BACTERIAL INFECTION ON

UPPER RESPIRATION TRACT

IKE IRMAWATI P.A, MSI MED
REVISED BY ERI DIAN
MIKROBIOLOGI FK YARSI

Haemophilus

Characteristics of Haemophilus
Small, pleomorphic gram-negative

coccobacilli, non motile

(+) cytochrome oxidase
Growth in culture requires exogenous hemin
(oxidized ferroprotoporphyrin) (X factor)
and/or nicotinamide adenine dinucleotide
(NAD) (V factor)

Haemophilus: Natural Habitats

Normal inhabitant of the upper respiratory,

gastrointestinal, and genital tracts of

humans except Haemophilus ducreyi (not
normal microbial flora)

Haemophilus species of
clinical importance
1. H. influenzae
-type

b is an important human pathogen

2. H. ducreyi
-sexually

transmitted pathogen (chancroid)

3. Other Haemophilus are normal flora

- H. parainfluenzae

- H. aphrophilus
- H. aegyptius

Haemophilus: Modes of Infection

Encapsulated strains of Haemophilus

influenzae associated with invasive infection

caused by person-to-person spread of H.
influenzae due to inhalation of infectious
respiratory droplets
Type b H. influenzae was most commonly
associated with disease prior to conjugate
vaccine but prevalence has declined with
advent of vaccination

Haemophilus: Types of Infectious

Disease
Encapsulated (types a-f) strains of H.

influenzae produce invasive infection

(pneumonia, meningitis, epiglottitis, and
bacteremia)
Unencapsulated (non-typeable) strains of H.
influenzae cause otitis media in children,
and lower respiratory tract infections (acute
tracheobronchitis, pneumonia) in children
and adults

Haemophilus: Species
Identification
Preliminary findings: small faintly-staining

(with safranin) gram-negative coccobacillary

to filamentous rods that grow on chocolate
agar but not sheep blood agar (except H.
aphrophilus that with passage in culture
grows on both)
X and V factor requirements determined
using X, V, and XV factor impregnated paper
strips on Mueller-Hinton agar

Haemophilus influenzae

Differentiation of Species
Hemolysis

Growth
Factor
X

Haemophilus influenzae
Aerobic gram-negative bacteria
Polysaccharide capsule
Six different serotypes (a-f) of

polysaccharide capsule
95% of invasive disease caused
by type b

Haemophilus influenzae type b

Clinical Features*

*prevaccination era

Haemophilus influenzae type b

Epidemiology

Reservoir

Transmission

Human
Asymptomatic carriers
Respiratory droplets

Antigenic Properties Contains 3 Major

surface antigens
1 Capsular polysaccharide
2 Outer membrane proteins (OMP)
3 Lipopolysaccharides ( LPS )

Haemophilus influenzae type b

Pathogenesis
Organism colonizes nasopharynx
In some persons organism invades

bloodstream and cause infection at distant

site
Antecedent upper respiratory tract infection
may be a contributing factor

Pathogenic Mechanisms
H. influenzae

Antiphagocytic polysaccharide capsule is the major

pathogenesis factor

Lipopolysaccharide lipid A component from the cell

wall (major role in non capsule strains)

All virulent strains produce neuraminidase and an

IgA protease

No exotoxins

Pathogenesis Host Factors

Hib conjugate vaccine (Poliribitol phosphate ( PRP)

capsule)
The Hib conjugate vaccine does not protect against

nontypeable strains
Persons at risk for invasive H influenzae disease

Asplenia

Immunocompromised

Basis for the H.influenzae type B

vaccine
The polysaccharide capsule of H.influenzae type B

is and represent its major virulence antiphagocitic

factor. The capsule contain ribose,ribitol,and
phosphate,known collectively as polyribitol
phosphate (PRP). Phagocytosis and complementmediated activity are stimulated in the presence of
antibodies directed at the H.influenzae type B
capsule.
H.influenzae type B vaccine contain PRP antigens
conjugated to specific protein carriers.

H. influenzae serotype b:
diagnosis and treatment timeline
Incubation

Signs or
symptoms

Exposure
Incubation period unknown
(~ 2-4d)

Infectiousness

Lab
Specimens

Prophylaxis

Onset*
Sudden
Onset

Management of
sequelae

Infectious while organisms are

present, or until 24-48h of antimicrobial
therapy
Specimens from sterile site, for culture (cerebrospinal
fluid, blood, pus, middle ear fluid). Gram Stain is
Immunize contacts aged <5y
presumptive
Antimicrobial prophylaxis

*Invasive disease includes meningitis, epiglottitis, pneumonia, septic arthritis, and cellulitis (less commonly osteomyelitis and pericarditis).
Modified from Michigan Health Department http://www.michigan.gov/documents/mdch/2Hflu_Rev2008_231415_7.pdf

 IsoVitaleX-enriched

chocolate agar
Requires 2 erythrocyte

factors for growth: X

(hemin) and V (NAD).
X & V factors are released

following lysis of red blood

cells
5% CO2 enhances growth

Haemophilus influenzae

Satellite Phenomenon
H. influenzae

Grows near S. aureus on blood agar:

satellite phenomenon.
Satellite phenomenon

S.aureus

Public Health AspectsH. influenzae

Typing based on capsule polysaccharide a f
Polyribose-ribitol phosphate (PRP) capsule

(type b)
Nonencapsulated (nontypeable) organisms

are part of normal flora of the respiratory tract

95% of invasive disease caused by type b

Polysaccharide Conjugate
Vaccines
Stimulates T-dependent immunity
Enhanced antibody production, especially in

young children
Repeat doses elicit booster response

Moraxella

Gram negativ diplococci

Neisseriaceae

Neisseria
Kingella
Eikenella
Simonsiella
Alysiella

Moraxellaceae

Moraxella
Acinetobacter

Characteristics of Moraxella
Gram-negative diplococci with adjacent sides

flattened
Frequently appear as intracellular gramnegative diplococci within polymorphonuclear
neutrophils

Characteristics of Moraxella
Growth Moraxella catarrhalis occurs on both

sheep blood and chocolate agar

Moraxella catarrhalis capnophilic (optimal
growth with 3-7% CO2)

Virulence factors:
Moraxella catarrhalis
Endotoxin
Pili
Beta-lactamase

Moraxella catarrhalis: Modes of

Infection
Oropharyngeal endogenous strains
spread into normally sterile
regions of the tracheobronchial
tree, the middle ear, and sinuses

Laboratory Diagnosis:
Moraxella catarrhalis

Direct smear from an otitis

media sample showing
intracellular gram-negative
diplococci

Laboratory Diagnosis:
Moraxella catarrhalis
Colonies appear smooth with a grayish-

white color
When colonies pushed with loop, they
scoot across media

Moraxella catarrhalis
growing on chocolate
agar after 24 hours of
incubation

Laboratory Diagnosis :
Moraxella catarrhalis

Oxidase positive
Catarrhalis Disc

Positive= blue-gren

Produce beta- lactamase

Characteristics of Moraxella
Moraxella rather than Branhamella accepted

taxonomically as the genus designation for M.

catarrhalis (family Moraxellaceae)
Even though M. catarrhalis not a member of
the family Neisseriaceae, morphologic and
biochemical similarity to Neisseria allows
clinical laboratory identification of M.
catarrhalis with Neisseria species

Moraxella catarrhalis: Natural Habitats

Present in the upper respiratory tract of 1.55.4% of healthy individuals, more commonly
in children (50.8%) and elderly adults (26.5%)

Moraxella catarrhalis: Types of Infectious

Disease
Acute purulent exacerbation of

chronic bronchitis
Causes 10-15% of episodes of
otitis media and sinusitis
Rarely associated with systemic
infection (endocarditis,
meningitits)

Selected Biochemical Reactions for Identification of

Neisseria and Moraxella catarrhalis1
Glu

Mal Lac
Suc
DNa
BE
N. gon
+

N. men
+
+

N. lac
+
+
+

M. cat

+
+
1Glu=glucose, Mal=maltose, Lac=lactose,
Suc=sucrose, DNa=DNase, BE=butyrate esterase
(indoxyl butyrate substrate), N. gon=N.
gonorrhoeae, N. men=N. meningitidis, N. lac=N.
lactamica, M. cat=Moraxella catarrhalis

Fusobacterium species
anaerobic, nonspore-forming, gram-negative

bacilli
Human infection usually results from F.
necrophorum subspecies funduliforme, but
infections with other species including F.
nucleatum, F.gonidiaformans, F. naviforme,
F.mortiferum, and F. varium have been
reported

Fusobacterium nucleatum

Fusobacterium infections are most common in

adolescents and young adults, but infections,

including fatal cases of Lemierre disease,
have been reported in infants and young
children
Diagnosis: anaerobic blood culture