Download - Respiratory Infection
![Page 1: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/1.jpg)
Respiratory InfectionRespiratory Infection
Ali Somily MD, FRCPC
![Page 2: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/2.jpg)
OUTLINEOUTLINE
![Page 3: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/3.jpg)
Upper Respiratory Tract Upper Respiratory Tract InfectionsInfections
![Page 4: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/4.jpg)
EtiologiesEtiologies Acute pharyngitis Bacterial
– Streptococcal (GAS)•Main •Most common bacterial
– Diphtheria •Rare
– N. gonorrhoeae, – B. pertussis
Viral •Most common
![Page 5: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/5.jpg)
EBV AdenopathyEBV Adenopathy
![Page 6: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/6.jpg)
Adenovirus & EBVAdenovirus & EBV
![Page 7: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/7.jpg)
GASGAS
![Page 8: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/8.jpg)
How to collect throat swab ?How to collect throat swab ?
![Page 9: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/9.jpg)
How to send it to the lab ?How to send it to the lab ?
Bacterial –Swab GAS
Viral –VTM
![Page 10: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/10.jpg)
What is the diagnosisWhat is the diagnosis
![Page 11: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/11.jpg)
Neck X-raysNeck X-rays
![Page 12: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/12.jpg)
AnatomyAnatomy
Paranasal Sinuses
![Page 13: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/13.jpg)
SinusitisSinusitis
![Page 14: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/14.jpg)
What is sinusitis?What is sinusitis?
An acute inflammatory process involving one or more of the paranasal sinuses.
5%-10% of URIs in children.Maxillary and ethmoid sinuses
are most frequently involved.
![Page 15: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/15.jpg)
Acute & Chronic SinusitisAcute & Chronic Sinusitis
Acute Sinusitis>10 days but < 30 days.
Subacute sinusitis >30 days without improvement.
Chronic sinusitis>120 days.
![Page 16: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/16.jpg)
Etiology of SinusitisEtiology of Sinusitis
70% of bacterial sinusitis is caused by:
Streptococcus pneumoniaeHaemophilus influenzaeMoraxella catarrhalis
![Page 17: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/17.jpg)
Clinical Presentations of Clinical Presentations of SinusitisSinusitis Periorbital edema Cellulitis Nasal mucosa is reddened or swollen Percussion or palpation tenderness over a
sinus Nasal discharge, thick, sometimes yellow
or green Postnasal discharge in posterior pharynx Difficult transillumination Swelling of turbinates Boggy pale turbinates
![Page 18: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/18.jpg)
Pale, Boggy TurbinatesPale, Boggy Turbinates
![Page 19: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/19.jpg)
Diagnostic TestsDiagnostic Tests
RadiographsUltrasonogramsCT scanning
Laboratory studies, such as culture of sinus puncture aspirates.
![Page 20: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/20.jpg)
Pharmacological Plan of CarePharmacological Plan of Care
Clarithromycin:15mg/kg/d in 2 divided doses(>30kg, 250mg q12)
![Page 21: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/21.jpg)
OTITIS MEDIAOTITIS MEDIA
Definition: Presence of a middle ear infection
Acute Otitis Media: occurrence of bacterial infection within the middle ear cavity.
Otitis Media with Effusion: presence of nonpurulent fluid within the middle ear cavity
![Page 22: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/22.jpg)
Normal & abnormal tympanic Normal & abnormal tympanic membranemembrane
![Page 23: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/23.jpg)
MICROBESMICROBES
Streptococcus pneumoniaeHaemophilus influenzae(non-
typeable)Moraxella catarrhalisGroup A StreptococcusStaph aureusPseudomonas aeruginosaRSV assoc. with Acute Otitis Media
![Page 24: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/24.jpg)
PATHOGENESISPATHOGENESIS
Otitis Media usually follows an URI in which there is edema of the eustacian tube, leading to blockage.
Other factors: allergic rhinitis, nasal polyps, adenoidal hypertrophy
![Page 25: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/25.jpg)
DiagnosisDiagnosis
Diagnostic tympanocentesis & myringotomy
![Page 26: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/26.jpg)
TREATMENTTREATMENT
Amoxicillin: 20-40 mg/kg/day tid for 10-14 days or,
Augmentin: 45 mg/kg/day po bid for 10-14 days
![Page 27: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/27.jpg)
NASOPHARYNGEAL NASOPHARYNGEAL CULTURESCULTURES Carrier of
– Streptococcus pyogenes,
– Corynebacterium diphtheriae
– Neisseria meningitidis
Limited Practical Value– Otitis Media– Sinusitis
For isolation of – Bordetella
pertussis– Viral
![Page 28: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/28.jpg)
Lower respiratory tract Lower respiratory tract infectioninfection
![Page 29: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/29.jpg)
![Page 31: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/31.jpg)
ClassificationClassification1. Typical
Pneumonia2. Atypical
Pneumonia
According to the following1. Organisms2. Treatment3. Presentation4. X-rays5. Prognosis
![Page 32: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/32.jpg)
EtiologyEtiology No agent isolated in 40 to 60% of cases Culture sensitivity (50%) of sputum culture for S.
pneumoniae, Agents of pneumonia are difficult to grow
– Legionella, – Chlamydia pneumoniae, – Mycoplasma pneumoniae).
C. pneumoniae – Second most common cause of pneumonia
M. pneumoniae – Most cases of ambulatory CAP (serologic methods)
Haemophilus influenzae and Legionella – The third and fourth most common bacterial causes of CAP
requiring hospitalization. Specimens are easily contaminated with upper
respiratory secretions,
![Page 33: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/33.jpg)
![Page 34: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/34.jpg)
S.pneumoS.pneumo
![Page 35: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/35.jpg)
PneumoniaPneumonia
![Page 36: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/36.jpg)
Staph.aureusStaph.aureus
![Page 37: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/37.jpg)
Lung abscess.Lung abscess.
![Page 38: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/38.jpg)
Pneumatocele and Pneumatocele and abscessabscess
![Page 39: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/39.jpg)
Transplant and CMVTransplant and CMV
![Page 40: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/40.jpg)
Hematological malignancy Hematological malignancy and Aspand Asp
![Page 41: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/41.jpg)
lobar pneumonialobar pneumonia
Primarily caused by – Streptococcus pneumoniae,– Legionella pneumophila. – Klebsiella pneumoniae, – "currant jelly" sputum tissue
damage and hemorrhage into the alveoli
![Page 42: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/42.jpg)
Escherichia coli – Often complicated by empyema
and septicemia.Pseudomonas aeruginosa Serratia marcescens
– Associated with a severe necrotizing pneumonia in immunosuppressed patients
![Page 43: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/43.jpg)
S.pneumoniaeS.pneumoniae
![Page 44: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/44.jpg)
![Page 45: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/45.jpg)
Lung abscessesLung abscesses
Anaerobes Staphylococcus aureusMycobacterium tuberculosisMycoplasma pneumoniaeFungus
![Page 46: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/46.jpg)
SpecimensSpecimens A. Acceptable
specimens 1. Sputum 2. Trachael and
transtracheal aspirates
3. Bronchial washings, bronchial alveolar lavage, bronchial brushes, and bronchial biopsy
4. Lung aspirate and lung biopsy
B. Unacceptable specimens
1. Saliva submitted as sputum
2. Twenty-four-hour sputum collection .
3. Swabs
![Page 47: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/47.jpg)
A. Media
•1. BAP•2. MAC•3. CHOC•4. Broth-BHI or THIO
![Page 48: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/48.jpg)
AnaerobsAnaerobs
Invasive procedure Processed as rapidly as possible. Collected and transported
anaerobically Cultured for anaerobes. Transtracheal aspiration Transbronchial biopsyProtected bronchial brushesBronchalveolar
![Page 49: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/49.jpg)
Protected bronchoscopy brush send for quantitative culture – Quantitative culture: Plate 10 µL. – Vortex the brush in 1 ml of BHI or
steril saline
![Page 50: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/50.jpg)
Sputum SpecimensSputum Specimens Teeth brush
– Contamination one log less
Mouthwash– Avoid antiseptic
Early morning– Pooled overnight
secretions – Discouraged 24 hr
collection– Contamination– Dilution
Induced sputum Sterile wide-
mouth jar – tightly fitted
screw-cap lid – press the rim of
the container under the lower lip
![Page 51: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/51.jpg)
Translaryngeal Translaryngeal (Transtracheal) Aspiration(Transtracheal) Aspiration
1. The patient is debilitated 2.Routine sputum samples have
failed to recover a causative organism in the face of clinical bacterial pneumonia.
3. An anaerobic pulmonary infection is suspected.
![Page 52: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/52.jpg)
![Page 53: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/53.jpg)
Bronchoalveolar Bronchoalveolar LavageLavageInjection of 30 to 50 mL The saline is then aspirated and
submitted for smear preparation and culture
The semiquantitative cultures>103 /mL that demonstrate
intracellular bacteria in more than 25% of the inflammatory cells are indicators of pneumonia that requires specific treatment.
![Page 54: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/54.jpg)
Other TestsOther Tests
Blood cultures – Streptococcus pneumoniae 25% to 30%
Direct fluorescent antibody tests Various Staining
– Pneumocystis carinii – The tissue forms of various fungi – Mycobacteria – Viral inclusions
Serological tests
![Page 55: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/55.jpg)
V. V. MICROSCOPICMICROSCOPIC
A. Smear preparationB. Microscopic screening (sputum specimens only)
![Page 56: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/56.jpg)
![Page 57: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/57.jpg)
![Page 58: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/58.jpg)
![Page 59: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/59.jpg)
![Page 60: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/60.jpg)
![Page 61: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/61.jpg)
![Page 62: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/62.jpg)
![Page 63: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/63.jpg)
![Page 64: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/64.jpg)
![Page 65: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/65.jpg)
![Page 66: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/66.jpg)
LegionellaLegionella
![Page 67: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/67.jpg)
Legionnaires' diseaseLegionnaires' disease
![Page 68: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/68.jpg)
StoryStory In the summer of 1976, public attention was focused
on an outbreak of severe pneumonia that caused many deaths in members of the American Legion convention in Philadelphia.
231 people within a short time, and 34 of them died After months of intensive investigations, a
previously unknown gram-negative bacillus was isolated.
Subsequent studies found this organism, named Legionella pneumophila, to be the cause of multple epidemic and sporadic infections.
The organism was previously not known to exist, because it stains poorly with conventional dyes and does not grow on common laboratory media.
Despite the initial problems with the isolation of Legionella organisms, it is now recognized to be a ubiquitous aquatic saprophyte.
![Page 69: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/69.jpg)
200 - 216 South Broad Street - Bellevue - Stratford Hotel (Fairmont Hotel) (1400 Walnut Street)]
Pneumophila means "love of the lungs" and Philadelphia means "city of brotherly love",
![Page 70: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/70.jpg)
TaxonomyTaxonomy
Taxonomic studies have shown that the family Legionellaceae – One genus, Legionella,
• 39 species – > 60 serogroups. (Approximately half of these
species and serogroups have been implicated in human disease, with the others found in environmental sources. )
L. pneumophila is the cause of almost 85% of all infections; – serotypes 1 is the most commonly isolated
![Page 71: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/71.jpg)
Physiology and StructurePhysiology and Structure
Slender, pleomorphic, gram-negative bacilli.
Stains poorly with common reagents.
Nutritionally fastidious with requirement for L-cysteine and enhanced growth with iron salts.
Nonfermentative.
![Page 72: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/72.jpg)
VirulenceVirulence
Capable of replication in alveolar macrophages (and amoeba 'in nature).
Prevents phagolysosome fusion.They enter the cell by
– C3b and mem.protein– CR3 and bacterial surface– Endocytosis to Macro and Mono
comp receptor
![Page 73: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/73.jpg)
![Page 74: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/74.jpg)
EpidemiologyEpidemiology
Capable of sporadic and epidemic disease. Commonly found in natural bodies of water,
cooling towers, condensers, and water systems (including hospital systems).
Summer and autumn Estimated to be between 10,000 and 20,000
cases in United States annually. Patients at high risk for symptomatic
disease include patients with compromised pulmonary function and patients with decreased cellular immunity (particularly transplant patients).
![Page 75: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/75.jpg)
![Page 76: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/76.jpg)
PresentationsPresentations
Diseases– Legionnaires' disease. – Pontiac fever.
![Page 77: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/77.jpg)
![Page 78: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/78.jpg)
DiagnosisDiagnosis
– Culture on BCYE agar is the diagnostic test of choice but positive titers develop late in the course of disease.
![Page 79: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/79.jpg)
![Page 80: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/80.jpg)
Gram stain of Gram stain of Legionella pneumophilaLegionella pneumophila grown on buffered charcoal-yeast grown on buffered charcoal-yeast
extract agarextract agar
![Page 81: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/81.jpg)
Legionella Legionella species may appear as species may appear as characteristic ground-glass colonies characteristic ground-glass colonies with iridescent edges, which is typical with iridescent edges, which is typical of L. pneumophila. of L. pneumophila.
![Page 82: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/82.jpg)
Non-pneumophila Non-pneumophila species may appear as species may appear as mucoid protuberant colonies (C) or raised mucoid protuberant colonies (C) or raised greyish white colonies (D). greyish white colonies (D).
![Page 83: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/83.jpg)
The colonies The colonies of of certain species certain species of Legionella of Legionella autofluoresce either blue-white (E) or red (F) autofluoresce either blue-white (E) or red (F) under long-wavelength UV light. under long-wavelength UV light.
![Page 84: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/84.jpg)
Immunofluorescent staining Immunofluorescent staining of of either respiratory specimens or either respiratory specimens or culture isolates should reveal short culture isolates should reveal short coccobacilli that stain a bright (3 coccobacilli that stain a bright (3 to 4+) apple greento 4+) apple green
![Page 85: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/85.jpg)
Direct fluorescent antibody stain of Direct fluorescent antibody stain of LegionellaLegionellamicdadei.micdadei.
![Page 86: Respiratory Infection](https://reader035.vdocuments.site/reader035/viewer/2022081416/568150ea550346895dbf03d6/html5/thumbnails/86.jpg)
Treatment, Control, and Treatment, Control, and PreventionPrevention Severe disease treated with azithromycin
or levofloxacin; less severe disease can be treated with erythromycin or tetracycline.
Rifampin can be added in sever cases Decrease environmental exposure to
reduce risk of disease. For environmental sources associated
with disease, treat with hyperchlorination, superheating, or copper-silver ionization