Gram Positive Bacteria Flashcards
where are Staphylococcus found in humans?
Found all over the skin
Form part of the human microbiota – normal flora
how is staphylococcus transmitted?
Transmitted by direct contact, via fomites and medical instruments
OPPORTUNISTIC pathogens
Cause minor to life threatening diseases
Staphylococcus genus
Genus is:
Gram positive
Facultatively anaerobic prokaryote
Staphylococcus shape
Spherical cells-clustered like grapes- due to cell division occuring in successively different planes and daughter cells remain attached
Staphle - greek for bunch of grapes
Kokkos - berry
Staphylococcus tolerance
Salt tolerant – sweat
Tolerant to desiccation, radiation and 60 deg C-survival on environmental surfaces
Desiccation - the removal of moisture from something
Survive in dust
Produce catalase
Can different between straph and streph. As one produces catalase to neutralise
2 staphylococcus species commonly associated with disease in humans
Staphylococcus aureus -more virulent
Staphylococcus epidermidis (collective term for many species) -part of normal flora of human skin-opportunistic pathogen
Common ‘staph’ infections occur when physical barriers breached.
Physical barriers breached, by IV drip, surgery,
Staphylococcus aureus defences against phagocytosis x3
Protein A coated – binds IgG stems and inhibits complement cascade (triggered by ab mol bound to ag)
Bound coagulase on surface – forms fibrin clots – hides bacteria
Slime/capsules – polysaccharide – inhibit chemotaxis and endocytosis by leukocytes and facilitates attachment (to entry points, IV drips, catheters)
Staphylococcus epidermidis
Relies almost exclusively on slime
Opportunistic – attach to urinary catheters, intravascular catheters – form biofilms
enzymes produced by Staphylococcus aureus x5
Coagulase – fibrin threads
Hyaluronidase – breaks down hyaluronic acid – major matrix component of cells
Staphylokinase – dissolves fibrin threads
Lipases – digest lipids- allows growth on skin and in cutaneous oil glands
β lactamase – 90%
Staphylococcus toxins
Cytolytic toxins – coded by genes and disrupt cytoplasmic membranes of cells including leukocytes.
Exfoliative toxin – dissolve intercellular bridge proteins causing skin sloughing
Enterotoxins – cause vomiting associated with Staphylococcal food poisoning
disease caused by staphylococcus toxins
Toxic shock syndrome toxin - fever, rash, low bp and loss of skin (tampons)
Noninvasive Staphylococcus aureus infection
food poisoning
Cutaneous Staphylococcus aureus infection
localised pyogenic lesions, e.g. SSS, impetigo
Folliculitis Staphylococcus aureus infection
hair follicle infection with progressive stages
furuncle or boil - extension of hf to surrounding tissue
carbuncle – coalesce of furuncle – deep tissue infection – fever/chills(2nd line)
Bacteremia caused by Staphylococcus aureus infections
systemic blood infection, septic
Endocarditis caused by Staphylococcus aureus infections
life-threatening inflammation of the inner lining of your heart’s chambers and valves(endocardium).
Resulting after bacteremia circulating through heart
other systemic diseases caused by Staphylococcus aureus infections
Pneumonia and empyema
Osteomyelitis caused by Staphylococcus aureus infections
infection of bone after bad bone breakage, breaks the skin
Other important groups of gram positive bacteria x7
Streptococci – lead to scarlet fever Bacillus - aerobic spore producers Clostridium Listeria Corynebacteria Mycobacteria Propionibacteria
Streptococci morphology
cocci
0.5-1.2um in diameter
Found in pairs and chains
characterics of streptococci
Gram positive cocci
Catalase negative
Facultatively anaerobic
Differentiation between gram positive cocci
Serology – reactions of antibodies to specific bacterial antigens
Haemolysis
Cell arrangement
Physiological – biochemical tests
Haemolysis differentiation
Alpha – Strep.pneumoniae & viridans streptococci
Beta – mainly Lancefield groups – Strep.pyogenes, Strep.agalactiae
Gamma – non haemolytic - Enterococci
Lancefield grouping
Serological classification scheme Based on the bacteria’s antigens Developed 1938 – Rebecca Lancefield Groups – A to H & K to V More significant human pathogens are in Lancefield groups A, B, C, D, F & G
Group A Streptococcus
AKA – GAS & S.pyogenes
1-2mm white colonies
Large zone of beta haemolysis on Blood agar at 24hrs
Bacitracin sensitive
Pathogenic species often capsulated
Pathogenesis of Group A Streptococcus
Evasion of phagocytosis
Protein M
membrane protein – destabilises complement interfering with opsonisation & lysis
Hyaluronic acid capsule
camouflage – ignored by WBCs
streptolysins
membrane bound proteins
lyse RBCs, WBCs & platelets
Interfere with oxygen-carrying capacity of blood, immunity & blood clotting
After being phagocytized – release streptolysins into phagocyte cytoplasm – causes lysosomes to be released = lyses of phagocyte & release of bacteria
Streptokinases
break down blood clots-facilitates rapid spread through infected & damaged tissue
4 distinct deoxyribonucleases
depolymerise DNA released from dead cells in abscesses – reduces firmness of pus & facilitates spread
C5a peptidase
breaks down C5a complement protein – acts as chemotactic factor – decreases movement of WBCs into infection site
Hyaluronidase
breaks down hyaluronic acid- facilitating spread through tissues
Toxins of Group A Streptococcus
Secretion of 3 distinct pyrogenic toxins-stimulate macrophage and T helper lymphocytes to release cytokines – stimulate fever, rash & shock – aka erythrogenic toxins
Toxin genes – carried on temperate phages = only lysogenised bacteria secrete
Epidemiology of Group A Streptococcus
Frequently infect pharynx or skin – resulting abscesses temporary – last only until specific immune responses occur against M proteins & streptolysins
GAS cause disease when competing microbiota depleted – large numbers gain rapid foothold before antibodies formed or patient immunocompromised
Following colonisation can invade deeper tissues & organs through barrier breaks
Spread is via respiratory droplets – especially in crowded conditions
Significance as pathogen declined since advent of antibiotics
GAS diseases x7
Pharyngitis Scarlet fever Pyoderma & Erysypelas Streptococcal Toxic Shock Syndrome Necrotizing fasciitis Rheumatic fever Glomerulonephritis - kidneys
GAS disease diagnosis
In the laboratory – Gram +ve cocci in pairs or short chains in cutaneous specimens
BA or BANA – haemolytic – Lancefield group A
ASOT - Anti-streptolysin O (ASO or ASLO) is the antibody made against streptolysin O, an immunogenic, oxygen-labile streptococcal hemolytic exotoxin produced by most strains of group A
Treatment for GAS
Penicillin
Erythromycin or Cephalexin for Penicillin allergic patients
Aggressive removal of non viable tissue in NF
Underlying infection arrested only in immune response resulting in RF & GN
Antibodies against M proteins confers long term protection but changes with strain
Group B streptococcus
S.agalactiae Bacitracin resistant Produces capsules – but targeted by antibodies – does not confer protection Predilection for newborns Produce proteases & haemolysins
Epidemiology of GBS
Normally colonise lower GI tract, genital & urinary tract
Maternal antibodies normally protects newborn
<1 week old – early onset infection
.1 week to 3 months –late onset infection
Mortality can >50%
Disease presentation of GBS
Mostly associated with
> Neonatal bacteremia, meningitis & pneumonia
Occurs 3/1000 newborns
Mortality reduced to 5% -rapid diagnosis & supportive care
25% permanent neurological damage – blindness, deafness or mental retardation
Diagnosis
Similar to GAS + B/C
treatment
Penicillin drug of choice
+ Streptomycin as some GBS can tolerate Pen x10 concentration
CDC recommend prophylaxis to newborns whose mums colonised with GBS
Immunisation
other Beta Haemolytic Streptococci x2
Group C – S.equisimilis (horses) – pharyngitis
Group F/G – S.anginosus – purulent abscesses
Penicillin effective against both
Viridans streptococci
Lack group specific carbohydrates
Normally inhabit mouth, pharynx, GI tract and urinary tract of humans
Viridans streptococci disease
Opportunistic – cause purulent abdominal infections & dental caries (dextran) – biofilm = dental plaque
Once in blood can cause meningitis & endocarditis
Streptococcus pneumoniae
Discovered 120 years ago – Louis Pasteur
Gram positive diplococcus