Staphylococcus aureus

Physical Characteristics Associated Diseases Transmission Patients at Risk

• Impetigo • Host = humans • Extremes of age
• Furunculosis • In adults: carried in anterior • Diseases ↓ local resistance
• Surgical wound infections nares, on skin, or vaginally • Granulocyte absence or
• Bacteremia • In neonates: carried in malfunction
• Pneumonia (1o & 2o) umbilicus, perineum, skin, or • Presence of foreign bodies
• Endocarditis GI tract • Antibiotic therapy
• Large Gram (+) cocci in • Osteomyelitis • Person-to-person hand • Encounter with health care
grape-like clusters
contact; inanimate objects system
• Catalase (+); Coagulase (+) Toxin-mediated Disease: • Attachment via fibronectin
• Resistant to harsh • Food poisoning • Abscess formation &
conditions • Toxic Shock Syndrome bloodstream invasion after
• β-hemolytic (produces • Scalded Skin Syndrome acute inflammatory response
golden yellow pigment)

Virulence Factors Diagnosis Treatment & Prevention Related Organisms

• Capsule (polysaccharide) • Gram stain • High incidence of antibiotic • There are 27 recognized
• Peptidoglycan • Culture resistance - Methicillin- species of Staphyococcus
• Teichoic acid (TA) & • Lab tests resistant strain (MRSA) • S. epidermidis = Coagulase
lipoteichoic acid (LTA) • Vancomycin, especially (-); Sensitive to novobiocin;
• Protein A Causes device & implant
for serious infections with
•Fibronectin-binding surface assoicated infection &
MRSA
proteins bacteremia; Common skin
• Warm compresses +/-
• Collagen adhesion protein commensal - nosocomial
topical antibiotics; drain pus;
• Fibrinogen binding protein • S. saprophyticus =
remove foreign body;
• Extracellular Factors: Coagulase (-); γ-hemolytic;
appropriate antibiotic
Toxins include Enterotoxins Causes UTIs; Resistant to
Coagulase, Catalase, coverage; supportive care
A-E, G-I, exfoliating toxins, & novobiocin
Hemolysins, Leukocidins,
toxic shock syndrome toxin
Hyaluronidase, Fibrinolysin,
(TSST-1)
Toxins, Biofilm production
 Streptococcus pyogenes (Group A)
Physical Characteristics Associated Diseases Transmission Patients at Risk
• Pharyngitis • Host = humans • Colder months/climates =
• Scarlet fever • Carried in nasopharynx pharyngitis
• Impetigo/pyoderma • Transmission via respiratory • Warmer months/climates =
• Erysipelas route or physical contact cutaneous infections
• Necrotizing fasciitis • Attachment via surface
• Streptococcal toxic shock ligands • Crowding
• Gram (+) cocci forming syndrome with Bacteremia • Cell structures are cross- • Poor hygiene
chains reacting antigens • Specific immunogenetic
• Catalase (-) Non-infectious complications: • Can act as superantigen predispositions
• β-Hemolytic • Glomerulonephritis (after
• Bacitracin-sensitive pharyngitis or cutaneous
infection)
• Acute rheumatic fever (after
pharyngitis)

Virulence Factors Diagnosis Treatment & Prevention Related Organisms

• Depends on diagnostic • S. agalactiae (Group B
• Capsule (hyaluronic acid) • Gram stain
testing & clinical presentation strep) = Causes neonatal
• M Protein on fimbriae • Culture
• For pharyngitis, 10 day sepsis & bacteremia &
• Lipoteichoic acid • Serology - anti-DNAase &
course of penicillin or meningitis
• C5a endopeptidase anti-streptolysin O antibody
• S. pneumoniae = α-
• Extracellular Factors: detection equivalent
Streptolysins O & S, • Rapid testing for antigen hemolytic; Causes pneumonia,
• For invasive disease,
Hyaluronidase, meningitis, & URT infections;
surgical intervention +
Streptokinase, DNAase, Encapsulated; optochin
antibiotics
NADase, Streptococcal sensitive
pyrogenic exotoxins, • Enterococcus faecalis =
• Vaccine development in
Streptococcal inhibitor of non-hemolytic; Nosocomial
progress, but complicated
complement (SIC) pathogen (UTI, bacteremia,
endocarditis, wound infection)
• S. viridans = α-hemolytic;
normal flora; optochin resistant
 Neisseria gonorrhoeae
Physical Characteristics Associated Diseases Transmission Patients at Risk
Local Diseases: • Host = humans • Southern & Central states
• Urethritis • Asymptomatic carriers: • Large cities
• Proctitis Female > Male • 15-30 year old age group
• Cervicitis • Transmission by sexual • Single
• Gram (-) diplococci • Ophthalmitis (esp. contact; also by “innocent” • Lower socioeconomic
• Fastidious anaerobe neonates) non-sexual contact & perinatal status
• Oxidase (+) • Pharyngitis • Attachment to microvilli of • # of sexual encounters &
non-ciliated cells → adjacent possible exposures
Disseminated Diseases: ciliastasis & sloughing off
• Peritonitis & Pelvic • Internalized & transport
Inflammatory Disease (PID) across cells in vacuoles
• Skin & joint disease via • Elicits intense inflammatory
bloodstream invasion response once in CT

Virulence Factors Diagnosis Treatment & Prevention Related Organisms

• Pili • Gram stain - urethral • Antibiotic resistance a major • Neisseria meningitidis
• Capsule (polysaccharide) discharge or pharynx problem - CDC has guidelines
• Endotoxin • Culture on specialized for current recommended tx
• Porin B media (Thayer-Martin) (changes over time)
• Opacity-associated enriched with elevated CO2 • Cephalosporin,
proteins & antibiotics to suppress ceftriaxone, cefixime, or
• IgA1 Proteases growth of competing bacteria alternative to treat
• Immunological methods uncomplicated cases
Rapid genotypic & • Molecular techniques • Azithromycin or
phenotypic changes to
surface proteins including pili doxycycline to treat co-
& capsule infection with Chlamydia
trachomatis

• Prevention = Safe sex

 Neisseria meningitidis
Physical Characteristics Associated Diseases Transmission Patients at Risk
Local Diseases: • Host = humans • Infants (1-5 years) &
• Rare upper respiratory • Mainly endemic in US; adolescents (12-18 years)
diseases (epiglotitis) epidemic in 3rd world • Crowding & close contact
• Pneumonia countries (dorms & army)
• Gram (-) diplococci • Carried in nasopharynx • Immune status
• Fastidious anaerobe • Transmission via respiratory
Disseminated Diseases: • Complement deficiency
• Oxidase (+) route (requires close contact)
• Meningitis • Colder climates favor
• 13 serotypes - A, B, & C • Attachment to non-ciliated
• Bacteremia transmission
associated with meningitis cells & M cells → local
epidemics • Fulminant disease
(meningococcemia = purpuric damage to ciliated cells
rash/lesions) • Minimal local inflammatory
response; asymptomatic
localized infection
• Crosses blood-brain barrier

Virulence Factors Diagnosis Treatment & Prevention Related Organisms

• Pili • Gram stain - CSF • Penicillin G or antibiotic • Neisseria gonorrhoeae
• Capsule (polysaccharide)** • Culture on specialized with better pharmacokinetics
• Endotoxin media (Thayer-Martin) (e.g. ceftriaxone,
• Porin B enriched with elevated CO2
• Opacity-associated rifampin, ciprofloxacin)
& antibiotics to suppress
proteins
growth of competing bacteria • Antibiotics prophylaxis for
• IgA1 Proteases
close contacts
Rapid genotypic & • Vaccination - polysaccharide
phenotypic changes to vs. conjugate form
surface proteins including pili
& capsule
 Haemophilus influenzae
Physical Characteristics Associated Diseases Transmission Patients at Risk
• Non-vaccinated people
• Bacteremia • Host = humans • Bimodal seasonal variation -
• Meningitis • Carried in nasopharynx peaks Sept to Dec & March
• Epiglottitis • Transmission via
• Small Gram (-) coccobacilli to May
• Septic arthritis respiratory route & direct
• Highly pleomorphic in tissue • Immune status
• Cellulitis contact
& body fluids • Genetic predisposition
• Otitis media • Attachment to non-ciliated
• Fastidious - requires linked to specific blood group
• Sinusitis epithelial cells → ciliastasis,
hematin & NAD; growth phenotypes & HLA antigens
• Conjunctivitis cilia sloughing & tight
enhanced by CO2 • Underlying pulm. disease
junction breakdown • Day care, elementary-aged
• Both encapsulated & • Invades between cells or younger siblings, smoke
nonencapsulated strains exposure
• 6 serotypes - Type B most • Antecedent resp. viral
invasive infection

Virulence Factors Diagnosis Treatment & Prevention Related Organisms

• Capsule - Type B is • Gram stain - better if • 40% are ampicillin resistant
polyribitol phosphate samples from CSF or ear • Non-invasive disease =
• Endotoxin then respiratory tract Doxycycline/quinolones
• IgA1 Protease • Culture - requires special • Invasive disease = 3rd
• Pili & other surface conditions generation cephalosporins
adhesions • Direct detection (ceftriaxone &
• Quellung test
cefotaxime)

• HiB Vaccine (conjugate

containing PRP capsule)
 Bordetella pertussis
Physical Characteristics Associated Diseases Transmission Patients at Risk
Catarrhal phase (1-3 weeks • Countries where vaccination
• Host = humans
post exposure): is not available (3rd world)
• Carried in nasopharynx
• Upper respiratory illness • Very young children - lack of
• Carriage is transient
symptoms including malaise, a fully developed immune
• Tiny Gram (-) coccobacilli • Maintains reservoir even in
low-grade fever, rhinorrhea & system
• Slow growing & fastidious immunized populations
watery eyes • Adults (as immunity from
• Transmission via respiratory
route (highly contagious) vaccine wears off)
Paroxysmal phase (3+ weeks): • Immune status
• Attachment to ciliated
• Episodes of coughing with no • Female > Male (unknown
epithelium → Ciliostasis &
time to breathe followed by reason)
local cell damage
inspiratory gasp
• Mainly a localized disease
• Lymphocytosis
• Secondary pneumonia
• Subconjunctival hemorrhage

Virulence Factors Diagnosis Treatment & Prevention Related Organisms

• Endotoxin • Nasopharyngeal swab (not • Erythromycin or
• Filamentous cotton) trimethoprim-
hemagglutinin** • Culture - difficult & tedious sulfamethoxazole in
• Tracheal cytotoxin b/c NAD required for growth Catarrhal phase
• Heat labile toxin • Serology for specific • Supportive therapy: close
• Adenylate cyclase antibodies monitoring of vitals,
• Pertussis toxin** • Direct detection & PCR nasotracheal suctioning,
• Capsule available but not used often oxygen, parenteral nutrition, &
• Clinical case definition is hydration
often the only basis used
• Vaccination - whole cell
(DPT) vs. acellular
• Antibiotic prophylaxis for
family
 Corynebacterium diphtheriae
Physical Characteristics Associated Diseases Transmission Patients at Risk
• Pharyngitis • Host = humans • Non-vaccinated
• Hypoxia • Carried in nasopharynx or • Children
• Fever on skin • Immuno-compromised
• Lymphadenitis • Transmission via
• Diptheria respiratory route
• Gram (+) bacilli • Bacteria remain localized
(pseudomembrane in
• Toxigenic & non-toxigenic but toxins spread via blood
pharynx)
strains
• Catalase (+)
Systemic Complications:
• Faculative anaerobe
• Toxic peripheral neuropathy
• Toxic myocarditis &
congestive heart failure

Virulence Factors Diagnosis Treatment & Prevention Related Organisms

• Diphtheria toxin - regulated • Gram stain • Penicillin or
by environmental factors • Culture erythromycin
• Pseudomembrane • Phage typing
formation • Vaccination (DPT)
• Passive immunization with
anti-toxin sera
 Pseudomonas aeruginosa
Physical Characteristics Associated Diseases Transmission Patients at Risk
• Localized infections • Inhabits soil, water, &
• Immunocompromised due
following surgery or burns vegetation
to underlying disease or
• Bacteremia • Transmission via hand
breakdown of nonspecific
• UTIs contact with hospital
host defenses
• Eye & Ear infections personnel
• Gram (-) bacilli • CNS infections • Opportunistic pathogen -
• Have flagellum - motile • Endocarditis nosocomial
• Obligate aerobe that can • Chronic respiratory
also grow anaerobically, at infection in cystic fibrosis
42oC & at high salt conditions patients
• Oxidase (+) • Acute pneumonia

Virulence Factors Diagnosis Treatment & Prevention Related Organisms

• Flagella • Gram stain • Resistant to many antibiotics
• Pili • Culture - greenish-metallic • Combined use of
• Endotoxin appearing colonies on blood aminoglycoside & a
• Toxin A agar with fruity (grape) smell beta-lactam antibiotic
• Extracellular enzymes (gentamicin,
including heat-stable carbenicillin)
hemolysin, phospholipase C, • Topical therapy of burn
pigments (pyocyanin & wounds
fluorescein), proteases
(elastase & alkaline protease), • Aseptic techniques
exoenzyme S, leukocidin
 Listeria monocytogenes
Physical Characteristics Associated Diseases Transmission Patients at Risk
• Listeriosis • Transmission via ingestion • Immunocompromised &
• Sepsis & Septicemia of raw contaminated food or Elderly
• Meningitis vaginally during childbirth • Pregnant women
• Encephalitis • Can grow extra- & • Fetuses - can spread
intracellularly congenitally across placenta
• Gram (+) bacilli • Intracellular survival or be acquired during labor &
• Has flagella - motile depends on hemolysin delivery
• Can grow at low • Stays localized except in
temperatures immunocompromised
• Catalase (+) patients
• β- Hemolytic
• Facultative anaerobe

Virulence Factors Diagnosis Treatment & Prevention Related Organisms

• H-antigen on flagella • Gram stain • High doses of Penicillin
• Hemolysin • Culture or Ampicillin +/-
• Listeriolysin O Gentamicin
• Phospholipases
• Hygienic food processing &
storage
• Avoid uncooked food
 Chlamydia trachomatis
Physical Characteristics Associated Diseases Transmission Patients at Risk
• Trachoma (Tr) = major • Host = humans • Adults & newborns most
cause of blindness • Life cycle within epithelial susceptible to IC - from
[Serotypes A, B, Ba, C] cell = invasion of elementary genital infection
• Small, obligate intracellular • Inclusion conjunctivitis (IC) body into phagosome → • LGV has higher incidence in
parasites with many [Serotypes A, B, Ba, D to K] conversion to reticulate body males
characteristics of Gram (-) • Lymphogranuloma → multiplication → release • 3rd world countries -
cocci, but lacks peptidoglycan venereum (LGV) [Serotypes of elementary bodies & cell transmission via poor
layer & muramic acid L1, L2, L2a, L3] death hygiene
• No pili or exotoxins • Non-gonococcal urethritis & • Cycle takes ~48 hours
cervicitis (NGU) [Serotypes D • Transmission via direct
to K] contact or contact with
infected fly

Virulence Factors Diagnosis Treatment & Prevention Related Organisms

• Can’t culture artificially, but • Tr: doxycycline or • Chlamydophilia psittaci
• Elementary body
can be grown within certain azithromycin • Chlamydophilia
cell lines pneumoniae
• IC: Adults = doxycycline
• For LGV - specific Ab
detection or direct detection or azithromycin; Pregnant
mothers = azithromycin,
erythromycin, or
amoxicillin
• NGU: doxycycline or
azithromycin
• LGV: doxycycline;
macrolides for young
children, pregnant women, or
people allergic to doxycycline
 Chlamydophila psittaci
Physical Characteristics Associated Diseases Transmission Patients at Risk
• Ornithosis (psitticosis) = • Life cycle within epithelial • Bird owners or people who
bronchial viral-like atypical cell = invasion of elementary frequent city parks
pneumonia (high fever, sore body into phagosome →
• Small, obligate intracellular throat, severe headache, conversion to reticulate body
parasites with many photophobia, nausea & → multiplication → release
characteristics of Gram (-) vomiting, irritated eyes, non- of elementary bodies & cell
cocci, but lacks peptidoglycan productive cough) death
layer & muramic acid • Can spread to CNS & also • Cycle takes ~48 hours
• No pili or exotoxins cause lung consolidation • Transmission via inhalation
of dried bird discharge

Virulence Factors Diagnosis Treatment & Prevention Related Organisms

• Can’t culture artificially • Chlamydia trachomatis
• Elementary body • Recovery of agent followed
• Tetracyclines or
• Chlamydophilia
by serology for Ab macrolides pneumoniae
 Chlamydophila pneumonia
Physical Characteristics Associated Diseases Transmission Patients at Risk
• Respiratory Tract • Life cycle within epithelial • Immunocompromised
Infections including atypical cell = invasion of elementary people
pneumonia, bronchitis, & body into phagosome →
• Small, obligate intracellular pharyngitis conversion to reticulate
parasites with many • May be involved in body → multiplication →
characteristics of Gram (-) coronary artery disease release of elementary
cocci, but lacks development bodies & cell death
peptidoglycan layer & • Cycle takes ~48 hours
muramic acid • Host = humans
• No pili or exotoxins • Transmission via
• TWAR serotype respiratory route

Virulence Factors Diagnosis Treatment & Prevention Related Organisms

• Elementary body • Can’t culture artificially • Doxycycline or • Chlamydophilia psittaci

• Serology to detect Ab erythromycin • Chlamydia trachomatis
 Legionella pneumophila
Physical Characteristics Associated Diseases Transmission Patients at Risk
• Legionnaires’ Disease • Grows in unicellular • Legionnaires’ Disease:
(legionellosis) = multi-system organisms in ground water epidemic from late summer
disease involving headache, • Transmission via inhalation of into early fall & endemic the
cough, fever, pneumonia, aerosolized droplets from rest of the year; ↑ incidence
liver degeneration, cardiac affected water source in males & people with
• Gram (-) bacilli arest, etc. • Invades phagocytic cells → pulmonary problems
• Fastidious • Pontiac Fever = flu-like prevents lysosome fusion & • Pontiac fever is always
• Aerobic syndrome, headache, acidication → multiplication → epidemic & is self-limiting
• Inhibited by high sodium dizziness, muscle pain release & cell death with • Immunocompromised &
concentrations • Forms microabcesses in cytokine release elderly
• Requires L-cysteine & iron lungs which coalesce to form • Can be found in lung or blood
for growth cavities • Several day incubation period
• No person to person
transmission

Virulence Factors Diagnosis Treatment & Prevention Related Organisms

• Type IV secretion system • Cultured on specific solid • Legionellosis:
• Pili agar with low sodium and Fluoroquinolones,
• Flagella high L-cysteine & ferric salt macrolides, or
• Cu-Zn superoxide • Serology
tetracyclines
dismutase & catalase-
• Pontaic fever is not treated
peroxidase
b/c self-limiting
• Toxins (RNAse,
phospholipase A & C)
 Mycoplasma pneumoniae
Physical Characteristics Associated Diseases Transmission Patients at Risk
• Normally found in respiratory
• Very small • Atypical pneumonia • Children ages 5-9 years old
& genitourinary tracts
• No cell wall (Walking pneumonia) - to young adults
• Can pass through membrane
• Pleomorphic confined to one lower lobe; • Slow progression &
filters
• Contains plastic membrane involved resp. mucosa; recovery times (weeks)
• Transmission via inhalation
consisting of sterols impairs ciliary function, but • 2-3 week incubation period
or infected droplets from close
• Requires very complex not alveoli function
personal contact with infected
media including cholesterol • Dry cough & remittent fever
• Fuses to cilia to create
& fatty acids superantigen → releases
• Motile (glides) toxic products which damage
• Facultative anaerobe adjacent cells & stimulate
• No toxins inflammatory cells
• Evades host response by
exchanging antigens with host

Virulence Factors Diagnosis Treatment & Prevention Related Organisms

• Protein P1 • Slow cultivation period • Macrolides, • Ureaplasma urealyticum
requiring very complex media Tetracyclines, or • Mycoplasma hominis
• Cold agglutinins Fluoroquinolones
• Complement fixation tests
• Direct detection of sputum
• Patchy infiltrate on CXR
 Ureaplasma urealyticum
Physical Characteristics Associated Diseases Transmission Patients at Risk
• Very small • Non-gonococcal urethritis & • Normally found in genital
• No cell wall prostatitis tracts of healthy, sexually
• Pleomorphic • Respiratory disease in active people
• Contains plastic membrane newborns • Passes through membrane
consisting of sterols filters
• Requires very complex • Fuses to cilia to create
media including cholesterol superantigen → releases
& fatty acids toxic products which damage
• Metabolizes urea for adjacent cells & stimulate
growth inflammatory cells
• No toxins • Evades host response by
exchanging antigens with
host

Virulence Factors Diagnosis Treatment & Prevention Related Organisms

• Slow cultivation period Doxycycline, • Mycoplasma pneumonia
requiring very complex media • Mycoplasma hominis
azithromycin,
erythromycin, or
levofloxacin
 Mycoplasma hominis
Physical Characteristics Associated Diseases Transmission Patients at Risk
• Pelvic inflammatory • Normally found in genital
• Very small
disease (PID) tracts of healthy sexually-
• No cell wall
• Postabortal & postpartum active people
• Contains plastic membrane
fevers • Can pass through membrane
consisting of sterols
• Pyelonephritis filters
• Requires very complex
• Respiratory disease in • Fuses to cilia to create
media including cholesterol
newborns superantigen → releases
& fatty acids
toxic products which damage
adjacent cells & stimulate
inflammatory cells
• Evades host response by
exchanging antigens with host

Virulence Factors Diagnosis Treatment & Prevention Related Organisms

• Slow cultivation period • Doxycycline or • Ureaplasma urealyticum
requiring very complex media clindamycin • Mycoplasma pneumoniae