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The Spectrum of Resident Flora of Respiratory Tract
Types of Resident Microorganisms
Common Residents Oral streptococci
Neisseria spp., Branhamella or Moraxella
Corynebacteria spp
Bacteroides
Anaerobic cocci (Veilonella)
Fusiform bacteri
Candida albicans
Streptococcus mutans
Haemophillus influenza
Occasional Residents Streptococcus pyogenes
Streptococcus pneumoniae
Neisseria meningitidis
Uncommon Residents Corynebacterium diphteriae
Klebsiella pneumoniae
Pseudomonas aeruginosa
Escherichia coli
Candida albicans
Residents in latent state in Pneumocystis jirovecii
tissues Mycobacterium tuberculosis
Cytomegalovirus (CMV)
Herpes simplex virus
Epstein-Barr virus
Major microbial Flora of the Upper Respiratory Tract
Organisms Oral cavity Nasopharynx Epiglottis, Paranasal
, Tonsil larynx sinus, Middle
ear
Gram-positive cocci
Coagulase-negative staphylococci NF NF UP
Staphylococcus aureus CC UP UP
Pneumococci (S. pneumoniae) CC UP CP
Group A streptococci CC,CP UP CP
Groups C and G streptococci NF,CC,UP
Other streptococci NF NF,CC
Gram-positive bacilli
Diphteroids NF NF
Corynebacterium diphtheriae UC,UP UP
Arcanobacterium haemoyticum
Gram-negative coccobacilli
Haemophilus influenzae CC,UP CP CP
Other Haemophilus species NF NF
Gram-negative cocci
Neisseria meningitidis CC,UP
Neisseria gonorrhoeae UC,UP
Other neisseria spesies NF NF UP
Moraxella catarrhalis NF NF CP
Major microbial Flora of the Upper Respiratory Tract
Organisms Oral cavity Nasopharynx, Epiglottis, Paranasal
Tonsil larynx sinus, Middle
ear
Gram-positive anaerobes
Anaerobic streptococci NF NF UP
Anaerobic diphtheroids NF NF
Actinomyces spesies NF,UP
Gram-negative bacilli
Enterobacteriaceae UC UC UP
Pseudomonas aeruginosa UC UC
Gram-negative anaerobes
Prevotella spesies NF,UP UP
Fusobacterium spesies NF,UP UP
Veilonella spesies NF
Mycobacterium
Mycobacterium tuberculosis UP UP UP UP
Spirochetes
Borrelia spesies NF,UP NF,UP
Treponema pallidum UP UP
Fungi
Candida albicans NF NF,UP
Aspergillus species UP
Mucor species UP
Major microbial Flora of the Upper Respiratory Tract
Organisms Oral cavity Nasopharynx, Epiglottis, Paranasal
Tonsil larynx sinus, Middle
ear
Chlamydophila (Chlamydia)
Chlamydophila pneumoniae UP
Mycoplasma
Mycoplasma pneumoniae UC,UP UP UC,UP
Viruses
Epstein-Barr virus CP,CC
Herpes simplex virus CC, CP UP
Influenza virus CP CP
Parainfluenza virus CP CP
Adenovirus CP,UC CP
Coxsackievirus CP CP
Rhinovirus CP CP,UC CP
Respiratory syncytial virus CP CP
Human metapenumovirus CP CP
Figure 1. A diagram showing common causes of infection and the resulting
diseases in the respiratory tract
Types of Respiratory Tract Infection
Types Microorganisms Consequences
Restricted to surface Common cold virus Local spread
Influenza virus Local (mucosal) defenses important
Streptococci in throat Adaptive (immune) response sometimes too late to
Chlamydia be important in recovery
Diphteria Short incubation period (days)
Pertussis
Candida albicans (thrush)
Spread through body Measles, mumps, rubella Little or no lesion at entry site
EBV, CMV Microbe spreads through body , returns to surface
Chlamydophila psittaci for final multiplication and shedding, e.g salivary
Q fever gland (mumps, EBV, CMV), respiratory tract
cryptococcosis (measles)
Adaptive immune response important in recovery
Longer incubation period (weeks)
Respiratory Invaders – Professional or Secondary
Type Requirement Examples
Professional Adhesion to normal mucosa (in Respiratory virus (influenza , rhinovirus)
invaders (infect spite of mucociliary system) Streptococcus pyogenes (throat)
healthy respiratory Streptococcus pneumoniae
tract) Mycoplasma pneumoniae
Chlamydia (psittacosis, chlamydial conjunctivitis
and pneumoniae, trachoma)
Ability to interfere with cilia Bordetella pertussis, M. pneumoniae, Strept.
pneumoniae (pneumolysin)
Ability to resist destruction in Corynebacterium diphteriae (toxin), Strept.
alveolar macrophage pneumoniae (pneumolysin)
Secondary invaders Initiation infection and damaged Staphylococcus aureus, Streptococcus pneumoniae,
(infect when host by respiratory virus (e.g pneumonia complicating influenza
defenses are influenza virus)
impaired) Local defenses impaired (e.g Staphylococcus aureus, Pseudomonas aeruginosa
cystic fibrosis),
Chronic bronchitis, local foreign H. influenzae, Streptococcus pneumoniae,
body or tumor depressed Pneumocystis jiroveci, CMV, M. tuberculosis
immune response (e.g AIDS,
neoplastic dusease)
Depressed resistance (e.g
Streptococcus pneumoniae, Staphylococcus aureus,
elderly, alcoholisms, renal or
H.influenzae
hepatic disease)
TABEL 1. Common Agents of Respiratory Infections
Clinical Illness Bacteria Viruses Fungi Other Comment
Acute Rhinosinusitis S.pneumonia Rhinovirus Rare Rare Virus are the most frequent cause of
H.influenzae Parainfluenza vi. acute rhinosinusitis
M.catarrhalis Adenovirus Only ± 2% of adult and 10% of children of
Influenza vi. viral sinusitis is complicated by acute
bacterial sinusitis (ABS)
Community-acquired ABS: S. pneumoniae
and ntHI.
Hospital-acquired ABS : more likely gram-
negative.
ABS usually self limited (75 % resolving
without treatment).
However, untreated ABS are at risk of
intracranial and orbital complications as
well as chronic sinus disease.
Maximum medicamentosa therapy: a.b +
sinus irigation + topical steroid
TABEL 1. Common Agents of Respiratory Infections
Clinical Bacteria Viruses Fungi Other Comment
Illness
Upper Respiratory Airway
Chronic Anaerobic strept . Aspergillus Certain Usually polymicrobial infection
Rhinosinusitis Prevotella spp. Mucor parasite Anaerobic organisms account 51%
(CRS) S. aureus Rhizopus spp s
Candida S.aureus has been cultured as many as
Enteric Gram-
33%
negative bacilli.
Pseudomonas Aspergillus, Mucor, Rhizopus spp produce
Alternaria invasive CRS
Nocardia Hypersensitivity reaction to airborne
Legionella fungi contribute to some case CRS
Atypical In immunocompromized : Candida,
mycobacteria. Alternaria, Nocardia, Legionella, and
atypical mycobact, also parasites.
Otitis Externa S.epidermidis Rare Rare Skin flora are major e/ agents
(OE) S.aureus A diffuse acute OE (Swimmer's ear) may
Diphtheroids be caused by P. aeruginosa, along with
P.acnes other skin flora
P.aeruginosa Malignant OE (severe necrotizing) usually
caused by P. aeruginosa.
TABEL 1. Common Agents of Respiratory Infections
• Hemagglutinin-Neuraminidase (HN
• Fusion protein (F). It promotes the fusion of host and
viral cell membranes which is an initial step in
infection.
• Matrix (M) protein, located just within the envelope,
is hydrophobic.
Viral Replication
RESPIRATORY SYNCYTIAL VIRUS
(RSV
• RSV is a member of family Paramyxoviridae,
genus Pneumovirus. Infection of cells results in
syncytium formation.
The Cell Structure