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Culture Documents
Gram-positive
Gram-negative
Rickettsias, Chlamydias, Spirochetes and Vibrios
Foodborne
Waterborne
Soilborne
Arthropodborne
Physical Contact
STD
Contact
Animal
Or, by..
Gram-positive
Gram-negative
Rickettsias, Chlamydias, Spirochetes and
Vibrios
Gram-positive bacteria
Staphylococcus aureus
grows in large, round,
opaque colonies
optimum temperature
37oC
facultative anaerobe
withstands high salt,
extremes in pH, & high
temperatures
produces many
virulence factors
Coagulase
Enzymes of S. aureus
Hyaluronidase
promotes invasion
Staphylokinase
digests blood clots
Dnase
digests DNA
Lipases
helps bacteria colonize oily
skin
Penicillinase
inactivates penicillin
Toxins of S. aureus
hemolysins
lyse RBCs
Leukocidin
damages cell membranes
Enterotoxins
act in the gastrointestinal tract
exfoliative toxin
separates epidermal layers
Staphylococcal Disease
Range from localized to systemic
Localized cutaneous infections invade skin through
wounds, follicles, or glands
folliculitis
superficial inflammation of hair follicle
usually resolved with no complications but can progress
furuncle
Boil
inflammation of hair follicle or sebaceous gland progresses into abscess
or pustule
carbuncle
larger and deeper lesion created by aggregation and interconnection of
a cluster of furuncles
impetigo
bubble-like swellings that can break and peel away
most common in newborns
Staphylococcal Disease
Systemic infections
osteomyelitis
infection is established
in the metaphysis
abscess forms
bacteremia
primary origin is
bacteria from another
infected site or medical
devices
endocarditis possible
Staphylococcal Disease
Toxigenic disease
food intoxication
ingestion of heat stable
enterotoxins
gastrointestinal distress
Other Staphylococci
S. epidermidis
lives on skin & mucous
membranes
endocarditis, bacteremia, UTI
S. hominis
lives around apocrine sweat
glands
S. capitis
live on scalp, face, external
ear
S. saprophyticus
infrequently lives on skin,
intestine, vagina; UTI
Streptococci
Gram-positive spherical/ovoid
cocci arranged in long chains
Non-spore-forming, nonmotile
Can form capsules & slime layers
Facultative anaerobes
Do not form catalase, but have a peroxidase
system
Small, nonpigmented colonies
Sensitive to drying, heat & disinfectants
25 species
Streptococci
Lancefield classification
system based on cell wall Ag
17 groups (A,B,C,.)
Another classification system
is based on hemolysis
reactions
-hemolysis
A,B,C,G & some D strains
hemolysis
-hemolysis
Enterococcus faecalis
does not induce hemolysis
Streptococci
Skin infections
Impetigo (pyoderma)
superficial lesions that break and form
highly contagious crust
often occurs in epidemics in school
children
associated with insect bites, poor
hygiene, and crowded living
conditions
Erysipelas
pathogen enters through a break in the
skin
eventually spreads to the dermis and
subcutaneous tissues
Throat infections
Streptococcal pharyngitis
strep throat
-hemolytic S. pyogenes
Most serious
streptococcal pathogen
Inhabits throat,
nasopharynx, occasionally
skin
Produces Ccarbohydrates, M-protein
(fimbrae), streptokinase,
hyaluronidase, DNase,
hemolysins
S. pyogenes
GAS
Humans only reservoir
Transmission
contact, droplets, food, fomites
Skin infections
pyoderma, impetigo,
erysipelas
Systemic infections
strep throat, pharyngitis,
scarlet fever
S. pyogenes
Causes streptococcal
pharyngitis
Strep throat
enters the upper
respiratory tract through
respiratory droplets
S. pyogenes
Strep throat and scarlet
fever can be treated by
antibiotics
Rheumatic fever
serious complication
affecting the joints and
heart
causes permanent heart
damage called rheumatic
heart disease
Acute glomerulonephritus
rare inflammatory
response to M proteins
may lead to renal damage
Group B: S. agalactiae
Regularly resides in human vagina, pharynx &
large intestine
can be transferred to infant during delivery &
cause severe infection
Most prevalent cause of neonatal pneumonia,
sepsis, & meningitis
Pregnant women should be screened & treated
Streptococcus pneumoniae
Causes 60-70% of all
bacterial pneumonias
Small, lancet-shaped cells
arranged in pairs and short
chains
Culture requires blood or
chocolate agar
Growth improved by 5-10%
CO2
Lack catalase &
peroxidases
cultures die in O2
S. pneumoniae
All pathogenic strains
form large capsules
major virulence factor
S. Pneumoniae Epidemiology
5-50% of all people carry it as normal flora
in pharynx
Does not survive long outside of its habitat
Pneumonia occurs when cells are aspirated
into the lungs of susceptible individuals
Pneumococci multiply
induce inflammatory response
hemolytic
Quellung test or capsular swelling
reaction
Bacillus
gram-positive
endospore-forming
motile rods
mostly saprobic
aerobic & catalase positive
versatile in degrading complex macromolecules
source of antibiotics
primary habitat is soil
2 species of medical importance
Bacillus anthracis
Bacillus cereus
Bacillus anthracis
facultative
large, block shaped
rods
central spores
develop under all
conditions except in the
living body
virulence factors
capsule & exotoxins
Bacillus anthracis
3 types of anthrax
Cutaneous
spores enter through skin,
black sore
least dangerous
Pulmonary
inhalation of spores
Gastrointestinal
ingested spores
Bacillus cereus
common airborne &
dustborne
grows in foods, spores
survive cooking & reheating
ingestion of toxin-containing
food
causes nausea,
vomiting, abdominal
cramps & diarrhea
24 hour duration
no treatment
spores abundant in the
environment
Clostridium
gram-positive
spore-forming rods
anaerobic & catalase negative
120 species
oval or spherical spores produced only under anaerobic
conditions
cause wound & tissue infections and food intoxications
C. difficile
C. botulinum
C. perfrogens
C. tetanis
Clostridium botulinum
Anaerobic, endospore-forming, Gram-positive
bacillus
Common in soil and water
Botulism results when the endopsores germinate
and produce botulism toxins
Clostridium botulinum
Causes 3 diseases
1. food poisoning
o
o
2. infant botulism
o
3. wound botulism
o
Clostridium botulinum
Diagnosis
Symptoms are diagnostic
Treatment
Administer neutralizing antibodies against botulism
toxin
Administer antimicrobial drugs in infant botulism cases
Prevention
Proper canning of food
Infants under 1 year should not consume honey
Clostridium perfringens
Gangrene
occurs when blood flow ceases to a part of
the body
Clostridium perfringens
Vegetative cells ferment
muscle carbohydrates and
decompose muscle proteins
Large amounts of gas
accumulate under the skin,
causing a crackling sound
-toxin damages and lyses
blood cells
Treatment involves:
Antibiotics
tissue debridement
Amputation
exposure in a hyperbaric
oxygen chamber
Clostridium tetani
Tetanus
Causes hyperactive muscle contractions
Spores can enter the body through a wound
produce toxins
Clostridium tetani
Symptoms of tetanus include:
Trismus (lockjaw)
involves spasms of the jaw muscle and clenching of the
teeth
Opisthotonus
involves muscle spasms that cause an arching of the back
Listeria monocytogenes
non-spore-forming gram-positive
ranging from coccobacilli to long filaments
1-4 flagella
no capsules
resistant to cold, heat, salt, pH extremes &
bile
primary reservoir is soil & water
can contaminate foods & grow during
refrigeration
Listeria monocytogenes
Listerosis
immunocompromised patients,
fetuses & neonates
affects brain & meninges
20% death rate
ampicillin &
trimethoprimsulfamethoxazole
Prevention
pasteurization & cooking
Mycoplasmas
M. pneumoniae
primary atypical
pneumonia
Walking pneumonia
Corynbacterium diptheriae
gram-positive irregular bacilli
produce catalase
2 stages of disease:
1. Local infection
upper respiratory tract inflammation
sore throat, nausea, vomiting,
swollen lymph nodes,
pseudomembrane formation
can cause asphyxiation
Corynbacterium diptheriae
Diagnostic methods
Pseudomembrane and swelling indicative
Stains
Conditions, history
Serological assay
Treatment:
Antitoxin
Penicillin or erythromycin
Mycobacteria
gram-positive irregular bacilli
acid-fast staining
strict aerobes
produce catalase
possess mycolic acids & a unique type of
peptidoglycan
do not form capsules, flagella or spores
grow slowly
2 medically important:
Mycobacterium tuberculosis
Mycobacterium leprae
Mycobacterium tuberculosis
contain complex waxes
& cord factor
prevent destruction by
lysosomes of
macrophages
transmitted by airborne
respiratory droplets
only 5% infected people
develop clinical disease
Primary TB
infectious dose 10 cells
phagocytosed by
alveolar macrophages
multiply intracellularly
Secondary TB
reactivation of bacilli
tubercles expand & drain into the
bronchial tubes & upper respiratory tract
gradually patient experiences more
severe symptoms
violent coughing, greenish or bloody sputum,
fever, anorexia, weight loss, fatigue
Extrapulmonary TB
during secondary TB, bacilli disseminate
to regional lymph nodes, kidneys, long
bones, genital tract, brain, meninges
these complications are grave
Diagnosis
1. in vivo or tuberculin
testing
2. X rays
3. direct identification
of acid-fast bacilli in
specimen
4. cultural isolation
and biochemical
testing
Treatment of TB
6-24 months of at least 2 drugs from a list
of 11
one pill regimen called Rifater (isoniazid,
rifampin, pyrazinamide)
vaccine based on attenuated bacilli
Calmet-Guerin strain of M. bovis used in
other countries
Mycobacterium leprae
Hansens bacillus
strict parasite
slowest growing of all species
multiplies within host cells in large packets
called globi
causes leprosy
chronic disease that begins in the skin & mucous
membranes & progresses into nerves
lepromatous
deeply nodular infection
causes severe disfigurement of the
face & extremities
Diagnosing
Combination of
symptomology,
microscopic
examination of
lesions, and patient
history
Detection of acid-fast
bacilli in skin lesions,
nasal discharges, and
tissue samples
Propionibacterium acnes
gram-positive rods
aerotolerant or
anaerobic
nontoxigenic
common resident of
sebaceous glands
causes acne
Actinomycetes
Filamentous Bacteria
Genera Actinomyces &
Nocardia are nonmotile
filamentous bacteria
related to mycobacteria
Actinomyces sp
responsible for diseases
of the oral cavity &
intestines
Nocardia brasiliensis
causes pulmonary
disease similar to TB
Bacterial Meningitis
meninges of brain and
spinal cord
cross the blood-brain
barrier
can be caused by
several bacterial
species
Neisseria meningitides
Streptococcus
pneumoniae
Haemophilus influenzae
Neisseria
Gram-negative, bean-shaped, diplococci
none develop flagella or spores
capsules on pathogens
Strict parasites
do not survive long outside of the host
Neisseria meningitidis
Virulence factors
capsule, pili, IgA protease
12 strains
serotypes A, B, C, cause most cases
Clinical Diagnosis
Gram stain, CSF,
blood, or
nasopharyngeal
sample
Culture for
differentiation
Rapid tests for
capsular antigen
Neisseria gonorrhoeae
Causes gonorrhea
Virulence factors
pili, other surface molecules, IgA protease
Gonorrhea
Males
urethritis, yellowish
discharge, scarring &
infertility
Extragenital infections
anal, pharygeal,
conjunctivitis,
septicemia, arthritis
Gonorrhea
Females
vaginitis, urethritis,
salpingitis (PID) mixed
anaerobic abdominal
infection
common cause of
sterility & ectopic tubal
pregnancies
Gonorrhea in Newborns
Infected as they pass
through birth canal
Eye inflammation,
blindness
Prevented by
prophylaxis after birth
Enterobacteriaceae Family
Enterics
gram-negative bacteria
many members inhabit soil,
water, & decaying matter
all members are small, nonsporing rods
facultative anaerobes
grow best in air
Enterobacteriaceae Family
Coliforms in Normal Flora
Rapid lactose-fermenting enteric bacteria that are normal flora and
opportunistic
E. coli
Enterobacter
Serratia
Klebsiella
Hafnia
Citrobacter
Enterobacteriaceae Family
True Pathogenic Enterics
Salmonella typhi
S. cholerae-suis
S. enteritidis
Shigella dysenteriae
S. flexneri
S. boydii
S. sonnei
Yersinia enterocolitica
Y. pseudotuberculosis
True Pathogenic
Nonenterics
Yersinia pestis
Testing of Enterics
miniaturized, multichambered tube
inoculating rod pulled through length of
tube
carries an inoculum to all chambers
Escherichia coli
enterotoxigenic E. coli
causes severe diarrhea due to heat-labile toxin & heatstable toxin
stimulate secretion & fluid loss
also has fimbrae
enteroinvasive E. coli
causes inflammatory disease of the large intestine
enteropathogenic E. coli
linked to wasting from infantile diarrhea
Enterohemorrhagic E. coli
Newest strain
Can permanently damage kidney
Escherichia coli
pathogenic strains frequent agents of
infantile diarrhea
greatest cause of mortality among babies
Klebsiella pneumoniae
Coliforms
normal inhabitant of
respiratory tract
large capsule
cause of nosocomial
pneumonia, meningitis,
bacteremia, wound
infections & UTIs
Other Coliforms
Serratia marcescens
produces a red pigment
causes pneumonia,
burn & wound
infections, septicemia &
meningitis
Citrobacter
opportunistic UTIs &
bacteremia
Salmonella
Motile
ferments glucose
S. cholerae-suis
pigs
S. enteritidis
1,700 serotypes
salmonellosis
zoonotic
gastroenteritis 2-5 days
Typhoid Fever
caused by Salmonella enterica
serotype Typhi
(S. typhi)
typhoid fever
ingested bacilli adhere to small
intestine
cause invasive diarrhea that leads
to septicemia
Flies
Food
Fingers
Feces
Fomites
Shigella
shigellosis
incapacitating dysentery
S. dysenteriae, S. sonnei,
S. flexneri & S. boydii
produce H2S or urease
Nonmotile
nonencapsulated
Shigella
invades villus of large intestine
can perforate intestine or invade blood
enters Peyers patches & instigates inflammatory
response
endotoxin & exotoxins
treatment
fluid replacement & ciprofloxacin & sulfa-trimethoprim
Yersinia pestis
tiny, gram-negative rod
unusual bipolar staining & capsules
virulence factors
capsular & envelope proteins protect against
phagocytosis & foster intracellular growth
coagulase
Yersinia pestis
sylvatic plague
humans develop plague through contact with wild
animals
urban plague
domestic or semidomestic animals or infected humans
flea vectors
bacteria replicates in gut, coagulase causes blood
clotting that blocks the esophagus
flea becomes ravenous
Pathology of Plague
bubonic
bacillus multiplies in flea bite, enters lymph, causes
necrosis & swelling in groin or axilla
bubo
septicemic
progression to massive bacterial growth
virulence factors cause intravascular coagulation
subcutaneous hemorrhage & purpura
black plague
pneumonic
infection localized to lungs, highly contagious
fatal without treatment
Plague
Treatment
streptomycin,
tetracycline or
chloramphenicol
Killed or attenuated
vaccine
Pathogenic, Gram-Negative,
Facultatively Anaerobic Bacilli
The Pasteurellaceae
Haemophilus
Haemophilus
influenzae
Most strains have
capsule that resists
phagocytosis
H. influenzae type b is
most significant
Pathogenic, Gram-Negative,
Facultatively Anaerobic Bacilli
The Pasteurellaceae
Haemophilus
Sexually transmitted
Haemophilus
Caused by H. ducreyi
Causes genital ulcer
called chancroid
Often asymptomatic
in women
Bartonella
small gram-negative
Fastidious, cultured on blood agar
causes:
trench fever
spread by lice
cat-scratch disease
lymphatic infection associated with a clawing injury by
cats
Brucella
Brucellosis, malta fever, undulant fever, & Bang
disease
zoonosis transmitted to humans from infected animals
aerobic coccobacilli
2 species
Brucella abortus (cattle)
Brucella suis (pigs)
combination of tetracycline
& rifampin or streptomycin
animal vaccine available
potential bioweapon
Bordetella pertussis
aerobic coccobacillus
causes pertussis or whooping cough
communicable childhood affliction
Bordetella pertussis
virulence factors
receptors that recognize & bind to ciliated
respiratory epithelial cells
toxins that destroy & dislodge ciliated cells
DTaP vaccine
acellular vaccine contains toxoid & other Ags
Pseudomonas
small gram-negative bacilli
single polar flagellum
produce oxidase & catalase
highly versatile metabolism
Pseudomonas aeruginosa
intestinal resident in 10% normal people
resistant to soaps, dyes, quaternary
ammonium disinfectants, drugs, drying
Use aerobic respiration
do not ferment carbohydrates
Pseudomonas aeruginosa
common cause of nosocomial infections in hosts
with burns, neoplastic disease, cystic fibrosis
complications include pneumonia, UTI,
abscesses, otitis, & corneal disease
grapelike odor
greenish-blue pigment (pyocyanin)
multidrug resistant
Francisella tularensis
causes tularemia
zoonotic disease of mammals (particularly rabbits)
endemic to the northern hemisphere
Aerobic bacilli
transmitted by contact with infected animals,
water & dust or bites by vectors
headache, backache, fever, chills, malaise &
weakness
10% death rate in systemic & pulmonic forms
intracellular persistence can lead to relapse
gentamicin or tetracycline
potential bioterrorism agent
Legionella pneumophila
Legionellosis, Legionaires
disease
Motile aerobic bacilli
widely distributed in water
live in close association with
amebas
prevalent in males over 50
nosocomial disease in elderly
patients
fever, cough, diarrhea,
abdominal pain, pneumonia
fatality rate of 3-30%
azithromycin
Coxiella burnetti
Q fever
intracellular parasite
produces an unusual resistant spore
harbored by a wide assortment of vertebrates &
arthropods
transmitted by air, dust, unpasteurized milk, ticks
usually inhaled causing pneumonitis, fever,
hepatitis
tetracycline treatment
vaccine available
Rickettsias, Chlamydias,
Spirochetes and Vibrios
Rickettsia
obligate intracellular parasites
gram-negative cell wall
among the smallest bacteria
nonmotile pleomorphic rods or coccobacilli
ticks, fleas & louse are involved in their life cycle
bacteria enter endothelial cells & cause necrosis
of the vascular lining
treat with tetracycline & chloramphenicol
4 Types of Rickettsioses
1. epidemic typhus
R. prowazekii
carried by lice
starts with a high fever, chills, headache, rash
Brill-Zinsser is a chronic, recurrent form
2. endemic typhus
R. typhi
harbored by mice & rats
occurs sporadically in areas of high flea infestation
milder symptoms
4 Types of Rickettsioses
3. Rocky Mountain spotted fever
R. rickettsii
zoonosis carried by dog & wood ticks
most cases on eastern seaboard
distinct spotted rash
4 Types of Rickettsioses
4. Ehrlichia genus
Chlamydia
obligate intracellular
parasites
small gram-negative cell
wall
alternate between 2
stages
elementary body
small metabolically inactive,
extracellular, infectious form
reticulate body
grows within host cell
vacuoles
Chlamydia trachomatis
trachoma
attacks the mucous membranes of the
eyes, genitourinary tract & lungs
ocular trachoma
severe infection, deforms eyelid &
cornea, may cause blindness
inclusion conjunctivitis
occurs as babies pass through birth
canal
prevented by prophylaxis
STD
urethritis, cervicitis, scarring
lymphogranuloma venereum
disfiguring disease of the external
genitalia & pelvic lymphatics
Other Chlamydia
C. pneumoniae
causes an atypical pneumonia
serious in asthma patients
C. psittaci
causes ornithosis
zoonosis transmitted to humans from bird vectors
highly communicable among all birds
Treponema
Gram-negative spirochetes
live in the oral cavity, intestinal tract, &
perigenital regions of humans & animals
pathogens are strict parasites
Treponema pallidum
human is the natural host
extremely fastidious &
sensitive
cannot survive long outside
of the host
causes syphilis
infectious dose is
57 organisms!!
Stages of Syphilis
Primary syphilis
appearance of hard
chancre at site of
inoculation
chancre heals
spontaneously
Secondary syphilis
fever, headache, sore
throat, red or brown rash
on skin, palms and soles
rash disappears
spontaneously
Stages of Syphilis
Tertiary syphilis
about 30% of infections enter
in tertiary stage
can last for 20 years or longer
neural, cardiovascular
symptoms, gummas develop
Congenital syphilis
nasal discharge, skin
eruptions, bone deformation,
nervous system abnormalities
Borrelia
Borrelioses
Gram-negative spirochetes
transmitted by arthropod vector
B. hermsii
relapsing fever
B. burgdorferi
Lyme disease
tick-borne
after 2-15-day incubation, patients have high
fever, shaking, chills, headache, & fatigue
Nausea, vomiting, muscle aches, abdominal
pain
extensive damage to liver, spleen, heart, kidneys, &
cranial nerves
tetracycline
Leptospira
Gram-negative spirochetes
L. interrogans
causes leptospirosis
zoonosis
bacteria shed in urine
infection occurs by contact
targets kidneys, liver, brain, eyes
Vibrio cholera
Cholera
Curviform gramnegative
top 7 causes of
morbidity & mortality
ingested with food or
water
infectious dose 108
Vibrio cholera
infects surface of small intestine,
noninvasive
cholera toxin causes electrolyte & water
loss through:
secretory diarrhea, resulting dehydration leads
to muscle, circulatory, & neurological symptoms
Treatment
oral rehydration, tetracycline
vaccine
Campylobacter jejuni
important cause of bacterial
gastroenteritis
transmitted by beverages &
food
Curviform gram-negative
Helicobacter pylori
Curviform gram-negative
discovered in 1979 in stomach biopsied
specimens
causes 90% of stomach & duodenal
ulcers
people with type O blood have a 1.5-2X
higher rate of ulcers
produces large amounts of urease
Miscellaneous
Alcaligenes
live primarily in soil & water
may become normal flora
A. faecalis
Aerobic, gram-negative bacilli
most common clinical species
isolated from feces, sputum, & urine
occasionally associated with
opportunistic infections
pneumonia, septicemia, & meningitis
Peridontal disease
soft tissue disease
plaque becomes calcified
into calculus above and
below the gingiva
irritates tender gingiva
causing inflammation
gingivitis
pockets between tooth &
gingiva are invaded by
bacteria
tooth socket may be
involved
peridontitis