Microbiological perspective of  lower respiratory tract infections Veronika Holá Institute for Microbiology Faculty of Medicine, Masaryk University  and St. Anne´s Faculty Hospital in Brno TZKM, spring 2018 Respiratory infections • Common infections • Strong economic impact • Transmitted in collectives • Outbreaks or epidemics 2 Respiratory infections • Localisation of infection in the respiratory tract • Distinguish – URTI – LRTI 3 URT infections – Infections of nose a nasopharynx – Infections of oropharynx incl. tonsillae – Infections of paranasal sinuses – Otitis media – Conjunctivitis – Infection of epiglottis – Infection of larynx and trachea – Infection of bronchi – Infection of bronchioli – + Infections of lungs 4 LRT infections Normal flora of RT • Nasal cavity • Pharynx • LRW 5 Incidence of pneumonia • First year of life • CZ ‐ 80 000 ‐ 150 000/year • Factors increasing lethality • Etiology of pneumonia – Infectious – Non‐infectious (=„pneumonitis“) 6 Pneumonia • Pneumonia – acute or chronic inflammation of lung parenchyme on the infectious, allergic, physical or chemical basis • Affected sites • Symptoms • Severity • Worldwide – 3rd most often cause of death 7 According to mechanism of development • Primary • Secondary • Alveolar • Interstitial 8 According to pathological‐anathomy According to RTG findings • Alar • Lobar • Segmental • Bronchopneumonia 9 According to clinical manifestation and RTG • Typical (bacterial) – Classical symptoms of pneumonia • Atypical pneumonia – Symptoms not typical for bacterial pneumonia – EA – IC pathogens 10 Atypical pneumonia • The term rather obsolete – mostly caused by • respiratory viruses • atypical bacteria • In bacterial agents, antibiotic therapy (doxycycline,  macrolides) Pneumonia ‐ according to course of  infection • Acute • Subacute • Chronic • Recurrenting • Migrating 12 Pneumonia ‐ according to course of  infection • Acute – Acute – community‐acquired pneumonia – Acute – nosocomial pneumonia • VAP  • Other 13 Etiology of community pneumonia I. • According to epidemiology and clinic • Community acquired • Acute – community‐acquired in healthy adults • Most common EA • Elderly • Atypical pneumonia 14 • Etiology of acute community‐acquired pneumonia in healthy  children – Bronchopneumonia • In newborns – Atypical pneumonia • In newborns 15 Etiology of community pneumonia II. • Acute community‐acquired pneumonia in  immunocompromised • In more serious immunodeficiency 16 Etiology of community pneumonia III. • Acute community‐acquired pneumonia after a contact with  animals – Bronchopneumonia – Haemorrhagic pneumonia – Atypical pneumonia 17 Etiology of community pneumonia IV. Etiology of nosocomial pneumonia I.  • Acute nosocomial VAP – ATB treatment • Early pneumonia • Most common EA 18 • Late  nosocomial pneumonia • Most common EA • Therapy 19 Etiology of nosocomial pneumonia II.  • Pneumonia in immunocompromised • Most common EA • Pneumonia in Social work institutions – Elderly – More resistant strains than in community 20 Etiology of nosocomial pneumonia III.  Etiology of subacute and chronic pneumonia • Subacute and  chronic pneumonia • Aspiration pneumonia and lung abscesses • Lung tuberculosis and mycobacterioses 21 Diagnostics of pneumonia I. • Physical finding • RTG of lungs • Microbiological examination of sputum  – Avoid saliva contact 22 CT of pneumonia with two abscesses surrounded by  pyogennic membrane Diagnostics of pneumonia II.  • Sputum – Mucopurulent, purulent samples – Semiquantitative inoculation • Haemoculture • Examination of exudate, BAL  • Urine examination for antigens • Serology • Blood count 23 Diagnostics of pneumonia III. • Panel of respiratory viruses and other  microoorganisms – Respiratory viruses • Include non‐viral agents – unculturable bacteria • Atypical pneumonia 24 Therapy of pneumoniae • According to type and etiology • In general • Acute bronchopenumonia • Atypical pneumoniae – Relapse • Treatment 25 Treatment • Nosocomial pneumonia • Symptomatic treatment • Nebulisation therapy • Regime arrangement • Satisfactory input of liquids, energy, vitamins • Breath rehabilitation • 6 weeks after recovery – functional examination of lungs 26 Complications • Respiratory insufficiency • Pleural exudate • Empyema • Lung abscesses • Pulmonary gangrese • Atelektasis and subsequent bronchiectasia • Sepsis with dissemination of infection to other localities (arthritis, otitis, nephritis, endocarditis, meningitis, peritonitis)  or septic shock 27 28