CHAPTER 5: MEDICALLY MOST IMPORTANT BACTERIA
negative staphylococcus by its resistance to Novobiocin
SECTION 1. GRAM-POSITIVE COCCI
Staphylococcaceae-cluster-forming cocci, nonmotile;
catalase-positive.
STAPHYLOCOCCUS AUREUS
• Gram-positive bacteria that are cocci-shaped and tend to be
arranged in clusters that are described as “grape-like”
• On media, these organisms can grow in up to 10% salt, and
colonies are often golden or yellow
• These organisms can grow aerobically or anaerobically
(facultative) and at temperatures between 18 C and 40 C
• Typical biochemical identification tests include catalase
positive, coagulase positive, novobiocin, mannitol
fermentation positive.
•Found in the environment and is also found in normal
human flora, located on the skin and mucous membranes of
most healthy individuals
•A major bacterial human pathogen that causes a wide
variety of clinical manifestations
• Does not normally cause infection on healthy skin;
however, if it is allowed to enter the bloodstream or internal
tissues, these bacteria may cause a variety of
potentially serious infections
• Transmission is typically from direct contact
• Are the causative agents of multiple human infections,
including bacteremia, infective endocarditis, skin and soft
tissue infections (e.g., impetigo, folliculitis, furuncles,
carbuncles, cellulitis, scalded skin syndrome, and others),
osteomyelitis, septic arthritis, prosthetic device infections,
pulmonary infections (e.g., pneumonia and empyema),
gastroenteritis, meningitis, toxic shock syndrome, and urinary
tract infections.
STAPHYLOCOCCUS EPIDERMIDIS
• A gram-positive bacterium, belongs to the group of
coagulase-negative staphylococci
• Common bacterial colonizers of the skin and mucous
membranes of humans and other mammals
• Analysis of the species genome indicated that the species
is well equipped with genes assumed to provide protection
from the harsh conditions encountered in its natural
habitat.
• As part of the human epithelial microflora, S. epidermidis
usually has a benign relationship with its host
• It has been proposed that S. epidermidis may have a
probiotic function by preventing colonization of more
pathogenic bacteria such as S. aureus
• Now the most frequent cause of nosocomial infections, at a
rate about as high as that due to its more virulent cousin
Staphylococcus aureus
• Accounts for at least 22% of bloodstream infections in
intensive care unit patients in the USA, which occur in at least
4–5/1000 Central intravenous catheters (CVC) insertions
• Second only to S. aureus, S. epidermidis causes ~ 13% of
prosthetic valve endocarditis (PVE) infections, with a high rate
of intracardiac abscesses (38%) and 24% mortality.
STAPHYLOCOCCUS SAPROPHYTICUS
• Gram-positive, coagulase-negative, non-hemolytic coccus
that is a common cause of uncomplicated urinary tract
infections (UTIs)
• Can be differentiated from another coagulase-
• Part of the normal human flora that colonizes the
perineum, rectum, urethra, cervix, and gastrointestinal tract
• Second most common cause of community-acquired
urinary tract infections, after Escherichia coli.
• The diagnosis of S. saprophyticus requires a confirmatory
urine culture. A positive culture is indicated by greater than
100,000 colony-forming units per mL, with a
sensitivity and specificity of more than 90%.
SECTION 1. GRAM-POSITIVE COCCI
Streptococcaceae- chain-forming cocci and
diplococci, nonmotile, catalase-negative
STREPTOCOCCUS PYOGENES
• A gram-positive, catalase-negative, oxidase negative, β-
hemolytic streptococci that occur in pairs or chains
• It is a facultative anaerobe, grows best in 5 to 10% carbon
dioxide, and forms pinpoint colonies on blood agar plates
• S. pyogenes usually colonizes, pharynx, anus, and genital
mucosa
• Infections caused by S. pyogenes are highly contagious.
Transmission can occur through airborne droplets, hand
contact with nasal discharge or with objects or surfaces
contaminated with bacteria, skin contact with contaminated
lesions, or contaminated food sources.
• GAS strains may lead to erysipelas or cellulitis, infection in
muscle and fascia resulting in myositis and necrotizing fascitis
usually following a mild trauma and can result in toxic shock
syndrome
• A leading cause of pharyngitis in children and adolescents
• The global burden of severe S. pyogenes infections is 18.1
million cases, with 1.78 million new cases per year.
STREPTOCOCCUS PNEUMONIAE
• A lancet-shaped, gram-positive, facultative anaerobic
organism that typically occurs in pairs or short chains
• Encapsulated S. pneumonia is pathogenic for humans, and
the capsular polysaccharide is the basis for which the
organism is classified. As of 2011, a total of 92 separate
serotypes have been isolated.
• Infection typically occurs after the colonization of the
oropharynx and nasopharynx of healthy individuals.
Inhalation of these colonies causes the infection of the lower
airways.
• Capsule helps in escaping phagocytosis by preventing the
access of granulocytes to the underlying cell wall; Second, its
ability to adhere to the respiratory epithelium and invasion.
STREPTOCOCCUS AGALACTIAE
• A chain-forming cocci, group antigen B, β-hemolysis
• Also known as Group B Streptococcus
• Skin and soft tissue infections attributed to GBS may
manifest as cellulitis, abscesses, foot infection, or decubitus
ulcers. GBS pneumonia is implicated and may lead to
neurological disease. Meningitis is a severe manifestation of
invasive GBS disease. It is uncommon in adults but a common
manifestation of late onset GBS infection in neonates. UTIs is
also manifested with GBS infection.
SECTION 1: GRAM-POSITIVE COCCI
Enteroccaceae- Chain-forming cocci and diplococci, a, b, or c-
hemolysis, group antigen D, catalase-negative
ENTEROCOCCUS FAECALIS
• A gram-positive, aesculin-positive, growth in 6.5% NaCl, pH
9.6 bacterium that can cause a variety of nosocomial
infections of which urinary tract infections are the most
common
• Enterococcus faecalis, while normally a gut commensal, is a
frequent cause of many serious human infections, including
urinary tract infections, endocarditis,
bacteremia, meningitis and wound infections
ENTEROCOCCUS FAECIUM
• A Gram-positive, gamma-hemolytic or non-hemolytic
bacterium
• Commensal in gastrointestinal tract of human and other
animals
• Can be pathogenic causing disease like neonatal meningitis
and endocarditis
• This bacterium has developed multi-drug antibiotic
resistance and uses colonization and secreted factors in
virulence (e.g. Vancomycin-resistant E. faecium)
SECTION 2: ENDOSPORE-FORMING GRAM-
POSITIVE RODS
BACILLUS ANTHRACIS
-A large Gram positive, aerobic, spore bearing bacillus, 1–1.5
× 3–10 μm in size, is the only obligate pathogen within the
genus bacillus.
-Non-motile and non-haemolytic on horse (or sheep’s) blood
agar, grows at 37°C, and forms typical white colonies with
bee’s eye appearance (that is, oval, slightly granular but not
dry, about 2 mm in diameter), which are characteristically
tacky on teasing with a loop.
BACILLUS ANTHRACIS
-90% of all human cases is cutaneous anthrax
-Anthrax meningitis can occur as an end stage process of any
of the forms of anthrax. The clinical
signs of meningitis, together with the appearance of blood in
cerebrospinal fluid, are usually followed by loss of
consciousness and death
-The prognosis of this form of anthrax is extremely poor
CLOSTRIDIUM TETANI
-Part of a genus of obligate anaerobic, saprophytic, gram-
positive organisms well known for its toxin-producing ability
making it one of the most dangerous of its genus
-The source of infection in most people is a wound. In others,
tetanus may develop from a burn injury, abscess following a
surgical procedure, intravenous drug abuse, or gangrene
-All ages are susceptible to infection, and the case-fatality
rate can approach 100% if immediate medical intervention is
not available.
-Tetanus is characterized by severe, diffuse muscle
contractions. The muscular rigidity and spasms of tetanus are
caused by tetanus toxins (tetanospasmin and tetanolysin)
-The transmission of C. tetani is through the exposure of a
deep tissue wound to the spores which are present in soil or
fecal matter from animals or humans.
CLOSTRIDIUM BOTULINUM
-An anaerobic gram-positive spore-forming rod with
subterminal spore
-It is ubiquitous, widely distributed as a saprophyte in soil,
animal manure, vegetables, and sea mud
-Produces botulinum toxin and causes botulism, a rare
disease manifested as various clinical syndromes ranging
from food poisoning, wound infection to infant botulism
-C. botulinum is non-invasive
CLOSTRIDIUM PERFRINGENS
-Anaerobic Gram-positive spore-forming bacillus
-With Type A toxin which is associated to food-poisoning and
non- foodborne diarrheal disease.
-May lead to acute gastrointestinal infection ranging in
severity from diarrhea to necrotizing enterocolitis and
myonecrosis in human
-This pathogen posses an arsenal of toxins that are
responsible for disease pathogenesis and can form spores
that are resistant to environmental stress.
CLOSTRIDIUM DIFFICILE
-Anaerobic Gram-positive spore-forming bacillus
-Occurs in the fecal flora of 1-4% of healthy adults and in 30-
50% of children during the first year of life
-Causes pseudomembranous colitis, symptoms can range
from diarrhea to life-threatening damage to the colon
-The pathological mechanism is based on formation of two
toxins: Toxin A is an enterotoxin that causes a dysfunction
characterized by increased secretion of electrolytes and
fluids, Toxin B is a cytotoxin that damages the mucosa of the
colon.
SECTION 3: REGULAR, NONSPORING, GRAM-
POSITIVE RODS
LISTERIA MONOCYTOGENES
-Facultative, intracellular, Gram-positive rod, catalase positive
and beta- hemolytic when grow on blood agar
-Infections includes but not limited to sepsis, meningitis,
encephalitis, spontaneous abortion, or fever and self-limiting
gastroenteritis in a healthy adult
-Common cause of meningitis in the young, elderly and
immunocompromised patient.
ERYSIPELOTHRIX RHUSIOPATHIAE
Slender, Gram-positive, catalase-negative, rod-shaped, non-
spore-forming, non-motile bacterium
-Commensal or a pathogen in a wide variety of vertebrate
and invertebrate species including swine, sheep, turkeys,
ducks and fish but also dogs, cats, chickens and rodents. It
has been isolated from flies, mites, lice and ticks
-Most human cases are related to occupational exposure
(Occupational disease)
-The organism is communicable from animals to humans --
generally by direct cutaneous contact/dermal injuries
The occurrence of systemic infection that does not have an
occupational link suggests that oropharyngeal or
gastrointestinal colonization may occur.
GARDNERELLA VAGINALIS
-Gram-positive, anaerobic, nonmotile, non-sporing,
nonencapsulated rod bacterium
-Normally, vaginal flora is predominated by the Lactobacilli
species, but when organisms such as Gardnerella begin to
overgrow and become the dominant species, this leads to
bacterial vaginosis (BV)
-The bacteria are thought to be sexually transmitted between
partners
-BV is associated with preterm birth and increased risk for
acquisition of HIV and other sexually transmitted infections.
SECTION 4: IRREGULAR, NON-SPORING, GRAM-
POSITIVE RODS
CORYNEBACTERIUM DIPHTHERIAE
-A nonmotile, non-capsulated, club-shaped, Gram-positive
bacillus
-This bacteria is classified into biotypes according to colony
morphology (mitis, intermedius and gravis)
-Mitis – black colonies with a gray periphery
-Gravis – large, gray colonies
-Intermedius – small, dull gray to black
-This bacteria infects the nasopharynx or skin
ACTINOMYCES ISRAELI
-A gram-positive, branching, anaerobic or microaerophilic
bacterium
-Often present commensally on the gums, tonsils and teeth
and may be present in the intestines and vagina
-Disease is called actinomycosis which is a chronic localized or
hematogenous anaerobic infection that may lead to local
abscess with multiple draining sinuses, tuberculosis-like
pneumonitis and low-grade systemic symptoms.
NOCARDIA ASTEROIDES
-An aerobic actinomycete, catalase-positive, Gram-positive
bacillus, with a branching filamentous form
-Found worldwide in a myriad of environments and has been
cultured from both fresh and saltwater, dust, soil, decaying
vegetation and decaying organic matter
-Involved in the saprophytic digestion and recycling of plant
material in natural environment
-The majority of Nocardia infections are thought to be due to
inhalation of bacteria via environmental sources, leading to
the most common form of the infection, pulmonary
nocardiosis.
SECTION 5: ACID-FAST BACTERIA
MYCOBACTERIUM TUBERCULOSIS
-Pathogenic acid-fast bacteria which is the causative agent of
tuberculosis (TB)
-First discovered by Robert Koch in 1882 and considered to be
one of the oldest known human disease
-One of the major causes of mortality, since two million
people die each year from this malady
-TB has many manifestations, affecting bone, the central
nervous system and many other organ systems
-Initiated by the deposition of Mycobacterium tuberculosis,
contained in aerosol droplets, onto lung alveolar surfaces.
MYCOBACTERIUM LEPRAE
-Pathogenic acid-fast bacteria which is the causative agent of
Hansen’s disease (a.k.a. leprosy).
-Leprosy is a chronic infectious disease that damages
peripheral nerves and can affect the skin, eyes, nose and
muscles. Nerve injury can cause severe disabling
deformities and blindness
-Although it is often thought of as a disease of ancient times,
it still occurs today and the WHO recorded 3.8 M new cases
of leprosy from 105 different countries in the
last decade.
-People with leprosy often suffer profound social stigma
-Symptoms mainly affect the skin, nerves and mucous
membranes-presence of large, discolored lesion
-Can be recognized by appearance of patches of skin, for
confirmation, the doctor will take a sample of the skin or
nerve to look for the bacteria under microscope.
MYCOBACTERIUM AVIUM
-A non-motile, non-spore-forming, gram-positive acid-fast
bacillus
-Ubiquitous and has been reported from the Americas, Asia
and Europe
-Mycobacterium avium Complex is acquired by inhalation and
can also be ingested into the gastrointestinal tract, where it
adheres to the mucosal epithelial cells and
infects the macrophages
-Several clinical patterns include pulmonary disease, skin and
soft tissue infections, musculoskeletal infections,
disseminated disease, catheter-associated disease and
lymphadenitis.
SECTION 6: GRAM-NEGATIVE AEROBIC COCCI AND
COCCOBACILLI
NEISSERIA GONORRHEAE
 Gram-negative, coffee-bean-shaped cocci
 This bacteria may cause gonorrhea which is a
sexually transmitted disease
 The pathogens penetrate the urogenital mucosa,
causing a local purulent infection. In men, the
prostate and epididymis can also become infected
 Hematogenous disseminated gonococci may also
cause arthritis or even endocarditis.
NEISSERIA MENINGITIS
-Gram-negative, encapsulated, aerobic, non-motile, coffee-
bean-shaped cocci
-Meningococci are parasites of the nasopharynx
-Causes significant morbidity and mortality in children and
young adults worldwide, regarded as a leading cause of
bacterial meningitis
-Onset of the meningitis is usually sudden, after an incubation
period of two to three days, with severe headache, fever,
neck stiffness and severe malaise. Severe hemorrhagic sepsis
sometimes develops.
EIKENELLA CORRODENS
-Gram-negative, microaerophilic bacillus that sometimes
appear as coccobacillary which is a normal inhabitant of
human mucosal surfaces
-This bacteria may cause severe invasive disease in human
but an uncommon cause of infection
-It is found most often part of a mixed infections, particularly
with streptococci, but is capable of independently causing
serious infection in both normal and immunocompromised
hosts.
- Cause head and neck infection, sinusitis, pulmonary
infection, arthritis, endocarditis, intraabdominal infection,
pancreatic abscesses, skull infection, vertebral osteomyelitis
and infection after human bite wounds.
SECTION 7: GRAM-NEGATIVE FACULTATIVE
ANAEROBIC RODS
ESCHERICHIA COLI
-Gram-negative, facultative anaerobic, rod-shaped, coliform
bacterium
-Commonly found in the lower intestine of warm-blooded
organisms
-Most E. coli strains are harmless, but some serotypes
(Enteropathogenic E. coli, Enterotoxigenic E. coli, etc.) can
cause serious food poisoning in their hosts, even pneumonia
and UTIs
-The harmless strains are part of the normal microbiota of the
gut, and can benefit their hosts by producing vitamin K2 and
preventing colonization of the intestine with pathogenic
bacteria, having a mutualistic relationship.
-Fecal-oral transmission is the major route through which
pathogenic strains of the bacterium cause disease
-Symptoms are abdominal cramps, diarrhea, nausea and
constant fatigue
SALMONELLA ENTERICA
-Gram-negative, facultative anerobic rod-shaped bacteria and
motile by peritrichous flagella
-The main niche of Salmonella serovars is the intestinal tract
of humans and farm animals, soil, bedding, litter and fecal
matter commonly identified as sources of
Salmonella contamination in farms
-Excreted in feces from which they may be transmitted by
insects and other animals to many places and are generally
found in polluted water.
SHIGELLA DYSENTERIAE
-Gram-negative, non-motile, facultative anaerobic, non-
spore-forming rods
-Infection is initiated by ingestion of shigellae usually via
fecal-oral contamination
-Symptoms of shigellosis include abdominal pain, tenesmus,
watery diarrhea and/or dysentery (multiple scanty, bloody,
mucoid stools). Other signs may include abdominal
tenderness, fever, vomiting, dehydration and convulsions.
-Shigellosis is endemic in developing countries where
sanitation is poor
-Shigellosis can be correctly diagnosed in most patients based
on fresh blood in the stool. Neutrophils in fecal smears is also
a strongly suggestive sign. Any clinical
diagnosis should be confirmed by cultivation of the etiologic
agent from stools.
SECTION 8: GRAM-NEGATIVE AEROBIC RODS
PSEUDOMONAS AERUGINOSA
-Gram-negative, aerobic, rod-shaped bacteria and motility is
by a single polar flagellum
-Normally this inhabit soil, water and vegetation
-Neutropenia in cancer patients and others receiving
immunosuppressive drugs contributes to infection
-Infection due to this bacteria is a serious problem in patients
hospitalized with cancer, cystic fibrosis and burns; fatality is
50%.
- Other infections caused include endocarditis, pneumonia,
and infections of the urinary tract, central nervous system,
wounds, eyes, ears, skin and musculoskeletal system
-Pseudomonas can be cultured in most-purpose media and
identified with biochemical media.
LEGIONELLA PNEUMOPHILA
-Gram-negative, aerobic, pleomorphic, flagellated, non-spore-
forming bacteria
-This is widely spread in nature, may reside in surface and
drinking water and are usually transmitted to humans in
aerosols
-This is not a member of the bacterial flora of humans
-Common presentation of this bacteria is acute pneumonia
(legionellosis).
-Extrapulmonary disease like pericarditis and endocarditis is
rare. Less often, disease presents as a non-pneumonic
epidemic, influenza-like illness called Pontiac fever.
BRUCELLA ABORTUS
-Gram-negative coccobacilli (short rods), non-spring, non-
motile and lack capsules or flagella
-The reservoirs of brucellosis are various wild, feral and
domestic animals
-May cause acute febrile disease or a persistent disease with
wide variety of symptoms
-The onset is influenza-like with high fever, limb and back
pains are usually severe, however sweating and fatigue are
marked. Splenomegaly may be the only finding on physical
examination.
SECTION 9: GRAM-NEGATIVE, AEROBIC/MICROAEROPHILIC,
HELICAL/VIBRIOID ROD BACTERIA
CAMPYLOBACTER JEJUNI
-Gram-negative, spirally curved, microaerophilic bacterium
-Campylobacter causes an estimated 1.5 million illnesses each
year in the US People can get the infection by eating raw or
undercooked poultry or eating something that touched it
-Recognized as a significant cause of human enteritis and is
associated with diarrheic illness in several animal species
including dogs, cats, cows, goats, pigs, etc.
CAMPYLOBACTER FETUS
-A Gram-negative S-shaped rod bacterium which is highly
motile due to corkscrew-like movement
-C. fetus subspecies fetus may cause reproductive disease in
ruminants; associated with abortion in sheep and cattle and
infertility of cattle. This same subspecies is a zoonotic
pathogen that has been reported to cause disease in
immunocompromised humans
-Infections are associated with gastroenteritis and, rarely,
sepsis in people
-Clinically relevant transmission between humans generally
involve neonates.
CAMPYLOBACTER PYLORI
-A Gram-negative, microaerophilic bacteria that is widely
distributed in the animal kingdom
-This can cause diarrheal illnesses, systemic infection, chronic
superficial gastritis, peptic ulcer disease, and can lead to
gastric carcinoma
-Symptoms experienced by individuals in developed countries
are diarrhea, abdominal pain, fever, nausea and vomiting. A
cholera-like illness with massive watery diarrhea may also
occur.
-Campylobacter enteritis is hard to distinguish from enteritis
caused by other pathogens. The presence of neutrophils or
blood in the feces of patients with acute diarrheal illnesses is
an important clue to infection. The diagnosis is confirmed by
isolating the organism from a fecal culture or, rarely, from a
blood culture.
SECTION 10: GRAM-NEGATIVE, SPIROCHETES,
HELICAL BACTERIA
TREPONEMA PALLIDUM
-A Gram-negative, microaerophilic, fastidious, corkscrew-
shaped bacterium
-Human are the only source of treponemal infection; there
are no known non-human reservoirs
-Treponemes cause diverse clinical manifestation. In patients
with acquired venereal syphilis, there is an initial genital tract
lesion (primary stage) followed by disseminated lesions
(secondary stage) and, in approximately one-third of
untreated individuals, cardiovascular and neurologic
problems (tertiary stage). Infection during pregnancy
(congenital syphilis) may result in fetal death or birth defects
-Treponema pallidum subsp pallidum causes venereal
syphilis; T pallidum subsppertenuecauses yaws; T pallidum
subsp endemicum causes endemic syphilis; andT carateum
causes pinta. Venereal syphilis is transmitted by sexual
contact; the other diseases are transmitted by close
nonvenereal contact.
-Treponemes are highly invasive pathogens which often
disseminate relatively soon after inoculation.
BORRELIA BURGDORFERI
-A Gram-negative, spirochete, microaerophilic, beta-
galactosidase bacterium
-Can be transmitted by tick
-May cause Lyme disease, a most common vector-borne
disease in the United States
-Symptoms of Erythema migrans (EM), may have vesicular or
necrotic areas in the center. It is often asymptomatic but may
be pruritic or painful, and it may be accompanied by systemic
symptoms, such as fever, malaise, headache, stiff
neck, myalgia, or arthralgia
LEPTOSPIRA INTERROGANS
-A Gram-negative, spirochete, spiral-shaped bacterium with
internal flagella
-May cause Leptospirosis, which is a worldwide zoonosis
affecting many wild and domestic animals
-Humans acquire the infection by contact with the urine of
infected animals. Human-to- human transmission is
extremely rare
-Humans are accidental hosts in whom this disseminated
disease varies in severity from subclinical to fatal.
-A multisystem, relapsing febrile disease with a rash and
manifestations such as arthritis, carditis, and neuritis
-The clinical diagnosis is confirmed by serology and also by
microscopic visualization of the organism in blood of
relapsing fever patients
-Areas known to harbor infected ticks and lice should be
avoided. Tetracycline is an effective treatment. No vaccines
are available