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Gram positive cocci Flashcards

1
Q

Staph aureus properties

A 
Catalase (+) 
 coagulase (+)
Mannitol fermentation (+) 
Phosphatase (+)
Heat stable nuclease (+)
Gram (+)
Cocci
 facultative anaerobes
Of test (++)
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2
Q

Toxins of staph aureus -

A 
Protein A.
complement  inhibitor protein
Staphylokinase
Capsule
Bound coagulase
(clumping factor)
Hemolysin
Panton Valentine Leucocidin
Enterotoxin
Exfoliative or epidermolytic toxin
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3
Q

Culture of staph aureus

A 
Blood agar
Hot cold phenomenon (toxin induced @ 37°c but clear on cooling @2to 8°c)
Selective media
Ludlam media
Milk salt agar
Nutrient agar
With glycerol monoacetate(pigment (+) d/t Beta carotene /golden yellow)
Slope(oil paint colony)
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4
Q

Staph aureus resistance

A

Penicillinase
PBP Altered(MRSA)
Vancomycin

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5
Q

Strains of staph aureus

A

Phage 2 ET A (Chro, heat stable) ET B(plasmid,heat labile)
Phage 1 enterotoxin F(TSS 1)
Protein A (Cowan 1 strain)

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6
Q

Enzymes of staph aureus

A 
Hyaluronidase 
 coagulase
Thermonuclease 
Lipase
Serine protease. 
Function:bacterial survival and spread
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7
Q

Methods of strain identification

Staph aureus

A 
Pulse field gel electrophoresis(genotyping- best method) 
Phage typing(epi strain 80/81)
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8
Q

Genes of staph aureus

A

Penicillinase- Blaz gene
MRSA-mec a gene
VRSA-dose dependant

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9
Q

Phage typing staph

A

80/81
Nutrient agar with susceptible strain
Phage added
Lysis of bacteria

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10
Q

Culture for resistant strain staph

A

MRSA
Mannitol salt agar with cefoxitin disk(yellow)

HA Vs CA
D test- lawn culture of MRSA strain in erythromycin (inducer) and clindamycin

VRSA
mic testing

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11
Q

Hosp acquired and Comm acquired staph

A

HA
Resistant
Less virulent
D Test positive

CA
Less resistant
More virulent
D test negative

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12
Q

MSCRAMM

A 
Microscopic surface component recognising adhesive matrix molecules
Function: adhesion
Gene:agr(accessory gene regulator)
Eg:clumping factor
       Lectins
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13
Q

SCC

A 
Staph cassette chromosome 
Gene encoding for virulence
Ass with insertion sequence
HA. 1,2,3
CA 4,5,6
10,11 zoonotic staph(intermedia,hypoxia)
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14
Q

Regulation of virulent gene expression staph

A

AGR

Sar

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15
Q

Pathogenesis of staph aureus

A

Adhesion
Colonisation
Invasion & evasion
Infection(local,metastatic)

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16
Q

Panton Valentine leucocidin

A

Synergohymenotrophic property
F &S
Cytolysis (PMN,macrophage,monocytes)
Invasive pathoogenesis

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17
Q

VRSA mic testing

A

VRSA >16micro gm/ml
VISA 4-8 micro gm/ml
VAN Sensitive <2microgram/ml

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18
Q

Adhesion

A

MSCRAMM

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19
Q

Invasion

A

Enzymes
Toxins(PVL)
Cell wall components(NAG,alpha toxin)-inflammatory response

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20
Q

Evasion

A

Microcapsule
Protein A
Chips

Function: antiphagocytic

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21
Q

Micrococcus

A 
Gram (+)
Catalase positive
Mannitol of test (-)
Tetrad
 aerobic
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22
Q

Streptococcus classification

A

Alpha (viridans)
Beta(lancefield group A to V except I&J)
Gamma(enterococcus)

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23
Q

Grouping of streptococci

A

Lancefield
A to J
Based on carbohydrates C

Griffith typing
Subgrouping of A
Based on m protein

Emm typing
Based on m gene
(genotype)

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24
Q

Streptococcus proteins

A

Structural proteins
Capsule(polysaccharide with hyaluronic acid)
Lipoteichoic acid
M protein

Toxins & enzymes
Hyaluronidase (antigenic)
Streptodornase (antigenic)
Streptokinase 
Erythrogenic toxin(super antigen)
Streptolysin O(antigenic)
Streptolysin S
Serine protease(inhibit IL - 8)
25
Diseases of streptococci
``` Scarlet fever Pharyngitis Pasties lines Sandpaper rash Strawberry tongue ``` ``` PSGN RHD Cellulitis(Peu de orange) Erysipelas Necrotising fasciitis Guttate psoriasis Impetigo contagiosa ```
26
Impetigo contagiosa
Honeycomb rash
27
Necrotising fasciitis | Flesh eating bacteria
M1 M3
28
PSGN
M1-4 M12 | M47 M49 M57 M59 M53-55 M61
29
scarlet fever
M28
30
RHD
M5 M6 M1 M19
31
Culture of streptococcus
Pike(transfer media) (sodium azide,crystal violet ,blood agar) Crystal violet, neomycin,blood agar Polymyxin/colistin,fusidic acid, blood agar
32
Investigation of streptococcus
Aso titre >200(RHD) | Antistreptodornase (PSGN)
33
Strawberry tongue
``` Kawasaki disease VIT B12 deficiency Scarlet fever Food and drug allergy TSS ```
34
Strep c
Upper respiratory tract infection S.equisimilis Diff from gpA strep:ferment ribose not trehalose Use:streptokinase for thrombolytic therapy
35
Gp B
Strep agalactiae Source female genital tract Cause early(<1week),late(2-12 weeks) Virulence polysaccharide capsule(10 types) Screening @35-37weeks by swab culture of vagina and anorectum
36
Strep F
Alpha haemolytic Minute strep Use:heterophile antigen for atypical pneumonia (primary) capnophilic
37
Group D
S bovis Species gallilyticus infantarius Subspecies gallilyticus,pasteurian,infantarius,coli Ass:colon Ca ,polyp,bowel lesions
38
Alpha haemolytic
``` Viridans streptococcus Salivarius Sanguis Mutants Mites Normal flora of mouth Induce: endocarditis (transient) by eating,toothbrushing,flossing,minor trauma,adherence to biological surfaces ``` Strep pneumonia
39
Enterococcus
``` Commensal flora of normal bowel(<1%) Faecalis(M/C) Faecium(Most resistant) Growth in 40%bile,9.6pH,6.5%NaCl Temp 46 to 60 deg el &10deg cel Test PYR positive Spectacle eye appearance ```
40
Virulence factors of enterococcus
``` Proteins Secreted Hemolysin Gelatinise Serine protease Cocolysin (inhibit endothelium) Lipoteichoic acid(increase Tnf alpha) Pheromones(conjugation without fimbriae) ``` Surface(structural) Adhesin of both org recognise MSCRAMM (To host collagen fibronectin fibrinogen) Stress protein of E.feacalis(Gls 24) resistance to bile salts
41
Diseases of enterococcus
``` UTI Bacteremia Endocarditis Meningitis Intraabd pelvic and soft tissue infections ```
42
Resistance of enterococcus
``` Van A(transposon) Vancomycin and teicoplanin Van B (transposon) vancomycin Van C(chromosome) vancomycin and teicoplanin ```
43
Mechanism of resistance to penicillins | Enterococcus
PBP5 Mutation in gene encoding it Hyper production of it
44
Vancomycin resistance mechanism | Enterococcus
Replacement of the last peptidoglycan residue from D ALA to D LACTATE(high resistance) or D SERINE( low resistance) Production of enzymes to destroy D ALA so that binding sites for vancomycin is not available
45
High level aminoglycoside resistance | Enterococcus
``` Gentamycin >500 micro gram/L Streptomycin >2000micro gram/L Linezolid. Mutation in 23rRNA genes rRNA methylase Daptomycin Change in membrane homeostasis ```
46
Investigations of enterococcus
PYR TEST positive | Bile esculin hydrolysis test black colour
47
Culture of enterococcus
Blood agar gamma hemolysin, pin point colonies | Telluride agar black colonies
48
Motile cocci
E gallinarum E casseliflavus Van C Resistance
49
Virulence factors of pneumococci
Structural Polysaccharide capsule(98 serotypes) Can diffuse into tissue Special soluble substance Toxins Techoeic acid Peptidoglycan Stimulates inflammatory response IL6 IL1 TNF alpha Pneumococcal H inhibitor Inhibition complement system Choline binding protein(CBPA) Pneumococcal surface protein(pspc) Neuraminidase(Nan A) Pneumococcal surface adhesion(psa A) Autolysin Release the toxins
50
Pneumococcus
``` Gram positive Alpha haemolytic Lanceolate/flame shaped Capnophilic Bile soluble Optochin sensitive ```
51
Confirmatory test for pneumococcus
Bile solubility test
52
Diseases caused by pneumococci
VAP Exception >5-6 days and mdr pseudomonas meningitis in adults fulminant Otitis media* <5 yrs
53
Tests for pneumococci (includes culture)
Inulin fermentation positive ``` Culture Blood agar Initially heaped up followed by alpha hemolysis Draughtsman colony Carrom coin colony ``` Optochinnsensitive Zone of inhibition of alpha hemolysis Bile solubility test Lysed by bile
54
Capnophilic bacteria
Gram positive cocci Strep f Beta haemolytic Step pneumoniae Alpha haemolytic
55
Vaccines
PPV 23 serotypes ``` High risk for vaccine to be avoided Chronic lung kidney heart liver d/s Immunocompromised ,DM Cochlear implantation * Splenectomy ``` PCV Polyvalent conjugate vaccine Serotypes 13 7 10/?13 serotypes High risk Ages<2m to 2 years Premature infants
56
PPSV/PPV | PCV
Polyvalent polysaccharide vaccine | Polyvalent conjugate vaccine
57
Pneumococcal resistance
Alteration of PBP
58
Pneumococcal treatment
Ceftriaxone Vancomycin Above drugs initially given Followed by penicillins

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