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Transcript
Streptococcus pneumoniae
Staphylococci
(Gram positive cocci)
Lecture 38
Faculty: Dr. Alvin Fox
1
KEYWORDS
•
−
−
−
−
−
−
−
−
• Staphylococcus aureus
S. pneumoniae
- coagulase (+)
diplococci
- MRSA (methicillin resistant S. aureus)
Pneumococcus
- opportunistic diseases
autolysin
- food poisoning/enterotoxins
bile solubility test
- toxic shock syndrome/toxic shock toxin
optochin susceptibility - exfoliative toxin/scalded skin syndrome
- α, β, γ and δ cytotoxins
capsule
- leucocidin
Quellung reaction
- lipase
Polyvalent vaccine
- hyaluronidase
- protein A
- coagulase (–)
- Staphylococcus epidermidis
2
- Staphylococcus saprophyticus
S. pneumoniae
3
S. pneumoniae
• leading cause of pneumonia
– particularly young and old
– member normal flora, nasopharynx
– replication and spread after damage to upper
respiratory tract (e.g. after the flu)
• bacteremia
• meningitis
• middle ear infections (otitis media) - children
4
S. pneumoniae
• α hemolytic
• pneumolysin
– degrades red blood cells under aerobic conditions
• grows well on sheep blood agar
• no group antigen
5
Diagnosis - spinal fluid
• direct Gram staining
• detection of capsular antigen
6
Autolysis – identification after
growth
autolysin
lipoteichoic acid
Bile
teichoic acid
-choline
peptidoglycan
autolysin
Cell membrane
7
C polysaccharide
• Teichoic acid (C polysaccharide)
– precipitates in serum
– binds C-reactive protein
8
Identification
optochin resistant
optochin sensitive
9
Capsule
• prominent
– virulent strains
• anti-phagocytic
• carbohydrate antigens
– highly variable among strains
– numerous serotypes
10
Capsular vaccine
• Immunity
– serotype specific
– to eradicate the organism in normal flora
• Vaccine
– a few major serotypes (polyvalent)
• Vaccination or the susceptible population
– young children
– elderly
• Immunization
– major serotypes susceptible to change
– population monitoring essential
11
Quellung reaction
• using antisera
• capsule "fixed"
• visible microscopically
12
Pathogenesis
• Teichoic acid
– complement activation
– large numbers of inflammatory cells at
infection site
13
Therapy
• S. pneumoniae
–
most strains susceptible to penicillin
– resistance is common
14
STAPHYLOCOCCI
•
•
•
•
•
Gram positive
Facultative anaerobes
Grape like-clusters
Catalase positive
Major components
of normal flora
- skin
- nares
15
Staphylococcus aureus
16
One of commonest opportunistic
infections, both hospital and community
acquired:
• pneumonia
• osteomyelitis
• septic arthritis
• bacteremia
• endocarditis
• abscesses/boils
• other skin infections
17
Antibiotic therapy
• Resistance to penicillin
– penicillinase
• Resistance to methicillin
‾ modified penicillin binding protein
‾ methicillin resistant S. aureus (MRSA)
•
Vancomycin
• current drug of choice
• resistance observed but uncommon at this time
18
Hospital infection control
• MRSA now such a problem
– monitoring by PCR of nasal swabs
– eradication
• antibiotics
• whole body antisepsis
19
Food poisoning
• not an infection
• food contaminated by humans
– growth of bacteria
– production of enterotoxin
• onset and recovery both occur
within few hours
20
Food poisoning
•
•
•
•
Vomiting
nausea
diarrhea
abdominal pain
21
Toxic shock syndrome.
22
Toxic shock syndrome
•
•
•
•
•
fever
rash
desquamation
vomiting
diarrhea
23
Toxic shock syndrome
• Toxic shock toxin
- Dissemination
• Organism
– no dissemination
24
S. aureus
• babies
– scalded skin syndrome
• exfoliatin
25
Lytic exotoxins:
•
•
•
•
α toxin
β toxin (sphingomyelinase C)
γ toxin
δ toxins
– detergent-like
• leucocidins
26
Protein A inhibits phagocytosis
Fc receptor
immunoglobulin
PHAGOCYTE
Protein A
BACTERIUM
27
Spread
• tissue-degrading enzymes
– lipase
– hyaluronidase
28
Identification
• Sheep blood agar
– β hemolytic
– yellow pigmented (aureus)
• mannitol fermentation
• coagulase-positive
• phage-typing, rarely performed
29
Staphylococcus epidermidis
• major member, skin flora
• opportunistic infection
- less common than S.aureus
• nosomial infections
- shunts, catheters
• artificial heart valves/joints
30
Identification
• Sheep blood agar
– non-hemolytic
– Non-pigmented
• Does not ferment mannitol
• Coagulase negative
31
Several other coagulase
negative staphylococcal species
• common on human skin
• some species cause opportunistic infection
32
Staphylococcus saprophyticus
• urinary tract infections
• this coagulase-negative species (and others)
– not usually differentiated from S. epidermidis
33
Summary Figure (Identification Scheme)
Note: S. viridans is
ALPHA hemolytic and
negative for all the tests
below
GRAM POSITIVE COCCI
Catalase
-
+
Staphylococcus(Clusters)
Coagulase
+
S. aureus
Beta hemolytic
mannitol
yellow
-
S. epidermidis
Non-hemolytic
mannitol
white
Streptococcus (pairs & chains)
Hemolysis/Test
BETA: Bacitracin
S. pyogenes(group A)
+
CAMP/ Hippurate
+
S. agalactiae (group B)
ALPHA: Optochin /Bile Solubility
+
S. pneumoniae
GAMMA OR ALPHA: Bile Esculin
+
6.5% NaCl
Enterococcus
+
Bile Esculin
+
6.5% NaCl
Group D
Non-Enterococcus
Group D
-
34