Non-fermenting gram negative bacilli

Pseudomonas aeruginosa
0 Found in soil, water, plants
0 Straight or curved GNB
0 Opportunistic pathogen, osteomyelitis, UTI,
pneumonia
0 Colonizes tissues by pili; has propensity to
form biofilms
0 Virulence: endotoxins, pili (N-
methylphenylalalnine pili), adhesins, alginate
biofilm, LPS, hemolysins, exoenzyme S,
pyocyanin, exotoxin A, intrinsic resistance to
antibiotics due to outer membrane
impermeability and efflux pump (moving of
toxic substances out of the cell)
0 Oxidase positive
0 Observation of exracellular pigmentation (blue
pyocyanin or yellow pyoverdin) in media

Burkholderia mallei
0 Glanders disease: mainly affects horses,
donkeys, mules, goats, dogs and cats
0 Human infections are rare and sporaqdic
0 Glanders bloodstream infections are fatal 7 to
10 days
0 Chronic form of Glanders: multiple abscess
within the muscles of arms and legs or in the
liver or spleen.
0 Localized infection: cut or scratch in the skin:
ulceration in 1-5 days with swollen lymph
nodes
0 Increase mucus production in the affected site

Burkholderia cepacia
0 MDR GNB
0 Opprtunistic
0 Pathogenesis: inhalation>pili attaches to
tissues> exoproducts(hemolysins, elastase- an
enzyme that break downs proteins)>tissue
damage





Burkholderia pseudomallei
0 Mellidiosis disease (Whitmores disease)-
pyogenic or granulomatous infection primarily
of the lung
0 Pathogenesis: inhalation; able to survive
intacellularly
0 Virulence: LPS ,capsule
0 GNB oxidase positive
0 Treatment: parenteral CAZ for 10 to 14 days

Acinetobacter baumannii
0 Pleomorphic, aerobic GNB
0 Colonizes aquatic environment
0 Commonly colonizes irrigation solutions and
intravenous solutions
0 Usually involve organ system that have a high
fluid content
0 Manifesting as nosocomial pneumonia, CAUTI
and infections associated with continuous
ambulatory peritoneal dialysis
0 MDR

Stenotrophomonas maltophilia
0 Strong affinity to maltose
0 Sewage, rivers, wells, loofah sponges, soil,
water
0 Nosocomial
0 Virulence: Dnase, Rnase, fibrinolysin, lipase,
hyaluronidase, proteases and elastase
0 Adherence to plastic, catheters etc
0 Ability to survive and multiply in intravenous
solutions

Campylobacter
0 Found in GITs of poultry, dogs, cats, cattle
0 Microaerophile, GN spiral/curved rods with
polar flagella
0 Diarrhea, reactive arthritis, Guiilen-Barre
Syndrome (demylination of peripheral nerves)
0 Invades cells of small intestine; disrupt fluid
absorption
0 Darting motility on wet mount




Gram negative cocci and diplococcic

Neisseria gonorrhea
0 Urethritis, arthritis, cervicitis, conjunctivitis,
throat infections
0 Small intracellular/extracellular GN diplococci
0 CAP, modified Thayer Martin or Martin-Lewis
agar
0 Requires and atmosphere of 5% CO2 and
incubation temperature of 35 to 37 C
0 Found only in humans
0 STD
0 Males: genital infection in the urethra, 2-7
days incubation, purulent discharge and
dysuria
0 Females: cervix, PID, vaginal discharge, dysuria,
abdominal pain
0 Treatment: PEN and TET
Virulence factors
1. Capsule: antiphagocytic
2. Pili (type IV pili): attachment to human cells,
antiphagocytic, facilitates genetic
transformation, bind iron and other cations
3. Protein I: major surface antigen, forms surface
pores, specific serotypes associated with
virulence
4. LPS
5. IgA: protease: destroys IgA1
6. Beta lactamases: hydrolyses beta lactam ring
in penicillin

Neisseria meningitidis
Meningococcus
Meningitis
Pathogenesis: colonizes the nasopharynx;
systemic spread without antibody-mediated
phagocytosis; protected by polysaccharide
capsule
Transmitted through respiratory droplets
100% mortality if untreated
Meningococcemia: septicemia with meningitis,
thrombosis and multi organ failure
Small petechial lesions observed on the trunk
and lower extremities> may progress to DIC
with shock
CAP, GC: transparent, non pigmented, non
hemolytic
Antigenic determinants: Serogroup 13,
immunotype 8, serogroups A, B, C, Y,
W135 associated with meningococcal
disease

Haemophilus
Facultative gram negative anaerobe, non
motile
Family Pasteurellaceae
Small, pleomorphic coccobacilli, bacilli or
filaments
Requires growth stimulating factors:
1. X Factor ( hematin)
2. V Factor (nicotinamide adenine dinucleotide-
NAD)
3. 5% CO2

Hemophilus influenzae
Human nasopharynx, influenza, meningitis in
children
Risk factors: absence of abs vs polysaccharide
capsule
Lab DX: particle agglutination test, Neufeld-
Quellung test for H. influenzae type B
satellitism test

Haemophilus parainfluenzae
Oropharynx
Requires only the V factor

Haemophilus ducreyi
Chancroid or soft chancre
STD
Painful genital ulcers with well defined margins
Requires the X factor





Legionella pneumophilia
Acute pneumonia (legionellosis)
Resides in surface and drinking water and
transmitted through aerosols
Multiplies intracellularly in alveolar
macrophages
Culture on special charcoal agar: charcoal
yeast extract agar

Gram Positive bacteria
Cocci and Bacilli
Cocci: aerobic/facultative anaerobe:
A. Staphylococcus
B. Streptococcus
C. Enterococcus
E. Lactococcus
F. Leuconostoc
G. Aerococcus
Cocci ; anaerobic:
A. Peptococcaceae
Bacilli: aerobic
A. Bacillus
B. Corynebacteria
C. Listeria
Erysipelothrix
Bacilli: anaerobic/microaerophilic
A. Clostridium
B. Actinomycetes

Streptococcus pneumoniae
Pneumonia
Bacterial meningitis
Pathogenesis: 83 types of polysaccharide
capsules> invasiveness to bloodstreams and
CSF: capsules inhibit phagocytosis by PMNs in
the lungs
Pili: colonizes the upper respiratory tract;
increase formation of large amounts of TNF by
the immune system during invasive infection.
Surface proteins: >500
Unique group of proteins of the pneumococcal
surface-choline binding proteins (CBPs):
includes important determinants of virulence:
PsPA(protective antigen), LytA,B and C(three
autolysins), CbpA (adhesin)
Diagnosis: lancet shaped GPDC from sputum,
blood, CSF
alpha hemolysis on BAP, bile solubility; optochin
sensitive, capsular swelling, characteristic lung
infiltrate by Xray

Streptococcus pyogenes
0 GPC in chains
0 White beta hemolytic bacitracin sensitive
colonies on BAP
0 Lancefield group A
0 M protein subtyping
0 Presence of antibody to Streptolysin O
0 Rash in scarlet fever, typical lesions in
impetigo, kidney failure in acute
glomerulonephritis, heart murmur in
rheumatic fever
0 Disease: group A Strep. (GAS): pharyngitis
(Strep Throat)
0 Skin infections: impetigo, erysipelas,
necrotizing, fascitis (flesh eating disease)
0 Toxin mediated diseases: scarlet fever, toxic
shock-like syndrome (TSS)
0 Disease associated with sequelae of inf:
rheumatic fever; acute glomerulonephritis
0 Pathogenesis: bind to cells by filaments of M
protein and lipoteichoic acid
0 Exoenzymes: hyaluronidase: spread of OS in
tissue
0 Erythrogenic toxins act as superantigens in TSS
0 Treatment: Penicillin

Streptococcus agalactiae
0 CAMP test: most S. agalactiae strains>
complete lysis of sheep RBC in agar
0 Meningitis in newborns
0 Pregnant women should undergo vaginal
culture to detect pathogen
0 Lancefield group B
0 Causative agent of mastitis in cows

Bacillus anthracis
0 Transmission: through the skin: handling
products from infected animals: cutaneous
anthrax: raised itchy bump resembling an
insect bite>painless ulcer within 1-2 days
0 With black necrotic area (eschar) in the center:
lymph glands swell
0 Trasmission through inhalation of spores:
woolsorters disease: initial symptoms:
common cold, bretahing problems, shock, fatal
if untreated
0 Lethal infection upon inhalation of 10,000 to
20,000 spores
0 Transmission through ingestion: eating
uncooked meat from infected animals:
intestinal anthrax: swelling of the intstine,
nausea, loss of apetite, vomiting and fever;
fatal in 25 to 60 percent of cases
0 McFadyeans reaction: short chains of B.
anthracis lying among amorphous,
disentegrated capsular material+WBC:
demonstrates a pink capsule around a blue
cell, after staining with methylene blue: used a
presumptive diagnosis for anthrax in a blood
smear.
0 Spores: are dormant: can survive in soil for
yearsin the dry form, can withstand hot boiling
or cold temperatures for 10 mins, can resist
most disenfectants

Bacillus cereus
0 Disease: food poisoning: vomiting, diarrhea
0 Pathogenesis: emetic toxin (ETE): higky
resistant to pH between 2 nd 11, to heat, and
to proteolytic cleavage
0 Three different enterotoxins: cytotoxic and cell
membrane active toxins that will make holes
or channels in membranes.
0 1. HBL: food poisoning; is also a hemolysin
0 2. Nhe: food poisoning
0 3. EntK: diarrhea, food poisoning
0 Isolation of OS from implicated food/stool;
aerobic, GPB spore-formers, BAP; ELISA for
enterotoxins; McCoy cells TC assay for cerulide
0 Associated with fried rice, dishes contaminated
with spores; improperly cooked;

Listeria monocytogenes
0 Food borne gatroenteritis, bacteremia in
pregant women and immunocompromised
individuals
0 Infant: sepsis within 2 days of birth. Late onset
meningitis 2 wks after vaginal birth
0 Found in unpasteurized milk and many raw
foods worldwide
0 Pathogenesis: ingestion of contaminated food>
bacteria invade intestinal epc> spread laterally
by mobilizing actin filaments and pushing OS
into contigous cells> affects cell functions
0 Production of listeriolysin O> escape from the
cell> septicemia > may cross the BBB>
meningitis, brain
0 Diagnosis: culture from blood/CSF in 5%
CO2for typical cols; pleomorphic, motile,
facultative anaerobic GPCB. Culture enhanced
by prolong incubation at 4C (cold
enrichment); serotyping of flagellar (H) and
somatic (O) Ags; detection of antibody to
listeriolysin O

Corynebacterium diphtheriae
0 Disease: diphtheria, skin infection
0 Pathogenesis: inhalation of bacteria>
attachment to back of throat> diphtheria
toxin> kills cells > inflamation> fibrin
accumulation> pseudomembrane> toxin in
blood stream
0 Diagnosis: GP club-shaped rods; growth on
med with tellurite (blck cols that accumulated
tellurium) Elek plate detects toxin production
by precipitation with antibody
0 Virulence: tox gene: structural gene carried by
family of Corynebacterium

Gardnerella vaginalis
0 Facultative anaerobic gram variable rod
0 Bacterial vaginitis
0 Pathogenesis: disruption in the normal vaginal
lactobacillus microflora (responsible for the
acidic environent)> malodorous, nonirritating
discharge
0 White thin coating on vaginal walls during the
pelvic exam
0 Produces vaginolysin: a pore forming toxin
which affects only human cells
0 Proteolysis: nitrous products: cadaverines and
putrescines> bad smell + loss of water
0 Diagnosis: vaginal discharge + NSS > clue cells
or clumps of organism attach to edges of
epithelial cells or floating free in the
preparation
0 Whiff test: 10% KOH prep of secretions > fishy
odor
0 Treated with metronidazole

Clostridium botulinum
0 Disease: botulism; food poisoning, infant
botulism, wound botulism
0 Sausage, meat products, canned vegetables
and seafood products
0 Pathogenesis: spores> germinate in anaerobic
environment or canned food> botulinum toxin
gas (odorless, tasteless but lethal if
consumed)> absorbed through gut or synapses
of peripheral nerves > blocks acetylcholine
release> flacid potentially painful paralysis
0 Diagnosis: GP square rods with swollen
subterminal spores
0 Anaerobic culture in BAP
0 Detection of toxin in food

Clostridium perfringens
0 Disease gas gangrene, food poisoning
0 Pathogenesis: spores in soil contaminate open
wouds> germinate in deep dirty wds>several
toxins> lyse kill cells> tissue death (necrosis)
0 Spores on contaminated meat germinate on
mild heating> grow rapidly inside
cans/packages> enterotoxin> diarrhea,
cramps> self limiting in 24 hours
0 Diagnosis: GPB with subterminal spores;
double zone of hemolysis on BAP; detection of
toxins; gas, foul smell in wounds
0 Oxoid m-CP medium: yellow
0 Reverse CAMP: positive: bow tie zone of
enhanced hemolysis pointing towards S.
agalactiae

Clostridium tetani
0 Disease: tetanus (lockjaw)
0 Pathogenesis: spores in soil> deep wounds>
germinate> tetanus toxin> nerves> synapses in
CNS
0 Interferes with chemical release need to stop
muscle contraction: spastic paralysis
0 Tetanus toxin or tetanospasmin
0 The organism multiplies locally but symptoms
appear remote form the infection site
0 Diagnosis: GP/GV
0 Anaerobic with swollen ends (drumstick
lollipop)- terminal spore

Clostridium difficile
0 Disease: antimicrobial chemotherapy disturb
normal intestinal microbiota flora: overgrowth
of Clostridium difficile
0 Antibiotic associated diarrhea ( AAD)
0 Colitis and pseudomembranous colitis
0 Pathogenesis: two toxins: toxin A-
enterotoxin> fluid accumulation in the bowel.
Toxin B- extremely lethal cytopathic toxin
0 Toxins are very unstable: degrade at room
temperature; may be undetectable within 3
hrs after collection of a stool specimen leading
to a flase negative result of the diagnosis.
0 Treatment 10 day course of antibiotics
including metronidazole or vancomycin(
administered orally).