Pathogenic Gram-Positive Bacteria Flashcards

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1
Q

Examples of Cocci and their morphology

A

Staphylococcus (in bunches), Streptococcus, (straight chain) and Enterococcus

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2
Q

Examples Bacilli

A

BLANCC

Bacillus,
Clostridium,
Listeria, Corynebacterium,
Nocardia,
Actinomyces

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3
Q

STAPHYLOCOCCI CLASSIFICATION
Family
Genus
Species (how many in total)

A

Family: Micrococcaceae
Genus: Micrococcus and Staphylococcus

Species:
S. aureus
S. saprophyticus
S. epidermidis
M. luteus

Over 33 species

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4
Q

General Characteristics STAPHYLOCOCCI

A
  • Gram-positive cocci
  • Non-motile
  • Non–spore-forming
  • Catalase-producing (catalase +ve)
  • Facultative anaerobes
  • Salt-tolerant
  • Desiccation resistant
    (survives in environt & on fomites)
  • ≈ 33 species
  • 14-17 species associated with man
  • Several veterinary pathogens
  • Many non-pathogenic
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5
Q

Coagulase-Positive Staphylococci

A

Human Pathogen:
S. aureus

Animal-associated species:
S. intermedius
S. hyicus
S. delphini
S. schleiferi

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6
Q

Coagulase-Negative Staphylococci

A

S. epidermidis
S. saprophyticus
S. haemolyticus

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7
Q

What is the Habitat, Source, Staphytoccus aureus?
What type of infections does it produce?
What’s the mode of transmission?
What are the sources of the organism?

A

Skin, anterior nares (carriers): part of normal flora in humans and animals

Type of Infections: Produce Superficial- Deep, Local - Systemic infections

Mode of transmission: traumatic introduction

Source of organism:
self
infected human host
carrier
fomite or environment

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8
Q

Pathogenicity staphylococci

A
  • Entry of only a few hundred bacteria can result in disease
  • Pathogenicity results from 3 features:
    Structures that enable it to evade phagocytosis
    Production of enzymes
    Production of toxins
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9
Q

What predisposing factors to S. aureus infections?

A
  • Injuries: Breach in skin
  • Immune response defects:
    Chemotaxis defects
    Opsonisation defects
    Neutrophil functional defects
  • Diabetes mellitus
  • Presence of foreign bodies
  • Chronic infections
  • Indwelling devices
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10
Q

Pathogenic Attributes of S. aureus: Structural Elements
What are the structural elements that contribute to the pathogenic attributes of S. aureus?

A
  • Protein A coats the cell surface
    Interferes with humoral immune responses by binding to class G antibodies
    Inhibits the complement cascade
  • Clumping Factor (Bound coagulase)
    Converts the soluble blood protein fibrinogen in insoluble fibrin molecules that form blood clots
    Fibrin clots hide the bacteria from phagocytic cells
  1. Synthesize loosely organized polysaccharide slime layers (often called capsules)
    Inhibit chemotaxis of and phagocytosis by leukocytes
    Facilitates attachment of Staphylococcus to artificial surfaces
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11
Q

Pathogenic Attributes of S. aureus: Enzymes Synthesis

A
  1. Coagulase
    Triggers blood clotting
  2. Hyaluronidase
    Breaks down hyaluronic acid, enabling the bacteria to spread between cells
  3. Staphylokinase
    Dissolves fibrin threads in blood clots, allowing Staphylococcus aureus to free itself from clots
  4. Lipases
    Digest lipids, allowing staphylococcus to grow on the skin’s surface and in cutaneous oil glands
  5. Beta-lactamase
    Breaks down penicillin
    Allows the bacteria to survive treatment with Beta-lactam antimicrobial drugs
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12
Q

Pathogenic Attributes of S. aureus: Toxins

A

Staphylococcus aureus produces toxins more frequently than S.epidermidis

  1. Cytolytic toxins
    Disrupts the cytoplasmic membrane of a variety of cells
    Leukocidin (Panton-Valentine): kill PMNs
    Heamolysin
    Alpha: platelets/WBCs/tissue
    Beta (hot/cold): sphingomyelin of RBCs
    Gamma: host cell membranes
    Delta: less lethal
  2. Exfoliative toxins
    Causes the patient’s skin cells to separate from each other and slough off the body (desquamation of skin)
    Epidermolytic toxin
    Phage group II staphylococci
  3. Toxic-shock-syndrome toxin
    Causes toxic shock syndrome
    Multisystem disease
    High fever
    Hypotension
    Shock
  4. Enterotoxins
    Stimulate the intestinal muscle contractions (abdominal pain), nausea, and intense vomiting associated with staphylococcal food poisoning (non-invasive). Pathogenicity is enterotoxins
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13
Q

Classification of Staphylococcal Diseases

A
  1. Localized or Systemic
  2. Invasive or Non-invasive
  3. Superficial or Deep
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14
Q

What are the most common Non invasive, Localized/Cutaneous and systemic Disease

A

Non invasive: Mediated mainly by toxin elaboration
Food poisoning from the ingestion of enterotoxin-contaminated food

Localized/Cutaneous:
Various skin conditions
scalded skin syndrome, extensive vesicular eruption of the skin
Impetigo (skin lesion with blisters that break and become covered with crusting exudate)
Styes infection of the follicle of eye lashes
Furuncles or folliculitis (infection of one hair follicle)
Carbancles (infection of several hair follicles)
Boils
Wound infections(progressive appearance of swelling and pain in a wound , (surgical wound infection seen after about 2 days from the surgery)

Systemic Disease”
Toxic shock syndrome-TSS toxin is absorbed into the blood and causes shock
Bacteremia-presence of bacteria in the blood
Endocarditis-occurs when bacteria attack the lining of the heart
Pneumonia-inflammation of the lungs in which the alveoli and bronchioles become filled with fluid
Osteomyelitis-inflammation of the bone marrow and the surrounding bone

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15
Q

Example of a difficult to treat systemic disease

A

Endocarditis-occurs when bacteria attack the lining of the heart causing inflammation

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16
Q

What are DEEP ABSCESSES?

A

Can be single or multiple
Breast abscess can occur in 1-3% of nursing mothers in puerperiem
Can produce mild to severe disease
Other sites - kidney, brain from septic foci in blood

17
Q

What are the steps in dianosing a bacterial infection?

A

Specimen
Smear
Culture
Biochemical Reactions
Antibiogram
Typing

18
Q

What would you expect to see in a Laboratory Diagnosis: Direct Smear Examination of S.aureus?

A

Microscopic Examination:
Gram-positive cocci
pairs and clusters
Numerous polymorphonuclear cells (PMNs)

On a micrograph:
Gram +ve cocci in bunches

19
Q

What Cultural Characteristics would you expect to see in a Laboratory Diagnosis?

A

Colony morphology:
Smooth, butyrous, white to yellow, creamy
S. aureus may produce hemolysis on blood agar

20
Q

Discuss the Catalase Identification Tests
What is the reagent?

A
  • Reagent is H2O2
  • Principle: tests for enzyme catalase
    2 H2O2 ——> 2 H2O + O2

*Drop H2O2 onto smear

Bubbling = POS (Most bacteria, O2 generated)

No bubbling = NEG (Streptococci and other lactic acid bacteria, no O2 generated)

21
Q

Discuss the Coagulase Identification Tests
What is the reagent
What are the 2 methods

A

reagent: citrated plasma

Detects enzyme coagulase
Cell-bound “clumping factor”
Extracellular enzyme “free coagulase”
Two methods
Slide test
Tube test: Tube test detects the extracellular enzyme “free coagulase”

22
Q

What is the Novobiocin Susceptibility Test?

A

Test to differentiate coagulase-negative staphylococci from S.saprophyticus from urine samples
S. saprophyticus is resistant (top)
Other CNS are susceptible

23
Q

Treatment

A
  • Drain infected area
  • Deep/metastatic infections
    semi-synthetic penicllins
    cephalosporins
    erythromycin
    clindamycin
  • Endocarditis
    semi-synthetic penicillin + an aminoglycoside
24
Q

Treatment & Antimicrobial Susceptibility

A

Treatment
Methicillin is the drug of choice to treat staphylococcal infections

For non–beta-lactamase producing S. aureus (methicillin-susceptible)
Penicillinase-resistant synthetic penicillins (methicillin, nafcillin, oxacillin, dicloxacillin)

For methicillin -resistant S. aureus (MRSA) and methicillin-resistant S. epidermidis (MRSE)
Vancomycin combined with rifampin or gentamicin

Emergence of vancomycin resistance

25
Q

Prevention

A

Carrier status prevents complete control
Proper hygiene, segregation of carrier from highly susceptible individuals
Good aseptic techniques when handling surgical instruments
Control of nosocomial infections

Hand antisepsis is the most important measure in preventing nosocomial infections

Also important is the proper cleansing of wounds and surgical openings, aseptic use of catheters or indwelling needles, an appropriate use of antiseptics

25
Q
A