Bacteria Associated With Skin Infections 1 Flashcards
Some bacteria associated with skin infections
Staphylococcus Streptococcus Erysipelothrix Bacillus Clostridium Mycobacterium
Some general Characteristics of Staphylococcus
Gram positive cocci in grape-like cluster Facultative anaerobe Some are capsulated Non-motile Non-spore forming
Classification of Staphylococcus
S. aureus
S. epidermidis
S. saprophyticus
Biotypes of S. aureus
Biotypes A, B, C, D
Most commonly found biotype in humans
Biotype A
S. aureus is involved the pathogenesis of
Superficial (Localized) Infection
Deep (Systemic) Infection
`Toxigenic diseases
Nosocomial Staphylococcus bacteria found in medical instruments or devices (including catheters, CSF shunts, prosthetic heart valve implants)
S. epidermidis
S. epidermidis is involved the pathogenesis of
Endocarditis associated with valvular prosthesis
Intravenous catheter infection
Peritonitis in patients undergoing CAPD
Ventricular shunt infections
S. saprophyticus is involved the pathogenesis of
Urinary tract infection in young sexually active women
Antigenic structures of Staphylococcus
Capsule
Slime layer
Protein A
Peptidoglycan-teichoic acid complex
True or False.
Antigenic structures are not always associated with the virulence factors.
True
Virulence Factor of Staphylococcus
Capsule Slime layer Protein A Polysaccharide A (Ribitol Teiochoic Acid) Extracellular enzymes Toxins
This is a virulence factor that is produced by some S. aureus strains (≥ 8 capsular types identified) and anti- phagocytic
Capsule
This is a virulence factor that is only produced by S. epidermidis
Slime layer
This is a virulence factor that is involved in adherence and persistence on foreign body; main factor contributing to biofilm formation
Slime layer
This is a virulence factor that is a surface protein convalently bound to peptidoglycan
Protein A
This is a virulence factor that is regularly present in human strains of S. aureus but not found in (coagulase-negative Staphylocccus or CONS)
Protein A
This is a virulence factor that is binds non-specifically with Fc portion of IgG
Protein A
When protein A binds to the Fc portion of IgG, it
Prevents Fc-mediated opsonization
Induces complement activation by generating chemotactic factors
Used in antigen detection (co-agglutination test)
This is the part of Polysaccharide A that provides rigid exoskeleton and has interpeptide bridge connecting oligoglycine peptides
Peptidoglycan
This is the part of Polysaccharide A that is composed of water soluble polymers of ribitol or glycerol phosphate
Teichoic acid
An extracellular enzyme that hydrolyzes hyaluronic acid in connective tissues
Hyaluronidase
Also known as spreading factor
Hyaluronidase
An extracellular enzyme that enhances invasion and survival in tissues by binding cells together and rendering the intercellular spaces passable to pathogen
Hyaluronidase
Also known as fat-splitting enzyme
Lipase
An extracellular enzyme that splits fats and oils
Lipase
An extracellular enzyme that is essential for survival of Staphyloccoccus in sebaceous areas of the body and in the formation of furuncles and carbuncles
Lipase
Also known as fibrinolysin
Staphylokinase
An extracellular enzyme that dissolves fibrin clots
Staphylokinase
An extracellular enzyme that lays down fibrin barrier during abscess formation to prevent the spread of organism that is bound in the center of the abscess
Free coagulase
True or False.
Hyaluronidase, lipase and staphylokinase are used for the spreas of the organism in the body while coagulase is for the localization of the organism.
True
Type of toxin that is expressed by about 2-4% of S. aureus and is a pore-forming cytotoxin causing leukocyte destruction and tissue necrosis
Leukocidin (e.g. Panton Valentine)
Type of toxin that is phage-encoded
Leukocidin
Two protein components of Leukocidin
LukS-PV (Slow)
LukF-PV (Fast)
Difference of LukS-PV from LukF-PV
Electrophoretic mobility
Type of toxin associated with recurrent skin and soft tissue infections and necrotizing pneumonia
Leukocidin
Four major types of hemolytic toxins
Alpha
Beta
Gamma
Delta
Toxin responsible for causing damage to red cell membrane and produce hemolytic zones on BAP
Hemolytic toxins
Major hemolytic toxin
Alpha
Hemolytic toxin that forms transmembrane pores and has lethal, dermonecrotic, and leucocidal activities
Alpha
Hemolytic toxin formed by majority of human strains of S. aureus but not CONS
Alpha
Hemolytic toxin that lipid binding domain that inserts directly into the lipid bilayer of the cell membrane → pores → cell death
Alpha
Toxin that produces intraepidermal splitting of tissues, blister formation and sssociated with S. aureus phage group II
Exfoliative (epidermolytic) toxins
Exfoliative toxin that recognize, hydrolyze desmosomes in the skin and cleave Desmoglein 1
Serine proteases
Four types of exfoliative toxins
Type A, B C, D
Major types of exfoliative toxins
ETA and ETB
Toxin that is a family of secreted proteins acting as superantigens which stimulate and enhance the lymphocyte response
Pyrogenic exotoxins
Two major types of pyrogenic toxins
Enterotoxins
Toxic Shock Syndrome Toxin-1
Seven antigen types of enterotoxins
A, B, C1, C2, D, E, F
Antigenic types of enterotoxins that cause food poisoning
A and D
Antigenic type of enterotoxins that cause necrotizing enterocolitis
B
Pyrogenic exotoxin that is synonymous with Enterotoxin F and associated with menstrual infections in women
Toxic Shock Syndrome Toxin-1 (TSST-1)
Superficial (localized) infections caused by S. aureus
Impetigo
Folliculitis
Furuncles
Carbuncles
Deep (systemic) diseases caused by S. aureus
Acute osteomyelitis
Acute endocarditis
Pneumonia
Toxigenic diseases caused by S. aureus
Staphylococcal Scalded Skin Syndrome (SSSS/ Ritter’s Disease)
Staphylococcal food poisoning
Toxic Shock Syndrome
True or False.
90% of impetigo cases are caused by S. aureus while the remaining 10% are caused by Group A Streptococci (GAS).
True
Type types of impetigo
Bullous impetigo (exclusively by S. aureus) Non-bullous impetigo (by Staph, Strep or both)
More common in children
Occur in warm, humid environments
Highly contagious
Spread by direct contact with lesions or with nasal carriers
Impetigo
Toxin mediated (exfoliative toxin) and accounts for 30% of impetigo cases
Bullous impetigo
Type of impetigo that is characterized by vesicles and bullae, when ruptured leaves ligth brown/yellow crusts with oozingn exudates
Bullous impetigo
True or False.
Bullous impetigo has fewer lesions than non-bullous impetigo.
True
Type of impetigo that represents host response to infection, no toxin is needed to produce clinical manifestations
Non-bullous impetigo
True or False.
Non-bullous impetigo is more contagious than the bullous impetigo.
True
Type of impetigo that accounts for >70% of impetigo cases
Non-bullous impetigo
Formation of the stiking characteristic of non-bullous impetigo
Macule/ papule → vesicles/ pustules → rupture leaving honey- colored crusts which discharge pus when pressured
Superficial infection that can occur through shaving, scratching or with any injury to the skin
Folliculitis
Follicular-based pustule, most commonly superficial or deep
Folliculitis
Most characteristic pustular lesion produced by Staph
Furuncles (boils)
Development of furuncles
Start as hard, tender, red nodule surrounding a hair follicle → abscess → pus discharged from center → resolve
True or False.
Furuncles does not need surgery and no antibiotic treatment.
True
True or False.
No manipulations should be done because it will disrupt the fibrin barrier that will be the start of dissemination.
True
Superficial inflammation that arise in hair-bearing areas where there is friction, occlusion, perspiration and may be isolated or multiple
Furuncles
Development of carbuncles
Start as smooth, dome-shaped, acutely tender, painful lesion → develop into swollen, painful area discharging pus from several sites
Clustered boils but is deeper, more sever, develop and heal more slowly
Carbuncles
Frequent areas where carbuncles are found
Nape of the neck, back or thighs
Reason why carbuncles are more severe than furuncles
It can be disseminated to vital organs like cavernous sinus or the subarachnoid space
Toxigenic disease that is characterized by stripping of superficial layers of the skin from the underlying tissue (involves exfoliative toxin)
SSSS/Ritter’s Disease
Most frequently involved age group
Infants and children <5 yrs
Major cause
S. aureus phage group II (most commonly, type 71)
Laboratory diagnosis of Staphylococcus
Gram stain Culture Differential test Susceptibility test Serology Serotyping Phage typing
Gram stain findings of Staphylococcus
Gram positive cocci in clusters
0.5 – 1.5 micrometer in diameter
Gram variable within neutrophils, in resolving lesions, in the presence of antibiotics, and in old cultures
Type of culture needed by Staphylococcus
Unenriched media
7.5%-10% NaCl and in 40% bile
True or False.
High concentration of NaCl is a selective medium for Staphylococcus allow growth of S. aureus but inhibit growth for other species.
True
Media used for diagnosing Staphylococcus
Blood Agar Plate
Mannitol Salt Agar
Phenyl Ethyl Alcohol Agar
Type of media that form smooth, raised colonies and mucoid, if encapsulated
BAP
Selective and differential media for S. aureus
MSA
True or False.
S. aureus is mannitol fermenting.
True
True or False.
Pathogenic staphylococci ferment mannitol and produce acid.
True
MSA contains
1% mannitol
7.5% NaCl
Phenol Red as pH as indicator
Results of MSA
Yellow: (+) acid producing mannitol fermenter
Pink or red: (-) non-mannitol fermenters
Staphylococcus species that are mannitol fermenters
S. aureus
S. saprophyticus
Two types of differential test used for Staphulococcus
Catalase test
Coagulase test
Test that differentiates staphylococci from streptococci
Catalase test
Reagent used in Catalase test
3% H2O2
Positive catalase test is seen as
Bubble formation/effervescence of gas (Immediate)
Results of catalase test
Streptococcus (-)
Staphylococcus (+)
Test that distinguishes the different species of Staphylococcus
Coagulase
Two types of coagulases secreted by S. aureus
Staphylocoagulase
von Willebrand factor binding protein
Coagulase that activates human prothrombin
Staphylocoagulase
Coagulase that activates human, rabbit, mouse prothrombin
von Willebrand factor binding protein
Coagulase test that detects bound coagulase/clumping factor produced exclusively by S. aureus
Slide test
Results of slide coagulase test
If the Slide test is positive no need to do the tube test; confirmed S. aureus
If negative proceed to tube test
Coagulase test that detects free coagulase and causes clotting of citrated plasma in the presence of coagulase reacting factor (CRF)
Tube test
Coagulase test that is for suspected S. aureus that fail to produce bound coagulase
Tube test
True or False.
Coagulase test is specific in detecting Staphylococcus aureus.
True
Test that is used for complete workup culture and sensitivity test after identification
Susceptibility test
Test that aids in choice of systemic drugs and an epidemiologic tool
Susceptibility test
Type of test that shows that antibody detection has no value
Serology
Test that is adjunct or supplementary to phage typing
Serotyping
Test for epidemiologic tracing of infection and depends on differing susceptibilities to lysis by phages, particularly Phage II
Phage typing
Suppurative infections are prevented and controlled by
Cleanliness, hygiene, and meticulous hand washing
Aseptic management of lesions
Isolation of persons with open lesions
Suppression/cure of nasal carriage
General chracteristics of streptococcus
Gram positive cocci in chains Evident in broth medium Facultative anaerobe Some are encapsulated Some are flagellated Non- spore forming Capsuled
Characterized by a small zone of beta surrounded by alpha hemolysis
Alpha prime hemolysis
This is based on group specific carbohydrate antigen (C-CHO) because amino sugar determines serologic specificity
Lancefield pattern
Components
GAS: _____________
GBS: _____________
GDS: _____________
GAS: rhamnose-N-acetylglucosamine
GBS: rhamnose-glucosamine
GDS: glycerol teichoic acid
Streptococcus groups
A-H, K-V (20 groups)
Groups of Human Streptococcus pathogen
A-G
Human Streptococcus pathogen that is of greater significance
A and B
Nucleotide-based typing scheme
emm classification system
Molecular gold standard for GAS typing for M protein- producing strains
emm classification system
Sequencing of the emm gene that encodes the M protein based on its amino acid sequence variability of the N terminus (5’ end) such as Streptococcus pyogenes
emm classification system
These are used for species which cannot be grouped under the existing ones and to speciate Viridans Streptococci
Biochemical reactions
Antigenic structures of GAS
Capsule Pili Protein antigens (M, F, G,T proteins) C5a peptidase Group-specific polysaccharide (C-CHO)
Virulence factors for GAS
Capsule Lipoteichoic acid M protein F protein G protein C5a peptidase Serum Opacity Factor Pyrogenic (Erythogenic) Exotoxins Hemolysins Spreading Factors
Virulence factor composed of hyaluronic acid
Capsule
Virulence factor that is not immunogenic because of its antigenic disguise, and anti-phagocytic
Capsule
Major virulence factor of Streptococcus pneumoniae
Capsule
Virulence factor that is a component of pili and binds with M protein, mediating oral/ pharyngeal and epithelial attachment and subsequent colonization
Lipoteichoic acid
Major virulence factor for GAS
M protein
Virulence factor that is a component of a pili anti- phagocytic and dominantly binds to epidermis
M protein
M protein is anti-phagocytic because
It prevents alternative complement pathway opsonization
True or False.
M proteins are strongly immunogenic because specific antibodies are produced against it. Hence, it is difficult to come up with vaccines for M-protein.
True
Virulence factor that is a fibronectin-binding protein
F protein
F protein + M protein
Mediates nasopharyngeal adherence
Surface-bound endopeptidase and cleaves C5a
C5a peptidase
Anti-polymorphonuclear leukocyte chemo-attractant
C5a peptidase
Virulence factor that is an alpha-lipoproteinase and produces opalescence in horse serum broth
Serum Opacity Factor
Adjunct to M typing
Serum Opacity Factor
True or False.
Pyrogenic or Erythrogenic Exotoxins are protein in nature.
True
Four antigenic types of pyrogenic exotoxins
A, B, C, D
Most significant antigenic type of pyrogenic exotoxins
Exotoxin A
Exotoxin B
ETA or ETB.
Associated with rash in scarlet fever and TSSL
ETA
ETA or ETB.
Responsible for tissue destruction in necrotizing fasciitis
ETB
ETA or ETB.
Superantigen - stimulates and enhances a response
ETA
Streptococcal gangrene
ETB
ETA or ETB.
Produced only by lysogenized strains (including bacteriophage)
ETA
Basis of Dick’s tests
Erythrogenic toxin
Presence of erythema or redness of the test site
Basis of Schultz-Charlton test
Anti-erythrogenic toxin
Presence of anti-blanching phenomenon
Rash fade
Virulence factor responsible for beta-hemolysis on BAP of Streptococcus pyogenes
Hemolysins (Cytotoxic)
2 distinct types of Streptolysin
Streptolysin O
Streptolysin S
SO or SS. Oxygen labile (will not produce if not on surface)
SO
SO or SS.
Hemolytic in reduced form (to see if there is hemolysis, stab should be performed)
SO
SO or SS.
Oxygen stable
SS
SO or SS.
Responsible for subsurface hemolysis
SO
SO or SS.
Serum soluble
SS
SO or SS.
Forms transmembrane pores
SO
SO or SS.
Strongly immunogenic
SO
SO or SS.
Responsible for surface hemolysis
SS
SO or SS.
Non-immunogenic
SS
SO or SS.
Can be used serologically to titrate
SS
Its titers are determined for the detection of previous or recent streptococcal pharyngeal infection
Anti-streptolysin O (ASO)
Enzymes that act as spreading factors in Streptococcus spp
Hyaluronidase
Streptokinase (Fibrinolysin)
DNAse (Streptodornase)
Spreading factor that splits hyaluronic acids in connective tissue
Hyaluronidase
Spreading factor that dissolves fibrin clot
Streptokinase (Fibrinolysin)
Spreading factor that depolymerizes viscous DNA in pus and is strongly immunogenic
DNAse (Streptodornase)
True or False.
Streptolysin O is higher following pharyngeal infection while DNAse is higher following skin infection.
True
Most dominant DNAse produced following skin infections
Anti-DNAse B
True or False.
Titers of Anti- DNAse B are determined for the detection of previous or recent streptococcal skin infection
True
True or False.
Anti-streptolysin O should be detected in pharyngeal infection.
True
Habitat of GAS
Inhabits URT and skin of humans
Transmission of GAS
Person to person by direct contact with mucosa or secretions (coughing, sneezing)
Fomites
Clinical Disease of S. pyogenes
Pharyngitis Impetigo (pyoderma) Erysipelas (St. Anthony’s Fire) Cellulitis Acute Bacterial Endocarditis Puerperal Fever Toxic Shock Syndrome-like Necrotizing fascitis Scarlet fever
Most important clinical disease cause by S. pyogenes
Pharyngitis
Associated with type A; non-bullous
Most cases begin with strep infection but staph replaces strep over time
Impetigo (pyoderma)
Associated M types are frequently nephritogenic (may cause acute glomerulonephritis)
In pharyngeal infection – rheumatogenic
Impetigo (pyoderma)
Peripherally spreading; hot, bright red, edematous, well circumscribed, sharply marginated lesions
Erysipelas
Erysipelas most commonly affects
Face and legs
Pattern of spread of Erysipelas
Spreads thru the lymphatic vessels
Age group most commonly affected by Erysipelas
Common in infants, children and the elderly; accompanied by severe constitutional symptoms
“flesh-eating bacteria”, “streptococcal gangrene” (requirement for aerobic conditions)
Necrotizing fascitis
Highly destructive and potentially lethal infection of soft tissue (fatty tissues, fascia, muscles) and always follows trauma
Necrotizing fascitis
Toxin the mediates necrotizing fascitis
ETB
Toxin that mediates Scarlet Fever
ETA
Scarlet colored (boiled lobster), body rashes (sandpaper-like), strawberry like tongue which evolves from tonsillar/pharyngeal focus
Scarlet Fever
Laboratory diagnosis used for GAS
Gram stain Culture Identification tests Antigenic detection Serology
General characteristics of GAS in culture
Greyish white, transparent to translucent matte or glossy
Glossy: ____________
Matte: ____________
Glossy: less M protein produced
Matte: more M protein produced
Media used to culture GAS
BAP
Chocolate Agar
Selective media: CNA, PEA
Tests used to identify GAS
Bacitracin disc test (TAXO A)
Pyroglutamic acid arylamidase test (PYR)
Test used to differentiate S. pyogenes from other beta-hemolytic streptococci
Bacitracin Disc Test
Test that is helpful in screening for group A strep in throat swab
Bacitracin disc test
Results of bacitracin disc test
(+) any zone of inhibition (susceptible): Group A
Diameter of zone of inhibition to be classifies as susceptible
10mm
True or False.
S. pyogenes is the only beta-hemolytic streptococcus that is PYR (+)
True
True or False.
Majority of Group A are PYR (+)
True
Result of PYR test
(+): Bright pink/cherry red color in 1 minute
Laboratory diagnostic that is based on reaction with monoclonal antibodies which reacts with group-specific carbohydrate antigen
Antigenic detection
Laboratory diagnostic test that can be used in typing or detection of the organism in clinical specimens or in cultures (Group A-agglutination if it is Group A)
Antigenic detection
Two types of serology testing for GAS
Anti-streptolysin O
Anti-DNAse B
Serology test that is used to demonstrate previous or recent streptococcal infection, significantly following skin infections
Anti-DNAse B serology
Prevention and control of GAS
Early detection and antimicrobial therapy
Treating carriers
Replacing penicillin with other antibiotics is a risk factor for antibiotic resistance
Selection pressure
Drug of choice for GAS
Penicillin