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CAMPYLOBACTER LEGIONELLA BARTONELLA

CAMPYLOBACTER LEGIONELLA BARTONELLA. Campylobacter sp. Organism Source(s) Human disease(s) C. coli Pigs, poultry, sheep, Gastroenteritis, bulls, birds septicemia C. jejuni ssp. jejuni Poultry, pigs, bulls, Gastroenteritis, dogs, cats, birds, others septicemia, meningitis,

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CAMPYLOBACTER LEGIONELLA BARTONELLA

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  1. CAMPYLOBACTER LEGIONELLA BARTONELLA

  2. Campylobacter sp. Organism Source(s) Human disease(s) C. coli Pigs, poultry, sheep, Gastroenteritis, bulls, birds septicemia C. jejuni ssp. jejuni Poultry, pigs, bulls, Gastroenteritis, dogs, cats, birds, others septicemia, meningitis, proctitis C. jejuni ssp. doylei Humans Gastroenteritis, gastritis, septicemia C. fetus ssp. fetus Cattle, sheep Septicemia, gastroenteritis, abortion, meningitis

  3. Clinical characteristics • C. coli and C. fetus cause most human disease • Transmitted through contaminated food, milk, or water • Campylobacter does not multiply in food • Person-to-person transmission is rare

  4. Clinical characteristics, cont. • Seasonality in the U.S.; late summer-early fall peak • Most common etiology of gastroenteritis in U.S. • GI disease is typically self-limiting • Post-infectious complications can include Guillain-Barré

  5. Laboratory Diagnosis • Specimen collection • No special requirements; stool and blood 1° specimens • For stool delayed more than 2 hrs: • Cary-Blair transport • Campy thio (thio broth with 0.16% agar and • vancomycin, trimethoprim, cephalothin, • polymyxin B and amphotericin B)

  6. Laboratory Diagnosis, cont. • Stool Culture • Selective media and optimal conditions required • Campy-CVA at UMHS • Brucella agar base with antibiotics • (cefoparazone, vancomycin, and amphotericin B) • 5% sheep blood • 42°C, microaerobic (10% CO2, 5% O2, 85% N2), 72 hrs

  7. Laboratory Diagnosis, cont. • Blood Culture • Can routinely be detected in commercial systems • Some isolates may require 2 weeks to be detected • Subcultures require incubation microaerobically

  8. Laboratory Diagnosis, cont. • Microbiologic characteristics • Growth at 42°C, microaerobically, grayish colonies • Gram-negative bacillus; faintly staining • Small rods, curved or seagull-winged • Motile (darting on wet prep) • Oxidase and catalase positive • Reported as Campylobacter sp.

  9. CDC Public Health Image Library (PHIL)

  10. http://www.lf3.cuni.cz/ustavy/mikrobiologie/rep/caje.htm

  11. Treatment • Antimicrobial Susceptibility Testing • Standardized methods recently made available, but • not routinely performed • Therapy • Susceptible to macrolides, tetracyclines, • aminoglycosides, and quinolones • Erythromycin is drug of choice for severe GI illness, • with Ciprofloxacin as an alternative • Parenteral therapy required for systemic infections

  12. Legionella sp. • Species isolated Species isolated from • from humans environment only • L. pneumophila, serotypes 1-15 L. cherrii • L. micdadei L. erythra • L. bozemanii L. gratiana • L. dumoffii L. jamestowniensis • L. feelei L. brunensis • L. gormanii L. brunensis • L. hackeliae L. fairfieldensis • L. longbeachae L. santicrusis • L. oakridgensis • L. wadsworthii • Over 40 species in the genus • L. pneumophila is the predominant pathogen

  13. Epidemiology and pathogenesis • Ubiquitous in environment; primarily aquatic habitat • Widely distributed in natural and man-made environments • Acquired environmentally, not person-to-person • Exposure through inhalation of aerosolized organisms • Can infect and multiply within free-living parasites • - survival in environment • Resist destruction following phagocytosis • - survival in host

  14. Clinical characteristics • Causative agent of Legionnaires’ Disease • - identified in 1976 following outbreak of • severe respiratory illness at an American • Legion convention in Philadelphia • - organism did not grow on routine media • - identification required months by CDC • Fever, pneumonia; case-fatality rate of 10-20%

  15. Clinical characteristics, cont. • Pontiac fever • - identified in Pontiac, MI • - self-limiting, not-fatal respiratory infection • Other infections • - wound abscesses, encephalitis, endocarditis

  16. Clinical characteristics, cont. • Highest at-risk populations • Immunocompromised • Heavy smoker • Over age 60 • Same organisms may manifest itself differently in • different individuals • Also impacted by baseline immunity and dose

  17. Laboratory Diagnosis • Specimen collection • Respiratory tract specimens • - sputum, BAL, pleural fluid • Blood, tissue, biopsy material • Specimen processing • Standard precautions (BSC) • Concentration of dilute specimens

  18. Laboratory Diagnosis, cont. • Direct detection • DFA for organism in respiratory specimens • Urine antigen test • Immunochromatographic commercial test • Only detects L. pneumophila, serogroup 1

  19. Legionella DFA Legionella Urine Ag

  20. Laboratory Diagnosis, cont. • Culture • Include Buffered Charcoal Yeast Extract (BCYE) Agar • Charcoal to detoxify specimen • Cysteine • Inhibitors (polymixin B, anisomycin, cefamandole) • Incubate 35 – 37°C, room air, for 7-10 days

  21. Laboratory Diagnosis, cont. • Identification • Small, gray-white to blue-green colonies • wet, ground-glass speckling • Gram stain yields thin, gram-negative rods • ID of colony using FA reagents • Report as Legionella sp.

  22. Colonies on BCYE http://www.rivm.nl/infectieziektenbulletin/bul1212/diagnose_en_preventie.html Gram stain http://reaannecy.free.fr/Documents/infectio/legionellose.htm

  23. Laboratory Diagnosis, cont. • Serodiagnosis • Turkey RBCs sensitized with Legionella antigens • Set up in pools for screening purposes • Incubate with patient serum and look for agglutination • Test against individual antigens for type-specificity • Only available at MDCH

  24. Treatment • Antimicrobial Susceptibility Testing • In vitro results do not correlate with clinical outcome, • so not routinely performed • Therapy • Azithromycin is effective against this and other causes • of “atypical pneumonia” • Fluoroquinolone for severely ill • Penicillins, cephalosporins, and aminoglycosides are • not effective

  25. Bartonella sp. • Organism Resevoir Transmission Disease(s) • B. bacilliformis ?humans Sand flies Carrión’s disease • B. quintana ?humans Human body Trench fever, relapsing • ?rodents louse fever, bacteremia, • endocarditis, bacillary • angiomatosis, • lymphadenopathy • B. henselae Domestic Cat bites or Cat-scratch disease, • cats scratches bacteremia, endocarditis, • bacillary angiomatosis, • peliosis hepatitis • Bartonella currently includes 16 species, only 5 cause human disease

  26. Epidemiology and pathogenesis • Agent primarily of zoonotic infections • Increasing in importance as a pathogen in • immunocompromised hosts • Pathogenesis is not well understood, but diseases • caused by all species seem to be pathologically similar

  27. Clinical characteristics • Trench fever (B. quintana) • - transmitted from infected body louse • - affected many soldiers in battle • - influenza-like headache, bone pain, • splenomegaly, maculopapular rash

  28. Clinical characteristics • Cat-scratch disease (B. henselae) • - papule or pustule develops at site • of cat bite/scratch • - regional tender lymphadenopathy develops • in 1-7 weeks • - disease ranges from chronic, self-limited • adenopathy, to severe systemic illness

  29. Cat-scratch disease Los Angeles Co. West Vector Control District http://www.lawestvector.org/bartonella.htm http://www.uvp5.univ-paris5.fr/ MICROBES/Diagnostic/Bartonella/Bartonella.asp

  30. Clinical characteristics • Bacillary angiomatosis (B. quintana and B. henselae) • - vascular proliferative disease (organisms • stimulate angiogenesis) • - small papules enlarge to form red – purple nodules • - can occur on the skin surface, in subcutaneous • tissue, or in visceral organs • - primarily seen in HIV+; some reports in transplant • patients

  31. Bacillary angiomatosis http://www.emedicine.com/derm/topic44.htm

  32. Laboratory Diagnosis • Specimen collection • Blood, tissue, biopsy material • Direct detection • Histopathologic detection in tissue using Warthin- • Starry silver stain • PCR for detection in tissue and body fluids

  33. Demonstration of Bartonella henselae in cardiac valve of a patient with blood culture-negative endocarditis. The bacilli appear as black granulations (Warthin Starry, original magnification X250). http://www.cdc.gov/ncidod/eid/vol8no2/01-0141-G2.htm

  34. Laboratory Diagnosis, cont. • Culture • Fastidious organism; culture infrequently performed

  35. Laboratory Diagnosis, cont. • Serodiagnosis • Main method for diagnosis • IFA using antigen prepared from co-cultures • HIV-infected patients may not mount an antibody • response to infection

  36. Treatment • Antimicrobial Susceptibility Testing • In vitro testing is difficult because of limited availability • of strains and fastidious nature of organism • Therapy • Aminoglycosides, beta-lactam agents, erythromycin, • and doxycycline • At-risk individuals should avoid exposures to cats

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