Flash Cards :

Medically Important Bacteria

from: Kaplan Medical & First Aid
Staphylococcus
 S. epidermidis
◦ Coagulase (-), gram (+) cocci
◦ Novobiocin sensitive
◦ Infections of catheters/shunts

 S. saprophyticus
◦ Coagulase (-), gram (+) cocci
◦ Novobiocin resistant
◦ “Honeymoon cystitis”

 Urinary Tract Infections

◦ E. coli, S. saprophyticus, K. pneumoniae, P. vulgaris.
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Staphylococcus
 S. aureus
◦ Coagulase (+), gram (+), catalase (+), ß-hemolytic of blood agar,
cocci in „grape‟ clusters.
◦ Gastroenteritis: 2-6 h onset, salty foods, custards.
◦ Endocarditis: acute
◦ Toxic Shock Syndrome: desquamating rash, fever, hypotension
◦ Impetigo: bullous + honey crusted lesions
◦ Pneumonia: nosocomial, typical, acute
◦ Osteomyelitis: #1 cause unless HbS mentioned
 Treatment:
◦ Gastroenteritis is self-limiting
◦ Nafcillin/oxacillin are DOC
◦ For MRSA: vancomycin
◦ For VRSA: quinupristin/dalfopristin (Synercid®)

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Streptococcus
 Group A Streptococcus (GAS); S. pyogenes
◦ Catalase (-), ß hemolytic, bacitracin sensitive, gram (+)
cocci
◦ Pharyngitis: abrupt onset, tonsillar anscesses
◦ Scarlet fever: blanching, sandpaper rash, strawberry tongue
◦ Impetigo: honey-crusted lesions
◦ Rheumatic fever: after streptococcal pharyngitis, ↑ ASO
titer
◦ Acute glomerulonephritis (AGN): after streptococcal skin
or throat infection, hypertension, edema, smoky urine.
 Treatment:
◦ ß lactam drugs (macrolides used in penicillin
allergy)
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Streptococcus
 Group B streptococcus (GBS); S. agalactiae
◦ Group B, ß- hemolytic, Bacitracin resistant,
Hydrolyzes hippurate
◦ Gram (+), catalase (-), CAMP test (+)
◦ Neonatal meningitis and septicemia: #1 cause,
especially in prolonged labors.
 Treatment:
◦ Ampicillin or penicillin (DOC)
◦ Clindamycin or erythromycin for penicillin
allergies

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Streptococcus
 Streptococcus pneumoniae
◦ Gram (+), catalase (-), α hemolytic, soluble in bile, Optochin sensitive, +
Quellung‟s reaction
◦ Pneumonia: typical, most common cause, rusty sputum (productive cough) &
lobar pneumonia
◦ Meningitis: many PMNs, ↓ glucose, ↑ protein in CSF, most common adult
cause.
◦ Otitis media and sinusitis: most common cause.
 Typical pneumonia:
◦ Bacterial pneumonia such as S. pneumoniae elicits neutrophils; arachidonic
acid metabolites (acute inflammatory mediators) cause pain & fever.
Pneumococcus produces lobar pneumonia with productive cough, grows on
blood agar, and usually responds well to penicillin treatment.
 Treatment:
◦ Bacterial pneumonia  macrolides
◦ Adult meningitis  ceftriaxone or cefotaxime
◦ Otitis media and sinusitis  amoxicillin, erythromycin (for allergic)
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Streptococcus
 Viridans streptococci (S. sanguis, S. mutans)
◦ Gram (+), catalase (-), α hemolytic, Optochin
resistant, bile insoluble
◦ Plaque and dental caries (S. mutans)
◦ Subacute bacterial endocarditis: preexisting
damage to heart valves; follows dental work (S.
sanguis)
 Tretment:
◦ Penicillin G with aminoglycosides for endocarditis

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 Enterococcus
 Enterococcus faecalis/faecium
◦ Gram (+), catalase (-), variable hemolysis, hydrolyzes
esculin
◦ Urinary/biliary tract infections – elderly males after
prostate treatment
◦ Subacute bacterial endocarditis – elderly males, follows
GI/GU surgery, preexisting heart valve damage

 Treatment:
◦ Some vancomycin-resistant strains have no reliable
effective treatment.
◦ VanA strains have UDP-N-acetylmuramyl pentapeptide
with the terminal D-alanyl-D-alanine replaced with D-
alanyl-D-lactate (functions in cell wall synthesis but does
NOT bind to vancomycin)
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Bacillus
 Bacillus anthracis
◦ Gram (+), spore forming aerobic rods
◦ Contact with animal hides or postal worker;
eschar or life-threatening pneumonia (wool
sorter‟s disease)
◦ Treatment : ciprofloxacin or doxycycline

 Bacillus cereus
◦ Rapid onset gastroenteritis
◦ Fried rice, Chinese restaurants
◦ Treatment : self-limiting
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Clostridium
 Clostridium tetani
◦ Dirty puncture wound
◦ Rigid paralysis TETanus is TETanic paralysis
◦ Treatment : TIG +
BOTulinum is from bad BOTtles
metronidazole/penicillin; of food and honey
spasmolytic (diazepam)
PERFringens PERForates a
gangrenous leg
 Clostridium botulinum
DIfficile causes DIiarrhea (Treat
◦ Home-canned alkaline with metronidazole)
vegetables
◦ Floppy baby syndrome
◦ Reversible flaccid paralysis
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Clostridium
 Clostridium perfringens
◦ Contaminated wound
◦ Pain, edema, gas, fever, tachycardia
◦ Food poisoning : reheated meats, noninflammatory
diarrhea
◦ Treatment :
 Gangrene  clindamycin, penicillin
 Food poisoning  self-limiting

 Clostridium difficile
◦ Hospitalized patient on antibiotics (antibiotics over-use)
◦ Develops colitis, diarrhea
◦ Treatment : metronidazole (vancomycin)

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Listeria
 Listeria monocytogenes
◦ Gram (+) rods, ß-hemolytic
◦ Facultative intracellular
◦ Foodborne (deli foods)  unpasteurized milk
◦ Transplacental – granulomatosis infantiseptica
◦ Neonatal septicemia and meningitis (3rd most
common cause)
◦ Meningitis in renal transplant or cancer patients
(most common cause)
 Treatment : ampicillin (+ gentamycin for IC
patients)
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Corynebacterium
 Corynebacterium diphtheriae
◦ Gram (+), aerobic, non-spore forming rods
◦ BULL NECK, myocarditis, nerve palsies
◦ Gray pseudomembrane  airway obstruction
◦ Toxin produced by lysogeny (ß-corynephage)
◦ Toxin ribosylates EF-2; heart, nerve damage
◦ V-L shapes  tellurite
◦ Metachromatic granules  Loeffler‟s
 Treatment :
◦ Erythromycin and antitoxin

ABCDEFG:
ADP-ribosylation; ß-corynephage; Corynebacterium Diphtheria; Elongation
Factor-2; metachromatic Granules
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Actinomyces
 Actinomyces israelii
◦ Patient with mycetoma on jaw line or spread
from IUD
◦ Causes oral/facial abscesses with sulfur
granules that may drain through sinus tracts in
skin (can cause 1 brain abscess)
◦ Sulfur granules in pus grow anaerobic, gram (+),
non-acid fast branching rods (resembling fungi)
 Treatment :
◦ Ampicillin or penicillin G and surgical drainage

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 Nocardia
 Nocardia asteoids and Nocardia brasiliensis
◦ Gram (+) filamentous bacilli, aerobic, PARTIALLY acid
fast
◦ Norcardiosis: Cavitary bronchopulmonary disease,
mycetomas (can cause multiple foci brain abscesses)
 Treatment :
◦ Sulfanomides or TMP-SMZ

SNAP:
Sulfa for Nocardia; Actinomyces use Penicillin
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Mycobacterium
 Mycobacterium Tuberculosis
◦ High risk patient (Low SES, HIV+, IV drug user)
◦ Chronic cough, weight loss
◦ Auramine rhodamine staining, acid fast bacilli in sputum
◦ Produce niacin, heat sensitive catalase
◦ Positive DTH test (PPD)
◦ Facultative intracellular
◦ Ghon complex:
 TB granulomas (Ghon focus) + lobar & perihilar lymph node
involvement
 Reflects 1˚ infection/exposure
 Treatment :
◦ 1st 2 mo  INH + Rifampin + Pyrazinamide
◦ Next 4 mo  INH + Rifampin

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Mycobacterium
 Mycobacterium leprae (leprosy)
◦ Acid fast bacilli in punch biopsy
◦ Immigrant patient with sensory loss in
extremities
◦ + lepromin skin test in Tuberculoid type (TL)
BUT NOT Lepromatous leprosy (LL)
◦ NO CULTURES
 Treatment:
◦ Dapsone & rifampin (with Clofazimine for LL)

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Neisseria
 Neisseria meningitidis
◦ Young adults with meningitis
◦ Abrupt onset with signs of endotoxin toxicity
 Oxidase (cytochrome C oxidase) test:
◦ flood colony with phenylenediamine; in presence of
oxidase, phenylenediamine turns black. Rapid test.
◦ Major oxidase-negative gram – group is
Enterobacteriaceae
 Treatment :
◦ Neonates & infants: Ampicillin and cefotaxime
◦ Children & adults: cefotaxime or ceftriaxone
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Neisseria
 Neisseria gonorrhoeae
◦ Sexually active patient
◦ Urethral/vaginal discharge (leukorrhea)
◦ Arthritis possible
◦ Neonatal ophthalmia
◦ Gram – diploccocus in neutrophils
 Treatment :
◦ ceftriaxone

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 Pseudomonas aeruginosa
◦ Oxidase (+), aerobic rod
◦ Blue-green pigments, fruity odor
◦ Burn infections – blue-green pus, fruity odor
◦ Typical pneumonia – CGD or CF
◦ UTI – catheterized patients
 Treatment :
◦ Penicillin + aminoglycoside
 Drug resistance (very common):
◦ Intrinsic resistance (missing high affinity porin some
drugs enter through);
◦ Plasmid mediated ß-lactamases and acetylating
enzymes.
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 Legionella pneumophila
◦ Elderly smoker, heavy drinker, or IC
◦ Exposure to aerosols of water (air
conditioning)
◦ Atypical pneumonia (legionnaires disease),
Pontiac fiver
◦ Associated with hyponatremia
 Treatment :
◦ Fluoroquinolone or azithromycin or
erythromycin with rifampin for IC patients

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 Francisella tularensis
◦ Patient with ulceroglandular disease, atypical
pneumonia, or gastrointestinal disease
◦ Arcansas/Missouri
◦ Exposure to rabbits/ticks

 Treatment :
◦ streptomycin

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 Bordetella pertussis
◦ Unvaccinated child (immigrant family or religious
objections)
◦ Cough with inspiratory “whoop” (3 stages):
 (1-2 wks) catarrhal : CONTAGIOUS
 (2-4 wks) paroxysmal : organism begin disappearing
 (>3 wks) convalescence : secondary complications
◦ Immunity:
 DTaP lasts 5 – 10 years (IgA)
 Immunity to actual pertussis is life long
 Treatment :
◦ Supportive care & Erythromycin (14 days)

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 Brucella species
◦ Patient with acute septicemia
◦ Exposure to animals or unpasteurized dairy
◦ California/Texas or travel to Mexico
 Treatment :
◦ Adults : rifampin & doxycycline (6 wks)
◦ Children : rifampin & cotrimoxazole

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 Campylobacter jejuni
◦ Patient with inflammatory diarrhea
◦ Microaerophillic, oxidase +, grows at 42˚C
◦ Ten or more stools/day, maybe frankly bloody
◦ Complications  GBS & reactive arthritis
 Treatment :
◦ Mostly fluid and electrolyte replacement.
◦ Erythromycin, fluoroquinolones, penicillin
resistant.

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 Helicobacter pylori
◦ Patient with gastritis, ulcers, stomach cancer
◦ Microaerophillic, oxidase +, urease +
◦ Reservoir  HUMANS

 Treatment :
◦ Omeprazole + amoxicillin + clarothromycin
◦ Treat for 10 – 14 days

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 Escherichia coli
◦ Isolation of E. coli from stool is not significant.

◦ Sorbitol MacConkey screen

◦ Most E. coli ferment sorbitol (Most EHEC do not – colorless)
◦ Toxins ↑ cAMP

 EPEC = P (pediatric)
 ETEC = T (traveller)
 EIEC = I (inflammatory)
 EHEC = H (hamburger; Hemolytic colitis and Hemolytic
Uremic Syndrome)

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 Shigella species
◦ patient with acute bloody diarrhea + fever

◦ Non-motile, non-H2S producer and non-lactose

fermenters

◦ Shigella sonnei (most common in U.S)

◦ Shigella dysenteriae (most severe disease) – SHIGA

TOXIN (neuro, cyto, entero)

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 Klebsiella pneumonia
◦ Elderly patient with typical pneumonia: currant jelly sputum
◦ UTI (catheterized associated)
◦ Septicemia
◦ IC or nosocomial
◦ Oxidase (-), encapsulated, lactose fermenters
◦ Treatment : 3rd generation cephalosporin

 Klebsiella Granulomatis
◦ Patient from Caribbean or New Guinea with subcutaneous
genital nodules
◦ Encapsulated, inside mononuclear cells
◦ Treatment :TMP-SMX; tetracyclines and erythromycin
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 Salmonella typhi
◦ Patient with fever, abdominal pain, rose spots
◦ Travel to endemic area
◦ Encapsulated, nonlactose fermenter, produces H2S and is
motile.
◦ Widal test +

 Treatment:
◦ Fluoroquinolones or 3rd gen cephalosporins

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 S. enteritidis, S. typhimurium
◦ Enterocolitis – inflammatory, follows ingestion of poultry
products or handling pet reptiles.
◦ Septicemia – very young or elderly
◦ Osteomyelitis – sickle cell disease

 Treatment:
◦ For gastroenteritis : self-limiting
◦ For invasive disease : Ampicillin, TMP-SMX, Fluoroquinolones or
3rd gen cephalosporins.

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 Yersinia pestis – THE PLAGUE!
◦ High fever, buboes (swelling of regional lymph nodes), conjunctivitis and
pneumonia
◦ Exposure to small rodents, desert Southwest
◦ Bipolar staining (“safety pin”)
◦ Treatment : aminoglycosides

 Yersinia enterolitica
◦ Patient with inflammatory diarrhea or pseudoappendicitis
◦ Cold climates; Unpasteurized milk, pork
◦ Non-lactose fermenters, non-H2S producers
◦ Treatment: For IC fluoroquinoloness or 3rd generation cephalosporins.

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  Proteus mirabilis/Proteus vulgaris
◦ Patient with UTI or septicemia

◦ Swarming motility on blood agar plate

◦ Staghorn renal calculi (struvite stones)

◦ Non-lactose fermenting, urease (+)

◦ Treatment : fluoroquinolones,TMP-SMX, or 3rd generation

cephalosporins for uncomplicated cases.

NOTE:
Weil Felix test: Antigens of OX strains of Proteus vulgaris cross-
react with rickettsial organisms. 33
 Gardnerella vaginalis:
◦ Female patient with increased thin gray vaginal
discharge and a “fishy” amine odor.
◦ Post antibiotic or menses
◦ Clue cells
◦ Whiff test +
◦ Treatment :
 Metronidazole or clindamycin

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◦ Patient with non-inflammatory diarrhea
; Dehydration
◦ Travel to endemic area
◦ Curved rods, polar flagella, oxidase (+)
◦ Treatment :
 fluid and electrolyte replacement
 Doxycycline or ciprofloxacin shorten disease and reduce carriage.

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◦ Patient with animal (cat) bite
◦ Cellulitis / lymphadenitis
: amoxicilin/clavulanate for cat bites

Eikenella “corrodes” agar, bleach like odor

corrodens From human bites of fist fight injuries  causes cellulitis

Capnocytphaga filamentous rods

canimorsus From dog bite wounds  causes cellulitis. Splenectomy
causes ovewhelming sepsis.

Bartonella cats and dogs/bites, scratches, fleas

henselae Cat scratch fever  causes bacillary angiomatosis (AIDS)
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◦ 3 mo – 2 y unvaccinated child – meningitis, pneumonia,
epiglottitis
◦ Smokers with COPD – bronchitis, pneumonia
◦ Requires factors X and V; + satellite test (grows near S. aureus)
◦ Treatment :
 Cefotaxime or ceftriaxone

◦ Soft and painful genital ulcers (chancroid)

◦ “you will cry with ducreyi”
◦ Slow to heal without treatment
◦ Treatment :
 Azithromycin, ceftriaxone, or ciprofloxacin
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 Bacteroides fragilis
◦ Patient with abdominal trauma, emergency
abdominal surgery
◦ Septicemia, peritonitis, abscess
◦ Anaerobic
◦ Treatment :
 Metronidazole, clindamycin, or cefoxitin
 Abscesses surgically drained.

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 Treponema pallidum
◦ Sexually active patient or neonate of IV drug-using female
◦ Primary-nontender, indurated genital chancre
◦ Secondary-maculopapular rash, copper colored rash, condyloma
lata
◦ Tertiary-gummas in CNS and cardiovascular system
◦ Spirillar, visualized by dark field or fluorescent antibody
◦ Specific and non-specific serologic tests.
◦ Treatment :
 Benzathine penicillin (long acting for primary and secondary form)
 Penicillin G for congenital and late syphilis
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 Borrelia burgdorferi
◦ Pateint with influenza like symptoms and erythema migrans
◦ Spring/summer seasons
◦ Northeast (Connecticut), Midwest (Wisconsin), West Coast
(California)
◦ Later-neurologic, cardiac, arthritis/arthralgias
◦ LYME disease (#1 tick borne disease in the U.S)
◦ Treatment :
 Doxycycline, amoxycillin, or azithromycin/clarithromycin
 Ceftriaxone for secondary
 Doxycycline or ceftriaxone for arthritis
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 Leptospira interrogans
◦ Patients with influenza-like symptoms ± GI symptoms
(Weil disease)
◦ Occupational (sewer worker) or recreational (jet skiers)
exposure to water aerosols
◦ Hawaii
◦ Spirochetes with terminal hooks
◦ Treatment :
 Penicillin G or Doxycycline

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 Rickettsia rickettsii
◦ Patient with influenza-like symptoms and petechial rash that
begins on ankles and wrists and moves to trunk
◦ Rocky mountain spotted fever (RMSF)
◦ East coast mountainous areas (North Carolina)
◦ Spring/Summer seasons
◦ Outdoor exposure
◦ Weil-Felix (+)

 Treatment :
◦ doxycycline

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 Coxiella burnetii
◦ Patient with fever, pneumonia, granulomatous
hepatitis
◦ Q-fever and chronic Q-fever
◦ Exposure to domestic animal breeding operation
◦ Diagnosed serologically

 Treatment :
◦ Doxycycline & erythromycin
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 Ehrlichia chaffeensis/Ehrlichia phagocytophila
◦ Patient with influenza-like symptoms, no rash, leukopenia,
thrombocytopenia
◦ Norteast (Connecticut), Midwest (Wisconsin) and West Coast
(California)  same as LYME disease (Borrelia)
◦ Spring/summer seasons
◦ Exposure to outdoor
◦ Morulae inside monocytes or granulocytes.

 Treatment :
◦ Doxycycline (begin before laboratory confirmation)

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 Chlamydia trachomatis
◦ Sexually active patient or neonate
◦ Adult : urethritis, cervicitis, PID, inclusion conjunctivitis
◦ Neonate : inclusion conjunctivitis/pneumonia
◦ Immigrant from Africa/Asia, swollen genital lymphadenopathy
◦ Cytoplasmic inclusion bodies in scrappings
◦ Active reticulate bodies & inactive elementary bodies

 Treatment :
◦ Doxycycline & azithromycin

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 C. pneumonia
◦ Atypical “walking” pneumonia

◦ Sputum with intracytoplasmic inclusions

◦ Prominent dry cough and hoarseness

◦ Treatment : Macrolides and tetracycline

 C. psittaci (psittacosis / ornithosis)

◦ Atypical pneumonia with hepatitis

◦ Cough may be absent and when present non-productive at first then

scant mucopurulent

◦ Treatment : Doxycycline

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 Mycoplasma pneumoniae
◦ Young adult with atypical pneumonia
◦ Mulberry-shaped colonies on media containing sterols
◦ Positive cold agglutinin test
◦ Treatment : erythromycin, azithromycin, & clarithromycin (NO
CEPHALOSPORINS or PENICILLINS)

 Ureaplasma urealyticum
◦ Adult with urethritis, prostatitis, renal calculi
◦ Alkaline urine; urease (+)
◦ Treatment : erythromycin or tetracycline

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