Microbiology: Gram Positive Cocci Flashcards
1
Q
GP Cocci (GPC)
A
- Staphylococcus
- Streptococcus
- Enterococcus
- Appear as dark purple clusters (strep as chains)
2
Q
Lab tests to differentiate GPC
A
- Catalase test: separates staph from strep and entero (only staph is catalase positive)
- Coagulase test: separates staph aureus from other staph (only staph aureus clots plasma)
- Hemolysis on blood agar: distinguishes various types of bacteria
- Alpha: partial hemolysis leaving green area (S penumoniae, Viridans)
- Beta: complete hemolysis leaving clear area (S pyogenes)
- Gamma: no hemolysis
- Lancefield grouping: group-specific cell wall Ags (groups A, B, D. Refers to polymorphic immunogen on well wall. Primarily beta/alpha hemolytic strep)
- Enterococci differ from strep in ability to grow in presence of high salt, bile, and hydrolyze esculin
3
Q
Characteristics of Staphylococcus
A
- Non-motile, non-spore forming
- Facultative anaerobes, grow on non-selective media
- Have polysaccharide capsule can also made of fibrin (due to coagulase)
- Techoic acid binds to fibronectin to facilitate adhesion
- Peptidoglycan has endotoxin effects (not an actual endotoxin)
4
Q
Characteristics of Streptococcus
A
- Facultative anaerobes
- Grow on 5% sheep blood or nutrient broths
- Secrete toxins
5
Q
Characteristics of Enterococcus
A
- Group D lancefield Ag
- Hemolysis patter variable
6
Q
3 most common disease causing GPC
A
- Staph Aureus
- Strep Pyogenes
- Enterococci (E faecalis, and E faecium)
7
Q
Staph Aureus
A
- Found in nose, epithelial and mucosal surfaces
- Spreads to sterile sites via trauma, person contact, fomites
- Grows on 5% sheep blood agar, selective media is mannitol salt agar
- Changes the color of sheep blood from red to gold via hemolysis (Au=gold)
8
Q
Virulence factors of Staph Aures
A
- Protein A: binds Fc component of Ig (prevents opsonization)
- Coagulase: builds insoluble fibrin capsule around bacteria (prevents immune cell access)
- Hemolysins (cytotoxins): directly toxic to hematopoietic cells
- Leukocidin: toxin specific to PMNs
- Catalase: prevents toxic action of PMN-derived hydrogen peroxide
- Penicillinase (B-lactamase): destroys B-lactam ring of penicillins and renders them inactive
- Capsule and techoic acid
9
Q
Penetration of Staph Aureus
A
- Hyaluronidase: hydrolyzes hyaluronic acid in CT
- Fibrinolysin: dissolves fibrin clots
- Lipases: allows survival and spread in fat-containing areas
10
Q
Secreted toxins of staph aureus
A
- Exfoliative toxins: causes scalded skin syndrome
- Enterotoxins
- Toxic Shock Syndrome Toxins (TSST): super antigen that cross-links MHCII on APCs causing non-specific T cell response
- Cytotoxins (alpha, beta, delta, gamma): panton valentine leukocidin (PVL, gamma toxin) found in methicillin resistant staph aureus (MRSA). Causes lysis of leukocytes via pore formation, tissue necrosis (acquired virulence factor)
11
Q
Medical syndromes of staph aureus
A
- Skin and soft tissue (impetigo, cellulitis, abscess, wounds)
- Bone and joint infections (osteomyelitis, septic arthritis)
- Pneumonia (infection of lung, empyema)
- Bacteremia and endocarditis (infection of blood, infection of heart valves, respectively)
- Food poisoning (enterotoxin B)
- Scalded skin syndrome (exfoliative toxin): blisters and peeling of skin
- TSS: localized growth of staph aureus w/ release of TSST into blood (fever, hypotension, rash, multi-organ failure)
12
Q
Therapy to staph aureus
A
- Have resistance to penicillin due to B-lactamase
- Alteration of PBP (to PBP2) causes MRSA (methicillin resistance), coded by mecA gene
- B-lactamase resistant penicillins (anti-staph penicillins) are not effective against MRSA, but are against some staph aureus
- Can use 1st generation cephalosporins
- Vancomycin very effective (especially against MRSA)
13
Q
Coagulase-negative staph
A
- Most common is S Epidermidis
- Colonizes surface of skin, mucous membranes
- Can spread during implantation of devices, form person contact
- Contains capsule
- Often resistant to B-lactamase penicillins, cephalosporins
- Sensitive to novobiocin
- Not very virulent, infect patients w/ indwelling medical devices and immunocompromised
- S Saprophyticus is 2nd most common cause of UTI (resistant to novobiocin, used bactrim or ciprofloxacin)
14
Q
Streptococcus Pyogenes
A
- Group A strep
- Infects skin and upper respiratory tract
- Not normal flora but may be carried on mucous
- Spread by person contact w/ mucous or respiratory droplets
- Beta hemolysis on blood agar, lancefield A group
- Different from other beta hemolytic strep by: bacitracin sensitive, and positive PYR test (has nz that forms red product)
- Tx is penicillin
15
Q
Virulence factors and toxins of strep pyogenes
A
- Capsule
- Lipotechoic acid, F proteins both bind to epithelial cells
- M proteins (used in epidemiological studies): antiphagocytic protein w/ over 100 serotypes
- Secretes many toxins: pyogenic (pus-forming) exotoxins, streptolysin S and O, streptokinase, hyaluronidase
16
Q
Medical syndromes of strep pyogenes
A
- Skin, soft tissue infections: erysipelas (superficial), cellulitis (deeper), necrotizing fasciitis (deep subcutaneous necrosis w/ high mortality), wounds
- Streptococcal pharyngitis (strep throat): pain, swelling, fever, white exudate on tonsils. Can be complicated by rheumatic fever, post-streptococcal glomerulonephritis, scarlet fever
- Pneumonia, bacteremia
- Puerperal fever (post-partum endomyometritis)
17
Q
Toxin complications of strep pyogenes
A
- Scarlet fever: pyogenes must be lysogenized by bacteriophage (stimulates to produce pyrogenic exotoxin or erythrogenic toxin). Both toxins are superantigens
- Is a complication of strep pharyngitis, onset of rash, fever, strawberry tongue. Tx w/ penicillin
- Streptococcal TSS
18
Q
Non-suppurative (no pus) sequelae
A
- Acute rheumatic fever (ARF) follows strep throat: cross-rxn of Abs to strep (M1 and M3) w/ Ags in heart
- Causes acute inflammation of joints, heart, subcutaneous tissue, CNS, chronic damage of heart valved
- Acute Glomerulonephritis (AGN) follows strep throat or skin infection: acute inflammation of glomeruli due to Ab-Ag (M12, M49) complexes in basement membrane of glomerulus
- Results in hematuria, proteinuria, hypertension, edema
- Tx for both is penicillin
19
Q
Streptococcus agalactiae (group B)
A
- Normal in female genital tract and lower GI, can colonize upper resp tract
- Mother to infant in utero transmission (10-30% of pregnant women asymptomatic)
- Looks same as group A strep under microscope and blood agar (both beta hemolysis), use CAMP test (extracellular protein acts synergistically w/ beta-lysin of S aureus to enhance hemolysis, found in GBS but not GAS)
- Causes UTI in pregnant women; neonatal septicemia, meningitis, penumonia; infections in immunocompromised
- PCR screening of pregnant women, with vaginal culture
- Tx is penicillin
20
Q
Viridan streptococci
A
- Alpha hemolytic (thus green)
- All resistant to antibio opticin
- Normal in GI, female genital, transmission is getting access to sterile sites
- Causes localized infections (abscesses) and systematic infections (endocarditis)
21
Q
Streptococcus Pneumoniae
A
- Nontypable, usually alpha hemolytic diplococci
- Identified by quellung rxn: adding anti-capsular Abs to cause swelling of capsule (also: optician sensitive; other viridans are resistant, and bile solubility test; bile lyses colonies)
- Colonizes nasopharynx, transmitted via respiratory secretions
- Virulence factors: capsule (what vaccines are directed against), pneumolysin (cholesterol dependent chymolysin (damages both alveolar epithelial and pulmonary endothelial cells, up regulate IL6)
- Diseases: penumonia, otitis media (ear), sinusitis, meningitis, bacteremia
- Tx: cephalosporin and vancomycin (resistant to penicillin)
- Prevention: adult vaccine w/ 23 capsular types, child one w/ 13
22
Q
Enterococci
A
- Most common are E faecalis, E faecium (group D strep)
- E faecium more likely to be drug resistant
- Both normal flora of human GI tract and female genital tract
- Transmission: access to normally sterile sites, person contact, fomites
- Most diseases in immunocompromised, healthy people can develop UTI
- Possible for endocarditis, peritonitis (infection of lining of abdomen due to bowel perforation), bacteremia
- Tx: inherently resistant to many antibios. Can use ampicillin + gentamicin (aminoglycoside), or vancomycin (effective against any GP)
23
Q
4 key bacteria w/ capsules
A
- S pneumo
- H influenzae
- N meningitidis
- Pseudomonas Aeruginosa
- Klebsiella pneumoniae
- All encapsulated bacteria have resistance to phagocytosis
- Removing spleen (asplenia) increases risk of infection to encapsulated bacteria