Professional Documents
Culture Documents
MDL 237 Staphylococci
MDL 237 Staphylococci
Rothia No
Micrococcus
2
General characteristics
The Staphylococci belong to the family Micrococcocaceae (a.k.a. Staph group) Related bacteria encountered in human clinical specimens include Staphylococcus, Micrococcus, and Rothia mucilaginosus (formerly Stomatococcus mucilaginosus) At this time, there are ~40 recognized species of the genus Staphylococcus There are only a few recognized species of Micrococcus and of Rothia
3
General characteristics
The Staph group is comprised of Grampositive cocci Based on planes of division they form various groupings which include clusters, tetrads, pairs, and even short chains When seen in pairs the longer axes are parallel rather than perpendicular (mutual)
4
General characteristics
Species of the genus Staphylococcus divide in random planes and tend to form irregular clusters (Staph=grape-like clusters, coccus=round) Micrococcus species first divide in parallel planes and them perpendicular to that resulting in predominance of tetrads Rothia species form short chains and small clusters. Here, the longer axes are perpendicular rather than rather than parallel.
5
Rothia
General characteristics
Staphylococci have a thick multilayered peptidoglycan as the major component of their cell walls, the same as all Gram-positive bacteria Staphylococcus species contain teichoic acids in their cell walls Teichoic acids stabilize the cell wall, hold association with cell membrane, function in transport, etc. Cell walls of Micrococcus & Rothia species do not contain teichoic acids
General characteristics
Members of the staph group are mostly nonencapsulated and all clinically relevant ones are nonmotile All Staph group organisms that grow in air are catalase positive
A small percentage of staphylococcal infections spread hematogenously to all regions of the body = systemic = bacteremia, and likely toxemia.
10
In addition to the coagulase positive S. aureus the most clinically significant species are: S. epidermidis S. saprophyticus Coagulase negative S. haemolyticus S. lugdunensis S. schleiferi S. intermedius Coagulase positive S. hyicus
11
13
17
Biochemical characteristic
Production of catalase is a defining characteristic of the Staphylococcus and Micrococcus species The catalase reaction of Rothia is weak or delayed and many are frankly catalase negative
19
Biochemical characteristic
Staphylococcus species can be differentiated from Micrococcus species based upon oxygen requirements: Staph is facultative and Micrococcus species are obligate aerobes Rothia can be differentiated from Staphylococcus and Micrococcus by its lack of growth on a highsalt medium, its negative catalase reaction, and its tendency to adhere firmly to an agar surface
20
21
Coagulase
Coagulase (staphylocoagulase) is a fibrinogen activating enzyme produced by some staph species - it has thrombin-like activity. In situ, coagulase combines with coagulase reacting factor (CRF) to catalyze the formation of fibrin clots around cells as a barrier to host immune components it is a virulence factor. Clinically significant staphylococci are usually divided into two groups: those that produce coagulase and those that do not Coagulase positive species include S. aureus, S. intermedius and S. hyicus S. intermedius and S. hyicus mostly inhabit animals and are only rarely found as a cause of human infections
22
Coagulase
Normal coagulation of plasma Thrombin Fibrinogen (soluble )
Fibrin (insoluble)
*EDTA Rabbit plasma is preferred for the free or tube coagulase test because it contains a large amount of CRF
23
Coagulase testing
Since staphylocoagulase is synthesized and secreted into the medium in which it is growing, it is known as free coagulase (i.e. it is not bound to the cell that secreted it) The free coagulase test is performed by mixing a Staphylococcus colony or growth from a broth with a small amount of plasma in a test tube It is therefore usually referred to as the tube coagulase test (a free coagulase test and a tube coagulase test is the same thing)
24
Coagulase testing
Rabbit plasma is preferred for the free (tube) coagulase test because it has more CRF than plasma from other species of animals including human plasma Cells of the test organism is mixed with rabbit plasma in a test tube and incubated at 35oC for up to 4 hours
25
Coagulase testing
The tube is observed hourly during the four hour incubation period The formation of a fibrin clot or gel indicates a positive test
26
Coagulase testing
S. aureus is the only coagulase positive species
found in human clinical specimens with any frequency (see previous discussion) In addition to staphylocoagulase some strains of S. aureus will produce staphylokinase (fibrinolysin) This enzyme will dissolve a fibrin clot (i.e. will have the opposite effect of coagulase)
27
Coagulase testing
This could be a cause of false negative coagulase tests if tubes are not examined regularly over the four hour period If the plasma gels before 4 hours the test is read as positive and discarded Only catalase positive Gram positive cocci should be tested for tube coagulase as some other organisms such as Enterobacter & Klebsiella can give false positive results.
28
Coagulase testing
Using rabbit plasma containing EDTA as anticoagulant will avoid the false positive tube coagulase tests caused by citrate consuming bacteria This will not be a problem if only catalase positive Gram-positive cocci are tested for coagulase
29
Clumping Factor
95% of S.aureus isolates produce a separate enzyme that catalyzes the formation of fibrin from fibrinogen This enzyme is referred to as bound coagulase because it is an integral part of the cell wall of S. aureus Bound coagulase is not secreted into the surrounding medium Unlike free coagulase this enzyme does not require CRF in the plasma substrate
30
Clumping Factor
It is also called slide coagulase or the clumping factor test. A clumping factor test, a bound coagulase test, and a slide coagulase test are synonymous. This is because the test is performed on a slide and the end point is the clumping of a heavy water or saline suspension of bacteria taken from an agar culture A loopful of plasma is thoroughly mixed with the heavy bacterial suspension on a slide and observed for clumping 31
Clumping Factor
Clumping of the suspension within 10 seconds indicates a positive test Human plasma is preferable to rabbit plasma for the slide coagulase test because it yields more consistent results. Note Your textbook indicates that rabbit plasma is used for
both coagulase test; this is contrary to the Staphylococcus chapter in the bible (The Manual of Clinical Microbiology published by The American Society for Microbiology)
32
Clumping Factor
The heavy cell suspension is first made in water or saline If clumping occurs prior to the addition of plasma this invalidates the test (false positive). Such strains are termed autoagglutinable and must be tested by the tube method. Since 5% of S.aureus produce free coagulase but not bound coagulase, an organism giving a negative clumping factor test must still be tested by the tube test
33
Protein A
Protein A is unique to, and is an integral part of the cell wall surface of S. aureus. Protein A has an anti-phagocytic property (a virulence factor). Protein A also has the unusual ability to bind specifically to Fc fragments of IgG (a sort of antigen-antibody reaction) from several species of animals, including Homo sapiens. This makes it well adapted for another test
34
S
S S Fc L S L S S=S.aureus with Protein A L=Latex particle
36
Protein A S
38
S. aureus is a problem
S. aureus has been generally considered the #1 human pathogen since the 1980s. Why:
It is everywhere Nosocomial: big problem in hospitals Antibiotic resistance: 25% increase in MRSA isolates from 87-97 ONLY resistant to vancomycin Lots of toxins Good at immune evasion, rapid growth & spread = bacteremia Numerous types of infections
42
Integument / wounds
S. aureus is a common resident of the skin and exposed mucus membranes: respiratory, genitourinary & gastrointestinal. S aureus is the most common cause of pathogenic integument infection in humans. S. aureus is the #1 cause of post-operative infection, whether it be introduced during the course of the operation or afterward. These initial infections often become systemic and have high mortality rates
46
Integument / wounds
Less severe integumentary cases include styes, pimples, folliculitis, and other localized absecces. Folliculitis (infected hair follicles) can become more deep seated causing a furuncle (a.k.a. boil). Multiple furuncles coalesce into a carbuncle. In severe, case S. aureus can spread hematogenously from here to any body site. S. aureus & S. pyogenes cause impetigo, the most common skin infection in children highly contagious Also causes scalded-skin syndrome (Ritters syndrome) in infants via production of an exfoliating toxin fairly rare, at least in US
47
Food poisoning
S. aureus is the #1 most common cause of food poisoning although it is comparatively mild in most cases. Symptoms include nausea, vomiting, diarrhea, abdominal cramping and mild fever. Symptom onset can be within minutes or hours of ingestion, with similar duration Foods: handled foods: wet, sugary or salty, handled after some preparation cooked, mixed, then served cold, at least initially
48
Acute or chronic osteomylitis, mainly in children Endocarditis Septic arthritis Mastitis Meningitis Phlebitis / thrombophlebitis (clotting)
49
Protein A: because protein A binds to the Fc fragment of IgG, this can interfere with IgGs ability to function as an opsonin (initiate phagocytosis) ie protein A is also antiphagocytic Protein A also prevents IgG from activating complement thus preventing its various antimicrobial activities (e.g. complement mediates cytolysis, immune adherence, and initiation of inflammation) Teichoic acids in the cell wall of S. aureus also inhibits complement activation
51
Penicillin resistance (possession of penicillnase) is coded on a plasmid the enzyme is also known as beta-lactamase: inactivates the betalactam ring of penicillins and other beta-lactam antibiotics such as the cephalosporins Semi-synthetic drugs (modified penicillins) such as methicillin and oxacillin were developed for treating beta lactamase positive S. aureus infections Some strains are now resistant to these drugs MRSA, etc. A recent survey indicated that as many as 34% of S. aureus isolates were MSRA.
54
Antimicrobial Susceptibility
Antimicrobial Susceptibility
MRSA is not only resistant to methicillin and most other penicillins and cephalosporins, but they are often resistant to almost all other antibiotics except vancomycin Although vancomycin is the drug of choice for treating MRSA infections, there are now vancomycin resistant (VRSA) S. aureus strains. The first VRSA strain was identified in Japan in 1997, and 8 cases were confirmed in the US in 2002.
55
Antimicrobial Susceptibility
A high percentage of CoNS are also resistant to methicillin. Even though these isolates may be responsible for a variety of infections, methicillin resistant varieties are no more likely to be associated with nosocomial infections than are methicillin sensitive isolates. Hospital and nursing home epidemiological surveillance programs are routinely conducted for MRSA but NOT for methicillin resistant coagulase negative staphylococci
56
CoNS S. epidermidis
The most common CoNS species in clinical samples is S. epidermidis, comprising 50-80% of these isolates. S. epidermidis can be presumptively differentiated from other Staph species on the basis of the following observations It does not ferment mannitol or trehalose Coagulase negative It is sensitive to novobiocin It is resistant to polymyxin B Pathology of S. epidermidis is alsmost exclusively associated with skin penetration in the hospital setting
58
CoNS S. epidermidis
S. epidermidis produces a capsule that adheres to plastic devices such as intravenous catheters, prosthetic heart valves, and shunts S. epidermidis and other CoNS are cause of native valve endocarditis
59
CoNS S. saprophyticus
Staphylococcus saprophyticus is a CoNS associated with urinary tract infections, mostly in females, especially college age women S. saprophyticus is one of the few frequently isolated CoNS that is resistant to Novobiocin Novobiocin resistant staphylococci causing significant bacteruria can be presumptively identified as S. saprophyticus
60
61
Micrococcus species
Micrococcus colonies are highly convex, yellow, not as glistening as Staph, and usually not as large as those of Staph Microscopically individual Micrococcus cells are somewhat larger than staphylococci and the predominant spatial arrangement is tetrads Tetrads and pairs of cells can set adjacent to form right angle geometric patterns like dominos
62
Micrococcus species
Refer to slide 21 of this Power Point for a few tests used in differentiating the three genera of the Micrococcaceae. Being obligate aerobes, Micrococcus species produce acid only in the open tube (O tube O reaction) of the Oxidation/Fermentation test medium.
63
64
Rothia mucilaginosus
Rothia mucilaginosus is most abundant in the oral cavity Microscopically Rothia species form short chains and small clusters. Here, the longer axes are perpendicular rather than parallel The texture of R. mucilagenosus colonies is unique: When pressure is applied using a loop, needle, or wooden applicator stick, R. mucilagenosus adheres tenaciously to the agar surface When further pressure is applied the upper portion of the colony peels off leaving the bottom portion sticking to the agar surface The most reliable test for differentiating R. mucilaginosus from staph and micrococci is strict salt sensitivity on salt agar (e.g.5-7.5% NaCl) such as mannitol salt agar. Micrococcus doesnt grow well, but it grows a little bit.
65
66