Identify bacteria by gram staining Flashcards

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1
Q

Which bacteria stain poorly/ don’t stain with Gram stain

A

Chlamydia (intracellular bacteria)

Coxiella

Legionella

Mycobacterium

Mycoplasma (no cell wall)

Rickettsia

Spiral - treponema, leptospira, borrelia

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2
Q

Gram positive bacteria divided into cocci and bacilli

How are cocci further divided?

A

Cells in clusters/ catalase positive - Staphylococcus

Cells in pairs/chains / catalase negative - streptococcus

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3
Q

How are staphylococci further characterised?

A

Coagulase positive - staph aureus

Coagulase negative -

  • Staph epidermidis
  • Staph saprophyticus
  • Staph capitis

Coagulase is an enzyme which causes clotting, by converting fibrinogen to fibrin

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4
Q

What is role of coagulase enzyme in staph aureus

A

Coagulase reacts with prothrombin in the blood producing complex called staphylothrombin

This enables the enzyme protease (from liver) to convert fibrinogen to fibrin.

This results in clotting of the blood.

Coagulase is tightly bound to the surface of the bacterium S. aureus and can coat its surface with fibrin upon contact with blood. The fibrin clot may protect the bacterium from phagocytosis and isolate it from other defenses of the host.

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5
Q

What is role of catalase enzyme in identifying gram positive bacteria

A

Catalase converts hydrogen peroxide to oxygen and water, thereby preventing oxidative damage.

We test to see if catalase positive, as can help (in addition to other tests) in identifying bacteria

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6
Q

Streptococci are further classified by their haemolytic properties on blood agar.

What effect do with gamma, alpha and beta haemolytic strep have on blood agar

A

Gamma-hemolytic species cause no hemolysis (also known as non-haemolytic)

Alpha-hemolytic species cause oxidization of iron in hemoglobin molecules within red blood cells, giving it a greenish color on blood agar

Beta-hemolytic species cause complete rupture of red blood cells. On blood agar, this appears as wide areas clear of blood cells surrounding bacterial colonies

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7
Q

What are examples of -

  • non-haemolytic strep
  • alpha haemolytic strep
A
  • gamma haemolytic strep
    Strep milleri
    Anaerobic strep
    Some enterococci
  • alpha haemolytic strep
    Strep pneumoniae
    Strep viridans (viride is green in latin)
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8
Q

Beta-hemolytic streptococci are further classified by Lancefield grouping, a serotype classification (that is, describing specific carbohydrates present on the bacterial cell wall) The 20 described serotypes are named Lancefield groups A to V (excluding I and J). H-S are non-pathogenic to humans

What are examples of -

Group A, B, C, streptococci
(these are main groups which cause human infection)

A

Group A -
Strep pyogenes - means produces pus

Group B - means unable produce milk. Infection neonatal/ maternal
Strep agalactiae

Group C - these are zoonoses
Strep dysgalactiae - difficulty producing milk
Strep equi - from horses
Strep equisimillis - horse-like
Strep zooepidemicus - outbreaks in zoos
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9
Q

What are examples of -

Group D, F, G streptococci
these are main groups which cause human infection

A

Group D - orginate in bowels
Enterococcus faecalis
Enterococcus faecium

Group F - (previously called strep milleri group
Strep anginosus
Strep intermedius
Strep constellatus

Group G -
Strep dysgalactiae - exact same bacteria as Group C version, except expressing different antigen - G

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10
Q

Out of all gram positive bacteria, which ones are most medically relevant?

A

Staph aureus

Alpha haemolytic -
Strep pneumoniae
Strep viridans

Beta haemolytic -
Group A - strep pyogenes
Group B - strep agalactiae

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11
Q

Beta-haemolytic strep A, C, G, can be thought of together, because they have similar sites of infection

Where in normal flora do A, C, G live?

What infections do they cause?

A

A - mucus membranes
C - mucus membranes and animals
G - mucus membranes and bowel (cancer)

Tonsillitis
Cellulitis
Septic arthritis
Osteomyelitis

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12
Q

Beta-haemolytic strep B, D, F can be thought of together, because they have similar sites of infection

Where in normal flora do B, D, F live?

What infections do they cause?

A

B - bowel, female genital tract
D - bowel
F - bowel

B - neonatal sepsis, septic arthritis, IE, infections in diabetes, associated pelvic cancer
D - IE, peritonitis, IV/ urinary catheter infection
F - peritonitis, empyema

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13
Q

Where does staph aureus live

What infections does staph aureus cause

A

Skin

Skin 
Bone
IE
Pulmonary - emypema/ pneumonia
Device-related infections
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14
Q

What infections do coagulase negative staph cause e.g staph epidermidis/ capitis/ hominis/ saprophyticus

A

S epidermidis - skin infections primarily, but also causes infections associated with implants - .eg IE, VP shunt, artificial joints

S capitis - skin

S hominis - skin

S saprophytocis - can cause UTI

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15
Q

Gram negatives divided into cocci and bacilli

Cocci are further divided into diplococci, coccobacilli, comma shaped, spirochete

What are examples of diplococci?

A

Neisseria Mengitidis - maltose fermenter
Neisseria Gonorrhoae - non-maltose fermenter
Moraxella catarrhalis

Lives mucus membranes

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16
Q

Gram negative bacilli can be divided into aerobic/ anaerobic/ facultative/ microaerophile

What are examples of anaerobic bacteria

A

Bacteroides
Lives as normal gut flora
Cause intra-abdominal infections related to perforation/ GI surgery

Fusobacterium
Cause Lemierre’s syndrome/ oropharyngeal disease

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17
Q

When looking at gram stains, look for field with neutrophils, as most likely to indicate bacteria causing infection, as opposed to commensal.

If from sterile site - should only see one morphotype of batceria

What is identification based on gram stain and morphologic feature, and what is most likely site -

  • gram positive cocci in clusters/ treads
  • gram positive cocci in long chains
A

Staphylococci
GI, respiratory tract, skin, blood, urine

Streptococci - all groups including strep viridans and enterococci

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18
Q

What is identification based on gram stain and morphologic feature, and what is most likely site -

  • gram positive diplococci and chains occassionally with a capsule
A

Strep pneumoniae
Respiratory, blood, CSF

Gram positive diplococci differ from gram negative dpilococci in that former are pointed at the ends, and latter are kidney bean shaped

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19
Q

Names examples of gram positive bacilli

A

Bacillus cereus/ anthracis

Corynebacterium

Clostridium -
Large, box-shaped. May release spores, decolourise and appear gram negative. They have enzymes which lyse neutrophils. So if present, and no WBC, then likely clostridium

Listeria -
Small. Usuaully just seen in CSF

Lactobacilli -
Long, slender. Can have variable shape such as chains, spirals, coccobacilli. Normal commensal of GI/ respiratory site

Diptherioids -
Small, club shaped. Normal commensal, rarely cause infection

20
Q

What is identification based on gram stain and morphologic feature, and what is most likely site -

  • gram positive coccobacilli
  • gram negative cocci
A
  • rarely seen clinically

- rarely seen clinically. Usually diplococci, and should be reported as such

21
Q

What is identification based on gram stain and morphologic feature, and what is most likely site -

  • gram negative coccobacilli
  • gram negative diplococci
A

Haemophilus influenzae - resp/ CSF
Gardnerella vaginalisis - gential

Neisseria gonorrhoae - gential/ joint
Neisseria meningitidis - CSF/ resp
Moraxella - respiratory tract

22
Q

What is identification based on gram stain and morphologic feature, and what is most likely site -

  • gram negative bacilli
A

Pseudomonas
E. Coli
Anaerobes - bacteriodes

Any site - GI, resp, skin, blood, urine

23
Q

Morphotypes expected from each site -

  • CSF
A

Gram neg diplococci - neiserria
Gram neg coccobacilli - haemophilus
Gram pos cocci - staph/ strep
Gram pos coccobacilli - listeria

Expect only 1 morphotype in CSF

Strep/ listeria expected in infants/ elderly

Staph epidermidis is not contaminant if patient has VP shunt

24
Q

Morphotypes expected from each site -

  • joints
A

Gram pos cocci - staph/ strep
Gram neg diplococci - neiserria
Gram neg coccobacilli - haemophilus
Gram neg bacilli - E. Coli

Expect only 1 morphotype in joint

25
Q

Morphotypes expected from each site -

  • Blood
A

Gram pos cocci - staph/ strep
Gram neg coccobacilli - haemophilus
Gram neg bacilli -pseudomonas, E. coli, bacterioides
Gram pos bacilli - clostridium, listeria, diptherioids

26
Q

Morphotypes expected from each site -

  • respiratory
A

Gram pos cocci - strep/ staph
Gram neg diplococci - moraxella
Gram neg coccobacilli - haemophilus
Gram neg bacilli - pseudomonas, E. Coli

Gram pos bacilli - lactobacilli/ diptherioids almost never clinically significant

Yeasts are common contaminant

27
Q

Morphotypes expected from each site -

  • wound/ abscess
A

Gram pos cocci - staph/ strep
Gram pos bacilli - clostridium, diptherioids
Gram neg bacilli - pseudomonas, E. Coli, bacteroides

More than one morphotype may be present

28
Q

Morphotypes expected from each site -

  • urine
A

Gram pos cocci - staph/ strep
Gram neg bacilli - pseudomonas, E. Coli, proteus, klebsiella
Yeasts

29
Q

Morphotypes expected from each site -

  • genital
A
Gram pos cocci - staph/ strep
Gram neg diplococci - neisseria
Gram neg coccobacilli - gardnerella 
Gram neg bacilli - pseudomoans, E. Coli
Yeasts
30
Q

Gram negatives divided into cocci and bacilli

Cocci are further divided into diplococci, coccobacilli comma shaped, spirochete

What are examples of coccobacilli?

A

Haemophilus influenzae - chocolate agar

Gardnerella

Bordatella pertusis

Brucella - milk

Pasteurella - animal bites

31
Q

Gram negatives divided into cocci and bacilli

Cocci are further divided into diplococci, coccoid rods, comma shaped, spirochete

What are examples of comma shaped cocci??

A

Campylobacter jejuni

Vibrio cholerae

H. pylori

32
Q

Gram negatives divided into cocci and bacilli

Cocci are further divided into diplococci, coccoid rods, comma shaped, spirochete

What are examples of spirochetes?

A

Borrelia burgdoferi - lyme
Borrelia recurrentis - louse

Leptospira

Treponema

33
Q

Gram negatives divided into cocci and bacilli

Bacilli can be classifed into lactose fermenter, non-lactose fermenter, enterics, and others (zoonoses)

What are examples of lactose fermenter bacilli?

A

Fast fermenter

  • Enterobacter
  • E. Coli
  • Klebsiella

Slow fermenter

  • Citrobacter
  • Serratia
34
Q

Gram negatives divided into cocci and bacilli

Bacilli can be classifed into lactose fermenter, non-lactose fermenter, enterics, and others (zoonoses)

What are examples of non-lactose fermenter bacilli?

A

Oxidase positive
- Pseudomonas

Oxidase negative

  • Proteus
  • Shigella
  • Salmonella
35
Q

Gram negatives divided into cocci and bacilli

Bacilli can be classifed into lactose fermenter, non-lactose fermenter, enterics, and others (zoonoses)

What are examples of enteric bacilli?

A

Bacteroides
Helicobacter
Yersinia entercolitica

Other common enterics are classified usually into fermenter/ non-fermenter/ comma shaped

  • Proteus
  • Shigella
  • Salmonella
  • Klebsiella
  • Enterobacter
  • Vibrio
  • Capylobacter
  • Pseudomonas
36
Q

Gram negatives divided into cocci and bacilli

Bacilli can be classifed into lactose fermenter, non-lactose fermenter, enterics, and others (zoonoses)

What are examples of others ( usually zoonoses)

A
  • Bartonella
  • Chlamydia psittaci
  • Coxiella burnetti
  • Francisella tularensis - ticks, rabbits, deer fly
  • Gardnerella
  • Legionella
  • Yersinia pestis
37
Q

Bacteria can also be classified by metabolism - aerobic, anaerobic, facultative, microaerophile

What are examples of gram positive bacilli aerobic

A

Bacillus (spores) - anthrax (cutaneous/ pulmonary), cereus - diarrhoea

Nocardia - can affect any system. Usually lungs causing pulmonary abscesses. Is related to actinomyces

38
Q

Bacteria can also be classified by metabolism - aerobic, anaerobic, facultative.

What are examples of gram positive bacilli anaerobic

A

Actinomyces

Clostridium

39
Q

Bacteria can also be classified by metabolism - aerobic, anaerobic, facultative.

What are examples of gram positive bacilli facultative

A

Corynebacterium

Lisertia

Lactobacillus

40
Q

Bacteria can also be classified by metabolism - aerobic, anaerobic, facultative.

What are examples of gram positive cocci anaerobic

What are examples of gram positive cocci aerobic

A

Peptostreptococcus

No aerobic

41
Q

Bacteria can also be classified by metabolism - aerobic, anaerobic, facultative.

What are examples of gram positive cocci facultative

A

Staphylococcus

Streptococcus

42
Q

Bacteria can also be classified by metabolism - aerobic, anaerobic, facultative.

What are examples of gram negative cocci facutlative

A

Neisseria
Moraxella
Kingella

43
Q

Bacteria can also be classified by metabolism - aerobic, anaerobic, facultative.

What are examples of gram negative bacilli facultative

A
E. Coli
Enterobacter
Klebsiella
Citrobacter
Serratia
Proteus
Salmonella
Shigella

Haemophilus
Eikenella
Pasteruella
Capnocytiphaga

44
Q

Bacteria can also be classified by metabolism - aerobic, anaerobic, facultative.

What are examples of gram negative bacilli aerobe

A

Bordetella
Leginonella
Pseudomonas
Vibrio

45
Q

Bacteria can also be classified by metabolism - aerobic, anaerobic, facultative.

What are examples of gram negative bacilli microaerophilic

A

Campylobacter

Helicobacter