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Microbiology 2 > Chlamydia, Mycoplasma & Ureaplasma > Flashcards

Chlamydia, Mycoplasma & Ureaplasma Flashcards

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1
Q

Chlamydia main points and 4 main species

A

> Non-Motile Gram Negative Bacteria

> Obligate intracellular Parasites

> Rely on host cell ATP for energy (Energy Parasites)

> Three species cause disease in Humans

  • C. pneumoniae
  • C. trachomatis
  • C. psittaci (infect animals and birds also)
> All species have Lipopolysaccharide (LPS) and Major Outer 
Membrane  Protein (MOMP) antigens that can be used in identification 
(serotypes)
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2
Q

Chlamydia Replication Cycle

A 
> Two Forms
Elementary Body (EB) - Small, round and infectious
Reticulate Body (RB) - Larger and noninfectious

> EB attaches to a host cell which forms a phagosome and ingests the EB
EB forms a RB and replicates by binary fusion
RB’s reorganizes and forms EB’s
The cell ruptures and release the EB’s

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3
Q

Chlamydia microscopic appearance

A

> Cytoplasmic inclusions are present in infected host cells
May be seen with a fluorescent antibody stain, Giemsa stain
or iodine stain

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4
Q

Chlamydia Trachomatis serologically variant strains

A

Serovars A, B, Ba, and C
> Serovars L1-L3
> Serovars D-K

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5
Q

Serovars A, B, Ba, and C

A
  • Cause Trachoma - a serious eye disease
  • Cause of endemic in Africa and Asia that is characterized by chronic
    conjunctivitis and can lead to blindness
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6
Q

Serovars L1-L3

A
  • Cause Lymphogranuloma venereum (LGV) - STD
  • Associated with genital ulcer disease in tropical countries
  • Groin lymph nodes may become filled with pus (bubo)
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7
Q

Serovars D-K

A

> Cause genital tract infections

Men - Cause Nongonococcal Urethritis (NGU)
- Can cause epididymitis, prostatitis and proctitis

Women - Cause urethritis, cervicitis, endometritis, PID, salpingitis and
proctitis
- Lead to infertility

> Inclusion Conjunctivitis

  • Occur in adults and newborns
  • inflammation of the mucous membrane covering the eyeball and the eyelid
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8
Q

Newborn Infections (C. Trachomatis)

A

neonatal conjunctivitis and pneumonia

pneumonia (if present) beginning at 1-3
months

conjunctivitis (if present) developing at 1-
2 weeks

  • In pneumonia - cough and fever
  • In conjunctivitis - eye discharge, eye swelling or both
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9
Q

C. trachomatis Specimens (will depend on clinical manifestations)

A

 Must contain host epithelial cells

> Endocervical, urethral and conjunctival swabs
- Urethral swabs should be collected at least one hour after urination

> Endocervical material (cytologic brush)

> Biopsies

> Lower Respiratory Secretions

> Aspirates from suspected LGV buboes

> Urine

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10
Q

C. trichomatis specimen collection

A
  • dacron, cotton & calcium alginate swabs can be ised

- wooden handled swabs should NOT be used ( may be toxic )

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11
Q

C. trichomatis specimen transport

A
  • specimens for culture must be placed in transport media & transported at 4 degrees celsius

transport media

  • 2-sucrose Phosphate ( 2SP)
  • sucrose Glutamate Phosphate
  • should arrive to lab within 24hrs of collection & be refrigerated
  • frozen(-70) if processing delayed
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12
Q

C.trichomatis ID ( culture methods )

A

> Direct Examination - Sensitive but technically demanding and
dependent on the quality of the specimen

> Direct Fluorescent Antibody (DFA) Test

  • Most sensitive method
  • Requires an experienced microscopist and is labor intensive
  • Should not be used routinely for genital tract specimens

> Iodine Stains
- Stains the glycogen in C. trachomatis inclusions

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13
Q

C. trichomatis ID ( non culture methods)

A

transport less rigorous than culture methods because
tests do not require viable organism

> DFA Tests
- Used on endocervical, urethral, conjunctival and respiratory
specimens

> Enzyme Immunoassay (EIA)

> Nucleic Acid Detection Tests - Detects the bacterial RNA -
Preferred Method

> Giemsa Stained Smears

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14
Q

C.trichomatis CDC ID recommendation

A

> Non-culture methods give a presumptive diagnosis
Results may be confirmed with a culture method test or a second
non- culture method test

> CDC Recommends that Culture Tests be performed on the following:

  • Urethral specimens from women and asymptomatic men
  • Nasopharyngeal specimens from infants
  • All rectal specimens
  • Vaginal specimens from prepubertal girls
  • Medicolegal cases (ex. Sexual abuse)
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15
Q

C. pneumoniae

A
  • common respiratory pathogen, may cause flulike symptoms, pneumonia, bronchitis, pharyngitis and sinusitis

> Also associated with asthma, coronary heart disease and
Guillain Barre syndrome ( rare autoimmune disorder)

> Detected with Fluorescein-labeled anti-C. pneumoniae
antibodies

> May be diagnosed serologically

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16
Q

C.psittaci

A

> Causes ornithosis (zoonotic disease)- Parrot Fever

> Usually acquired from infected birds - Inhalation of the
bacteria

> Patients may be asymptomatic or have a fever and
pneumonia

> Detected through serology

17
Q

Mycoplasma & Ureaplasma

A

- Widely distributed in nature and are found in humans, animals
and the environment

 The smallest, self replicating organisms (once thought to be
viruses)

 Bacteria lacking a cell wall (Not stained with Gram stain)

 Range in size from coccoid to tapered rods (Pleomorphic)

 Significant Human Pathogens:
> Mycoplasma pneumoniae (Respiratory tract disease)
> Mycoplasma hominis (Urogenital tract disease)
> Ureaplasma urealyticum (Urogenital tract disease)

18
Q

Mycoplasma

A

 Mycoplasma spp. are generally slow growers, highly fastidious
and facultative anaerobes

 small colonies ranging in size from 15um-300um

 Often grow embedded beneath the surface of solid media

 Some species form colonies with raised centers (“fried egg
appearance”)

 Common contaminants

19
Q

Mycoplasma pneumoniae ( what it causes, how it is transmitted,)

A
  • infects respiratory tracts, causes primarily atypical pneumonia- “ walking pneumonia”
    > NOT a normal commensal organism
    > Isolation in significant and considered a pathogen
    > Can also cause pharyngitis and bronchitis
    > Rarely spreads to other body sites
    > Transmission most likely through aerosol droplet spray
20
Q

M.pneumoniae ( common age and season infected, symptoms)

A

> occurs in older children, teenagers and young adults

> occur in fall/early winter
around back- to-school time

> connected to closed-in populations ex.
Military bases, prisons, dormitories

> Infections could be asymptomatic or very mild

> Symptoms can include headache, low-grade fever, malaise,
anorexia, dry cough

21
Q

Mycoplasma hominis

A

> Colonize the urogenital tracts of many sexually active adults

> Opportunistic pathogen

> Associated with Bacterial Vaginosis (BV), PID, postpartum
fever, meningitis in premature infants and other infections

> Not reported as a cause of Nongonococcal Urethritis (NGU)

22
Q

Ureaplasma urealyticum

A

> Colonize the urogenital tracts of many men and women

> May cause NGU in men

> Does not cause disease in the lower genital tract of females

> Associated with BV and upper genital tract infections in
females

23
Q

Mycoplasma & Ureaplasma in newborns & immunocompromised

A

 M. hominis and Ureaplasma spp. can be transmitted to
neonates during delivery

 Associated with congenital bacteremia, pneumonia and chronic
lung disease in premature infants

 U. urealyticum is a common organism isolated from tracheal
aspirates of low birth weight infants with respiratory disease
- sometimes isolated from infants born via caesarean section
(infection occurring in utero)

\ recovered from CSF specimens in high risk
newborns (premature, low birth weights)
* If CSF is negative for bacteria, when symptoms suggest
meningitis, culture for M. hominis and U. urealyticum should be
performed

 In immunocompromised individuals, can lead to bacteremia and
invasive disease of joints and respiratory tract

24
Q

Mycoplasma & Ureaplasma specimen collection & transport

A

> Specimens may include body fluids, blood, sputum, synovial fluid, CSF,
amniotic fluid, urine, wound aspirates, tissue samples, nasopharyngeal swabs,
cervical swabs and vaginal swabs

> The lack of cell wall make these organisms are sensitive to drying and heat

> If transport delayed, specimens should be placed in a transport medium
such as SP4, Shepard 10B broth or 2SP

> Cotton tip swabs and wooden shafts should be avoided - inhibitory effects
Swabs should be made of Dacron polyester or calcium alginate with aluminum
or plastic shafts

> On arrival in the laboratory, specimens should be placed in fridge and
processed within 6 hrs or frozen at - 70 degree Celsius if delayed more than 24hrs

25
Q

Mycoplasma & Ureaplasma direct examination

A

> Gram stain not useful due to lack of cell wall
DNA fluorescent stain maybe use but not specific (ex. acridine orange)
PCR technology may be used for detection

26
Q

Mycoplasma & Ureaplasma Culture

A

> Often done at the reference laboratory

> Special media have been developed for isolation

> Media is enriched with sterols and other nutrients (dependant on
species)

> Antimicrobial agents often included to inhibit contaminants

> M. hominis and U. urealyticum may grow on NYC media
M. hominis may be cultured on BAP and CHOC agar

27
Q

I Mycoplasma & Ureaplasma incubation period

A

> M. pneumoniae are incubated for 3-4 weeks
M. hominis and U. urealyticum held for one week before
reported as negative

28
Q

Mycoplasma & Ureaplasma Identification

A

> Mycoplasma colonies often have the fried egg appearance

> Ureaplasmal colonies are very small and do not tend to have
the fried egg appearance - hard to see with the naked eye

> Key characteristic used to identify U. urealyticum is its ability to hydrolyze urea

> Serology testing used to detect antibodies but typically done at the reference
lab level

29
Q

Mycoplasma & Ureaplasma Antimicrobial susceptibility

A

> Resistant to many antimicrobials due to the lack of a cell wall

> M. pneumoniae is susceptible to tetracyclines, newer fluoroquinolones and
macrolides (erythromycin) but resistance is emerging

> Standard antimicrobial sensitivity testing should be conducted

Microbiology 2 (22 decks)

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