33
A SEMINAR PRESENTATION ON LABORATORY DIAGNOSIS OF UPPER AND LOWER RESPIRATORY TRACT INFECTIONS BY: OGUNWOLA, OLUWATOSIN OPEYEMI MARCH, 2016.

Diagnosis of Upper and Lower Respiratory Tract Infections

Embed Size (px)

Citation preview

Page 1: Diagnosis of Upper and Lower Respiratory Tract Infections

A SEMINAR PRESENTATION ON LABORATORY DIAGNOSIS OF

UPPER AND LOWER RESPIRATORY TRACT

INFECTIONSBY:

OGUNWOLA, OLUWATOSIN OPEYEMI

MARCH, 2016.

Page 2: Diagnosis of Upper and Lower Respiratory Tract Infections

2

INTRODUCTION The respiratory system is a system of organs functioning in

respiration and in humans consisting esp. of the nose, nasal passages, pharynx, larynx, trachea, bronchi, and lungs

The respiratory tract is the site of an exceptionally large range of disorders for three main reasons: It is exposed to the environment and therefore may be affected

by inhaled organisms, dusts, or gases It possesses a large network of capillaries through which the

entire output of the heart has to pass, which means that diseases that affect the small blood vessels are likely to affect the lungs

It may be the site of “sensitivity” or allergy that may profoundly affect the functioning of the entire body systems.

Page 3: Diagnosis of Upper and Lower Respiratory Tract Infections

3

INTRODUCTION CONT’D The upper respiratory tract as defined, is the anatomic area

extending from the anterior nasal passages to the larynx.

Upper respiratory tract infection (URTI) has been recognized as one of the most common medical problems in the daily lives of people worldwide.

URTIs can be characterized by a group of disorders which include common cold, pharyngitis, tonsillitis, epiglottitis, sinusitis, bronchitis, rhinitis, and nasopharyngitis, which significantly occurs in upper respiratory tract.

Page 4: Diagnosis of Upper and Lower Respiratory Tract Infections

4

INTRODUCTION CONT’D The lower respiratory tract therefore comprises of the

anatomical region extending from the trachea to the lungs.

Due to its location and the activities of the lungs in oxygenation, the Lower respiratory tract, by all standards, is a sterile part of the body, hence lower respiratory tract infections are minimal.

Page 5: Diagnosis of Upper and Lower Respiratory Tract Infections

5

INTRODUCTION CONT’D

Page 6: Diagnosis of Upper and Lower Respiratory Tract Infections

6

INTRODUCTION CONT’D

URTIs have been characterized as acute febrile illnesses presentingwith cough, coryza, sore throat, and hoarseness, which forms the prime reason to get affected by URTI.

However, it has been suggested that the vast majority of URTIs cases have been benign, and thus, the exact aetiology of URTIs has not been understood completely.

The infection show various symptoms like coughing, sore throat, sneezing, difficulty in breathing, runny nose, muscle pain, and weakness.

Page 7: Diagnosis of Upper and Lower Respiratory Tract Infections

7

EPIDEMIOLOGY Upper respiratory tract infections are the most common

types of infectious diseases among adults. It is estimated that each adult experiences two(2) to four(4) respiratory infections annually.

Lower RTIs are the less common but the most common cause of deaths in developing countries.

As of 2010, LRTIs caused about 2.8 million deaths which is a slight fall when compared with the 3.4 million in 1990.

The morbidity of these infections is estimated to be about 75 million physician visits per year in developed countries.

Page 8: Diagnosis of Upper and Lower Respiratory Tract Infections

8

PATHOGENESISCommon cold

The term common cold can be referred to as one of the upper respiratory infection whose first infectious site is the nose, which further radiates to throat and sinuses.

It is caused by approximately 200 viruses, with a developing time of symptoms of 7-10 days.

It occurs frequently, especially in young during the dry harmattan period.Symptoms include:

1. Nasal discharge2. Nasal obstruction3. Sneezing4. Cough5. Fever may be present

Page 9: Diagnosis of Upper and Lower Respiratory Tract Infections

9

PATHOGENESIS CONT’DPharyngitisPharyngitis, the inflammation of pharynx or throat at back side, can be divided into two types, i.e., acute and chronic.

In addition, the pharyngitis can be classified into viral pharyngitis and bacterial pharyngitis according to their cause.It has been known to occur at an age of 4-8 years.

Factors like cold, allergies, toxic fumes, accumulation of chemicals, and flu have been suggested to result in pharyngitis.

Page 10: Diagnosis of Upper and Lower Respiratory Tract Infections

10

PATHOGENESIS CONT’DPneumonia

Acute pneumonia has its onset either prior to or immediately after admission to hospital. It is one of the most common infectious causes of death worldwide.

Patients with acute pneumonia usually have a cough, chest signs and fever.

The cough may or may not be productive of purulent sputum. Chest signs are variable and prone to subjective interpretation.

Page 11: Diagnosis of Upper and Lower Respiratory Tract Infections

11

PATHOGENESIS CONT’D

Others include: Acute sinusitis Laryngitis Tonsillitis Epiglottitis Rhinitis Nasopharyngitis Bronchitis

1. Tracheobronchitis2. Acute bronchitis3. Chronic bronchitis

Page 12: Diagnosis of Upper and Lower Respiratory Tract Infections

12

Features of pneumonia caused by different organisms

Page 13: Diagnosis of Upper and Lower Respiratory Tract Infections

13

PATHOGENESIS CONT’DPULMONARY TUBERCULOSIS

Pulmonary tuberculosis is common throughout the developing world. Primary infection follows airborne transmission from an individual with pulmonary tuberculosis.

Clinical Features Of Pulmonary Tuberculosis Fever Night sweats Weight loss Haemoptysis

Page 14: Diagnosis of Upper and Lower Respiratory Tract Infections

14

PATHOGENESIS CONT’D

Clinical Features Of Pulmonary Tuberculosis Fever Night sweats Weight loss Haemoptysis Diagnosis of Sputum for Tuberculosis

Sputum should be subjected to acid fast stain (either by Ziehl–Neelsen or auramine–phenol with the use of the fluorescent microscope).

Page 15: Diagnosis of Upper and Lower Respiratory Tract Infections

15

Organisms that infects the Respiratory tractBACTERIA FUNGI VIRUSESStreptococcus pneumoniae Aspergillus niger Rhinoviruses

Staphylococcus aureus Corona viruses

Corynebacterium diphtheriae Adenoviruses

Streptococcus pyogenes Influenza virus

Mycobacterium tuberculosis Respiratory syncytial virus

Pseudomonas aeruginosa Parainfluenza viruses

Haemophilus influenzae Epstein–Barr virusArcanobacterium haemolyticumKlebsiella pneumoniae

Page 16: Diagnosis of Upper and Lower Respiratory Tract Infections

16

PHYSIO-ANATOMICAL DEFENCE MECHANISMS

Page 17: Diagnosis of Upper and Lower Respiratory Tract Infections

17

Page 18: Diagnosis of Upper and Lower Respiratory Tract Infections

18

CLINICAL FEATURESThe features of different respiratory tract infectionslargely depend on the structures where inflammation

islocalised and the extent to which function is altered.

So,infection of the nasopharynx will result in a nasal

discharge, bronchitis in cough and sputum production, and

pneumonia in cough and sputum, but also in increased

respiratory rate and chest radiograph changes.Most upper respiratory tract infections are caused byviruses and are self-limiting

Page 19: Diagnosis of Upper and Lower Respiratory Tract Infections

19

SAMPLES COLLECTED Throat swab Saliva Sputum Pleural aspirates Bronchial aspirates Nasal swab Pernasal swab

Page 20: Diagnosis of Upper and Lower Respiratory Tract Infections

20

LABORATORY DIAGNOSIS COLLECTION OF RESPIRATORY TRACT

SPECIMENSSpecimens should be collected before the commencement of antibiotic therapy by an experienced physician, nurse or laboratory scientist.

Page 21: Diagnosis of Upper and Lower Respiratory Tract Infections

21

LABORATORY DIAGNOSIS CONT’D

RECEPTIONThe sample is forwarded from the clinicians in the wards

to the laboratory via a transport medium or in a ice- frozen flask

It is received at the reception and adequately recorded into the various registers and sample jackets.

It is then taken into the laboratory for the laboratory diagnosis proper.

Page 22: Diagnosis of Upper and Lower Respiratory Tract Infections

22

The diagnosis for each samples includes:SITE OF CCOLLECTION

TYPE OF SAMPLE

INCRIMINATING PATHOGENS

DIAGNOSIS

1. Anterior nares Nasal Swab 1. Streptococcus pneumoniae2. Haemophilus influenzae4. Staphylococcus aureus5. Gram negative bacilli

• Microscopy• Gram stain• Culture• Biochemical

tests

2. Pharynx and Larynx

Throat swabPernasal swabSputum

1. Streptococcus pneumoniae2. Staphylococcus aureus3. Gram negative bacilli

• Microscopy• Gram stain• Culture• Biochemical

tests

3. Trachea, bronchi and lungs

•Tracheal aspirates•Pleural aspirates•Blood

1. Same as larynx2. Neisseria gonorrhea

Page 23: Diagnosis of Upper and Lower Respiratory Tract Infections

23

PATHOGENS AVAILABLE ASSAYSLegionella species Culture of respiratory secretions and tissues on buffered

charcoal yeast extracts(BCYE)SerologyPCR

Chlamydia species SerologyCulturePCR

Mycoplasma pneumoniae SerologyCulture

VIRUSES

Herpse Simplex virus Virus isolation and PCR

Varicella-zoster virus Virus isolationDirect Fluorescent Antibody test

FUNGI

Cryptococcus species Gomori methanamine stainCalcoflour whitePeriodic Acid Schiff

Candida species Gram stainGomori methanamine stainCalcoflour whitePeriodic Acid Schiff

Page 24: Diagnosis of Upper and Lower Respiratory Tract Infections

24

TRADITIONAL METHODS OF LABORATORY DIAGNOSIS

Gram reaction (direct gram) Culture on MacConkey and Chocolate agars Microscopical examination of wet preparation Biochemical tests

Susceptibility testing

Gram Positive Cocci Gram Negative cocci Gram Negative Bacilli

Catalase Catalase OxidaseCoagulase Coagulase MotilityOptochin IndoleBacitracin Citrate

Urease

Page 25: Diagnosis of Upper and Lower Respiratory Tract Infections

25

LABORATORY DIAGNOSIS CONT’D

NONE SPECIFIC TESTS Nucleic Acid Amplification Test (NAAT)NAATs for the detection of upper and lower respiratory tract

infections offer several advantages over the traditional detection methods, never the less it has some disadvantages in cost, carryover contamination.

These NAATs include:PCRELISA

Page 26: Diagnosis of Upper and Lower Respiratory Tract Infections

26

LABORATORY DIAGNOSIS CONT’DDIAGNOSIS OF SPUTUM FOR TUBERCULOSISSample collection

Three consecutive early morning specimens should be stained in this way. Sputum specimens should be treated as a potential infection hazard, with proper warning given to ward, pottering and laboratory staff.

Page 27: Diagnosis of Upper and Lower Respiratory Tract Infections

27

LABORATORY DIAGNOSIS CONT’DDiagnosis of Sputum for Tuberculosis

1. Sputum should be subjected to acid fast stain (either by Ziehl–Neelsen or auramine–phenol with the use of the fluorescent microscope).2. Culture3. Susceptibility Testing

The results of acid-fast stain can be provided the same day, but culture, identification and susceptibility results take several weeks because of the slow growth rate of mycobacterium.

Page 28: Diagnosis of Upper and Lower Respiratory Tract Infections

28

DIAGNOSIS OF SPUTUM The radiographic appearance of the neck and lungs in

tuberculosis

A. X-ray of the neck B. X-ray of the lungs

Page 29: Diagnosis of Upper and Lower Respiratory Tract Infections

29

LABORATORY DIAGNOSIS CONT’D

NUCLEIC ACID AMPLIFICATION TEST (NAAT)NAATs for the detection of upper and lower respiratory tract

infections offer several advantages over the traditional detection methods, never the less it has some disadvantages in cost, carryover contamination.

These NAATs include:PCRELISA

Page 30: Diagnosis of Upper and Lower Respiratory Tract Infections

30

LABORATORY DIAGNOSIS CONT’D

Serology

Chlamydia species Neisseria meningitidis Sources: Laboratory images http://www.krackeler.com/graphics/0010/jpg/3506.jpg

IMAGES OF SEROLOGICAL KITS

Page 31: Diagnosis of Upper and Lower Respiratory Tract Infections

31

REFERENCES Agius G., Dindinaud G., Biggar J., Peyre R., Vaillant V., Poupet J.Y., Cisse M.F.,

and Castets M. (1990). An epidemic of respiratory syncytial virus in elderly people: clinical and serological findings. Journal of Medical Virology. 30: 117–127.

Bartlett J. G., Dowell S.F., Mandell L.A., and Fine M.J. (2000). Practice guidelines for the management of community acquired pneumonia in adults. Clinical Infectious Diseases. 31:347–382.

Hindiyeh M.A., Hillyard D.Y., and Carroll K.C. (2001). Evaluation of the Prodesse Hexaplex multiplex PCR assay for direct detection of seven respiratory viruses in clinical specimens. American Journal of Clinical Pathology. 116:218–224.

Karen C. C (2002). Laboratory Diagnosis of Lower Respiratory Tract Infections: Controversy and Conundrums. Journal Of Clinical Microbiology. 40(9): 3115–3120

Laboratory Diagnosis of Lower Respiratory Tract Infections, Cumitech, 7A, Sep. 1987.

Page 32: Diagnosis of Upper and Lower Respiratory Tract Infections

32

REFERENCES CONT’D Lozano R., Naghavi M., Foreman K., and Bolliger I. (2012). Global and regional

mortality from 235 causes of death for 20 age groups in 1990 and 2010; a systematic analysis for the global burden of disease study. The Lancet Journal. 380: 2095-2128.

Mortality and burden of diseases estimates for WHO member states in 2002. World Health Organisation.

Murdoch D. R., Laing R.T., Mills G.D., Karalus N.C., Town G.I., and Reller L.B. (2001). Evaluation of a rapid immunochromatographic test for detection of Streptococcus pneumoniae antigen in urine samples from adults with community-acquired pneumonia. Journal of Clinical Microbiology. 39:3495–3498.

  Reimer L.G., Carroll K.C. (2008). Role of the Microbiology Laboratory in the

Diagnosis of Lower Respiratory Tract Infections. Clinical Infectious Diseases. 26:743-748.

The American Journal of Medicine, Continuing Education Series, New Challenges in Respiratory Tract Infections and Causative Pathogens, Nov. 1997.  

Page 33: Diagnosis of Upper and Lower Respiratory Tract Infections

33

THANK YOU FOR LISTENING