STAPHYLOCOCCUS

Zeinab Abd Elkhalek

Prof. of Medical Microbiology & Immunology
SYSTEMATIC MICROBIOLOGY
 BACTERIA
Bacteria can be classified according to
their shape into:

1 – Spherical (cocci)
2 – Rods (bacilli)
3 – Comma shaped (vibrios)
4 – Spirals (spirochetes)
 COCCI
G+ve G-ve

Groups: Staphylo-cocci Neisseria

Chains: Strepto-cocci
Diplo : Strept. pneumoniae
Cocci
STAPHYLOCOCCI
• G+ve spherical cells.
• Arranged in clusters (groups).
• Produce pigmented colonies on agar
(white-yellow)
• Catalase positive.
• Some are members of the normal flora of
skin and mucus membrane, others are
pathogenic (cause diseases).
 Cocci: staphylococci
The genus staphylococcus includes many
species, those of clinical importance are:
1. Staph aureus → the most pathogenic
for humans
2. Staph epidermidis → normal flora
3. Staph saprophyticus → normal flora
normally not pathogenic but can cause disease
under certain conditions, often associated with
implanted appliances and devices in immuno-
compromised patients.
STAPHYLOCOCCUS AUREUS
 STAPHYLOCOCCUS AUREUS

It is responsible for 80% of human

suppurative infections, both community
acquired or in hospitals, all over the world.
 Morphology

Gram-positive
spherical bacteria
(0.5 to 1.5 μm in
diameter) that occur
in irregular grape-
like clusters
 STAPHYLOCOCCUS AUREUS

Culture and growth characteristics

• Aerobic, facultative anaerobic
Grow at 37oC, on most
bacteriologic media

• On nutrient agar → pigmented

colonies (golden yellow)

• On blood agar → pigmented

colonies surrounded by complete
hemolysis
 STAPHYLOCOCCUS AUREUS

Culture and growth characteristics

• Can grow at high concentrations of
NaCL.

• Can ferment variety of sugars,

mannite is important because it is
fermented by S. aureus only (not by
other species).

Growth on mannitol
salt agar
 STAPHYLOCOCCUS AUREUS

Biochemical Reactions

1. Catalase positive
2. Coagulase positive
 Virulence and pathogenesis
•Staphylocoagulase: It converts plasma fibrinogen to fibrin forming a
fibrin barrier thus, bacteria could protect themselves from phagocytic and
immune defences. It also leads to localization of infection.
•Clumping factor (or bound coagulase) reacts with fibrinogen to cause
organisms to aggregate.
•Invasins: Leucocidin, staphylokinase and hyaluronidase promote
bacterial spread in tissues.
•Protein A: It combines non-specifically with Fc-portion of IgG leading to
inhibition of opsonization.
•Exotoxins & Superantigens:
- Enterotoxins: There are six antigenic types (A, B, C, D, E and G) that
are responsible for staphylococcal food poisoning.
- Toxic shock syndrome toxin (TSST-1)
- Epidermolytic exotoxins (exfoliatin): These toxins damage host tissues
in staphylococcal scalded skin syndrome (SSSS),
Diseases caused by Staph aureus
1 – Infections
2 – Toxigenic diseases
 Staphylococcal infections
S. aureus can cause pyogenic infections of
varying severity.
• Source of infection:
A case or a healthy carrier (harbors the
organism in the nose, throat, on the skin,
under the nail and in the perineal area)
• Mode of infection:
Air borne, or by contact
 DISEASES CAUSED BY S. AUREUS

A) PYOGENIC infections
Frequent, often acute, pyogenic and localized at the portal of entry
Local skin infections are by far the most common
- Folliculitis, furuncles, carbuncles, or abscess.
- Postoperative surgical wound infections (hospital-acquired):
-Traumatic wound infections following skin injury and burns.

Invasive staphylococcal conditions occur in

immunocompromised individuals. Invasion of bloodstream
(bacteraemia) and spread to numerous body sites leading to
pneumonia, osteomyelitis, arthritis, endocarditis, brain abscess,
and rarely meningitis. A resulting septicaemia may be rapidly fatal.
 DISEASES CAUSED BY S. AUREUS
B) TOXIN-MEDIATED DISEASES
I. Staphylococcal food poisoning
•It is the commonest type of food poisoning.
•It is caused by heat-stable S. aureus enterotoxins (six
antigenic types (A, B, C, D, E and G))
•very short incubation period of 1-6 hours.
•manifests as vomiting and diarrhoea.
•Source is usually a carrier such as foodhandlers harbouring
the pathogen on their hands or in the nose.
 DISEASES CAUSED BY S. AUREUS
B) TOXIN-MEDIATED DISEASES
II. Toxic shock syndrome (TSS)
•TSS is due to infection or colonization by TSST-1 producing S. aureus.
TSS is prevalent in young menstruating females who use vaginal
tampons The disease is characterized by sudden onset of fever,
diarrhoea, vomiting, hypotension and a diffuse macular erythematous
rash. Kidney, liver or CNS may be involved. The mortality rate has been
10-15%.

III. Staphylococcal scalded skin syndrome (SSSS)

SSSS occurs in neonates and children under 5 years of age, follows
conjunctivitis or an upper respiratory tract infection. Large bulla are
formed under the epidermis which ruptures leaving moist, red, scalded
dermis.
Scalded Skin Syndrome
 Laboratory Diagnosis
A-Specimens: Swabs from the site of suppuration, pus, sputum, urine,
CSF. Blood for blood culture (bacteraemia, septicaemia, endocarditis).
Vaginal swab or tampon for culture in suspected TSS.
B-Direct Gram-stained smear
Gram-positive cocci arranged in clusters in association with inflammatory
cells.
C-Cultivation
The organism is isolated on blood agar. Contaminated specimens (e.g.,
faeces) can be plated on mannitol salt agar. Blood samples showed be
cultured by Blood cultures technique
D-Identification;
•Colony on blood agar: golden yellow in colour and usually surrounded with
a clear zone of complete haemolysis.
•Colony on mannitol salt agar: yellow due to change in colour of phenol red
indicator as a result of acid production from mannitol.
•Coagulase positive.
Direct Gram-stained smear of satph. infections
 complete haemolysis on Bl. agar

S. aureus culture

golden yellow pig. On nutrient agar

Yellow colour on mannitol salt agar
Identification of S. aureus

Gram-stain of Staphylococcus culture

 Identification of S. aureus

Coagulase Test

Staphylococcus aureus

Staphylococcus aureus

Coagulase negative Staph.

 Treatment & antibiotic sensitivity
• Penicillin-resistant S. aureus: Approximately 95% of S. aureus strains
are resistant to penicillin (penicillinase-labile penicillins).It is plasmid
mediated.. Strains resistant to penicillins remain susceptible to the semi
synthetic (penicillinase-stable) penicillins (e.g., oxacillin and
methicillin), and to cephalosporins.

• Methicillin-resistant S. aureus (MRSA): Infections caused by MRSA

strains cannot be treated with any of the beta-lactam antibiotics.
Expression of new penicillin binding protein (PBP) is due to acquisition of
chromosomal mecA gene. MRSA isolates are often multiply resistant to
commonly used antimicrobial agents, including erythromycin,
clindamycin, and tetracycline. Vancomycin can be used empirically as the
drug of choice

• Vancomycin-resistant S. aureus: Some strains of MRSA displayed

intermediate (VISA) or full resistance (VRSA) to vancomycin. Since
vancomycin is one of the glycopeptides, susceptibility is expressed also
as GISA or GRSA. The new antibiotic linezolid is used-for treatment
Mechanisms of resistance to beta-lactam antibiotics include:
1. Enzymatic destruction of penicillin by β-lactamase (penicillinase).
2. Expression of new penicillin binding protein (PBP) in case of MRSA.
 Prevention
• There is no vaccines.
• Certain measures should be taken in
hospitals to control the spread of
staphylococcal infections including ;
1.Frequent hand washing
2.Aseptic management of lesions.
3.Treatment of nasal carriers or their removal
from high risk areas e.g. operating rooms,
ICU, newborn nurseries.