15.-Legionella Klesiella Pseudomonas H Pilory

8/17/2019 15.-Legionella Klesiella Pseudomonas H Pilory

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LEGIONELLA


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Citoplasma ADNPared celular Membrana

celular

Ribosomas

Flagelo


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Características

Bacilos Gram –

Tienen flagelos y fimbriasProteína : MIP (potenciador infectividad

del Macrófago)

Legiolisina fosfolipasa C.


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Patogenia

Patógeno intracelular.

Ingresa por inhalación fagosoma:multiplicación activa de bacteria

bronconeumonía-neumonía.Otros. Riñón, bazo, etc.


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Clínica

Infec. Subclínicas

Enf, Legionarios:L. Pneumophila

Fiebre de PontiacInfecciones extrapulmonares:

piel

Nefritis pericarditisAbsceso. Peritonieal.


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Epidemiología

Microorganismo . ubicuos

- Relacionado al ambiente

- Factores de amplificación,

- Mecanismos de diseminación

- Factores de virulencia- Susceptibilidad del huésped


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Diagnóstico

Método directo

Detección de Ag por Inmunofluorescencia.

Detección de á nucleicos.Aislamiento: BCYE

Método indirecto serológicos

Inmunofluorencia . Indirecta Elisa.


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Rayos x de tórax - Legionella

Consolidación dellóbulo superior

Rayos X normales


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Tratamiento

Eritromicina

Rifampicina

Azitromicina

Claritromicina


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PSEUDOMONA

AURUGINOSA


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Morfologia

BACILOS GRAM NEGATIVOS 1-3, 0, 5-

1 umCAPA POLISACÁRIDA LIMO.

FLAGELO POLAR


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Determinantes de patogenecidad

FACTORES CELULARES

ACTIVIDAD BIOLÓGICA

Fimbrias (pili) Adherencia al epitelio

Flagelo Movilidad, invasividad

Polisacárido envoltura Adherencia, toxicidad neutrófilos

Exopolisacárido mucoide

(alginato)

Adherencia, forma biopelicula, inhibefagocitosis, reduce actividadantibióticos

LPS (lípido A) Efecto endotoxina: fiebre, hipotensión,

leucopenia, shock

Antígeno O Protege a la bacteria del complemento

Proteínas shock térmico Adaptación al estrés bacteriano, laayuda a sobrevivir, induce respuestahuésped


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FACTORES EXTRACELULARES

Proteasas (elastasa,proteasa alcalina).

Adherencia tisular, invasividad, necrosis,degradan IgG e IgA

Exotoxina A

Bloquea síntesis proteica, necrosis tisular,citotóxica (macrófagos), invasividad,leucocitosis. Induce formación Ac. Anti-toxinaA.

Exoenzima SR

Necrosis pulmonar, invasividad, diseminaciónhemática

Citotoxina Toxicidad letal para leucocitos

Fosfolipasas

Efecto membrana, hemólisis, flogógenas

Ferripioquelina (fpq)

Captación de hierro

Pioverdina

Captación de hierro

Piocianina

Lesiona epitelio, dificulta función ciliar, y

asociada fpq libera radicales OH


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Cuadros Clínicos

Infecciones deltracto respiratorio

Infeccionesurinarias

Infeccionesosteoarticulares

Infeccionesoculares

Infecciones óticas

Infeccionescutáneas

Bacteriemias

EndocarditisInfeccionesmeníngeas

Infeccionesgastrointestinales


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Diagnostico microbiológico

Aislamiento

Identificación

Tipado: serotipia, biotipia, genotipia

Sensibilidad de los antimicrobianos


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Tratamiento

Carboxipenicilinas

cefalosporinas de 3 y 4 generación:

Ceftazidima cefepima ceppirona.

Batalactámico + aminoglicosido.


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Epidemiología

UBICUO

OPORTUNISTA


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Profilaxis y control

1. En el hospital aislamiento

2. Higiene individual. Infección

endógena3. Vigilancia y control de fómites

4. Comité de infecciones: supervisión5. Vacunas: quemados


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KLEBSIELLA


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CARACTERISTICAS

Bacilos Gram-

No móviles

Fermentan lalactosa

Descarboxilanlisina

Forman coloniasmucoides yhúmedas

Dos especies :

K. pneumoniae

K. oxytoca

K. ozaenae

K.rhinoscleromatis


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MECANISMOS DEPATOGENICIDAD

Cápsula (K)


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†KLEBSIELLA


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†KLEBSIELLA


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Enfermedades


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Enfermedades

• Neumonía por aspiración serotipos 1,2.

• Dolor pleurítico. Esputo espeso y sanguinolente. Jalea degrosella.

• Resistente a muchos fármacos. Mortalidad ante 40-60%.

• Infecciones Urinarias: Serotipo 8-9-19-24

• Pielonefritis y cistitis.

K.

Neumoniae

• Rinitis atrófica y ocena.

• Rinitis atrófica: áreas de metaplasia escamosa. Glándulasatróficas.

• Ocena: exudado verdoso maloliente.

K.

Azaenae

• Rinoscleroma

• Inicia con catarro común. Inflamación granulomatosa de víasnasales. Masas tumorales.

• Estudio anatomopatológico, muestra macrófagos espumosos.Células gigantes y bacilos encapsulados.

K.

Rhinoscleromatis


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Tratamiento

Ciprofloxacina

TMP –

SM X

Cefalosporina antiseudomónica detercera generación.

Rifampicina


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HELICOBACTERPYLORI


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Morfología y fisiología

- Bacilo gram Negativo: curvo o Espiralado

- 0.51 um de ancho y 2,5-4 um de largo.

- Tiene 4-6 flagelos unipolares


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Especies del género Helicobacter

Gástricas

No Gástricas

H. Pylori

H. Cinaedi

H. Heilmanii

H. Felis

H. Mustelae

H. NemestrinaeH. acinonyx

H. fennelliae


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Determinantes de PatogenicidadPatogenia

Movilidad

Adhesinas

Ureasa

Citotoxina vacuolante

Otros: Proteína CagA, dismutasa desuperóxido, lipopolisacárido.


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Úlcera Duodenal

Carcinoma olinfoma MALT

Colonización

GastritisÚlcera Gástrica


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Manifestaciones Clínicas

Gastritis aguda.Intoxicaciónalimentaria

Gastritis Crónicasuperficial difusa

Gastritis CrónicaAtrófica

Ulcera Gástrica oDuodenal

AdenocarcinomaGástrico

Linfoma Gástrico


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Ó


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GASTRITIS CRÓNICA


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GASTRITIS CRÓNICA

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GASTRITIS CRONICA ATRÓFICA

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GASTRITIS CRÓNICA ATRÓFICA

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Diagnóstico

• DIAGNÓSTICO ENDOSCÓPICO DIRECTO- Histológico coloraciones especiales

- Microbiológico. Agar sangre, Agar chocolate, Agar Brucella.

- PCR:• DIAGNÓSTICO ENDOSCÓPICO INDIRECTO

- Prueba de la Ureasa

• DIAGNÓSTICO NO ENDOSCÓPICO

- Detección de anticuerpos contra H Pylori en suero o ensaliva.

- Urea Breath Test

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TEST FOR DIAGNOSIS OF HELICOBACTER PYLORI


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TEST FOR DIAGNOSIS OF HELICOBACTER PYLORI

TestSensitivity/Specifity

(%) Cost ($)

Endoscopic Test Histology 95/80 – 99 50-100

Special Stains 90/99 200

Culture 60-90/100 150

Ureasa tests 90/95 10

Nonendoscopic Test

Antibody tests

Quantitative ELISA 85-90/85-90 500-100

Qualitative serum 90/90 10-15

Qualitative whole blood

85-90/90

10-15

Urea breath tests C-13 95/95 280

C-14 95/95 60

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TratamientoAntibacterianos, bismuto yantiulceroso.

Epidemiología

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Documents

15.-Legionella Klesiella Pseudomonas H Pilory