Staphylococcus aureus + Gram -Poihe 4 Shapes 4 Ma 1 OnyeeRepbonen- fend ene + cantee-Posie 4 Comal Posie 3 Henson 2 Sindee Facer ‘4 Tovethck ptlone To 5S) e syieien fete Tis te wa hd be sn it ines tec ths tocn ae eer -¢Eatoe Sigs: tt tat aya hv nd as 2 Teginenbensolete eng lienhons Laine ‘8 Canal of Wy eps 4 Alkeom lala SSCRAN) ‘ap wihaneine al ta ‘ete ‘Blo Fg ft een et a stn eet na cs © Net of ie * Fess oh cS Ap + Canasta Coates > Noni 1 Batata no Dine case by xt Sal Srp 689i Dae Hessen eatin dg ats ie es of log hale Usd aut mata Senders, Coed ERS ts Signo eae Fest “Enamel caney esis Al eS yams ‘Peso, ea darlene saa ch eae sec. pdms Aine tao uma oii Cima TSS Siptlonal Fol nig lasso tol) hair gsi onset oss 8) Peabwihasoet yng al dre foe ease fw itp oe bd best) Fete sele st cea, sarod, Teste od acti tn ot odie ld ie sd x (ean Se canisters Shen inais ree Sai © He scone suns ants pbb itsy stn =Staphylococcus saprophyticus (@larvete ty Gram - Positive Shape - cocci, in clusters + Motility — none + Oxygen Requirements - facultative anaerobe + Catalase - Positive * Coagulase - Negative * Urease - Positive + Hemolysis - Gamma + Novobicin - Resistant + Does not ferment = mannitol > Virulence Factors * Many aquaporins to help regulate pH Forse eatS Bal ms > Worldwide © Urinary Tract Infections o 24 most common cause of UTIs © Often in young, sexually active women | DD F-Tea nol} (3) «= Visualization of Gram-staining + Non-fermenting growth on Mannitol Salt Agar * Catalase test, Coagulase test ¥ Nitrofurantoin vy TMP-SMX > Part of normal flora of skin and nose > Young, sexually active women Staphylococcus epidermidis Celere-le coulis (ac) Gram - Positive Shape ~ cocci, in clusters Motility — none Oxygen Requirements - facultative anaerobe Catalase ~ Positive + Coagulase - Negative + Urease - Positive + Hemolysis - Gamma * Novobicin - Sensitive + Does not ferment = mannitol Virulence Factors “ Biofilm production odes Worldwide © Often a contaminant of blood cultures © Often infects prosthetics, implants, indwelling catheters, ‘sual mn of Gram-staining + Non-fermenting growth on Mannitol Salt Agar * Catalase test, Coagulase test y Vancomycin > Part of normal flora of skin and nose » Anyone with indwelling catheters > Prosthetic valveStreptococcus pyogenes ‘Shape — Coen chains Oxygen Requirements acaive smncobe ‘Seatalane —Nevsive Hlemalysis Bet 2 Bactracin - Sen ‘3 Virulence Factors “Haniel capsule SSpeA = canes np 4 Spot = cases opis ‘S Mproten = Iibis agosto ' Suepokinae = Preventing @DNive~ Destroys Neuttophl Exeelllar Taps (NETS) ‘S Pyezenic Exooin A= Superaigens which cas case Spencoeal toe shock sinrome ‘0 Stnpcyain Ol S=Acanobis hemolysis which causes beta enalsn of cll and iser plngoytone ‘@Enytrogene Tonin cones erythema of ki and tog ‘ Dywalidonytaylamidane (PVR) "ene 1 Suopt Rapid Test PVR) {Direct somact 1 ASO (Ant Stepan 0) ¥ Peni 7 Ifsevere toxic shock woome fo Sueptsoccal Phayaais (Step Throat) ‘Can bose Rheum Fever '/M Protein on hater crow rest with proteins inthe Ret, this a ase ucimmine resctone and het damage (ype? Bypercmats) eerpentl Fever ‘infect of the wns fer cid © Impetigo ‘© Infection of deep dermis, no production of ps, spreads hoirntlly in skin (oot dum), demarcation Is very Kose © Epidrsinfection wil emphatic snvvement, demaration is defined sd (0 Bocca wens, tpl, heck econ dog re ler; tomgpe sehr wih hte exoats Csawbesry tongue”) sandpuper fash (sometimes ery Bmatows) ha blanches wth presi and evel flakes of and phate Necrotizing fives Extensive ficial ad tue meen © Catsed by Spe fo Strptooccal Tote Shock Syme (SS) Caused by pyrogenic exons © thea nos © Tee fe, subcutaneous nodules eased by hypersensitivity to pepioglyean Acontact wih ites oF Acute pont steploceeal shomerdooephete ‘0 Rae Kiecy denage duc tome complex depnion (1yp0-3 Iypesensitvin).cokscoored urine, happens 2 weeks er ep throat O skin 1 cindanyein Streptococcus pneumoniae Gram - Positive Shape ~ Diplococcus, “lancet shaped” + Motility ~ None © Oxygen Requirements - Facultative anaerobe Oxidase ~ Negative 4 Catalase — Negative Hemolysis — Alpha Optochin - Sensitive Capsule - Polysaccharide Bile — Soluble 4 Virulence Factors Pneumolysin 4 Toxic tothe bacteria, once the bacteria are dead, itis released into the environment Kills endothelial cells, paralyzes respiratory cilia, reduces phagocytic ability increases antiinflammatory cytokines, cenuses platelet activation Tg protease 4 Choline Binding Protein 4 Auachment to epithelial cells > Patt of normal flora of skin and nose > Patients with Sickle Cell Disease > Patients without a spleen ‘© Pneumococcal meningitis ‘ Fever, headache, stiff neck, amuse ‘© Most common bacterial cause (6 Oiitis Media ‘0 Pheumonine ‘0 Causes @ unilobular pneumonia with rust-colored sputun| ‘© Most common cause of bacterial preumonia inthe world ‘© Shaking chills, high fever, hemoptysis, chest pain ‘© Acate Rhinosiausits eee " contaminated ai droplets Part of the normal flora ce Children get the protein-conjugated vaccine 10 ‘activate Teells Adults over 65 can get the polysaccharide ‘vaccine to activate B-cells ¥ Treat with Azithromycin of ceptriaxone ae * Culture and biochemical testsStreptococcus agalactiae + Gram - Positive + Shape — Diplococeus + Motility — None Oxygen Requirements - Facultative anaerobe © Neonatal sepsis and meningitis © All women are screened prior to labor because it can be a vaginal normal flora and spread to the neonate at birth ‘© Most common cause of neonatal sepsis + Oxidase — Negative © Montality rate of 16% + Catalase — Negative © Infant pneumonia # Hemolysis — Beta © Neonatal septic arthritis, Bacitracin - Resistant st © Particularly of the wrist + Hippurate — Positive + Pyrrolidonyl - Negative + Virulence Factors “CAMP Factor # Causes hemolysis + Creates synergistic hemolysis when plated with S. aureus + Polysaccharide capsule Prevents phagocytosis ¥ Prophylactic IV penicillin can be given to GBS+ mom’s during labor QAscending Y Treat neonate with sepsis with During vaginal birth ampicillin+gentamycin until cultures confirm GBS, then you can switch to penicillin * Blood cultures = Lumbar punctures idemiology pris > Worldwide > Part of normal flora of vagina, anus, mouth, gastrointestinal tract, > Neonates who had a vaginal birth > Premature neonatesEnterococcus spp. * Gram - Positive * Shape — Cocci, in chains * Motility None * Oxygen Requirements - Facultative anaerobe * Oxidase — Negative “+ Catalase — Negative * Pyrrolidonyl Arylamidase — Positive ¢ Hemolysis ~ Gamma “Formerly part of Group D Streptococcus + Likes high salt + Likes bile salts O Self-inoculation OFecal-oral = Laboratory culture and biochemical tests © Gastroenteritis © Urinary Tract Infection © Especially in those with catheters © Endocarditis © Biliary Tract Infection © Vancomycin-Resistant Enterococcus (VRE) o Common cause of nosocomial, multidrug-resistant disease » Worldwide > Found in the normal flora of the colon > Hospitalized patients Y Ampicillin, when it’s susceptible (but often physicians don’t even see these infections) v Treat VRE with linezolid or tigecycline Y Treat UTIs with nitrofurantoinViridans Streptococci eielacoent S + Gram - Positive Shape — Cocei + Motility — None “+ Oxygen Requirements - Facultative anaerobe + Oxidase — Negative “ Catalase — Negative “ Hemolysis — Alpha % Optochin - Resistant ‘% Bile — Insoluble ee presen > Worldwide » Part of normal flora of mouth Trans i O Contaminated air droplets Q Part of the normal flora o Dental cavities © Streptococcus mutans associated with this © Subacute infective endocarditis © Grabs onto previously damaged heart valves and creates a fibrin- platelet aggregates to form a vegetation © Streptococcus sanguinis is associated with this * Culture and biochemical tests Y Good dental hygiene Y Amoxicillin for dental proceduresBacillus anthracis Characteristics + Gram - Positive + Shape — Bacillus, in chains + Motility —None + Oxygen Requirements. - Facultative anaerobe + Oxidase — Negative + Catalase — Positive + Hemolysis — Gamma + Bioterrorism agent + Forms endospores Oxygen required + Virulence Factors %D-glutamic acid capsule Anthrax Toxin “Edema Factor (EF) ‘Increases cAMP causing edema Lethal Factor (LF) Causes cell death by destroying MAPK, Protective Antigen 4 Porin to get toxins into host cells Perry and Risk Groups > Worldwide > Spores are found in soil and permafrost BPe Uns) Direct contact, Ingestion, or inhalation of cendospores, Associated with sheep farming and other animal work Se © Cutaneous Anthrax ‘© Caused by spores into the skin Painless ‘© Forms an erythematous papule > vesicular lesion > ulcerative lesion > scab “black eschar” Pulmonary Anthrax ‘© Mild fever, nonproductive cough which quickly progresses to respiratory distress and cyanosis as the alveoli are destroyed, widened mediastinum, and bloody pleural effusions © 95% mortality wien not treated, 45% when treated © Gastrointestinal Anthrax o Rare © Ulcerations in the upper gastrointestinal tract 0 >40% mortality with treatment Diagnosis * Culture and biochemical tests ¥ Fluoroquinolones Y Anthrax vaccine ¥ A mixture of several heat-inactivated toxins (no bacteria, “acellular”) Recommended for military, lab workers, and animal handlersBacillus cereus Gram - Positive Shape ~ Bacillus, in chains “ Motility —None “ Oxygen Requirements ~ Facultative anaerobe 4 Oxidase — Negative + Catalase ~ Positive 4 Hemolysis — Beta 4+ Forms endospores ¢ Oxygen required Virulence Factors Cereulide Peptide Toxin + Heat-stable and acid stable Acts as enterotoxin inducing watery diarrhea > Worldwide BbenTs TAO Ingestion of endospores or pre-formed toxins ORighly associated with reheated rice © Food poisoning o Emetic form © Caused by the ingestion of preformed toxin- containing food © Incubation time is 1-6 hours © Causes nausea and vomiting o Diartheal Form © Caused by ingestion of spores © Causes a non-inflammatory, watery diarthea induced by the secreted enterotoxins * Culture and biochemical tests zig Y Supportive ¥ Reheat food to the correct CDC recommended temperatures ¥ Since this disease is mostly caused by toxins, antibiotics are often not helpfulClostridium perfringens ‘© Gram - Positive ‘© Clostridial Food Poisoning ‘Shape ~ Bacillus ‘o Longer incubation period Motility — None (© Nausea, abdominal pain, watery diarhea & Oxygen Requirements - © Myonecrosis / “Gas Gangrene” Obligate anaerobe ‘© Incubation 1-4 days Catalase — Negative © Severe pain at the site of the wound, feels like heavy Forms endospores pressure, edema, discoloration, hmorthagic bulla, © Heraplyxte ~Foumnia doable zum of; ‘extensive hydrogen and carbon dioxide released at wound Tinioby iit site “gas” causing crepitus + Virulence Factors o Meiiony <0 *¢Abpha loom © Mostly caused by alpha toxin ‘Pisa phospholipase and desuoys fight also affect the uters after childbirth or abortions ‘cell membranes of RBCs, WBCs, preformed with non-sterile instruments (think non-medical and muscle cells co © Cpa clotting sind Shion (© Might lead to Clostridial Toxic Shock Syndrome Theta Toxin + Destroys cholesterol in cell ‘membranes killing cells & Bnterotoxin + Culture and identification, NAAT 4 Increases intracellsar calcium in diahea ¥ Tissue wounds should be debrided @Heavlbite immediately ¥ All open wounds should be irigated, cleaned, and healed properly » Spores found in soil ¥ Remove all necrotic tissue > Can be normal flora of gut ¥ Penicillin+Clindamycin Transmission Direct contact with endospores especially in ‘open wounds ingestion of endospores, bacteria, or toxinsClostridium tetani Gram - Positive Shape — Bacillus 4 Motility —Peritrichous, with tory motility 4+ Oxygen Requirements - © Generalized Tetanas fo Most common. form © Can lead to death due to exhaustion or respiratory failure ‘Tris “Tock jaw” Obligate anacrobe ‘o Neatly always the frst symptom in adults ‘Catalase —Nepatve 1 Spastic paralysis ofthe jaw muscles (clenches teeth) Forms endospores ceRaie ake ‘Virulence Factors Paralysis ofthe facial muscles causing a ereepy-looking smile 4 Tetanospasmin © Opisthotnos *$ Cleaver: SNARE protests, blocking the © Spastic paralysis ofthe back muscles causing a backward arching ofthe release of inhibitory tansmites (GABA and head, neck, and spine lycine) on Renshaw cells twiggering the 4 fonliy 139% alpha neurons and muscle contraction «Neonatal Tetanus (spastic paralysis) ‘© Generalized tetanus that occurs in neonates, moms are usually not “Travels ftom the wound site into the spinal vaccinated, long-term sequelve likely, Mortality >30% cord through retrograde axonal tansport—g Local Teta (© A mild, painful, persistent spasm around the injury site ‘© Cephalic Tetanus co Rare, presents asthe dysfunction of I or more cranial nerves Worldwide > Found in soil = * Culture, PCR, and biochemical tests Po Direct contact with spores especialy in open Antitetmospasmin antibody to newalize the activity of te toxin, single-dose wounds injection ingestion of spores, bacteria, or toxins Mascle relaxants, dark room to reduce triggering muscle spasms and seizures OsSpores can contaminate an unhealed umbilical ¥ Anibioces are mostly unproven stump (particularly when nonsterile ¥ DIP Vaccine instruments are used) ¥ Deactivated toxin ¥ Needs boosters (Tdap) every 10 yearsClostridium botulinum Gram - Positive + Shape ~ Bacillus Motility — None + Oxygen Requirements - Obligate anaerobe + Catalase — Negative ‘+ Forms endospores + Virulence Factors + Botulinum Toxin # Heat-abile Released once bacteria die, and ineversibly inhibits the release of acetylcholine at the neuromuscular junction causing flaccid paralysis Epidemio Paneer > Worldwide > Spores found in soil Transmis CLAdults ingest toxin-contaminated foods (often improperly canned foods) Babies ingest spores which then germinate in the GI tract and release the toxin (often in honey, particularly raw honey) U Spores can infect wounds or be inhaled but this is less likely © Botulism Food Poisoning ‘© Incubation of 12-36 h © Presents with ptosis, diplopia, and a descending paralysis including inability to swallow, speech difficulties, overall weakness of muscles, death from respiratory paralysis ‘© Infant botulism “floppy baby syndrome” © Most common presentation © 18-36 hours afier eating © 3-20 weeks are most commonly affected © Causes constipation, poor feeding, respiratory distress, flaccid paralysis * Toxin can be detected in serum and gut Treatment ¥ Don't give babies honey until after yo ¥ Can food properly ¥ Heat food properly Y Horse heptavalent antitoxin can neutralize toxinClostridium difficile eed 4 Now called Clastridioidis difficile Gram - Positive ‘© Shape — Bacillus 4 Motility None Oxygen Requirements - Obligate anaerobe Catalase ~ Negative Forms endospores Virulence Factors ‘Toxin A 4 Destroys the brush border ofthe ‘gut mucosa casing diathea Toxin B Disrps the exoskeleton causing necrosis and formation of pseudomembranes erry > Werlwide > Often normal flora ofthe G tact > Endospres canbe found inal hospital > Associated with hospital stays > Associated with clindamycin and other antibiotic treatment > Associated with proton-pump inbiitrs er cc iret Comtact with spores in envitonment fen an normal Soa resident, when the toml flor are killed this opprcunistic brceria wll ver grow causing symptoms o Diathea © Often nosocomial inston,antibotcassocated iarhes, opportunistic infection fo Severe watery diana with avery dsintive smell ‘0 Monti at 40% Psewdomemiranous eas ‘Fever, abdominal pain, foul-smelling diamhea ‘© Exuadates composed of fibrin, mucin, and PMNs alta tothe mucosal surice ‘© Consequence ofthe release of eyokines ‘© Can lad to toxin megacolon, perforation, and death ne * Smal + Toxin detection in stool via ELISA * Glutamate debyérogenase, Toxin A ot Toxin B + Nocaultwe because this is ofen anormal flea resident He ¥ Butemely dificult to weat and contol 41. Metronidzole ¥ Recommended first line by European Society of Clinical Microbiology and Infectious Disease ¥ 2 oral vaneomyin ¥ For severe cases ¥ Onl because IV doesn't get into the gu well ¥ Recommended first line by most medical associations in the US. % Stoo! transplant ¥ When antibiotics filed this is attempting to reestablish the nomal fora ¥ 150% effective, but choosing the comet dono, timing, dosage ial til under investigation