renal module.pptx microbiology of renal module

Good ppt

1. Renal module for Health officer Students By: Fikru Adere ( MLT,MSc ) Email : [email protected]

2. Klebsiella 05-Oct-24 Fikru Adere (BSc, MSc) 2

3. General features 05-Oct-24 Fikru Adere (BSc, MSc) 3 Non-motile Capsulated Lactose positive Most are urease positive Grow on OM forming large mucoid colonies. Short plump straight rods. Capsular halo seen prominently in gram stain. Commensals, saprophytes.

4. 05-Oct-24 Fikru Adere (BSc, MSc) 4 Usually found in GI tract There are seven specie, Important K. pneumoniae and Klebsiella oxytoca , less imporant ozaena , K. rhinoscleromatis K. pneumoniae is mostly commonly isolated species Possesses a polysaccharide capsule, which protects against phagocytosis and antibiotics Makes the colonies moist and mucoid Has a distinctive “yeasty” odor

5. 05-Oct-24 Fikru Adere (BSc, MSc) 5 Virulence factors Pilli : adherence to respiratory and urinary epithelium. Capsule: Mucoid capsule is anti- phagocytic and acts as a major virulence factor. About 80 capsular (K) antigens are presently recognized. Type K2, K3 and K21 are of particular significance in human disease.

6. 05-Oct-24 Fikru Adere (BSc, MSc) 6 Klebsiella - microscopy

7. 05-Oct-24 Fikru Adere (BSc, MSc) 7 Klebsiella on nutrient agar and blood agar

8. 05-Oct-24 Fikru Adere (BSc, MSc) 8 1. Pneumonia diabetics, alcoholics and immuno compromised patients. Lung abscess Lobar pneumonia – necrotic destruction of the alveolar spaces, cavity formation and production of thick blood tinged viscous sputum. Prognosis is grave with 50% mortality. Serotypes 1, 2, 3. UTI Septicaemia Wound infection Meningitis

9. 05-Oct-24 Fikru Adere (BSc, MSc) 9 is associated with hospital acquired infections of wounds and of the urinary tract. It is also found in the respiratory tract where it may cause infection, particularly in immunocompromised patients. Klebsiella aerogenes

10. 05-Oct-24 Fikru Adere (BSc, MSc) 10 Specimen: urine, pus, blood etc. depending on the site of infection. Morphology Klebsiellae are Gram negative, non-motile, usually capsulated rods .

11. Culture 05-Oct-24 Fikru Adere (BSc, MSc) 11 it grows on macConkey and blood agar media. Colonies appear mucoid and pink in macconkey agar media.

12. BAP 05-Oct-24 Fikru Adere (BSc, MSc) 12 Non-hemolytic (gamma-hemolytic), mucous colonies of K.pneumoniae on blood agar.

13. Biochemical tests 05-Oct-24 Fikru Adere (BSc, MSc) 13 T hey ferment glucose and lactose producing acid and gas. Typing: based on about 90 capsular (k) antigens there are three types – k2, k3 and k21. I M Vi C test : - - + + TSI agar Acid with gas Urease Positive

14. 05-Oct-24 Fikru Adere (BSc, MSc) 14 Biochemical tests Klebsiellae are indole negative ( K. oxytoca is indole positive), do not produce H2S. Key: VP = Voges - Proskauer , Lact = Lactose fermentation, Ure = Urease , Cit = Citrate, Mal = Malonate utilization, LDC = Lysine decarboxylase

15. Prevention and control 05-Oct-24 Fikru Adere (BSc, MSc) 15 Removing of urinary catheters when they are no longer needed. Taking proper care of respiratory therapy devices.

16. 05-Oct-24 Fikru Adere (BSc, MSc) 16 E.coli Urinary tract infections Ascending urinary tract infection Urinary tract infection can be: Ascending = via urethra Descending = haematogenous route

17. Enterobacter , Citrobacter and Serratia 05-Oct-24 Fikru Adere (BSc, MSc) 17 Primary infections caused by Enterobacter , Citrobacter and Serratia are rare in immunocompetent patients. Gram-negative lactose fermenting rods . found as a commensal in the intestinal tract of humans and animals and moist environments.

18. 05-Oct-24 Fikru Adere (BSc, MSc) 18 Genus Enterobacter Medical important species is E.aerogens . Occurs as indigenous intestinal flora . Enterobacter aerogens is associated with UTI, wound infection and septicaemia in immuno -compromised and chronically debilitated patients.

19. 05-Oct-24 Fikru Adere (BSc, MSc) 19 Enterobacter cont’d… It produces mucoid colony resembling klebsiella on MacConkey agar. It is similar to klebsiella in many biochemical characters; however, it is motile. Give positive for tests for motility, citrate, VP & produce gas from glucose. I M Vi C test : - - + +

20. 05-Oct-24 Fikru Adere (BSc, MSc) 20 Genus Citrobacter It is gram-negative lactose fermenting motile rods , and opportunistic pathogen. Medical important species is Citrobacter freundii . Citrobacter freundii is associated with UTI, wound infection and septicaemia in immuno-compromised and chronically debilitated patients . Cases of neonatal meningitis also have been reported. Similar to E. coli except in being citrate positive. I M Vi C test : ++ - +

21. SERRATIA 05-Oct-24 Fikru Adere (BSc, MSc) 21 is a gram-negative motile rod found in soil & water. SPP: Serratia marcescens cause pneumonia, UTI, bacteremia & endocarditis particularly as cross infection in hospitalized patients and narcotic addicts. Most strains produce red colonies. Only about 10% of the isolates form red pigment S. marcescens is multiple resistant to penicillins & aminoglycosides Infections can be treated with 3 rd generation cephalosporins .

22. 05-Oct-24 Fikru Adere (BSc, MSc) 22 Major characteristics Ferments lactose slowly Produce characteristic pink pigment, especially when cultures are left at room temperature S. marscens on nutrient agar →

23. GENUS PROTEUS 05-Oct-24 Fikru Adere (BSc, MSc) 23 They are gram-negative, motile, non-capsulated, pleomorphic rods. Proteus species are found in the intestinal tract of humans and animals, soil, sewage and water. Lactose non-fermenters. The name proteus refers to their pleomorphism . Urease +

24. Proteus cont’d… 05-Oct-24 Fikru Adere (BSc, MSc) 24 Weil Felix observed that flagellated strains growing on agar formed a thin surface film resembling the moist produced by breathing on glass. Species of medical importance: P. mirabilis P. vulgaris

25. Culture characteristics 05-Oct-24 Fikru Adere (BSc, MSc) 25 Putrefactive (fishy) odor Swarming observed on NA, BA Pale colonies on Mac and DCA and no swarming Indole + (except pmi) H2S + (pmi and pvu) MR +, VP – Citrate + (except M.morganii ) I M Vi C test : + +-+

26. 05-Oct-24 Fikru Adere (BSc, MSc) 26 Swarming: wavy growth, thin filmy layer in concentric circles shown by p.vulgaris and p.mirabilis in culture plates. To inhibit swarming: 6% agar

27. 05-Oct-24 Fikru Adere (BSc, MSc) 27 Swarming of P roteus on nutrient agar and blood agar

28. Clinical disease 05-Oct-24 Fikru Adere (BSc, MSc) 28 Urinary tract infections Urease producing organisms cause liberation of ammonia which raises the pH of the urine. Alkalized urine favors precipitation of calcium that creates environment favorable for deposition of calcium and magnesium salts and the formation of kidney stones. Proteus infections tend to occur in patients in obstructive lesions of urinary tract following diagnostic instrumentation or during prolonged catheterization (exogenous infection).

29. 05-Oct-24 Fikru Adere (BSc, MSc) 29 Wound infections Septicaemia Acute otitis media

30. 05-Oct-24 Fikru Adere (BSc, MSc) 30 Specimen: Urine , pus, blood, ear discharge Smear : Gram-negative rods

31. Culture: 05-Oct-24 Fikru Adere (BSc, MSc) 31 Produce characteristic swarming growth over the surface of blood agar. Non-lactose fermenting colonies in macConkey agar. Proteus species have a characteristic smell

32. Swarming on BAP 05-Oct-24 Fikru Adere (BSc, MSc) 32 P . mirabilis and P. vulgaris is typical their ability to swarm

33. Biochemical reaction: 05-Oct-24 Fikru Adere (BSc, MSc) 33 Proteus spp ……….. Urease positive P . vulgaris………... Indole positive P . mirabilis……….. Indole negative Serology : Cross react with Weil- fellix test

34. Urease test 05-Oct-24 Fikru Adere (BSc, MSc) 34 This test is used to identify bacteria capable of hydrolyzing urea using the enzyme urease. The hydrolysis of urea forms the weak base, ammonia, as one of its products. This weak base raises the pH of the media above 8.4 and the pH indicator, phenol red, turns from yellow to pink .

35. Weil-Felix reaction 05-Oct-24 Fikru Adere (BSc, MSc) 35 They observed that certain non-motile strains of proteus were agglutinated with sera from typhus fever patients. This heterophile agglutination due to sharing of a carbohydrate hapten by certain strains of proteus and rickettsia forms basis of weil -Felix reaction for Dx of certain rickettsial infections. Non-motile proteus strains OX2, OX19 ( P.vulgaris ) and OXK ( P.mirabilis ) used in agglutination test.

36. 8-12 MICRONS Abebe M, CHS, ASTU 5 October 2024 36

37. Candidia Species of Candida other than C. glabrata also produce pseudohyphae and true hyphae C. glabrata , the second most common species of Candida in many settings, is incapable of forming pseudohyphae , germ tubes, or true hyphae under most conditions. Abebe M, CHS, ASTU 5 October 2024 37

38. Clinical disease 1 1 Mucocutaneous involvement Oral thrush Vaginitis and balanitis Bronchial and pulmonary Alimentary: esophagitis, gastritis, peritonitis, enteric and perianal disease Abebe M, CHS, ASTU 5 October 2024 38

39. Abebe M, CHS, ASTU 5 October 2024 39

40. Abebe M, CHS, ASTU 5 October 2024 40

41. Abebe M, CHS, ASTU 5 October 2024 41

42. Candidiasis in infants Abebe M, CHS, ASTU 5 October 2024 42

43. Clinical disease 2 2 Cutaneous involvement Paranochia and onchomycosis Diaper rash Candidal granuloma Generalized candidiasis Abebe M, CHS, ASTU 5 October 2024 43

44. Clinical disease 3 Systemic involvement Urinary tract Endocarditis Meningitis Septicemia Disseminated to internal organs Abebe M, CHS, ASTU 5 October 2024 44

45. Dimorphism Ability to switch between yeast and hyphal growth Essential for its pathogenicity Allows escape from macrophage Is it true dimorphism? Abebe M, CHS, ASTU 5 October 2024 45

46. Phagocytosis C. albicans is phagocytosed by macrophages and neutrophils Normally destroyed in the phagolysosome C. albicans can use different carbon sources, by rapidly adapting its metabolism This allows C. albicans to grow hyphae and perforate the plasma membrane of the macrophage Releases the fungal cell while killing the macrophage Abebe M, CHS, ASTU 5 October 2024 46

47. 47 DIAGNOSIS Direct examination KOH Skin and nail scrapings are best examined in 10-20 % KOH or calcoflour white-finding typical budding yeast cells and pseudohyphae . Gram- stain Sputum, exudates, centrifuged spinal fluid etc may be examined in Gram stain smears → shows large gram positive budding yeast cells with pseudohyphea . Abebe M, CHS, ASTU 5 October 2024 47

48. 48 Culture and identification Growth is rapid on sabouroud’s dextrose blood agar, trypticase soy, and many other media. Creamy yeast colonies are formed after overnight incubation at temperature of 21 C or 37 C ; the optimum growth temperature is around 30 C . C.albicans grows as round-to-oval yeast cells that are 4-6µm in diameter. Psudohyphae and hyphae also seen; especially at lower incubation temperature (i.e. 22 C-25 C) and on nutritionally poor media. 5 October 2024 48

49. DP Monga, FOM, AAU 2010 49 Candida albicans is differentiated from other Candida species by: Budding of yeast cell. Germ-tube test: - Rapid development of germ tubes when yeast cells incubated in serum at 37 o C for 60-90 minutes. Chlamydospore formation when incubated at 22 o C on cornmeal agar. Abebe M, CHS, ASTU 5 October 2024 49

50. 50 Germ tube test Germ tube positive Germ tube negative Abebe M, CHS, ASTU 5 October 2024 50

51. Serologic Tests Limited specificity and sensitivity-usefulness? Serum antibodies and CMI present in normal population(endogenous infection) Detecting of circulating cell wall mannan by latex agg test or EIA valuable but sensitivity ? Abebe M, CHS, ASTU 5 October 2024 51

52. Treatment Mucosal and cutaneous infections may be treated with a number of different topical creams , lotions, ointments, and suppositories containing various azole antifungal agents . Oral systemic therapy of these infections may also be accomplished with either fluconazole or itraconazole . 5 October 2024 Abebe M, CHS, ASTU 52

53. REFERENCE Murray PR et al, editors: Manual of clinical microbiology American Society for Microbiology Jawetz , Melnick , & Adelberg's Medical Microbiology, by Vishal Baron's Medical Microbiology F. H. Kayser , Basic Principles of Medical Microbiology and Immunology F. H. Kayser , Bacteriology II Stephen H. Gillespie, Peter M. Hawkey Principles and Practice of Clinical Bacteriology Second Edition Richard A. Harvey, Pamella C. Champ, Microbiology, Lippincott’s illustrated reviews Monica Cheesbrough , District LaboratoryPractice in Tropical Countries Part II 05-Oct-24 Fikru A. 53