Infections of the
Respiratory System
Chapter 15
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Learning Objectives
Lesson 15.1: Streptococcal Infections
and Other Common Bacterial Infections
1. Name the criteria necessary for microbes to
cause an infection of the respiratory system
2. Identify the microbes typically present in the
normal flora of the respiratory tract
3. Name the different streptococcal respiratory
infections and describe the transmission,
symptoms, and treatment for each
4. Discuss drug-resistant Streptococcus
pneumoniae disease
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Learning Objectives
Lesson 15.1: Streptococcal Infections and
Other Common Bacterial Infections (Cont.)
5. Describe the transmission and treatment of
mycoplasmal and chlamydial pneumonias
6. Discuss pertussis, tuberculosis, and their
treatments
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Infections in the Respiratory Tract
⬤For an infection of the respiratory system to occur
due to an exogenous agent, the following criteria
must be met:
⮚ A sufficient number (dose) of infectious agents must be
inhaled
⮚ The infectious agents must be airborne or contained in
droplet nuclei
⮚ The infectious organism must remain alive and viable
while in the air
⮚ The organism must find susceptible tissue in the host
suitable for attachment and growth
⬤Once in the respiratory tract, the organism must
colonize the surfaces before it can cause disease
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Respiratory Tract
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Bacterial Infections:
Streptococcal Infections
⬤Strep throat or streptococcal pharyngitis
⮚ Caused by group A Streptococcus
⮚ Most common bacterial infection of the throat
⮚ Can occur at any age, but is most common in
children
⮚ Transmission through person-to-person contact
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Streptococcus pyogenes
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Bacterial Infections:
Streptococcal Infections (Cont.)
⬤Scarlet fever
⮚ Group A beta-hemolytic streptococci;
Streptococcus pyogenes
⮚ Incubation period 1 to 2 days
⮚ Begins with fever and sore throat; might also
exhibit chills, vomiting, abdominal pain
⮚ “Strawberry tongue” due to exotoxins
⮚ Antibiotic treatment
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Scarlet Fever
From Zitelli BJ, Davis HW: Atlas of pediatric physical diagnosis, ed 5. St. Louis, 2008, Mosby.
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Bacterial Infections:
Streptococcal Infections (Cont.)
⬤Streptococcus pneumoniae
⮚ Gram-positive, encapsulated alpha-hemolytic
Diplococcus (Pneumococcus)
⮚ Common cause of mild respiratory illness
⮚ Also major source for pneumonia
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Bacterial Infections:
Streptococcal Infections (Cont.)
⬤Streptococcus pneumoniae (Cont.)
⮚ Common inhabitant of the nasopharynx of healthy
people
⮚ Can cause disease when it reaches other areas
such as the eustachian tubes, nasal sinuses,
lungs, etc.
⮚ Can be transmitted by person-to-person contact
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Bacterial Infections:
Streptococcal Infections (Cont.)
⬤Streptococcus pneumoniae (Cont.)
⮚ Risk for pneumococcal pneumonia is highest in
young children, the elderly, people with chronic
medical conditions, and immunocompromised
people
⮚ Vaccination is available
• Recommended for all adults 65 and older and for
immunocompromised people
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Streptococcus pneumoniae
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Bacterial Infections:
Streptococcal Infections (Cont.)
⬤Drug-resistant Streptococcus pneumoniae
disease (DRSP)
⮚ Pneumonia, bacteremia, otitis media, meningitis,
peritonitis, sinusitis
⮚ Contributing factor—overuse of antimicrobial
agents—emerging resistant strains
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Bacterial Infections:
Streptococcal Infections (Cont.)
⬤DRSP (Cont.)
⮚ Outbreaks reported in nursing homes, child care
centers, and institutions for HIV-infected people
⮚ Pneumococcal conjugate vaccine is available
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Other Common
Bacterial Infections
⬤Mycoplasma pneumoniae
⮚ Primary atypical pneumonia—relatively mild
⮚ Usually affects people younger than 40
⮚ Transmission: Respiratory droplets from person-
to-person
⮚ Usually due to crowded areas
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Mycoplasma pneumoniae
From Forbes BA, Sahm DF, Weissfeld AS: Bailey and Scott’s diagnostic microbiology, ed 12, St. Louis, 2007, Mosby.
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Other Common
Bacterial Infections (Cont.)
⬤Chlamydophila pneumoniae
⮚ One of the major causes of pneumonia or
bronchitis
⮚ Transmission by respiratory secretions
⮚ Most common in school-age children
⮚ Community-acquired pneumonia—easily passed
from one individual to another
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Other Common
Bacterial Infections (Cont.)
⬤Pertussis (whooping cough)
⮚ Highly contagious
⮚ Caused by Bordetella pertussis—small, aerobic,
gram-negative coccobacillus
⮚ Can cause permanent disability and death
⮚ Person-to-person transmission by airborne
droplets
⮚ Vaccine available
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Bordetella pertussis
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Other Common
Bacterial Infections (Cont.)
⬤Tuberculosis (TB)
⮚ Caused by Mycobacterium tuberculosis
⮚ Transmitted through air—infected person coughs,
sneezes, or talks
⮚ Usually infects the lungs
⮚ Infected persons may not show symptoms but
may have latent tuberculosis
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Other Common
Bacterial Infections (Cont.)
⬤TB (Cont.)
⮚ Annually approximately 8 million people worldwide
develop active TB with nearly 2 million deaths
⮚ Initial symptoms—fever, night sweats, and loss of
appetite
⮚ Some may go into remission; some become more
chronic and debilitating
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Other Common
Bacterial Infections (Cont.)
⬤TB (Cont.)
⮚ Antibiotic treatment available
⮚ TB vaccines are available
• Recommended in countries where disease is endemic
⮚ Transmission can largely be prevented if infected
persons are identified and put on antibiotic
regimen
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Mycobacterium
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Learning Objectives
Lesson 15.2: Rare and Opportunistic
Bacterial, Viral, and Fungal Infections
7. Describe rare and opportunistic respiratory
infections caused by bacteria
8. Compare and contrast the common cold and
influenza, and their prevention and treatment
9. Describe infections of the respiratory system
caused by fungi and the treatment of their
infections
[Link] the common symptoms of upper
and lower respiratory system infections, the
possible treatments, and prevention
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Rare Opportunistic Infections
⬤Staphylococcal pneumonia
⮚ Rare in healthy adults
⮚ Common in immunocompromised individuals
⮚ Usually hospital- and institution-acquired
⮚ Penicillin—treatment of choice
⮚ More strains of Staphylococcus become resistant
to penicillin—the use of vancomycin may be
required
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Rare Opportunistic Infections (Cont.)
⬤Haemophilus infections
⮚ Many Haemophilus species are part of the normal
flora
⮚ Haemophilus influenzae—gram-negative
coccobacillus—common cause of bronchitis in
children and chronic bronchitis in adults
• May also cause meningitis
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Haemophilus influenzae
From Murray PR, Rosenthal KS, Pfaller MA: Medical microbiology, ed 7, Philadelphia, 2013, Saunders.
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Rare Opportunistic Infections (Cont.)
⬤Klebsiella pneumoniae
⮚ Gram-negative, encapsulated bacillus
⮚ Most often hospital-acquired
⮚ At risk: Infants, older persons, alcoholics, persons
with chronic disease
⮚ Fatality: 25% to 50% of infected patients
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Rare Opportunistic Infections (Cont.)
⬤Diphtheria
⮚ Corynebacterium diphtheriae—facultative
anaerobic, gram-positive bacillus
⮚ Infects throat and nose—upper respiratory illness
⮚ Forms pseudomembrane on tonsils and throat;
can cause life-threatening respiratory obstruction
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Rare Opportunistic Infections (Cont.)
⬤Diphtheria (Cont.)
⮚ Bacterium produces exotoxins that can potentially
spread via blood
⮚ Other organs (e.g., the heart) can be damaged
⮚ Vaccine available
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Corynebacterium diphtheriae
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Rare Opportunistic Infections (Cont.)
⬤Legionellosis
⮚ Legionella pneumophila—gram-negative bacillus
⮚ Found in water sources
⮚ Contracted by inhalation of water mist containing
the organism
⮚ Difficult to distinguish from other pneumonias—
specific tests necessary
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Rare Opportunistic Infections (Cont.)
⬤Psittacosis
⮚ Chlamydia psittaci—obligate intracellular
⮚ Found in bird droppings—infectious for months
⮚ Spread from birds to humans
⮚ Fever, chills, headache, muscle aches, dry cough,
often pneumonia
⮚ Antibiotics
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Rare Opportunistic Infections (Cont.)
⬤Inhalation anthrax
⮚ Bacillus anthracis—gram-positive, spore-forming,
facultative anaerobe
⮚ Found in wild and domestic vertebrates
⮚ Infection: Through skin, inhalation, ingestion
⮚ Once spores germinate—release of toxin
• Causes internal bleeding, swelling, tissue necrosis
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Bacillus anthracis
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Rare Opportunistic Infections (Cont.)
⬤Q Fever
⮚ Zoonotic—Coxiella burnetii—gram-positive, spore-
forming coccobacillus
⮚ Globally—affects sheep, goats, cattle, dogs, cats,
birds, rodents, and ticks
⮚ Organism can be excreted in milk, urine, feces
⮚ Is resistant to heat, drying, common disinfectants
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Rare Opportunistic Infections (Cont.)
⬤Q Fever (Cont.)
⮚ Human infection by inhaling the organism from
contaminated barnyard dust, birth fluids, extracts
of infected herd animals, bites from infected ticks
⮚ Fever, headache, muscle pain, cough, chest pain
during breathing, shortness of breath, jaundice,
clay-colored stool
⮚ Antibiotic—best early in the disease
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Viral Infections
⬤About 90% of acute respiratory and 50% of
lower respiratory infections are caused by
viruses
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Viral Infections (Cont.)
⬤Common cold
⮚ Variety of viruses invade the nasopharynx
⮚ Most frequent human disease
⮚ Lasts 3 to 5 days
⮚ Rhinitis, runny nose, nasal congestion, sneezing
⮚ Common precursor for ear infections—not
necessarily bacterial
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Viral Infections (Cont.)
⬤Common cold (Cont.)
⮚ More than 200 different cold viruses
⮚ Highly contagious—spreads rapidly
⮚ No specific treatment—plenty of rest, lots of fluids
⮚ Over-the-counter medication to help relieve the
symptoms
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Viral Infections (Cont.)
⬤Influenza (flu)
⮚ Caused by orthomyxoviruses
• RNA viruses designated as types A, B, and C
⮚ Person-to-person infection, or by fomites
⮚ Flu patients are more susceptible to bacterial
infections than healthy persons
⮚ New flu virus variants result from frequent
antigenic changes
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Influenza Virus
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Viral Infections (Cont.)
⬤Influenza (Cont.)
⮚ Fever, headache, fatigue, dry cough, sore throat,
runny or stuffy nose, muscle aches
⮚ Gastrointestinal symptoms (sometimes)—nausea,
vomiting, diarrhea—more common in children than
adults
⮚ Epidemics in the United States typically during
winter
⮚ Vaccination available
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Viral Infections (Cont.)
⬤Viral pneumonia
⮚ About half of all pneumonias are caused by
viruses such as influenza virus, adenovirus,
coxsackievirus, chickenpox, measles,
cytomegalovirus, respiratory syncytial virus
⮚ Fever, nonproductive cough, rhinitis, myalgia,
headache
⮚ Different viruses may cause different symptoms
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Viral Infections (Cont.)
⬤Hantavirus pulmonary syndrome (HPS)
⮚ Caused by hantaviruses
⮚ Deadly disease
⮚ Carried by rodents
⮚ Transmission through contact with infected
animals, their urine, and/or droppings
⮚ Acute respiratory stress syndrome
⮚ Fatalities in 30% to 40% of cases
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Viral Infections (Cont.)
⬤Severe acute respiratory syndrome (SARS)
⮚ SARS coronavirus
⮚ Person-to-person transmission by respiratory
droplets
⮚ Can be life threatening
⮚ High fever, headache, body aches, dry cough,
followed by pneumonia
⮚ Antipyretics, supplemental oxygen, additional
ventilatory support
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Fungal Infections
⬤Histoplasmosis
⮚ Histoplasma capsulatum
⮚ Acute respiratory infection—primarily affects the
lungs—occasionally other organs
⮚ Transmission by inhalation of airborne conidia
⮚ Reservoirs: Soil around old chicken houses,
starling bird roosts, bat caves
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Fungal Infections (Cont.)
⬤Histoplasmosis (Cont.)
⮚ Most infected persons do not show symptoms
⮚ With symptoms (heavy exposure)
• Fever
• Headache
• Nonproductive cough
⮚ Progressive disease generally occurs in young
and elderly, also in immunocompromised persons
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Histoplasma capsulatum
From Forbes BA, Sahm DF, Weissfeld AS: Bailey and Scott’s diagnostic microbiology, ed 12, St. Louis, 2007, Mosby.
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Fungal Infections (Cont.)
⬤Coccidioidomycosis
⮚ Caused by Coccidioides immitis
⮚ Resides in southwestern United States, parts of
Mexico, and areas in South America
⮚ Reservoirs: Desert soil, rodent burrows,
archaeological remains, mines
⮚ Transmission: Inhalation of airborne arthroconidia
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Fungal Infections (Cont.)
⬤Coccidioidomycosis (Cont.)
⮚ 60%—no symptoms
⮚ 40%—mild to severe symptoms
⮚ Symptoms: Cough, chest pain, fever, chills, night
sweats, headache, muscle stiffness, muscle
aches, joint stiffness, rash, blood-tinged sputum
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Fungal Infections (Cont.)
⬤Coccidioidomycosis (Cont.)
⮚ Acute form usually fades without treatment
⮚ Bed rest and treatment of flulike symptoms
⮚ Relapses may occur in people with compromised
immune systems
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Coccidioides immitis
From Forbes BA, Sahm DF, Weissfeld AS: Bailey and Scott’s diagnostic microbiology, ed 12, St. Louis, 2007, Mosby.
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Fungal Infections (Cont.)
⬤Blastomycosis
⮚ Acute or chronic infection
⮚ Caused by Blastomyces dermatitidis
⮚ Transmission: Inhalation
⮚ Primarily affects the lungs; may spread via
bloodstream to other areas (e.g., skin)
⮚ Reservoir: Primarily wood and soil
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Fungal Infections (Cont.)
⬤Blastomycosis (Cont.)
⮚ Treatment may not be required if infection stays in
lungs
⮚ May require months of antifungal treatments if
infection spreads
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Blastomyces dermatitidis
From Forbes BA, Sahm DF, Weissfeld AS: Bailey and Scott’s diagnostic microbiology, ed 12, St. Louis, 2007, Mosby.
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Fungal Infections (Cont.)
⬤Pulmonary aspergillosis
⮚ Caused by one or more species of Aspergillus, a
mold found in decaying plants, stored hay,
compost piles, bird droppings, excess dust
accumulations
⮚ Spores transmitted by inhalation
⮚ May colonize in upper or lower respiratory tract
⮚ Antifungal drugs; sometimes administered by IV
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Aspergillus spp.
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Questions?
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