Gram Positive Cocci Part 1 (Exam 1) Flashcards
What characteristics are shared by all gram-positive cocci
all have a spherical shape, no endospores, and are aerobic
How are gram positive cocci differentiated
presence of catalase
What is the function of catalase
breaks down peroxide into oxygen and water
What are the catalase positive gram positive cocci
staphylococcus
What are the catalase negative gram positive cocci
streptococcus and enterococcus
What type of structure does staphylococcus have
grape like clusters
What type of structure does streptococcus have
chains or pairs
What type of infections does staphylococcus have
pyogenic infection
What type of infections does streptococcus have
pyrogenic infections
What is the difference between pyogenic and pyrogenic infections
pyogenic= pus (neutrophils) pyrogenic= fever (TNF alpha, IL-1, IL-6)
How will staph appear on gram stain
purple cocci in clusters
What are the environmental requirements of staph
facultative anaerobes
halophiles
non-motile
What are halophiles
salt loving, can grow in high salt concentrations at at 18-40C
What is the catalase reaction results of staph
catalase positive
What diseases are associated with Staph aureus
Toxin mediated diseases cutaneous diseases
systemic diseases
What are the toxin mediated diseases of staph aureus
Scalded skin syndrome
TSS
Food poisoning
What are the cutaneous diseases of staph aureus
folliculitis, carbuncles, impetigo, wound infections
What are the systemic diseases of staph aureus
bacteremia empyema endocarditis osteomyelitis pneumonia septic arthritis
What diseases are associated with staph epidermidis
bacteremia
endocarditis
UTIs
opportunistic infections
How do opportunistic infections of staph epidermidis occur
via catheters, shunts, prosthetics
What diseases are associated with staph saprophyticus
UTIs; opportunistic infections
Staph saprophyticus UTIs often occur in what population
young, newly sexually active women
What are other staph distractors in questions? Be familiar enough to not pick them
S. lugdunensis
S haemolyticus
Where are staph found normally
oropharynx, GI tract, urogenital tract
Where is S. epidermidis found on everyone
the skin
What percent of population carries S. aureus and are healthy
15-20%
How is staph transmitted
direct contact or fomites
What is staph susceptible to
hand washing
disinfectants, antiseptics
high temps
What are the main virulence factors seen in staph
capsule
peptidoglycan
teichoic acids
What role does the capsule of staph play in virulence
inhibits phagocytosis by PMNs
What role does peptidoglycan play in staph virulence
makes cell wall rigid
stimulates cytokine production, activates complement, causes aggregation of PMNs to form an abscess
What role do teichoic acids play in staph virulence
major component of cell wall
binds to fibronectin and mediates attachment to mucosal surfaces
What type of immunogen is teichoic acid
poor
What will be the gram stain, catalase, and coagulase results of staph aureus
gram positive cocci
catalase positive
coagulase positive
What agar is used to culture staph aureus
blood agar
mannitol salt agar
What is staph aureus on blood agar
beta hemolytic
What are the specific virulence factors associated with staph aureus
adhesins
protein A
toxins
enzymes
What do the adhesins do
adhere to host matrix proteins: fibronectin, fibrinogen, elastin, collagen
What are the toxin mediated diseases associated with staph aureus
scalded skin syndrome/ bulious impetigo
TSS
food poisoning
What are the suppurative infections associated with staph aureus
folliculitis, impetigo, furuncles, boils, bacteremia, endocarditis, pneumonia, empyema, osteomyelitis, septic arthritis
What role does protein A play in virulence of S. aureus
binds to Fc receptors of IgG to prevent trigger of immune response
forms immune complexes
binds up complement
What virulence factor of S. aureus can be used as identification
Protein A, only found on S. aureus
What are the 5 cytolytic toxins of S. aureus
alpha delta beta gamma Panton-Valentine (PV) leukocidin
What is the function of cytolytic toxins of S. aureus
membrane damaging toxins: act as perforins
What are the 2 exfoliative toxins of S. aureus
A and B
What are the 8 enterotoxins of S. aureus
A-E, G-I
What toxin from S. aureus is associated with toxic shock syndrome
TSST-1
What toxins of S. aureus are superantigens
TSST-1, exfoliative toxin A, enterotoxins
Where do superantigens bind
to TCR-MHCII groove
How will cytolytic toxins of S. aureus affect neutrophils
lyse all neutrophils
What does lysis of neutrophils lead to
release of lysosomal enzymes and damage to tissue
Describe the effects of the alpha-gamma cytolytic toxins of S. aureus
affect RBCs and other cell types
What is the function of the P-V leukocidin in S. aureus
pore formation in PMNs
What are the heat tolerances of the exfoliative toxins of S. aureus
ETA is heat stable
ETB is heat labile
What is the function of ETA and ETB
serine proteases
What do serine proteases do
split intercellular bridges (desmosomes) in stratum granulosum epidermis
Will there be bacteria or WBCs in affected area of S. aureus skin infections
none
What are the two diseases associated with exfoliative toxins of S. aureus
Staphylococcal scalded skin syndrome and bullous impetigo
What is scalded skin syndrome characterized by
exfoliative dermatitis
Who is scalded skin syndrome commonly seen in
neonates and young children
What is another name for scalded skin syndrome
Ritter’s disease
What is the progression of scalded skin syndrome
abrupt onset of localized perioral erythema that covers the entire body
large cutaneous blisters form
epithelial desquamation
What is bullous impetigo
localized form of SSSS
What is the symptom of bullous impetigo
superficial skin blisters
What is different in bullous impetigo than scalded skin syndrome
culture positive
What type of toxin is responsibel for S. aureus food poisoning
enterotoxin
What are enterotoxins
superantigens that are heat and acid resistant
What type of cells are thought to be responsible for the emesis associated with S. aureus food poisoning
mast cells
What toxin is associated with staphylococcal pseudomembranous enterocolitis
Enterotoxin B
What can enterotoxin b also cause
TSS
How can staph aureus lead to TSS
enterotoxins enter blood to cause TSS
hypotension: fluid leaves vasculature and enters tissue
What cuases the presentation of S. aureus food poisoning
sudden onset of diarrhea, vomiting
Does heating food kill the toxin
no
How is S. aureus food poisoning transmitted
human carrier with wound infection contaminates food
What foods are common for S. aureus food poisoning
salted meats
custard filled pastries
potato salad
ice cream
What will be the result of Toxic shock syndrome toxin-1 staph aureus
cytokine storm leading to hypotension
Where are S. aureus that produce TSST-1 found
rapidly in hyperabsorbent tampons
What are the clinical manifestation of TSS from staph aureus
fever
hypotension
diffuse macular erythematous rash
What is the function of coagulase in S. aureus
converts fibrinogen to fibrin
What are the 2 forms of coagulase
bound and free
What does bound coagulase do
converts fibrinogen to insoluble fibrin
What does free coagulase do
reacts with globulin plasma factor then converts fibrinogen to fibrin
What is used to differentiate S. aureus from other staph species
coagulase test
What is the function of catalase in s aureus
breakdown H2O2
What is the function of penicillinase in S. aureus
breaks down beta lactams
What is the pathogenesis of S. aureus
production of toxin: no organisms are present at site
direct invasion and destruction of tissue: suppurative infections, organisms are present
What factors contribute to the enhanced virulence of Staph aaureus
presence of foreign body
congenital diseases
Where are S. aureus found in TSS and scalded skin syndrome
TSS: toxin in blood, bug not in blood
Scalded skin: bug not found in skin, bug found in mom’s vaginal tract or nose
How will S. aureus impetigo present
superficial infection
small macule: pus filled vesicle primarily on face and limbs
What population is most at risk of impetigo
young children
What is S. aureus foliculitis
pyogenic infection in hair follicles
What is folliculitis presentation symptoms
follicle base is raised and reddened, contains pus
stye: base of eyelid
What is a S. aureus furuncle
large, painful, raised nodules
What is a s. aureus carbuncle
extension of furuncles into subcuaneous tissues and blood; abscess
Symptoms of carbuncle
fever, chills, bacteria
How will s. aureus appear on microscopy
gram positive cocci in grape like clusters
What agars can be used to culture S. aureus
Blood agar
Mannitol salts agar
What seriological tests can be used to diagnoses Staph aureus
antibodies to teichoic acids
What gene encodes for methicillin resistance in S. aureus
mecA
What does the mecA gene encode
mutant PBP
How is the mutant PBP different than normalPBP
low affinity for beta lactams
What does low affinity for beta lactams mean
resistance to all penicillins, cephalosporins, carbapenems
What chromosome carried the mecA gene
staphylococcal cassette chromosome
How is mecA gene detected
PCR and PFGE
How is high level antibiotic resistance acquired in S. aureus
van A gene from vancomycin resistant enterococci
What antibiotic is used to treat MRSA
vancomycin
How is staph epidermidis diagnosed
novobiocin sensitive, will not grow
What disease is associated with S. epidermidis
UTI and endocarditis
How is staph saprophyticus diagnosed
Novobiocin resistant
What disease is associated with staph saprophyticus
UTI in young, sexually active females