gram positive (purple/blue) coccirods (bacilli) clostridium (anaerobe) listeria bacillus...
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Gram Positive (purple/blue)
Cocci Rods (bacilli)CLOSTRIDIUM (anaerobe) LISTERIABACILLUSCORYNEBACTERIUM
Catalse (+)STAPH
Catalse (-)STREP
Coagulase (+)S. AUREUS
Coagulase (-)
Novobiocin (+)S. EPIDERMIDIS
Novobiocin (-)S. PNEUMONIAE
Hemolysis
α
β
γ
CapsuleS. PNEUMONIA
No CapsuleVIRIDANS STREP
Group AS. PYOGENESGroup BS. AGALACTAIE
ENTEROCOCCUSPEPTOSTREPTOCOCCUS
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Gram Negative (pink)
Cocci Rods
“Coccoid” RodsH. FLUPASTURELLABRUCELLABORDETELLA PERTUSSISMaltose Fermenter
NEISSERIA MENINGITIDISNon FermenterNEISSERIA GONORRHOEAE
Fast lactose FermenterKLEBSIELLAE. COLIENTEROBACTER
Slow FermenterCITROBACTERSERRATIA
Lactose Nonfermenter
Oxidase NegativeSHIGELLASALMONELLAPROTEUS
Oxidase PositivePSEUDOMONAS
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Gram positive Gram negative
2 envelope layers: 1) cytoplasmic membrane 2) thick peptidoglycan layer
3 envelope layers: 1) cytoplasmic membrane 2 )thin peptidoglycan layer
3) phospholipid/LPS Low lipid content High lipid contentNo endotoxin Endotoxin No periplasmic space Periplasmic space
Teichoic Acid O Specific Side chain
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Metabolic Characteristics
• Obligate aerobes
• Facultative anaerobes
• Microaerophilic bacteria
• Obligate Anaerobes
•Love oxygen •Need it to grow•Have all 3 enzymes
•Like oxygen /doesn’t require it
•Can use anaerobic fermentation
•Catalase and Superoxide Dismutase
•Like small amounts of oxygen•Aerotolerent anaerobes•Superoxide Dismutase
•Don’t like oxygen•No enzymes to counter act
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Gram Positive Pathogens• Cocci
– Staphylococci– Streptococci
• Rods (bacilli)– Spore formers
• Bacillus • Clostridium
– Nonspore formers• Nonfilamentous
– Corynebacterium– Listeria– [Mycobacterium-kind of]
• Filamentous– Actinomyces– Nocardia
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Gram Positive Pathogens
Staphylococcus
StreptococcusCocci-catalase test
Streptococci-negative
Staphylococci-positive
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Genus: Staphylococci• Gram Positive Cocci in groups and clusters• Catalase positive• Coagulase Test for differentiation
– S. Aureus-positive– S. Epidermidis-negative– S. Saprophyticus-negative
Virulence factors
•Surface protein A binds to Fc portion of IgG (prevents opsonization)
•Enterotoxin and TSST-1 toxins
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Staphylococcus AureusDirect infection
Impetigo
MRSA
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Staphylococcus Aureus diseases due to toxins
Scalded Skin Syndrome
Enterotoxin
Very stable
TSST-1
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Genus: Staphylococcus
Staph Epidermidis
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Genus: Streptococcus
Catalase Negative Gram Positive Cocci in pairs and chains
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Genus: Streptococcus
• S. pyogenes• S. agalactiae• S. pneumoniae • Enterococcus
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Genus: Streptococcus
• Lancefield Antigens– Lancefield antigens denote cell wall carbohydrates– The presence of Lancefield antigens defines the
pyogenic streptococci– Groups A through T
• A,B, C and D are most important
– Some Streptococcus are not assigned (they do not possess) Lancefield antigens
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Genus: Streptococcus
• Hemolysis on BAP• The hemolysis is defined as alpha, beta and gamma
No Complete Partial
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Genus: Streptococcus• Strep Pyogenes
– Group A Beta Strep– Strep throat, scarlet fever, rheumatic fever, acute
glomerulonephritis, impetigo• Strep Agalactactiae
– Group B Beta Strep– Perinatal sepsis, meningitis and/or pneumonia
• Strep Pneumoniae– Pneumococcus– Optichin Sensitive– Otitis media, pneumonia, meningitis
• Enterococcus – Group D– UTI
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Genus: Streptococcus
• Group A Beta Strep– S. pyogenes
• Strep Throat• Scarlet Fever• Rheumatic Fever• Post Streptococcal Glomerulonephritis• Impetigo
Strawberry tongue
Pharyngitis
Lancefield Antigen Hemolysis on BAP
Chromatographic Immunoassay
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Genus: Streptococcus
• Strep Agalactactiae– Group B Beta Strep– Perinatal sepsis, meningitis and/or
pneumonia• Early Sepsis within one week of birth• Late Sepsis from 7days to 3 months of
birth
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Genus: Streptococcus• Alpha hemolysis• Optichin Sensitive• Gram positive Lancet Shaped Diplococci • Strep Pneumoniae
– Pneumococcus (nickname)– Otitis media, pneumonia, meningitis
Right lower lobe pneumoniaencapsulated
Significant sequalae
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Genus: Streptococcus
• Enterococcus – Group D– Virulence Factors
• Abx resistant due to PBP• Acquired Resistance• Enzymes• Adherence factors• Biofilm formation
– UTI, catheter related infections
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Gram Positive Spore Forming Rods
• Bacillus (Fac. Anaerobe)• Clostridium (Strict Anaerobe)
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Genus: Bacillus
• Fac. Anaerobe• G + Spore Forming Rod • Bacillus
– B. Anthracis• Cutaneous• Respiratory• Intestinal
RespiratoryB. Anthracis
BAP
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Genus: Clostridium
• Anaerobic G + Rod• Spore formers• Clostridium
– C. Perfringens– C Tetni– C. Botulinum– C. Difficile
Target hemolysis on BAP ~ two zones due to production of 2 toxins
Myonecrosis/ gas gangrene
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Genus: Clostridium• Anaerobic G + Rod• Spore formers• Clostridium
– C. Perfringens– C Tetni– C. Botulinum– C. Difficile
Terminal Spore
Tennis Racket
Neurotoxin binds to presynaptic terminals in prevents transmission of inhibitory neurotransmitters
DTP and DTaP
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Genus: Clostridium
• Anaerobic G + Rod• Spore formers• Clostridium
– C. Perfringens– C Tetni– C. Botulinum– C. Difficile
Infantile Botulism caused by spore ingestion with endogenous toxin production
Spores
Toxin ingestion (usual)
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Genus: Clostridium• Anaerobic G + Rod• Spore formers• Clostridium
– C. Perfringens– C Tetni– C. Botulinum– C. Difficile
Plain film of abdomen showing bowel wall thickening, loss of haustral markings (thin arrow) and dilation of the ascending and transverse colon (thick arrow)
Endoscopic view of Psuedomembranous colitis
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Gram Positive Nonspore Forming Rods
• Nonfilamentous– Corynebacterium– Listeria– [Mycobacterium-kind of]
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Genus: Corynebacterium• Gram Positive Nonspore Forming Rods• Immobile• Nonencapsulated• Nonfilamentous• Corynebacterium
– C. Diphtheriae
Pallisades/ Chinese Letter Arrangements
Barred appearance (metachromatic granules)
Pseudomembrane of throat and/or nasal cavity
DTP and DTaP
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Genus: Listeria
• Gram Positive Nonspore Forming Coccobacilus• Tumbling motility at 25 degrees Celsius• Nonfilamentous
– Listeria• L. Monocytogenes
Beta hemolysis
Raw milk, soft cheeses, ice cream, raw vegetables, raw or cooked poultry, raw meat, raw or smoked fish
Transplacental and birth canal transmission
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Genus: Mycobacterium• Gram Positive Nonfilamentous Nonspore Forming Rods• Strict aerobe• Very slow growing• Weakly gram positive• Acid Fast-waxy cell wall-mycolic acid
– [Mycobacterium -kind of]• M. Tuberculosis• M.Leprae
Divides every 15 to 20 hours
Acid fast gram positive bacteria
PPD
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Genus: Mycobacterium• Gram Positive Nonfilamentous Nonspore Forming Rods• Waxy coating->acid fast• Aerobic/ nonmotile• Can not grow in artificial culture• [Mycobacterium -kind of]
– M. Tuberculosis– M.Leprae
• Leprosy• Hanson’s Disease
Nine banded Armadillo
Incubation is 2-20 years
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• Gram Positive Filamentous Nonspore Forming Rods
• Aerobic to Fac. Anaerobe• Opportunistic• Actinomyces
– A. Israelii• Nocardia
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Genus: Actinomyces
• Gram Positive Filamentous Nonspore Forming Rods
• Aerobic to Fac. Anaerobe• Non acid fast• Opportunisitic• Actinomyces
– A. Israelii Lumpy Jaw
Actinomycoses infections are polymicrobial
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Genus: Nocardia• Gram Positive Filamentous • Branching• Weakly acid fast• Strict aerobe• Catalase positive• Nonspore Forming Rods
– Nocardia
Primary source is soil
Colonies smell like wet dirt
Low virulence opportunistic infection
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Now on to Gram Negatives
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Gram Negative Cocci
• Neisseria– N. Meningitidis– N. Gonnorhea
• Moraxella– Branhemella Cattorhalis
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• Gram Negative Cocci • Kidney bean shape• Ferments maltose and glucose like
meningitis• Oxidase and catalase positive• Endotoxin production• Neisseria
– N. Meningitidis• Meningiococcus (nickname)• Meningitis, septic shock
– N. Gonnorhea
Nonblanching petechial rash
Kidney bean shape
Not B
Direct or from cultured specimen
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• Gram Negative Cocci• Kidney bean shaped • Neisseria
– N. Gonorrhea• Gonorrhea• Ophthalmia Neonatorum
Culture is the gold standard
Nucleic Acid Amplification TestsOphthalmia Neonatorum
$$$
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• Gram Negative Cocci • Aerobic• Moraxella
– Branhemella Catorrhalis• Otitis media, sinusitis
sinusitis
Otitis media
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Gram Negative Spirochetes
• Treponema– T. Pallidum
• Borrelia– B. Burgdorfi– B. Recurrentis
• Leptospira
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Gram Negative Spirochetes• Too small for gram stain• Can not be cultured from clinical specimen• Dark field microscopy of clinical sample• Treponema
– T. Pallidum• Syphillus-acquired and congenital
– Nontreponemal tests– Treponemal tests
Electron Micrograph
Secondary stage
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Gram Negative Spirochetes
• Microaerophilic• Geimsa or Wright stain• Borrelia
– B. Burgdorfi
Erythema migrans
western black-legged tick (Ixodes)
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Gram Negative Spirochete• Aerobic• Motile• G –cell envelope• Animal reservoirs• Flexible spirochete• Not seen on gram stain• Dark field microscopy• Leptospira
– L. Interrigans
Petichial rash
Fine spirals with hooked ends
Water transmission
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Many Many Gram Negative Bacilli• Respiratory
– Heamophilus – Bordetella– Legionella– Gardnerella
• Zoonotics– Yersinia– Franicisella– Brucella– Pasteurella– Bartonella
• Enterics – Many many
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Respiratory Gram Negative Bacilli
• small pleomorphic, gram-negative coccobacillus. • Nonmotile• non–spore-forming• fastidious• facultative anaerobe• Heamophilus
– H. Influenzae– H. Ducryi
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Respiratory Gram Negative Bacilli
• Small pleomorphic, gram-negative coccobacillus. • Nonmotile• non–spore-forming• Fastidious-X &V factor• facultative anaerobe• Heamophilus
– H. Influenzae• HIb• Epiglottitis, otitis media, meningitis, pneumonia
– H. Ducryi
Otitis media
Satelliting around Staph.
Epiglottitis
Insp. Stridor
conjugated
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Respiratory Gram Negative Bacilli
• small pleomorphic, gram-negative coccobacillus.
• Nonmotile• non–spore-forming• Fastidious-X &V factor
– Dies quickly outside of body
• facultative anaerobe Heamophilus – H. Ducryi
• “soft chancre”• Culture is difficult• chancroid
Painful genital ulcer
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Respiratory Gram Negative Bacilli
• Small aerobic G- Coccobacilllus• Singly and in pairs• Nicotinamide required for (slow)
growth• Bordetella
– B. Pertussis– Whooping cough
Bordet-Gengou medium
ELISA or PCR assays
DTP & DTaP Paroxysmal cough with an inspiratory whoop
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Respiratory Gram Negative Bacilli
• Nicotinamide required for (slow) growth• Bordetella
– B. Pertussis– Whooping cough
Virulence factors•Pili and surface protein for adhesion•Pertussis toxin•Enzyme that disrupts immune response•Peptidoglycan injury to ciliated trachea cells
Bordet-Gengou medium
ELISA or PCR assays
DTP & DTaP
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Respiratory Gram Negative Bacilli
• Poorly staining• Facultative Intracellular parasite• Compromised host• Aerobic• Legionella
– L. Pneumophila• Legionnaires' disease
– Pneumonia
Urinary antigenSputum culture
Paired serum sample
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NONRespiratory Gram Negative Bacilli
• Presumptive Identification– Clue Cells– KOH
• Does not require X & V factors• Gardnerella
– G. Vaginalis• Bacterial Vaginosis (BV), preterm labor
cervicitis
Whiff TestClue cells
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Zoonotic Gram Negative Bacilli• Yersinia
• Y. Pestis– Franicisella
• F. Tulerensis– Brucella
• B. Suis• B. Meltensis• B. Abortus• B. Canis
– Pasteurella• P. Multicida
– Bartonella• B. Henselae• B. Quintana
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Bubonic Plague
Zoonotic Gram Negative Bacilli• Nonmotile• G- rod• Yersinia
• Y. Pestis
Pneumonic Plague
bubo
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•G- bacillus•Aerobic•Low infecting dose•Vector->tick or deer fly•Special media•Immunoflourescence•Serum Serology (>1:40)•Franicisella
• F. Tularensis• Pneumonia• Glandular
Zoonotic Gram Negative Bacilli
ulceroglandular
pneumonia
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Zoonotic Gram Negative Bacilli
• Nonmotile• Non-acid fast• Nonsporeforming• Small G- coccobacillus• Catalase, oxidase and urease positive• Brucella
– Brucellosis
Blood culture
Recurrent flu-like symptoms with granulomas
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Zoonotic Gram Negative Bacilli
• Small G- coccobacillus• Nonspore forming• Oxidase positive• Ferments CHO• Nonmotile• PCN susceptible• Bacteriophage encoded toxin• Pasteurella
– P. Multocida• Cellulitis associated with
animal bites
Well demarcated cellulitis
Grows on BAP
Bipolar staining
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Zoonotic Gram Negative Bacilli
• fastidious • pleomorphic • aerobic • gram-negative bacillus • Bartonella
– B. Henselae• Cat Scratch Fever
– B. Quintana• Trench fever• Urban Trench Fever
Cat scratch fever
Pediculus humanus
Paired sera
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Family: Enterobacteriacea• Escherichia Coli• Shigella• Salmonella• Yersinia• Klebsiella• Proteus• Enterobacter • Serratia
•Enterics live in the gut-> are members of the family of Enterobacteriacea•O antigen is lipopolysaccaride•K antigen is polysaccharide capsule•H-flagellar antigen
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Enterics• Facultative Anaerobe• Large G- Rods• Nonsporeformers• Normal Flora• Escherichia Coli
– E. Coli (nickname)– E. Coli 0157:H7 or
0157– UTI, Sepsis, Enteric
E.Coli, Respiratory illness, multiple opportunistic infections
UTI/ Pyelonephritis
Motile strains with peritrichous flagella
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Enterics• Facultative
Anaerobe• Large G- Rods• Nonsporeformers • Relatively inert
• Shigella– S. Sonnei– S. Flexneri– S. Dysenteriae
• Shigillosis
The O antigens (LPS) define the four species of Shigella
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Enterics• G- Rod• Nonsporulating,• Facultative anaerobe• Ferment glucose• Reduce nitrate• Peritrichous flagella when
motile• Produce gas upon sugar
fermentation Salmonella– S. Typhi
• Typhoid Fever– S. Enteritidis
• Gastroenteritis
Carrier states
Eggs & Enteritidis
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Enterics• Nonmotile• G - rods • Prominent
polysaccharide capsule
• Multi Drug Resistant• Recently important
in nosocomial infections
• Normal flora• Klebsiella
– K. Pneumoniae• Pneumonia in
debilitated, UTI, etc etc.
Encapsulated/ multi drug resistant
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Enterics• Gram Negative Rod• Normal Flora• Hydrolyzes Urea (struvite
stone formation)• Proteus
– P. Mirabilis• Opportunistic infections
including UTI
Highly motile
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Enterics• G-Rod• Multi drug
resistance• Enterobacter
– E. Aerogenes– E. Cloacae
• UTI,Endocarditis, opportunistic infection
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Enterics• G-rods• Opportunistic
infection Serratia– S. Marcescens
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Other Gram Negative Rods• Vibrio• Helicobacter• Pseudomonas• Bacteroides
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Other Gram Negative Rods• Vibrio
– V. Cholerae
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Other Gram Negative Rods• Helicobacter
– H. Pylori
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Other Gram Negative Rods• Helicobacter
– Campylobacter Jejuni
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Other Gram Negative Rods
• Pseudomonas– Ps. Aeruginosa
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Other Gram Negative Rods
• Bacteroides – B. Fragilis
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• Chlamydia• Rickettsia • Coxiella• Ehrlichia
Weird Bugs
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• Chlamydia – C. Trachomatis
Weird Bugs
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• Obligate intercellular gram negative coccobacilli
• Vector– Dermacentor variabilis (dog
tick) East US– Dermacentor andersoni
Rocky Mountain region and Canada
• Rickettsia– R. Ricketseii
Weird Bugs
Peticheal rash
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• Obligate intercellular gram negative coccobacilli
• Coxiella Brunetti
Weird Bugs
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• Ehrlichia– E. chaffeensis– E. ewingii
Weird Bugs
Amblyomma americanum
Nymph left ; adult right
Ehrlichea in white tail deer fawn
Distribution of Amblyomma americanum
[Lone Star Tick]
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Genus: Mycoplasma
• Pleomorphic• No cell wall• Mycoplasma
– M. Pneumoniae• Atypical pneumonia
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The Inevitable Exceptions
• Mycobacteria– Weakly gram positive – Better seen with acid fast stain
• Spirochetes– Too small for light microscopy– Need Dark field microscopy
• Mycoplasma– No cell wall– Neither G+ or G-