Professional Documents
Culture Documents
Bacterial Infectious
Bacterial Infectious
BACTERIAL
INFECTIONS
Dra.
Pauline
Solis
OUTLINE
Gram-positive
bacteria
Gram-negative
bacteria
Anaerobic
bacteria
Mycobacteria
Spirochetes
Mycoplasma
Chlamydia
Rickettsia
GRAM
POSITIVE
BACTERIA
I.
II.
III.
IV.
V.
VI.
VII.
VIII.
o
o
Staphylococcus
epidermidis
Streptococcus
pneumoniae
Epidemiology
Pathogenesis
Clinical
Manifestations
Diagnosis
Treatment
Prognosis
Prevention
Group
A
Streptococci
Streptococcus
pyogenes
Pathogenesis
Clnical
Manifestation
Diagnosis
Tretment
Complication
Prognosis
Prevention
Rheumatic
Heart
Fever
Jones
Criteria
Treatment
Virulence
Factors
Teichoic
acid
cell
wall
structure
that
mediates
adhesion
to
mucosal
cells
Slime
layer
-
loose
polysaccharide
capsule
which
interfere
with
opsonophagocytosis.
Coagulase
and/or
clumping
factor
-
interacts
with
fibrinogen
to
cause
large
clumps
of
organisms,
interfering
with
effective
phagocytosis
o Causes
plasma
to
clot
by
interacting
with
fibrinogen
and
this
may
have
an
important
Protein
A
-
present
in
most
strains
of
S.
aureus
o
o
Clinical
Manifestations
Treatment
Listeria
Actinomyces
Nocardia
Aerobic
Grow
in
pairs
and
clusters
Ubiquitous
o
STAPHYLOCOCCI
Exfoliatins
A
and
B
o
Diphtheria
Epidemiology
Pathogenesis
Clinical
Manifestations
Diagnosis
Treatment
Prognosis
Prevention
Group
B
Streptococci
Streptococcus
agalactiae
Pathogenesis
Clinical
Manifestations
Diagnosis
Treatment
Prognosis
Prevention
Toxin-mediated
diseases
o
Impetigo
Furuncles
Cellulitis
Abscess
Lymphadenitis
Paronychia
Omphalitis
wound
infection
Bacteremia
is
common
o
o
Staphylococcus
aureus
Most
common
cause
of
pyogenic
infection
of
the
skin
and
soft
tissue
o
o
o
o
o
o
o
o
Staphylococci
Staphylococcus
aureus
Virulence
factors
Epidemiology
Pathogenesis
Clinical
Manifestations
Diagnosis
Treatment
Prognosis
Prevention
Coagulase-negative:
S.
epidermidis,
S.
saprophyticus,
S.
haemolyticus
o
Epidemiology
Many
neonates
are
colonized
within
the
1st
wk
of
life
20-40%
of
normal
individuals
carry
at
least
1
strain
of
S.
aureus
in
the
anterior
nares
at
any
given
time
Colonizers
nose,
skin,
umbilicus,
vagina,
perianal
area
Heavily
colonized
nasal
carriers
(often
aggravated
by
a
viral
URTI
effective
disseminators
Transmission:
auto-inoculation
or
direct
contact
hand
washing
is
essential
Invasive
disease
may
follow
colonization
Factors
that
increase
the
likelihood
of
infection
o
o
o
o
o
o
o
o
Wounds
skin
disease
VPS
Catheterization
Corticosteroid
Malnutrition
Azotemia
Influenza
-
predispose
to
secondary
bacterial
infection
with
staphylococci
o
o
o
o
Neutropenia
o
o
Clinical
Manifestations
o
o
o
Impetigo
contagiosa
Ecthyma
bullous
impetigo
folliculitis
hydradenitis
furuncles,
carbuncles
staphylococcal
scalded
skin
syndrome,
and
staphylococcal
scarlet
fever
Diagnosis
Requires
isolation
of
the
organism
from
sterile
sites
-
cellulitis
aspirates,
abscess
cavities,
blood,
bone
or
joint
aspirates
Swab
cultures
of
surfaces
are
NOT
useful
-
may
reflect
surface
contamination
rather
than
the
true
cause
of
infection
Tissue
samples
or
fluid
aspirates
in
a
syringe
provide
the
best
culture
material.
Diagnosis
of
S.
aureus
food
poisoning
is
made
on
the
basis
of
epidemiologic
and
clinical
findings
o
Endocarditis
o
Job
syndrome
Chediak-Higashi
syndrome,
Wiskott-
Aldrich
syndrome
Pyomyositis
o Localized
staphylococcal
abscesses
in
muscle
associated
with
elevation
of
muscle
enzymes
sometimes
without
septicemia
Osteomyelitis
and
suppurative
arthritis
in
children
o
Trauma
Surgery
foreign
bodies
burns
Chemotaxis
defects
Pathogenesis
Barriers
to
infection
intact
skin
and
mucous
membranes
o
o
o
o
o
Treatment
Abscesses
incision
and
drainage
Foreign
bodies
removal
Antibiotics
choice
must
be
based
on
local
susceptibility
patterns
o
o
o
o
o
o
STREPTOCOCCUS
PNEUMONIAE
Pneumococcus
Gram-(+),
lancet-shaped,
polysaccharide
encapsulated
diplococcus,
singly
or
in
chains
o
Staphylococcus
epidermidis
Coagulase-negative
Staphylococcus
(CONS)
Cause
infections
in
patients
with
indwelling
foreign
devices
-
IV
catheters,
HD
shunts
and
grafts,
CSF
shunts,
PD
catheters,
pacemaker
wires
and
electrodes,
prosthetic
cardiac
valves,
and
prosthetic
joints
Common
cause
of
nosocomial
neonatal
infection
Normal
inhabitants
of
the
human
skin,
throat,
mouth,
vagina,
and
urethra
Colonization
precedes
infection
Direct
inoculation
during
surgery
Produce
an
exopolysaccharide
protective
biofilm,
or
slime
layer
surrounds
the
organism,
enhance
adhesion
to
foreign
surfaces,
resist
phagocytosis,
and
impair
antibiotic
penetration
True
bacteremia
should
be
suspected
if
o
o
Prognosis
High
fatality
rate
for
untreated
bacteremia
S.
aureus
pneumonia
can
be
fatal
at
any
age
o
o
o
Epidemiology
Most
healthy
individuals
carry
various
S.
pneumoniae
serotypes
in
their
upper
respiratory
tract
>90%
of
children
6
mos
to
5
yrs
harbor
S.
pneumoniae
in
nasopharynx
at
some
time
Carriage
does
not
consistently
induce
local
or
systemic
immunity
sufficient
to
prevent
later
reacquisition
of
the
same
serotype
Carriage
rate
peaks
on
the1st
and
2nd
yr
of
life
gradually
decline
Most
frequent
cause
of
bacteremia,
bacterial
pneumonia,
and
otitis
media
Second
most
common
cause
of
meningitis
in
children
Increased
susceptibility
to
pneumococcal
infection
o
o
o
o
o
o
o
Pathogenesis
Abnormal
clearance
mechanisms
allergy,
irritants,
viral
infections
Resistance
to
phagocytosis
Poor
prognosis
-
very
large
numbers
of
pneumococci
and
high
concentrations
of
capsular
polysaccharide
in
the
blood
and
CSF
Greatest
risk
for
invasive
pneumococcal
disease
(IPD)
-
infants
<2
y/o
poor
antibody
production
to
most
serotypes
Increased
frequency
of
pneumococcal
disease
in
asplenia
deficient
opsonization
and
absence
of
clearance
by
the
spleen
of
circulating
bacteria
Clinical
Manifestations
Signs
and
symptoms
are
related
to
the
anatomic
site
of
disease
IPD
pneumonia,
sepsis,
meningitis
Otitis
media,
sinusitis,
osteomyelitis,
arthritis,
endocarditis
Diagnosis
Recovery
of
S.
pneumoniae
from
the
site
of
infection
or
from
blood
Blood
cultures
should
be
obtained
in
children
with
pneumonia,
meningitis,
arthritis,
osteomyelitis,
peritonitis,
pericarditis,
or
gangrenous
skin
lesions
Pronounced
leukocytosis,
WBC
>15,000/mm3.
Treatment
Emperic
therapy
depends
on
local
susceptibility
patterns
High-level
-lactam
resistance
and
MDR
strains
Penicillins
for
susceptible
strains
o
o
o
o
o
o
o
o
Clinical
Manifestations
Important
cause
of
acute
pharyngitis
and
pneumonia
Nonbullous
and
bullous
impetigo
Erysipelas
o
Scarlet
Fever
o
o
PPSV23
Unpredictable
immunologic
responsiveness
and
efficacy
following
administration
in
children
<2
yr
of
age.
Contains
purified
polysaccharide
of
23
pneumococcal
serotypes
responsible
for
>95%
of
cases
of
invasive
disease
o
o
Prevention
Pneumococcal
polysaccharide
vaccines
o
o
Pathogenesis
Virulence
of
GAS
depends
primarily
on
the
M
protein
o
o
Cefuroxime
Ceftriaxone/Cefotaxime
Diagnosis
Culture
of
a
throat
swab
-
remains
the
standard
for
the
documentation
of
GAS
in
URT
and
for
onfirmation
of
the
clinical
diagnosis
of
acute
GAS
pharyngitis
Rapid
antigen
detection
tests
Elevated
or
increasing
streptococcal
antibody
titer
retrospective
o
o
Treatment
Antibiotics
for
GAS
pharyngitis
-
prevent
acute
rheumatic
fever,
shorten
clinical
course,
reduce
transmission,
and
prevent
suppurative
complications
Penicillin
as
the
drug
of
choice
no
resistance
reported
yet
o
o
o
o
No
animal
model
Cytotoxicity
theory
Immune-mediated
pathogenesis
o
o
o
Treatment
Antibiotics
for
10
days
for
initial
attacks
Anti-inflammatory
therapy
aspirin.
Steroids
Sedatives/anticonvulsants
for
sydenham
chorea
Long
term
antibiotic
prophylaxis
to
prevent
recurrences,
infective
endocarditis
GROUP
B
STREPTOCOCCI
(GBS)
Streptococcus
agalactiae
Major
cause
of
neonatal
bacterial
sepsis
in
the
USA
Facultative
anaerobic
gram-positive
cocci,
in
chains
or
diplococci;
small
gray-white
colonies
on
solid
medium
Presumptive
identification
o
o
o
o
Carditis
Polyarthritis
Erythema
marginatum
Subcutaneous
nodules
Chorea
Minor
criteria
o
o
Jones
Criteria
Major
criteria
o
o
o
o
o
Pathogenesis
o
o
o
Rheumatogenicity
o
Prognosis
Excellent
with
complete
recovery
if
properly
treated
GAS
pharyngitis
Treatment
within
9
days
of
onset
acute
rheumatic
fever
is
prevented
No
evidence
that
acute
PSGN
can
be
prevented
once
pharyngitis
or
pyoderma
with
a
nephritogenic
strain
of
GAS
has
occurred
Prevention
The
only
specific
indication
for
long-term
use
of
antibiotics
to
prevent
GAS
infections
is
for
patients
with
a
history
of
acute
rheumatic
fever
or
rheumatic
heart
disease
No
vaccine
available
yet
Rheumatic
Fever
Considerable
evidence
to
support
the
link
between
GAS
upper
pharyngitis
tract
infections
and
acute
RF
and
RHD
o
Diagnosis
Diagnosis
of
invasive
GBS
disease
thru
isolation
and
identification
of
the
organism
from
a
normally
sterile
site
-
blood,
urine,
CSF
Isolation
of
GBS
from
gastric
or
tracheal
aspirates
or
from
skin
or
mucous
membranes
indicates
colonization
and
is
NOT
diagnostic
of
invasive
disease
Antigen
detection
methods
using
group
B
polysaccharide-specific
antiserum
-
latex
particle
agglutination
o
o
o
Prognosis
Neurodevelopmental
delay
due
to
meningitis
Favorable
outcome
for
focal
infections
Prevention
Chemoprophylaxis
-
elimination
of
colonization
from
the
mother
or
infant
o
Vancomycin-resistant
enterococci
o
o
o
DIPHTHERIA
Acute
toxic
infection
caused
typically
by
Corynebacterium
diphtheriae
Aerobic,
nonencapsulated,
non
spore-forming,
mostly
nonmotile,
pleomorphic,
gram-positive
bacilli
Isolation
is
enhanced
by
use
of
a
selective
medium
(i.e.,
cystine-tellurite
blood
agar
or
Tinsdale
agar)
that
inhibits
growth
of
competing
organisms
gray-black
colonies
The
ability
to
produce
diphtheritic
toxin
results
from
acquisition
of
a
lysogenic
Corynebacteriophage
which
encodes
the
diphtheritic
toxin
gene
and
confers
diphtheria-
producing
potential
Demonstration
of
diphtheritic
toxin
production
or
potential
for
toxin
production
by
an
isolate
is
necessary
to
confirm
disease
Toxigenic
and
nontoxigenic
strains
are
indistinguishable
by
colony
type,
microscopic
features,
or
biochemical
test
results
Epidemiology
Exclusive
inhabitant
of
human
mucous
membranes
and
skin
Transmission
via
respiratory
droplets,
direct
contact
with
respiratory
secretions
of
symptomatic
individuals,
or
exudate
from
infected
skin
lesions
Asymptomatic
respiratory
tract
carriage
is
important
in
transmission
Skin
infection
and
skin
carriage
-
silent
reservoirs
of
C.
diphtheriae
Organisms
can
remain
viable
in
dust
or
on
fomites
for
up
to
6
mos
Pathogenesis
Both
toxigenic
and
nontoxigenic
strains
cause
skin
and
mucosal
infection
o
o
o
o
o
o
o
Detox
your
life
in
4
easy
steps:
Get
rid
of
anyone
who:
1.
Lies
to
you.
2.
Disrespects
you.
3.
Uses
you.
4.
Puts
you
down.
(A
Simple
Reminder)
Diagnosis
Specimens
for
culture
nose,
throat,
mucocutaneous
lesion
A
portion
of
membrane
should
be
removed
and
submitted
for
culture
along
with
underlying
exudate
Use
selective
medium
for
C.
diphtheriae
Culture
isolates
of
coryneform
organisms
should
be
identified
to
the
species
level,
and
toxigenicity
and
antimicrobial
susceptibility
tests
should
be
performed
for
C.
diphtheriae
isolates
Treatment
Specific
antitoxin
-
mainstay
of
therapy
o
o
Cutaneous
diphtheria
o
o
o
o
o
o
Depends
on:
o
Clinical
Manifestations
Respiratory
tract
diphtheria
o
o
o
Prognosis