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Gram Positive Cocci

:
genus STAPHYLOCOCCUS

Staphylococci: General
Characteristics
• Greek: “staphyle”= bunch of grapes
• arranged in clusters, divides in many
planes
• Gram positive
• Catalase positive
• Grow best in aerobic conditions but may
behave as facultative anaerobes
• Grow in 7.5% NaCl

Gram Positive cocci in clusters .

saprophyticus: opportunistic infections. aureus: most important pathogen responsible for most human infections • S. epidermidis: opportunistic infections • S. UTI in sexually active females . Coagulase positive Staphylococci – Staphylococcus aureus • 2. Coagulase negative Staphylococci – Staphylococcus epidermidis – Staphylococcus saprophyticus • S.Staphylococci: Classification • 1.

intestine • Source of organism . fomite or environment .can be infected human host.part of normal flora in humans and animals: nose.Staphylococcus aureus • Major human pathogen • Habitat . carrier.

IL-6 fever.Staphylococci: Determinants of Pathogenicity 1. TNF alpha. Exotoxins a. circulatory collapse and shock . pyrogenic exotoxins= interacts with both MHC-II of macrophages and specific variable regions on T-cells “superantigens” release IL-1. capillary leak.

aureus. (1) Enterotoxin A= most common.Staphylococci: Determinants of Pathogenicity a. Enterotoxins= in 33% of S. vomiting and diarrhea (2) Enterotoxin B-F= structure and function same with A .

TSST-1= fever. multiple organ dysfunction and shock .Staphylococci: Determinants of Pathogenicity b.

Leucocidin: kills PMNs and macrophages d. Exfoliatins (epidermolysin): cleave stratum corneum .Staphylococci: Determinants of Pathogenicity c.

prevents Abs from binding to bacteria. hinders opsonization massive complement activation--shock . facilitates tissue destruction Protein A: covalently bound to peptidoglycan in >90% of isolates . gamma and sigma: lyse RBCs. beta.Staphylococci: Determinants of Pathogenicity Hemolysins alpha.binds to Fc portion of IgG.

Enzymes B-lactamase (penicillinase) fibrinolysin (staphylokinase) DNAse phospholipase hyaluronidase .Staphylococci: Determinants of Pathogenicity 4.

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perineum • Breach in mucosal barriers . children.skin.Natural history of disease • Many neonates.can enter underlying tissue • Characteristic abscesses • Disease due to toxin production . nasopharynx. adults -intermittently colonised by S. aureus • Usual sites .

Pyoderma (impetigo) b. Folliculitis. Superficial infections a.Staphylococci: Clinical Disease 1. furuncles (boils) and sties c. Abscesses and carbuncles .

Folliculitis .

Carbuncle .

Pneumonia c. Arthritis e. Bacteremia. Acute endocarditis d. Deep infections a. Osteomyelitis b. septicemia f. Deep organ abscesses (brain. lungs) .Staphylococci: Clinical Disease 2. kidney.

Brain abscess .

Acute infective endocarditis .

Staphylococcal food poisoning c. Scalded skin syndrome (SSS) (1) bullous impetigo (2) staphylococcal scarlet fever b. Toxic shock syndrome (TSS) .Staphylococci: Clinical Disease 3. Staphylococcal toxin diseases a.

Bullous impetigo .

Staphylococci: Epidemiology • Colonizes skin and mucous membranes of 30% of normal humans • Anterior nares: most common site • Human to human transmission • Nosocomial infectious agent • Contamination of food by handlers • Phage typing used to trace the source .

aerobic conditions • 7.5% NaCl. 40% bile. biochemical identification .Staphylococci: Laboratory Diagnosis Microscopic: gram (+) cocci in clusters Culture: on: • BloodAgar. • mannitol salt agar • Identification: coagulase test.

Gram Positive cocci in clusters .

S. epidermidis culture .

Coagulase test .

1st gen cephalosporin: for penicillin allergic pts • Vancomycin: for MRSA . nafcillin) • First generation cephalosporin • Erythromycin.Staphylococci: Treatment • Most isolates now resistant to penicillin • Penicillinase-resistant penicillin (methicillin. clindamycin. oxacillin.

IV route. evacuation of pus.Staphylococci: Treatment • Both superficial and deep infections need to be given antibiotics but deep infections need higher doses. and prolonged treatment • Surgical therapy: incision. debridement or drainage are compulsory for localised collections (furuncles. abcesses) .

Staphylococci: Control and Prevention • Suppress the carrier state • Diligent aseptic practices • Stock vaccine and autovaccine available .