Download bacterial eye pathogens - UAB School of Optometry

BACTERIAL EYE PATHOGENS
Dr. WILLIAM J. BENJAMIN
Eye Physiology & Ocular Prosthetics Laboratory
University of Alabama at Birmingham
School of Optometry
Presented at the UAB School of Optometry as Part of
MIC 200: MICROBIOLOGY and IMMUNOLOGY
O t b 30 & November
October
N
b 3,
3 2008
GRAM (+) POSITIVE COCCI
EYE PATHOGENS
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Staphylococcus aureus & epidermidis
Micrococcus species
Streptococcus pneumoniae (diplococcus)
Streptococcus pyogenese & agalactiae
Streptococcus viridans & equisimilus
GRAM (+) POSITIVE BACILLI
EYE PATHOGENS
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Bacillus cereus & 4 other species
Corynebacterium diphtheriae (w/o phage B)
Propionibacterium acnes (Acne)
Clostridium perfringens (Gangrene)
Listeria monocytogenes
GRAM (+) POSITIVE BACILLI
EYE PATHOGENS
Propionibacterium acnes
GRAM (–) NEGATIVE COCCI
EYE PATHOGENS
Ô Neisseria gonorrhoeae (diplococcus)
Ô Neisseria meningitidis
Ô Moraxella (Branhamella) catarrhalis
GRAM (–) NEGATIVE BACILLI
EYE PATHOGENS
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Pseudomonas aeruginosa
Haemophilus influenzae
Haemophilus aegyptius (Koch-Weeks Bacilli)
Moraxella lacunata (diplobacillus)
Proteus species (esp. Proteus mirabilis)
Serratia marcescens
GRAM (–) NEGATIVE BACILLI
EYE PATHOGENS
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Escherichia coli
Klebsiella species
Azotobacter species
Fusobacterium species
Pasteurella species
Yersinia species
Bacteroides fragilis
COCCOBACILLI
EYE PATHOGENS
Ô Acinetobacter species
Ô Brucella species (Brucellosis)
Ô Francisella tularensis (Tularemia)
* sometimes also, Haemophilus species
SPIROCHETE
EYE PATHOGENS
Ô Treponema pallidum (Syphilis)
Ô Borrelia burgdorferi (Lyme Disease)
Ô Leptospira interrogans (Leptospirosis)
BACTERIAL MECHANISMS TO
HEIGHTEN VIRULENCE AND
RESISTANCE
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PHYSIOLOGICAL ADAPTATIONS TO DRUG
PENICILLIN RESISTANCE: Beta Lactamase
CELL WALL: Most Gram (–), Some Gram (+)
CAPSULE or SLIME COAT of Polysaccharide
CAPSULE,
BIOFILM FORMATION (Exopolysaccharide)
COAGULASE: Fibrin Coat / Staph. aureus
BACTERIAL MECHANISMS TO
HEIGHTEN VIRULENCE AND
RESISTANCE
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FLAGELLA: Some Rods, All Spirochetes
PILI (FIMBRIAE): Most Gram (–) Rods
CYST FORMATION: Azotobacter species
SPORE FORMATION: Bacillus species
BACTERICINS
CYTOTOXINS: Fibroblasts, Epithelial Cells
Leukocidins
BACTERIAL MECHANISMS TO
HEIGHTEN VIRULENCE AND
RESISTANCE
Ô ENDOTOXINS: Within Cell Walls of Gram (–)
Ô EXOTOXINS: Clostridium botulinum & tetani
Ô PROTEASES and LIPASES
Collagenase Sphingomyelinase “IgA
IgA -ase
ase”
Elastase
Phospholipidase Streptokinase
Hemolysin Lecithinase
Hyaluronidase
Catalase
Esterase
Fibrinolysin
HOW BACTERIA BECOME
RESISTANT TO
ANTIBACTERIALS
Ô CELL WALL and MEMBRANE ALTERATIONS
Mutations Decrease Drug Transport
Ô PRODUCE ENZYMES TO INACTIVATE DRUG
Split Molecule or Add Groups
Ô RIBOSOMAL ALTERATIONS
Decrease Drug Binding at 30S Ribosome
Ô INCREASE BIOFILM PRODUCTION
HOW BACTERIA BECOME
RESISTANT TO
ANTIBACTERIALS
Ô DNA / RNA RELATED ALTERATIONS
Reduce Binding To Polymerase, Gyrase
Ô METABOLIC PATHWAY ALTERATIONS
Key Metabolites Obtained Thru Diff Path
Ô SPREAD OF VIRULENT PROPERTIES
Plasmid Exchange Between Bacteria
Ô INCREASED PURULENCE: PABA in Purulence a Contraindication to Sulfonamides
HOW ANTIBACTERIALS WORK
Ô INHIBIT CELL WALL SYNTHESIS
Cell Lysis or Alters Cell Shape
Iron Acquisition Proteins in Cell Wall
Electron Transport System in Cell Wall
EXAMPLES: Penicillins
Penicillins, Cephalosporins
Bacitracin, Vancomycin
Ô INHIBIT DNA / RNA SYNTHESIS
Bind DNA Polymerase or DNA Gyrase
EXAMPLE: Rifamycin
HOW ANTIBACTERIALS WORK
Ô INHIBIT CELL MEMBRANE FUNCTION
Leakage of Cell Contents
Intracellular Build-up of Toxic Byproducts
“Starve” Cell of Nutrients, Metabolites
EXAMPLE: Polymixins
Ô INHIBIT PROTEIN SYNTHESIS
At the Ribosome (30S)
Blocks tRNA from Forming Properly
EXAMPLE: Aminoglycosides
CULTURING OF BACTERIA
FROM THE CONJUNCTIVA AND
EYELIDS
CULTURING OF BACTERIA
FROM THE CONJUNCTIVA AND
EYELIDS
Staphylococcus aureus
CULTURING OF BACTERIA
FROM THE CONJUNCTIVA AND
EYELIDS
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STERILE SALINE; NO ANESTHETIC
DACRON SOAKED IN CALCIUM ALGINATE
DACRON OR COTTON TIP APPLICATORS
SWAB INNER LID MARGIN
Lower Preferred, but …..
Ô STREAK MARKED AGAR PLATE & DISPOSE
Ô SWAB PALP CONJ & C-d-S
Lower Preferred, but …..
Ô STREAK MARKED AGAR PLATE & DISPOSE
CULTURING OF BACTERIA
FROM THE CONJUNCTIVA AND
EYELIDS
CULTURING OF BACTERIA
FROM THE CONJUNCTIVA AND
EYELIDS
CULTURING OF BACTERIA
FROM THE CONJUNCTIVA AND
EYELIDS
Ô INCUBATE AT 35 DEGREES FOR 24-48 Hrs.
OR SEND TO MICRO LABORATORY
Ô DO NOT WAIT TO START ANTIBIOTICS
Ô KEY AGAR PLATES FOR THE O.D. OFFICE
Blood Agar: Use for Everything
Chocolate Agar: If Suspect Neisseria, etc.
Sabouraud’s
Sabouraud
s Agar: Fungi; 25 Deg,
Deg 2-10 Days
Ô CULTURE TRANSPORT PACKS: Not Good,
but sometimes necessary
CULTURING OF BACTERIA
FROM THE CONJUNCTIVA AND
EYELIDS
Ô OCULAR PATHOGENS REQUIRING
CHOCOLATE AGAR + CO2
Neisseria gonorrhoeae*
Haemophilus sp.
Moraxella lacunata
* Other Neisseria also grow better this way
Ô CULTURE TRANSPORT PACKS: Not Good,
y
but sometimes necessary
CULTURING OF BACTERIA
FROM THE CONJUNCTIVA AND
EYELIDS
CULTURING OF BACTERIA
FROM THE CONJUNCTIVA AND
EYELIDS
CULTURING OF BACTERIA
FROM THE CONJUNCTIVA,
AND EYELIDS
CULTURING OF BACTERIA
FROM THE CONJUNCTIVA AND
EYELIDS
CULTURING OF BACTERIA
FROM CORNEAL ULCERS
Ô STERILE SALINE; ANESTHETIC REQUIRED
Ô KIMURA SPATULA but not CYTOBRUSH
Ô DACRON SOAKED IN CALCIUM ALGINATE
Ô DACRON OR COTTON TIP APPLICATORS
Ô SCRAPE CENTER AND LEADING MARGIN
CORNEAL PATHOGENS
WITH SPECIAL AFFINITY FOR
CORNEAL EPITHELIUM
Ô Streptococcus pneumoniae
Prefers Corneal Epithelial Cells in general
Be sure to scrape the “leading edge”
Ô Pseudomonas aeruginosa
Prefers Basal Corneal Epithelial Cells
Be sure to scrape the center at bottom
Ô Staphylococcus aureus
CULTURING OF BACTERIA
FROM CORNEAL ULCERS
Ô STREAK AGAR PLATE
Ô DISPOSE OR FLAME: Be sure to let cool
Ô INCUBATION AT 35 DEGREES FOR 24-48 Hr.
OR SEND TO MICRO LABORATORY
Ô 50% of Microbial Ulcers WON’T
WON T GROW OUT
CULTURING OF BACTERIA
FROM CORNEAL ULCERS
Ô 50% of Microbial Ulcers WON’T GROW OUT
Ô Therefore, many attempts are “Culture-Negative”
CULTURING OF BACTERIA
FROM CORNEAL ULCERS
Ô 50% of Microbial Ulcers WON’T GROW OUT
Ô Ulcers should not be called “Sterile”
CULTURING OF BACTERIA
FROM CORNEAL ULCERS
Ô 50% of Microbial Ulcers WON’T GROW OUT
Ô Such an Ulcer is a “Culture-Negative Ulcer”
but is not necessarily a “Sterile
Sterile Ulcer”
Ulcer
CULTURING OF BACTERIA
FROM CORNEAL ULCERS
Culture-Negative Macular
Keratitis turned Ulcer
Started on Tobramycin
Ophthalmic Drops every 2
hours as dual Macular
Keratitis with Anterior
Chamber Reaction
Intensified to dual Ulcers
overnight with greater ACR
and Corneal Edema, VA ↓
Fortified Tobramycin and
F tifi d Vancomycin
Fortified
V
i
alternating every half hour
CULTURING OF BACTERIA:
The Hospital Micro Laboratory
CULTURING OF BACTERIA:
The Hospital Micro Laboratory
IDENTIFICATION OF BACTERIA
FROM CULTURES
Ô GRAM STAIN FOR (+) or (–), CELL MORPHOL.
Ô DIFF QUIK or GIEMSA STAIN SMEARS FOR
HOST INFLAMMATORY CELLS
Ô COLONY MORPHOLOGY, COLOR, ODOR,
AFTER GROWTH ON AGAR PLATES
Ô IF GRAM (+) COCCI, GO TO CATALASE TEST
Micro Labs do same
same, automated
automated, quicker
Ô IF GRAM (–) BACILLI, GO TO STRIP TESTS
Micro Labs do same, automated, quicker
IDENTIFICATION OF BACTERIA
FROM CULTURES
IDENTIFICATION OF BACTERIA
FROM CULTURES
Ô GRAM STAIN FOR (+) or (–), CELL MORPHOL.
Ô DIFF QUIK or GIEMSA STAIN SMEARS FOR
HOST INFLAMMATORY CELLS
Ô COLONY MORPHOLOGY, COLOR, ODOR,
AFTER GROWTH ON AGAR PLATES
Ô IF GRAM (+) COCCI, GO TO CATALASE TEST
Micro Labs do same
same, automated
automated, quicker
Ô IF GRAM (–) BACILLI, GO TO STRIP TESTS
Micro Labs do same, automated, quicker
IDENTIFICATION OF BACTERIA
FROM CULTURES
Serratia marcescens
IDENTIFICATION OF BACTERIA
FROM CULTURES
Pseudomonas aeruginosa
IDENTIFICATION OF BACTERIA
FROM CULTURES
Ô GRAM STAIN FOR (+) or (–), CELL MORPHOL.
Ô DIFF QUIK or GIEMSA STAIN SMEARS FOR
HOST INFLAMMATORY CELLS
Ô COLONY MORPHOLOGY, COLOR, ODOR,
AFTER GROWTH ON AGAR PLATES
Ô IF GRAM (+) COCCI, GO TO CATALASE TEST
Micro Labs do same
same, automated
automated, quicker
Ô IF GRAM (–) BACILLI, GO TO STRIP TESTS
Micro Labs do same, automated, quicker
IDENTIFICATION OF
BACTERIA
FROM
CULTURES:
GRAM (+)
COCCI
IDENTIFICATION OF BACTERIA
FROM CULTURES: GRAM (–) RODS
IDENTIFICATION OF BACTERIA
FROM CULTURES: AUTOMATION
IDENTIFICATION OF BACTERIA
FROM CULTURES: ANAEROBES
IDENTIFICATION OF BACTERIA
FROM CULTURES
Ô IF GRAM (+) BACILLI, SEND TO EXPERT
Ô IF GRAM (–) COCCI, MUST BE Neisseriarelated BUT SEND TO EXPERT ANYWAY
Ô IF COCCOBACILLI, SEND TO EXPERT
Micro Labs do these last three categories by
hand, plus any strange Gram (+) Cocci and
Gram (–) Bacilli
IDENTIFICATION OF BACTERIA
FROM CULTURES
QuadFerm Test for Neisseriarelated organisms
ID OF GRAM (+) COCCI
((continued … )
ID OF GRAM (+) COCCI
( … continued)
IDENTIFICATION OF GRAM (+)
COCCI
Ô CATALASE TEST
Catalase (+) = Staphylococcus species
Catalase (–) = Streptococcus species
Ô COAGULASE TEST / MANNITOL FERMENT.
Coagulase (+)
( ) = Staphylococcus aureus
Coagulase (–) =
Staphylococcus epidermidis, et al
IDENTIFICATION OF GRAM (+)
COCCI
Mannitol fermentation = Coagulase test (+) and (–)
IDENTIFICATION OF GRAM (+)
COCCI
Ô GAMMA (NO) HEMOLYSIS (Nonhemolytic)
Group D Streptococcus sp. (Enterococci)
Ô BETA (COMPLETE) HEMOLYSIS
A DISC (Bacitracin) Sensitive (+)
p A: Streptococcus
p
pyogenes
py
g
Group
A DISC (Bacitracin) Insensitive (–)
Non Group A, Beta Hemolytic Strept.
species (Streptococcus agalactiae)
Ô A Disc = Bacitracin
IDENTIFICATION OF GRAM (+)
COCCI
Streptococcus pyogenes
(Strong ß hemolysis
hemolysis, A disc sensitive)
IDENTIFICATION OF GRAM (+)
COCCI
Streptococcus agalactiae
(Weak ß hemolysis,
A disc insensitive)
ID OF GRAM (+) COCCI:
Strong vs. Weak ß Hemolysis
CAMP Test: Staph. aureus, Strept. agalactiae, & Strept. pyogenes
IDENTIFICATION OF GRAM (+)
COCCI
Ô ALPHA (INCOMPLETE) HEMOLYSIS
P DISC (Optochin) Sensitive (+)
Streptococcus pneumoniae
P DISC (Optochin) Insensitive (–)
( )
Streptococcus viridans or Group D
Ô P Disc = optochin = ethyl hydrochloride
IDENTIFICATION OF GRAM (+)
COCCI
Streptococcus pneumoniae
(α hemolysis,
hemolysis P disc sensitive)
IDENTIFICATION OF GRAM (+)
COCCI and GRAM (–) BACILLI
Ô AUTOMATED IDENTIFICATION
IDENTIFICATION OF GRAM (+)
COCCI and GRAM (–) BACILLI
Ô AUTOMATED IDENTIFICATION
BACTERIAL SUSCEPTIBILITY
TO ANTI-BACTERIALS
DISC DIFFUSION METHOD
Ô LARGE QUANTITY OF BACTERIUM NEEDED
Ô PLACE IN THIOGLYCOLLATE BROTH, MIX
Ô STANDARDIZED MUELLER-HINTON AGAR
MH+5%
MH
5% Sheep Blood for Strept. pneumo.
MH Chocolated for Neisseria, Moraxella,
& Haemophilus species
Ô STREAK EVENLY OVER ENTIRE SURFACE
Ô PLACE SET OF DISCS WITH DIFF AGENTS
BACTERIAL SUSCEPTIBILITY
TO ANTI-BACTERIALS
DISC DIFFUSION METHOD
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INCUBATE 24 Hrs. AT 35 DEGREES
DIAMETERS OF INHIBITORY ZONES IN mm
COMPARE DIAM’s TO STANDARD CHART
THIS PROCEDURE HAS
BEEN AUTOMATED,
COMPUTERIZED FOR
Mueller Hinton Agar
Mueller-Hinton
BACTERIAL SUSCEPTIBILITY
TO ANTI-BACTERIALS
DISC DIFFUSION METHOD
Anti-bacterials for Gram (+)
BACTERIAL SUSCEPTIBILITY
TO ANTI-BACTERIALS
DISC DIFFUSION METHOD
Anti-bacterials for Gram (–)
BACTERIAL SUSCEPTIBILITY
TO ANTI-BACTERIALS
DISC DIFFUSION METHOD
Anti-bacterials
A
ib
i l for
f
Streptococcus pneumoniae
BACTERIAL SUSCEPTIBILITY
TO ANTI-BACTERIALS
SERIAL DILUTION METHOD
Ô TEST TUBES WITH BROTH & AGENT
Ô AGENT IN DIMINISHING CONCENTRATION
Ô LOWEST CONC. TO DENY VISIBLE GROWTH
Minimum Inhibitory Concentration (MIC)
Ô LOWEST CONC. TO KILL 99.9% INOCULUM
Minimum Bactericidal Concentration (MBC)
BACTERIAL SUSCEPTIBILITY
TO ANTI-BACTERIALS
SERIAL DILUTION METHOD
Ô AUTOMATED SERIAL DILUTION vs. LIMITED
AGENTS COMBINED WITH ID OF GRAM (+) and ((–))
BACTERIAL SUSCEPTIBILITY
TO ANTI-BACTERIALS
EPSILOMETER METHOD
Ô LARGE QUANTITY OF BACTERIUM NEEDED
Ô MIX IN THIOGLYCOLATE BROTH
Ô STANDARDIZED MUELLER-HINTON AGAR
MH+5%
MH
5% Sheep Blood for Strept. pneumo.
MH Chocolated for Neisseria, Moraxella,
& Haemophilus species
Ô STREAK EVENLY OVER ENTIRE SURFACE
BACTERIAL SUSCEPTIBILITY
TO ANTI-BACTERIALS
EPSILOMETER METHOD
Ô PLACE SET OF “E TEST” STRIPS WITH DIFF.
ANTIMICROBIAL AGENTS
Ô EACH AGENT IN DIMINISHING CONCENTRATION ALONG E TEST STRIP
Ô INCUBATE 24 Hrs. AT 35 DEGREES
Ô ASSESS INHIBITION FOR MINIMUM INHIBITORY CONCENTRATION (MIC)
BACTERIAL SUSCEPTIBILITY
TO ANTI-BACTERIALS
EPSILOMETER METHOD
BACTERIAL SUSCEPTIBILITY
TO ANTI-BACTERIALS
EPSILOMETER METHOD
BACTERIAL SUSCEPTIBILITY
TO ANTI-BACTERIALS
EPSILOMETER METHOD
CLINICAL PEARLS ABOUT
BACTERIAL SUSCEPTIBLITY
Ô BACTERIA IN EYE MAY ALTER PHYSIOLOGICALLY AFTER TREATMENT IS BEGUN
Ô GROWTH ON AGAR PLATE in vitro MAY BE
DIFFERENT THAN BACTERIA in vivo
Ô SUSCEPTIBILITY TESTS MAY NOT INDICATE
SUSCEPTIBILITY OF BACTERIA IN EYE
Ô ANTIBACTERIALS MUST BE USED FULL 10
to 14 DAYS TO KILL RESISTANT STRAINS
Ô DON’T “TAPER OFF” ANTIBACTERIALS
CLINICAL PEARLS ABOUT
BACTERIAL SUSCEPTIBLITY
Ô SAVE THE NEW, MORE POTENT ANTIBACTERIALS UNTIL THEY ARE NECESSARY?
Ô CLINICAL DILEMMA: The Flouroquinolones
Ciprofloxacin (Alcon Ciloxan) Cipro
38.9%
Ofloxacin (Allergan Ocuflox)
Floxacin 0.8%
Norfloxacin (Merck Chibroxin) Noroxin
~0%
Levofloxacin (Santen Quixin) Levaquin 40.9%
Gatifloxacin (Allergan Zymar) Tequin
8.3%
Moxifloxacin (Alcon Vigamox) Avelox 10
10.8%
8%
Ô FOLLOW THE EXAMPLE OF TOBRAMYCIN?
Ô USE TOPICALS NOT USED SYSTEMICALLY
Systemic use creates resistant strains
CLINICAL PEARLS ABOUT
BACTERIAL SUSCEPTIBLITY
Ô Farhi & Kowalski
(2007) Tested 1161
Conj’itis Isolates vs.
11 Antibacterials
DRUG
SUSCEPTIBILITY
COST
Moxifloxacin
86%
$73.38
Ofloxacin
86%
$46.75
Ciprofloxacin
84%
$49.18
Gatifloxacin
%
84%
$70.38
$
Sulfacetamide
84%
$13.11
PolyTrim
80%
$22.18
Gentamicin
74%
$14 68
$14.68
Bacitracin
70%
$10.82
Tobramycin
68%
$15.13
Erythromycin
62%
$11.17
CLINICAL PEARLS ABOUT
BACTERIAL SUSCEPTIBLITY
ÔSodium sulfacetamide, a bacteriostatic agent, with
84% in vitro coverage of all isolates, and an average
cost of $13.11, appeared to be most cost-effective
cost effective
for empirical coverage of bacterial conjunctivitis.
ÔThe fluoroquinolones, although more expensive and
of recent introduction
introduction, gave only similar coverage
coverage.
ÔPERHAPS RESISTANCE FADED AWAY AFTER 20
YEARS OF DISUSE FOR SODIUM SULFACETAMIDE!
Will there be a 20-year recycling effort?
MICROORGANISMS THAT CAN
INFECT (PENETRATE ?) THE
INTACT CORNEA
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Neisseria gonorrhoeae
Streptococcus pneumoniae
Corynebacterium diphtheriae (+ other sp.)
Haemophilus sp.
sp (H.
(H aegyptius,
aegyptius H.
H influenzae)
Listeria sp. ( L. monocytogenes)
BACTERIA THAT CAUSE
MAJORITY OF
CONJUNCTIVITIS IN CHILDREN
Ô Streptococcus pneumoniae (< 5 years old)
Ô Haemophilus aegyptius (< 5 years old)
Ô Staphylococcus aureus (> 5 years old)
INSTANCES WHEN MICRO LAB
STUDIES ARE MANDATORY
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NEONATAL CONJUNCTIVITIS
HYPERACUTE CONJUNCTIVITIS
MEMBRANEOUS CONJUNCTIVITIS
CORNEAL ULCERS not obviously Herpetic
POSTOPERATIVE EYE INFECTIONS
SEVERE LONG-STANDING
LONG STANDING CONJUNCTIVITIS
SUSPECTED FUNGAL EYE INFECTION
MICROORGANISMS CAUSING
CONJUNCTIVAL MEMBRANES or
PSEUDOMEMBRANES
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Neisseria gonorrhoeae
Streptococcus pneumoniae
Corynebacterium diphtheriae
Streptococcus species
Adenovirus
Herpes simplex virus
Chlamydia trachomatis
BACILLUS CEREUS
BACILLUS CEREUS
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UBIQUITOUS; SPORE FORMING G(+) Rod
EXOTOXIN: Highly Virulent Pathogen
PENETRATING EYE TRAUMA
METASTATIC INFECTION OF DRUG ADDICT
POST-TRAUMATIC ENDOPHTHALMITIS
CORNEAL RING ABCESS WITHIN 24 Hrs.
EYE IS BLIND WITHIN 72 Hrs. OF INFECTION
NEISSERIA GONORRHOEAE
NEISSERIA GONORRHOEAE
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G(–) COFFEE BEAN SHAPED DIPLOCOCCUS
OPHTHALMIA NEONATORUM
YOUNG, SEXUALLY ACTIVE ADULTS
ATTACKS MUCOSAL EPITHELIUM
ACUTE COPIOUSLY PURULENT CONJ’ITIS
CAN PENETRATE INTACT CORNEAL EPITH.
UNTREAT: CORN. ULCER, PERFORATION
REQUIRES CHOCOLATE AGAR + CO2
NEISSERIA GONORRHOEAE
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Ô
IgA -ase, OUTER MEMBRANE ADHESINS
PILI (FIMBRIAE)
IRON ACQUISITION PROTEIN IN CELL WALL
QUICKLY KILLED BY HEAT,
HEAT DRYING,
DRYING SUN
MUTATED VERSIONS HAVE RESISTANCE:
Beta Lactamase Production
Altered Cell Wall Structure
Ô CONJ. MEMBRANE or PSEUDOMEMBRANE
HAEMOPHILUS AEGYPTIUS
(Koch-Weeks Bacillus)
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Ô
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Ô
G(–) ROD, SUBSPECIES OF H. influenzae
RARELY CAUSES SYSTEMIC ILLNESS
ACUTE CONJ’ITIS WITH BRIEF INCUBATION
MOST COMMON IN WARM MONTHS,
MONTHS SOUTH
MUCOPURULENT DISCHARGE; Kids < 5 yrs
INFERIOR LIMBUS ULCERATIONS
SOME SCARRING OF INFERIOR CORNEA
HAEMOPHILUS AEGYPTIUS
(Koch-Weeks Bacillus)
Ô
Ô
Ô
Ô
Ô
Ô
PILI (FIMBRIAE)
ENDOTOXIN
CAPSULE
GROWTH ENHANCED AROUND Staph.
Staph sp.
sp
CAN INFECT INTACT CORNEAL EPITHELIUM
REQUIRES CHOCOLATE AGAR + CO2
MORAXELLA LACUNATA
MORAXELLA LACUNATA
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Ô
G(–) DIPLOBACILLUS with PILI (FIMBRIAE)
ANGULAR BLEPHAROCONJ’ITIS (Temporal)
CORNEAL ULCERATION with HYPOPYON
RARE IN YOUNG CHILDREN
MUST NOW DIFFERENTIATE FROM Staph.
REQUIRES CHOCOLATE AGAR + CO2
STREPTOCOCCUS
PNEUMONIAE
STREPTOCOCCUS
PNEUMONIAE
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Ô
G(+) DIPLOCOCCUS with PILI (FIMBRIAE)
OPHTHALMIA NEONATORUM
ADULT DACRYOCYSTITIS
ACUTE CATARRHAL CONJ’ITIS;
CONJ ITIS; Kids < 5 yrs
CORNEAL ULCERATIONS with HYPOPYON
SHOWS PREFERENTIAL ADHERENCE TO
CORNEAL EPITHELIAL CELLS
Ô CONJ. MEMBRANE or PSEUDOMEMBRANE
STREPTOCOCCUS
PNEUMONIAE
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Ô
WELL ORGANIZED CAPSULE (SLIME COAT)
BIOFILM (GLYCOCALYX)
IgA -ase
Fibrinolysin
Hyaluronidase
Streptokinase
Hemolysin
Leukocidin
PNEUMOLYSIN: Inhibit Chemotaxis of PMNs
CAN INFECT INTACT CORNEAL EPITHELIUM
PSEUDOMONAS AERUGINOSA
PSEUDOMONAS AERUGINOSA
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UBIQUITOUS G(–) ROD
MOST VIRULENT CORNEAL PATHOGEN
CAN NOT PENETRATE INTACT EPITHELIUM
CORNEAL ULCERATIONS AND KERATITIS
CAN PERFORATE CORNEA IN 24 Hrs.
CAN FEED ON FLUORESCEIN IN SOLUTION
CAN FEED ON CAMPHOR, NAPHTHALENE
CAN GROW IN DISTILLED WATER
PSEUDOMONAS AERUGINOSA
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PILI (FIMBRIAE); BIOFILM
POLAR FLAGELLUM
Endotoxin
Elastase
Proteases
Exotoxins
Phosphatase
Collagenase
HEMOLYSIN: Unusual for a Gram (–)
BLUE-GREEN
BLUE
GREEN PURULENCE from BG PYACIN
SHOWS PREFERENTIAL ADHERENCE TO
BASAL CORNEAL EPITHELIAL CELLS
STAPHYLOCOCCUS AUREUS
STAPHYLOCOCCUS AUREUS
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G(+) COCCI, NORMAL OCULAR FLORA
COMMON & CHRONIC EYELID INFECTIONS
HORDEOLUM: Nearly always the cause
ACUTE & CHRONIC CONJ’ITIS;
CONJ ITIS; Kids > 5 yrs
KERATITIS AND OCCASIONAL ULCERATION
POST-OPERATIVE
POST
OPERATIVE ENDOPHTHALMITIS
MEIBOMIAN GLAND DYSFUNCTION: Most
common, with Propionibacterium acnes
STAPHYLOCOCCUS AUREUS
Ô CELL WALL BINDING PROTEIN BINDS TO
CORN EPITHELIAL SURFACE FIBRONECTIN
CORN.
Ô Catalase
Wax Esterase
Hemolysin
Ô Coagulase
Cholesterol Esterase
Ô Exotoxins
Cytotoxins
Leukocidins
Ô Hyaluronidase
Ô GROWS SLOWLY EVEN AT 5 DEGREES AND
CAN CONTAMINATE REFRIDGERATED SOLN
STREPT. VIRIDANS
STAPH EPIDERMIDIS
STAPH.
LINE-UP: CAN YOU IDENTIFY
THE PERPETRATOR ?