Gram Positive Cocci: STAPHYLOCOCCUS

EDWARD-BENGIE L. MAGSOMBOL, MD, FPCP, FPCC Department of Microbiology Fatima College of Medicine

Staphylococci: General Characteristics

Greek: staphyle= bunch of grapes arranged in clusters, divides in many planes Gram positive Catalase positive Grow best in aerobic conditions but may behave as facultative anaerobes Grow in 7.5% NaCl

Gram Positive cocci in clusters

Staphylococci: Classification

S. aureus: most important pathogen responsible for most human infections S. epidermidis: opportunistic infections S. saprophyticus: opportunistic infections, UTI in sexually active females

Staphylococci: Structure

Cell wall teichoic acid S. aureus= ribitol teichoic acid S. epidermidis= glycerol teichoic acid Peptidoglycan tetrapeptides attached to muramic acid residues and linked by pentaglycine bridges sensitive to lysostaphin (S. staphylolyticus)

Staphylococci: Determinants of Pathogenicity

1.

Exotoxins a. pyrogenic exotoxins= interacts with both MHC-II of macrophages and specific variable regions on T-cells superantigens release IL-1, TNF alpha, IL-6 fever, capillary leak, circulatory collapse and shock

Staphylococci: Determinants of Pathogenicity

2.

Types a. Enterotoxins= in 33% of S. aureus; heat stable CHONs (1) Enterotoxin A= most common; vomiting and diarrhea (2) Enterotoxin B-F= structure and function same with A

Staphylococci: Determinants of Pathogenicity

2.

Types b. TSST-1= fever, multiple organ dysfunction and shock structurally identical to enterotoxin F

Staphylococci: Determinants of Pathogenicity

b.

c.

Leucocidin: kills PMNs and macrophages Exfoliatins: cleave stratum corneum coded by chromosomal gene or plasmid immunogenic

Staphylococci: Determinants of Pathogenicity

2. Hemolysins alpha, beta, gamma and sigma: lyse RBCs; facilitates tissue destruction 3. Protein A: surface CHON covalently bound to peptidoglycan in >90% of isolates MOA: binds to Fc portion of IgG, prevents Abs from binding to bacteria, hinders opsonization massive complement activation--shock

Staphylococci: Determinants of Pathogenicity

4.

Enzymes B-lacamase (penicillinase) fibrinolysin (staphylokinase) DNAse phospholipase hyaluronidase

Staphylococci: Clinical Disease

1.

Superficial infections a. Pyoderma (impetigo) b. Folliculitis, furuncles (boils) and sties c. Abscesses and carbuncles

Folliculitis

Carbuncle

Staphylococci: Clinical Disease

2.

Deep infections a. Osteomyelitis b. Pneumonia c. Acute endocarditis d. Arthritis e. Bacteremia, septicemia f. Deep organ abscesses (brain, kidney, lungs)

Brain abscess

Acute infective endocarditis

Staphylococci: Clinical Disease

3.

Staphylococcal toxin diseases a. Scalded skin syndrome (SSS) (1) bullous impetigo (2) staphylococcal scarlet fever b. Staphylococcal food poisoning c. Toxic shock syndrome (TSS)

Bullous impetigo

Staphylococci: Epidemiology

Colonizes skin and mucous membranes of 30% of normal humans Anterior nares: most common site Human to human transmission Nosocomial infectious agent Contamination of food by handlers Phage typing used to trace the source

Staphylococci: Laboratory Diagnosis

Microscopic: gram (+) cocci in clusters Culture: BAP, aerobic conditions 7.5% NaCl, 40% bile, polymyxin mannitol salt agar Identification: coagulase test mannitol fermentation

Gram Positive cocci in clusters

S. epidermidis culture

Coagulase test

Staphylococci: Treatment

Most isolates now resistant to penicillin Penicillinase-resistant penicillin (methicillin, oxacillin, nafcillin) First generation cephalosporin Vancomycin: for MRSA Erythromycin, clindamycin, 1st gen cephalosporin: for penicillin allergic pts

Staphylococci: Treatment

Both superficial and deep infections need to be given antibiotics but deep infections need higher doses, IV route, and prolonged treatment Debridement or drainage may be needed

Staphylococci: Control and Prevention

Suppress the carrier state Diligent aseptic practices No vaccine available