Burton's Microbiology

for the Health Sciences

Chapter 19. Bacterial Infections

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 19 Outline
• Introduction • Bacterial Infections of the
Oral Region
• How do Bacteria Cause
Disease? • Bacterial Infections of the
Gastrointestinal
• Bacterial Infections of the
Skin • Bacterial Infections of the
Genitourinary System
• Bacterial Infections of the
Ears • Bacterial Infections of the
Circulatory System
• Bacterial Infections of the
Eyes • Bacterial Infections of the
Central Nervous System
• Bacterial Infections of the
Respiratory System
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 Chapter 19, cont.

• Diseases Caused by
Anaerobic Bacteria
• Diseases Associated
With Biofilms
• Recap of Major
Bacterial Infections of
Humans
• Appropriate Therapy for
Bacterial Infections

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How Do Bacteria Cause Disease?

• Adherence and colonization factors

• Factors that prevent activation of complement
• Factors that enable escape from phagocytosis by white
blood cells
• Factors that prevent destruction within phagocytes
• Factors that suppress the host immune system (i.e.,
factors that cause immunosuppression)
• Endotoxin (a component of the cell walls of Gram-
negative bacteria)

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How Do Bacteria Cause Disease?, cont.

• Production of exotoxins (e.g., cytotoxins, enterotoxins,

neurotoxins)
• Production of necrotic and other types of destructive
enzymes

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Bacterial Infections of the Skin
• Acne • Leprosy (Hansen Disease)
– Propionibacterium acnes – Mycobacterium leprae; an
and other acid-fast bacillus
Propionibacterium spp.;
anaerobic Gram + bacilli • Staphylococcal Skin Infections
(Folliculitis, Furuncles,
• Anthrax, Woolsorter’s Disease Abscesses, etc.)
– Bacillus anthracis; a spore- – Staphylococcus aureus, a
forming, Gram + bacillus Gram + coccus
• Gas Gangrene (Myonecrosis) • Streptococcal Skin Infections
(Scarlet Fever, Erysipelas, etc.)
– Anaerobic bacteria in the
genus Clostridium, – Streptococcus pyogenes, a
especially C. perfringens Gram + coccus

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Bacterial Infections of the Skin, cont.
• Wound Infections
– Result when protective skin barrier is broken
as a result of burns, punctures, surgical
procedures, or bites
– Opportunistic indigenous microflora and
environmental bacteria can invade and cause
local or deep tissue infections
– Pathogens may spread through blood or
lymph, causing serious systemic infections

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Viral and Bacterial Ear Infections
• Otitis Externa (External Otitis, Ear Canal Infection,
Swimmer’s Ear)
– Escherichia coli, Pseudomonas aeruginosa, Proteus
vulgaris, Staphylococcus aureus; less commonly caused
by a fungus such as Aspergillus

• Otitis Media (Middle Ear Infection)

– Bacterial causes: Streptococcus pneumoniae, a Gram +
diplococcus; Haemophilus influenzae,a Gram - bacillus;
and Moraxella catarrhalis, a Gram - diplococcus
– Viral causes: measles, parainfluenza, and respiratory
syncytial (RSV) viruses (RSV)

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Bacterial Infections of the Eyes
• Bacterial Conjunctivitis (“Pinkeye”)
– Haemophilus influenzae biogroup aegyptius and
Streptococcus pneumoniae are the most common causes
• Chlamydial Conjunctivitis (Inclusion Conjunctivitis,
Paratrachoma)
– Certain serotypes (serovars) of Chlamydia trachomatis
• Trachoma (Chlamydia Keratoconjunctivitis)
– Certain serotypes of Chlamydia trachomatis
• Gonococcal Conjunctivitis (Gonorrheal Ophthalmia
Neonatorum)
– Neisseria gonorrhoeae; a Gram - diplococcus; also called
gonococcus or GC
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Bacterial Infections of the Upper
Respiratory Tract
• Diphtheria
– Corynebacterium diphtheriae; a pleomorophic, Gram
+ bacillus
– Transmission occurs via airborne droplets, direct
contact, contaminated fomites, and raw milk
• Streptococcal Pharyngitis (Strep Throat)
– Streptococcus pyogenes; beta-hemolytic, catalase-
negative, Gram + cocci in chains
– Transmission is human-to-human by direct contact,
usually hands; also via aerosol droplets
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Infections of the Lower Respiratory Tract
Having Multiple Causes

• Pneumonia
– May be caused by Gram + or Gram - bacteria,
mycoplasmas, chlamydias, viruses, fungi, or protozoa
– Community-acquired bacterial pneumonia is most
frequently caused by Streptococcus pneumoniae
• S. pneumoniae is the most common cause of
pneumonia in the world
– Transmission, in most cases, occurs via infected
humans

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Gram-Positive Streptococcus pneumoniae
in a Gram-Stained Smear of a Purulent
Sputum. Note the diplococci.

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Bacterial Infections of the Lower
Respiratory Tract

• Legionellosis (Legionnaire’s Disease, Pontiac Fever)

– Legionella pneumophila, a poorly staining, Gram -
bacillus; transmission is via environmental water
sources, ponds, air-conditioning systems, hot tubs,
etc.
• Mycoplasmal Pneumonia (Primary Atypical Pneumonia)
– Mycoplasma pneumoniae, tiny, Gram - bacteria,
lacking cell walls; transmission occurs via droplet
inhalation, direct contact with an infected person, or
contaminated articles

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Bacterial Infections of the Lower
Respiratory Tract, cont.

• Tuberculosis (TB)
– Primarily Mycobacterium tuberculosis (a slow-
growing, acid-fast, Gram-positive to Gram-variable
bacillus), occasionally other Mycobacterium spp.;
transmission occurs primarily via infected humans
(airborne droplets)
• Whooping Cough (Pertussis)
– Bordetella pertussis, a small, encapsulated,
nonmotile, Gram - coccobacillus that produces
endotoxin and exotoxins; transmission occurs via
infected humans (i.e., droplets by coughing)
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Bacterial Infections of the Oral Cavity

• Terms relating to infectious diseases of the oral cavity:

dental caries, periodontal disease, gingivitis, periodontitis
• Acute Necrotizing Ulcerative Gingivitis (ANUG); also
known as Vincent’s Angina and Trench Mouth
– A synergistic infection involving 2 or more species of
anaerobic bacteria of the indigenous oral microflora;
most commonly, Fusobacterium nucleatum and
Treponema vincentii

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Bacterial Infections of the GI Tract
• Bacterial Gastritis and Ulcers
– Helicobacter pylori, a curved, microaerophilic, capnophilic,
Gram - bacillus
– Transmission occurs via infected humans; probably by
ingestion; presumed to be either oral-oral or fecal-oral
• Campylobacter Enteritis
– Campylobacter jejuni (less common, C. coli), curved, S-
shaped or spiral Gram - bacillus
– Transmission occurs via animals, including poultry, cattle,
sheep, swine, rodents, birds, kittens, puppies, and other
pets
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Bacterial Infections of the GI Tract, cont.
• Cholera
– Certain biotypes of Vibrio cholerae serogroup 01, curved,
Gram - bacillus that secretes enterotoxin
– Transmission occurs via infected humans and aquatic
reservoirs; fecal-oral route
• Salmonellosis
– Members of the family Enterobacteriaceae, Gram - bacilli
that invade intestinal cells, release endotoxin, and produce
cytotoxins and enterotoxins
– Transmission occurs via domestic and wild animals;
contaminated food, fecal-oral, food handlers,
contaminated water

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Bacterial Infections of the GI Tract, cont.
• Typhoid Fever (Enteric Fever)
– Salmonella typhi, a Gram - bacillus that releases
endotoxin and produce exotoxins
– Transmission occurs via infected humans for typhoid
and paratyphoid; some people become carriers after
infection (e.g., “Typhoid Mary”)
• Shigellosis (Bacillary Dysentery)
– Shigella dysenteriae, S. flexneri, S. boydii, and S.
sonnei; nonmotile, Gram - bacilli, members of the
family Enterobacteriaceae
– Transmission occurs via infected humans

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Enterovirulent Escherichia coli
• Enterohemorrhagic E. coli (EHEC) Diarrhea
– Escherichia coli O157:H7 is most commonly involved;
others include O26:H11, O111:H8, and O104H21;
Gram - bacillus that produces potent cytotoxins
– Transmission occurs via cattle feces; also infected
humans, fecal-oral route
• Enterotoxigenic E. coli (ETEC) Diarrhea (Traveler’s
Diarrhea)
– Many different serotypes of enterotoxigenic E. coli
– Transmission is via infected humans, fecal-oral route

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 Urinary Tract Infections (UTIs)
• The most common causes of UTIs are E. coli and other
members of the family Enterobacteriaceae (especially
Proteus and Klebsiella).
• Other common causes of UTIs are Enterococcus spp.,
Staphylococcus spp. (especially S. aureus, S.
epidermidis, and S. saprophyticus), and Pseudomonas
aeruginosa.
• UTIs may be acquired either within a healthcare
setting (called healthcare-associated UTIs) or
elsewhere (called community-acquired UTIs).
• UTIs are the most common type of healthcare-
associated infection.
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Many Gram-Negative Bacilli and Many Pink-
Staining PMNs Can be Seen in This Gram-Stained
Urine Sediment From a Patient With Cystitis

PMNs

Gram-negative bacilli

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Bacterial STDs
• Genital Chlamydial Infections
(Genital Chlamydiasis) • Syphilis
– Certain serotypes of – Treponema pallidum;
Chlamydia trachomatis; Gram-variable, tightly-
obligate intracellular Gram coiled spirochete; too thin
- bacteria to be seen by brightfield
– Transmission via infected microscopy; can be seen
humans, direct sexual by darkfield microscopy
contact, or mother-to- – Transmission via infected
neonate during birth humans, by direct contact
• Gonorrhea with lesions, body
secretions, mucous
– Neisseria gonorrhoeae; a membranes, blood, semen,
Gram - diplococcus etc.; usually sexual
contact; also blood
– Transmission via infected transfusions and
humans, usually sexual transplacentally from
contact or direct mucous mother to fetus
membrane-to-mucous
membrane contact
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Gram-Stained Urethral Exudate From a
Male Patient With Gonorrhea.
Note the Numerous Gram-Negative Intracellular
Diplococci.

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Other Bacterial STDs
• Bacterial STDs that occur more frequently in parts of the
world other than the United States:
– Chancroid – caused by Haemophilus ducreyi; a Gram
- bacterium
– Granuloma inguinale – caused by
Calymmatobacterium granulomatis; a Gram -
bacterium
– Lymphogranuloma venereum – caused by certain
serotypes of Chlamydia trachomatis
• STDs may be transmitted simultaneously; if a patient is
diagnosed with one particular type of STD, other types
should be sought.

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Rickettsial and Ehrlichial Diseases of the
Cardiovascular System
• Rocky Mountain Spotted Fever (Tickborne Typhus Fever)
– Rickettsia rickettsii; a Gram – bacterium; an obligate
intracellular pathogen
– Transmission occurs via infected ticks on dogs,
rodents, and other animals
• Endemic Typhus Fever (Murine Typus Fever, Fleaborne
Typhus)
– Rickettsia typhi; a Gram - bacterium; an obligate
intracellular pathogen
– Transmission occurs via rats, mice, possibly other
mammals, infected rat fleas
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Rickettsial and Ehrlichial Diseases
of the Cardiovascular System, cont.

• Epidemic Typhus Fever (Louseborne Typhus)

– Rickettsia prowazekii; a Gram – bacterium; an
obligate intracellular pathogen
– Reservoirs are infected humans and body lice
• Erlichiosis
– Gram-negative coccobacilli, closely related to
rickettsias; obligate intraleukocytic pathogens
– Reservoir unknown; transmission is via tick bite

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Other Bacterial Infections
of the Cardiovascular System
• Lyme Disease (Lyme Borreliosis)
– Borrelia burgdorferi; a Gram -, loosely coiled spirochete
– Transmission is via tick bite
• Plague (“Black Death,” Bubonic Plague, Pneumonic Plague,
Septicemic Plague)
– Yersinia pestis; a non-motile, bipolar-staining, Gram -
coccobacillus
– Transmission is via wild rodents and their fleas (flea bite)
• Tularemia (Rabbit Fever)
– Francisella tularensis; a pleomophic, Gram - coccobacillus
– Transmission is via tick bite; associated with rabbits

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Bacterial Infections of the CNS
• Listeriosis
– Listeria monocytogenes; a Gram + coccobacillus
– Transmission occurs via ingestion of raw or
contaminated milk, soft cheeses, and vegetables
• Tetanus (Lockjaw)
– Clostridium tetani; a motile, Gram + anaerobic,
spore-forming bacillus
– Transmission occurs via spores of C. tetani entering
a puncture wound, burn, or needlestick by
contamination with soil, dust, or feces

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Tetanus Patient Displaying the Bodily
Posture Known as Opisthotonos

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