● AKA pyrogenic exotoxin C

Staphylococci ● Causes nearly all cases of

menstruating associated Toxic
-”Bunches of grapes”
Shock Syndrome
-Berrys
● Systemic effects: fever,
-Belong to the family Micrococcaceae
desquamation, hypotension (low
-Gram-positive cocci appearance:
blood pressure) potentially leading to
➢ Single in pairs or clusters
shock and death.

General Characteristics
3. Exfoliative Toxin
-Catalase producing bacteria
-AKA epidermolytic toxin
➢ Catalase positive
-Causes the epidermal layer of skin to
-Non-motile
slough off and is known to cause
-Non Spore forming
staphylococcal Scalded Skin Syndrome.
-Glucose fermenters
4. Cytotoxins
General Characteristics of the colony
● Alpha, beta, delta, and gamma
- 4-8mm colonies
produced by a variety of
-Creamy white or light gold color
Staphylococcal species
-"Butter looking
Alpha toxin
➢ disrupts smooth muscle in
Staphylococcus species blood vessels and is toxic to
erythrocytes, leukocytes,
hepatocytes, and platelets
Staphylococcus aureus Beta toxin
➢ Known as
-Most virulent species sphingomyelinase
-Culture: golden yellow colonies ➢ Work in conjunction with
-Halophile alpha toxin
➢ Can survive high salt concentration ➢ Heat-labile sphingomyelinase
w/c catalyzes the hydrolysis
Virulence Factors of membrane phospholipids
1. Enterotoxins resulting in cell lysis
● heat-stable endotoxin that cause
various symptoms, including Delta toxin
Diarrhea and vomiting ➢ Cytolytic to erythrocytes and
● Resistant to hydrolysis by the gastric demonstrates nonspecific
and intestinal enzymes. membrane toxicity to other
● Considered as super antigens mammalian cells
● Stable to heating at 100°C for 30 ➢ Produced by S. aureus, S.
minutes epidermidis, and S.
haemolyticus
2. Toxic Shock Syndrome Toxin (TSS-1)
 Gamma toxin
➢ produced by all strains of S.
aureus function in
association with the Panton
Valentine leukocidin (PVL)
○ PVL: toxic to
leukocytes
5. Enzymes
a. Staphylocoagulase
➔ causes bacterial cells to
agglutinate in plasma
b. Hyaluronidase
➔ Spreading Factor
➔ Important in invasion and
survival
➔ Hydrolyzes hyaluronic acid
present in the intracellular
ground - permitting the
spread of bacteria during
infection
c. Lipases
➔ Fat Splitting enzyme
➔ Responsible for the survival
in sebaceous area of the
body
d. Protein A
➔ has the ability to bind the Fe
portion of IgG as well as
complement
e. Catalase
➔ heme enzyme
➔ Catalase Test: Hydrogen
peroxide
➔ If the organism can produce
catalase: breaksdown
hydrogen peroxide to water
and oxygen
➔ + result: production of
bubbles or bubbling
f. Coagulase
➔ Coagulates fibrin in plasma
➔ Formation of fibrin layer
around the bacterial cell
➔ 2 types:
◆ Bound
coagulase/clumping
factor
◆ Unbound coagulase/
free coagulase
g. Staphylokinase
➔ AKA fibrinolysis
➔ Fibrinolytic activity
h. DNAse
➔ Lowers viscosity of exudates
i. Beta-Lactamase
➔ Breaks down penicillin and
other beta lactam drugs
j. Panton-Valentine Leukocidin
(Cytolytic toxin)
➔ Toxic to leukocyte or WBC
main
Epidemiology
Infections caused by Staphylococcus
aureus
1. Folliculitis
-Relatively mild inflammation of a hair
follicle or oil gland
-Infected area: raised and red.
2. Furuncles
-Extension of folliculitis
-Large, raised, superficial abscesses.
3. Carbuncles
-Occur when larger, more invasive lesions
develop from multiple furuncles
4. Bullous impetigo
-Causes staphylococcal pustules that are
large and surrounded by a small zone of
erythema
Associated disease and infections -Most commonly drug induced, but some
cases have been linked to infections and
1. Toxin induced disease vaccines
2. Bacteremia/sepsis
➢ Bacteremia: bacterial 5. Food Poisoning
infection occur in blood -Enterotoxin A and B have been associated
3. UTI with gastrointestinal disturbances.
4. Acute bacterial endocarditis
➢ Bacterial infection in heart Differential tests for
valves
5. Cutaneous infection
Staphylococcus aureus
6. Osteomyelitis
➢ Infection in bones 1. Coagulase Test
7. Septic arthritis -Best test for pathogenic S. aureus
➢ In joints -Reagent: rabbit plasma
-Methods: Slide and Tube Method
Staphylococcus aureus infections ➢ Slide method:
1. Toxic Shock Syndrome ○ screen catalase positive
-Fatal multisystem disease colonies
-Onset of: chills, vomiting, diarrhea, muscle ○ Detects cell bound coagulase
aches and rash which reacts with the
-Progress to hypotension and shock fibrinogen in plasma

2. Scalded skin syndrome

-Ritter disease
-Extensive exfoliative dermatitis
-Children / neonates
Layers of the epidermis

➢ Tube method:
○ More sensitive method
○ Confirmatory test
○ Detects
extracellular/unbound or free
coagulase
3. Acute bacterial endocarditis
○ Inoculate tube containing
-Begins with: high fever, fast heart rate,
plasma and incubate at 35°
fatigue, and rapid extensive heart valve
○ Positive result: clot/coagulum
damage
formation after 1-4 hours of
incubation.
4. Toxic Epidermal Necrolysis
 4. Polymyxin sensitivity test
-Resistance

5. Voges-Proskauer test
-pink color

2. Tellurite Glycine Agar

-Jet black colonies
MR-VP
-MR: Methyl red
➢ 5-6 drops of methyl red
➢ + result: red
-VP: Voges-Proskauer
➢ 6 drops: alpha naphthol
➢ 2 drops: KDH

6. DNAse test
-Clearing of the dye

3. Mannitol Fermentation Test

-MSA: 1% mannitol and 7.5% NaCl
-pH indicator: phenol red
-Positive result: colonies surrounded by
yellow halos
Methicillin Resistant
Staphylococcus aureus (MRSA)

-Acquired alter prolonged hospital stay Staphylococcus

-Infections:
➢ Sores or boils epidermidis
➢ Serious skin infections
-Normal flora of the skin
➢ Lung infection
-Medical instruments:
➢ UTI
➢ Catheters
➢ Prosthetic heart valves
-Poly-gamma-DL-glutamic acid –
Adherence to devices
-Other factors: catheterization,
implantations, Hospitally acquired,
healthcare acquired UTIs

Culture
-Small to medium sized
-Non-hemolytic
-Non-pigmented (transparent)
-White opaque colonies
-Contains mecA gene
➢ Causes mutations to resistance
(resistant to all β-lactams)
-Spread through contact or touching the
skin
➢ Physical or direct contact

-MRSA is carried by 2% of the world’s

population

CHROMagar
Biochemical Test
-Selective and differential media for the
-MSA negative
identification of MRSA
➢ But positive in S. aureus
-Produce a mauve-colored colony, allowing
-CoNS negative
for the identification of the organisms
➢ Coagulase negative but positive in
S. aureus
Mauve color colony

Antimicrobial Test
-Susceptible with 5 ug Novobiocin
➢ Differentiate S. epidermidis to S.
saprophyticus (resistant to
novobiocin)
-(16-27 mm ZOI) -Resistant to 5 ug novobiocin
-Resistant: if there is no ZOI -(6-12 mm ZOI)
➢ Ex. bacitracin
-Susceptible: furazolidone

Diseases
-Catheter induced UTI
-Septicemia
-Endocarditis (heart valve transplantation)

Treatment
-Vancomycin and Rifampin

Staphylococcus
saprophyticus
-Associated with: Staphylococcus
➢ Commonly acquired UTI among
young sexually active females lugdunensis
-Adheres more effectively to the epithelial
-More aggressive than other CoNS
lining of the urogenital tract than other
-Disease caused:
CoNS
➢ TSS
-Rarely found on:
➢ Osteomyelitis
➢ Mucous membrane
➢ Septic arthritis
➢ Skin
➢ Endocarditis
-The second most common cause of UTI
-Also acquired in the hospital
➢ First common cause: Escherichia
-mecA gene
coli
➢ Codes for oxacillin resistance
➢ In MRSA: penicillin resistance
Culture
-Non-hemolytic
Microscopic Examination
-White opaque colonies
-Gram-positive + PMNs (polymorphonuclear
-65% are yellow colonies
Neutrophils)
➢ Lighter shade
➢ exudates, joint fluids, aspirated
-35% are white colonies
secretions, and other body fluids
-A culture should be done regardless of the
Biochemical Test
results of microscopic examination
-MSA negative/pos
-CoNS negative
-DNAse negative Isolation and Identification

Antimicrobial test -Staphylococci grow easily in routine

laboratory culture media, particularly sheep
blood agar.
-Selective Medium - MSA, CNA, and PEA
➢ They facilitate to grow gram pos
cocci
-CHROMagar - Isolation of S. aureus
(MRSA)

-Colony appearance:

S. aureus hemolytic zones

around colonies,
rarely exhibit
pigment production
with extended
Incubation

S. epidermidis usually small - to

medium sized,
nonhemolytic gray
to white colonies

S. saprophyticus slightly larger

colonies with about
50% of the strains
producing yellow
pigment

S. lugdunensis Medium to large;

unpigmented or
cream to
yellow-orange, may
be beta-hemolytic

S. haemolyticus medium-sized
colonies, with
moderate or weak
hemolysis and
variable
pigmentation