Lectures 1 & 2 - Clinical Bacteriology I & II Flashcards
What is the human microbiome?
Ecological community of commensal, symbiotic, and pathogenic bacteria that share our body space
Which is larger: the human microbiome or the human genome?
Human microbiome (over 1M genes compared to 23K)
Does the microbial community composition differ at different body locations?
YUP
What are the 6 dominant bacterial phyla in each of the different body sites?
- Firmicutes
- Bacteroidetes
- Fusobacteria
- Actinobacteria
- Cyanobacteria
- Proteobacteria
Do we all have the same core composition of our microbiome?
YUP
What is dysbiosis?
Shifts in the microbiome that cause many infectious diseases (e.g. IBD, T2 DM, necrotizing enterocolitis)
What are biofilms? What to note? Example?
Bacterial communities growing in an organized manner on surfaces
Note: cells growing in biofilms are different from those growing in fluid (planktonic growth) => biofilm bacteria grow slower, they may use different metabolic pathways, are more antibiotic resistant, and have greater opportunity for horizontal gene transfer
Example: with a UTI, the bacteria in the urine have a different phenotype from those attaching to the bladder epithelium
Why do biofilms not have a lot of time to grow?
Because the barrier epithelia desquamate
What are the 3 non-shedding surfaces of the human body?
- Teeth
- Bone
- Prosthesis such as dentures, joints, heart valves, etc.
Describe the growth of a biofilm. 5 steps.
- Adhesion to the surface of the substratum by receptor-ligand interactions: random event influenced by surface free energy and proinquity (nearness) of bacterial cells that are in fluid and bounce by Brownian movement
- Colonization: cell division
- Accumulation: creating a linking film
- Climax community: this causes physiological changes to the environment due to consumption and production of molecules, which permits other bacteria to attach to pioneers = succession causing interbacterial aggregation + formation of fluid channels in between micro-colonies of microorganisms
- Dispersal: the climax community is a dynamic entity where cells enter or leave promoting diversification => pieces of the climax community break off when they cannot resist the shear force of the fluid phase => can reattach downstream to start a new biofilm thanks to the extracellular polysaccharide
Is adhesion of bacterium to the surface of the substratum reversible?
YUP
What are pioneer organisms?
Bacterial species that originally adhere to the surface of the substratum
Other name for interbacterial aggregation in a biofilm?
Co-aggregation
Are the pioneer organisms actually binding to the subtratum?
NOPE - they are binding to a conditioning film derived from the fluid phase (e.g. plasma, saliva, respiratory secretions) by selective absorption of proteins
Can climax communities grow on shedding surfaces of the body? What to note?
NOPE - unless there is a wound
What allows bacteria to adhere to each other in a climax community?
Extracellular polysaccharides
What are the pioneer bacteria on teeth?
Alpha-hemolytic streptococci
Can biofilms grow on both biotic and abiotic surfaces?
YUP
3 types of abiotic surfaces that biofilms grow on?
- Medical devices: orthopedic devices, transcutaneous devices, catheters
- Hospital equipment: hemodialysis machines, mechanical ventilators, shunts, surfaces
- Others: contact lens cases
3 examples of diseases characterized by the growth of biofilms?
- Osteomyelitis
- Cystic fibrosis
- Otitis media
How do clinicians think about bacteria?
As individual infectious agents that need to be isolated, identified, and tested for antibiotic susceptibility
Describe the diagnostic cycle of infectious diseases. 11 steps.
- Patient consults a physician because of signs or symptoms suggesting an infectious disease
- Physician examines patient and makes a tentative clinical diagnosis
- Cultures from one or more anatomic sites may be indicated, depending on the findings of medical history and physical examination
- An appropriate specimen for culture must be collected and a transport container(s) selected that will maintain the viability of any pathogenic organisms during transit
- Once the specimen is received in the laboratory, the information on the request form is entered into a computer file or log book
- The specimens are examined visually and, depending on the physician’s order and the nature of the specimen, wet mounts and smears may be prepared and stained for microscopic examination
- Observations may or may not be immediately reported to the physician depending on the definitiveness of the results and specimens that require definitive identification of potentially pathogenic microbes are processed further
- One or more culture media are selected, or if viral diseases are suspected, appropriate cell lines are chosen that will be inoculated with a portion of the specimen. All agar plates are streaked for colony isolation; then plates, broths, and cell cultures are placed in an incubator with appropriate temperature and environmental conditions to maximize the growth and replication of microbes
- After a specified incubation period, the cultures are examined both visually and microscopically. Often presumptive microbial identifications can be made and antibiotic sensitivity testing is conducted.
- A final report is issued if a definitive answer can be given; if not, the report should be delayed while subcultures and additional test procedures are performed to identify the organisms definitively
- Physician interprets reports and institutes appropriate therapy
How should a specimen container be labeled? What should be sent along with it?
The specimen container must be properly labeled with the patient’s name, location, date and time of collection, and type of specimen
Should be accompanied by a physician’s orders to be transcribed to a laboratory request form or entered into a computer data file (or both), including essential clinical findings, a working diagnosis, and any information that may require laboratory personnel to apply other than routine procedures to recover uncommon or particularly fastidious microorganisms
What should a physician do when sending a specimen to a lab if an infectious disease, caused by less commonly encountered or fastidious microorganisms, is suspected? Why? Example?
Physicians should either call the laboratory or indicate on the laboratory request slip
Reason: certain culture media required for the optimum recovery of certain fastidious or slow-growing microorganisms may not be available or used in many laboratories
For example: the recovery of bacterial species belonging to the genera Brucella, Pasteurella, Moraxella, Haemophilus, Neisseria, Leptospira, Vibrio, Campylobacter, and Legionella, among others, may require special culture media or alternative techniques
Why should the physician indicate a working diagnosis to the lab analyzing a specimen?
Because special culture media, adjusted incubation temperatures, or alternative analytical techniques may be necessary
Can all human bacteria pathogen be cultivated on artificial media? Examples?
NOPE
Examples: Treponema pallidum and Mycobacterium leprae
What 8 variables must be considered to successfully cultivate bacteria in the clinical laboratory?
- Temperature
- pH
- Gaseous requirements
- Minerals and trace elements
- Vitamins
- Nitrogen sources
- Carbon sources
- Energy generation
What are the 5 different types of bacterial species based on gaseous requirements? Describe each. Which is most common clinically?
- Obligate aerobes: completely dependent on the presence of O2 and cannot grow without it
- Microaerophiles: require O2 at about 0.2 atmospheres (4%) and are inhibited, but not killed by higher O2 levels
- Capnophiles: grow best in elevated CO2 (5-10%)
- ***Facultative anaerobes: grow in the presence and absence of O2, but usually prefer growth in O2 because respiration yields 38 moles ATP/mole glucose vs fermentation yields only 2-3 moles ATP
- Obligate anaerobes: cannot grow in the presence of O2 for unknown reasons (note: some anaerobes are ‘aerotolerant’)
What is the normal air composition?
- N2 = 78%
- O2 = 21%
- CO2 = 0.03%
What is the media of choice for collecting the clinical specimen from a normally sterile site? What about for contaminated sites?
- Sterile sites: liquid media such as blood bottles
- Contaminated sites with the resident microbiota (skin and barrier epithelia): need to be plated onto a solid (agar) surface to allow dilution of the specimen and separation of the various bacteria in the specimen
What is the end point of growing and isolating bacteria?
To obtain a pure culture of the causative bacterium
What body sites are normally sterile?
Blood, CSF, urine
Are most human infections caused by single organisms?
YUP
How is a blood culture performed? 4 steps.
- A minimum of 10 ml of blood is taken and injected into two or more “blood bottles” with specific media for aerobic and anaerobic incubation
- Most cultures are monitored for 5 days
- If a vial is positive (presents with turbidity) a gram stain is performed and the attending physician is notified that the patient is bacteremic
- An aliquot of the blood bottle is sub-cultured onto agar media to isolate the pathogen for identification and antibiotic susceptibility testing
How to reduce the probability of obtaining a false positive when a blood culture is performed?
Multiple sets of cultures reduces the probability of having a positive culture due to skin contaminants:
Set 1 = L. antecubital fossa at 0 min
Set 2 = R. antecubital fossa at 30 min
Set 3 = R or L anticubital fossa at 90 min
Which take longer to grow: aerobic or anaerobic bacteria?
Anaerobic
What is the bacterial growth curve?
- X-axis: time
- Y-axis: log of the number of bacteria over time
Done with “batch cultures”
What are the 4 phases of the bacterial growth curve?
- LAG PHASE
- EXPONENTIAL (LOG) PHASE
- STATIONARY PHASE
- DEATH PHASE
What is a “batch culture” of a bacteria?
Bacteria grown with a fixed volume of liquid nutrient medium
Describe the lag phase of the bacterial growth curve. 5 and overall
- Increase in cell size but little or no cell division
- Intense metabolic activity
- Uptake of nutrients and macromolecular biosynthesis of DNA, protein, etc.
- Sensitivity to physical and chemical agents such as antibiotics
- Uniform staining with Gram’s stain
=> adaptation to the host
Describe the exponential phase of the bacterial growth curve. 8 and overall
- Maximum growth rate as far as the environment allows
- Minimum generation time
- Balanced growth
- Cellular reproduction most active
- Most susceptible to uptake of foreign DNA
- Most susceptible to antimicrobial agents
- Uniform staining with Gram’s stain
- Possible exotoxin production
=> signs and symptoms with tissue destruction
Describe the stationary phase of the bacterial growth curve. 5
- Growth rate slows
- Number of bacterial deaths equals number of new cells
- Metabolic rate slows
- Production of secondary metabolites, e.g., antibiotics, spores, inducible enzymes
- Phagocytosis aided by antibodies
Describe the death phase of the bacterial growth curve. 2 and overall.
- Number of deaths exceeds number of new cells formed
- Culture may die out, or a small fraction of the population may survive for a long time
=> bacterial mopping up and clearance
Other name for the death phase of the bacterial growth curve?
Logarithmic decline phase
5 methods to identify bacteria?
- Direct microscopic examination
- Antigen detection = serology
- Cell component detection = chemical/biochemical analysis: for example, ability to utilize sugars and nitrogen sources or the activities of enzymes
- Molecular diagnosis: DNA probes and/or PCR
- Culture
2 subtypes of microscopic examinations of bacteria?
- Wet mounts
2. Stains: Gram’s, acid fast, auramine-rhodamine, silver, etc.
What does a bacterial culture try to look for?
- Colonial characteristics
2. Physiological/biochemical properties
2 types of shapes of bacteria?
- Sphere => coccus
2. Rod => bacillus
4 types of coccus bacteria?
- Single
- Pairs = diplococcus
- Clusters
- Chains
4 types of bacillus bacteria?
- Thin
- Slender
- Curved
- Corkscrew
What does a gram stain test?
Tests for the presence of 2 different types of cell wall:
- Gram (+) cell wall
- Gram (-) cell wall
Example of disease that can be diagnosed by Gram’s stain? Explain.
Bacterial meningitis with CSF specimen
6 possible causes:
1. Streptococcus pneumoniae: gram (+) diplococcus
- Streptococcus agalactiae (group B): gram (+) chain coccus
- Listeria monocytogenes: gram (+) rod
- Neisseria meningitidis: intracellular gram (-) diplococcus
- Escherichia coli: gram (-) rod
- Haemophilus influenzae: encapsulated gram (-) coccobacillus
How to conduct a Gram’s stain?
- Place a drop of specimen on slide and allow it to air-dry
- Heat fix-it under a flame
- Add crystal violet and let it sit for 30 sec
- Wash it off with water
- Add Lugol’s iodine and let it sit for 30 sec
- Wash it off with water
- Lugol’s iodine forms a complex with the crystal violet which lodges in the cell wall
- Run alcohol along the surface of the slide to try to remove the complex from the cell wall
9a. If complex cannot be removed => cell is stained purple => gram (+) bacterium
9b. If complex is removed => gram (-) bacterium => safranin counter-stain is used
What is important about the bacteria Listeria monocytogenes?
It can cross the placenta
What is an acid-fast stain used for? What color does it stain?
To test for organisms that belong to the genus mycobacterium (e.g. tuberculosis) => carbol fuchsin stains mycobacterium as red beaded rods and the background stains blue with methylene blue
How can you tell the specimen for tuberculosis test is a deep sputum for the respiratory tree?
Inflammatory cells are present
3 types of agar-based media?
- General purpose media
- Differential and partly selective media
- Selective media
Describe general purpose agar-based media. 2 subtypes?
Nutritionally rich media used in the primary recovery of human pathogens
- Blood agar: contains 5% sheep blood => ‘indicator’ medium that reveals the production of hemolysins (cytotoxic exotoxins) by bacteria by the lysis of the red blood cells (RBCs) in the medium
- Chocolate agar: more nutritious than blood agar because the RBCs are lysed (higher temp) and release cofactors such as NAD and hemin into the medium => used to recover fastidious human bacterial pathogens
Describe differential and partly selective media. 2 subtypes?
Designed to favor the growth of certain groups of bacteria while inhibiting others (usually gram (+) bacteria) and cause the pigmentation of certain bacterial colonies
- Mannitol-salt agar
- MacConkey agar