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Genus Staphylococ cus

Speci es S. aureu s

Properties Gram +ve cocci Grapelike (cluster s) Goldenyellow appear ance in culture

Virulence factors Has B-lactamase = therefore ressistant to some penicillin (meticilin) Protein A = prevent compliment binding with Ab Capsule = poorly immunogenic. Therefore hard to produce vaccine. Peptidoglycan has endotoxinlike properties = stimulate microphage to produce cytokines. Exotoxin 1. Enterotoxin = causing food poisoning 2. Toxic shock syndrome toxin = causes toxic shock

Disease Due to toxin 1. Abcess 2. Food poisoning 3. Toxic shock syndrome Skin 1. Scalded skin 2. Impetigo (bullous) 3. Surgical site sepsis 4. Osteomyelitis 5. Pneumonia 6. Endocarditis 7. Carbuncle

Treatment vancomycin, to which gentamicin is sometimes added daptomycin Trimethopri msulfamethox azole or clindamycin For TSS = using fluids, pressor drugs, and inotropic drugs

Diagnosis Using smear from lession. Will reveal clusters of cocci. Golden yellow in colour. Mannitol -salt agar is a commonl y used screenin g device for Sta. aureu as it is coagulas epositive.

3. Exofoliative toxin = causes scalded skin Enzymes 1. Catalase = degrade H2O2. Therefore neutrophil to kill. 2. Coagulase = cause blood to clot by converting prothrombin to thrombin 3. Haemlysin = lyse RBC 4. Leucocidin = kill leucocytes 1

Genus Streptococ cus

Species S. pyogen es -

Properties Gram +ve cocci Appear in pairs or chains Catalase negative Have differed haemolytic properties 1. Alpha haemolyric = form green zone around colonies due to incomplete haemolysis 2. Beta haemolytic = form clear zone around colonies due to complete haemolysis of RBC. 3. Gamma haemolysis = no haemolysis . -

Virulence Factors Capsule = antiphagocytotic M protein = antiphagocytotic and has many serotypes that cause different diseases. Also for attachment Enzymes 1. Hyaluronidase = degrades hyaluronic acid and causing strep to spread. 2. Streptokinase = causing plasminogen to form plasmin (dissolve clot) 3. DNAse = degrade DNA in exudates of necrotic tissues. 4. Haemolysin Streptolysin O = inactivated by oxidation and antigenic. Streptolysin S = not inactivated by oxygen. 5. Erythrogenic toxin = causing rash of scarlet fever. Mechanism same as Toxin Shock Syndrome. 6. Exotoxin A = causes strep toxic shock syndrome 7. Exotoxin B = potease -

Disease Pyogenic infection (inflammation induced locally) 1. Pharyngitis 2. Tonsillitis 3. Sore throat 4. Cellulitis 5. Nacrotising fascilitis Exotoxin production 1. Scarlrt fever 2. Toxic shock syndrome Immunologic (antibody against a component of the organism cross-reacts with normal tissue) 1. Rheumatic fever 2. Acute glumerulonep hritis

Treatments penicillin G or amoxicilli n oral penicillin V penicillinallergic patients, erythrom ycin

Diagnosis Rapid test uses swab from throat. Enzyme reacts with antibody and bind to latex particles. Agglutinati on of latex will occur. Stained smear from wound. In culture, if inhibited by bacitracin, they are group A streptococ cus.

that rapidly destroy tissues. Causing necrotizing fasciitis (flesh eating).

Genus Streptococc us

Species S. pneumoni ae

Properties Gram +ve cocci Diplococcic Alpha haemolytic lysed by bile or deoxychola te growth inhibited by optochin

Virulence factors - polysaccharide capsule = antiphagocytotic - lipotechoic acid = causes toxic shock syndrome-like disease - Pneumolysin, the hemolysin that causes alpha hemolysis ~ not so important to know

Disease - Bronchopneumo nia - Lobar pneumonia - Bacteraemia (presence of bacteria in blood) - Meningitis

Treatments penicillins and erythromycin in severe, penicilin G. fluoroquinolone with good antipneumococc al activity, such as levofloxacin

Diagnosis In sputum. Lancetshaped diplococcic. Growth inhibited by optochin. CSF is positive for meningitis.

Genus Baccilus

Species B. cereus

Properties - Gram +ve bacilli - Aerobic growth - Spore forming species


B. anthracis

Gram +ve bacilli Aerobic growth Spore forming In chains Have antiphago cytotic capsule

Virulence Factors - 2 exotoxins Similar to cholera toxin, it increases cyclic AMP Similar to staphylococcal enterotoxin, it is a superantigen - Exotoxin has 3 components protective antigen binds to cells edema factor is an adenylate cyclase lethal factor is a protease that inhibits cell growth

Disease Causes food poisoning

Treatment Symptomatic tratment

Diagnosis Not usually done


Ciprofloxacin Doxycycline (alternative)

Smears show large, grampositive rods in chains Spores not seen as it formed when nutrients insufficient

Clostridiu m

C. tetani -

Gram +ve bacilli Anaerobic growth Spore forming Tennis racket shape or drumstick Gram +ve bacilli Anaerobic growth Spore forming

Virulence Factor
Tetanus toxin (tetanospas min) blocks release of inhibitory transmitters -

Tetanus -

Tetanus immune globulin (tetanus antitoxin) metronidazole or penicillin G can be given -

rarely isolated has terminal spore

Clostridiu m

C. botulinum

Clostridiu m

C. perfringen s

Gram +ve bacilli Anaerobic growth Spore forming

Botulinum toxin blocks the release of acetylcholine Has 8 serotypes Type A for botox alpha toxin (lecithinase), which damages cell membranes, including


Trivalent antitoxin (types A, B, and E)

Usually not cultured

Gas gangrene Food poisoning

Penicillin G

those of erythrocytes, resulting in hemolysis. Degradative enzymes produce gas in tissues.

1.organisms are cultured anaerobically and

2.then identified by sugar fermentatio n reactions and organic acid production colonies exhibit a double zone of hemolysis presence of exotoxins in the filtrate of a patient's stool

Clostridiu m

C. difficile

Gram +ve bacilli Anaerobic growth Spore forming

Cytotoxin damages colon mucosa

Pseudomembranous colitis

Oral metronidazole or vancomycin should be given and fluids replaced

Genus Corynebacteriu m

Species C. diphtria e

Properties Gram +ve bacilli Aerobic growth Non-spore forming Arranged in palisade/ Chinese letter Has granules that stain metachromat ically (a dye that stains the rest of the cell blue will stain the granules red)

Virulence factor - ADPribosylati on of elongatio n factor 2 (EF-2) inhibits protein synthesis of eukaryot es. - It must be infected with bacteriop hage to be pathogen ic. If not, toxin cant be produced

Disease - Diphtheria (thick, gray, adherent pseudo membrane over tonsils and throat.

Treatment Antitoxin (preferred, will bind to toxin) Penicillin G and erythromycin Treatment should be given without delay

Diagnosis Isolating the organisms and investigate toxin production. It will be cultured on Lffler's medium, a tellurite plate, and a blood agar plate. typical gray-black color of tellurium will be formed. Can also be stained with methyline blue (granules)

Genus Listeri a

Species L. monocytogene s

Properties - Gram +ve bacilli - Aerobic growth - Non-spore forming - Shape almost similar to corynebacte rium but has tumbling movement. - Colonies on blood agar produce narrow Bhemolytic region (like streptococc us)

Virulence factors - Listeriolysin allows it to escape phagosome - Its ability to invade placenta, pass meninges and GIT is due to interaction of internalin and E-cadherin

Disease Meningitis and sepsis Febrile gastroenteriti s

Treatments trimethoprimsulfamethoxazol e (meningitis and sepsis) ampicillin and gentamicin ampicillin and trimethoprimsulfamethoxazol e

Diagnosis - Gram stain and culture. Culture will show narrow Bhemolyti c region and motile organis ms.

Genus Neisseri a

Species N. gonorrhoea e

Properties - Gram ve diplococc i - No capsule - Kidneybean shaped diplococc i with neutroph ils - Some produce Blactamas e - Has three outer membran e protein - Has many serotypes - Has endotoxi n in its outer membran e

Virulence factors



Pilli. Attachment to mucosal surface and antiphagocytot ic. LOS, lipooligosacch arides (in cell wall) IgA protease hydrolyses IgA that prevent attachment to mucosa.

Local = gonorrhea Ascending = pelvic inflammatory disease Disseminated = disseminated gonococcal infection Neonatal = conjunctivitis

Local = Ceftriaxone plus doxycycline Ascending = Ceftriaxone plus doxycycline

Disseminated = ceftriaxone Neonatal = ceftriaxone

Diagnosis - Growth inhibited by toxic trace metals and fatty acids in certain media (blood agar plate) - Oxidase +ve as they have cytochrome c. cause phenylenedi amine turn purple or black

Genus Neisser ia

Species N. meningiti dis -

Properties Gram ve diplococci Polysaccharide capsule that is antiphagocytot ic Has many serotypes

Virulence factors



Diagnosis procedure same as gonococci. Meningococci To differentiate, meningitidis ferment maltose, whereas gonococci do not (both organisms ferment glucose).

Lipopolysaccharid e capsule that is antiphagocytotic and ressist polymorphonuclea r leukocytes (PMNs). Endotoxin LPS which causes fever and shock IgA protease that hydrolyse IgA that prevent attachment to mucosa

Meningitis, meningococce mia

penicillin G

Genus Salmonell a

Species S. typhi S. paratypji A S. paratyph iB S. paratyph iC

Properties Gram ve bacillus Produce H2S Live both within and outside enteric tract Ferment glucose Facultative anaerobes Oxidase negative (no cytochrome) Reduce nitrate to nitrites

Virulence factors



Capsular Vi (antiphagocy totic) O antigen which divide salmonella into group A to I Also has H antigen

Typhoid fever Paratyphoid fever A Paratyphoid fever B Paratyphoid fever C Enterocolitis (inflammation of small intestine and colon)

Typhoid fever = ceftriaxon e or ciprofloxa cin Typhoid carrier = Ampicillin or ciprofloxa cin

Diagnosis - Colourless colonies on MacConkeys agar and EMB(eosin methyline blue)agar that indicates no lactose fermenting - On TSI (triple sugar iron) agar, an alkaline slant and an acid butt, frequently with both gas and H2S (black color in the butt), are produced


Genus Shigell a

Species S. dysentria e S. boydii S. flexneri S. sonnei

Properties Gram ve bacillus Can be distinguished from salmonella by: Non motile Do not produce H2S

Virulence factors



Also has O antigen which divides it into groups Disease exclusive in GIT Invades mucosa of distal ileum and colon

Bacillary dysentery (bloody diarrhea)

Fluoroquinolone (severe cases)

Diagnosis - Colourless colonies on MacConkey s and EMB agar (no lactose fermentatio n) - On TSI agar, they cause an alkaline slant and an acid butt, with no gas and no H2S.


Genus Bordetella

Species B. pertussis -


Virulence factors



Diagnosis -

Pertussis (whooping cough) Meningitis Respiratory tract infection Plague Pneumonia

Haemophil us

H. influenza

Yersinia Legionella

Y. pestis L. pneumoph ila K. pnemonia e E. cloacae S. marcescen s

Klebsiella Enterobact er Serratia

Gram ve bacilli Opportunisti c pathogens Vary similar features K. has large capsule S. produces red colonies

Opportunisti c pathogens

Pneumonia Urinary tract infection

Aminoglycosid e Some are antibiotically ressistant

Produced coloured colonies in MacConk yes and EMB agar due to lactose fermenta tion


Genus Pseudomon as

Species P. aerugino sa

Properties - Gram ve bacilli - Aerobic growth (differs from other enteroba cteria) - Oxidase +ve (has cytochro me c) - Has pyocyani n that colour the pus blue - Has pyoverdi n that (fluoresc ent greenyellow pigment)

Virulence factors



Opportunistic hospitals pathogens Endotoxin causes sepsis (presence of toxins in blood) and septic shock Exotoxin A causes tissues necrosis (death of cells or tissues) Enzymes like elastase and protease are histotoxic and help invasion in bloodstream

Sepsis Pneumonia Urinary tract infection

antipseudomonal penicillin aminoglycoside resistant to many antibiotics

Diagnosis - colourless colonies on MacConke ys and EMB agar (no fermentati on) - metallic sheen of the growth on TSI agar (oxidase +ve) - blue-green on agar


Genus Bacteroide s

Species B. fragilis

Properties - Gram ve bacilli - Anaerobic growth - Non-spore froming

Virulence factors



Part of normal flora Has capsule Hyalurunidase, collagenase and phospolipase causes tissue damage Also has O antigen that divides them into groups The exotoxin is called choleragen causes the loss of water and ions from the cell

Serious anaerobic infection like: sepsis, peritonitis , and abscesses Cholera


V. cholera e

Gram ve bacilli Comma shaped

penicillin resistant Metronidazole (preferred) cefoxitin, clindamycin, and chloramphenico l (alternatives) Water and electrolyte replacement Antibiotics not necessary

Diagnosis - ferment sugar and producing certain acids

On TSI agar, an acid slant and an acid butt without gas or H2S are seen

Colonies from the stool will be colorless as lactose is fermented slowly They differs from other enterobact eria as they are oxidase +ve


Speci es Campylobact C. er foetus C. jejuni


Properties Gram ve bacilli Spiral shaped Has same comma or S shape as vibrio microaerophilic, growing best in 5% oxygen rather than normal atmosphere Gram ve bacilli Spiral shape Same as campylobacter appearance Differs in that it is urease +ve and C. otherwise

Virulence factors



Diagnosis Grown in microaeropjili c condition (5% O2) Characteristic comma shape, motile and resistant to nalidixic acid specimen taken from gastric mucosa. Appearance same as campylobacte r except Helicobacter is urease +ve

pathogenesis is unclear

C. foetus causes bacterae mia C. jejuni causes watery diarrhea

Erythromycin or ciprofloxacin to treat C. jejuni


H. pylori

Attaches to mucus secreting cells of mucosa Production of ammonia from urea by the organism's urease, coupled with an inflammatory response, leads to damage to the mucosa (stomach)

Gastritis Gastric ulcer

amoxicillin and metronidazol e tetracycline can also replaces amoxicilin


Genus Species Mycoplasma M. pneumoniae

Properties - Walless and smallest free-living organism - Poor on gram stain and antibiotic is ineffective

Virulence factors



Pathogen only for human In lungs, rod shape with tapered tips for attachment

Atypical pneumonia

Erithromycin Azithromycin Tetracycline

Diagnosis - Serological testing usually done

Mycoplasma M. hominis

Pelvic inflammator y disease


Genus Mycobacteri a

Species M. tubercolosi s

Properties - Acid-fast bacilli - Not gram +ve nor ve - able to retain the carbolfuchsi n stain despite treatment with ethanol hydrochloric acid mixture - grows slow - obligate aerobe - virulent strain grows in cord-like pattern - resistant to most antimycoba cterial drugs

Virulence factors



survive within phagoso me of macroph ages can dissemin ate via bloodstre am to many organs The parenchy mal exudative lesion and the draining lymph nodes together are called a Ghon complex



Diagnosis - acid-fast staining - biochemical test = produce niacin



Species -

Properties same acidfast property as M. tuberculosis grows very slowly grows with low temp

Virulence factors



Diagnosis acid-fast staining

Mycobacteria M. leprae

replicates intracellularl y

Leprosy (Hansens disease)


Mycobacteria M. bovis

same acidfast property as M.tuberculos is


Mycobacteria Atypical mycobacteria

Same acidfast property Classified in 4 groups


Genus Spirochete s

Species Treponem a pallidum

Properties - Thin wall, flexible, spiral rods - Seen by darkfield illuminat ion, silver impregn ation or fluoresc ence stain

Virulence factors



Transmitted by sexual contact or to fetus Very slow to grow In primary, local and nontender ulcer is formed Secondary, spread to many organs, maculopapular rash and pastules occur Tertiary shows granuloma and CNS involved


Penicillin G

Diagnosis - Serological test - microscopy


Genus Spirochet e

Species Borrelia burgdorfer i Borrelia recurrentis

Properties - large and loosely coiled - stain with Gemsa stain - +ve growth in media thin, tight spirals can only be seen by dark illumina tion +ve growth on media

Virulence factors



Spread by tick bite and louse bite

Lyme disease (burgdorferi) Relapsing fever (recurrentis)


Diagnosis - Clinical observations - microscopy

Spirochet e

Leptospira interrogan s

spread by food contamin ated with infected animal urine


Penicillin G

Serological test