Kingdom: Bacteria Phylum: Firmicutes Class: Bacilli Order: Bacillales Family:Staphylococcaceae Genus: Staphylococcus

Staphylococcus

• Gram positive cocci in clusters or groups. • Catalase positive • Facultative anaerobes • Oxidase-negative • Medically important Organisms:
• Staphylococcus aureus, • staphylococcus epidermidis, • staphylococcus saprophyticus.

Catalase Test

Staphylococcus

Staphylococcus classification
Staphylococcus
Catalase +, clusters

Coagulase Positive

Non-Coagulase

S.aureus
β hemolytic, yellow on Blood agar, Mannitol positive.

S.epidermidis
Novobiocin sensitive, β or γ Hemolytic

S.Saprophyticus
Novobiocin resistant, γ hemolytic

Staphylococcus aureus
• Coagulase positive • Golden yellow colony on blood agar • Nonmotile, Nonsporeforming
Mannitol fermentation • Facultative anaerobe • Fermentation of glucose produces mainly lactic acid • Ferments mannitol (distinguishes from S. epidermidis)

Staphylococcus aureus

To perform the Slide Coagulase Test, place a 2ml of coagulase reagent (rabbit plasma) onto a clean test tube, and then add several colonies of the unknown Staphylococcus. Mix well. If fine grains of sand or small clumps are seen, the coagulase test is positive. If the mixture remains smooth (milky looking), the coagulase test is negative. Courtesy: http://staff.um.edu.mt.

Virulent Factors
Adhesion:
 Clumping factor - surface proteins
• Attaches to laminin, fibronectin, fibrin and fibrinogen, collagen (osteomyelitis)

Invasion:
 alpha toxin (alpha - hemolysin)
 membrane-damaging toxin (platelets and monocytes)

 ß-toxin (sphingomyelinase) – β-hemolysis.  delta toxin – detergent like (produced by s. aureus and s.epidermidis)  Leukocidin – acts on PMN’s (↑ dermatonecrotic strains)  Coagulase
 extracellular protein binds to prothrombin → staphylothrombin → inhibits Phagocytosis

 Staphylokinase, proteases, a lipase, (DNase) and a fatty acid modifying enzyme (FAME) important in abscesses

Exotoxins
 Enterotoxin – leads emesis ( food poisoning in 2-6 hrs)  TSST-1 (superantigen) – Toxic shock syndrome  Exfoliatin toxin – Scalded skin syndrome (Cadherins in desmosomes)

Pencillinase Host Defenses escape
 Capsular Polysaccharide  Protein A
 Surface protein binds IgG molecules by their Fc region ↓ opsonization.

Super antigen animation

Virulent Factors

Courtesy : Dr.Kenneth Toder

Epidemiology
 Most opportunistic Pathogen  Nosocomial

 Skin, mucus membrane and nasal areas.
 Food, tampons, trauma, immune suppression etc

Pathogenesis
Food Poisoning: Enterotoxin

Skin Infections: Invasion: Leukocidin, hemolysins.
Pneumonia: Invasion: hemolysins, Leukocidin and coagulase. Endocarditis: Invasion: Coagulase, staphylokinase, hemolysins and leukocidins. Osteomyelitis & septic arthritis: Invasion: Surface proteins to collagen, hemolysins and leukocidin

Toxic Shock Syndrome: TSST 1, Enterotoxin.

Scalded skin syndrome: Exfolitin toxin

Clinical features
Skin conditions: Folliculitis, Carbuncle, furuncle, Impetigo, Mastitis, Surgical infections Opportunistic, immune suppression. Pneumonia: Fever, chills, cough, consolidation, effusion Hospitalized pts, post influenza infection, immune suppressed pts. Acute Endocarditis: IV drug abuse, tricuspid valve, pneumonia Osteomyelitis & Septic arthritis: Most common, trauma or hematogenous Food poisoning: 2-6 hrs onset, resolve in 24-48 hrs. Mayonnaise, salads etc Toxic shock syndrome: Tampons, sutures, Endometritis etc. Scalded skin syndrome: Children with skin infections and umbilical cord infections.

Impetigo

Scalded skin syndrome

Folliculitis

furuncle Toxic shock syndrome Carbuncle
Courtesy by CDC

Diagnosis
 Gram staining
 Catalase test  Coagulase test

 Yellow colonies on blood agar
 PYR +  Bacitracin resistant.

Gram Positive cocci Identification

• Treatment: • Resistance to penicillin • Vancomycin drug of choice

MRSA
Resistant to Antibiotics HA MRSA CA MRSA Susceptibility – hospitalized patients, immune suppressed, improper hygiene, athletes etc. Treatment: Vancomycin.

Staphylococcus epidermidis
• Gram +, in clusters can’t differentiate in gram stain with S.aureus. • Coagulase negative • Mannitol negative • Thick polysaccharide capsule, delta toxin. • Most common on skin flora

• Common contaminant of blood samples
• Nosocomial

Virulent factors: • Polysaccharide capsule • Delta toxin

• Clinical conditions : • Nosocomial infections • Catheters and prosthetic devices • Endocarditis of prosthetic heart valves

• Infections of artificial joints

Diagnosis
• Coagulase negative

• Mannitol negative
• Beta or gamma hemolytic on blood agar • Novobiocin sensitive

Treatment
• Resistant to antibiotics • Vancomycin

Staphylococcus saprophyticus
• Gram positive cocci inclusters • Non hemolytic • Coagulase negative • Mannitol negative • Novobiocin resistant • UTI in sudden sexually active women (honey moon cystitis)

Diagnosis
• Novobiocin resistant • Coagulase negative • Mannitol negative

Treatment
• Penicillin

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