Lecture 15 - Staph/Strep/Enterococci Flashcards

1
Q

Gram-? Shape?

A

Positive. Cocci (spherical).

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2
Q

Which leukotoxins are used by Strep pyogenes?

A

SLO and SLS

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3
Q

Motility?

A

non-motile

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4
Q

Why are these superbugs call nocosomial?

A

Hospital acquired

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5
Q

How are superbugs formed?

A
  1. Arise from antibiotic misuse (i.e.
    overuse, insufficient use, inappropriate
    use, use in livestock)
  2. Incomplete antibiotic treatment that fails
    to kill all bacteria – survival of strains
    that evolved to resist the antibiotic
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6
Q

Besides Lancefield, another way to classify Streptococci/Enterococci?

A

Based on lysis of red blood cells

RBCs) by membrane-disrupting “hemolysins” (alpha, beta or gamma-hemolytic

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7
Q

What do alpha, beta and gamma classifications stand for?

A

Alpha- partial lysis (S pneumo, Enterococcus)
Beta - complete lysis (GAS, GBS)
Gamma - no lysis (Enterococcus)

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8
Q

Which organisms do GAS infect?

A

Humans, most pathogenic

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9
Q

Where is GAS usually located in host?

A

Respiratory tract

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10
Q

What kinds of diseases does GAS cause?

A
  1. Localized diseases: strep throat (pharyngitis), tonsillitis, Scarlet fever, impetigo (skin inf’n), wound infections, postpartum infections, endocarditis
  2. Invasive disease: necrotizing fasciitis (“flesh-eating disease”), streptococcal toxic shock syndrome (sepsis), pneumonia
    3.Post-streptococcal illnesses: rheumatic fever, rheumatic heart disease, glomerulonephritis – autoimmune disease caused by GAS antigens
    mimicking host antigens (eg. heart muscle)
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11
Q

What is Necrotizing fasciitis?

A
infection deep in
subcutaneous tissues that
spreads along fascial planes,
destroying muscle and fat;
initially cellulitis followed by
bullae (fluid filled blisters),
gangrene, systemic toxicity,
multi-organ failure and
mortality in more than 50% of
patients
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12
Q

What is Streptococcal toxic shock syndrome? Which toxins/superantigens are involved?

A
Multi-system
toxicity (sepsis) following soft
tissue infection progressing to
shock and organ failure –
caused by toxins like
streptococcal pyrogenic
exotoxin (SPE), streptococcal
mitogenic exotoxin (SME),
streptococcal superantigen
(SSA)
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13
Q

What are the exotoxins secreted by GAS?

A

Leukotoxins, NADase, Hyaluronidase, superantigens, SIC

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14
Q

What are leukotoxins?

A

Membrane disrupting toxins - form pores in
host cell membranes, including leukocytes (neutrophils, macrophages, lymphocytes), epithelial cells, RBCs (“hemolysins” ® b-hemolysis); lead to host cell apoptosis, cause tissue damage – allow invasion of the bacteria into tissues – may be cholesteroldependent pore-forming proteins (like L. monocytogenes LLO) - streptolysin O (SLO), SLS

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15
Q

What are NADases?

A

Enters host cells via
pores formed by streptolysins -
cleaves host NAD+

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16
Q

What are Hyaluronidases?

A

Can degrade
host connective tissue ->
invasion. Also present in GAS acid capsule.

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17
Q

What are superantigens expressed by Strep?

A

SPE (streptococcal pyogenic exotoxins; SpeA and SpeC), SME (streptococcal mitogenic exotoxin), and SSA (streptococcal superantigen)

18
Q

What to SIC’s do?

A

Interferes with coagulation and fibrinolysis, interferes with wound healing.

19
Q

What are GAS envelope virulence factors?

A

M and M-like protein, Pili, HA capsule, fibronectin binding proteins, LTA, SpyCEP, C5s peptidase, and many more.

20
Q

What is M protein?

A

Binds extracellular matrix - immune evasion. Attached to cell wall. Immunogenic, but highly variable from strain to strain. MSCRAMMS are an example.

21
Q

What is the HA in the HA capsule? What else is located in the HA capsule?

A

HA is a polysaccharide, resembles polysaccharides on
human connective tissue so is non-antigenic – masks bacterial antigens (-> immune evasion). Hyaluronidase found in GAS envelope.

22
Q

What is the function of MSCRAMM’s?

A

Surface adhesins that bind to extracellular matrix that promote adherence, persistence and self-mimicry. Surface proteases and hyaluronidase can
degrade these matrices, providing nutrients and
allowing the bacteria to invade deeper into
tissues, enter bloodstream

23
Q

How are MSCRAMMs and pili attached to cell wall when they are being made?

A

Sortases via C-terminal sortase motif LPXTG

24
Q

What are sortases?

A

Sortases are enzymes anchored in the plasma membrane that catalyze attachment of proteins to the cell wall of Gram-positive bacteria

25
Q

What is the acyl enzyme intermediate?

A

Substrate cell envelope protein (virulence factors) attached to sortase via Thr-Cys bond (proteolysis) after translocation across membrane and before final transpeptidation.

26
Q

What is the final anchor for cell envelope virulence factors?

A

Proteins on the peptidoglycan wall or Lipid II (transpeptidation)

27
Q

What are the functions of pili in Strep/Staph/Entero?

A

Function in attachment to epithelial cells (adhesion),

microcolony formation, pathogenesis

28
Q

How are pilin subunits bound?

A

(1) non-covalent interactions plus (2) an intermolecular
(intersubunit) isopeptide (amide) bond between the C-term Thr (T) of one pilin and a Lys (K) side chain in the adjacent pilin

29
Q

What are the three main types of pilin?

A

A - Main structural pilin (major)
B - Terminal pilin
C - Tip-associated pilin (adhesin)

30
Q

Where are Staph located?

A

Nasal passages

31
Q

What is MRSA?

A

Methicillin-resistant S. aureus (MRSA) – a superbug - is becoming more prevalent – MRSA is not just resistant to methicillin and other penicillium-based drugs but is in fact resistant to most antibiotics (is multi-drug resistant)

32
Q

How can MRSA and CA-MRSA be acquired?

A

Casual social contact

33
Q

What are Staph MSCRAMMS?

A

Protein A and clumping factor

34
Q

What is protein A and why is it important?

A

Binds to the conserved Fc portion of IgG – prevents opsonin-mediated phagocytosis but also camouflages the bacteria so they are not recognised by the immune system – immune evasion (purified protein A is used in laboratories to purify antibodies and to capture antibody/antigen)

35
Q

What does clumping factor do?

A

Inactivates C3b - prevents opsonin-mediated phagocytosis; binds to fibrinogen

36
Q

What do superantigens do?

A
  1. Superantigens (SAg) bind directly to THC
    receptors and to MHC class II molecules
    and cross-link them, which activates the T
    cells – superantigens are capable of
    binding to and activating as much as 20%
    of THC
  2. Results in massive detrimental cytokine
    release (a cytokine storm) by the T cells
    (TNF-a, IL-1, IL-2) à PMN infiltration
  3. Causes fever, nausea, vomiting, endothelial
    damage, capillary leakage, hypotension
    and, in extreme cases, “toxic shock
    syndrome” – can be fatal
37
Q

Why are superantigens so dangerous for hosts?

A

Superantigens bind to conserved regions on
MHC class II and T cell receptor, bringing
antigen presenting cells and TH cells together
and activating the T cells to release cytokines.
Many more T cells become activated than
would those specific for the MHC II:peptide
complex.

38
Q

What are PMNs?

A

polymorphonuclear cells - monocytes, neutrophils, etc.

39
Q

What are superantigens of Staph?

A

Staphylococcal enterotoxins (SEs: SEB and SEH), staphylococcal toxic shock syndrome toxin (TSST)

40
Q

How does toxic shock syndrome develop in the host?

A

There is an initial T cell derived initial peak of IL-2, INFγ and TNF-α followed by a second peak from macrophage-derived cytokines such as IL-1, IL-6, IL-8 and TNF-α, along with chemokines, leukotrienes,
prostaglandins and complement, that in severe cases may result in vasodilatation associated with vascular leakage of fluid, leading to tissue hypoperfusion, shock and multiorgan failure.