Pyogenic Bacteria

▪ Gram +ve
i. Staphylococci
ii. Streptococci

▪ Gram –ve
i. Neisseria
▪ Gram +ve, cocci, cluster

▪ Catalase +ve (H2O2 H2O + O )

▪ Halophilic

▪ Non-motile, non-spore forming

▪ Facultative anaerobe
▪ More than 40 species
▪ Few strains capsulated, slim layer
▪ Temp 18-400C
▪ Saprophytic
▪ Mucosal surface (nares, nasopharynx, vagina).

▪ Skin (Axilla, groin, perianal area).

▪ Staph. aureus 30% asymptomatic carriage.

▪ 90 million in USA.

▪ 5 million MRSA in USA

I. Endo-pigment

1. Yellow (golden)
e.g., Staph. aureus

2. White
e.g., Staph. epidermidis
Staph. saprophyticus
II. Coagulase

Staph. aureus +ve

Staph.epidermidis &
Staph. saprophyticus -ve
▪ Yellow pigments

▪ Smooth colonies

▪ 30% carrier (skin, nose)

▪ β- hemolytic

▪ Capacity to be virulent

▪ Capacity to be become drug resistant

▪ Protein A

▪ Toxin

▪ Enzymes

▪ Others
▪ Toxins
1. Enterotoxin (Intoxication)
2. Exfolative (Epidermolytic) toxin
3. TSST 1,2
4. Cytolytic toxin
i. Leucocidin
ii. Hemolysin
▪ Enzymes

1. Catalase

2. Coagulase
• Bound coagulase (clumping factor)
• Free coagulase
3. β- lactamase

4. Hyaluronidase

5. Fibrinolysin (Staphylokinase)

6. Lipase, proteinase, Dnase, Nuclease

Pathogenesis

1. Colonization
2. Invasion of host defenses
3. Avoidance of host defenses
• Capsular polysaccharide
• Protein A
• Coagulase
• Catalase
• Leucocidin
Clinical Manifestation

I. Cutaneous infection
i. Impetigo “pyoderma”

ii. Folliculitis
Clinical Manifestation

iii. Furnucles “boils” face , axilla ‘female’

iv. Carbuncles

v. Scalded skin syndrome

(SSS) Ritter’s disease
II. Others

1. Primary Nosocomial Infection “Hospital

Cross Infection”
e.g Postoperative wound infection
e.g Pneumonia ICU
e.g food poisoning
2. Food poisoning
3. Stye
4. Osteomylitis
5. Metastatic Staphylococcus infection
6. TSS
7. Mastitis
8. Bacteremia systemic toxicity
9. Endocarditis
10. Tonsillitis
11. UTI “occasionaly”
Mode of infection

▪ Direct contact (hands and clothing)

▪ Droplet infection (air borne)

Epidemiology

▪ Outbreaks of post-operative surgical wound infection

▪ Outbreaks of food poisoning

Lab Diagnosis

▪ Specimen
▪ Culture on
o Nutrient agar Pigments
o Blood agar hemolysis
▪ Gram stain
Lab Diagnosis

▪ Catalase test
▪ Coagulase test
▪ Biochemical tests
▪ Phage typing
Treatment

▪ Mostly (80%) β- lactamase producer

▪ OPD patient (ampicillin, amoxicillin)
▪ Hospital acquired infection vancomycin
Prevention

▪ Aseptic management of lesions

▪ Frequent cleaning of possible contaminating
objective + area
▪ Hand wash
Methicillin Resistant Staph. aureus (MRSA)

▪ mec A gene
▪ 1990 Exploded (especially in hospitals
▪ More virulent
▪ Flesh eating bacteria from bench to beside
MRSA ... who caught the infection

I. High Risk
• ICU
• NICU
• Surgical unit
• Burn unit
II. Frequent Visit Hospital
• Dialysis
• HIV
• Long term care
III. Emergency
Route of Transmission

▪ Ventilator ICU
▪ IV line
▪ Ulcers
▪ Wounds
 I.V Line
Blood

Bactermia Septicemia Deeper

abscesses

Failure of essential organs

Death “high mortality rate 50%”

 Prevention

• Infection • Monitoring • Frequent bathing

• Isolation • Hand • Clinical
Control of babies /
• Transfer
wash waste screening decrease
Practice incidence
• Ward closure personnel
• Cord treatment
• Diaper area
Vancomycin Intermediate / Resistant Staph. aureus
(VISA / VRSA)

▪ Plasmid mediated from VRE

Prevention
o Aseptic technique with infectious patient
o Prevent antimicrobial resistance
o Prevent transmission
o Prevent infection
Coagulase Negative Staphylococci

▪ Normal flora of skin

▪ White shiny colonies

▪ Coagulase –ve
▪ Opportunistic pathogen
o Immunodeficient patient
o Introduction of foreign body
e. g Cannulae , catheters, shunts...etc
o Renal dialysis
o Skin abrasion & burns
1. Staph. epidermidis
Cause – Prosthetic medical device associated
infection (Bacteremia, Endocarditis, Peritonitis)

2. Staph. saprophyticus
Cause – UTI in female (Pregnant – Young)
▪ Gram +ve
▪ Microaerophilic
▪ Chain or paris (Dipolococci)
▪ Catalase –ve
 Classification
I. Hemolytic activity on Blood agar

β- hemolysis α- hemolysis γ- hemolysis

Complete lysis Partial lysis Non hemolysis

II. Lancefield grouping A to U V. Optochin test VI. Esculin test

(cell wall = c-carbohydrate)
III.Bacteriacin sensitivity test Sensitive Resistant Positive Negative
Group A Sensitive
Group B-U Resistant
Enterococcus
IV.M-protein Strept.
Group A ˃ 80 serotypes pneumoniae other non-
Viridans hemolytic
Sterptococci Sterptococci
• Hemolytic activity

• Optichin test

•Bacitracin sensitivity test

1. Group A Streptococci (e.g Strept. Pyogenes)
▪ URS, Tonsillitis - pharyngitis
▪ M Protein
▪ Erythrogenic toxin
▪ Streptolysin O
o O2 labile
o Immunogenic “ASOT”
▪ Streptolysin S
o O2 stable
o Non-immunogenic
▪ DNase, Hyaluronidase, C5a peptidase.
▪ Streptokinase
I. Suppurative
▪ Sore throat

▪ Impetigo

▪ Erysipelas

▪ Scarlet fever

▪ Cellulitis
II. Non suppurative
▪ Rheumatic fever (RF) = R-Heart F “Autoimmune disease”

▪ Acute glomerulonephritis (AGN)

▪ Specimen
▪ Culture on Blood agar
▪ Gram stain
▪ Bacitracin test
▪ ASOT
▪ Penicillin
▪ Cephalosporin
▪ Erythromycin

N.B. Antibiotic therapy for pharyngitis

o Relief symptoms

o Prevent RF
2. Group B Streptococci (e.g Strept. agalactiae)

▪ Transient flora, GIT, female vagina

▪ 10-30% pregnant female

▪ Premature membrane rupture

▪ Risk of premature delivery

premature infant
▪ Early onset (first weeks)
o Neonatal meningitis
o Neonatal pneumonia
o Neonatal sepsis
o Neonatal septicemia
▪ Late
o Exogenous route
o Bacteremia
o Meningitis
▪ Adults
o Pneumonia
o Wound
o Bone & joint infection
▪ Pregnant female
o Postpartum fever
o Postpartum sepsis
o Intrapartum fever
o Premature membrane rupture
o Endometeritis -UTI
▪ Penicillin

▪ Cephalosporin

▪ Aminoglycoside

▪ Vancomycin in serious infection

1. Optochin sensitive
e.g Strep. pneumoniae
▪ G +ve
▪ Diplococci
▪ Capsulated (88 serotypes)
▪ Catalase –ve
▪ Pneumolysin
Endogenous - Exogenous (air borne)

Oropharynx

Lung Sinuses Middle ear Blood

Pneumonia Sinusitis Otitis media Meningitis

Bacteremia
▪ Surface protein “adhesion”

▪ Capsule 1 – 23 pathogenic

▪ IgA protease “anti IgA1”

▪ Pneumolysin
▪ Specimen – culture on Blood agar

▪ Optochin sensitivity test

▪ Quellung (swelling) test

▪ Penicillin

▪ Cephalosporin

▪ Erythromycin

▪ Chloramphenicol
▪ Polyvalent (1 – 23) capsular vaccine given to
children
2. Optochin Resistant (Viridans group)
▪ Strep. mutans (non hemolytic)
▪ Strep. salivarius
▪ Strep. sangius Endocarditis
▪ Strep. mellari due to alveolar abscess,
brain & liver abscess
▪ Strep. mitis
▪ Enterococcus – previously group D Strep. fecalis
▪ GIT normal flora
▪ Halophilic
▪ Nosocomial infection
▪ Bacteremia Endocarditis
e.g Catheterized patient UTI
▪ Multiple resistant to antibiotic
e.g Vancomycin VRE
(Pediatric)
Family: Neisseriaceae

▪ Gram negative & aerobic bacteria

I. Neisseria
II. Moraxella (Branhamella)
III. Kingella
IV. Acinetobacter
▪ G –ve, diplococci

▪ Oxidase +ve

▪ Pili (fimbriae) = OMP + LOS

▪ 2 medically important
o N. gonorrheae
o N. meningitidis
▪ Adjacent flattened side
▪ Frequently intracellular – PMNs
▪ Fastidious
▪ Relatively fragile
▪ Best grow at 35 – 36 oC
▪ Incubation period 2 days
▪ Causes Gonorrhea
▪ Pili “Fimbriae”
▪ OMP
▪ LOS
▪ IgA protease
(effect IgA1)
▪ Sexually
▪ Mother baby “during birth”
I. Uncomplicated
▪ Male symptomatic
▪ Female usually asymptomatic
▪ Rectal infection (Proctitis)
▪ Pharyngeal infection
▪ Occular infection
(Ophthalamia Neonatorum)
II. Complicated
▪ Orchitis
▪ Salpangitis
▪ PID
▪ Prostitis
▪ Arthritis
▪ Dermatitis
▪ Meningitis
▪ Endocarditis
▪ Male discharge Gram stain
95% +ve result
▪ Female exudate (cervix female swab not HVS)
▪ Culture
▪ Oxidase test
▪ Glucose utilization
▪ β-lactamase producer

i.e resistant to penicillin

▪ Cephalosporin, erythromycin or

tetracycline

▪ Occular infection 1% silver nitrate

▪ Capsulated “13 serotype”

(A, B, C, D, H, I, K, L, X, Y, Z, W135, 29E)

▪ Human pathogen

▪ IP 1-3 days
▪ Risk group children < 5 years

▪ Highest incidence

▪ Transmission Airbone
▪ Meningococcal meningitis

o Kernig’s sign

o Brudzinski's sign

▪ Meningococcemia
▪ Fulminant Meningococcemia

“Water-House Friderichsen Syndrome”

▪ Petechiae
▪ Specimen

o CSF – Blood

o Culture

o Capsular detection

o Glucose + Maltose Utilization

▪ Penicillin drug of choice (DOC)

▪ Cephalosporin
▪ Capsular PLs vaccine

▪ Breast feeding

▪ Chloramphenicol for contact

▪ M. catarhalis

▪ Grow at 28oC

▪ Opportunistic infection

e.g Otitis media, Sinusitis, Bronchopneumonia