Chapter 19: Gram Positive, Pathogenic Bacteria Flashcards
What are some general characteristics of Gram positive pathogenic bacteria?
Stain purple when Gram-stained
Two major groups based on content of DNA
Low G+C bacteria:
Cocci (Staphylococcus, Streptococcus, and Enterococcus)
Bacilli (Bacillus, Clostridium, Listeria, and Mycoplasmas)
HIgh G + C Bacteria
Rod Shaped (Corynebacteria, Mycobacteria, Proponibacteria)
Filamentous (Nocardia, Actinomyces)
What are some general characteristics of the Staphylococcus genus?
Normal member of human’s microbiota
May be an opportunistic pathogen
What is the general structure and physiology of Staphylococcus?
Gram positive cocci, nonmotile, facultative anaerobes
Cells occur in grape-like clusters
Salt tolerant- Tolerate salt of human skin
Tolerant of dessication- survive on environmental surfaces
Synthesizes catalase
What are the two species of Staphylococcus are commonly associated with human disease?
Staphylococus aures: More virulent, variety of conditions depending on site of infection
Staphylococcus epidermidis: Normal microbiota of human skin, opportunistic infection
How does a bacterial species become virulent?
Infections result when staphylococci breach body’s physical barriers
Entry of only a few hundred bacteria can result in disease
Pathogenicity results from three factors: Production of toxins, enzymes, and antiphagocytic factors
What are some structural defences of Staphylococcus against phagocytosis?
Protein A- coats the surface of the cell, interferes with humoral immune responses by inhibiting opsonization, inhibit complement cascade
Bound coagulase enzyme- converts fibrinogen into fibrin molecules, fibrin clot hide the bacteria from phagocytic cells
Slime layers (capsules)- inhibit leukocyte chemotaxis and phagocytosis, facilitate attachment of Staphyloccous to surfaces
Define opsonization
Opsonization is the neutralization of an antigen by an antibody which allows it to be engulfed by a phagocyte
Define the complement cascade pathway
Proteins in blood serum that help the immune response
What are the pathogenic enzymes produced by Staphylococcus?
Cell free coagulase- triggers blood clotting
Hyaluronidase- break down hyaluronic acid, enables the bacteria to spread between cells
Staphylokinase- dissolves fibrin threads into blood clots, allows S. aureus to free itself from clots
Lipases- digest lipisd, allow Staphylococcus to grow on skin and in oil glands
Beta-lactamase- breaks down penicillin, allows bacteria to survive treatment with beta-lactam antimicrobial drugs
What are the toxins produced by Staphylococcus?
S. aureus produces toxins more frequently than S. epidermidis
Cytolytic toxins- alpha, beta, gamma, delta, and leukocidins (lyse leukocytes), disrupt the cytoplasmic membrane of a variety of cells
Exfoliative toxins- cause skin cells to separate and slough off
Toxin-shock syndrome toxin- causes toxic shock syndrome
Entertoxins: (A,B,C, D, and E), stimulate symptoms associated with food poisoning, are heat stable
What are the types of disease caused by Staphylococcus?
Three categories of disease:
Noninvasive- Food poisioning, due to ingestion of enterotoxin-contaminated food, consumed bacteria do not continue to produce the disease, less than 24 hours
Cutaneous- Various, Scalded skin syndrome, impetigo, follicultis, sty, furuncle, carbuncle
Systemic- variety of infections when bacteria invade deeper tissues
What are the effects of scalded skin syndrome?
Exfoliative toxin causes reddened pathches of the epidermis to slough off
Blisters contain clear fluid lacking bacteria or WBCs
What are the characteristics of impetigo?
Reddened patches of skin become pus filled vsicles that eventually curst over
Generally affects children (immune system not as developed)
What are the characteristics of toxic shock syndrome?
Occurs when TSS toxin is absorbed through the skin
Characterized by fever, vomiting, red rash, low BP, loss of sheets of skin (desquamation)
Correlated with tampon use and knowledge
What are the other systemic diseases caused by Staphylococcus aureus?
Bactermia- bacteria enter into bloodstream
Endocarditis- bacteria present in the lining of the heart
Pneumonia- an inflammation of lungs where alveoli and bronchioles become filled with fluid
Osteomyelitis- bacteria invades the bones causing inflammation of bone marrow and surrounding bone
How is a Staphylococci infection diagnosed?
Detect gram positive, cluster like arrangments of bacteria
If bacteria are able to clot blood, they are coagulase positive (characteristic to S. aureus)
How do you treat and prevent a Staphyloccocal infection?
Only 5% of strains are susceptible to penicilin
Methicillin (in MRSA must treat with vancomycin)
Hand antisepsis important to prevent nosocomial infections
What are the general characteristics of Streptococcus?
Gram positive cocci, facultative anaerobes
Arranged in pairs or chains, catalase negative
Classified on the basis of antigens, types of hemolysis, cell arrangment, or physiological properties
Often categorized based on Lancefield Classification
What is the Lancefield classification system?
Streptococci species are classified using the Lancefield system
Divided into serotypes based on bacteria’s antigens
Includes serotypes A through H and K through V
Lancefield groups A and B include the significant human pathogens
What is the species of Group A Streptococci?
Group A- Streptococcus pyogenes, forms white colonies surround by a large zone of beta hemolysis
What are the components that make S. pyogenes pathogenic?
Structural components- Protein M (analgoues in funcion to Protein A), Hyaluronic acid capsule (remain hidden from phagocytic cells)
Enzymes- Streptokinase, deoxyribonucleotides, C5A peptidase (complement breaking peptide), hyaluronidase
Pyrogenic toxins (Erythrogenic toxins)- stimulate the release of cytokines (proteins) that cause fever, toxin carried on bacteriophages (only lysogneized strains are able to cause disease)
Streptolysins- lyse red blood cells, WBCs, and platelets
What are the group A streptococcal diseases?
Pharyngitis “strep throat”- inflammation of pharynx
Scarlet fever- involves lysogenized strain of S. pyogenes (Due to pyrogenic toxins) Strawberry red tongue
Pyoderma (similar to impetigo) and erysipelas- pus-producing lesions involving lymph nodes, pain, and inflammation
Streptococcal toxinc shock like syndrome (TSLS)
Necrotizing fasciitis- caused by “flesh eating bacteria” bacteria spread deep within the body along the fascia
Rheumatic fever- autoimmune, antibodies cross-react with heart antigens, inflammation leads to damage of heart valves and msucle, leads to achy joints
Glomerulonephritis- autoimmune, antibodies against group A Streptococcus accumulate in the glomeruli and nephrons of the kidneys causing inflammation, causes tea-colored urine
How do you diagnose, treat, and prevent a Streptococcal Group A infection?
Diagnosis- Gram + pair or chain found in cutaneous specimens, streptococci normally in the pharynx (not diagnostic), immunological tests
Treatment- penicillin is effective, sensitive to erythromycin, cephalosporin, and bacitracin
Prevention- antibodies against M protein provide protection
What are the characteristics of Group B Streptococcal strains?
Group B- BABY, Streptococcus agalactiae
Beta-hemolysis zones that are smaller, gram positive cocci in chains
Group specific polysaccharide cell wall antigens, resistant to bacitracin
How is Streptococcus agalactiae pathogenic?
Capsule is not protective (unlike S. pyogenes)
Often infects newborns without specific antibodies
Produces enzymes (proteases, hemolysins, hyaluronidase, etc.) whose roles are not yet understood
What are the diseases caused by S. agalactiae?
Associated with neonatal bactermia, meningitis, and pneumonia
Older, immunocomprimised patients also at risk
How is S. agalactiae diagnosed, treated, and prevented?
Diagnosis- ELISA test used to identify group B streptococcus
Treatment-Penicilin G is the drug of choice
Prevention- immunization of women can protect future children
What is the Viridans Group?
Alpha-hemolytic Streptococci (incompletely break down RBCs, WBCs, etc.)
Lack group specific carbohydrates- cannot be classified using Lancefield system
Many produce a green pigment when grown on blood media
Inhabit mouth, pharynx, GI tract, genital tract, and urinary tract
One cause of dental caries and dental plaque- Stick to dental surfaces via dextarn
If enter the blood can cause meningitis and endocarditis
What is the other alpha-hemolytic Streptococcus species?
Streptococcus pneumoniae
Gram positive cocci that most commonly form pairs
Form unpigmented, alpha hemolytic colonies on blood agar
What are the virulence factors of Streptococcus pneumoniae?
Polysaccaride capsule (required for virulence)
Phosphorylcholine- stimulates cells to phagocytize the bacteria
Protein adhesin- mediates binding of cells to epithelial cells of pharynx
Secretory IgA protease- destroys IgA (anitbodies found in the pharynx)
Pneumolysin- binds to cholesterol in the cytoplasmic membranes of epithelial cells, producing pores that result in cell lysis
What are the pneumoccoal diseases caused by S. pneumoniae?
Pneumococcal pneumonia- bacteria multiply in the alveoli, damaging the alveolar lining, allowing fluid, RBCs, and leukocytes to enter the lunds
Sinusitis and otitis media- bacteria can invade the sinuses and middle ear causing pus and inflammation
Bacteremia and endocarditis- colonize in the blood and heart
Pneumococcal meningitis- spread to the meninges
How is a S. pneumoniae infection diagnosed, treated, and prevented?
Diagnosis- gram-stain of sputum smears, confirmed with Quellung reaction (anti-capsular antibodies cause the capsule to swell)
Treatment- penicillin
Prevention- vaccine made from purified capsular material
What are the characteristics of the Enterococcus genus?
Previously classified with group D streptococcus- reclassified as a separate genus
Gram positive, unencapsulated, catalase negative, non-hemolytic
Forms short chains and pairs
Can grow up to 45 degrees Celsius, pH 9.6, and can grow in the presence of salt and bile
Found in the human colon where it is rarely pathogenic- may introduce disease if found in a different area
Enterococcus faecalis and Enterococcus faecium