Bacteriology 1

Bacterial
Genus
G
+ / -
General Characteristics Species Species Characteristics/
Lab Diagnosis
Clinical Diseases Virulence/Treatment/Other
Epidemiology
Staphylo-
coccus
+
Cocci
Catalase Positive
Facultative anaerobes

Grape like clusters
- never present in chains
- Catalase Positive:
- used to differentiate
between staphylococci
and streptococcus
- non motile


- staphylococci usually
found on anterior nares,
nasopharynx, or on skin
of the human body
- commonly shed:
- passed person to
person
- persist in environment
- disinfection and
handwashing is
essential
- S. aureus is present in
20-50% of humans
- endocarditis:
-mortality ~50%
Aureus - Coagulase Pos.
- -hemolytic
- True pathogen
- Light gold blood agar
colonies
- Salt tolerant
- Ferments manitol
- mannitol/salt agar test:
- contains 7.5% NaCl
- mannitol is used as
carbon/energy source
- only S. aureus can
tolerate & grow on agar
- changes manitol from
phenol red to yellow

Toxin Based:
- Scalded-skin syndrome:
- inflammation around mouth and then spreads to body
- blisters form leads to Nikolskys Sign (peel @ touch)
- Bullous Impetigo
- Food poisoning
- bacteria in food
- heating kills bacteria (not toxin)
- symptoms: 1-6hrs
- nausea/vomiting
- abdominal pain & diarrhea
- Toxic Shock Syndrome:
- tampon, wound, abrupt, multi-organ failure
-high fever, vomiting, diarrhea, muscle pain
Bacterium Based: pyogenic infections
-folliculitis- infected hair follicle
-furuncle- boil or abscess
-carbuncle- abscess that spread through subcutaneous
tissue
-impetigo- involve s. pyogenes
- red macula
- pustule (may rupture/crust)
- bacteremia & endocarditis
- begin with flu like symptoms
- if prolongedendocarditis
- reduced cardiac output
- septic emboli
- pneumonia & empyema (pus in a cavity/space)
- acquired via aspiration/blood
- old, young
- osteomylitis & septic arthritis
-metaphyseal long bone effected
- adults: Brodies abscess
- children: abrupt onset
- septic joint, back pain






- virulence factors:
- Structural
- Protein A anti-Fc IgG
- toxins:
- , , , cytotoxins:
- lyse cells (i.e RBC) by acting
on cell membrane
- leukocidin:
- form pores in WBC membrane
- exfoliative toxins:
- cause loss of superficial skin
layer
- enterotoxin A-E:
- heat-stabile toxins
- act as superantigens
- act on GI neural receptors
- cause vomiting
- TSST
- act as superantigen
-increase cytokine release
- hypovolemic shock
- inhibit phagocytosis
- Protein A on cell wall of bacteria
binds to Fc receptor on
neutrophils
- prevent phagocytosis
- attachment:
- teichoic acids
- microcapsule or slime layer
- enzymes:
- coagulase, catalase, penicillinase
hyaluronidase, lipase, nuclease

Treatment:
- Resistance via Beta-lactamase
- resistant to PBP alternates
- MRSA
- Vancomycin, Clindamycin
Epidermidis - opportunistic pathogen
- no -hemolysis of blood
- Coagulase Neg.
- Novobiocin
- Polysaccharide Capsule adheres to prosthetic devices
- associated with nosocomial infections
- Blood Culture contamination


Treatment:
- Vancomycin


Other CNS Staphylococci Infections:
- subacute endocarditis
- artificial valves
- catheter/shunt infections
- prosthetic join infections
- glomerulonephritis
Saprophyticus - opportunistic pathogen
- no -hemolysis of blood
- Coagulase Neg.
- Novobiocin
Urinary Tract Infections:
- mainly in young females who are 1
st
time sexually active
- dysuria, pyruia
Haemolyticus - opportunistic pathogen
- no -hemolysis of blood
- Coagulase Neg.

Bacteriology 2

Bacterial
Genus
G
+ / -
General Characteristics Species Species Characteristics/
Lab Diagnosis
Clinical Diseases Virulence/Treatment/Other
Epidemiology
Strepto-
coccus
+
Cocci
Catalase Negative
Anaerobic

- Cocci in pairs or
chains
- some are hemolytic
- Capsule
- require enriched media
for good growth


S. Pyogenus:
- often colonize (found) in
oropharynx - SWAB
- usually transferred via
large droplet transmission
- pharyngitis usually seen
in 5-15yr olds
- crowded indoor living
fascilitates spreading
- soft tissue infections are
usually preceded by
breaks in skin:
- pyoderma
- erydipelas
- cellulites
- fasciitis
- necrotizing fasciitis:
- mortality > 50%
- Strep. Shock Syndrome:
- increased in
immunodepressed
patients (i.e. AIDs,
cancer, diabetes
mellitus, heart &
pulmonary disease)














Pyogenus - Lancefield Group A
- Catalase Neg.
- -hemolytic
- (large zone)
- PYR Pos.
- Pyrrolidonyl
Arylamidase
- unique to pyogenus
- M-protein (gives matte
appearance)
- short of long chains -
usually found coupled
with WBCs
- not usually on skin
- small glossy or matte
white colonies
- latex agglutination:
- used to detect group-
specific antigens
back of oropharynx
- Strict anaerobes
- aero (O2) tolerant
- but grows best in low
O2 environments

- Bacitracin Sensitive
- inhibits S. pyogenus
growth on blood agar
- only Beta-H strep Sens

Toxin Based Supportive:
Pharyngitis: (similar to viral pharyngitis)
- abrupt onset of symptoms:
- sore throat, fever, malaise, headache
- tonsilor erythema, hypertrophy, and exudates
- possible abscesses, otitis media, sinusitis
- enlarged anterior cervical lymph nodes
Scarlet Fever:
- caused via lysogenization w/ phage that contains
the gene for pyrogenic exotoxin
- day 1: (pharyngitis)
- buccal mucosa, temples, deep red cheeks
- pale area around nose and mouth
- yellow coat on tongue (shed: strawberry tongue)
- day 2: (rash spares face)
- starts at trunk and neck and spread to extremities
Pyroderma (impetigo):
- confined purulent (pussy) infection on skin
- person-person contact, children poor hygiene
- purulent vescicles rupture, & honey colored crust over
Erysipelas:
- acute skin infection with systemic signs
- preceded by pharyngitis or skin infections
- red, edematous skin with sharp demarcated borders
- common on leg (with local inflammation)
- local lymph node enlargement
Cellulitis:
- acute, spreading inflammation involving skin and
subcutaneous tissue
- different from erysipelas (indistinct non raised margins)
- may be caused by non-pyogenus species
Necrotizing Fasciitis:
- subcutaneous necrotic infection that spreads along
fascial planes
- begins with cellulites & associated with severe pain
- extensive damage to muscle and fat (gangrene)
- gangrene and bacteremia
- systemic symptoms and signs
- treatment: antibiotics & surgical debridement
Streptococcal Shock Syndrome (TSS):
- initial soft tissue inflammation, bacteremia
- may have shock and organ failure
Post-Streptococcal (non-supportive) Disease:
- Rheumatic Fever: ASO test
- M-protein auto-antibodies to cardiac myosin etc.
- heart, joints, blood vessel inflammation
- chronic progressive heart damage
- permenant residual damage recurrent
- Subacute Endocarditis
- Ashchoff body- pathognomic lesion
- Acute Glomerulonephritis: (type III hypersensitivity)
- anti DNase Test
Virulence Factors:
- Capsule
-has M-protein found on fimbriae
- inhibits complement activation
- antiphagocytic, adherence
- Lipoteichoic Acid, F protein
- Strep. Pyogenic exotoxins A, B, C:
- Heat labile, supertoxin
- shock, organ failure, fever, rash
- T-cell proliferation
- B-cell suppression
- A & C: superantigens
- inhibit liver clearance of
endotoxin
- B: cause tissue invasion & spread
of necrotizing fasciitis
- streptolysin O:
- responsible for -hemolysis
- antigenic (anti-streptolysin O
antibodies will be formed following
infection)
- oxygen Labile
- streptolysin S:
- also responsible for -hemolysis
- not antigenic
- Oxygen stable
- streptodornase (DNase):
- causes necrosis
- Hyalyuronidase:
- spreading factor
- streptokinase:
- type of fibrinolysin
- activates plasmin causing the
break up of fibrin blood clots
- C5a peptidase
- prevents PMN action


Treatment:
- Penecillin G:
- given early to prevent rheumatic
fever in pharyngitis patients
- erythromycin, cephalosporin
- Drainage of pustules
- Debridement (in Necrotizing
Fascititis)

Bacteriology 3

Bacterial
Genus
G
+ / -
General Characteristics Species Species Characteristics/
Lab Diagnosis
Clinical Diseases Virulence/Treatment/Other
Epidemiology





S. Agalactiae:
- normally found in GI tract
& genitourinary tract
-15-20% of women carry
this in vagina pregnancy
- Screen all preg women


S. Pneumoniae:
- commonly found in throat
& nasopharynx in healthy
people (5-40%)
- Disease occurs when
spread to:
- lungs, ears, paranasal
sin











S. Viridans:
- colonize throat, GI tract,
and genitourinary tract
uses, meninges
- immune complex depositions in glomerulus
- edema, hematuria, proteinuria
- decreased urination, hypertention
- no long term residual damage
Agalactiae - Lancefield Group B
- -hemolytic
- Bacitracin Resistant
- Hippurate Hydrolysis
- CAMP pos.
- Facultative anaerobes
- CSF or urine test
Neonatal Diseases
- Septicemia, Meningitis, Pneumonia :
- most important cause of this
- Neurolgic Sequelae, low mortality
- Early Onset: in-utero or at birth
- Late Onset: exogenous sorurce Meningitis
- stiff neck seen more in adults
Virulence Factors:
- Capsule (pyogenic)
- C5a inactivating peptidase
Treatment of Choice:
- Penecillin G
- w/ aminoglycoside if serious
- Chemoprophylaxis - @ risk mothers
Pneumoniae - No Lancefield Group
- -hemolytic
- Catalse Neg.
- Facultative anaerobes
- bullet diplococci
- in pairs or short chains
- round glistening colonies
- Capsule (83 ser.)
- Optochin Sensitive
- antibiotic culture test
- only strep sens, dies
- Bile Soluble/Sensitive
- no growth on media
- Quellung Pos.
- Anti-Capsular Ab`s
- swelling
Pneumonia- occurs when bacteria spreads to lungs
- S. pneumonia is the most common cause of
pneumonia, lobar pneumonia
- predisposing factors:
-crowded conditions, alcohol/drugs, splenectormy, COPD
- alveolar edema PMNS, RBCs, etc
- abrupt onset:
- chills, high fever, bloody cough, pleuritic chest pain
Otitis Media- occurs when bacteria spreads to ears
Sinusitis- occurs when bacteria is spread to paranasal
sinuses
Meningitis- occurs when bacteria is spread to meninges
Virulence Factors:
- Capsule - Antiphagocytic (pyogenic)
- surface protein adhesion
- pneumolysin O:
- pores in cell, prevents O2 burst
- alpha hemolysin, cilia
-Colonization, Tissue destruction
- IgA protease, adhesins
- Teichoic acid, peptidoglycan
fragments & pneumolysin:
- activate complement system
- inflammation
- teichoic acid: adhesin
Treatment:
- Penecillin resistant - PBP
- resistance due to alt transpeptides
- Vaccine (Conjugated, Unconjugated)
- Other: erythromycin, vancomycin,
quinolones, ceftriaxone
Viridans
(aginus, mitus,
mutans)
- No Lancefield Group
- /non-hemolytic
- Facultative anaerobes
- have some antibiotic
resistance
Dental Infections:
- can bind to teeth and ferment sugar
- cause dental cavities
Subacute Endocarditis
- usually occurs on previously damaged heart valves
- Brain abscesses
- intra-abdominal infections
Treatment:
- Penecillin, aminoglycoside
Entero-
coccus
- enteric commensals Faecalis /
Faecium
- Lancefield Group D
- Variable hemolysis
- Facultative anaerobes
- Hydrolyze Esculin
-in presence of bile
and salt
- Cocci, pairs, short
chains
- different genus but still
considered part of
streptococcus family
- non-hemolytic or
-hemolytic
- can grow in 6.5% salt &
40% bile
Nosocomial Infections Leading Cause-
- affect urinary tract and blood - UTI
- via catheter use, prolonged hospitalization, or antibiotic
use
- can effect abdomen after bowel surgery
Endocarditis:
- high mortality
Biliary Tract infection
- resistant to vancomyocine,
sulfonamides, tetracyclines,
erythromycin, cephasporins
- New VRE antibiotics
-linezolid, quinipristin, fluorquinones
Bacteriology 4

Bacterial
Genus
G
+ / -
General Characteristics Species Species Characteristics/
Lab Diagnosis
Clinical Diseases Virulence/Treatment/Other
Epidemiology
Bacilllus
+
Large Rod
Spore forming
Aerobic & Fac Anaerobic

- form endospores
- Aerobic & facultative
anaerobes


Anthracis:
- disease of herbivores
- spore inhalation
- exposure to animals
may infect people
- Bioterrorism
- Postal workers
- Military, wool sorters





Cereus:
- catheter related
- drug users
- opportunistic infection
Anthracis - Protein Capsule
- Non - Motile
- large bacillus
- single, paired w/ long
serpentine chains
- Aerobic, Fac Anaerobic
- rough colonies (uneven
surfaces):
- medium-large size
- gray color
- raised
- medusa head
extensions on edges
- Spores stain
Malachite Green stain
- Capsule stain
- India Ink stain
- MacFadyean Meth
Blue
- DFA test Pos.

Cutaneous Anthrax:
- papule at site rapidly to ulcer w/ vesicles necrotic
eschar (black scab)
- systemic signs: lymphadenopathy, edema
GI anthrax:
- upper GI tract: ulcers similar to cutaneous anthrax
- lower GI tract: nausea, vomiting, malaise
- mortality ~ 100%
Inhalation Anthrax (Woolsorters disease):
- in alveoli Mediastinal Lymph Nodes via alveolar
macrophages
- may remain latent (asymptomatic, 2 months)
- initial onset: (non-specific)
- fever, shortness of breath, cough, headache,
vomiting, chills, chest/abdominal pain
- stage 2:
- increased fever, edema, lymph node enlargement
- Almost all cases
- 3 days after initial symptoms shock & death
Virulence Factors:
- poly-D-glutamic acid capsule
- protein capsule via pX02
- three exotoxins via plasmid pX01:
- PA, EF, LF
- protective antigen: mediates entry
- more immunogenic
- edema factor: a cyclase CAMP
- lethal factor: kills cells, TNF, IL1
- PA + EF = EdTx, PA + LF = LeTx

Diagnosis:
- microscopic examination of papules
& ulcers

Treatment:
- ciprofloxacin is recommended
- vaccination & burning carcasses
- vaccine for high risk humans
- Resistant to sulfanomide,
Cephalosporin

Cereus - No capsule
- Motile
- Only Aerobic
- wax coloured
Gastroenteritis Food Poisoning:
- heat-stabil toxin, proteolysis-resistant enterotoxin
- vomiting (via spore contaminated rice)
- heat-labile toxin activates adenylate cyclase
- diarrhea (via spore contaminated meat,
vegetables, or sauces)
- Ocular infections blindness, via PLC, cereolysin, HLtx
Virulence Factors:
- heat stabile toxin
- heat labile toxin
Treatment:
- usually resolves, acute
- Vancomycin, clindamyicn, ciproflaxin
Clos-
tridium
+
Large Rod
Spore forming
Anaerobic

- will not grow in
conditions of > 10% O2
- founding soil, water,
sewage
- normal GI flora
- produce exotoxins
- Infections 1) Skin,
2) Food 3) Colitis


Perfringens:
- normally found in GI
tract of humans and
animals
- feces contaminate soil
- found everywhere,
prevention difficult

Perfringens - large, retangular bacillus
- rarely have endospores
- Non-motile, (motile on
media)
- Double zone hemolysis
- spreading growth on agar
- gas gangrene- H and
CO2 from carbohydrates
- Enzymes:
- collagenase
- protease
- hylaronidase
- DNase
- neuraminadase
- Culture via RCM
- Roberstons cooked
meat medium
- Skin and Soft Tissue Diseases:
- cellulites (inflammatio) w/ gas formation (gangrene)
- fasciitis (supportive myositis):
- progression of cellulites with pus collection along
muscle paines
- myonecrosis (Gas Gangrene):
- most serious disease
- intense pain onset is 1-4 days after infection
- rapid progression with edema, hemorrhagic bullae,
muscle necrosis, shock, renal failure, and death
- crepitance (gas in tissue)
- Food Poisoning Type A & C
- short incubation (8-24hrs) and short course
- abdominal cramps & watery diarrhea
- *no fever, nausea or vomiting
- Enteritis Necroticans (pig bell disease): Type C
- necrosis of jejunum 50% mortality
- bloody diarrhea, shock, peritonitis (inflammation of
peritoneum)
- Via Pork and Sweet Potatoes Trypsin Inhibitor
- Septicemia
- bacteria in circulating blood
- bacteria seen blood cultures (may be normal in people)
Type A Perfringens:
- -toxin- (lecthinase lethal toxin)
- causes soft-tissue infections,
food poisioning, primary septicemia
- increases vascular permeability
- causes hemolysis
Type C Perfringens (Most common):
- & toxin
- toxin- (Protected via Trypsin-I)
- cause enteritis necroticans
Other Toxins:
- -toxin- pores, altering
capillary permeability, heart damage
- enterotoxin- alters membrane
permeability
Treatment:
- lab diagonosis: only used to confirm
- aggressive treatment:
- surgical debridgement
- high dose penicillin
- food poisoning:
- no antibiotic treatment
- hyperbaric oxygen
Bacteriology 5

Bacterial
Genus
G
+ / -
General Characteristics Species Species Characteristics/
Lab Diagnosis
Clinical Diseases Virulence/Treatment/Other
Epidemiology
Botulinum:
- found in soil and water
- rare in US
- Canned food, fish (A,B,E)




















Tetani:
- underdeveloped
countries:
- 20-50% mortality
- usually caused by
non-sterile care of
Umbilicus
-Epi: soil, GI, spores
- US: toxoid immunization
sometimes (rarely)
causes disease


Difficile:
- relapses may occur in up
to 30% of the patients
- can be eliminated
using second courses
of treatment
Botulinum - Motile (H antigen)
- fastidious (complex
nutritional
requirements)
- form endospores
- 7 possible toxins
- each bacterial isolate
only has 1 toxin
- RCM
- growth on anaerobic
medium
- ferment glucose, digest
milk proteins,


- Flaccid Paralysis
- Foodborne Botulism:
- caused by 12-36 hour incubation of food
- ingestion of contaminated food
- nausea, dry mouth, and sometimes diarrhea
- weakness / dizziness
- blurred vision (fixed dilated pupils)
- constipation and abdominal pain
- *no fever, flaccid paralysis
- respiratory paralysis may cause death
- Irreveribl bound toxin, months for recovery
- Infant Botulism:
- most common in US
- often seen when feeding baby non-pasturized honey
- neurotoxin colonize in GI tract
- floppy baby syndrome-
- constipation, weak cry, poor muscle tone, failure to
thrive, possible (rare) death
- C Botulin does not survive in adults
- Wound Botulism: C Botulin
- neurotoxin produced in contaminated wounds
- associated with cocaine use
- Inhalation Botulism: Bioterrorism
- Botulinum Toxin:
- targets cholinergic nerves
- blocks acetylcholine release
Treatment:
- clinical diagnosis done first
- culture and toxin activity used for
confirmation
- treatment:
- ventilation support
- trivalent botulinum anti-toxin or
heptavalent antitoxin (used for
military; prepared in horses)
- elimination of organism from GI:
- gastric lavage
- antibiotics:
- metronidazole
- NO penicillin
- *antibiotics only used for
wound botulism
- prevention:
- proper food storage,
- food heating
- no honey for babies
Tetani - Drum stick
-small, rounded
terminal spores
- Motile (H antigen)
- may be gram negative in
very young or old cultures
- Strict Anaerobe
- very sensitive to
oxygen toxicity
- Grows as film, no
colonies
- proteolytic, no
fermentation
- anti tetanus toxin test
Tetany- spastic paralysis
- Generalized:
- unregulated muscle contracts
- caused by tetanospasmin
- trismus- inability to open mouth (locked-jaw)
- Opisthotonus- massive contraction of back muscles
- risus sardonicus- facial spasms, grimace, smile
- Localized
- @ site of infection
- Neonatal
- umbilical infection developing world

- Tetanus remains bound to nerves wait for recovery
Tetanospasmin - heat labile neurotoxin
- released from lysed cells
- A-B toxin (Light , Heavy)
- A -Chain: travels retrograde via
neurons and localizes in presynaptic
nerve terminals- B-anti sialic Recptors
- blocks the release of GABA and
glycine (inhibitory neurotransmitters)
Tetanolysin- oxygen-labile hemolysin
Treatment:
- diagnosis based on clinical signs
- debridgement, passive ab, DPT,
vaccination with toxoid + Booster
- antibiotics: metronidazole
Difficile - Motile (H antigen)
- Strict anaerobe
- part of normal flora of GI
tract
- Antibiotic-associated diarrhea colitis
- caused by ampicillin or clindamyocin
- result in alterations of normal flora
- Leads to Pseudomembranous Colitis (PMC)
- enterotoxin (toxin A): Diarrhea
- chemotactic for neutrophils
- cause cytokine release in ileum
- hypersecretion of fluid
- hemorrhagic necrosis
- cytotoxin (toxin B): Cell Death
- causes depolymerization of actin
- results in cell death
Treatment:
- culture isolation on selective media
- invitro cytotoxicity assay
-*immunoassay of enterotoxin in stool
- discontinuation of symptom causing
previous antibiotics
- metronidazole or vancomycin
Bacteriology 6

Bacterial
Genus
G
+ / -
General Characteristics Species Species Characteristics/
Lab Diagnosis
Clinical Diseases Virulence/Treatment/Other
Epidemiology
Corny-
bacterium
+

Rod
Non Spore Forming
Fac Anaerobic
_____________________

- Humans only reservoirs
- Normal Flora
- skin, URT, GI, UTI
- throat swab
- Worldwide, USSR
outbreak
- Uncommon US
- Primarily Paediatric
Disease
diptheria - Catalase Pos.
- Non - Motile
- Arabinose cell wall
-Non Acid Fast
- Pleiomorphic bacillius
- club shaped, terminal
swelling
- Chinese letter
- palisades
- V,Y shaped
-Microscopy:
- Metachromatic granules
- via Alberts Stain
- Culture Analysis
- Potassium Tellurite-
Tinsdale Agar
- gray black colonies
- cysteinase produces
brown halos
- Loefflers serum
- enhances m. granule
growth
- Toxicity Test
- Elek Test
- Immuno Assay
- Tox detection

Respiratory Diptheria
- Sudden Onset: malaise, sore throat, exudative
pharyngitis, local infection
- Pseudomembrane (WBC, fibrin, cells, exudate)
- hard to remove, causes tissue bleeding
- breathing obstruction
- site of toxin release
- Bullneck appearance
Cutaneous Diptheria
- via skin contact person person
- Initial Papule chronic non healing ulcer w/ gray
Membrane



Virulence:
- Exotoxin gene lysogenized
- A toxin: prevents EF 2
- B toxin: entry
- cysteinase

Treatment/Prevention:
- use clinical diagnosis, toxic test
- Diptheria antitoxin immediately to,
neturalize exotoxin (binds irreversibly)
- Penicillin or Erythromycin
- Bed rest, open airway
- Immunization: DPT toxoid w/ boost
















Listeria




+
Rod
Non Spore Forming
Fac Anaerobic
_____________________

- GI of mammals, soil,
water
- Outbreak via food
- Unpasteruized Cheese
(US), milk, meat
- In utero infection
- Highest mortality of all
food infections











monocytogen
es
- - hemolyitic (weak)
- Catalase Pos.
- Motile
- cold enhancement

Fetal/Neonatal Disease
- Early Onset: In utero, high fetal mortality
- Late Onset: Neonatal Meningitis
Adult:
- Mild flu like, GI diarrhea, fever
- Sepsis or Meningitis in Immunocompromised or fetus











- Intracellular Parasite
- Macrophage, epithelial cells
- Listeriolsyin O, PLC
- released via phagolysosome pH
- heat labile, antigenic
- Endotoxin
- LPS- Lipid A
- only g Pos w/ LPS
- Internalins
- Actin: cell to cell movement

Other Listeria

- Acne (Proprionibacterium acnes)
- Dental Caries (Lactobacillus)
- Erysipelothrix rhusopathiae
- Rare skin infection via animal products

Bacteriology 7

Bacterial
Genus
G
+ / -
General Characteristics Species Species Characteristics/
Lab Diagnosis
Clinical Diseases Virulence/Treatment/Other
Epidemiology
Myco-
bacteria

Bacilli
Acid Fast
Obligate aerobe

- acid-fast bacilli
- stain poorly with gram
stain
- high lipid content in cell
walls
- mycolic acid
- waxes
- beaded

Tuberculosis:

- RESV: human alveoli
- MOT: PP via droplets
- #1 infection cause of
death in the world
- S.E. Asia, Sub-Saharan
Africa, E. Europe
- US: seen in prisoners,
street people, IV
drug users, AIDs
Patients
- BCG vaccine given to
many foreign immigrants,
conflicting results with
PPD test
- elimination difficult, 1/3
population affected




















Tuberculosis - Non- motile
- resistant to acids, alkalis,
and drying
- non spore former
- mostly effects people with
depressed immune
function and poor living
conditions (crowding,
poor nutrition, poor
hygene)
- Ziel Neilson (carbol
fuschin stain)
- cannot be decolorized
- Kinyoun AFB
- sensitivty for
respiratory specimens
- +ve AFB = chance of
TB
- due to high glycolipid
content

Diagnosis:
- Mantoux TB test
- (+) skin test w/ purified
PPD derivative (cell
wall), type IV Reaciton
- X-ray of lungs
- w/+ve Mantoux
- look @ apical lungs for
granuloma
- AFB stain or auramine-
rhodamine-labeled
antibody stain
- prolonged incubation
(weeks) of culture on
Lowenstein-jensen or
middlebrook agar
- broth culture is faster
-Turant Flurochrome
method
- nucleic acid probes, gas
chromatography of lipids
or 16s rRNA sequencing
can be used for ID
- nucleic acid detection:
1hr -1day
- test for rRNA or DNA
- Gen-Probe MTD test:
- tests respiratory samples
that are AF positive
- Roche-Amplicor test:
- uses PCR
Tuberculosis:
- Primary Tuberculosis/Initial Infection:
Healthy Persion
- large number bacteria form granulomas
- small numbers bacteria macrophages eliminate them
- bacteria may remain dormant in granulomas for years
- exudative lesions, no disease, only infection
- Ghon complex: (opaque swirls in upper lung on Xray)
- subpleural granuloma
- found in hilar lymph nodes
- inflammation and limited replication in lung spot
- Bacteria macrophages, inhibit Phagolysosome fusion
Immunocompromised Patient
- contagious spread of infection and cavitation
- coin lesion in lung
- symptoms:
- acute inflammation with PMNs (neutrophils)
- fever; non-productive cough; pleuritic pain
- abdominal pain, diarrhea, fever, weight loss
- three outcomes:
- complete resolution with scar formation
- massive necrosis of a tubercle
- disseminated disease
- Secondary Tuberculosis:
- reinfection or reactivation of previous infection
- tubercle erosion releases dormant bacteria
- Increase risk with age, health
- more granulomas (may spread to other parts of lungs
and through blood to other organs)
- cavitation can occur from caseous necrosis
- disseminated TB: spread to other organs
- malaise, headache, weight loss/anorexia
- wasting, night sweats, fever
- cough with or without blood
Other clinical Presentations:
- scrofula- cervical adenitis with swollen non tender
lymph nodes
- erythema nodosum - tender nodules or extensor
surfaces of ulna and tibia
- military tuberculosis- disseminated meningitis
- osteomyelitis- potts disease
- oropharyngeal TB:
- dysuria - diffuculty (pain) when urinating
- hematuria - blood in urine
- flank pain
- Meningitis


- Cell wall made of mycolic acids
- cord factor (trehalose dimycolate)
- inhibit chemotaxis
- proteins plus wax- Most impt.
- elicit delayed hypersensitivity
- Phthiocerol dimycoserate:
- lung pathology (caseous necrosis)
- sulfolipids:
- prevent phagosome-lysosome
fusion (prevents death by
macrophage)
- grows intracellularly
- resistant to acids, alkalis and drying
Granuloma Cells:
- produced by type IV hypersensitivity
reaction
- epitheloid macrophages and
langerhan cells in center
- center can undergo caseous
necrosis
- surrounded by lymphocytes, plasma
cells, and fibroblast
- fibroblasts produce outside layer
of connective tissue
- tubercle: granuloma with necrosis
center and fibrous tissue
surrounding

Treatment:
- 9 24 mnth with multiple antibiotics
- start with 2 or more of isoniazid
(INH), rifampin, pyrazinamide,
and ethambutol for 2 months
- then 4-6 months with INH
- BCG Vaccine
- controversial vaccine for M. bovis
interferes with PPD test false
positive, need chest X Ray


Bacteriology 8

Bacterial
Genus
G
+ / -
General Characteristics Species Species Characteristics/
Lab Diagnosis
Clinical Diseases Virulence/Treatment/Other
Epidemiology
Atypical Non-chromogens:
- found in bodies of water
- exposure via aerosols or
ingestion
















MAC:
- disease in immune-
competent





Leprae:
- RESV: armadillo, humans
- MOT: respiratory, wound
- 2003 endemic Africa,
Asia
Photo-
chromagens
- group 1 mycobacteria
- slow growing
- pigment formation only in
light

Scoto-
chromogens
- group 2 mycobacteria
- slow growing
- pigment formation in dark
or light

Non-
chromogens
- group 3 mycobacteria
- slow growing
- no pigment formation
- include M. avium-
intracellulaire of
tuberculosis

- overwhelming disseminated diseases

Treatment:
- for M. avium complex uses:
- clarithromycin, azithromycin,
ethambutol, rifabutin
Rapidly
growing
mycobacteria
- group 4 mycobacteria
- Low virulence
- stain irregularyl
- RARELY cause human diseases
- Nosocomial Infection
post surgery, catheters, prosthetic heart valves etc..


Treatment:
- resistant to most drugs
- DOC: Clarithromycin, imipenenm,
amikacin, cefoxitin, sulfonamides
- remove iatrogenic agent
Avium and
intracellulare
- M. avium disease In Hiv Patients
- Three forms of disease
- 1. Middle age older men w/ smoking, pulmonary disease
- 2. Lady Windermeres Syndrome
- elderly women who suppress cough reflex
- inflammatory change infections with MAC
- 3. Solitary Pulmonary Nodule
- in terminal HIV patients
Treatment:
- calithromycin or azithromycin w/
ethambutol and rifampin
leprae - optimal temp.: 30C
- cannot grown in labs,
needs cell culture
- grow in footpads of
mice or armadillos

Diagnosis:
- clinical presentation
- histopathology
- skin test reactivity or
presence of acid-fast
bacilli in skin lesions

Hansens Disease:
- chronic infection affesct skin and peripheral nerves
- Tuberculoid Leprosy PauBacillary (PB)
- Non-Progressive, Sudden onset
- seen in persons with good cell mediated immunity
- Few erythematous or hyperpigmented plaques with
raised borders (macular lesions)
- Severe peripheral nerve damage
with complete sensory loss
- Low Infectivity
- Normal/Weak AB Response; Th1, IL2, IFN, IL12
- Lepromin Reactive
- Lepromatous leprosy MultiBacillary (MB)
- Progressive
- seen in persons with defective cell mediated
responses to M. leprae, slow onset
- erythematous macules, papules, nodules,
thickened skin, hypopigmented
- extensive tissue destruction with
patchy sensory loss
- extensive tissue loss in face, hands, fingers
- high infectivity
- Strong/Hyper-Ab Respons; Il4, IL10
- Lepromin Non- Reactive
Treatment:
- Tuberculoid leprosy:
- (1-5 lesions); treat 6 months
- Dapsone with or without rifampin
- Lepromatous leprosy:
- (> 5 lesions); treat 1 year
- add clofazimine to above
-*prompt recognition and treatment of
infected persons to halt spread
Bacteriology 9

Bacterial
Genus
G
+ / -
General Characteristics Species Species Characteristics/
Lab Diagnosis
Clinical Diseases Virulence/Treatment/Other
Epidemiology
Nocardiac
eae
+
Aerobic Bacilli
Acid Fast
Actinomycetes
_____________________

Nocardia:
- RESV: animals and
humans, found in
soil and decaying
vegetation
- MOT: inhalation
- exogenous infections
- Most coming in HIV,
organ transplant,
immunocompromised,
pulmonary disease
patients





Rhodococcus:
- rhodococcus equi is most
important human
pathogen
- formerly cornybacterium
- seen in HIV patients
- no soil or animals!




Gordonia:
- RESV: soil
- MOT: Nosocomial
- rare opportunisitc
infection
nocardia - Catalase Pos.
- partially Acid Fast
- stain poorly
- dry waxy, white orange
colonies
- Some have delicate
filamentous forms called
aerial hyphae as they
are similar to fungal
hyphal forms
Diagnosis:
- Microscopy
- stain poorly with gram
stain
- aerial hyphae
- acid fast
- BCYE agar
- week long culture
- Molecular analysis to
confirm diagnosis
- Sabourauds Dextrose
agar
- Bronchopulmonary Disease
- cough, dyspnea, fever, cavitation into pleura
- in immunocompromised, pneumonia w/ cavitation and
dissemination (CNS spread)
- Cutaneous Infections
- Primary infection
- mycetoma, lymphocutaneous infections, cellulitis,
subcutaneous abscess
- Secondary Infection: if it spreads from lung
- Lymphocutaneous Infection
- cutaneous nodules, ulceration along lymphatic
- (Compare: similar to Sporothrix Fungi)
- 1/3 of all patients: CNS involvement, meningitis,
brain abscess
- Actinomycotic Mycetoma
- mycetoma refers to disease via fungi or bacteria
- Painless, chronic localized subcutaneous swelling,
suppuration, and formation of multiple sinus tracts
- defective drainage of connective tissue possible
- Caused by N brasiliensi in Americas


Virulence:
- cell wall similar to mycobacteria
- cell wall w/ shorter mycolic acids
- Intracellular Organism
- Prevent phagolysosome fusion via
cord factor (trehalose)
- prevent acidification of phagosome
- superoxide dismutase
- protective

Treatment:
- surgicial
- DOC: sulfonamides

rhodococcus - weakly acid fast
- initially appear rod then
revert to coccoid forms
- Diagnosis:
- Aerobic
- no selective media
- mucoid colonies
- slow growth
- Immmunocompromised Patients:
- invasive pulmonary disease (nodules, lung abscess,
dissemination to lymph nodes, meninges, pericardium
and skin)
- opportunistic infections
Virulence:
- Facultative intracellular
- survives in macrophages
- causes granulomas abscess

Treatment:
- erythromycin, rifampin, ciproflaxin
- vancomycin, imipenem,
aminoglycosides
- Resistant to penicillin and
cephalosporins
gordonia
&
tsukamurella
- similar to rhoddococcus
- partially acid fast
- Gordonia:
- pulmonary and cutaneous infections
- noscomial via catheters
- Tsukamurella:
- nosocomial via catheters

- mycolic acid
dermatop
hilus
+
Other Actinomycetes

Dermatophilus:
- soil
- animal exposure:
butches, veterninarians,
hunters, etc

- Exudative Dermitits w/ encrustations involving hands and
feet
Treatment:
- penicillin + aminoglycoside
tropherym
a
Whipplii - PAS stain Pos - Whipples Disease:
- arthralgia, diarrhea, abdominal pain, weight loss,
lymphadenopathy, fever, increased skin pigmentation
- foamy macrophages in l. propria of small intestine
Treatment:
- penicillin, streptomycin, tri-sulfa
thermophi
llic
Thermactino
yces/
Saccharopoly
spora/
Saccharomon
ospora
- Serological - Allerigic Pneumonitis:
- farmers lung
- hypersensitivity reaction to repeated exposure to
thermophillic actinomycetes found in decaying vegetation
- lung granuolomas w/ pulmonary edema, eosinophilia,
and excess IgE


Bacteriology 10

Bacterial
Genus
G
+ / -
General Characteristics Species Species Characteristics/
Lab Diagnosis
Clinical Diseases Virulence/Treatment/Other
Epidemiology
Campylo-
bacter
-
Spiral Bacilli
Fac. Anaerobic
Microaerophilic

- low dna ( G+C)
- zoonotic animal
reservoirs
- food, water, milk
- more common than
salmonella and shigella

- RESV: normal GI flora of
many wild and
domestic
animals
- MOT: Raw Poultry, F O

jejuni - Motile: Darting
- curved rods with two
polar flagellum @
opposite ends
- Oxidase Pos.
- non-fermenter
- Catalase Pos.
- Hippurate Hydrolysis

Diagnosis:
- Campy Agar
- selective media with
blood or charcoal to
remove toxic oxygen
and antibiotics that
inhibit normal flora
- Grows best @ 42 C
- not usually gram stained







Gastroenteritis Diarrhea:
- begins watery and foul smelling
- later becomes bloody and pusy
- more than 10 stools a day
- abdominal pain, malaise, nausea, vomiting
Ulcerated Jejunum:
- abscesses in jejunum
Guillain-Barre Syndrome:
- autoimmune disease involving Antibodies that cross-react
with antigens on neurons and lead to acute
neuromuscular paralysis
- reactive arthritis
- septicemia, meningitis


Virulence Factors:
- low ID50
- adherence to and invasion of
intestinal mucosa

Treatment:
- fluid and electrolyte replacement
- erythromycin, flouroquinolones,
macrolides, chloramphenicoletc
Helico-
bacter
-
Spiral Bacilli
Fac. Anaerobic
microaerophilic


- RESV: Humans only
- MOT: F O, O O

pylori - spiral shaped bacterium
- Motile: high, with tuft of
polar flagella
- Oxidase Pos.
- Catalase Pos.
- Produces Urease
- does not ferment or
oxidize sugars
- invade neutral pH areas
of stomach and cause
inflammation

Diagnosis:
- Biopsy
- Urease activity
- Urease breath test
measure breath for
ammonia and radioactive
CO2 (after swallowing
radioactive urea)
- serology, Ab detection






Chronic gastritis
- recurrent pains in upper abdominal
- frequent bleeding in GI tract
- no bacteremia
Peptic ulcers
- Gastric or duodenal
- recurrent pains in upper abdominal
- frequent bleeding in GI tract
- no bacteremia
Stomach Cancers


Virulence factors:
- urease
- acid-inhibitory protein
- mucinases and phospholipases:
- penetrate stomach mucous layer
- superoxide dismutase and catalase:
- inhibit phagocytic killing
- Biotype 1: produces vacuolating
cytotoxin
Treatment:
- DOC: Omeprazole (proton pump
inhibitor) + amoxicillin +
clarithromycin + bismuth (Pepto
Bismol)
- Omeprazole + tetracycline +
metronidazole + bismuth
Bacteriology 11

Bacterial
Genus
G
+ / -
General Characteristics Species Species Characteristics/
Lab Diagnosis
Clinical Diseases Virulence/Treatment/Other
Epidemiology
Vibrio
-
Curved Bacilli
Fac. Anaerobic

- 60 species, curved,
comma shaped
- Species:
- parahaemolyticus,
cholera, Vulnifus
_____________________

- RESV: human colon
- MOT: contaminated food
or water, FO
- PP rare
- present in esturian and
marine environments
with salinity and
temperatures between
10C and 30C from
human fecal
contamination
- associated with shellfish
- requires high dose to
cause infection because it
is killed by stomach acids

Cholera - curved rods, w/ polar
flagellum
- Oxidase Pos.
- Fermenter
- Motile: Darting Motility
- subdivided by O antigen
- O1 & O139 cause
classical cholera
- O1 biotypes:
- El Tor
- classical
Diagnosis:
- rarely observed on gram
stain of stool or wounds
- Culture of fresh stool on
TCBS agar
- Motility Detection
- Hanging drop method
- DF Microscopy
- must be protected from
drying
- appropriate transport
medium required if lab is
delayed
- biochemical tests /
serology

Vibrio Cholerae:
- incubation period: 2-3 days
- abrupt onset of watery diarrhea
- rice-water stools - feces streaked water stools that
contain mucus
- severe fluid and electrolyte loss
- metabolic acidosis
- hypokalemia (cardiac arrhythmias)
- hypovolemic shock (renal failure)
- mortality: 60% if untreated; 1% if given fluid replacement
Vibrio Parahaemolyticus (shellfish):
- self-limited explosive diarrhea to mild-cholera like
symptoms,
- wound infection in people w. contaminated sea water
- bacterimia
Vibrio Vulnifus:
- Virulent species of vibrio
- rapidly progressive wound infections or septicemia
following the consumption or handling of contaminated
oysters, cellulitis
- initial swelling and pain progression to vesicles
- important in immunocompromised and liver disease
Virulence Factors:
- Cholera A-B Toxin
- heat labile enterotoxin
- activates adenyl. cyclase- cAMP
- causes hypersecretion of water
and electrolytes
- Hap (hemagglutination) gene:
- stimulates II-8 production and
degredation of junctions of
intestinal mucosa
- causes mild to moderate diarrhea
in absence of cholera toxin
Adherence:
- pili: (toxin coregulated pilus (TCP)
gene complex)
- used for attachment / adherence
- accessory colonization factor (ACF)
genes
Treatment:
- fluid/electrolyte replacement
- antibiotic therapy:
- doxycycline or ciprofloxacine
- may reduce exotoxin production
- doxycline, minocylcine w/
fluroquinonolone or cefotaxime
used to treat v. vulnifus wound
infections
Prevention:
- killed parenteral and oral vaccines
- tetracycline prophlaxis







Aeromona
s
-
Bacilli
Fac. Anerobic.
_____________________

- RESV: fresh and brackish
waters
Hydrophila,
caviae,
veronii biovar
sobria
Gastroenteritis:
-via water or food
- acute severe illness in children
- chronic diarrhea in adults
- resembles shigellosis Blood, WBC in stool
Wound Infection: via water
Opportunistic Infection:
Treatment:
- self limited
- DOC: ciproflaxin, gentamicin,
amikacin, Tri-Sulfa
- antibiotics for chronic diarrhea
- Resistant to penicillin,
cephalosporin, erythromycin








Bacteriology 12

Bacterial
Genus
G
+ / -
General Characteristics Species Species Characteristics/
Lab Diagnosis
Clinical Diseases Virulence/Treatment/Other
Epidemiology
Entero-
bacteria-
ceae
-
Bacilli
Fac. Anaerobic
Catalase Pos.
Oxidase Neg.

- RESV: human, animal GI
- MOT: fecal - oral
- enteric bacilli
- No spore formation
- found as normal flora in
humans and animals
- members of normal
intestinal flora
- true facultative anaerobes
- most common important
species of
enterobacteriaceae to
cause human diseases
- opportunistic
pathogens

_____________________






Intestinal Diseases:
- MOT: F O via water
- diarrheal diseases





















Escherichia
Coli
(E. Coli)

General
Characteristic
Of E. Coli
- Motile or nonmotile
- Ferment glucose and
lactose (MacConkey
Agar)
- Reduce Nitrate, energy
- Non-selective agars
- bovine species:
- have hemorrhagic
strains

Extra Intestinal Disease:
Urinary Tract infection:
- uncomplicated --. Cystis = lower UTI
- complicated pyelonephritis = upper UTI
- E. coli is most common cause of UTI
- comes from GI tract
- P. pili or fimbriae cause E. coli to adhere to uroepithelial
cells allosing the bacteria to ascend into the urethra
- may decrease IgA transport into the lumen
Neonatal Septicemia & Meningitis: (K1 antigen)
- E. coli is second most common cause (1
st
: S. agalactiae)
- Neonatal meningitis treatment:
- ampicillin + cefalotaxime
Septicemia - Nosocomial:
- invasion along IV lines or escape from GI tract after
cytotoxic drugs damage to mucosa, highly mortality in IC
- endotoxin shock, pneumonia
- treatment:
- parenteral antibiotics (3
rd
generation cephalosporin +
aminoglycosides)
Meningitis:
- OMP-A: outer membrane protein that allows the K-1
capsule to cross epithelium & enter blood brain
barrier
- K-1 Capsule: increases bacterial survival in brain
Gastroenterides/Diarrhea


Virulence Factors:
- adhesions:
- variable p-pili, fimbriae
- colonizing factor antigen (CFA)
- exotoxins:
- vertotoxin
- heat-stable toxin
- heat-labile toxins
- Shiga - Toxins
- hemolysis
- antigens:
- O-antigen
- present in all E.coli strains
- heat stable
- polysaccharide core of
Lippopolysaccharide (LPS)
- Lipid A released @ lysis
- H-antigen
- only present on motile strains
- removed via heat/alcohol
- can change between 2 forms
- K-antigen
- capsule or fimbriae
- sequestration of growth factors, Fe
Entero-
Toxigenic
E. Coli
(ETEC)
- Intimin Neg.
- enterohemolysin negative
- primarily involves small
intestine
- infective at high doses

Identification:
- immunoassay
- bioassay in animals
- DNA probes or PCR for
toxins
Travelers Diarrhea- watery stool
- No fever

Toxins:
- Heat Labile Toxin:
- E. colli adhere to CFA-1
through CFA-4
- activates adenylate cyclase
- increase cAMP (like cholera)
- increases outflow of Cl
-
& H2O
- Heat Stabile Toxin
- type A:
- increases cGMP
- water loss, diarrhea
- type B:
- activates intracellular
calcium
- secrete cyclic nucleotide
independent bicarbonate
- CFA - Colonizing Factors:
- attachment to epithelium
Treatment:
- rehydration
- trimethoprim-sulfamethoxazole
- slows peristalsis


Bacteriology 13

Bacterial
Genus
G
+ / -
General Characteristics Species Species Characteristics/
Lab Diagnosis
Clinical Diseases Virulence/Treatment/Other
Epidemiology
































EHEC:
- RESV: Cattle
- MOT: Food or water w/
human, cattle feces
- most common Ecoli w/
toxin production
- primarily involves colon
- infective at low doses
- can survive low pH
- more common in Western
Canada and northern US
- 10% get renal heart
failure
- 3-5% mortality rate






Entero-
Invasive
E. Coli
(EIEC)
- invasive
- Intimin Neg.
- enterohemolysin negative
- involves small intestine
and colon
- infective at high doses
- same pathogenicity as
type 1 shigela

- Begin as watery diarrhea progress to dysentery
bloody dystentry w/ mucus + WBC in feces
- mucoid, bloody, leukocytic (WBC) stool
- minimal blood: usually if it gets into circulation it will
get destroyed
- high fever & abdominal cramps

Plasmid:
- invade local mucosa
- use host actin filaments for motility
Invasive Gene Product:
- Type III secretion system
- Ipa A- related to invasiveness
- Ipa B- lyses vacuole
- Not impt?
Entero-
pathogenic
E. Coli
(EPEC)
- Intimin Pos.
- enterohemolysin negative
- primarily involves small
intestine
- infective at high doses
Infant Diarrhea:
- second most common cause after rotovirus
- prefusive watery diarrhea in 0-1 year olds
- increased cytoplasmic Ca
2+

- outbreaks seen in day care centers and peds wards
watery & bloody stool
high fever


Plasmid (60MDa, pMAR2, EAF, bfpa)
- attach to epithelial cells via bundle-
forming pili (BFP)
LEE:
- attach to and efface brush border of
epithelium by injection and
phosphorylation of TIR receptor
which is then presented by host cell
and allows binding of intimin
(OMP) and entry of E. coli
AE lesions:
-results in loss of microvilli from
intestinal epithelium and the
formation of cuplike pedestals
(where EPEC) attach (adherence
and effacement lesions)
Serology:
- O26, O111, etc
Treatment:
- for blood diarrhea with pus and
fever: flouroquinolones


Entero-
Hemolytic
E. Coli
(EHEC
0157:H7)
- Intimin Pos.
- Enterohemolysin Pos.
- Non Sorbitol Fermenter
- compare Klebsiella
Serology:
- most common: O157:H7
- others: O26, O111, etc...

Diagnosis:
- isolation of non-sorbitol
fermenters on sorbitol
MacConkeys agar
- DNA probes for
verotoxin gene

Hemolytic Uremic Syndrome:
- more common in children under age 5
- microangiopathic hemolytic anemia
- thrombocytopenia
- renal failure
- hemorrhagic colitis (watery bloody stool)
- no fever
- no excessive WBCs
- *antibiotic use may increase chance of HUS and kidney
damage

Clinical Presentation:
- pallor (pale skin)
- weakness
- irritability
- anuria or oliguria




Toxins:
- Shiga Toxin (Verotoxin/STX toxin)
- inhibits protein synthesis
- injures 60S ribosome
- types 1 and 2
- kills cells with STX receptors
- absorptive villus cells
(NOT secertory crypt cells)
- renal epithelium cells
- reach here through blood
- ascending/transverse colon
- often induces proinflammatory
cytokine expression
Treatment:
- Rehydrate
- No antibiotics
Bacteriology 14

Bacterial
Genus
G
+ / -
General Characteristics Species Species Characteristics/
Lab Diagnosis
Clinical Diseases Virulence/Treatment/Other
Epidemiology











Entero-
Aggregative
E. Coli
(EAEC)
- attach to each other via
fimbriae to create
stacked-brick-like
Biofilm
- aggregative adherence
to intestinal epithelium
and typical lesion:
- mucus aggregates of
bacteria seen on surface
- shorter, rounder villi
- hemorrhagic necrosis of
villus tip
- inflammation

Persistant Diarrhea:
- low grade fever
- vomiting
- no mucus or blood present in diarrhea
Travelers Diarrhea
Neonatal Meningitis:
- treated with ampicillin + cefataxime
Virulence:
Plasmid:
- aggregative adherence to HEp-2
cells
Enterotoxins


Shigella:
- RESV: Humans only
- MOT: FO,PP, via
fecal contamination of h
hands
- highly infectious
- highly communicable
- primarly effects children
under 15 years old
- day care centers,
nurseries






Salmonella
RESV: Typhi humans
Others all animals
MOT: Food, water, FO
- most common source:
- eggs, poultry, dairy
products
- S. typhi only needs low
infectious dose
- all others require high
infectious dose










Shigella - Ferments glucose
- MacConkey Agar
- Non Motile: No flagella
- do NOT ferment lactose
- do NOT produce
hydrogen sulfide gas
Species:
- Sonnei, flexneri,
dysenteriae (most
severe)
Diagnosis:
- Widal Test
Shigellosis:
- short incubation period, few organisms
- abdominal cramping and tenesmus (rectal spasms)
- diarrhea
- fever
- blood stool with pus (dysentery)


Virulence Factors:
- endotoxin
- adherence genes
- invasion genes
- intracellular replication genes
- Shiga Toxin:
- seen in S. dysenteriae
- disrupts protein synthesis
- causes endothelial damage
- renal failure: disrupts glomerulus
- actin filament rearrangement
transfers bacteria from host to host
Treatment:
- self limited
- start w/ trimeth/sulfa
- switch based on susceptibility testing

Salmonella - Motile (flagella)
- Oxidase Neg.
- Fac. Anaerobic
- Ferment glucose
- do NOT ferment lactose
- Hydrogen Sulfide Gas
production
Species:
- enterica & bongori
Diagnosis:
- EMB, MacConkey media
- used to distinguish
lactose fermenters from
non-lactose fermenters
- XLP selective media:
- distinguish between
salmonella and shigella
- Selenite F Broth
Typhoid (enteric) Fever:
- via dissemination of S. enterica typhi (has a vaccine)
- bacteria are taken up by macrophages from M cells
- transported to and multiply in liver, spleen, & bone
marrow
- colonization of gall bladder, reinfection of intestines
- fever appear 10-14 days after infection
- rose spots on chest
- diarrhea may be seen later in disease
- treatment: flouroquinolones, chloroamphenicol, etc..
Asymptomatic colonization:
- treatment: flouroquinolones, chloroamphenicol, etc..
Gastroenteritis:
- via salmonella enteritidis
- nausea, vomiting, non-bloody diarrhea
- fever, abdominal cramps, myalgias, headache
- lasts 2 days 1 week
- antibiotic treatment NOT recommended
Septicemia:
- more likely in young or immunocompromised people
- treatment: flouroquinolones, chloroamphenicol, etc..
Virulence Factors:
- invade & survive in M cells of
peyers patches and macrophages
- fimbriae
- invasion proteins (Sips / Ssps)
- can survive acid environment of
phagosomes (ATR gene)
- endotoxin


Bacteriology 15

Bacterial
Genus
G
+ / -
General Characteristics Species Species Characteristics/
Lab Diagnosis
Clinical Diseases Virulence/Treatment/Other
Epidemiology
Yersina pestis:
- Zoonotic
- RESV: Rats, squirrles
- Vector: Fleas Y. Pestis,
- Xenopsylla
cheopsis
- MOT: Flea Vector











Other Yersinia:
- RESV: pigs, rodents,
rabbits
-MOT: milk, meat, water
- Zoonotic
- Zoo animals, humans are
accidental hosts
Yersina pestis - Diagnosis;
- bipolar staining safety
pin appearance
- human (true) pathogen
- resistant to phagocytic
killing
Sylvatic Plague:
- spread by squirrels, rabbits, rats, cats
Bubbonic plague
- high fever, axilla or groin lymph node inflammation
Buboes
- bacteremia at later stage
- 75% mortality if untreated
- DOC: Tetracylcine
Pneumonic Plague:
- high fever, malaise, pulmonary signs
- highly infectious
- 90% mortality if untreated
- DOC: Tetracylcine





- Capsule
- Cytokine decresse
- Plasminogen Activator Protease:
- only in Y. pestis
- degrades C3b & C5a
- reduces phagocytosis & clot
breakdown
- Yersinia Outer Proteins (YOPs):
- for adherence
- YopE: depolymerization of actin
microfilaments
- YopH: dephosphorylation of host cell
proteins
- YopJ/P: initiate apoptosis of
macrophages
- YpkA: serine/threonine kinase
activity
- YopB/D & YopN: translocation and
sensory function
- YopM: inhibition of platelet
aggregation
Treatment:
- vaccine
- chemoprophylaxis with
tetracycline


Yersina
Entercolitica
&
Yersina
Pseudo-
tuberculosis
- enterics
- rarely enter blood
- human (true) pathogen

Enterocolitis:
- diarrhea, fever, abdominal pain
- may become chronic terminal ileum ( mimic
appendicitis) or may recover in 1-2 weeks
- may cause bacteremia and endotoxic shock if
contaminated blood products are given



Klebsiella
pneumoniae
- MacConkey agar
- w/ Mucoid colonies
- Community acquired
- bacilli, large capsules
- Sorbitol Fermentation
Lobar Pneumonia:
- alcoholics and immunocompromised at risk
- Necrotic pneumonia destruction of alveolar spaces
- cavity formation
- Currant Jelly Sputum
- Only pyogenic bacterium w/ permanent damage to lungs




Virulence Factor:
- large capsule!!!
Proteus
Mirabilis
- colonies show swarming
growth
- Urease Pos.
Urinary Tract Infection
- facilitates renal stone formation via urease production
- increase pH




Enterobacter,
Citrobacter,
Morganella,
&
Serratia
- TSA, Blood agar, Eosin
methylene blue (Lactose
fermenter detection)
- Nosocomial:
-infections of neonates and immunocompromised patients
-multiple antibiotic resistant
- meningitis, brain abscess
Treatment:
- use susceptibility testing to
determine which antibiotics are not
resistant





Bacteriology 16

Bacterial
Genus
G
+ / -
General Characteristics Species Species Characteristics/
Lab Diagnosis
Clinical Diseases Virulence/Treatment/Other
Epidemiology
Pseudo-
monas
-
Curved Rod
Obligate Aerobe
_____________________

- RESV:
- common environment:
- soil, water, normal flora
of moist skin and colon
- resistant to many
antibiotics and
antiseptic, disinfectants
- population at risk:
- burns
- cystic fibrosis
- immunosuppressed
- in dwelling catheters
- opportunistic pathogens
- minimal nutritional
requirements
- tolerant to wide range
of temperature
- Most common
Nosocomial and drug
resistant infection

Aeruginosa - Oxidase Pos.
- Motile: polar flagella
- slightly curved or straight
rod shaped
- does NOT ferment sugars
- pigment production:
- pyocyanin (blue/green)
- flourescein (yellow)
- pyorubin (red/brown)

Diagnosis:
- Non-lactose fermenter
on EBM or MacConkeys
- Flat, spreading colonies
with hemolysis
- sweet, fruity odor \
(grapes)
- blue-green pigment on
TSA blood agar
- confirm ID by
biochemical testing
- Centramide Agar

Urinary Tract infection:
Pneumonia:
- especially in cystic fibrosis patients
Wound Infections:
- especially in burn patients
Septicemia:
- mortality: 50%
Ecthyma Gangrenosum:
- Black Necrotic Lesions on Skin: compare B.anthracis
Endocarditis:
- seen in IV drug users
Corneal Infections: Oncylitis
Osteomyelitis:
- diabetics, children, IV drug users

Treatment:
- sensitivity testing*
- DOC: antipseudomonal penicillin + aminoglycoside
- patient care:
- timely removal of catheters
- care of burns
Virulence:
- Slime layer in Polysaccharide
Capsule
- adhesin
- inhibits phagocytic and antibiotic
killing
- Pili: adhesion
- LPS: endotoxin
- phospholipase C & rhamnolipids:
- hemolysins
- breakdown membrane lipids
- inhibit ciliary function
- pyocyanin
- impairs ciliary function
- stimulates inflammation
- mediates tissue damage
- toxins:
- exotoxin A: ribosylates EF-2
- similar to diphtheria toxin
- exotoxin B: inhibits translation
- exoenzyme S: ADP-ribosylation
of GTP-binding
proteins
- enzymes:
- protease, phospholipase,
elastase*
- cause pulmonary hemorrhages
- Invasins:
- elastase, alkaline protease,
hemolysins, cytotoxin,
siderphores, pyocyanin
diffusible pigment
Bacter-
oides
-
Pleomorphic Rod
Anaerobic
_____________________

- RESV: Normal flora
- break in mucosa
- tissue necrosis
- poor blood supply
- predominant organism in
human colon
- found in vagina of 60%
of women
- predisposing factors:
- surgery, trauma
- chronic disease
- not communicable
- often found with
facultative anaerobes
- MC anaerobic infection
after abdominal surgery
fragilis - Bile Esculin Formation
- Black Halo
- anaerobic w/ blood agar
- identification by
- pleomorphic size & shape
- non-spore former
biochemical tests
Intra-abdominal Infections:
- peritonitis
- local abscess
Pelvic Abscesses:
Necrotizing Fasciitis:
Bacteremia:
- low number

Virulence:
- polysaccharide capsule
- little or no endotoxin activity

Treatment:
- DOC: Mentronidazole
- aminoglycosides to treat facultative
anaerobe
- presurgery antibiotic prophylaxis
Bacteriology 17

Bacterial
Genus
G
+ / -
General Characteristics Species Species Characteristics/
Lab Diagnosis
Clinical Diseases Virulence/Treatment/Other
Epidemiology
Bordetella
-
Small coccoBacilli
Strict Aerobe

- affect respiratory system
_____________________


- RESV: humans
- MOT: aerosols
- occurred primarily in
children in past
- more cases in older
children & adults
- endemic worldwide
although incidence
reduced by vaccine
- care in collection and
transport of tracheal
aspirate
- cannot be grown on
cotton
Pertussis - extremely small cocco-
bacilli
- no sugar fermentation
- require enriched media
containing charcoal,
starch, blood, or albumin
to absorb toxic
substances from agar
- slow growing
-7 days make tiny colonies
- *huge increases in
lymphocytes
Diagnosis
- Culture sensitive to
drying
- use Bordet-Gengou
medium
- DFA of specimen, ELISA
- false positives and false
negatives are common
- require nicotinamide
factor V (NAD)
- PCR or agglutination ID
Whooping Cough:
- 7-10 day incubation
- 3 stages:
1. catarrhal resembles common cold
2. paroxysmal after 1 2 weeks
- ciliated epithelium lost, impairs mucus clearance
- classic whooping cough paroxysms on inspiration
- often terminate with vomiting and exhaustion
3. convolascent after 2- 4 weeks
- paroxysomes diminish in number and severity
- 2 complication can occurs
Treatment:
- mainly supportive - erythromycin
- antibiotics do not change course of
disease
- DPT Vaccine - inactivated (whole
cell) vaccine given with diphtheria
and tetanus toxoids (DPT Vaccine)
- newer multivalent vaccines confer
equal protection w/ few side effects




Virulence:
- O & K antigens
- two LPSs:
- lipid A & lipid X
- activate alternative complement
pathway and lead to cytokine
release
- filamentous hemagglutinin on pili
(FHA)
- adhere to ciliated epithelium
- also bind to CR3 on neutrophile
- initiate phagocytosis
- S2 unit of toxin= binding
- Adenylate cyclase synthesis
Toxins:
- pertussis toxin*
- S1 ribosylates G protein
- removes inhibition of adenylate
cyclase, cAMP
- cause lymphocytosis
- cannot enter 2 lymphoid tissue
- tracheal cytotoxin - kills ciliated
cells and stimulates IL-1 release
- acts in concert with endotoxin
Haemo-
philus
-
Small Bacilli

- affect respiratory system


- RESV: Humans only
- MOT: Respiratory droplet
- Normal Flora
- encapsulated species are
rare as normal flora
- encapsulated serotype b
- caused over 95% of
invasive diseases
before vaccines
- type c & f & nontypable
(nonencapsulated)
species now cause most
diseases
- People at risk:
- without Abs
- defective complement,
no spleen






Influenza - small, sometimes
pleomorphic bacilli
- Catalase Pos.
- capsule on many strains

Diagnosis:
- CSF culture: meningitis
- Blood culture: epiglottitis,
cellulitis, arthritis,
pneumonia
- Media w/ X-factor
(hematin) or V factor
(NAD) or both
- found on chocolate agar
- Mueller Hinton Agar
- Satellitism:
- s aureus produces
NAD, enhances growth,
RBC lysis on blood
Agar
- aspirates required for
URT
- Quellung Pos.
Diseases previously cased by type b:
- Meningitis:
- starts from nasopharynx
- mild upper respiratory tract infection before
meningitis signs appear
- Epiglottitis
- cellulites & swelling
- more common in 2-4 year old boys
- Cellulitis:
- fever and cellulites with reddish- blue patches on
cheeks or periorbital area
- Arthritis:
Disease caused by non-encapsulated strains:
- Otitis Media & Sinusitis:
- one of the most common causes of otitis media
- Pneumonia:
- seen in elderly and COPD & alcoholism patients
- Subacute endocarditis:
- Conjunctivitis (pink eye) & Brazilian purpuric fever
- vomiting & fever following conjunctivitis
- caused by biogroup aegyptius
- if untreated:
- petechiae, purpura, shock, death

Virulence:
- obligate parasites on mucus
membrane
- polysaccharide antiphagocytic
capsule (polyribitol phosphate) for
tybe b**
- IgA proteases
- Pili & nonpilus for adherence
- translocated across epithelium and
endothelium into blood - bacteremia
- cell wall:
- impair ciliary function*
- damage respiratory epithelium*
Treatment:
- meningitis: cefotaxime & cefriaxone
- check nasopharynx for carriage
- non-type b diseases:
- amoxicillin + clavulanate
- 2 or 3 cephalosporin or
trimethoprom + sulfonamide
- Hib conjugate capsular
polysaccharide vaccine:
- given at 2, 4, 6 mon, w/ boost @ 15
- vaccine for type b, 95% effective
ducreyi - aegyptius & H. ducreyi
require special media


Chancroid
- ulcerated STD
- painful ulcer with erythematous base
- inguinal lymphadenopathy
Treatment:
- azithromycin
- chancroid requires swab of base or
margin of ulcer in throat
Bacteriology 18

Bacterial
Genus
G
+ / -
General Characteristics Species Species Characteristics/
Lab Diagnosis
Clinical Diseases Virulence/Treatment/Other
Epidemiology
Legionella
-
Pleomorphic Bacilli
Microaerophilic
Catalase Pos

- affect respiratory system

- RESV: natural bodies of
water, cooling towers,
condensers, water
systems
- MOT: inhalation of
aerosols , from showers,
AC systems, and cooling
Towers
- more likely in chronic lung
disease patients or the
immunocompromised






Pneumophila - Motile
- Slender, pleomorphic
baccili
- slow growing
- does NOT ferment sugars
Diagnosis
- gram stains poorly
- DFA staining of sputum
- Fastidious, culture w/
Fe, cysteine, absorbant
remove fatty acids
- BCYE agar w/ long
incubation culture

Asymptomatic Infection:
Pontiac Fever:
- self-limiting febrile disease
- headache, flu - like
- resolves in 2-5 days
Legionnaires Disease: (legionellosis or pneumonia)
- incubation of 2-10 days
- begins with fever, chills, headache
- dry nonproductive coughs
- spreads and becomes multiorgan:
- GI, CNS, liver, kidneys
- primarily manifest as multilobar pneumonia with
inflammation and microbascesses
- 15-20%
Virulence:
- facultative intracellular parasites
- multiply inside alveolar macrophage
- prevent phagolysosome fusion
Treatment:
- Azithromycin or flouroquiolone or
Erythromycin + rifampin
Francisella
-
Small coccoBacillus
Strict Aerobe
Zoonotic


- worldwide distribution
- RESV:
- wild and domestic
- fish, birds, arthropods
- in US: Main RESV:
- rabbits, ticks, muskrats
- Missouri, Arkansas
Oklahoma
- MOT: infectied tick
bite, contact with
infected animal,
consumption of
contaminated meat
or water
- low ID through bite and
Inhalation
- tularemia infection is a
danger physician (BE
CAREFUL)




tularenis - very small coccobacillus
- Non-Motile
- thin lipid capsule
- antiphagocytic
- fastidious (req. cysteine)
- strict aerobe

Diagnosis:
- culture on chocolate,
blood or BCYE agar
- requires prolonged
incubation
Identificiation:
- preliminary by slow
growth of very small
coccobacilli on
chocolate Agar
- Confirmation by
- agglutination tests
- Serology by indirect
fluorescent antibody
tests(IFA)

Tularemia, Glandular Fever, Rabbit Fever, Tick Fever:
- 3-5 day incubation
- symptoms:
- fever, chills, malaise, fatigue
- lymphadenopathy, possible bacteremia
- Forms :
- Ulceroglandular- common with papule on skin in
area of enlarged lymph node
papule ulcerates necrotic
- Oculoglandular- direct inoculation of eye
- causes conjunctivitis
- Glandular- lymphadenopathy without ulcers
- Typhoidal- systemic disease with multiorgan
involvement
- Oropharyngeal- acquired via ingestion
- Gastrointestinal- acquired via ingestion
- Pneumonic- inhalation
- serious with high mortality unless it is diagnosed
early and treated
- intracellular parasite that survives I
in macrophages
- prevents phagosome- lysosome
fusion
Treatment:
- DOC: Streptomycin
- also: gentamycin, tobramycin
Prevention:
- live-attenuated vaccine lessens
severity (does not prevent disease)
- avoid reservoirs & vectors
- do not handle ill-appearing rabbits
- wear gloves while skinning rabit
- remove ticks promptly
Bacteriology 19

Bacterial
Genus
G
+ / -
General Characteristics Species Species Characteristics/
Lab Diagnosis
Clinical Diseases Virulence/Treatment/Other
Epidemiology
Brucella
-
Small coccoBacillus
Strict Aerobic
Zoonotic


- rare in US
- RESV:
- B. abortus (cattle)
- B. melitensis (goats &
sheep)
- B. suis (swine)
- B. canis (dogs, foxes,
coyotes)
- most cases in U.S. in
Hispanics of CA and TX
from comsumption
of unpasteurized milk
and other dairy products
- B. canis does NOT react
with other species
Abortus,
melitenisis,
suis,
&
Canis
- small coccobacillus
- Non-Motile
- no capsule
- strictly aerobic
- some require CO2 as well
- no sugar fermentation
- Growth in tissues w/
erythritol (sugar):
- in breast, uterus,
placenta, epididymus
Diagnosis:
- prolonged incubation
Identification:
- Oxidase Pos.
- reactive with antibodies
- culture biphasic medium
- Castenedas medium
- 4 x in serum Ab
Undulant Fever:
- incubation up to 2 months
- initital symptoms:
- malaise, chills, sweats, fatigue, weakness, myalgias,
weight loss, arthralgias, dry cough,
- intermittent fever: seen in untreated patients
- advanced disease:
- symptoms seen in various tissues
- mild complication bacteria:
- B. abortus ; B. canis
- destructive lesions and prolonged course bacteria:
- B. suis
- severe lesions and high complications:
- B. melitenisis
- cause sterility, abortion, asymptomatic, carriage in animals

Virulence:
- intracellular parasites in
macrophages
- inhibit neutrophil degranulation
- carried to various organs in
macrophages
- liver, spleen, lymph nodes, bone
marrow, kidneys
- form granulomas here
- cause tissue destruction
Treatment:
- DOC: Doxycycline combined with
gentamycine, streptomycin,
or rifampin
- reduce relapses
Prevention:
- animal examination, elimination (if
infected), vaccination (cannot be
used on humans)
- avoid unpastuerized milk
- protective clothing
Paste-
urella
-
Small coccoBacilli
Zoonotic


- RESV: animal mouths
- mainly dogs/cats
- MOT: animal bites
- especially cat bites
multocida - small gram-negative rods
(coccobacilli)

Diagnosis:
- rarely cultured in lab
because prophylaxis is
done after a dog bite

Localized Cellulitis
- seen after animal bite or scratch
Lymphadenitis
- seen after animal bite or scratch
Exacerbation or Chronic Respiratory Disease:
- seen in people with underlying pulmonary disease
Systemic Infection:
- seen in immunocompromised patients
Virulence Factors:
- endotoxin, capsule*
- can spread rapidly within skin
Treatment: Prophylaxis:
- Penicillin G, ampicillin,
amoxicillin, clavulanate
- given for animal bites
- clean thoroughly
Bartonella
-
Pleomorphic Bacilli
Zoonotic
_____________________

- RESV: oral flora of cat
- MOT: cat to cat via fleas
- cat scratch
Henselae

Cat-Scratch Fever in Immunocompetent mainly:
- 1-2 week incubation following kitten bite or scratch
- Localized lympadenopathy
- especially on head, neck, upper arms, axilla
- fever, headache, fatigue, anorexia may be present
- mild & self-limiting
Bacillary Angiomatosis:
- more common in immunocompromised patients
- proliferative vascular lesions on skin and organs
- biopsy tissue seen w/ Warthin-Starry stain or DFA

Actino-
bacillus
-
Bacilli
Zoonotic
Muris Rat Bite Fever:
- follows bite or scratch by rat or other rodents like mice
and gerbils
- oral or urine secretion contact could also cause it
- 2-10 day incubation period
- abrupt onset of chills and fever, vomiting joint or back
pain, headache, muscle pain
- red rash mostly on hands and feet develop 2-4 days
after onset of fever
- one or more large joints may become swollen and
painful
Treatment:
- DOC: penicillin
Spirullum
-
- same as above Minus - same as above Rat Bite Fever - same as above
Bacteriology 20

Bacterial
Genus
G
+ / -
General Characteristics Species Species Characteristics/
Lab Diagnosis
Clinical Diseases Virulence/Treatment/Other
Epidemiology
Treponem
a
-
Thin Spiral Spirochete
Microaerophilic
_____________________

- RESV: Strictly human
pathogen
- MOT: Sexual,
Transplacental,
blood rare


pallidum - Motile: endoflagella
- Not grown on media or in
cell culture too thin
- Killed by drying and
increase in temperature
- thin, spiral, flexible rods

- Diagnosis:
- Specific Abs & Non-
specific Abs (regain)
- DF microscopy
- Fluorescent stain
- Histologic Silver Stain
- Nontreponemal Test:
- Serological
- Non-Specific Test
- Beef cardiolipin reacts w/
patient IgG, IgM (recent
vs,chronic infection)
(regain)
- VDRL (serum)
- RPR (preferred, plasma)
- Revert to negative after
treatment
- False positives occur w/
leprosy, hepatitis B,
infectious mononucleosis,
and autoimmune
diseases
- For Screening
- Treponemal Test:
- Specific tests
- Treponemal Ag reactive
w/ patient AB
- FTA - ABS
(immunofluorescence)
- TPHA or MHA-TP
(hemagglutination)
- Positive for life
- Expensive
- Confirmatory test











- Primary Syphilis
- Multiplication at site hard chancre in 2-10 wks
- Infectious but not painful
- Secondary Syphilis:
- Spirochetes spread maculopapular rash
- On palms and soles @ 1-3 months after inoculation
- Moist lesions on genitalia (condyloma lata)
- Many spirochetes present with high infectivity
- Cure: 1/3 of primary and secondary
- Latency: 1/3 no lesions but Abs present
- Early (1-2 yrs): Secondary Syphillis, recurrent,
infectious
- Late: No symptoms; no infectivity
Tertiary Syphillis:
- Progresses 30 yr, treponemes infrequent, 30% mortality
- Gummas (granulomas):
- In skin, bones (fractures, joint immobilization), and liver
- Neurosyphillis (CNS):
- Mononuclear infiltration w/ endoarteritis, gummas
- Paresis from atrophy of the entire brain
- Tabes dorsalis, ARP
- Atrophy of posterior roots of the lumbar region
locomotor ataxia
- Cardiovascular:
- Aortitis, aortic aneurysm
- Congenital Syphillis
- Mother Fetus @ 10 - 15 wks
- Fetal death, abortion, stillbirth
- Multiple fetal abnormalities:
- Fulminate infection
- Diffuse rash w/ desquamation
- Impairment of liver and lungs
- Keratitis in eyes
- Affects bones and teeth
- Saddle nose, Sabre shins
- Hutchinsons Teeth - notched incisors

Virulence:
- No LPS
- Endoflagella (axial filaments)
- under outer sheath, external to
outer membrane
- No toxins!!!
- Hyaluronidase: Spreads in tissue
- Infects endothelium of small blood
vessels - invasive
Treatment:
- Benzathine Pen G
- No resistance observed
- Jarisch-Herxheimer reaction:
- 2 syphilis patient w/ Pen G
- Flu-like symptoms
- Mediated by TNF
- Can occur after treatment of
other spirochetes
- Pen G Allergy:
- Tetracycline or erythromycin
Prevention:
- condoms, prophylactic antibiotics
- scan all preganant women
Bacteriology 21

Bacterial
Genus
G
+ / -
General Characteristics Species Species Characteristics/
Lab Diagnosis
Clinical Diseases Virulence/Treatment/Other
Epidemiology
Borrelia
-
Loose, Coiled Spirochete
Microaerophilic
Zoonotic
_____________________

Burgdorferi:
- RESV: white-footed
mouse; deer
(mammals impt for
tick life cycle)
- MOT: Tick bites
(Ixodes dammini
and I. pacificus)
- Require 24-48 hours of
feeding
- Most often from nymphs
than adults or larvae
- Most common vector-
borne disease in U.S.
- In U.S. Atlantic
seaboard, northern
Midwest, and West Coast












Recurrentis:
- RESV: Humans
- MOT: Vector = Human
body louse
- Crowded, unsanitary
conditions (war, natural
disasters)

Other:
- RESV: Rodent, small
mammals
- MOT: Soft ticks Vector
w/ animal bite
- Ethiopia, Rwanda, Andes

burgdorferi - Irregular, loosely coiled;
larger than other
spirochetes
- Motile: endoflagella
(axial)
- Gram Stain
- Giesma Stain
- Culture w/ serum or
tissue extract, not useful
- Lab Confirmation:
- Isolation
- IgM, IgG levels
- Significant in Ab titer
between acute and
convalescent serum
samples
Diagnosis:
- Erythema chronicum
migrans (ECM)
- Isolation is low, especially
in early disease
- Serology:
- ELISA
- Indirect for IgM or rise in
IgG preferred
- Abs are slow to appear
(2-4 weeks after ECM)
- False positives in patients
with syphilis
- Confirm w/ Western blot



Pathogenisis:
- Blood Organs, systemic; Abs cause Clearance
- Slow immune response
Lyme Disease:
-Stage 1:
- ECM: Erythema chronicum migrans (bulls eye)
- Nonpruritic, painless circular rash with clear center
and red edges
- Flu like symptosm and Athralgias
- Stage 2: Cardiac or neurologic
- Cardio: Myocarditis, heart block
- Neuro: Aseptic meningitis or cranial neuropathies
- Latency
- Stage 3:
- Mainly chronic arthritis of large joints;
- CNS disease may progress
- Summary of Late Manifestations (in 80% after weeks)
- Neurologic: meningitis, encephalitis, peripheral
nerve neuropathy
- Cardiac: heart block, myocarditis, congestive heart
failure
- Arthralgias and arthritis persist for years
- No toxins or virulence factors!!!

Treatment:
- Early: doxycycline or amoxicillin
- Late: Pen G or ceftriaxone given IV
- Neurologic and musculoskeletal
- requires prolonged treatment

Prevention:
- Avoid ticks, protective clothing, insect
repellant
Recurrentis
& others
- Epidemic relapsing fever:
- Clinically endemic and epidemic are the same
- 1 week incubation
- Abrupt onset Fever:
- Shaking chills, fever, muscle aches and headaches ,
sweats, rash, corresponding to bacteremia
- Bacteremia & fever recur (relapse)
- Single in epidemic relapsing fever
- Repeated in endemic relapsing fever
Virulence:
- Antigenic variation evade immune
- via VMP lipoprotein
- Febrile and afebrile periods
- No toxins!!!

- Treatment:
- Doxycycline or erythromycin
- Jarisch-Herxheimer Rxn possible

- Prevention:
- Rodent, sprays, hygiene, no vaccine
Bacteriology 22

Bacterial
Genus
G
+ / -
General Characteristics Species Species Characteristics/
Lab Diagnosis
Clinical Diseases Virulence/Treatment/Other
Epidemiology
Leptospira
-
Thin Coiled Spirochete
Aerobic
Zoonotic


- RESV: Rodents, dogs,
farm animals
- MOT: Breaks in skin,
water w/ urine,
feces, handling
infected tissues,
food
- Tropical climates
- Occur in warm months
recreational exposure to
contaminated water
(lakes, rivers,
contaminated with animal
urine)
Interrogans - Motile
- thin tightly coiled
spirochete
- NOT gram stained
- Hook at one or both ends
hockey stick appearance

- Culture:
- Fletcher
- EMJH
- Tween 80 albumin
- Slow growers
- Incubation 4 months: deal
results in 2 weeks.
- Present in blood or CSF
during first 10 days of
infection and in urine after
1st week and as long as
3 months.
Diagnosis:
- PCR, DNA probes
- Serology:
MAT, microscopic
agglutination test -
agglutinate live
leptospires
- Elisa test
- Cross Rxn w/ other
spirochetal infections
(syphilis,relapsing fever
and lyme disease)
Microscopy:
- Unreliable: light
microscopy, gram stain,
silver stain, DF

















Leptospirosis:
- Mild febrile onset
- High bacteria count in CSF and Blood
- Headache, muscle ache
- Systemic disease:
- aseptic meningitis, rash and jaundice
- Overwhelming disease:
- Icteric / Weils disease
- above symptoms w/ renal disease, multi organ
hemorrhage especially liver and kidneys, mental change
- also congenital disease
Leptospirosis:
- excreted in animal urine
- bacteria circulate though body in blood
- fever, dysfunction in various organs
- biphastic:
- fever, chills, intense headache, conjuctival suffusion
- short period of resolution followed by asceptic
meningitis, with possible liver and kidney damage
Treatment:
- Severe disease(Weils/icteric):
- IV Pen G or tetracycline
- Mild disease:
- ampicillin, amoxicillin, or
doxycycline
Prevention:
- Control rats, vaccinate pets

Bacteriology 23

Bacterial
Genus
G
+ / -
General Characteristics Species Species Characteristics/
Lab Diagnosis
Clinical Diseases Virulence/Treatment/Other
Epidemiology
Mycoplas
ma

Pleomorphic Acid Fast
Fac. Anaerobic
_____________________

Pneumonia:
- RESV: Human only
- MOT: Droplets,
respiratory
- Most common in school-
age children and young
adults
- Smallest free-living
organism!!!
pneumoniae - Motile
- round, oblong shape
- Diagnosis:
- no gram stain
- fried egg appearance
- Culture
- Microaerophilic solid
media
- Aerobic Special Broth
media
- Serologic tests
- complement fixation
(CF)
- +ve = No Lysis
- Cold agglutinin Pos.
- group O human RBCs
- Not a very good test!










- Mycoplasma pneumoniae
- Upper respiratory tract
- Sore throat or earache
- Low-grade fever
- Dry, nonproductive cough; occasionally paroxysmal
- Malaise
- Tracheobronchitis
- Infiltration with lymphocytes and plasma cells
- Atypical (walking) pneumonia
- Patchy bronchopneumonia with myalgias
- Secondary complications can occur
- Slow resolution
Virulence Factors:
- Adherence:
- P1: Polar tip structures/adhesins
- adherence to respiratory epithelium
- loss of cilia
- Hydrogen Peroxide Production
- direct cytotoxic effects
- Immobilizes cilia
- Necrosis of ciliated epithelium
- Superantigen: increase inflammation
- No cell walls!!!
- Cannot be treated with -lactams
- Plasma membrane with three layers
and sterols

Genitalium
&
Ureaplasma
urealyticum











- Some cases of nongonococcal urethritis (NGU)
- bringing at urination, discharge
- No cell walls
hominis - Pyelonephritis, pelvic inflammatory disease (PID), and
postpartum fever












Bacteriology 24

Bacterial
Genus
G
+ / -
General Characteristics Species Species Characteristics/
Lab Diagnosis
Clinical Diseases Virulence/Treatment/Other
Epidemiology
Chlamydi
aceae

-
Small Bacilli
_____________________

Trachomatis
RESV: Human pathogen,
children
MOT: Eye Eye droplets,
hands, clothing,
flies,aerosols, fecal
contamination,
Mother fetus
- Most common STD in
U.S.
- Caused by types D-K
- 80% women; 25% men
- #1 cause of blindness in
the world
- LGV: Endemic in Middle
East, North Africa, and
India













Pneumonia:
- RESV: Human pathogen
- MOT: PP






Psittaci:
- RESV: any bird
- MOT: dried bird
excrement
inhalation

trachomatis

Diagnosis:
- difficult
- Immunofluorescent (DFA)
- ELISA
- Molecular probes
- Probe 16S rRNA
- Two morphological forms:
- Elementary body (EB)
- Infectious
- resistant to harsh
conditions, env stablitiy
- no division
- infects mononuclear
phagocytes
- prevents phago-
lysosome fusion
- Reticulate body (RB)
- non-infectious
- metabolically active
- (binary fission) inside
phagosome
- only intracellular
Lifecycle:
- 18-24 hours RBs EBs
- 24-48 hours cell
ruptures EBs released
- Trachomatis Biovar:
- Involves non-ciliated columnar, cuboidal, and transitional
epithelial cells
- Pathogenesis: destruction of infected cells and
inflammatory response
- Infection through minute abrasions or lacerations
- Often asymptomatic
- Urogenital Infections:
- Epididymitis, prostatitis, proctitis, nongonococcal urethritis
(NGU)
- Cervicitis, salpingitis, PID, infertility, and ectopic
pregnancy
- Reiters Syndrome/Urogenital Infection:
- Urethritis, conjunctivitis, polyarthritis, and
mucocutaneous lesions
- Autoimmune disorder caused by cross-reactive Abs
- Mostly in young white males
- Adult conjunctivitis:
- Preceded by genital infection
- Autoinoculation and oral genital contact
- Ocular Trachoma:
- Begins w/ follicular conjunctivitis corneal ulceration
and scarring blindness
- Nenonatal Conjunctivitis:
- @ birth from infected mother, can lead to blindness
- Infant Pneumonia:
-Pulmonary in newborns 2-3 weeks after birth
- Lymphogranulosum venereum (LGV)
- Chronic STD endemic in Africa, Asia, and S. America
- 1 painless papule or ulcer 2inflammation and
swelling of regional lymph nodes can rupture and form
fistulas systemic: fever, chills, anorexia, headache,
myalgias, arthralgias
Virulence:
- Obligate intracellular parasites (RB)
- Cannot make their own ATP
- Intracellular replication
- Prevent Phago-Lysosome Fusion
- Plasma membrane and outer
membrane
- no peptidoglycan layer
- Attach to microvilli and actively
penetrate
- Two human biovars:
- trachoma
- lymphogranuloma venerueum

Treatment:
- LGV, pneumonia, psittacosis:
- doxycycline
- STD:
- azithromycin recommended
- Newborn conjunctivitis & pneumonia:
- prophylactic erythromycin
pneumoniae - Atypical Pneumonia:
- Bronchitis, pneumonia, sinusitis, or asymptomatic infection
- Persistent cough and malaise
- Pneumonia in single lobe
- most patients are not hospitalized




Treatment:
- Macrolides

psittaci - Diagnosis:
- Serological
- Psittacosis (parrot fever):
- Atypical Pneumonia
- Disease of parrots that can be transmitted to humans
- Starts in respiratory tract and spreads to phagocytic cells
in liver and spleen
- Headache, high fever, chills, malaise, and myalgia
- Nonproductive cough, rales, and consolidation
- Multiplication -> necrosis
- secondary inflammation in lungs and other organs

Treatment:
- Tetracyclines or macrolides
- Controlled by treating pet birds or
limiting contact
Bacteriology 25

Bacterial
Genus
G
+ / -
General Characteristics Species Species Characteristics/
Lab Diagnosis
Clinical Diseases Virulence/Treatment/Other
Epidemiology
Rickett-
sieae
-
- very small coccobacilli
- stain poorly
- minimal peptidoglycan
- weak endotoxin
- obligate intracellular
parasites (need cells
energy)


- animal reservoirs
- transmitted by athropods
Rickettsii - most common rickettsial
pathogen in U.S.


- Hardticks (Dermacentor)
are reservoir and vector
- transmission requires
prolonged feeding
Rocky Mountain Spotted Fever-
- incubation of 2-6 days
- fever, chills, headache, myalgias
- petechiae rashes- minute hemorrhagic spots
- spreads from extremities to trunk
- may occur in palms and soles
- complications:
- GI symptoms, repiratory failure, encephalitis, renal failure
Diagnosis:
- stain with Giemsa or fluorescent-labeled antibody
- do this instead of gram stain
- culture at reference labs
- *serologic diagnosis:
- weil-felix test:
- causes agglutination of proteus O Antigens
- indirect fluorescent antibody test:
- sensitive and specific ,4-fold rise in titer Treatment:
- Doxycycline and chloamphenicol
- no vaccine
Virulence:
- stimulation of phagocytosis
- intracellular growth
- spotted fever group in nucleus
- typhus group in cytoplasm
- coxiella in cytoplasmic vacuoles
- replicates in endothelium
- causes vasculitis
- leads to petechiae &
hemostatic disturbances
- exception: coxiella
Prowazekii - humans are reservoir
- occurs under crowded,
unsanitary conditions
- C. & S. America, Africa,
Asia
Epidemic or Louse-Borne Typhus:
- high fever, chills, severe headaches, myalgias
- arthralgias- severe (non-inflammatory) joint pain
- <40% have petechial rashes
- complications: myocarditis, CNS dysfunction
Diagnosis: indirect fluorescent antibodies
Treatment:: tetracyclines or chloramphenicol
Typhi - rodents are reservoirs
- rat fleas: vectors
- U.S. Gluf States, S.
California, Asia, Africa,
Europe, S. America
Endemic or Murine or Flea-borne typhus:
- 50% have rash
- similar symptoms to epidemic typhus
Diagnosis: indirect fluorescent antibodies
Treatment:: tetracyclines or chloramphenicol
Ehrlichia
-
Chaffeensis - reservoirs: white tailed
deer and pet dogs
- vector: lone star tick
Human monocytic ehrlichiosis:
- similar to Rocky mountain spotted fever
- similar to Rocky mountain spotted fever
- 1-3 week incubation period
- high fever, headache, malaise, myalgia
- destruction of WBCs and platelets
- Rash in 20% of patients
- more common in monocytic form
Treatment:
- doxycycline
- avoid ticks
Ewingii
&
Phago-
cytophila
- reservoirs: small
mammals
- vector: ixodes ticks
Human Granulocytic Ehrlichiosis:
- similar to Rocky mountain spotted fever
- 1-3 week incubation period
- high fever, headache, malaise, myalgia
- destruction of WBCs and platelets
- Rash in 20% of patients
- more common in monocytic form
Treatment:
- doxycycline
- avoid ticks
Coxiella
-
Burnetii - transmission:
- inhalation of airborne
particles from infected
cattle, sheep, goats
Q Fever:
- proliferation of bacteria in respiratory tract before they
disseminate
- influenza like syndrome, atypical pneumonia
- granulomatous hepatitis, encephalopathy
Virulence:
- associated with antigenic variation of
LPS antigen
Treatment:
- tetracyclines
- phase I antigen vaccine in Australia
Bacteriology 26

Bacterial
Genus
G
+ / -
General Characteristics Species Species Characteristics/
Lab Diagnosis
Clinical Diseases Virulence/Treatment/Other
Epidemiology
Neisseria-
ce
-
Diplococci
Aerobic?
Catalase Pos.
Oxidase Pos.

- kidney bean shaped
- oxidative-positive
- cytochrome c, need Fe
- Aerobic
- but grows best in 5%
CO2 (high CO2)
environments


Meningitis:
- RESV: humans only host
- MOT: air droplets
- peak late winter / early
spring
- 5-15% chronic carriers
- disease more common in
C5-C9 deficient people


Gonorrhoeae:
- RESV: humans only host
- MOT: STD
- risk of acquisition on first
exposure:
M: 20%
F: 50% (main RESV)
- aftican-americans more
prone to these infections
- penicillin no longer
antibiotic of choice












meningitis - Acid production via
glucose and maltose
oxidative metabolism
- oxidase-positive
- catalase-positive
- susceptible to drying and
cool temperatures
- blood and CSF test
- diplococci w/in PMNs
- latex agglutination via
soluble polysaccharide
antigen
Culture:
- Thayer-martin agar or
chocolate agar


Meningitis
- abrupt onset w/ headache, fever, seizures
- may have just fever and vomiting (less specific signs)
- mortality close to 100% if not treated
Meningoccemia (septicemia):
- More serious, life threatening
- skin rash types
- urticarial- hives (type 1 hypersensitivity)
- maculopapular- raised non-fluid filled
- petechial- hemorrhagic spots caused by thrombosis
of small blood vessels in skin
- indicate development of disseminated
intravascular coagulation (DIC)
- malaise, weakness, headache
- hypotension, peripheral vasoconstriction, cyanotic
extremities
Waterhouse- Friderichsen Sydrome:
- severe form of meningococcemia
- disseminated intravascular coagulation, shock (DIC)
- bilateral destruction of adrenal glands Fatal
Virulence Factors:
- True polysaccharide capsule
(main virulence factor) protects from
intracellular killing
- LPS endotoxin w/ Lipid A
- pili attach to receptors on
non-ciliated cells of nasopharynx
- Por A, Por B
- avoid phagocytic killing and migrate
to subepithelial space
- endotoxin (LPS):
- causes diffuse vascular damage
- IgA protease
- Transferrin - absorb iron
- serogroups: A, B, C, X, Y, W135
- A: more likely to cause epidemics
in undeveloped countries
Treatment:
- DOC: penicillin
- prophylactic treatment to those that
may be exposed:
- antibiotics
- group specific vaccine
gonorrhoeae - Acid production via
glucose oxidation
- doughnut shaped
diplococci
- oxidase-positive
- catalase-positive
- Fastidious: require
complex media, humid
atmosphere,cysteine high
CO2
Culture:
- Thayer-martin agar for
gonorrhea, and on
chocolate agar for
infections
- Chlamydia: #1 STD, co-
infection w/ gonorrhea

Gonorrhea:
- Pathogenesis: OMPs for invasion,
- Enter subepithilum TNF- via LOS complement
activation Risk for Immunocompromised
- Men:
- purulent urethral discharge and dysuria
- 95% of men have acute symptoms
- G -ve diplococci seen in gram stain of discharge
- anorectal infection
- Women:
- cervix with vaginal discharge, dysuria, abdominal
pain, bartholin gland abscess
- *often may be asymptomatic
- can spread up into fallopian tube & abdominal cavity
- can cause pelvic inflammation disease, salpingitis
- sterility, ectopic pregnancy, abscess
Disseminated Gonococcemia:
- systemic infection Joints and skin ARTHRITIS
- Pustular Rash
Ophthalmia Neonatorum:
- Mother fetus @ delivery
- Purulent Conjunctivitis Lid Edema, Erythema,
discharge
*Additional Treatment:
- 1% silver nitrate or 1% tetracycline or 0.5%
erythromycine ointment placed in new borns eyes to
protect baby
- sex education, aggressive detection, and follow up on
sexual contacts
Virulence Factors:
- NO capsule - but neg charge
- pili for attachment
- lack immunity to re-infection
- LOS has lipid A and weak
endotoxin activity
- outer membrane proteins (OMPs):
- PorA: prevent lysosome-
phagosome fusion
- Opa: mediate binding to
epithelial cell
- Rmp: stimulate antibodies to
block bactericidal activity
against bacteria
- Transferrin - absorb iron
- IgA protease, -lactamase

Treatment:
- Resistance:
- Penicillin: L, PBP
- Tetra, erthyro, amino, cipro
- DOC: cephalosporin: ceftriaxone
- doxycycline or azithromycine if
- Chlamydia is also presen
Bacteriology 27