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Microbiology: Presented by Alyazeed Hussein, BSC
Microbiology: Presented by Alyazeed Hussein, BSC
Presented by
Alyazeed hussein, BSc
BACTERIOLOGY
Gram positive cocci
Staphylococci:
Staphylococcus aureus: S.aureus as resident flora, primarily in the anterior nares.
Isolated from abscesses, wound infections. Cause osteomyelitis in Children and adults.
scalded skin syndrome (SSS) and toxic shock syndrome (TSS).
Identifying characteristics:
Gram-positive cocci arranged in clusters. Colonies are golden color- beta-hemolytic on
blood agar.
Catalase and coagulase positive(catalase mediates the breakdown of hydrogen peroxide
into oxygen and water), coagulase enzyme convert fibrinogen to fibrin causes plasma to
clot.
Tolerate the high salt concentration (7.5%) of mannitol salt agar (MSA): ferments
mannitol and produces yellow colonies vs other staphylococci.
DNase test positive (S.aureus) vs other staph.
Penicillin resistance is due to beta-lactamase production.
Methicillin resistant S. aureus (MRSA) is resistant to β-lactam antibiotics because of
production of altered penicillin-binding proteins.
Coagulase-negative staphylococci(GNS):
are very common skin flora and are mostly nonpathogenic. However, they can cause
disease in immunosuppressed patients. This group of bacteria causes urinary tract
infections (UTIs) and is associated with infections of catheters.
Characteristics:
Gram-positive cocci arranged in clusters
Colonies appear white to gray on blood agar and nonhemolytic.
Catalase positive and coagulase negative.
infections associated with indwelling device.
1. Staphylococcus epidermidis: coagulase negative staphylococci, novobiocin
sensitive.
2. S. saprophyticus: Significant only in UTIs, novobiocin resistant.
Streptococci:
General Characteristics:
Catalase-negative, gram-positive cocci arranged in pairs and chains.
Can be alpha- or beta-hemolytic, or gamma- nonhemolytic on blood agar.
Lancefield grouping is based on a cell wall antigen:
1. Group A Streptococcus (S. pyogenes):
(pharyngitis), pneumonia, otitis media (middle ear infections), rheumatic fever and
post-streptococcal
glomerulonephritis(ASO): anti-streptolysin O=exotoxin.
Sensitive to bacitracin, colonies show a large zone of beta-hemolysis.
2. Group B Streptococcus (S. agalactiae):
25% of all females carry the bacteria as normal vaginal flora.
Neonates acquire infections during birth, resulting in meningitis.
Colonies are beta-hemolysis on BA.
CAMP test(Christie-Atkinson-Munch-Peterson) arrow head of hemolysis, resistant to
bacitracin.
3.Group D Streptococcus(E. faecalis):
Positive for growth in 6.5% NaCl.
Can be alpha-, beta-, or most commonly nonhemolytic.
Vancomycin-resistant enterococci (VRE).
Cause subacute bacterial endocarditis (SBE), UTI and abdominal
infections.
CAMP test
Streptococcus pneumoniae:
Normal flora of upper respiratory tract but can cause: Pneumonia and Meningitis.
Gram-positive diplococci that are lancet shaped, and alpha hemolytic(green colonies).
Grows on BA with 5-10% CO2.
Sensitive to Optochin.
Viridans streptococci: S. mutans, S. intermedius,
Normal flora of the oral cavity, respiratory tract, and gastrointestinal (GI) tract mucosa.
Major cause of bacterial endocarditis in people with damaged heart valves.
Alpha-hemolytic colonies(green color),
Sensitive to vancomycin.
Note that! Coagulase test: differentiate S.aureus(positive) from other staphylococci(negative).
Novobiocin disc: differentiate S.epidermidis (sensitive) from S.saprophyticus (resistant).
Catalse test: differentiate staphylococci(positive) from streptococci(negative).
Bacitracin disc: differentiate S.pyogenes(sensitive) from S. agalactiae (resistant).
CAMP test: differentiate S. agalactiae (positive) from other streptococci (negative).
Growth at (6.5% NaCl): E.faecalis(grow), other streptococci(inhibited).
Vancomycin: Viridans (sensitive) vs Enterococci (resistant).
viridans pneumococci point
Techniques:
Saline wet mounts are quick and easy to perform and will allow trophozoite motility and
helminth ova and larvae to be seen.
Iodine wet mounts are useful for the staining and detection of ova and protozoan cysts in stool
samples.
Formol ether concentration technique(FECT): for helminths and protozoa( 10% formalin).
Flotation technique: zinc sulphate, for light eggs e.g. H.nana, not used for heavy eggs,
trematodes and operculated eggs.
Modified acid-fast stain(cold) Kinyoun stain, is used to detect Cryptosporidium and Isospora.
The cellophane (Scotch) tape method is used to collect Enterobius vermicularis (pinworm) eggs from the perirectal
area.
EnteroTest (string test) is used to obtain duodenal contents: giardia(gelatin capsule).
Types of specimen:
Feces: Giardia, Cryptosporidium, Ascaris, Enterobius,
Duodenal aspiration: Giardia, strongyloides.
Blood: Plasmodium, Leishmania, Trypanosoma, and microfilariae.
Skin: Onchocerca and Leishmania.
Vaginal or urethral: Trichomonas.
Eye scrapings: Acanthamoeba.
Urine: Schistosoma and Trichomonas.
Sputum: Paragonimus westermani, Ascaris and Strongyloides.
INTESTINAL PROTOZOA:
Entamoeba histolytica:
Of the amoebae the principal pathogen for humans, causes amoebic dysentery(flask shape ulcer).
Cyst: infective stage, contain 1 to 4 nuclei vs Entamoeba coli 8 nuclei. (food and water).
Trophozoites: one nuclus, motile by pseudopods, cytoplasm contain RBCs.
Giardia lamblia (Giardia intestinalis):
Causes mild to moderate diarrhea, Severe infections can lead to malabsorption (steatorrhea)
Cyst: infective stage, ovale shaped contain 2 – 4 nuclei.
Trophozoite: motile by 4 pairs of flagella (falling leaf motility) and pear shaped, with two nuclei on each side of a
central axostyle. (duodenal aspiration or biopsy).
Balantidium coli:
Is the only member of the ciliates known to infect humans.
Fecal/oral route.
Intestinal ulcers.
Trophozoite: the cell membrane is covered with cilia, large, kidney-shaped macronucleus. A small,
spherical micronucleus is present adjacent to the macronucleus.
Cyst: infective stage, spherical to ellipsoid in shape, single kidney-shaped macronucleus, often
with a small, spherical micronucleus, small vacuoles in the cytoplasm.
Cryptosporidium parvum:
Causes cryptosporidiosis, which is characterized by moderate to severe diarrhea.
In patients with acquired immunodeficiency syndrome (AIDS) Cryptosporidium infections are an
important cause of death due to dehydration.
Diagnosis: acid-fast oocysts in stool(modified acid fast stain, cold acid fast). In light infection
Sheather’s sugar flotation method used.
Cystoisospora belli:
Cause Cystoisosporiasis, diarrhea and malabsorption.
Opportunistic infection (AIDS).
The oocysts are the diagnostic forms observed in human fecal specimens. Immature oocysts
contain a single sporocyst, the mature oocysts that contain two sporocysts.
Trichomonas vaginalis:
a sexually transmitted disease, causes vaginitis in women
(green frothy discharge).
Trophozoites (An undulating membrane is present that
extends from the basal body) are the infective stage and
infect the epithelial or mucosal Lining of the vagina, urethra,
and prostate gland, trophozoites are highly motile by
flagella(Jerky motility) so easy to detect by wet preparation ,
found in urine and vaginal discharges.
Note that!!! T,vaginalis have no cyst.
Hemoflagellates:
1.Trypansoma:
Vector is tsetse fly (infective metacyclic trypomastigotes.
Trypansoma brucei: causes African trypanosomiasis or sleeping sickness, and infection affects the
lymphatic system and CNS.
gambiense and rhodesiense.
Trypansoma cruzi: causes Chagas disease or American trypanosomiasis(chagoma), conjunctivitis,
edema of the face and legs, and heart muscle involvement leading to myocarditis.
2.Leishmania:
leishmaniasis, sand fly is the vector, promastigote as an infective stage (Macrophages).
Cutaneous leishmaniasis is characterized by skin and mucous membrane ulcers(L.tropica, L.major).
Viscral leishmaniasis(kala-azar): Liver, spleen(L.donovani).
Diagnosis: amastigote in the blood or tissue.
Toxoplasma gondii:
Cause toxoplasmosis.
Infective stage is oocysts (water/food contaminated with cat feces or
transplacental.
Oocyst release tachyzoites in the small intestine.
Lab diagnosis: IgM & IgG.
Plasmodium spp:
Causes: Malaria.
Tertian malaria: P.falciparum, P.vivax
and P.ovale
Quartan malaria: P.malariae.
Paroxysm: cold, hot, sweat.
Transmitted by female anopheles
mosquito during blood
meal(sporozoites).
Cerebral malariae caused by
P.falciparum.
Diagnosis: Blood film is gold
standard.
Unfixed Thick smears(qualitaitve),
Fixed thin film, methanol(quantitation
and differentiation).
P.malarie P.ovale P.vivax P.falciparm findings
All stages All stages All stages Ring stage and Blood
gametocytes, stages
Cytoadherance
phenomenon
Aspergillus flavus
Aspergillus
fumigatus
Aspergillus niger
Aspergillus terreus
Opportunistic fungi:
1. Fusarium spp: keratitis, endophthalmitis and systemic infections.
5. Sporothrix schenkii, (sporotrichosis).
VIROLOGY
General Characteristics of Viruses:
Viruses are obligate intracellular parasites unable to self-replicate. Once inside living cells, viruses induce the host cell
to synthesize virus particles.
The genome is either DNA or RNA.
Replicate by Assembly.
Viral Structure:
I . Virion is the entire viral particle.
2. Capsid is the protein coat that encloses the genetic material.
3. Capsomer is the protein subunit that makes up the capsid.
4. Nucleocapsid is composed of the capsid and genetic material.
5. The envelope vs (Naked viruses).
Samples for viral culture must be placed into a viral transport medium (VTM).
Upper respiratory tract infections: rhinovirus, influenza virus, parainfluenza virus, respiratory syncytial virus (RSV),
Epstein-Barr virus (EBY), and coronavirus.
bronchitis can be caused by influenza virus, parainfluenza virus, Respiratory Syncytial Virus RSV(children), and
adenovirus.
Cutaneous Infections: Caused by HSV-1, HSV-2, VZV,measles virus, rubella virus.
Genital Infections (Urethritis, Cervicitis, etc.)
l. Caused by HSV-2 and human papillomavirus
2. Genital tract infections are typically sexually transmitted.
Gastroenteritis
Caused by a number of viruses, including rotaviruses: diarrhea with dehydration and runny nose
particularly young children.
Neonatal infections are acquired in utero, during childbirth, or soon after childbirth.
The infections can be caused by HSV, CMV, and rubella virus (TORCH profile).
VIRAL IDENTIFICATION:
Electron Microscopy: (poxvirus, light microscope).
Cytopathic effect(CPE): changes of the infected cells:
Enlarged cells > Cytomegalovirus (CMV).
Inclusion bodies > Negri bodies (eosinophilic cytoplasmic inclusion) > rabies virus.
syncytium-multinucleated cell > RSV.
For intracellular viruses( immunofluorescence).
Viral Isolation:
Cell culture(tissue culture), (suitable host cells e.g. respiratory epithelium, neurons).
Monkey kidney cells.
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