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MICROBIOLOGY &PARASITOLOGYTo God be the Greatest Glory!MEDICAL BACTERIOLOGYnullnull####### MICROORGANISM RESERVOIR TRANSMISSION METABOLISM VIRULENCE FACTORS TOXINS CLINICAL SYNDROMES####### PREVENTION####### DIAGNOSIS NOTESStaphylococcusaureusHuman nose **(an terior nares) ** and skinDirect cont...

Description

MICROBIOLOGY & PARASITOLOGY

To God be the Greatest Glory!

MEDICAL BACTERI BACTERIOLOGY OLOGY ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! !

! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! !

GRAM-POSITIVE!COCCI! GRAM-STAIN!

OTHER!FEATURES!

Gram!Positive!Cocci! in!Clusters!

ORGANISM!

Catalase-positive! Coagulase-positive! Catalase-positive! Coagulase-negative! Novobiocin-sensitive! Catalase-positive! Coagulase-negative! Novobiocin-resistant!

!

Staphyloccus*aureus!

- capsules!serve!as!an

Staphyloccus*epidermidis!

! Some*Killers*Have*Pretty*Nice,*Elegant,*Shiny*Bodies*

Staphyloccus*saprophyticus*

*

K

! GRAM-STAIN!

OTHER!FEATURES!

Gram!Positive!Cocci! in!Chains!

ORGANISM!

Catalase-negative! Alpha-hemolytic! Bile-optochin-sensitive! Catalase-negative! Alpha-hemolytic! Bile-optochin-resistant! Catalase-negative! Beta-hemolytic! Bacitracin-sensitive! Catalase-negative! Beta-hemolytic! Bacitracin-resistant! Catalase-negative! Gamma-hemolytic!

GRAM-STAIN!

O2!UTILIZATION!

* *

Streptococcus*pneumoniae*

S

Viridans*streptococci!

*

(Group*A*Beta*Hemolytic*Streptococcus* /*GABHS)!

! - Catalase!degrades!H2O2!into!H2O!and!bubbles!of!O2!before!it!can!be!

Streptococcus*agalactiae*

converted!to!microbicidal!products!by!the!enzyme!myeloperoxidase!

(Group*B*Streptococcus*/*GBS)!

- People!with !

PLACES!NBSH!

!

ORGANISM!

!

*

!

Aerobic! Motile!

-, ,!or!lollipoplike!

* *

Gas-forming!

*

! ! !

Pseudomonas* Listeria* Aspergillus* Candida* E.*coli* Staphylococci* Nocardia* B.*cepacia* Serratia* H.*pylori*

! !

Non-Sporeforming!grampositive!rods!

)!

have!recurrent!infections!with!certain!catalase-positive!organisms!

Group*D*Streptoccocci!

OTHER!FEATURES!

Anaerobic!

*

Streptococcus*pyogenes*

Non-motile!

Spore-forming! gram-positive! rods!

*

!

! GRAM-POSITIVE!BACILLI!

!

!

- are ! - Asplenics!have!Ü!opsonizing!ability!and!thus!Û!risk!for!severe!infections! - Give!S.#pneumoniae,#H.#influenzae,#N.#meningitidis#vaccines!

Non-motile! ! !

Aerobic! Curved!

PIGMENT-PRODUCING!BACTERIA! Actinomyces*israelii* Staphylococcus*aureus* Pseudomonas*aeruginosa*

* Serratia*marcescens*

! ! (pyocyanin!and!pyoverdin)! !

MICROORGANISM!

RESERVOIR! (anterior!nares)! and ! ! !

aureus* * *

TRANSMISSION! Direct!contact!(Hands)! ! Fomites! ! Contaminated!food!

*

MICROORGANISM!

RESERVOIR!

METABOLISM!

VIRULENCE!FACTORS!

!

IMMUNOMODULATORS:! To#test,#rub#a#wire# Protein!A:!prevents! loop#across#a#colony# complement!activation;! of#gram-positive# binds!IgG,!preventing! cocci#and#mix#on#a# opsonization!and! slide#with#H202.#If# phagocytosis! bubbles#appear,# ! this#indicates#that# Coagulase:!Allows!insoluble! H202#is#being#broken# fibrin!formation!around! down#into#oxygen# organism,!protecting!it! bubbles#and#water;# from!phagocytosis! catalase-positive# ! staphylococci#are# Hemolysins!(cytotoxins):! present.# toxic!to!hematopoietic!cells! ! ! ! Leukocidin:!specific!for! ! WBCs! Salt-tolerant!on! ! Mannitol!salt!agar! Catalase:!detoxifies! (halotorelant)! hydrogen!peroxide! ! Facultative!anaerobe! ! Penicillinase:!secreted!form! of!beta-lactamase;!disrupts! the!beta-lactam!portion!of! the!penicillin!molecule,! thereby!inactivating!the! antibiotic! ! TISSUE!PENETRANCE:! Hyaluronidase: ;!breaks!down! proteoglycans!in!connective! tissue!(hyaluronic!acid) ! Fibrinolysin! (Staphylokinase):!dissolves! fibrin!clots! ! Lipase:!spread!in!fatcontaining!areas!of!the! body! ! Protease:!destroys!tissue! proteins! !

TRANSMISSION!

METABOLISM!

Staphylococcus* epidermidis*

Humans!(normal! skin!flora)!

Autoinfection! Catalase-positive! Direct!contact!(hands)! ! Coagulase-negative!

Staphylococcus* saphrophyticus*

Humans!

!

TREATMENT!AND! DIAGNOSIS! PREVENTION! Methicillin-sensitive* GRAM-STAIN:!! :!causes! PYOGENIC:! SA*(MSSA)*! reveals!gram-positive! epidermal!separation! SKIN!and!SOFT!TISSUE!INFECTIONS! î bullous*impetigo,!folliculitis,!furuncles,! î Penicillinasecocci!in!grape-like! in!Scalded!Skin! carbuncles,!cellulitis,!hidradenitis* cluster!! resistant! Syndrome! ! suppurativa,!mastitis,!surgical!site! ! penicillins! infections! heat(nafcillin,!oxacillin,! CULTURE:! ! - Beta-hemolytic! stable):!superantigens! ACUTE!ENDOCARDITIS! and!dicloxacillin)! - Produces!a!golden! ! causing!food! î most!common!cause!of!acute! yellow!colonies!on! Methicillin-resistant* poisoning!! endocarditis! blood!agar! SA*(MRSA)! ! î native!valve!(tricuspid!valve)!in!IV! - “Gold!color”!is!due! î contain!altered! drug!abusers! to!pigment! penicillin-binding! ! PNEUMONIA! STAPHYLOXANTHIN! protein!(PRB)! :!superantigen! î due!to!resistance! ! leading!to!toxic!shock! î nosocomial!pneumonia,!VAP,! Polymerase!chain! necrotizing!pneumonia! gene!mecA ! syndrome! î complicated!by!empyema,!abscess!or! î DOC!is! reaction!(PCR):!mecA* ! pneumatocele! gene!for!MRSA! vancomycin! causes! î post-viral*pneumonia! ! marked!necrosis!of!the! * OSTEOMYELITIS!and!SEPTIC!ARTHRITIS! Vancomycinskin!and!hemolysis! resistant*SA*(VRSA)! î from!hematogenous!spread!or!local! î DOC!is!linezolid! introduction!at!wound!site! î Brodie!Abscess:!sequestered!focus!of! ! osteomyelitis!arising!in!the! metaphyseal!area!of!a!long!bone! TOXINS!

CLINICAL!SYNDROMES!

!

separation#occurs#at#dermo-epidermal# junction)! !

TOXIC!SHOCK!SYNDROME! î fever,!hypotension,!sloughing!of! filiform!papillaeàstrawberry*tongue,! desquamating*rash*and!multi-organ! involvement!(>3)! î usually*no*site*of*pyogenic* inflammation;*blood*CS*negative! î tampon-using!menstruating!women!or! in!patients!with!nasal*packing!for! epistaxis!

VIRULENCE!FACTORS!

TOXINS!

CLINICAL!SYNDROMES!

UTI!IN!WOMEN! nd î S.*saprophyticus*is*the*2 *most*

!

!

[!

Humans!

Respiratory!droplets! ! !

Bacitracin! Group!B!Strep! Resistant! Group!A!Strep! Sensitive!

!

TREATMENT!AND! PREVENTION! Vancomycin!(50%! methicillin! resistance)! ! Removal!of! prosthetic!device!

Fluoroquinolones! ! TMP-SMX! common*cause*of*UTI*in*sexually* active*women#

!

Streptococcus* pyogenes* * Group!A!BetaHemolytic! Streptococcus! (GABHS)!

î

Causes!of! Necrotizing! Pneumonia! S.!aureus! Pseudomonas! Aspergillus! Viral!Pneumonia!!

SCALDED!SKIN!SYNDROME!(Ritter! Disease)! î exfoliatin!cleaves!desmoglein!in! desmosomes! î separation!of!skin!at!stratum! granulosum!(vs#TENS/Lyell*disease:#

Catalase-positive! ! Coagulase-negative! Facultative!anaerobe! Nitrite-negative! Novobiocin-resistant! (Novo*SERS)! Catalase-negative! ! Bacitracin-sensitive! (B-BRAS)*

associated!with!a! propensity!to!form! abscesses! ! ! !

!

Most!common!cause!of:! - prosthetic!valve!endocarditis! - septic!arthritis!in!prosthetic!joints! - ventriculoperitoneal!shunt! infections! !

!

Panton-Valentine! Leukocidin! (PVL),!which!is!

î î î

TOXIGENIC:! GASTROENTERITIS! î acute!onset!(4!hrs)!of!vomiting!and! diarrhea!due!to!ingestion!of!preformed* heat-stable*enterotoxin! î source:!salad!made!with!mayonnaise* (potato!or!tuna!salad)!

Polysaccharide!capsule:! ! adheres!to!a!variety!of! prostheti c!devices;!f orms!a! ! Facultative!anaerobe! biofilm! ! ! Novobiocin-sensitive! Highly!resistant!to! (Novo*SERS)* antibiotics!

(unlike#E.#coli)#

NOTES! 95%!resistance!to! penicillins! ! 60%!MRSA!in!the! Philippines! ! Community!acquired! methicillin!resistant! Staphylococcus! aureus!(CA-MRSA)! produces!a!particular! leukocidin!called!

DIAGNOSIS!

NOTES!

GRAM!STAIN:! NOVOBIOCIN! gram-positive!cocci!in! Sensitive!! clusters! Epidermidis! ! Resistant! CULTURE:! White!colonies!on! Saprophyticus! blood!agar,!non! hemolytic! GRAM!STAIN:!! ! gram-positive!cocci!in! clusters! !

CULTURE:! Whitish,!nonhemolytic!on!blood! agar! Hyaluronidase:!degrades! Erythrogenic!toxin:! PYOGENIC:! Disease!of!poverty! DOC!is!Penicillin!G! GRAM!STAIN:! hyaluronic!acid!(spreading! produces!scarlet!fever! IMPETIGO!CONTAGIOSA:!perioral! Gram-positive!cocci!in! ! ! ! chains! The!antigenic! blisters!with!honey-colored!crust;! factor)! Patients!with!a! ! components!of!the! Streptolysin!O! accumulation!of!neutrophils!beyond!the! history!of!rheumatic! ! Beta-hemolytic! streptococcal!cell! Streptokinase!(fibrinolysin)!! (oxygen-labile):!highly! stratum!corneum;!complication!includes! fever!require!long! PSAGN! antigenic,!causes!AB! *Anti-streptokinase# wall:! term!antibiotic* Lancefield!group!A! ! antibodies#decrease#efficiency# formation;!destroys! prophylaxis!to! - C!carbohydrate:! ERYSIPELAS:!superficial!infection! of#streptokinase#in#managing# RBCs!and!WBCs;!and!is! Positive!PYR!test! prevent!recurrence! for!Lancefield! extending!into!dermal!lymphatics! MI# PYR!test!measures! the!reason!for!the! of!the!disease! typing! ! CELLULITIS:!deeper!infection!involving! hydrolysis!of!1! beta!hemolysis - M!protein!(80! pyrrolidonyl-Bsubcutaneous/dermal!tissues;!facilitated! DNase!(streptodornase):! *ASO*Titers#to# types):!a!major* naphthylamide!and! degrades!DNA!in!exudates! document#antecedent* by!hyaluronidase!(spreading!factor)! virulence*factor! release!of!Bor!necrotic!tissue!! PHARYNGITIS# PHARYNGITIS:!most!common!bacterial! naphthylamine,!which!in! for!the!group!A! *Anti-DNAse*B#to#document# # cause!of!sore!throat! streptococcus;! the!presence!of!pantecedent#SKIN#infection# Streptolysin!S! ! dimethylaminocinnamal inhibits!the! ! TOXIGENIC:! (oxygen-stable):!not! dehyde!forms!a!red! activation!of! C5a!peptidase:!inactivates! antigenic! SCARLET!FEVER:!“second!disease”;! compound! complement!and! complement!C5a! ! post-pharyngitic;!due!to!erythrogenic! Advantage:!takes!38C,! ! PROM!(>18h),!vaginal!colonization,!and! All!pregnant!women! complement!deficiency! should!be!screened! ! for!GBS!colonization! ENDOMETRITIS!→!most!commonly! at!35-37!wks!AOG;!if! (+),!chemopolymicrobial;!foul-smelling!lochia!! prophylaxis!with!IV! penicillin!or! Ampicillin!4h!prior! to!delivery! UTIs!due!to!indwelling!urinary!catheters! Penicillin!plus! and!urinary!tract!instrumentation!! gentamicin* ! ! BILIARY!TRACT!INFECTIONS! Vancomycin*for! ! penicillin-resistance! ! ENDOCARDITIS!in!patients!who! underwent!GIT*surgery!due!to! Linezolid!for! Enterococcus**faecalis! vancomycinresistant!strains! * ! MARANTIC!ENDOCARDITIS*in!patients! with!abdominal!malignancy!due!to! Streptococcus*bovis! CLINICAL!SYNDROMES!

PNEUMONIA:!*most!common!cause!of! CAP!in!adults;!rust-colored!sputum*

Penicillin!G! ! Levofloxacin!or! OTITIS!MEDIA:!most!common!cause!in! Vancomycin! children! combined!with! ! BACTERIAL!MENINGITIS:!most!common! Ceftriaxone!for! penicillin!resistance! cause!in!adults! ! * SINUSITIS!!

retards!phagocytosis;!major* virulence*factor;!has!84! serotypes;!antigenic! ! IgA!protease:!for! colonization! ! c-substance:!reacts!with! CRP! !

!

!

SEPTIC!SHOCK:!splenectomy!predisposes! to!sepsis!from!encapsulated!bacteria! !

DIAGNOSIS!

NOTES!

Gram-positive!cocci!in! chains! ! Beta-hemolytic!

Most!common!cause! of!neonatal!sepsis!in! the!world!(the! universe,!rather)!J! ! CAUSES!OF! NEONATAL! MENINGITIS:! î GBS! î Escherichia*coli* î Listeria* monocytogenes!

!

CAMP!test–positive: CAMP!factor!enlarges! the!area!of!hemolysis! formed!by!S.*aureus

! !

Lancefield!!group!B!

Gram-positive!cocci!in! chains! * Gamma*hemolytic* colonies! * Lancefield*group*D* ! Positive!PYR!test! * !

There!is!a!remarkable! association!between! S.*bovis!infection! and!colon!cancer!

Gram-positive! Polyvalent!(23-type)! "lancet-shaped"!cocci! polysaccharide! vaccine! in!pairs!or!chains! ! ! Alpha-hemolytic! Conjugated!vaccine:! ! pneumococcal! Positive!Quellung! polysaccharide! reaction:!capsular* swelling#when#mixed#with#a# coupled!with!carrier! small#amount#of#antiserum# protein!(diphtheria! (serum#with#antibodies#to# toxoid)! the#capsular#antigens)# and#methylene#blue# !

No!Lancefield!antigen! Oral!flora!

Viridans! Streptococci*

Enters!bloodstream! during!dental* procedures! !

Catalase-negative!

Glycocalyx!enhances!

!

adhesion!to!damaged* heart*valves! ! Protected!from!host! defenses!within! vegetations! !

Bile!and!optochinresistant! OVRPS*(overpass)* Viridans strep live in the mouth because they are not afraid of the chin (op-to-chin resistant)!

!

DENTAL!CARIES:!S.*mutans*

Gram-positive!cocci!in! chains! SUBACUTE!BACTERIAL!ENDOCARDITIS! ! (SBE):!S.*sanguis*à!most!common!cause! * Alpha-hemolytic! Vancomycin*for! of!subacute!and!native!valve! ! penicillin-resistance! endocarditis! ! !

!

BRAIN!ABSCESSES:*S.*intermedius!

Penicillin!G!+/-! aminoglycoside! (Gentamicin)!

Linezolid!for! vancomycinresistant!strains!

OVeRPaSs! OPTOCHIN! Viridans! Resistant! Pneumoniae! Sensitive!

!

MICROORGANISM!

RESERVOIR!

Bacillus*anthracis*

Herbivores! (zoonotic):!! -!Sheep! -!Goats!!!!!! -!Cattle!!!!!!!! ! Habitat!is!soil!!!!!

* * * * * * * * *

TRANSMISSION!

METABOLISM!

VIRULENCE!FACTORS!

Contact!with!infected! animals!or!inhalation! of!spores!from!animal! hair!or!wool! (woolsorter’s!disease)! !

Aerobic!(but!since!it! can!grow!without!!! oxygen.!It!is!classified! as!a!facultative! anaerobe)!

Protein!capsule:!polymer!of! gamma-D-glutamic!acid;! antiphagocytic;!encoded! on!a!plasmid!called!pXO2! ! ! Virulence*depends*on* acquiring*2*plasmids.#One# carries#the#gene#for#the# protein#capsule#(pXO2);#the# other#carries#the#gene#for#its# exotoxin#(pXO1)# ! !

Human-to-human! transmission!has!never! been!reported.!

!!

* Cutaneous!Anthrax!

TREATMENT!AND! PREVENTION! Cutaneous!Anthrax:! DOC!is!ciprofloxacin! Most*common*route*of*entry*(95%)* plasmin!pXO1)! - Direct!epidermal!contact!with!spores! ! contains!3!separate! Inhalational!/! causes!localized!tissue!necrosis,! proteins,!which!by! evidenced!by!a!painless!round!black! Gastrointestinal! themselves!are! lesion!with!a!rim!of!edema! Anthrax:! nontoxic!but! (malignant!pustule)! Ciprofloxacin!or! together!produce!the! Doxycycline!with!1! - 20%!mortality!rate! systemic!effects!of! or!2!additional! anthrax:! INHALATIONAL/PULMONARY!ANTHRAX:! antibiotics! - Edema!factor!(EF): - inhaled!spores!from!animals! (Rifampin,! the active A subunit (Woolsorter’s!disease)!or!from! of the exotoxin; Vancomycin,! weaponized!preparations! calmodulinPenicillin,! (bioterrorism)! dependent Imipenem,! - prolonged*latent*period*(2mos)! adenylate cyclase Clindamycin,! before!rapid!deterioration* - Protective!antigen! Clarithromycin)! - massively*enlarged*mediastinal* (PA):!promotes! ! entry!of!EF!into! lymph*nodes;*pulmonary* Vaccine:!for!highhemorrhage*(MCC*of*death);! phagocytic!cells!!! risk!individuals;! meningeal!symptoms* - Lethal!factor!(LF):! composed!of!the! - 100%!mortality!rate!without! zinc!metalloprotective!antigen! immediate!treatment! protease!that! (PA);!Animal! inactivates!protein! GASTROINTESTINAL!ANTHRAX:! vaccine!is! kinase;!stimulates! - ingestion!of!live!spores!leads!to!UGI! composed!of!a!live! the!macrophage!to! ulceration,!edema,!and!sepsis! strain,!attenuated! release!TNF-a!and! - vomiting!abdominal!pain,!bloody! by!loss!of!its! IL-1B!à!death! diarrhea! protein!capsule! PA!+!EF!=!Edema!Toxin! - rapidly!progressive!course! PA!+!LF!=!Lethal!Toxin! - mortality!approaches!100%! TOXINS!

CLINICAL!SYNDROMES!

Exotoxin!(encoded!on! CUTANEOUS!ANTHRAX:!

!

DIAGNOSIS!

NOTES!

Aerobic,!gram-positive! box-car!shaped!rods;! spore-forming;!NONMOTILE! ! Medusa!head! morphology!on! culture:!dry!“ground! glass”!surface!and! irregular!with! projections!along!lines! of!inoculation! ! Serology! ! PCR!of!nasal!swab** * *

Bacillus!anthracis!is! the!only!bacterium! with!a!capsule! composed!of!protein! (poly-D-glutamic! acid).! ! Infections!result!to! permanent!immunity! (if!the!patient! survives)!

!

Bacillus*cereus*

!

Endospores! ! ! Spores!on!grains!such! as!rice!survive! steaming!and!rapid! frying! ! Spores!germinate! when!rice!is!kept! warm!for!many!hours! (e.g.,!reheated!fried! rice)!à!Chinese!fried! rice!syndrome!

No!capsule! !

ENTEROTOXINS! EMETIC!FORM! DIARRHEAL!FORM! Heat-labile:!similar!to! Rice! Meat,!vegetables! the!enterotoxin!of! Short!IP:!6!hrs!! cholera!and!the!LT! (mean,!2h)! (mean,!9h)! from!E.*coli;*causes! Vomiting,!nausea,! Diarrhea,!nausea,! ADP-ribosylation,! abdominal!cramps! abdominal!cramps! increasing!cAMP* Shorter!duration:! Longer!duration:! * 8-10h!(mean,!9)! 20-36h!(mean,!24)! Heat-stable:! Heat-stable! Heat-labile! staphylococcal-like! enterotoxin! enterotoxin! enterotoxin!functions! Similar!to! Resembles! as!superantigen! staphylococcal! clostridial! food!poisoning! gastroenteritis! ! OPHTHALMITIS:!occur!after!penetrating! eye!injuries!of!the!eye!with!soilcontaminated!object;!complete!loss!of! light!perception!within!48!h!of!injury!

Food!Poisoning:! Symptomatic! treatment!only;! food!poisoning! is!caused!by!the! pre-formed! enterotoxin! ! Ophthalmitis:! Vancomycin! Clindamycin! Ciprofloxacin! Gentamicin! ! Resistant!to!betalactam!antibiotics!! !!

!

! RAXIBACUMAB:! monoclonal!antibody! for!use!in!inhalational! anthrax!

! ! ! MCC!of!death!is! pulmonary! hemorrhage!in:! - Anthrax! - Leptospirosis! (Weil’s!syndrome)! - Congenital!syphilis!

Aerobic,!gram-positive! ! spore-forming!rod;! MOTILE! ! Culture!specimen!from! suspected!food!source!

MICROORGANISM!

RESERVOIR! Habitat!is!soil!

Clostridium*tetani*

TRANSMISSION!

METABOLISM!

Endospores:! introduced!through! wound!or!traumatic! break!in!the!skin! - Skin!popping!in!IV! drug!use! - Stepping!on!a!nail!

Spores!germinate! under!anaerobic! conditions!in!the! wound!

VIRULENCE!FACTORS! Motile:!Flagella!(so!Hantigen-positive)!

!

TETANUS!PROPHYLAXIS! WOUND!

Clean,!minor!

Contaminated!

VACCINATION!HISTORY! Uncertain!or!3!doses! Toxoid! Toxoid! TIG!(ATS)! TIG!(ATS)! (TeANA)! (TeANA)! NO!(Yes,!only! YES! NO! NO! if!last!dose! given!>10y)! NO!(Yes,!only! YES! YES! NO! if!last!dose! given!>5y)!

Endospores!(heat! Habitat!is!soil! ! resistant)! Alkaline* vegetables!such!as! green!beans,! peppers!and! mushroom:! Home-canned! Zip-lock! storage!bags!

Clostridium* botulinum*

Anaerobic!

Motile:!Flagella!(so!Hantigen-positive)!

*

Smoked*fish* !

Wild,*raw*honey:! associated!with! infant!botulism* *
...