Systematic Bacteriology

Course
“ Coordinator” Prof. Vincent Rotimi

Dr. Noura Al-Sweih

 Systematic Bacteriology
Course
Theory 24 lectures
13  Dr. Noura
9  Prof. Rotimi
MDS
Small group tutorials (5 Practical)
10 hrs  Clinical Cases
Systematic Bacteriology Course
 Systematic Bacteriology
Course
Assessment  25th Nov 06, 2:30 hrs

MCQs, Short note, Cases, EMQs

To be able to analyze,
diagnose and manage different
clinical infectious diseases

Course Aim
 Course Objectives
 To know common bacterial pathogens
causing different infectious diseases
 To develop diagnostic approach to diagnose
different infectious diseases
 To develop logical and rational management
approach for the different infectious diseases
 To know the different preventive strategies
available to control infectious diseases
Clinical Case
 Patient data { age, complaint, risk factors ,,,}
 Clinical examination & site of infection
 Type of clinical sample
 Microscopic description {Gram-stain, pus
cell}
 Macroscopic description {mucoid, yellow,
green colonies} CSF turbid
 Culture report / biochemical reaction
Microscopic Description
 Gram-positive Cocci
 Gram-positive cocci in clusters
 Gram-positive cocci in chain
 Gram-positive diplococci
 Gram-positive Bacilli
 Gram-positive bacilli in chain
 Gram-positive bacilli in Chinese letters, curved
 Gram-positive branching bacilli
Gram-positive Cocci
Gram-positive Bacilli
Microscopic Description
 Gram-negative cocci
 Gram-negative diplococci
 Gram-negative cocco-bacilli “ pleomorphic”

 Gram-negative bacilli
Gram-negative

diplococci

bacilii
 Macroscopic description
E.Coli Klebsiella
Mac/LF Klebsiella

mucoid

Pseudomonas

green diphtheria
Tellurite media
 Macroscopic description
Salmonella
Shigella Salmonella

Mac/ NLF SS/Black

Shigella

TSI/No black
SS/ no black
 Biochemical reactions

latex biochemical

Catalase +

coagulase
 Biochemical reactions
haemolysis

latex

optochin

Resistant
Sensitive
STAPHYLOCOCCI
Dr. Noura AL-Sweih
Description & Morphology

 Gram-Positive Cocci
arranged in cluster

 Catalase Positive
Classification

Coagulase test

+ -
S.aureus S. epidermidis
S. saprophyticus
Classification of Staphylococci
Gram-Positive Cocci

Catalase- Positive

Staphylococcus
Coagulase

Positive Negative
S.aureus S. saprophyticus
S. epidermidis
Novobiocin

Sensitive Resistant
S.epidermidis S.saprophyticus
Staphylococcus aureus
 ID of S.aureus { Gram-positive
cocci in cluster, catalase + and
coagulase+}

 Where can we find it?

 In the nose of 30% of healthy people &
skin
 Diseases

 A-Toxin mediated diseases

 B-Pyogenic infections {due to

multiplication}
Staphylococcal Toxins
 Enterotoxins

 Epidermolytic Toxins

 Toxic Shock Syndrome Toxin

[ TSST-1]
Toxin Mediated Diseases
Food Poisoning
 Enterotoxins

 Contaminated food with toxins (Dairy

products eg. milk, cheese)

 1-2 hrs symptoms; nausea & vomiting

Case
 A 3 year old boy developed sever vomiting 2
hrs after drinking milk, the most likely
causative agent is ---------------
Scalded Skin Syndrome SSS
 Epidermolytic Toxins

 Neonates & children

up to 10 years
 Fever, toxaemia &
disseminated
erythematous skin
lesion
 Toxins induce intra-
epidermal blisters
Case
 A 5 month old baby admitted with fever,
irritability and skin exfoliation
 What is your professional diagnosis?
 What is the causative organism?
 What is the drug of choice?
 Toxic Shock Syndrome TSS
 Young women

 Fever, rash, vomiting, ⇓ Bp \ Multi-organ

failure, shock, death

 TSST-1 act as superantigen

Activate T lymphocyte 
cytokines & tumor necrosis factor (TNF)
Pyogenic Infective Diseases
Pyogenic Infections
 Skin infections

 Bacteremia

 Bone infections

 Pneumonia
 Skin infections
 Boils  hair follicle or sebaceous gland
 Carbuncles  more than one hair follicle 
often on the back of neck
 Impetigo  children
 Erysipelas & Cellulitis
 Abscesses subcutaneous [ axilla, groin]
 Mastitis
 Wound infection
Case
 A 25 year old lactating mother developed breast
abscess, the doctor drain the abscess and the pus sent
to the lab for microscopy and culture, Gram-smear
showed many pus cells and Gram-positive cocci
arranged in clusters.
 What is the likely causative pathogen?
 Name other infections caused by this organism?
Skin infections

boil

cellulitis

impetigo
carbuncle
Other Pyogenic Infections
 Bacteraemia & Septicaemia

 Osteomyelitis  acute & chronic

 Pneumonia  2nrdy to viral infections

Case
 A 65 year old man admitted to the hospital
with high fever, confusion and back pain.
Blood culture grew Gram-Positive cocci
arranged in clusters after 13 hrs
 What is your provisional diagnosis?
 Name the likely causative organism?
 What laboratory test you will do to confirm the
identification of the organism?
Epidemiology
 Source of Infection:
Human with Infected Lesions:
Direct contact
Air-borne
Food  food handlers
Healthy carriers

Animals
Epidemiology
 Modes of Infection

Exogenous

Endogenous
Case
 5 patients developed wound infection after surgery
in ward 20 within the last 10 days. Wound swab
grew Gram-Positive cocci arranged in clusters and
were coagulase positive.
 Name the likely causative agent
 What will be the source of the infection if all the patients
were operated by the same surgeon?
 What will be the source of the infection if the patients
were operated by different surgeons?
 Laboratory diagnosis
 Gram stain

 Golden or yellow colonies

 Catalase & Coagulase positive

 Antibiotic Resistance
 Penicillin  > 90% resistant (not used for treating
infection caused by staphylococci)
 Cloxacillin (drug of first choice for S.aureus if not
MRSA)
 If Methicillin sensitive MSSA
S\ Cloxacillin & cephalosporin
 If Methicillin resistant  MRSA*
Resistant to all B- lactam (cephalosporin) &often
to aminoglycosides & glycopeptides are the drug
of choice
* Common problem in some Kuwait
 Antibiotic Resistance
Glycopeptides (vancomycin & Teicoplanin)

If Glycopeptides Resistant  GISA, VISA,

VRSA
* New problem, incidence low in Kuwait
* New antibiotic  Linezolide
Treatment

 What are the drug of choice for S.aureus

infections?
 Staphylococcus epidermidis

 Normal flora of the skin

 Emerge as a pathogen reflect

1- ⇑ of implants such as shunts, lines,
valves
2- ⇑no. of immunocompromised patients
Staphylococcus epidermidis
 Pathogenicity related to ability to adhere
to synthetic biomaterials and produce
extracellular Slime 

1- Inhibit proliferation of WBC

2- Inhibit antibiotic penetration

 Staphylococcus epidermidis
Epidemiology

 Nosocomial infection

 Foreign Body infection

Disease
 S. epidermidis
¤ Septicaemia
¤ CSF shunt infection
¤ Peritonitis  CAPD
¤ UTI catheters
Endocarditis  Prosthetic valve
Case
 A 73 year old lady had hip joint replacement
2 years back admitted to the hospital with
H/O fever for last 5 days not improve on oral
amoxicillin. Blood culture grew Gram-
Positive cocci arranged in clusters
 Name the likely causative organism
 What is the drug of choice?
S. epidermidis
 Treatment
A- Usually multi-resistant to
R [ penicillin, cloxacillin,
cephalosporins]

B- Vancomycin & teicoplanin drug of first

choice
Staphylococcus saprophyticus
 Common cause of UTI in community

 Mainly affects young women

 Honey-moon cystitis
S. Saprophyicus
Treatment

Trimethoprime

Norfloxacin
Laboratory Diagnosis
 Gram stain
 Catalase ----
 Coagulase ------
 Novobiocin sensitivity
● Sensitive  -------- ---
● Resistant  -----------
Classification of Staphylococci
Gram-Positive Cocci

Catalase- Positive

Staphylococcus
Coagulase

Positive Negative
S.aureus S. saprophyticus
S. epidermidis
Novobiocin

Sensitive Resistant
S.epidermidis S.saprophyticus