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Clinical Bacteriology > (F) Lesson 13: Non-fermenters and Miscellaneous Gram-Negative Bacilli (Part 1) > Flashcards

(F) Lesson 13: Non-fermenters and Miscellaneous Gram-Negative Bacilli (Part 1) Flashcards

1
Q

The heart and soul of microbiology

A

Identification

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2
Q

If a patient is infected with an organism, one thing we can do is perform?

A

Culture and Sensitivity

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3
Q
  • It is not a routine procedure inside the clinical premises.
  • It is rarely done.
  • It is only done when the disease is deadly or the infection is already severe.
  • There is something wrong with the clinical intervention.
A

Culture and Sensitivity

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4
Q

In the Philippines instead of culture and sensitivity, we do what?

A

Empiric Therapy

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5
Q
  • We look at the clinical presentation, not on the causative agent of the infection.
  • A broad-spectrum antibiotic is prescribed
  • We do trial-and-error
A

Empiric Therapy

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6
Q

Determines the best antibiotic that can be prescribed to the patient

A

AST

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7
Q

What do we do when we receive unknown samples?

A
  1. Gram-staining
  2. Culture with BAP, CAP, and MAC
  3. Biochemical Testing
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8
Q
  • Comes 2nd in a clinical setting, but essential to do
  • Do not report normal flora
A

Gram Stain

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9
Q
  • The special media will be used for follow-up
  • In these plates, we will observe the hemolytic pattern.
A

Culture using BAP, MAC, and CAP

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10
Q

Medium

  • Will separate G(-) from G(+)
  • Selective for G(-) due to an inhibitor
  • Determines whether an organism is a lactose fermenter or not
  • Non-fermenters have high diagnostic significance
A

MAC

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11
Q

Medium

  • For fastidious organisms and gonococcal species
A

CAP

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12
Q
  • After G/S or culture, subject it to ____ depending on the growth.
A

Biochemical testing

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13
Q
  • Through ____, you can narrow down the possible causative agents of the infection.
A

Biochemical test results

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14
Q
  • One of the biggest points of differentiation in G(-) organisms
A

TSI or carbohydrate fermentation test

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15
Q
  • Causes difficulty in ID
  • We use the wrong manner of testing
A

Non-reactive organisms or biochemically inert organism

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16
Q

They do not ferment any carbohydrates, rather they oxidize carbohydrates.

A

Non-fermenters

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17
Q

General Characteristics

  • Grow much better in an ____ environment
A

Aerobic

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18
Q

General Characteristics

T or F: Non-fastidious organisms grow on regular media, even w/o supplementation.

A

T

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19
Q

General Characteristics

  • Most non-fermenters are oxidase (positive/negative).
A

Positive

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20
Q

General Characteristics

This differentiates Enterobacteriaceae from non-fermenters since most Enterobacteriaceae are (-) oxidase.

A

Oxidase Test

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21
Q

The only (+) oxidase Enterobacteriaceae

A

Plesiomonas spp.

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22
Q

T or F: Non-fermenters are non-ubiquitous and are rarely found in most environments.

A

F (ubiquitous and found in most environments)

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23
Q

General Characteristics

Can withstand treatment with ____ and ____

A

Chlorhexidine (antiseptic solution) and quaternary ammonium compounds (QACs)

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24
Q

Risk Factors for Clinical Infections

  • Diabetes mellitus
  • Cancer
  • Steroids
  • Transplantation
A

Immunosuppression/Immunocompromisation

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25
Q

Risk Factors for Clinical Infections

  • Gunshots, knife wounds, punctures
  • Surgery
  • Burns
A

Trauma

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26
Q

Risk Factors for Clinical Infections

  • Catheters. urinary or bloodstream
  • Prosthetic devices—joints, valves
  • Corneal implants or contact lenses
A

Foreign Body Implantation

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27
Q

Risk Factors for Clinical Infections

  • Dialysate
  • Saline irrigations
A

Infused Fluids

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28
Q

Biochemical Characteristics and Identification

  • Gram stain of non-fermenters?
A

Thin, gram-negative pleomorphic

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29
Q

Biochemical Characteristics and Identification

  • Non-fermenters are usually oxidase (positive/negative).

Paulit-ulit tayo ha.

A

Positive

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30
Q

Biochemical Characteristics and Identification

  • No acid production in the slant or butt of ____ or ____
A

TSIA or KIA

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31
Q

Biochemical Characteristic and Identification

  • (Nonreactivity/Reactivity) in 24 hours in commercial multi-test kit systems used primarily for the identification of Enterobacteriaceae
A

Nonreactivity

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32
Q

Biochemical Characteristics and Identification

  • (Resistance/Susceptibility) to a variety of classes of antimicrobial agents, such as aminoglycosides, third-generation cephalosporins, penicillins, and fluoroquinolone
A

Resistance

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33
Q

Identify the pigment produced by these organisms.

  • Chryseobacterium and Elizabethkingia spp. (weak fermenters)
  • Sphingomonas paucimobilis
  • Pseudomonas (Chryseomonas) luteola
  • Pseudomonas oryzihabitans
  • Sphingobacterium spp.
  • Pseudomonas stutzeri
A

Yellow

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34
Q

Identify the pigment produced by these organisms.

  • Methylobacterium spp.
  • Roseomonas spp.
A

Pink

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35
Q

Identify the pigment produced by these organisms.

  • Acinetobacter spp.
A

Purple

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36
Q

Identify the pigment produced by these organisms.

  • Pseudomonas aeruginosa
A

Blue-Green

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37
Q

Identify the pigment produced by these organisms.

  • Chromobacterium violaceum
A

Violet

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38
Q

Identify the pigment produced by these organisms.

  • Stenotrophomonas maltophilia
A

Lavender to lavender-green (blood agar)

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39
Q

Identify the pigment produced by these organisms.

  • Pseudomonas stutzeri
  • Shewanella putrefaciens
A

Tan

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40
Q

These species produce wrinkled colonies?

A
  1. Pseudomonas stutzeri
  2. Pseudomonas oryzihabitans
  3. Burkholderia pseudomallei
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41
Q

Identify the odor of the following organisms.

  • Alcaligenes faecalis
  • Myroides odoratus
  • Pseudomonas aeruginosa (grapes)
A

Sweet

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42
Q

Identify the odor of the following organisms.

  • E0-4
  • Neisseria zoodegmatis
A

Popcorn

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43
Q
  • Most nonfermenters are (motile/non-motile) even on plated media
A

Motile

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44
Q
  • Serrated or spreading colonies can be suspected as?
A

Pseudomonas aeruginosa

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45
Q
  • ____ colonies indicate that the organism is motile
A

Spreading

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46
Q

These species are non-motile.

A
  • Acinetobacter spp.
  • Moraxella spp.
  • Chryseobacterium spp. and Elizabethkingia spp.
  • Sphingobacterium spp.
  • Oligella spp.
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47
Q

Most non-fermenters are oxidase-positive except?

A
  • Acinetobacter spp.
  • Stenotrophomonas maltophilia
  • Pseudomonas luteola and P. oryzihabitans
  • Burkholderia cepacia
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48
Q

This species produces blackening in the media when cultured.

A

Shewanella putrefaciens

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49
Q
  • Tests whether organisms are glucose oxidizers or fermenters
  • Medium: Hugh & Leifson
  • Uses two tubes, 1 is topped with mineral oil to mimic an anaerobic environment since it tests the oxidation and fermentation capability of an organism when it comes to utilizing carbohydrates
  • (+) yellow = acid
  • (-) green = no acid
A

Oxidase and Fermentation Test (OF Test)

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50
Q
  • High carbohydrate, low peptone
  • Contents: 1% glucose, 1% agar, peptone
A

Hugh and Leifson

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51
Q

Hugh and Leifson Medium

Solidifies the medium, differentiating semi-solid from broth media

A

Agar

52
Q

Hugh and Leifson Medium

Buffer for enteric bacteria, which can directly kill them

A

Peptone

53
Q
  • Indicator of Hugh and Leifson
  • The original color of the medium is green since it is metachromatic
  • It detects changes in pH
A

Bromothymol blue

54
Q

OF Test

Fermentation requires what?

A

Mineral oil

55
Q

OF Test

Changes in (anaerobic/aerobic) tube = (+) oxidation

A

Aerobic

56
Q

OF Test

Changes in anaerobic tube = (+) (fermentation/oxidation)

A

Fermentation

57
Q

Match the results with the organism.

  1. Escherichia coli
  2. Pseudomonas
  3. Alacaligenes

A. +/-
B. -/-
C. +/+

A
  1. C
  2. A
  3. B
58
Q

Organisms that neither oxidize nor ferment.

A

Asaccharolytic organisms

59
Q
  • Uses two tubes subjected to different temperatures
  • Temperature: 35°C and 42°C
A

Growth at 42°C

60
Q

Identify the organism.

  • Both tubes contain growth (at 35°C and 42°C).
A

Pseudomonas aeruginosa

61
Q

Identify the organism.

  • There is growth only in the 35°C tube.
A

Pseudomonas fluorescens

62
Q
  • ID of Pseudomonas from Enterobacteriaceae
  • Not necessary since you can perform oxidase test
  • Uses the Cetrimide agar which is a selective agar
A

Cetrimide Test

63
Q

Cetrimide Test

If cetrimide media is unavailable, perform ____ as an alternative

A

Oxidase test

64
Q

Cetrimide Test

Positive with growth?

A

Pseudomonas aeruginosa

65
Q

Cetrimide Test

Negative with no growth?

A

Escherichia coli

66
Q

Familiarize yourself with the prelimenaries of Non-fermenters.

A
  1. Gram Staining: Gram-negative coccobacilli
  2. TSI: K/K
  3. MAC: Positive/Growth on MAC
  4. Oxidase Test: Most are oxidase-positive
  5. O/F Test: Non-oxidizer can either mean the organism is a fermenter or asaccharolytic
67
Q
  • Genus: Pseudomonas
  • Accounts for the largest percentage of all nonfermenters isolated from clinical specimens
A

Pseudomonas (Pseudomonads)

68
Q

Fluorescent or non-fluorescent?

  • P. aeruginosa
  • P. fluorescens
  • P. putida
  • P. veronii
  • P. mosselii
  • P. monteilii
A

Fluorescent

69
Q

Fluorescent or non-fluorescent?

  • P. stutzeri
  • P. mendocina
  • P. alcaligenes
  • P. pseudoalcaligenes
  • P. luteola
  • P. oryzihabitans
A

Non-fluorescent

70
Q
  • G(-) bacillus or coccobacillus
  • Strictly aerobic metabolism
  • Motile usually with polar or polar tufts of flagella
  • (+) Oxidase (P. luteola, P. oryzihabitans)
  • (+) Catalase
  • (+) growth on MAC
  • Usually an oxidizer of carbohydrates, but some species are asaccharolytic
A

Pseudomonads

Characteristics common to Pseudomonads

71
Q
  • Has a main character syndrome
  • Most commonly isolated species (moist environments, pools, hot tubs, catheters, humidifiers)
  • The leading cause of nosocomial (hospital-acquired) respiratory tract infections
  • When isolated from a sterile body site, it constitutes a true infection
A

Pseudomonas aeruginosa

72
Q

Pseudomonas aeruginosa

Since many antibiotics are found in hospitals, their continuous exposure to those results in the development of ____ among organisms.

A

Resistance

73
Q

What are the sterile parts of the body?

A
  • Blood
  • Pleural fluid
  • Joint fluids or tissues
  • Cerebrospinal fluid (CSF)
74
Q

Clinical Infections of Pseudomonas aeruginosa

  • Presented with ecthyma gangrenosum of skin
  • Different from sepsis (sepsis when it multiplies)
  • (+) bacteria in the blood
A

Bacteremia

75
Q

Clinical Infections of Pseudomonas aeruginosa

What are the top 3 bacteremia-causing bacteria?

A
  1. Klebsiella pneumoniae
  2. Escherichia coli
  3. Pseudomonas aeruginosa
76
Q

Clinical Infections of Pseudomonas aeruginosa

  • Either you die of infection or airway obstruction
A

Pulmonary Disease

Especially among individuals with CF

77
Q

Clinical Infections of Pseudomonas aeruginosa

  • An inherited disorder, defect in mucus-producing gene resulting in very thick production of mucus that may attract organisms.
A

Cystic fibrosis

78
Q

Clinical Infections of Pseudomonas aeruginosa

  • Ear infection among swimmers or divers
A

Otitis externa

79
Q

Clinical Infections of Pseudomonas aeruginosa

  • Also called Jacuzzi or hot tub syndrome ( they thrive well even in higher temperatures (42 deg C))
A

Necrotizing Skin Rash

80
Q

Clinical Manifestations of Pseudomonas aeruginosa

Familiarize yourself with the rest of the clinical manifestations of Pseudomonas aeruginosa.

A
  • Wound infections
  • Nosocomial urinary tract infections (UTIs)
  • Endocarditis
  • Infections following burns or trauma
  • Meningitis
  • Infections of the nail beds in people with artificial nails
  • Keratitis
  • Endophthalmitis
81
Q

Clinical Manifestations of Pseudomonas aeruginosa

  • One of the risk factors for infection
A

Immunocompromisation

82
Q

Clinical Manifestations of Pseudomonas aeruginosa

T or F: The majority of nonfermenters produce pulmonary infections.

A

T

83
Q

Virulence Factors of Pseudomonas aeruginosa

  • A substance by P. aeruginosa to produce biofilm as armor
  • Causes mucoid colonies in CF
A

Alginate

84
Q

Virulence Factors of Pseudomonas aeruginosa

  • Can be made from other substances aside from alginate
  • This makes organisms resistant to antibiotics, even WBCs since they can’t be identified
  • Destruction of this can expose the organism for it to be more susceptible to phagocytosis
A

Biofilm

85
Q

Virulence Factors of Pseudomonas aeruginosa

  • Like the Corynebacterium, it can also produce exo- and endotoxins
  • Most important exotoxin
  • Blocks protein synthesis
A

Exotoxin A

86
Q

Pigments of Pseudomonas fluorescent group

  • Yellow-green or yellow-brown pigment
  • Water-soluble and fluoresces under short-wavelength UV light
A

Pyoverdin

87
Q

Pigments of Pseudomonas fluorescent group

Blue

A

Pyocyanin

88
Q

Pigments of Pseudomonas fluorescent group

Red

A

Pyorubin

89
Q

Pigments of Pseudomonas fluorescent group

Brown

A

Pyomelanin

90
Q

Pseudomonas aeruginosa

Growth on Sheep Blood Agar (SBA)

A

Beta-hemolytic, flat spreading colonies with a metallic sheen

91
Q

Pseudomonas aeruginosa

The fruity, grape-like ordor is due to?

A

2-aminoceptophenone

92
Q

Pseudomonas aeruginosa

It is (positive/negative) for:

  • Denitrification of nitrate and nitrite
  • Arginine dihydrolase (ADH)
  • Growth at 42° C
  • Citrate
  • Acetamide utilization
A

Positive

93
Q

Pseudomonas aeruginosa

Growth on ____ which is selective and differential for P. aeruginosa ID

A

Cetrimide agar

94
Q

Pseudomonas aeruginosa

Detergent that inhibits bacteria

A

Cetrimide

95
Q

Pseudomonas aeruginosa

  • Medium enhances pigments produced by P. aeruginosa
A

Cetrimide agar

96
Q

Pseuodomonas aeruginosa

Resistant or Susceptible?

  • Penicillin
  • Ampicillin
  • First- and second-generation cephalosporins
  • Trimethoprim-sulfamethoxazole
  • Chloramphenicol
  • Tetracycline
A

Resistant

97
Q

Pseudomonas aeruginosa

  • Aminoglycosides
  • Semisynthetic penicillins (piperacillin and ticarcillin)
  • Third- and fourth-generation cephalosporins (ceftazidime, cefepime)
  • Carbapenem (except ertapenem)
  • Fluoroquinolones
A

Susceptible

98
Q
  • Can develop resistance while undergoing treatment
  • It would require ____
A

AST

99
Q

Pseudomonas aeruginosa

____ for severe infections:

  • Ceftazidime/cefepime/piperacillin/carbapenem (imipenem or meropenem) + Aminoglycoside (tobramycin or amikacin)
A

Combination therapy

100
Q

Pseudomonas aeruginosa

  • Can be fatal in critically ill patients
A

Multidrug resistant P. aeruginosa

101
Q
  • Very low virulence, rarely causing clinical disease (has very low infectivity rate)
  • From respiratory specimens, contaminated blood products, urine, cosmetics, hospital equipment, and fluids
  • Both are associated with transfusion-associated septicemia
  • To differentiate against P. aeruginosa: (+) pyocyanin and growth at 42 deg C
  • (+) Pyoverdin, xylose
  • (-) Pyocyanin, no growth at 42°C, nitrate to nitrite
A

Pseudomonas fluorescens and Pseudomonas putida

102
Q

Used to differentiate Pseudomonas fluorescens and Pseudomonas putida

A

Gelatin hydrolysis

103
Q

Positive for gelatin hydrolysis?

A

Pseudomonas fluorescens

104
Q

Negative for gelatin hydrolysis?

A

Pseudomonas putida

105
Q

Pseudomonas fluorescens and Pseudomonas putida

Resistant or Susceptible?

  • Carbenicillin
  • SXT
A

Resistant

106
Q

Pseudomonas fluorescens and Pseudomonas putida

Resistant or Susceptible?

  • Aminoglycosides
  • Polymyxin
  • Piperacillin
A

Susceptible

107
Q
  • Associated with catheter-related sepsis in patients with cancer
A

Pseudomonas putida

108
Q
  • Pseudobacteremia
  • Mistakenly identified as P. fluorescens: P. mosselii (2002), P. veronii, and P. montelilii
A

Pseudomonas fluorescens

109
Q

Used for identification for Pseudomonas fluorescens?

A

MALDI-TOF (Matrix-Assisted Laser Desorption Ionization-Time of Flight)

110
Q
  • Non-pigmented, non-hemolytic
  • (+) oxidase, catalase, ADH, optimal growth at 30 deg C
A

Pseudomonas mosselii

111
Q
  • Rare isolate and even rarer pathogen in the clinical laboratory
  • To differentiate against P. aeruginosa
  • (+) starch hydrolysis, nitrate to nitrite (soil denitrifier), anaerobe
  • (-) arginine dihydrolase (ADH)
  • Colonies: wrinkled, leathery, adherent colonies that may produce a light-yellow or brown pigment
  • Causes septicemia, meningitis in the HIV-infected patient, pneumonia (especially in CF and other immunocompromised patients), endocarditis, postsurgical wound infections, septic arthritis, conjunctivitis, and UTIs in an immunocompromised host
A

Pseudomonas stutzeri

112
Q

Pseudomonas stutzeri

Resistant/Susceptible?

  • Chloramphenicol
  • First and second-generation cephalosporins
A

Resistant

113
Q

Pseudomonas stutzeri

Resistant/Susceptible?

  • Aminoglycosides
  • SXT
  • Ampicillin
  • Polymyxin
  • Tetracyclines
  • Fluoroquinolones
  • Third-generation cephalosporins
A

Susceptible

114
Q
  • In soil and water, rarely from human specimens
  • Colonies: non wrinkled, flat colonies that may appear with a yellowish-brown pigment smooth buttery appearance
  • (-) pyoverdin, acetamide, proteolysis, starch hydrolysis
    (+) oxidase, arginine dihydrolase (ADH), motile (single polar flagella), glucose, xylose
A

Pseudomonas mendocina

115
Q

Pseudomonas mendocina

Used as the differentiation for Pseudomonas aeruginosa

A

Pigment

116
Q

T or F: Pseudomonas mendocina is a non-producer of pyoverdin.

A

T

117
Q
  • Contaminants when isolated from clinical specimens
  • (+) oxidase, MAC, nitrate to nitrite, motile (polar flagella)
  • (-) biochemical test
A

Pseudomonas alcaligenes and pseudomonas pseudoalcaligenes

118
Q

T or F: Pseudomonas alcaligenes/pseudoalcaligenes are known to be really biochemically inert: comes out negative for the majority of the biochemical testing panel.

A

T

119
Q

Identify the organism.

Positive for arginine dihydrolase and is a weak fructose fermenter.

A

Pseudomonas pseudoalcaligenes

120
Q
  • Only member of the Pseudomonas family that are (-) oxidase
  • Both from soil and water, wounds, abscesses, blood cultures, peritoneal and chronic ambulatory peritoneal dialysis (CAPD) fluids
  • Higher risk for infection by these organisms in the presence of foreign materials (e.g., catheters), corticosteroid use, and immunocompromised states
  • Both are G(-), non-fermenter
  • (-) oxidase
  • (+) catalase, motile, glucose oxidizer, MAC growth
  • Colonies: wrinkled or rough colonies that produce an intracellular non-diffusible yellow pigment
A

Pseudomonas luteola and Pseudomonas oryzihabitans

121
Q

Used to differentiate Pseudomonas oryzihabitans and Pseumonas luteola

A
  • Ortho-nitrophenyl-galactopyranoside or O’Nitrophenyl-β-D-galactopyranoside (ONPG) test
  • Esculin hydrolysis
122
Q

Positive for ONPG, Esculin hydrolysis or Ortho-nitrophenyl-galactopyranoside?

A

Pseudomonas oryzihabitans

123
Q

Negative for ONPG, Esculin hydrolysis or Ortho-nitrophenyl-galactopyranoside?

A

Pseudomonas luteola

124
Q
  • Japanese rice paddies, hospital drains, and respiratory therapy equipment
  • Possible from an octopus bite while swimming in the ocean
  • From the eye of one patient with postoperative endophthalmitis
  • Resistant: first- and second-generation cephalosporins
  • Usually susceptible to penicillin
  • (+) ONPG, esculin hydrolysis
A

Pseudomonas oryzihabitans

125
Q
  • Sole isolate from a case of prosthetic valve endocarditis and subdiaphragmatic abscess from multiple brain abscesses in a child
  • Sensitive to all β-lactams.
  • (-) ONPG, esculin hydrolysis
A

Pseudomonas luteola

Clinical Bacteriology (33 decks)

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