Uncommon Bacterial Pathogens

Chapter 13
Cell wall-deficient bacteria

Mycoplasma species

 Mycoplasma is the smallest free living

microorganism with size smaller than
some viruses. These microorganisms are
fastidious, facultative anaerobes and
aerobes.

 They lack cell wall and the genetic

capability to synthesize peptidoglycan.
They are, instead, enclosed by a simple
cell membrane made of lipids (mainly
sterols) and protein bilayer, making
them neither Gram positive nor Gram
negative microorganisms. However, this
membrane makes those species
pleomorphic (cocci, rods, or
filamentous) in microscopic
appearance.
 Mycoplasma requires sterols for the stability and flexibility of their membrane. Sterols are
acquired from the environment, usually as cholesterol from animal sources.

 Mycoplasma enclose small genomes that encode for 600 proteins in comparing with E.
coli genomes that encode for 4000 protein-genes. This number is not enough for covering
their life requirements, thus some Mycoplasmas invade their victims intracellularly and also
require DNA-enriched media to be cultivated.

 Seven different species of Mycoplasma have been associated with various infections in
human. M. pneumonia is the most clinically important species and causes atypical
pneumonia. Other species cause arthritis, salivary glands and genital infections.
Mycoplasma pneumoniae
 M. pneumonia is a common cause of upper respiratory infections;
atypical pneumonia. This disease is called atypical because having
different symptoms from the usual bacterial pneumonia.

 Mycoplasma pneumoniae also causes cold agglutinin disease (CAD)

characterized by extravascular destruction of red blood cells. In this
disease Mycoplasma triggers the body to make certain types of
antibodies called cold agglutinins of the type IgM. They cause red blood
cells to clump together (agglutinate) at low temperatures.

 Cold agglutinins bind to antigens of certain blood group system resulting

in sensitization and complement fixation on RBCs. This occurs only in
regions of the bodies where the temperature is low. Once the red cells
circulate and return to the worm body core, these antibodies are eluted
but still sensitized by the complement and when cross the spleen they are
captured and destroyed.
 Culture protocols could be used
only in special laboratories and
for research purposes.

 Because more than two-thirds of

patients with symptomatic lower
respiratory M pneumoniae
infection develop high titers of
cold agglutinins, their
demonstration can be useful in
some clinical situations.

 However, cold agglutinins and

have been observed in other viral
infections. Molecular assays are
the most reliable testing, in which
whole blood specimen is tested,
blood leukocytes, or tissue
biopsies for PCR.
Obligate Intracellular and Nonculturable Bacteria
Chlamydia species

 These organisms require the biochemical resources of the eukaryotic host cell
environment to fuel their metabolism for growth and replication because they are
unable to produce high-energy compounds such as ATP.

 C. trachomatis:
The primary host is human and it is the agent of trachoma, which is an inflammation of
the eye ends with scarring and 70% blind. C. trachomatis is also associated with pelvic
inflammatory disease and sexually-transmitted diseases, such as lymphogranuloma
venereum that cause acute lymphadenitis of the linguinal lymph nodes ends with
chronic genital hyperplasia.

 C. pneumoniae: transmitted by aerosolized droplets from person to person. It has

been associated with pneumonia, bronchitis, pharyngitis, and flu-like illness.

 Cytology, cell-culture, direct detection of antigen or nucleic acids, and serologic

testing are the most common laboratory methods for diagnosis. Specimens for
diagnosis of each species are obtained from the infected tissue directly.
Rickettsia species
 Several species of rickettsiae are
transmitted to human via a
arthropods vectors. After being
deposited directly into the
bloodstream.

 Rickettsia is the agent of spotted fever

and typhus. While "typhoid" means
"typhus-like", typhus and typhoid
fever are distinct diseases caused by
different of bacteria.

 Biopsy of skin tissue from the rash is the

preferred specimen to demonstrate
their presence. PCR, immunohistology,
and serodiagnosis are done.

 Avoid contact with infected persons

and keep good sanitation can limit
the infection.