16/9/2022

STAPHYLOCOCCUS

STAPHYLOCOCCUS

• Gram (+) spherical cells, in grape like clusters

• Ubiquitous – found everywhere
• normal microbiota of the skin and mucous membranes of humans
• found in the skin (especially armpits and groin), nose and nasopharynx, throat,
gastrointestinal tract
• found regularly on clothing, bed linens, and other fomites in human
environments

• Very common pathogens in hospitals

• Causes wide variety of disease
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MOST FREQUENTLY ENCOUNTERED

PATHOGENIC SPECIES

• Staphylococcus aureus
• Coagulase (+) - enzyme activating prothrombin causing blood to clot
• Very common human pathogen
• Causes abscesses/suppuration

• Staphylococcus epidermidis
• Staphylococcus saprophyticus
• Staphylococcus lugdunensis

VIRULENCE FACTORS THAT INHIBIT

HOST DEFENSES

• Protein A (SpA) – adhesin; binds the Fc portion of IgG, may

protect the organism from opsonization and phagocytosis

• Coagulase - lead to fibrin formation around the bacteria,

protecting it from phagocytosis
• Clumping factor - for adherence of Staph to fibrin and fibrinogen

• Hemolysins - 4 types (alpha, beta, gamma, and delta); destroy red

blood cells, neutrophils, macrophages, and platelets

• Leukocidins - destroy leukocytes (white blood cells)

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Fab – binds to antigen / bacterial component

Fc – binds to elements of the immune system

(no activation of (activation-induced

phagocytosis) cell death)

VIRULENCE FACTORS RELATED TO

DRUG RESISTANCE

• Penicillinase
• also called beta-lactamase
• inactivates the antibiotic penicillin by disrupting the beta-lactam ring

• Novel penicillin binding protein

• some strains of Staphylococcus aureus have new (novel) penicillin
binding proteins that are resistant to penicillin and other antibiotics
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EFFECT OF PENICILLINASE TO
PENICILLIN

VIRULENCE FACTORS RELATED TO

TISSUE INVASION

• Hyaluronidase ("Spreading Factor") - breaks down proteoglycans in

connective tissue

• Staphylokinase - lyses formed fibrin clots (like streptokinase)

• Lipases - degrades fats and oils, which often accumulate on the surface
of our body
• facilitates Staphylococcus aureus' colonization of sebaceous glands

• Proteinase – destroys tissue proteins

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EXOTOXINS

• Exfoliatin/exfoliative toxin - exotoxin that causes

the skin to slough off
• Dissolves the mucopolysaccharide matrix of the
epidermis
• Staphylococcal scalded skin syndrome

• Enterotoxins (heat stable) - cause food poisoning,

resulting in vomiting and diarrhea

EXOTOXINS

• Toxic Shock Syndrome toxin (TSST-1)

• Analogous to the pyrogenic toxin produced by Lancefield

group A beta-hemolytic streptococci, but is far more
deadly

• Causes toxic shock syndrome and is found in 20% of

Staphylococcus aureas isolates
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Video from Animated biology with Arpan https://www.youtube.com/watch?v=T4uBVYes4og

MECHANISMS OF DISEASE

• Exotoxin release • Direct organ invasion

• Gastroenteritis (food poisoning) • Pneumonia
• Toxic shock syndrome • Meningitis
• Scalded skin syndrome • Osteomyelitis
• Acute bacterial endocarditis
• Septic arthritis
• Skin infections
• Bacteremia/sepsis
• Urinary tract infection
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GASTROENTERITIS/FOOD POISONING

• Staphylococci can grow in food and produce an enterotoxin

• Victim will eat the food containing the pre-formed toxin, which
then stimulates peristalsis of the intestine
• Ingestion of 25 μg of enterotoxin B results in vomiting and diarrhea

• Nausea, vomiting, diarrhea, abdominal pain/cramps, and

occasionally fever
• Can develop within 30 minutes to 8 hours (usually within 4-6 hours)

• Lasts 12 to 24 hours (self-limited)

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STAPHYLOCOCCAL TOXIC SHOCK

SYNDROME

• Mediated by the exotoxin TSST-1

• Often associated with tampon use in young women, but it can

affect anyone of any age – including men and children

• Exotoxin is absorbed systemically and acts as a superantigen 

stimulates a massive immune response

• Activate a very large number of T cells  produce massive

amounts of cytokines such as interleukin and tumor necrosis
factor
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STAPHYLOCOCCAL SCALDED SKIN

SYNDROME

• Mediated by the exfoliative toxin (exfoliative toxins A and B)

• Similar in pathogenesis to toxic shock syndrome

• Usually affects neonates with local infection of the recently

severed umbilicus or older children with skin infections

• Causes detachment of the outermost skin layer (epidermis)

• Healing is rapid and mortality low (below 5%)

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DISEASE RESULTING FROM DIRECT

ORGAN INVASION

• Pneumonia
• 2 routes of infection – hematogeneous and aerogenous
• Staphylococcus aureus is a rare but severe cause of
community-acquired bacterial pneumonia
• More common in hospitalized patients
• Usually follows a viral influenza (flu) upper respiratory
illness

DISEASE RESULTING FROM DIRECT

ORGAN INVASION

• Meningitis, Cerebritis, Brain Abscess

• Patients can present with high fever, stiff neck, headache,
obtundation, coma, and focal neurologic signs

• Osteomyelitis
• Infection spreads to the bone, presenting locally with
warm, swollen tissue over the bone and with systemic
fever and chills
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DISEASE RESULTING FROM DIRECT

ORGAN INVASION

• Acute Endocarditis
• Destructive infection of the heart valves with the sudden onset of
high fever, chills and body aches
• Cause rapid valvular destruction and embolism of vegetations
(bacteria) to the brain or lung

• Blood and catheter infections

• Staphylococcus aureus can migrate from the skin and colonize
central venous catheters resulting in bacteremia, sepsis, and septic
shock as well as endocarditis

DISEASE RESULTING FROM DIRECT

ORGAN INVASION

• Septic Arthritis
• Invasion of the synovial membrane (lining of the joints)
• S. aureus is the most common pathogen causing this disease in the pediatric
age group and in adults over the age of 50
• Patients complain of an acutely painful red swollen joint with decreased
range of motion
• Many patients will permanently lose the function of the involved joint if
untreated
• Diagnosis requires examination of the synovial fluid, which will
characteristically appear yellowish and turbid, with a huge number of
neutrophils (>100,000), as well as a positive Gram stain or culture
• Therapy requires drainage of the joint and antimicrobial therapy
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STAPHYLOCOCCAL SKIN INFECTIONS

• Impetigo
• Contagious infection usually occurs on the face, especially around
the mouth
• Small vesicles lead to pustules, which crust over to become honey-
colored, wet, and flaky

• Cellulitis
• Deeper infection of the skin and subcutaneous tissue; tissue
becomes hot, red, shiny and swollen
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STAPHYLOCOCCAL SKIN INFECTIONS

• Furuncles and Carbuncles

• Furuncle – abscess involving the hair follicle and surrounding soft
tissue
• Carbuncle - clusters of several furuncles communicating under the
skin

• Wound infections
• Any skin wound can be infected with Staphylococcus aureus,
resulting in an abscess, cellulitis, or both
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METHICILLIN-RESISTANT
STAPHYLOCOCCUS AUREUS (MRSA)

• First recognized in the 1960s

• Strain of Staphylococcus aureus that has acquired

resistance to methicillin, cloxacillin and nafcillin used to
treat infections by penicillinase-producing Staph infections

• Most MRSA infections occur in people who have been in

hospitals or other health care settings, such as nursing
homes and dialysis centers
• called healthcare-associated MRSA (HA-MRSA)
https://www.mayoclinic.org/diseases-conditions/mrsa/symptoms-causes/syc-20375336
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METHICILLIN-RESISTANT
STAPHYLOCOCCUS AUREUS (MRSA)

• HA-MRSA can be spread by health care workers touching people with

unclean hands or people touching unclean surfaces

• Associated with invasive procedures or devices, such as surgeries,

intravenous tubing or artificial joints

• Risk factors for HA-MRSA include

• Hospitalized - specially older adults and people with weakened immune
systems
• Individuals who have an invasive medical device or tubes
• Residence in nursing homes or long-term care facilities

https://www.mayoclinic.org/diseases-conditions/mrsa/symptoms-causes/syc-20375336

METHICILLIN-RESISTANT
STAPHYLOCOCCUS AUREUS (MRSA)

• Community-associated MRSA (CA-MRSA) can also occur

among healthy people
• Often begins as a painful skin boil
• Usually spread by skin-to-skin contact

• Risk factors for CA-MRSA include

• Participating in contact sports.
• Living in crowded or unsanitary conditions.
• Using illicit injected drugs.

https://www.mayoclinic.org/diseases-conditions/mrsa/symptoms-causes/syc-20375336
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METHICILLIN-RESISTANT
STAPHYLOCOCCUS AUREUS (MRSA)

• Preventing CA-MRSA
• Hand hygiene
• Scrub hands briskly for at least 20 seconds
• Carry a small bottle of hand sanitizer containing at least 60%
alcohol for times when you don't have access to soap and water.

• Keep wounds covered - Keep cuts and scrapes clean and covered
with clean, dry bandages until they heal. Keeping wounds covered
can help prevent the spread of the bacteria.

• Keep personal items personal - Avoid sharing personal items like

towels, sheets, razors, clothing and athletic equipment.
https://www.mayoclinic.org/diseases-conditions/mrsa/symptoms-causes/syc-20375336

METHICILLIN-RESISTANT
STAPHYLOCOCCUS AUREUS (MRSA)

• Preventing CA-MRSA

• Shower after athletic games or practices - Shower

immediately after each game or practice. Use soap and
water. Don't share towels.

• Sanitize linens - If you have a cut or sore, wash towels

and bed linens in a washing machine set to the hottest
water setting (with added bleach, if possible) and dry
them in a hot dryer. Wash gym and athletic clothes after
each wearing.
https://www.mayoclinic.org/diseases-conditions/mrsa/symptoms-causes/syc-20375336
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COAGULASE NEGATIVE
STAPHYLOCOCCI

• Staphylococcus epidermidis - most common cause of

human infection by coagulase-negative Staphylococci

• Staphylococcus saprophyticus - relatively common cause of

urinary tract infections in young women

• Staphylococcus lugdunensis - causes a disease spectrum

similar to S aureus

STAPHYLOCOCCUS EPIDERMIDIS

• Part of the normal bacterial flora and is widely found on the

body

• Immunocompromised hospital patients with Foley urine

catheters or intravenous lines can become infected when this
organism migrates from the skin along the tubing

• Causes infections of prosthetic devices in the body, such as

prosthetic joints, prosthetic heart valves, and peritoneal dialysis
catheters
• S. epidermidis is the most frequent organism isolated from infected
indwelling prosthetic devices
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STAPHYLOCOCCUS SAPROPHYTICUS

• Colonizes the perineum, rectum, urethra, cervix and gastrointestinal

tract

• Second most common cause of uncomplicated urinary tract infection

in sexually active young females (after E. coli)
• Most common bacterial infection in women

• Also causes urinary tract infection with complications of acute

pyelonephritis, epididymitis, prostatitis, and urethritis
• immunocompromised, elderly, male, pregnant, diabetic, and/or with urologic
abnormalities such as indwelling catheters or kidney disease

STAPHYLOCOCCUS LUGDUNENSIS

• named for Lyon, France where it was first recognized

• Has some features of S. aureus and some coagulase-
negative Staph

• Causes same infections as S. aureus

• Skin and soft tissue infections, infective endocarditis, bone and
prosthetic joint infection

• Antimicrobial susceptibilities are more like those of S.

aureus
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READING ASSIGNMENT FOR 9/20: SPORE

FORMING GRAM POSITIVE - BACILLUS
AND CLOSTRIDIUM