Bacterial diseases

BSc in Nursing and Midwifery

Kamuzu University of Health Sciences
26.04.2022
 Learning outcomes
• By the end of this lecture students must know
– Virulence factors
– Skin diseases and their causative agent
– Respiratory diseases and their causative agent
– Mode of transmission of different diseases
– Sexually transmitted
 How do bacteria cause disease?
• Here are various bacterial virulence factors,
which enable pathogens to cause diseases
– Adherence and colonization factors
– Factors that prevent activation of complement
– Factors that enable escape from phagocytosis by
white blood cells(WBCs)
– Factors that prevent destruction within
phagocytes
– Factors that suppress the host immune system
– Endotoxin
– Production of exotoxin i.e. enterotoxins,cytotoxins
and neurotoxin
– Production of necrotic and other types of
destructive enzymes
 Bacterial infections of the skin
ACNE
• Acne is common condition in which pores become
clogged with dried sebum, flaked skin and bacteria
which leads to formation of blackheads and
whiteheads and inflamed , infected abscesses.
• Acne is most common among teenagers
• Etiological agents are anaerobic, Gram positive bacilli
– Propionibacterium acnes
– Propionibacterium spp
• Infected humans serve as reservoirs
• Acne is not transmissible
• Diagnosis is made on clinical grounds
 ANTHRAX (woolsorter disease)
• Can affect
– Skin (cuteneous anthrax)
– Lungs (inhalation or pulmonary anthrax)
– Gastrointestinal tract( gastrointestinal anthrax)
• Depending on the port of entry of the etiological
agent
• In cutaneous anthrax ,depressed blackened lesions
called eschars form due to necrotoxin
• Inhalation and gastrointestinal anthrax are often fatal
• Etiological agent is B. Anthracis
• A encapsulated, spore forming ,Gram positive bacillus
• Reservoirs include
– Anthrax infected animals
– Spores that may be present in the soil
– Animal hair
– Wool
– Animal skins and hides
• Transmission occurs via
– Entry of endospore through breaks in skin
– Inhalation of spores
– Ingestion of bacteria in contaminated meat
• Pulmonary anthrax is not transmitted from
person to person
• Anthrax is diagnosed by isolation of B.anthacis
from blood, lesions,or discharges
• B.anthracis is considered an agent of bioterrorism
 Gas gangrene(clostridial myonecrosis)
• After clostridium spores enter and germinate
in a wound ,vegetative pathogens produce
necrotizing exoenzymes and toxins, which
destroy muscles and soft tissues allowing
deeper penetration by the organisms.
• Gases released from the infecting pathogens
causes pockets of gas to develop in the
infected tissue
• Tissue destruction occurs rapidly, often
necessitating amputation of infected anatomic
site
• Etiological agent is Clostridium perfringens
• Soil is the primary reservoir
• Humans become infected when soil containing
spores enter an open wound
• Person to person transmission does not occur
• The presence of Gram positive or Gram Variable
bacilli in gram stained smears of wound specimen
should lead one to suspect gas gangrene
 Staphylococal skin infections
(folliculitis,furuncles,carbuncles,abscesses,impetigo, impetigo of the new born,scalded skin
syndrome)

• Virtually all infected hair follicles, boils, carbuncles

and styes involve Staphylococuss aureus
• Skin lesions are localized and uncomplicated
• Seeding off the bloodstream may lead to
pneumonia, lung abscess, osteomyelitis, sepsis,
endocarditis, meningitis or brain abscess
• With impetigo which occurs mainly in children ,pus
filled blisters(pastules) may appear anywhere on
the body
• Impetigo of the newborn and staphylococcal
scalded skin syndrome(SSSS) may occur as
epidemics in hospital nurseries
• Etiological agent is S.aureus. A gram positive
coccus
• Impetigo may also be caused by Streptococcus
pyogenes, a gram positive coccus
• Staphylococcus aureus spread through skin by
production of hyaluronidase
• SSSS is produced by strains of S.aureus that produce
exfoliative toxin
• Which causes the top layer of skin to split from the
rest of the skin
• Infected humans serve as reservoirs
• Persons with draining lesion or any purulent discharge
are the most common source of epidemic spread
• Transmission occurs via direct contact with person
having purulent lesion
• In hospitals staph infections can be spread by the
hands of health care workers
• Infecting strain must be isolated on culture
media and identified
• Identification can be done by detecting
coagulase
• Susceptibility testing must be done because
many strains of S.aureus are multidrug
resistant
 Viral and bacterial ear infections
Otitis external(External otitis, ear canal infection,
swimmer's ear)
• Otitis externa is an infection of the outer ear canal
with itching, pain, a malodorus discharge,
tenderness,redness, swelling and impaired hearing
• It is common during summer swimming season
• Trapped water in the external ear canal can lead to
wet ,softened skin, which is easily infected by bacteria
or fungi
• Otitis externa is referred to as swimmer’s ear
• It often result from swimming in water contaminated
with Pseudomonas aeruginosa
• Usual etiological agents are E.coli,
P.aeruginosa,P.vulgaris, S.aureus. Fungi or
Aspergillus spp
• Reservoirs contaminated swimming pool water,
indigenous microbiota, articles inserted in the
earcanal for cleaning out wax and debris
• Diagnosis
– material from the infected ear canal should be
sent to the lab for culture and sensitivity
 Otitis media (middle ear infection)
• Often develops as a complication of the
common cold
• Its manifestations include
– Persistent and severe earache
– Temporary hearing loss
– Pressure in the middle ear
– Bulging of the ear drum
– Nausea, vomiting, diarrhea and fever in young
children
• Etiological agents are bacteria or viruses
• Three most bacterial causes are Streptococcus
pnuemoniae(gram positive diplococcus), haemophilus
influenzae( gram negative bacilli) Moraxella
catarrhalis(gram negative diplococcus),(S.aureus,Strep.
Pyogenes)
• Viral causes ,measles virus, parainfluenza virus,
respiratory syncytial virus
• It is not communicable
• Sample should be sent to lab for culture
• Β-Lactamase testing should be performed on isolates of
H.influenza
 Bacterial infections of the eyes
Bacterial conjuctivitis (“Pinkeye”)
• It involves irritation and reddening of
conjuctiva, edema of eyelids, mucopururent
discharge,and sensitivity to light
• It is highly contagious
• Etiological agents
– Most common are Haemophilus influenzae
subsp.aegypticus ,streptococcus pnuemoniae
• Humans serve as reservoirs
• Human to human transmission occurs via
contact with eye and respiratory discharges,
contaminated fingers, facial tissues
clothing ,eye makeup, eye medication,
opthalmic instruments and contact lens wetting
and contact lens cleaning agents
• Diagnosis
– Infection of the eye caused by bacteria( chlamydia)
and viruses should be differentiated from allergic
manifestations and irritations by microscopic
examination of the exudate, culture of pathogens
A. Bacterial conjunctivitis characterized by mucopurulent
discharge andconjunctival hyperemia.
B. Severe purulent discharge seen in hyperacute bacterial
conjunctivitis secondary to gonorrhea.
C. Intensely hyperemic response with thin, watery discharge
characteristic of viral conjunctivitis.
Images reproduced with permission:©2013 American Academy
ofOphthalmology.

A.Bacterial
B.Hyperacute bacterial conjunctivitis C.Viralconjunctivitis
conjunctivitis
 Chlamydial conjunctivitis (inclusion conjunctivitis, paratrachoma
conjunctivitis)

• In neonates, acute chlamydial conjunctivitis with

mucopurulent discharge may result in mild scarring of
conjunctivae and cornea
• It may be concurrent with chlamydial nasopharygitis
or pneumonia
• In adults, chlamydial conjunctivitis may be concurrent
with non-gonococcal urethritis or cervicitis
• Etiological agents are certain serotypes of
chlamydial trachomatis
• A gram negative bacterium and obligate intracellular
pathogen
• Infected human serve as reservoirs
• Transmission occurs via contact with genital
discharges of infected people, contaminated fingers
to eye, infections in newborns via an infected birth
canal, non chlorinated swimming pools
• Diagnosis
– Chlamydia do not grow on artificial media
– Diagnosis made by cell culture
– Molecular diagnostic methods
– Immunodiagnostic procedures
 Gonococcal conjunctivitis (gonorrheal
ophthalmia neonatorium)
• It is associated with an acute redness and
swelling of conjunctiva and purulent discharge
• Corneal ulcers, perforation and blindness may
occur if the disease is untreated
• It is caused by Neisseria gonorrhoeae, kidney
bean shaped,Gram negative diplococcus
• Infected birth canals serve as reservoirs
• Transmission occur via contact with the infected birth
canal during delivery.
• Adult infection can result from finger to eye contact
with infectious genital secretions
• Diagnosis
– is by microscopic observation of Gram negative
diplococci in smear of purulent material and isolation
of N.gonorrhoeae on appropriate media ie chocolate
agar or Thayer-martins agar
Bacterial infections of upper respiratory tract

Diphtheria
• It is a potentially serious upper respiratory tact
infection
• This acute, contagious bacterial disease primarily
involves the tonsils, pharynx,larynx and nose
• Occasional involves other mucus membrane, skin and
conjunctivae and the vagina
• Characteristic lesion is asymmetrical, adherent gray
white membrane in the throat
• Sore throat ,swollen and tender cervical lymph
nodes,tonsilitis ,and swelling of the neck are common
• The membrane may cause airway obstruction
• Diphtheria is a major killer in developing
countries
• It is controlled by vaccination with diptheria
toxoid
• Etiologic agent
– Caused by toxigenic strains of Corynebacterium
dipheriae, pleomophic G+ bacilli that form V,L, and
Y arrangement of bacilli
• Infected humans serve as reservoirs
• Transmission occurs via airborne droplets,
direct contact, and contaminated formites
• A Nasopharyangeal swab and throat swab
should be sent to the lab for diagnosis
 Streptococcal pharyngitis(strep throat)
• It is an acute bacterial infection of the throat with
soreness, chills,fever, headache, beefy red throat, white
patches of pus on pharyngeal epithelium, enlarged
tonsils and enlarged and tender cervical lymph nodes
• The infection may spread to the middle ear, sinuses, or
the organs of hearing
• Untreated strep throat can lead to complications such as
scarlet fever, rheumatic fever and glomerular nephritis
• The later two conditions result from depositions of
immune complexes beneath heart and kidney tissue
• Etiologic agent
– Streptococcus pyogenes, a β-hemolytic,catalase
negative,gram positive coccus in chains
• Infected humans serve as reservoirs
• Transmission occurs human to human by direct
contact , usually hands, aerosal droplets, secretions
from patients and nasal carriers
• Contaminated Milk and milk products have
been associated with foodborne outbreaks of
streptococcal pharyngitis
• A sole purpose of a routine throat culture is to
determine whether a patient does or does not
have strep throat
• If β-hemolytic streptococci are isolated they are
tested to determine whether they are group A
streptococci
 Bacterial infection of the lower respiratory
tract
Tuberculosis
• It is an acute or chronic disease mycobacterial
infection of the lower respiratory tract with
malaise, fever,night sweats, weight loss and
productive cough
• Shortness of breath, chest pain,hemoptysis and
hoarseness may occur in advanced stages
• Wide spread TB,known as military TB ,involves
many lesions throughout the body.
• Etiological agent
• It is caused by any species of the mycobacterium
tuberculosis complex
• Mostly mycobacterium tuberculosis
• A slow growing, acid fast gram positive to gram
variable bacillus
• Infected humans are the primary reservoirs
• Rarely primates ,cattle and infected mammals can
serve as reservoirs
• Transmission occurs via airborne droplets produced by
infected people during coughing ,sneezing and even talking
or singing
• Bovine TB may result from exposure to infected cattle , or
ingestion of unpasteurized contaminated milk or other
diary products
• Diagnosis
– Demonstration of an acid fast bacilli(AFB) in sputum
specimen
– Isolation of M.tuberculosis on lowenstein jensen or
middlebrooke culture media
 Whooping cough
• Highly contagious, acute bacterial childhood infection
• The first stage involve mild, cold-like symptoms
• The second stage produce severe ,uncontrollable
coughing fits. The coughing often end in a prolonged
high pitched,deeply indrawn breath
• The coughing fits produce a clear tenacious mucus and
vomiting. They may be so severe as to cause lung
rupture,bleeding in the eyes and brain, broken ribs,
rectal prolapse, or hernia
• The third stage usually begins within 4 weeks of onset
• Etiologic agent is Bordetella pertussis, a small
encapsulated, non motile, Gram negative
coccobacillus
• It producess endotoxin and exotoxin
• Infected humans serve as reserviors
• Transmission occur by droplet produced by
coughing
• Molecular diagnostic procedures are considered
the preferable tests to diagnose pertussis
Bacterial infections of gastrointestinal tract

Bacteria Gastritis and Gastric Ulcers

• Infection with Helicobacter pylori can cause
chronic bacterial gastritis duodenal ulcers.
• Gastritis is suspected when the person has upper
abdominal pain with nausea or heartburn
• People with duodenal ulcers may experience
gnawing,burning,aching, mild to moderate pain
just below the breastbone,an empty feeling and
hunger
• Drinking milk, eating or taking antiacids generally
relieves the pain
• Gastric ulcers and adenocarcinoma are also
epidemiologically associated with H.pylori infection
• Gastric ulcer can cause swelling of the tissues
leading into the small intestines
• This prevents food from easily passing out of the
stomach
• This in turn can cause pain, bloating, nausea, or
vomiting after eating.
• Complications include penetration, perforation,
bleeding and obstruction
• Etiological agents is H.Pylori a curved, gram negative
bacillus
• It is found on the mucus secreting epithelial cells of the
stomach.
• Human serve as reservoirs
• Transmission occurs via ingestion; presumed to be either
oral-oral or fecal oral transmission
• Diagnosis techniques include staining and culturing of
gastric and duodenal biopsy specimen, urea breath test,
NH4 excretion test,molecular diagnostic procedures
and immunodiagnostic procedures
 Cholera
• Cholera is an acute bacterial diarrheal disease with
profuse watery stools, occasional vomiting and
rapid dehydration.
• if untreated, circulatory collapse, renal failure and
death may occur.
• It is world wide disease
• Etiological agent is Vibrio cholerae ,comma shaped
gram negative bacilli
• It secretes an enterotoxin called choleragen
• Reservoirs include infected humans and aquatic
reservoirs
• Transimssion occur via the fecal oral
route,contact with feces or vomitus of infected
people, ingestion of fecally contaminated water
or food or mechanical transmission by flies
• Diagnosis
• Rectal swabs or stool specimens should be
inoculated onto thiosulphate citrate bile
sucrose (TCBS)agar
 Bacterial sexually transmitted diseases

Gonorrhea
• It is important to know that not all clinical
presentations involve the genital tract.
• Gonorrhea may present as asymptomatic
mucosal infection, ophthalmia neonatorum,
urethritis, proctitis, pharyngitis,epididymitis,
cervicitis, Bartholin gland infection, pelvic
inflamatory disease, endometritis,salpingitis,
peritonitis and disseminated gonococcal infection
• Patients with disseminated gonococcal infection
have myalgia,anthralgia,polyathritis, and a
characteristic dermatitis
• Urethral discharge and painful urination are
common in infected men ,2-7 days after
infection
• Infected women may be asymptomatic for
weeks or months, during which time severe
damage to the reproductive system may occur
• Its is caused by Neisseria gonorrhoeae, a gram negative
diplococcus
• Infected human serve as reservoirs
• Transmission occurs via direct mucus membrane to
mucus membrane contact
• Diagnosis
• In male patients can be diagnosed by typical
appearance of gram stained urethral discharge
specimens, with numerous WBCs with numerous
intracellular and extracellular gram negative dipplococci
• Molecular diagnostic techniques are also employed
• Specimens are inoculated on chocolate agar
 Syphilis
• It is a treponemal disease
• It occurs in four stages
• Primary syphilis . Painless lesion known as chancre
which occur where Treponema pallidum entered
the genital mucosa or skin
• Secondary syphilis . A skin rash about 4-6 weeks
later with fever and mucus membrane lesion
• This is followed by a long latent period
• Tertiary syphilis with damage to the central nervous
system, cardiovascular system,visceral organs,
bones, sense organs
• Etiologic agent is T.pallidum, a gram variable, tightly
coiled spirochete
• Infected humans serve as reservoirs
• Transmission occur via direct contact with lesions,
body secretions, mucous membrane,blood, semen,
saliva and vaginal discharges of infected people
• During sexual contact, blood transfusion and
transplancentally
• Diagnosis
• Primary syphilis can be diagnosed by darkfield
microscopy
• Immunodiagnostic procedures ie rapid plasma
reagin(RPR), venereal disease research
laboratories(VDRL)
 Conclusion
• Give any virulence factors of microorganism
• Give any two skin diseases and their causative
agent
• Give an two Respiratory diseases and their
causative agent
• What is the mode of transmission of enteric
diseases
• Give two sexually transmitted
• Thank you