Staphylococcus Name of microbe Family Genus Species staphylococcaceae Staphylococcus s.aureus,s.intermedius (coagulase +ve) s.epidermidis, s.hemolyticus, s.hominis,s.

capitis (coagulase ve) Gram +ve Spherical shape Arrange in grape cluster Non-sporing Non-motile Capsulated (microcapsule)

Streptococcus

Pneumococcus

streptococcaceae Streptococcus Pneumococcus St.pyogens,st.pneumococci,st.anginosus, st.fecalis

Morphology

St.pyogens Gram +ve Spherical shape Arrange in chain Non-sporing Non-motile Capsulated (composed of hyaluronic acid)

Gram +ve (diplococcic) Ovoid or lancet shape Non-sporing Non-motile Capsulated, encapsulated each pair

Physio. props.

Facultative anaerobes

1.facultative anaerobes i. -hemolytic streptococci (produce greenish discoloration with partial hemolysis around colonies) ii. -hemolytic streptococci (produce a sharply defined, clear, colorless zone of hemolysisaccording to group C carbohydrate Ag. 20 Lancefield group (A-U),which st.pyogens in group A) iii. -hemolytic streptococci (nonhemolytic streptococci produced no change in medium) 2.obligate anaerobes (peptostreptococci)

Facultative anaerobes

Cultural props.

Grow readily in ordinary media, temperature optimum 0 37 C,pH 7.4-7.6 Colonies sharply define, round, convex, smooth, shiny, opaque Produces a golden yellow pigment on solid media (i.e. milk salt agar) On blood agar: colonies are surrounded by a zone of complete hemolysis On MacConkeys agar: colonies are smaller,pink due to lactose fermentation. In liquid media: produces uniform turbidity,sometimes precipitated at bottom of the test tube S.Aureus Ferment glucose, levulose, maltose, lactose, sucrose, forming ACID Mannitol fermentation: S.aureus ferment in both aerobic and anaerobic condition S.epidermidis not ferment in both condition S.saprophyticus ferment only in aerobic + + (s.epidermidis -) + liquify + + reduces

Grow only in enriched media Blood agar: colonies are small, circular, semitransparent, low convex disk with area of clear hemolysis around them (due to O2 labile hemolysin O Liquid media (glucose or serum broth): granular turbidity with a powdery deposit. No pellicle formed.

Grow only in enriched media Readily stain with anyline dyes Capsule may be demonstrated by a clear halo in Indian ink preparation On blood agar (18h incubation): colonies are small, dome shaped and glistening, with area of green discoloration around the colonies.

Biochem. Props. Sugars fermentation

Ferment several sugars producing ACID Not reduces ribose (the main differential characteristics)

Ferment several sugars forming ACID

Catalase Oxidase Coagulase Methyl red Gelatin Indole phosphatase H2S Nitrates reduction Bile solubility Insulin

Not soluble

soluble Split

Resistance

Antigenic structure

Most resistance Dried on threads, retain their viability for 3-6 months 0 Withstand 60 C for 30min Resist 1% phenols for 15min Sensitive to anyline dyes, particularly to brilliant green (used to treat pyogenic disease) Antigenically complex, antibodies are produced to many cellular (i.e. capsular Ag, peptidoglycan, techoic acid of cell walls, protein A) and extracellular component (toxins & enzymes) 1. Polysaccharides Ag (>50 Ag) Poly A: Extracted from pathogenic strain Isolated from patients with septicemia, conjunctivitis, osteomilitis Poly B Found as nonvirulent @ nonpathogenic strain Different from poly A in serological reaction and chem. structrure Poly C Contain specific polysaccharides found both as virulent and nonvirulent strain 2.protein Ag Common to all species

Easily destroy by heat 54 C, 20mins Rapid inactivated by antiseptic but can survive in dust for several weeks, if protected from sunlight More resistant to crystal violet Susceptible to many antibiotics 1.C carbohydrates Integral part of cell wall 2.M,T and R protein AG M: responsible for the bacterial virulence by virtue of their antiphagocytic props Is heat & acid stable Susceptible to tryptic digestion T&R: has no relation to virulence Is an acid labile Trypsin resistant antigen in many serotypes of st.pyogens

Readily destroyed by 0 heat 52 C, 15mins and antiseptic

Type specific capsular polysaccharides Used for serological classification

Factors of pathogenicity

1.Cellular Peptidoglycan layer Major component of cell wall Stimulates production of endogenous pyrogens Activates production IL-1 from monocytes Attracts PMN leucocytes Activates complement Protein A Covalently linked to peptidoglycan layer Techoic acids Mediate the attachment to mucosal surface through their specific binding fibronectin 2.extracellular Clumping factors@ bound coagulase Binds fibrinogen, convert it to fibrin Cause staphy. to clump or aggregate 3.exotoxins Hemolysins -hemolysin: from patient -hemolysin: from animals necrotic toxins fibnolysins lethal toxins 4.enzymes plasmacoagulase lecithinase hyaluronidase lipases nucleases, penicillinase, lechitinase

1.capsule inhibit phagocytosis by both neutrophils and macrophages 2.M-protein localized on cell wall has cytotoxic activity against neutrophils inhibit leukocytes migration in capillaries 3.F-protein major adhesion for bacterial adhesion to epithelial cells of pharynx and skin (fimbriae) 4.hemolysin streptolysin O O2 labile protein Responsible for hemolysis Streptolysin S O2 stable non antigenic peptide The release involve a variety of nonspecific carrier protein 5.toxins (pyerogenic exotoxins) Cause fever and rash Alters Ab response Damage macrophage Enhances susceptibility to endotoxin shock 6.fibrinolysin (streptokinase) Activates fibrinolytic system 7.enzymes Hyaluronidase, ribonuclease, protease, phosphatase, esterase, amylase

1.capsule Virulence factor Noncapsulated pneumococci are avirulent Prevent phagocytosis 2.hemolysin, leukocidin, neuraminidase

Source of infection Mode of transmission

Pathogenesis

Human-to-human spread (direct@ indirect) Air borne Food borne Iatrogenic Contaminated instrument Enter body through skin or mucous membrane Overcome lymphatic barrier Penetrate bloodsepticemia Cause inflammation by toxins

Human (patient, carrier) Inhalation of contaminated droplets Contact Contaminated dust or formites

Tendency to spread locally, along lymphatic and through blood stream

Clinical symptoms

1. 2. 3. 4. 5. 6. 7. 8.

Local lesion General infection (sepsis septicopyemiae) Secondary infection (influenza,small pox) Food poisoning Nosocomial infection (cross infection Mixed infection Deep infection (acute osteomyelitis) Resp. tract (tonsillitis, empyema, septic arthritis)

1. 2. 3. 4. 5. 6. 7. 8.

Colonize nasopharynx and oropharynx Spread to distant loci (lung(pneumonia), paranasal sinuses(sinusitis), ears(otitis media), meninges(meningi tis) Resp. infection (pharyngitis, tonsillitis) Otitis Skin (impetigo, erysepilas) Nephritis Endocarditis Meningitis Arthritis Pleural sepsis

Lab diagnosis Treatment

Prophylaxis

Nonspecific Antibiotics Specific S. bacteriophage S. toxoids S. autovaccines S. immune sera S. immunoglobulin Hygiene Treatment of vitamin deficiencies Prevention of traumatism Hospital disinfection

*Refer to class notes* Long term of penicillin administration in children (or use erythromycin- more sensitive)

Antibiotics (penicillin, encephalosporins, erythromycin, chloramphenicol)

Prevention of rheumatic fever

Polycapsullar vaccine containing polysaccharides from 2-3 serotypes of pneumococci