Gram positive bacteria Flashcards

Outline main features of: – Streptococcus – Staphylococcus – Corynebacterium How they cause disease – Their virulence factors Approaches to their control

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1
Q

Classification of bacteria

A

Obligate intracellular bacteria
Bacteria that may be cultured on artificial media (most)
-with or without a cell wall
–>growing as single cells or growing as filaments
—>rods or spirochaetes
—->gram positive or gram negative (or zn stain positive) then aerobic and anaerobic

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2
Q

Pain in shoulder, elevated temperature
• MRI scan, disc infection and osteomyelitis C6 &C7
• Blood cultures
– Staphylococcus aureus;

A

Gram positive cocci in clusters
Bone infection due to massive bacterial overload or trauma usually
Referred pain down the nerve from disc
Treat with flucloxacillin 3 months

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3
Q

Staphylococcus species

A

Currently at least 40 species
– Coagulase +ve or – ve
– Coagulase: enzyme produced by bacteria that clots
blood plasma. Fibrin clot formation around bacteria
may protect from phagocytosis.
– S.aureus most important (coag. +ve)
– Coagulase -ve species important in opportunistic
infections

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4
Q

Staphylococcus normal habitat

A

Nose and skin

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5
Q

Staph. aureus + spread

A

Means golden - forms yellow dots on agar
Spread by aerosol and touch
-carriers and shedders

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6
Q

Staph. aureus MRSA

A

Resistant to

  • β-lactams
  • gentamicin, erythromycin, tetracycline
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7
Q

Staph. aureus virulence factors

A
Pore-forming toxins (some strains)
-α - haemolysin & Panton-Valentine
Leucocidin (PVL) - causes haemmorhagic pneumonia
Proteases
-Exfoliatin
Toxic Shock Syndrome toxin (TSST) - (stimulates cytokine
release)
Protein A (surface protein which
binds Ig’s in wrong orientation)
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8
Q

Associated conditions with Staph aureus - pyogenic

A
Wound
infections
Abscesses
(boils,
carbuncles)
Impetigo
Septicaemia
Osteomyelitis
Pneumonia
Endocarditis
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9
Q

Associated conditions with Staph aureus - toxin mediated

A

Scalded skin syndrome
Toxic shock syndrome
Food poisoning

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10
Q

Associated conditions with Staph aureus - coagulase negative

A

Infected implants
Endocarditis
Septicaemia

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11
Q

Coagulase-negative Staphylococci

A

S. epidermis

S. Saprophyticus

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12
Q

S. epidermidis

A

Infections in debilitated, prostheses, catheters
(opportunistic)
Main virulence factor -
ability to form persistent biofilms

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13
Q

S. saprophyticus

A

Acute cystitis
• haemagglutinin for
adhesion
• Urease – kidney stones

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14
Q
Wound received to shoulder
3 days later spreading
inflammation
– Fever, malaise 
Swab culture: Streptococcus pyogenes
A

Gram positive cocci in chains
β-haemolytic (group A)
Facultatively anaerobic
Penecillin sensitive

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15
Q

Haemolysis - 3 types

A
α - partial, greening
-e.g. S.intermedius
-H2O2 reacts with Hb
β- complete lysis
-e.g. S.pyogenes
-Haemolysins O & S
Non (or γ) - no lysis
-e.g. some S.mutans
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16
Q

Streptococci classification

A

Classified in 3 ways

  1. Haemolysis
  2. Lancefield typing
  3. Biochemical properties
17
Q

Sero-grouping: Lancefield grouping definition

A

Method of grouping catalase negative, coagulase negative bacteria based on bacterial carbohydrate cell surface antigens

18
Q

Sero-grouping

A

Carbohydrate cell surface antigens -
Lancefield A-H and K-V
-antiserum to each group added
to a suspension of bacteria: clumping indicates
recognition
Not all equally important
-group A - S.pyogenes; important pathogen
-group B - S.agalactiae neonatal infections

19
Q

Infections of S. pyogenes infections

A
Wound infections >> cellulitis
Tonsillitis & pharyngitis
Otitis media
Impetigo
Scarlet fever
20
Q

Complications of S. pyogenes infections

A

Infection with any strain of S.pyogenes can give rise to immunologically mediated complications (prompt treatment needed)
Rheumatic fever
-inflammatory disease of heart, joints, skin, brain. Often
follows Strep. throat infection
-antibody cross reactivity
Glomerulonephritis
-inflammatory disease sometimes following
S.pyogenes infection

21
Q

Complications of S. pyogenes infections - assessment of risk

A

Estimated from Anti-SLO titre

22
Q

Anti-SLO titre

A

Anti-streptiolysin O (ASLO) titre
-ASLO – Antibody against SLO.
-SLO – beta heamolysis
Streptococcal exoenzymes are bound to
biologically inert latex particles
If streptococcal antibodies present in the test
sample, reaction occurs.
Presence of an ASO titer of >200 IU/mL in the
serum = agglutination of the latex particles

23
Q

S. pyogenes virulence factors

A
SURFACE:
Capsule - hyaluronic acid (protection)
M protein - surface protein (encourages complement degradation) - cross reactivity?
EXPORTED FACTORS
Enzymes:
-hyaluronidase - spreading
-streptokinase - breaks down clots
-C5a peptidase - reduces chemotaxis
Toxins:
-streptolysins O 7 s - binds cholesterol
-erythrogenic toxin - SPeA - exaggerated response (streptococcal pyrogenic endotoxin A)
24
Q
Heavy smoker noted
nasal congestion and
fever
2 days later cough and
severe pain in chest
“Rust-coloured” sputum
Chest X-ray –
consolidation
Blood & sputum culture
-“draughtsman” colonies
-S.pneumoniae
A

Raised edge with little dimple in middle

Pneumonia

25
Q

S. pneumoniae

A

Normal commensal in oro-pharynx ~ 30%
of population
Causes - pneumonia, otitis media,
sinusitis, meningitis

26
Q

S. pneumoniae - predisposing factors

A
  • impaired mucus trapping (e.g. viral infection)
  • hypogammaglobulinaemia
  • asplenia
27
Q

S. pneumonia virulence factors

A
Capsule
-polysaccharide (84 types),
antiphagocytic
-polyvalent vaccine - 23 types (available to >2 year olds at risk)
of infection
Inflammatory wall
constituents
-teichoic acid bound to
peptidoglycan (choline)
Cytotoxin
-pneumolysin
28
Q

Viridans streptococci

A
Collective name for oral
streptococci
α- or non-haemolytic
Some cause dental caries &
abscesses
Important in infective endocarditits
-S. sanguinis, S. oralis
Cause deep organ abscesses (e.g.
brain, liver)
Most virulent are the “milleri group”
-S.intermedius, S.anginosus,
S.constellatus
29
Q
Child with severe sore throat,
fever, malaise for 2 days
Lymphadenopathy in neck,
rapid breathing
Thick greyish membrane on
tonsils
Swab showed pleomorphic
(irregular) Gram-positive rods
A
A special stain showed
metachromatic granules
indicating Corynebacterium
diphtheriae
Treated with anti-toxin (preformed
antibody to toxin) and
erythromycin
30
Q

Diptheria

A

Thick dirty white/ grey/ green/ black coating
‘Bull Neck’
DTP vaccine

31
Q

Incidence of diptheria in the UK

A

Cases and deaths dropped dramatically after birth of NHS

Vaccinations almost 100% at 2 years now (since 1980)

32
Q

C.diphtheriae

A
Droplet spread
Can grow in the presence of
potassium tellurite –
selective method for isolating
this bacteria from throats of pxs
Toxin
-inhibits protein synthesis
(inactivates elongation
factor-2 in host cells by adding ADP-ribosyl group to
aa dipthamide)
-toxin recognition (Elek plate including anti-toxin diffusing from filter paper)
33
Q

C. diphtheriae prevention

A

vaccination – toxoid

inactivated toxin

34
Q

DTP vaccine

A
Inactivated Diphtheria	
toxin, inactivated	
tetanus toxin, and	
acellular pertussis	
(selected	antigens -toxins & adhesins)