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Staph Aureus
Staph Aureus
As for its “golden” color, when it’s grown on blood agar plates, the colonies
have a distinctive golden-yellow color.
Catalase positive bacteria will foam up, while in catalase negative bacteria,
nothing happens.
So let’s say that we stir up some Staph aureus bacteria in a liquid “emulsion”,
and then add a few drops of plasma which contains fibrinogen. The
coagulase positive staph aureus will convert the soluble fibrinogen to sticky
fibrin, which then visibly clumps up, whereas coagulase negative bacteria
won’t.
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Staph aureus is extremely common and about a quarter of the population is
colonized by it, usually in their nostrils, groin, armpits, and other parts of
their skin.
But, most of the time it’s a normal part of our skin flora, and doesn’t cause
trouble.
If more and more Staph aureus is around on the skin, it begins to penetrate
through tiny microfissures in the skin, like you get with eczema, as well as
larger breaks in the skin like you might get after shaving.
So low levels of staph aureus with intact skin leads to colonization, whereas
high levels of Staph aureus with breaks in the skin lead to infections.
When staph aureus invades into the skin it can lead to localized skin
infections like a pimple which can evolve into a furuncle, or a boil.
There can also be diffuse skin infections, like superficial impetigo which is an
infection of the epidermis, or deeper-reaching cellulitis, which is an infection
of the dermis and can spread over larger surfaces rapidly.
These abscesses can occur all over the body including in the mouth where
they’re called dental abscesses, and they can develop within various organs
like the liver, kidney, spleen, and brain.
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Now if the infection is overlying a muscle, it can spread into the muscle
causing a pyomyositis.
If it gets into the bone it can cause osteomyelitis, and if it gets into the joint
space it can cause septic arthritis.
There’s typically a widespread immune reaction that causes the blood vessels
to expand and the blood pressure to fall. The result is hypotension and poor
perfusion to various organs - a process called sepsis.
Once it’s in the blood, Staph aureus can also get to various parts of the body.
It can get into the central nervous system - causing bacterial meningitis or
an epidural abscess in the spine.
Bits of the vegetations can then chip off and embolize further causing other
local infections around the body.
Now, in addition to invading the body through the skin, Staph aureus can
also enter directly into the bloodstream when a person is getting surgery or
having dental work done. These events occur infrequently, but when they do
come up it’s important to take precautions.
For example, individuals at high risk of getting serious disease with Staph
aureus - like immunocompromised individuals or those that are at risk
for infective endocarditis - should be given antibiotic prophylaxis.
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The biofilm is, essentially, a layer of “slime” within which the Staph
aureus live. It forms when a cluster of Staph aureus adheres to a surface
either a natural one like the surface of a valve or an artificial one like the
surface of a catheter.
The cells that are surrounded by the gel-like layer of exopolysaccharides, can
communicate with one other through biochemical signals and can even swap
genetic information back and forth - including antibiotic resistance genes.
In addition, Staph aureus thrives but doesn’t divide rapidly within these
biofilms, and it’s relatively hard for antibiotics to penetrate into the biofilms.
Combined that makes it much harder to get rid of these biofilm infections,
and often requires simply removing the surface that they’re growing on, if
possible.
In fact, there are five major toxins related to S. aureus - toxic shock syndrome
toxin 1, or TSST-1, Panton-Valentine leukocidin toxin, hemolysin, exfoliatin,
and enterotoxin… toxin.
TSST-1 is produced at the site of infection, and can enter the bloodstream.
When TSST-1 binds to the MHC II receptors on these cells, it really stimulates
them, making them release loads of pro-inflammatory chemicals
called cytokines, creating a cytokine storm.
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Panton-Valentine leukocidin toxin, or PVL, punches holes in leukocytes - our
immune cells, killing them, and giving the toxin its name.
Leukocytes with holes in their cell membrane, die through necrosis and that
triggers inflammation.
Staph aureus uses iron in its own metabolism, so this is one way it gets
access to that coveted heavy metal.
It creates painful patches of red skin, with fluid filled blisters, but it often
resolves within a few weeks.
Finally, there’s enterotoxin. Staph aureus might land on food and start to
generate enterotoxin.
The enterotoxin is quite stable in the environment, and can remain active
even after the bacteria are killed off by cooking. The toxin can even withstand
boiling at 100 degrees Celsius for a few minutes!
If the toxin is eaten, it can cause food poisoning - with symptoms like
vomiting and diarrhea a few hours after ingestion.
The main treatment for infections is antibiotics, but Staph aureus adapts
quickly and has developed resistance to a number of antibiotics.
Penicillins, which are beta lactam antibiotics, were tried early on. They work
by disrupting disabling the enzyme DD-transpeptidase, which is a penicillin
binding protein, or PBP.
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PBP is in charge of crosslinking the long strands of amino polysaccharides
that make the peptidoglycan cell wall, running in parallel.
Protruding from the tips of the NAM subunits are tetrapeptide and
pentapeptide chains.
These peptide chains can link to other peptide chains from the neighboring
strands through a process known as transpeptidation.
If PBPs aren’t allowed to work, no peptidoglycan is made, and the cell wall
becomes leaky. So when the bacteria try to divide and make more cell wall -
they simply can’t and they die.
Nowadays, practically all strains of Staph aureus make beta lactamases which
allow them to simply disable beta lactam antibiotics by breaking their beta
lactam ring.
Next, antibiotics called beta lactamase inhibitors, like clavulanic acid, were
used to bind and disable the beta lactamases.
Methicillin and older penicillins can’t physically fit into them, rendering them
ineffective.
These methicillin resistant staph aureus strains are called MRSA for short -
and have become more common around the world.
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HA-MRSA is found in places like hospitals and nursing homes, where there
are lots of chronically ill patients and a high usage of antibiotics.
Both HA-MRSA and CA-MRSA pose a major problem because infections with
those strains cannot be treated with beta lactam antibiotics.
Summary
All right, quick recap! S. aureus is a gram positive coccus that grows in
clusters.
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It’s a part of the normal skin and nasal flora in about a quarter of the
population, but if it overgrows or if the skin is damaged, then it can cause
disease through direct colonization, toxin production, or both.
Summary
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