell dse., asplenia) Rifampin reduces oropharynx colonization and prevents meningitis in unvaccinated, close contacts <2 years.

BORDETELLA

Small, Gram-negative, encapsulated coccobacilli Strict aerobes

Bordetella pertussis
Distinguishing Characteristics MORPHOLOGY: GROWTH: Regan-Lowe or Bordet-Gengou media SOC: Saline nasal wash nasopharyngeal cultures Reservoir/Transmission Human (vaccinated); respiratory droplet Pathogenesis B. pertussis Is a Mucosal Surface Pathogen Attachment to nasopharyngeal ciliated epithelial cells (Filamentous hemagglutinin)

ect immunofluorescence (DFA) on nasopharyngeal smear Treatment Supportive care; hospitalization if <6 months, erythromycin Prevention Vaccine: DTaP; immunity wanes 5-7 years Babies born with little or no immunity (IgA) from mom Erythromycin x 5 days

Haemophilus aegypticus
-Weeks Bacillus

Purulent Conjunctivitis

Pertussis toxin (on outer membrane) aids in attachment to target recptor Toxins damage respiratory epithelium. Adenylate cyclase toxin: impairs leukocyte chemotaxis inhibits phagocytosis and causes local edema Tracheal cytotoxin: interferes with ciliary action; kill ciliated cells

Bordetella parapertussis Bordetella bronchiseptica

-) bacilli RESERVOIR: RT of canines DISEASE: (in human) Chronic RTI

Topical Sulfonamides

Haemophilus ducreyi
ease. Chancroid (genital ulcers): soft, painful chancre Slow to heal without treatment Open lesions increase transmission of HIV

EGBII; 8-15-11

GENUS: Small Gram-negative rods Facultative anaerobic Bipolar staining

PASTEURELLA

and regional lymph node enlargement and suppuration Traumatic implantation while skinning rabbits ulceroglandular disease Aerosols (skinning rabbits) pneumonia Ingestion (of undercooked, infected meat or contaminated water) produces typhoidal tularemia. Pathogenesis Facultative intracellular pathogen (localizes in reticuloendothelial cells) Granulomatous response Disease Tularemia Endemic in every state of U.S. Arkansas and Missouri highest Treatment Streptomycin (DOC) Gentamicin/ Tetracycline Prevention Protect against tick bites, gloves while butchering rabbits Live, attenuated vaccine for persons in high-risk occupations

Pathogenesis Endotoxin Facultative intracellular parasite (localizes in cells of reticuloendothelial system (RES) septicemia Granulomatous response with central necrosis Disease Brucellosis (undulant fever) B. abortus: B. suis: B. melitensis: B. canis: Acute Septicemias -104F (often in afternoon) -like symptoms, including arthralgias, myalgia, back pain

Reservoir U.S.: desert southwest, rodents, e.g., prairie dogs, chipmunks, squirrels, field mice, and voles Transmission Wild rodents flea bite sylvatic plague Human-to-human transmission by respiratory droplets Pathogenesis Coagulase-contaminated mouth parts of flea Endotoxin Two antigens (V and W) Envelope antigen (F-1) inhibits phagocytosis Disease Bubonic Plague uninfected human-coagulase rolecontaminated mouth parts Symptoms: Rapidly increasing fever Regional buboes Conjunctivitis untreated Pneumonic Plague

Pasteurella multocida
Distinguishing Characteristics Small , encapsulated gram-negative rods Reservoir Mouths of many animals, especially cats and dogs Transmission Animal bites; particularly from cat bites Disease Wound infection leading to cellulitis with lymphadenitis Pathogenesis Endotoxin, capsule; spreads rapidly within skin, no exotoxins known Lab Diagnosis Rarely cultured because routine prophylaxis is common. Treatment/Prevention DOC: PEN G Amoxicillin/clavulanate for cat bites. Amoxicillin/Clavulanate is standard prophylaxis and treatment for most bites (human included), along with thorough cleaning

Undulant Form: Milder, often a result of incomplete treatment Chronic Form n one year)

GENUS: Gram-negative rods Zoonotic Facultative intracellular pathogen

BRUCELLA
Treatment: DOC: Tetracycline + Gentamicin Ampicillin

-10%

bubonic plague or inhalation of organisms from infected individual. Highly contagious! Treatment Streptomycin with tetracycline Strict quarantine for 72 hours after starting antibiotics Prevention Animal control; avoid sick and dead animals. Killed vaccine is available for high-risk occupations.

GENUS: Gram-negative small pleomophic rods Facultative intracellular pathogen

FRANCISELLA

Brucella species
Distinguishing Characteristics Small Gram-negative rods, aerobic Facultative intracellular Catalase (+); Oxidase (+) Serological confirmation of disease of disease most common Culture is hazardous. Reservoir Domestic livestock Transmission Unpasteurized dairy products Direct contact with the animal, work in slaughterhouse

Prevention Vaccinate animals Pasteurize milk, especially goat milk.

Francisella tularensis
Distinguishing Characteristics Small Gram-negative rod Serodiagnosis; culture is hazardous Reservoir Many species of wild animals, especially rabbits, deer, and rodents Transmission Tick bite (Dermacentor) ulceroglandular disease, characterized by fever, ulcer at bite site,

GENUS: Gram-negative rod Enterobacteriaceae (oxidase negative)

YERSINIA

Yersinia pestis
Distinguishing Characteristics Small Gram-negative rods with bipolar staining (safety pin) Facultative intracellular parasite Coagulase + Clinical specimens and cultures and hazardous Serodiagnosis or direct immunofluorescence

EGBII; 8-15-11