\haemophilus influenzae and bordetella features, transmission, types ,virulence factors,lab diagnosis traeatment ,prevention

1. Haemophilus &Haemophilus &
BordetellaBordetella

2. HaemophilusHaemophilus
 First isolated in 1892 by Robert Pfeiffer – HenceFirst isolated in 1892 by Robert Pfeiffer – Hence
also called Pfeiffer’s bacillusalso called Pfeiffer’s bacillus
 Was thought to be the infectious agent for fluWas thought to be the infectious agent for flu
 Was also called Bacillus influenzaeWas also called Bacillus influenzae
 Common SpeciesCommon Species
 H. influenzaeH. influenzae
 H. parainfluenzaeH. parainfluenzae
 H. ducreyiH. ducreyi

3. Haemophilus influenzaeHaemophilus influenzae
 Gram negative Rods.Gram negative Rods.
 Range from coccobacillary to long filamentousRange from coccobacillary to long filamentous
forms.forms.
 Non – motileNon – motile
 AerobicAerobic
 Fastidious organismsFastidious organisms

4. Haemophilus influenzaeHaemophilus influenzae
 Humans are the only natural hostsHumans are the only natural hosts
 Transmission:Transmission: respiratory droplet spreadrespiratory droplet spread
 Peak Prevalence of Meningitis:Peak Prevalence of Meningitis: 6 – 126 – 12
monthsmonths
 The incidence of Hib fell by 95% in populationsThe incidence of Hib fell by 95% in populations
with high rates of vaccinationwith high rates of vaccination

5. Haemophilus influenzaeHaemophilus influenzae
Two main typesTwo main types::
 II The uncapsulated (untypable) strainsThe uncapsulated (untypable) strains
 IIII The encapsulated strainsThe encapsulated strains

6. CapsuleCapsule
 Polysaccharide in naturePolysaccharide in nature
 Six types : a, b, c, d, e and fSix types : a, b, c, d, e and f
 Type b is associated with most severe form ofType b is associated with most severe form of
diseasedisease
 Hib capsule is Polyribitol Phosphate (PRP)Hib capsule is Polyribitol Phosphate (PRP)

7. Haemophilus influenzaeHaemophilus influenzae
UnencapsulatedUnencapsulated
Responsible for localizedResponsible for localized
infections i.e.infections i.e.
 Otitis mediaOtitis media
 ConjuctivitisConjuctivitis
 BronchitisBronchitis
 SinusitisSinusitis
CapsulatedCapsulated
Responsible for InvasiveResponsible for Invasive
disease i.e.disease i.e.
 MeningitisMeningitis
 SepticaemiaSepticaemia
 EpiglottitisEpiglottitis
 PneumoniaPneumonia
 Septic arthritisSeptic arthritis
 CellulitisCellulitis

8. LABORATORY DIAGNOSISLABORATORY DIAGNOSIS
 Clinical SpecimensClinical Specimens
 Blood, sputum, CSF, Joint fluidBlood, sputum, CSF, Joint fluid
 MicroscopyMicroscopy
 Gram StainGram Stain
 Flourescent antibody stainFlourescent antibody stain
 CultureCulture
 Chocolate Agar (Factor V & X)Chocolate Agar (Factor V & X)
 SerologySerology
 Latex agglutination, Counter immunoelectrophoresisLatex agglutination, Counter immunoelectrophoresis
 PCRPCR

9. Growth requirements in VitroGrowth requirements in Vitro
 FactorFactor VV HeminHemin
 FactorFactor XX NADNAD
 Chocolate agar provide both these factorsChocolate agar provide both these factors
 Growth is enhanced in 5% CoGrowth is enhanced in 5% Co22

10. TREATMENTTREATMENT
 Meningitis – CeftriaxoneMeningitis – Ceftriaxone
 Otitis media & Sinusistis – Amoxycillin-Otitis media & Sinusistis – Amoxycillin-
clavulanate & Co-trimoxazoleclavulanate & Co-trimoxazole
PREVENTIONPREVENTION
 Vaccine against hemophilus type-b (Hib)Vaccine against hemophilus type-b (Hib)
 Age 2-15 monthsAge 2-15 months
 Conjugate vaccineConjugate vaccine
 RifampicinRifampicin

11. Haemophilus ducreyiHaemophilus ducreyi
 Causes a sexually transmitted infection calledCauses a sexually transmitted infection called
ChancroidChancroid
 Requires only Factor X for growthRequires only Factor X for growth

12. Bordetella pertussisBordetella pertussis
 Small CoccobacillarySmall Coccobacillary
 Gram negative rodGram negative rod
 CapsulatedCapsulated
 Causes Pertussis (Whooping Cough) – a highlyCauses Pertussis (Whooping Cough) – a highly
infectious disease in its early phaseinfectious disease in its early phase

13. Bordetella pertussisBordetella pertussis
 Pathogen only for humansPathogen only for humans
 Transmitted by airborne dropletsTransmitted by airborne droplets
 Highly contagiousHighly contagious
 Worldwide distributionWorldwide distribution
 Primarily infants & young childrenPrimarily infants & young children

14. PATHOGENESISPATHOGENESIS
 Attachment to cilia via haemagglutinin on PilliAttachment to cilia via haemagglutinin on Pilli
 ADP-ribosylation of Gi-proteinADP-ribosylation of Gi-protein  stimulationstimulation
of Adenylate cyclaseof Adenylate cyclase  ↑ in cAMP levels↑ in cAMP levels  ↑↑
in protein kinase activityin protein kinase activity
 ADP-ribosylation of Gi-proteinADP-ribosylation of Gi-protein  ↑ in signal↑ in signal
transduction pathwaytransduction pathway  LymphocytosisLymphocytosis
 Adenylate cyclase- inhibits neutrophilAdenylate cyclase- inhibits neutrophil
bactericidal activitybactericidal activity
 Cytotoxin- damages ciliated cells by acting inCytotoxin- damages ciliated cells by acting in
concert with endotoxinconcert with endotoxin

15. CLINICAL FEATURESCLINICAL FEATURES
 Acute tracheobronchitis in childrenAcute tracheobronchitis in children
 Mild upper respiratory tract symptomsMild upper respiratory tract symptoms
 Severe paroxysmal cough (1 to 4 weeks)Severe paroxysmal cough (1 to 4 weeks)
 Death due to pneumoniaDeath due to pneumonia
 In AdultsIn Adults
 Paroxysmal cough lasting weeks (100 day cough)Paroxysmal cough lasting weeks (100 day cough)
 Whoop is absentWhoop is absent

16. Laboratory DiagnosisLaboratory Diagnosis
 Clinical SpecimensClinical Specimens
 Nasopharyngeal swabNasopharyngeal swab
 MicroscopyMicroscopy
 Gram negative rodsGram negative rods
 Flourescent antibody stainingFlourescent antibody staining
 CultureCulture
 Bordet gengou medium (20-30% blood)Bordet gengou medium (20-30% blood)
 SerologySerology
 Agglutination with specific antiseraAgglutination with specific antisera
 PCRPCR

17. TREATMENTTREATMENT
 AntibioticAntibiotic
 ErythromycinErythromycin
 Supportive CareSupportive Care
 Oxygen TherapyOxygen Therapy
 Suction of mucusSuction of mucus

18. PREVENTIONPREVENTION
 VaccinesVaccines
 Acellular pertussis vaccineAcellular pertussis vaccine
 BoostrixBoostrix
 AdacelAdacel
 Killed VaccineKilled Vaccine
 Higher side effects (encephalopathy)Higher side effects (encephalopathy)
 AntibioticsAntibiotics
 ErythromycinErythromycin
 Un-immunized & exposedUn-immunized & exposed
 Immunized & < 4 yrs.Immunized & < 4 yrs.

19. QUESTIONS???QUESTIONS???