Chapter 1 Systemic bacteriology

- staphylococci -
according to Coagulase test

Coagulase +ve Coagulase -ve (CNS)

Staph. aureus S. epidermidis S. saprophytics
Coagulase Positive Negative Negative
Haemolysis Haemolytic Non haemolytic Non haemolytic
Color on MSA Yellow Rose Rose
A major pathogen Potentially pathogenic Usually non pathogenic
Pathogenicity
of human With catheter, prosthesis May cause UTI in young female
Natural habitat Nostril carriers Skin and anterior nares Genital tract & perineum
Staphylococcus aureus
Found commensal in the nostril of 40 %

- Gram +ve cocci arranged in grape like clusters, non motile, non capsulated, non spore.

- O2 ( facultative anaerobe ) - CO2 ( atmospheric ) - PH ( 7.5 ) -Temp. ( 37 oc )

- Media : Simple media: Nutrient agar → give Golden yellow colonies.
Enriched media: Blood agar → give Clear zone of β heamolysis.
Selective media : Mannitol salt agar (10% ) → give yellow colonies.

N.B Staph aureus is a halophilic organism tolerates 10-15% Na CL

 Catalase +ve  Coagulase +ve  Ferment mannite with acid only .

there are 3 cell wall components are antigenic:
 Teichoic acid (mediate adherence)  Peptidoglycan  Protein A .

-Each staph is attacked by specific one or series of bacteriophages (depend on specific receptor on cell wall)
-Used to trace source of infection (in case of food poisoning and infection in hospitals)

 Structural:  protein A bind to Fc of IgG  So it is anti-opsonization (anti-opsonization)

 Non structural Enzymes:
1- Coagulase  localizing factor →deposition of fibrin on their surface preventing phagocytosis
2- Catalase  inactivate toxic H2O2 prevent killing within phagocytes.
3- Clumping factor (adhesin)  fibrinogen-binding protein is an important adhesin.
It leads to attachment of the organism to traumatized tissue and blood clot.
4- Spreading factors (invasins): promote bacterial spread in tissue
Fibrinolysin → dissolve fibrin clot (namedstaphylokinase)
Hyaluronidase → dissolves hyaluronic acid

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 Chapter 1 Systemic bacteriology
 Toxins:
1- Heamolysin : destroy RBCs  responsible for clear β heamolytic zone
2- Leucocidin : destroy WBCs  responsible for pus formation
3- Enterotoxin : 6 exotoxins ( A…F ) act on intestine  cause food poisoning
 Resist boiling for 30 min.  Resist Gut enzyme
4- Toxic Shock Syndrome Toxin (TSST-1) :  cause Toxic Shock Syndrome
 It is super Ag  It is enterotoxin F
5- Exfoliative or epidermatolytic toxin:  cause scalded skin syndrome
 It is super Ag  cause proteolysis of epidermis

N.B Enterotoxins, TSST and Exofoliatin of staph aureus act as super antigens

(is due to combined effect of extracellular factors and enzymes + toxins + invasive properties)
Source of infection: the chief source is human nasal carriers
Mode of transmission: by contact or air born
Clinical findings:
➢ Pyogenic diseases:
( staph aureus responsible for 80% of human suppurative infection )
1- Localized: a) abscess, folliculitis, furuncle, carbuncle.
b) Wound infection: post-operative surgical wound infection or post trauma.
2- Staphylococcal pneumonia: frequent complication following viral infection (influenza)
3- Invasive: bacteremia, empyema, endocarditis, Meningitis, osteomyelitis.

➢ Toxigenic diseases:
1- Food poisoning
 It is a self limiting disease…Following:
- Ingestion of contaminated carbohydrate food with already formed staph enterotoxin
- Nausea, vomiting, colic with no fever ,
- short incubation period (1..8 h)
2-Toxic shock syndrome (TSS)
By type of staph secreting TSST-1
- Fever. Nausea & vomiting & hypotension, rash, organ failure  death
- Usually affect menstruating female using tampons also children or man with wound infection.
3-Scalded skin syndrome (SSS)
By type of staph secreting exfoliatin
- It is characterized by desquamation of skin in neonates and childrenbullous formation

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 Chapter 1 Systemic bacteriology

1- Specimen : pus, sputum, blood , C.S.F

In food poisoning → nasal swab from food handler, vomitus or food remnants
2- Smear →Gram +ve cocci arranged in grape
3- Culture →on nutrient agar, blood agar and mannitol salt agar
incubated for 24 hr, aerobically at 370, 7.5 pH with atmospheric CO2
Colony identified by:
o Colony morphology →G.Yellow on nutrient – βheamolysis on blood – yellow colonies on MSA
o Film → G+ve cocci arranged in grape
o BR →Catalase +ve, Coagulase +ve (free and bound coagulase), Ferment mannite with acid only

4- Phage typing to trace source of infection by comparing:

isolated staph from food and food handler with those isolated from patient vomitus and food remnants

5- ELISA serological detection of staph enterotoxin (in case of food poisoning)

- Because of the frequency of drug resistance

 antibiotic sensitivity test is essential to help in choice of treatment.
- Methicillin is the drug of choice in penicillin resistant staph
 That acquire (R- factor) a plasmid coding for B-lactamase production.
Methicillin resistant staph aureus (MRSA)
- Staph aureus that are resistant to methicillin and other B-lactam antibiotics
- Resistance of MRSA is due to presence of a chromosomal gene (mec A gene).
- Mec A gene code for alternation of penicillin binding proteins (PBPs)
- MRSA are responsible for 25% of nosocomial (hospital acquired) infection.
- Vancomycin is the drug of choice in the treatment of MRSAbut now VRSA appear
- Linezolid is the drug of choice in the treatment of VRSA

N.B: Main difference between S. aureus & CNS:

1) Coagulase test
2) Mannitol fermentation (color on MSA)
3) Haemolysis on blood agar