2022 - Microbiology - Medically Important Bacteria II (Part 2)

MEDICALLY IMPORTANT BACTERIA II
(PART 2)
UMMP Stage 1 (Cohort 2022/2027)
20 January 2023
Associate Professor Dr Nadia Atiya

Department of Medical Microbiology
Faculty of Medicine, University of Malaya
Consultant Clinical Microbiologist
University of Malaya Medical Centre
LEARNING OBJECTIVES
At the end of the Medically Important Bacteria II (Part 1 & Part 2) lectures,
students should be able to describe the following, regarding medically important
Gram negative bacteria and spirochaetes:
 Bacterial classification & identification including microbiological characteristics

and some basic methods used for laboratory identification (microscopic and
macroscopic morphology, etc)
 Epidemiology (modes of transmission, risk factors)
 Pathogenesis (self-reading from textbooks and will also be covered in other

lectures)
 Clinical manifestations/infections
 Prevention and infection control (will not be extensively covered in this lecture,
but slides provided for self-reading; will be covered in detail in future lectures)
GRAM NEGATIVE BACTERIA
ENTEROBACTERIACEAE NONENTEROBACTERIACEAE
 Enterobacteriaceae = family of Gram-negative rod/bacilli  Straight Gram-negative rods/bacilli

• Acinetobacter baumanii
bacteria whom *MOST members are part of the normal flora of • Bacteroides fragilis (obligate
anaerobe)
the colon and rectum AND are aerobes but can be facultative • Burkhoderia pseudomallei
anaerobes AND are oxidase-negative • Pseudomonas aeruginosa
 Straight Gram negative rods/bacilli  Curved Gram-negative rods/bacilli
• Escherichia coli* • Vibrio spp.
• Proteus species* • Campylobacter spp.
• Enterobacter species*  Gram-negative cocci
• Salmonella secies • Acinetobacter baumanii
• Shigella species • Neisseria meningitidis
• Klebsiella pneumoniae* • Neisseria gonorrhoeae
• Yersinia species • Moraxella catarrhalis
• Serratia marcescens*  Gram-negative coccobacilli
• Acinetobacter baumanii
• Bordetella pertussis
• Brucella spp.
• Francisella tularensis
• Haemophilus influenzae
Mnemonic: Enterobacteriaceae are • Pasteurella multocida
PESSKY Strains of bacteria
(Escherichia, Proteus, Enterobacter,
Salmonella, Shigella, Klebsiella,
Yersinia, Serratia)
NONENTEROBACTERIACEAE
(Curved Gram-negative rods/bacilli
bacteria)
Vibrio species
 Vibrio spp. exists as free-living bacteria in
aquatic/marine environments (water).
 Vibrio cholerae and Vibrio parahaemolyticus are the
most common causes of Vibrio infections.
 MICROBIOLOGICAL CHARACTERISTICS
Curved, comma-shaped Gram-negative
 Curved, comma-shaped Gram-negative rods/bacilli rods/bacilli on Gram stain
 Facultative anaerobes.
 Generally considered a nonlactose-fermenter but
can be late/slow lactose-fermenters.
 Oxidase +ve, motile bacteria.

Vibrio cholerae
 CLINICAL MANIFESTATIONS
 Aetiological/causative agent of cholera,
Curved, Gram negative rods/bacilli
which is a gastroenteritis (diarrhoeal illness) that on Gram stain
typically produces “rice water” stool.

 However, most infections are asymptomatic.
 For those who are symptomatic, disease can be
mild-moderate to severe (can cause massive,
watery diarrhoea; morbidity & mortality due to
severe dehydration). Yellow (sucrose-fermenting) colonies
on TCBS agar
 TRANSMISSION
 Consumption of contaminated food and
water (foodborne and waterborne disease).
“Rice water” stools

RE-EMERGENCE OF CHOLERA IN HAITI
Vibrio parahaemolyticus
o Gastroenteritis (diarrhoea, abdominal

cramps, nausea, vomiting, and fever)
o Wound infections
 TRANSMISSION
o Gastroenteritis: Consumption of
contaminated food (especially seafood).
o Wound infections: Most often associated with

marine recreational activities (swimming, etc)
Green (nonsucrose-fermenting)
colonies on TCBS agar
Vibrio species
 PREVENTION
 A clean water supply and appropriate sanitation are the cornerstones of
cholera prevention.
 Travelers to regions where cholera is endemic should take necessary
precautions such as avoid drinking tap water, eating food from street
vendors, eating raw or undercooked food especially seafood.
 Avoid cross-contamination of cooked foods by raw seafood.

(Gram-negative cocci)
Neisseria meningitidis
 Can be part of the normal flora of the throat.
 Can cause colonisation and/or asymptomatic carriage
in the nasopharynx. Gram negative “coffee-bean”- or “kidney-

bean” -shaped diplococci
 Aetiological/causative agent of meningoccocal
infections.
 8 serogroups commonly cause infections in humans
(A, B, C, X, Y, Z, W135, and L)
 MICROBIOLOGICAL CHARACTERISTICS
 Gram-negative diplococci
Neisseria meningitidis colonies on
 Oxidase +ve, nonmotile chocolate agar
*Meninges: Tissue layer surrounding the brain and spinal cord that consists of 3 parts: the pia, arachnoid, and dura
maters.
*Bacterial meningitis: Infection of the arachnoid mater and the cerebrospinal fluid (CSF) in both the subarachnoid
space and the cerebral ventricles.
*Cerebrospinal fluid (CSF): fluid that surrounds the brain and spinal cord
Skin lesions seen in meningococcaemia
 EPIDEMIOLOGY: Areas with frequent epidemics of meningococcal
meningitis:
Reproduced from: The Centers for Disease Control and Prevention and Brunette, GW
(Ed). CDC Health Information for International Travel 2016.
 EPIDEMIOLOGY
 3 age groups mainly affected: infants & children
aged < 5 years ; adolescents and young adults aged 16 – 21
years of age; and adults aged ≥ 65 years.
o Mode of transmission
 Transmitted from person-to-person through
droplets* of respiratory/throat secretions containing
Neisseria meningitidis.
 Colonisation of the nasopharynx which occurs via
inhalation of droplets* containing Neisseria meningitidis
is a prerequisite for the development of systemic
infection.
o Risk factors:
 Nasopharyngeal carriage
 Complement deficiency
 Being a university student (odds ratio: 3.4); intimate
kissing with multiple partners (odds ratio: 3.7).
 Occupational exposure – clinical microbiologists are at ↑
risk.
*Droplets: particles of respiratory secretion ≥ 5 microns in size
 PREVENTION
o Vaccination - only recommended for those with
risk factors for infection.
o Use of infection control transmission-based
precautions i.e. droplet precautions* for 24 hours
after institution of effective antibiotics in patients
with suspected or confirmed infection.
o Antimicrobial chemoprophylaxis of close contacts.
*Droplet precautions are infection control measures used for the care of patients with suspected or confirmed
infections that are transmitted via airborne/aerosol droplets (≥ 5 microns) and include isolation of the patient in a
private room/cohorting, use of a facemask when within 1 – 2 metres of the patient, among others.
Neisseria gonorrhoeae
 Gram-negative diplococci
 Oxidase +ve, nonmotile
Gram negative “coffee-bean”- “kidney-bean”-

shaped diplococci
Neisseria gonorrhoeae colonies

on chocolate agar
 CLINICAL INFECTIONS
 Aetiological agent of gonorrhoea (purulent infection
of the mucous membrane* surfaces), which is a
sexually transmitted infection (STI).
 In women, the most common clinical infection is
Penile/urethral discharge
cervicitis (vaginal pruritus and/or a mucopurulent due to gonorrhoeae
discharge).
 In men, the most common clinical infection is
urethritis (penile /urethral discharge and/or dysuria).
 It can also cause neonatal conjunctivitis
 Always considered pathogenic when identified.
Neonatal conjunctivitis due to

Neisseria gonorrhoeae (ophthalmia
neonatorum)
 EPIDEMIOLOGY
- Cases are most commonly seen among adolescents and
young adults.
o Modes of transmission
 Sexual contact (sexually transmitted infection).
 Vertical transmission during childbirth.
o Risk factors
• Young age
• Recent new sexual partner or multiple sexual partners.
• Previous gonorrhoea
 PREVENTION
 Use of barrier methods (condoms) ↓ risk of transmission of gonorrhoea and other STIs.
(Straight Gram-negative bacilli)
Pseudomonas aeruginosa
 An organism that is commonly found in the environment including
soil and especially water (water faucets, sinks, respiratory
equipment, contact lens cleaning solutions, and disinfectants)
which can serve as reservoirs for infection.
 Straight, Gram-negative rods/bacilli
 Obligate/strict aerobe
 Oxidase +ve, motile bacteria
 Produces 2 pigments: pyocyanin (which can colour the pus in a
wound blue) and pyoverdin; both these pigments diffuse into
culture agar, imparting a blue-green colour. Pseudomonas aeruginosa green

colonies on nutrient agar
 CLINICAL INFECTIONS/MANIFESTATIONS
 Usually a hospital-acquired (nosocomial),
opportunistic pathogen (especially in the setting of
immunocompromised host or foreign body (central
line/urinary catheter).
Cellulitis due to a burn wound infection
caused by Pseudomonas aeruginosa
 Common causative agent of pneumonia, lung
abscesses, bacteraemia, urinary tract infection, skin
infections (folliculitis, ecthyma gangrenosum, cellulitis
[burn wound infections]), otitis media, otitis externa,

Ecthyma gangrenosum – nerotic skin lesion
due to Pseudomonas aeruginosa
eye infections, meningitis.
 EPIDEMIOLOGY
 In hospitals, can be transmitted through direct contact i.e. spread via the
hands of healthcare workers or through indirect contact e.g. via
hospital/medical equipments that get contaminated and are not properly
cleaned.
o Risk factors
 Hospitalised patients, especially patients who are immunocompromised,

have surgical wound infections, those with skin burns, on ventilators, have
central lines or urinary catheters inserted.
Pseudomonas aeruginosa can cause folliculitis ("hot tub
rash") and otitis externa ("swimmers' ear") in nearly 13% of
those enjoying recreational waters.
 PREVENTION & CONTROL
o Hospital-acquired infections:
 Hospitalised patients who are colonised or infected with
multidrug-resistant Pseudomonas aeruginosa (i.e. strains that are resistant to
multiple antibiotics) should be place on infection control measures (standard* and
contact** precautions) to prevent person-to-person transmission.
o Community-acquired infections:
 Avoid pools that may be poorly maintained, as they may be highly contaminated with
Pseudomonas aeruginosa.
*Standard precautions: infection control measures used in the care of all hospitalised patients and include hand hygiene before & after
every patient
 contact,
Keep use of gloves,
contact gowns,
lenses andandsolutions
eye protection,
from among others. contaminated.
becoming
**Contact precautions: infection control measures used in the care of patients who are colonised/infected with an organism that
spreads through contact; measures include placing the patient in a private room, washing hands before and after touching the patient,
among others.
Burkholderia pseudomallei
 Widely distributed in the environment.
 Readily found in mud/soil and fresh surface water in endemic regions.
 Aetiological/causative agent of melioidosis (also called Whitmore's disease).

Typical skin lesions seen in melioidosis
 Most patients with melioidosis do not have symptoms.

 When symptomatic, the most common clinical manifestations are pneumonia
and localised skin infection.
 EPIDEMIOLOGY
o Modes of transmission:
 Percutaneous inoculation* during contact with contaminated soil or water is the
predominant mode of transmission
 Inhalation of contaminated dust/water droplets, ingestion of contaminated
water are possible but uncommon routes of transmission.
o Risk factors: Diabetes, alcoholism, chronic renal disease
*percutaneous inoculation: introduction of organisms to a person through broken skin (such as a cut
or burn)
o Melioidosis is predominantly a disease of tropical climates and

occurs mainly in Southeast Asia, northern Australia, South Asia, and China.
Burkholderia pseudomallei on Gram stain showing Gram-negative rods with

bipolar staining resembling safety pins (arrows)
B. pseudomallei on MacConkey
agar - “metallic sheen” colonies Mature B. pseudomallei colonies on blood agar -wrinkled
“cornflower” appearance
A RECENT CASE OF MELIODOSIS AT UNIVERSITY MALAYA
MEDICAL CENTRE
 40-year-old male patient presented to UMMC A&E with prolonged fever and cough.
 Subsequently warded at UMMC intensive care unit with respiratory distress requiring
ventilation.
 Works in the farming industry and is a known diabetic.
 An organism grew from his blood culture: Bipolar staining Gram-negative rods/bacilli
on Gram stain; oxidase +ve, metallic sheen colonies on MacConkey agar.
 In view of the suggestive clinical history and microbiological findings, the culture result
was reported out by the clinical microbiologist as a presumptive Burkholderia
pseudomallei.
 Appropriate antibiotic regimen was immediately instituted.
 1 day later, identification of Burkholderia pseudomallei was confirmed based on
further biochemical testing; patient’s diagnosis confirmed as melioidosis; antibiotic
regimen was continued.

 PREVENTION
o For persons living in endemic areas:
 Engaged in high risk occupational or recreational activities -
cover all open wounds with waterproof dressings and
wearing boots and gloves during outdoor activities.
 With debilitating diseases and those with traumatic
wounds - avoid exposure to soil or water, such as rice
paddies.
 With skin lacerations, abrasions or burns that have been
contaminated with soil or surface water – wounds should
be immediately and thoroughly cleaned.

(Gram-negative coccobacilli
bacteria)
Brucella species
 Zoonotic agents
 Causative agents of brucellosis.
 6 species are recognised within the genus Brucella.
 Brucella melitensis, Brucella abortus, Brucella suis and Brucella canis are known to
cause human disease.
 The majority of human infections worldwide are caused by Brucella melitensis.
 Human infections due to Brucella melitensis is the MOST COMON zoonosis* worldwide.
 Gram-negative coccobacilli
 Most Brucella strains are oxidase +ve, urease +ve and nonmotile.
Brucella spp. on Gram stain: Small Gram-negative coccobacilli
Brucella species
Brucella species
Worldwide incidence of human brucellosis
 Major endemic areas include countries of the Mediterranean basin,

parts of Mexico and Central and South America, Asia.
 Brucellosis is considered endemic in Malaysia.
Brucella species
 EPIDEMIOLOGY
 Consumption of food products derived from infected animals (e.g.

unpasteurised milk, dairy products like cheese).
 Direct contact with blood/body fluids/secretions of infected animals (cattle,
goats, sheep, pigs, etc) through skin cuts/abrasions or conjunctival splashes.
 Inhalation of contaminated aerosols.
o Risk factors
 High-risk occupations – farmers/slaughterhouse workers, veterinarians,

microbiologists, etc.
Brucellosis cases at University Malaya Medical Centre
 In 2009, the first case of brucellosis caused by Brucella
melitensis was seen at UMMC in over 15 years.
 Between December 2012 and February 2014:
o 6 patients were diagnosed with brucellosis caused by
Brucella melitensis.
o 1 patient had drunk unpasteurised cow's milk.
o The remaining 5 patients regularly consumed

unpasteurised goat's milk bought from different “pasar
tani” within Kuala Lumpur and surrounding cities.
o All patients presented with prolonged fever for at
least 2 weeks.
o The blood cultures of all the cases grew Brucella
melitensis which was confirmed by molecular
identification methods.
Brucellosis cases at University Malaya Medical Centre
October 2016
o 71-year-old lady presented to UMMC with a 2-month history of
severe nonspecific backache, which started around the lumbar
region, then localised around the upper thoracic and cervical
region.
o MRI cervical spine showed an epidural abscess and a C5/C6
prolapsed intervertebral disc.
o Culture of epidural abscess grew an oxidase +ve and urease
+ve organism. Gram stain revealed small Gram-negative
coccobacilli. Presumptive identification of Brucella species was
reported out and antibiotic treatment was started.
o Further history taking revealed that she had a history of rearing
swine and chickens in the past. She also claims that there are
many cows and goats in her “kampung”.
o Further microbiological tests including molecular tests
confirmed the identification of Brucella species. Patient’s final MRI cervical spine of the patient
diagnosis - brucellosis. (arrow indicating the epidural
abscess)
Brucella species
 PREVENTION
o Public education (consumption of only thoroughly
cooked meat, avoidance of raw and
untreated/unpasterised dairy products like milk,
cheese, ice cream, etc).
o Those in high risk occupations who carry out high-
risk procedures should wear protective
clothing/adequate personal protective equipment
e.g. overall/coat, apron, rubber gloves, boots.

(Pleomorphic Gram-negative
bacteria)
Acinetobacter baumanii
 Commonly found in the environment (water, soil) and
hospitals (ventilation equipment, catheters).
 In humans, it can colonise skin, wounds, respiratory and
gastrointestinal tracts.
 Pleomorphic morphology on Gram stain (can appear as Acinetobacter baumanii on Gram
stain
Gram-negative rods/bacilli, Gram-negative cocci and/or
Gram negative coccobacilli).
 Nonlactose-fermenter.
 Oxidase –ve, nonmotile.
o Low-grade pathogen that typically causes healthcare-
associated infections e.g. pneumonia (esp. ventilator- Acinetobacter baumanii
nonlactose-fermenting colonies
associated), bacteraemia/septicaemia, etc.
on MacConkey agar
Presented at:
Published in:
 EPIDEMIOLOGY
 Direct contact (person to person contact) i.e. via the hands of healthcare
workers.
 Contact with contaminated surfaces/fomites.
o Risk factors:
 Hospitalisation esp. intensive care unit admission, surgery, catheterisation,

antibiotic exposure.
 PREVENTION & CONTROL
 Regular environmental cleaning in hospital important
because of the ability of Acinetobacter species to survive on inanimate surfaces
and contaminate other surfaces that contact it.
 Hospitalised patients who are colonised or infected with multidrug-resistant
Acinetobacter baumanii (i.e. strains that are resistant to multiple antibiotics) should
be place on infection control precautions (standard* and contact** precautions) to
prevent person-to-person transmission.

*Standard precautions: infection control measures used in the care of all hospitalised patients and include hand hygiene before & after
every patient contact, use of gloves, gowns, and eye protection, among others.
**Contact precautions: infection control measures used in the care of patients who are colonised/infected with an organism that spreads
through contact; measures include placing the patient in a private room, washing hands before and after touching the patient, among
others.
SPIROCHAETES
Spirochaetes (Borrelia, Leptospira, Treponema)
Leptospira spp.
 The genus Leptospira contains 22 species.
 10 are regarded as pathogenic (e.g Leptospira interrogans).

 The organism infects a variety of both wild and domestic mammals,
especially rodents, cattle, sheep, goats, etc
 Rodents are the most important reservoirs for
maintaining transmission in most settings.

 Aetiological/causative agent of leptospirosis, which is a
zoonosis.
 Can present as an asymptomatic/subclinical illness, a self-limited systemic infection, or a

severe, potentially fatal illness accompanied by multiorgan failure.
 Symptoms: abrupt onset of fever, rigors, myalgias, and headache.
 Conjunctival suffusion in a patient with a nonspecific febrile illness should raise suspicion for
leptospirosis.
Leptospira spp.
 EPIDEMIOLOGY
o Leptospirosis occurs worldwide, but most common in
temperate/tropical climates. including Malaysia.
o Mode of transmission
 Exposure to environmental sources, such as urine from infected animals,
water/soil contaminated with urine from infected animals or infected animal
tissue.
 Portals of entry include cuts or abraded skin, mucous membranes, or conjunctivae.

o Risk factors
 High risk occupations - farmers, sewer workers, veterinarians, etc
 Certain outdoor recreational activities - jungle trekking, swimming, kayaking, etc in

contaminated lakes and rivers.
Leptospira spp.
Modes of transmission of Leptospira species

CDC Update: Outbreak of Acute Febrile
Illness Among Athletes Participating in
Eco-Challenge-Sabah 2000
Leptospira spp.
 PREVENTION
o Eliminating contact with potentially infected animals.
o Avoiding swimming or wading in water that might be contaminated with animal
urine.
o Wearing protective clothing or footwear for those those exposed to
contaminated water or soil because of their job or recreational activities.

OTHER MEDICALLY IMPORTANT
BACTERIA
BACTERIA CLINICAL INFECTIONS/DISEASES
I. GRAM-NEGATIVE BACTERIA
Citrobacter species Mainly a cause of nosocomial infections (urinary tract infection, pneumonia, etc)
Enterobacter species Common cause of nosocomial infections (ventilator-associated pneumoniae, burn and
surgical wound infections, catheter or device-related infections, post-neurosurgical
meningitis)
Serratia marcescens Common cause of nosocomial infections (bacteraemia/bloodstream infection, urinary tract
infection, wound infection)
Shigella species Gastroenteritis (watery diarrhoea, dysentery)

*Zoonotic agent
Yersinia species Gastroenteritis (Yersinia enterocolitica, Yersinis tuberculosis), plague (Yersinia pestis)
*Zoonotic agent
Bacteroides species Abscess (intra-abdominal, brain, lung)
Campylobacter species Gastroenteritis
*Zoonotic agent
Haemophilus influenzae Sinusitis, acute otitis media, conjunctivitis, community-acquired pneumonia
Moraxella catarrhalis Sinusitis, acute otitis media

Bordetella pertussis Respiratory infection (pertussis/whooping cough)
Francisella tularensis Tularaemia

*Zoonotic agent
Pasteurella multocida Skin and soft tissue infections (cellulitis), bone and joint infections (osteomyelitis),
*Zoonotic agent respiratory infections, bacteraemia/bloodstream infection
II. SPIROCHAETES
Treponema pallidum Causative/aetiological agent of syphilis
Borrelia burgdorferi Causative/aetiological agent of Lyme disease

*Zoonotic agent
III. BACTERIA THAT EITHER CAN’T BE SEEN OR CAN’T BE EASILY SEEN ON GRAM STAIN
Chlamydia species
a) Chlamydia pneumoniae Community-acquired pneumonia
b) Chlamydia psittaci Causative/aetiological agent of psittacosis

*Zoonotic agent
c) Chlamydia trachomatis Urethritis (sexually transmitted infection), trachoma
Mycoplasma pneumoniae Community-acquired pneumonia
Legionella pneumophila Community-acquired pneumonia

III. BACTERIA THAT EITHER CAN’T BE SEEN OR CAN’T BE EASILY SEEN ON GRAM STAIN
Rickettsia prowazeckii Causative/aetiological agent of epidemic typhus

*Zoonotic agent
Orientia tsutsugamushi Causative/aetiological agent of scrub typhus

*Zoonotic agent
Coxiella burnetti Causative/aetiological agent of Q fever

*Zoonotic agent
COMMON CLINICAL INFECTIONS & THE
IMPORTANT BACTERIAL PATHOGENS THAT CAUSE
THEM
*NOTE: Slides 64-76 have no voice-over*
TYPE OF CLINICAL GRAM STAIN EXAMPLES OF IMPORTANT BACTERIAL PATHOGENS
INFECTION MORPHOLOGY
 Skin & soft GPC  Staphylococcus aureus, Streptococcus pyogenes (group A

tissue infections streptococcus), Enterococcus species (wound infections)
GPR  Bacillus anthracis, Clostridium species (especially

Clostridium perfringens)
GNR  ENTEROBACTERIACEAE:
 Escherichia coli, Klebsiella pneumoniae, Proteus species,
Enterobacter species
 NONENTEROBACTERIACEAE:
 Pseudomonas aeruginosa (infected burn wounds,
ecthyma gangrenosum), Stenotrophomonas
maltophilia, Burkholderia pseudomallei, Pasteurella
TYPE OF CLINICAL INFECTION GRAM STAIN
MORPHOLOGY EXAMPLES OF IMPORTANT
BACTERIAL PATHOGENS
Bone/joint Osteomyelitis GPC  Staphylococcus epidermidis,

infections Staphylococcus aureus
GNR  Salmonella species, Pasteurella

multocida (may also appear as
GNCB)
GNCB  Brucella species, Haemophilus

influenzae
Septic arthritis GPC  Staphylococcus aureus, beta-

haemolytic streptococci
TYPE OF CLINICAL INFECTION GRAM STAIN IMPORTANT BACTERIAL PATHOGENS
MORPHOLOGY
 Central nervous Meningitis GPC  Staphylococcus epidermidis,

system infections Staphylococcus aureus,
Streptococcus pneumoniae,
Streptococcus pyogenes (group A
streptococcus), Streptococcus
agalactiae (group B streptococcus),
Enterococcus species
GPR  Listeria monocytogenes
GNC  Neisseria meningitidis
GNR  Escherichia coli, Klebsiella

pneumoniae, Enterobacter species,
TYPE OF CLINICAL INFECTION GRAM STAIN IMPORTANT BACTERIAL
MORPHOLOGY PATHOGENS
 Upper respiratory Acute otitis GPC  Streptococcus pneumoniae

tract infections media
GNC  Moraxella catarrhalis
GNCB  Haemophilus influenzae
Chronic otitis GNR  Pseudomonas aeruginosa

media
Pharyngitis GPC  Streptococcus pyogenes (group

A streptococcus)
GPR  Arcanobacterium
haemolyticum,Corynebacterium
diphtheriae
GNC  Neisseria gonorrhoeae
Bacteria that can’t be  Chlamydia pneumoniae

TYPE OF CLINICAL GRAM STAIN MORPHOLOGY IMPORTANT BACTERIAL PATHOGENS
INFECTION
 Lower GPC  Staphylococcus aureus, Streptococcus

respiratory tract pneumoniae
infection
(pneumonia)
GPR  Bacillus anthracis
GNC  Moraxella catarrhalis
 Escherichia coli, Klebsiella pneumoniae,
Proteus species, Enterobacter species
 Pseudomonas aeruginosa,
Stenotrophomonas maltophilia,
GNCB  Haemophilus influenzae

TYPE OF GRAM STAIN IMPORTANT BACTERIAL PATHOGENS
CLINICAL MORPHOLOGY
INFECTION
 Endocarditis GPC  Staphylococcus epidermidis, Staphylococcus aureus,

Streptococcus species (viridans streptococci,
Streptococcus bovis, etc), Enterococcus species
GNR  HACEK organisms (Haemophilus aphrophilus

[subsequently called Aggregatibacter aphrophilus &
Aggregatibacter paraphrophilus]; Aggregatibacter
actinomycetemcomitan; Cardiobacterium hominis;
Eikenella corrodens; and Kingella kingae) and various
other Gram negative bacteria
MORPHOLOGY
GPC  Staphylococcus epidermidis,

 Bacteraemia/bloodstream Staphylococcus aureus, Streptococcus
infection/septicaemia pyogenes, Enterococcus species
 Escherichia coli, Klebsiella pneumoniae,
Proteus species, Salmonella species
 Pseudomonas aeruginosa,
Stenotrophomonas maltophilia,
Burkholderia pseudomallei, Pasteurella
multocida (may also appear as GNCB)
MORPHOLOGY
 Gastroinestinal tract Gastroenteritis GPC Staphylococcus aureus*

infections/
diseases
GPR Bacillus anthracis, Bacillus cereus*,
Clostridium difficile, Listeria
monocytogenes
Straight GNR Escherichia coli (pathogenic strains),

Salmonella species, Shigella species
Curved GNR Campylobacter species, Vibrio

species
Botulism GPR Clostridium botulinum
Intraabdominal GPC Enterococcus species

abscess
GPR Actinomyces species
CLINICAL INFECTION GRAM STAIN IMPORTANT BACTERIAL PATHOGENS
MORPHOLOGY
 Urinary tract infection GPC  Staphylococcus saprophyticus,

Enterococcus species
 Escherichia coli, Klebsiella
pneumoniae, Proteus mirabilis
 Pseudomonas aeruginosa
TYPE OF CLINICAL GRAM STAIN IMPORTANT BACTERIAL PATHOGENS
INFECTION MORPHOLOGY
 Genital infections GNC Neisseria gonorrhoeae
GNCB Haemophilus ducreyi
Bacteria that can’t be Chlamydia trachomatis, Treponema

Gram stained/are poorly pallidum
stained with Gram stain
 Eye infections Acute conjunctivitis GPC Staphylococcus aureus,

Streptococcus pneumoniae
GNC Moraxella catarrhalis,

GNCB Haemophilus influenzae
Bacteria that can’t Chlamydia trachomatis

be Gram stained/are
poorly stained with
Gram stain
Endophthalmitis GPC Staphylococcus aureus,

 Ear infections Otitis externa GPC Staphylococcus aureus
GPR Corynebacterium species
GNR Pseudomonas aeruginosa

TAKE-HOME MESSAGE
 A solid foundation in the knowledge taught during the Medically Important
Bacteria Lectures and its application in clinical practice, will aid in accurate
interpretation of microbiological reports and appropriate management of
patients with suspected or confirmed bacterial infections.

FURTHER READING
o Other bacteria not covered in detail in this lecture can also be tested in the
exams, including but not limited to Bordetella pertussis, Legionella
pneumophila, Campylobacter spp., Shigella, spp., Bacteroides spp.,
Haemophilus influenzae, Treponema pallidum, etc

RECOMMENDED SOURCES OF
READING
o Medical Microbiology (Murray et al)
o Medical Microbiology (Greenwood)
o Review of Medical Microbiology & Immunology (Levinson)
o Medical Microbiology (Jawetz, Melnick and Adelburg)

THANK YOU

2022 - Microbiology - Medically Important Bacteria II (Part 2)

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2022 - Microbiology - Medically Important Bacteria II (Part 2)

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MEDICALLY IMPORTANT BACTERIA II

Associate Professor Dr Nadia Atiya

 Bacterial classification & identification including microbiological characteristics

 Epidemiology (modes of transmission, risk factors)

 Pathogenesis (self-reading from textbooks and will also be covered in other

 Enterobacteriaceae = family of Gram-negative rod/bacilli  Straight Gram-negative rods/bacilli

aquatic/marine environments (water).

 Vibrio cholerae and Vibrio parahaemolyticus are the

most common causes of Vibrio infections.

 Generally considered a nonlactose-fermenter but

can be late/slow lactose-fermenters.

 Oxidase +ve, motile bacteria.

typically produces “rice water” stool.

“Rice water” stools

o Gastroenteritis (diarrhoea, abdominal

o Wound infections: Most often associated with

 A clean water supply and appropriate sanitation are the cornerstones of

 Travelers to regions where cholera is endemic should take necessary

vendors, eating raw or undercooked food especially seafood.

 Avoid cross-contamination of cooked foods by raw seafood.

 Can be part of the normal flora of the throat.

 Can cause colonisation and/or asymptomatic carriage

in the nasopharynx. Gram negative “coffee-bean”- or “kidney-

 8 serogroups commonly cause infections in humans

(A, B, C, X, Y, Z, W135, and L)

o Vaccination - only recommended for those with

risk factors for infection.

o Use of infection control transmission-based

precautions i.e. droplet precautions* for 24 hours

after institution of effective antibiotics in patients

with suspected or confirmed infection.

o Antimicrobial chemoprophylaxis of close contacts.

 Oxidase +ve, nonmotile

Gram negative “coffee-bean”- “kidney-bean”-

Neisseria gonorrhoeae colonies

 Always considered pathogenic when identified.

Neonatal conjunctivitis due to

- Cases are most commonly seen among adolescents and

 Sexual contact (sexually transmitted infection).

 Vertical transmission during childbirth.

• Recent new sexual partner or multiple sexual partners.

soil and especially water (water faucets, sinks, respiratory

equipment, contact lens cleaning solutions, and disinfectants)

which can serve as reservoirs for infection.

 Straight, Gram-negative rods/bacilli

 Oxidase +ve, motile bacteria

 Produces 2 pigments: pyocyanin (which can colour the pus in a

wound blue) and pyoverdin; both these pigments diffuse into

culture agar, imparting a blue-green colour. Pseudomonas aeruginosa green

 Usually a hospital-acquired (nosocomial),

opportunistic pathogen (especially in the setting of

immunocompromised host or foreign body (central

abscesses, bacteraemia, urinary tract infection, skin

infections (folliculitis, ecthyma gangrenosum, cellulitis

[burn wound infections]), otitis media, otitis externa,

 Hospitalised patients, especially patients who are immunocompromised,

 Hospitalised patients who are colonised or infected with

multidrug-resistant Pseudomonas aeruginosa (i.e. strains that are resistant to

multiple antibiotics) should be place on infection control measures (standard* and

contact** precautions) to prevent person-to-person transmission.

 Widely distributed in the environment.

 Readily found in mud/soil and fresh surface water in endemic regions.

 Aetiological/causative agent of melioidosis (also called Whitmore's disease).