Practical taxonomy

1
Practical taxonomy
Miscellanous bacteria
Mycoplasma, Ureaplasma, Chlamydia Ricketsiaceae Sp
irochetales - Spirochetes, Leptospira,
Borrelia Mycobacterium Nocardia , Actinomycetes,
2
GenusBacillus - Gsporeforming bacilli, aerobic
and facultatively anaerobic

• Bacillus anthracis,Bacillus
  cereus,Other Bacillus sp.
• Bacillus cereus - 2 enterotoxins
  -
  heat stable - emetic form - contaminated rice -
  heat resistant spores survive initial cooking
  that kills vegetative cells, germinate, multiply
  and toxin is not destroyed by reheting
  
  - heat labile - diarrheal form
  - adenylcyclase-cAMP system stimulation in
  intestinal cells - fluid accumulation
  -contaminated meat and vegetable - toxin is
  produced in situ, longer incubaion
• Panophthalmitis - traumatic eye infection (soil,
  penetrating object), complete loss, massive
  destruction
  
  - toxins - necrotic - heat labile
  enterotoxin
  - cereolysin - hemolysin
  
  -
  phospholipase C - lecithinase
• Ubiquitous, isolation witout symptoms
  contamination
• Other Bacillus - immunosupressed patients - shunt
  and catheter inf.

3
Bacillus antracis
4
Bacillus anthracis

• Spore and capsule (protein) not seen in clinical
  specimens
• Antrax toxin - 3 antigenically distinct
  components -protective Ag, lethal factor, edema
  factor - not active separately,
• Pathogenesis capsule - antiphagocytic, Ab are
  not protective, toxins are active in cooperation
  of protective lethal or edema f.
• Cultivation - on nonselective media, rapidly
  growing adherent colonies, no hemolysis, Non
  motility,liquifaction of agar
  
  Microscopy caput medusae
  serpentine like chains,

5
Bacillus anthracis

• Human diseases - cutaneous - inoculation -
  painless papule, ulcer, necrosis
  
  
  - respiratory -
  inhalation - rapid progresive diffuse pulmonary
  involvement - respiratory failure - 95 mortality
  
  -
  gastrointestinal - ingestion - rare - mesenteric
  adenopathy, hemorrhage, ascites, 90 mortality
• Therapy - PNC (TTC, CMP)., control of animal
  antrax, vaccination.

6
Bacillus antracis
7
Non sporeforming G bacilli - heterogenous group

• Corynebacterium - coryneforms, diphtheroids- C.
  diphteriae (diphtheria), C. jeikeium
  (oportunistic). C. urealyticum(urinary tranct
  inf.), C. pseudodiphthericum (endocarditis), C.
  ulcerans (pharyngitis)
• Arcanobacterium haemolyticum - pharyngitis
• Actinomyces - granulomatous ulcerative inf.
• Rhodococcus - suppurative pneumonia,
  opportunistic
• Listeria - meningitis, septicemia, granulomatosis
  infantiseptica
• Erysipelothrix - erysipeloid, septicemia,
  endocarditis
• Gardnerella - bacterial vaginosis

8
Corynebacterium

• Pleoimorphia, Grods, forming short chains, china
  letters, or letter Y,V - forms
• Metachromatic granuls resulting colour differs
  from the colour of the used one
• Special cell wall structure mesodiaminopimelic
  acid, arabinogalactan, mycolic acid with short
  chains taxonomic neighbour to mycobacteria
• C. diphtheriae preventabil disease diphthteria
• asymptomatic carriage in pharynx droplet
  transmission
• C. jeikeium - JK - oportunistic patogen in
  immunocompromised - hematological disorders
• Others - transmitted from annimals

9
Corynebacterium- patogenesis and immunity

• Diphtheric exotoxin - tox gen can be transmitted
  to bacteria (C. diftérie, C. ulcerans,
  C.pseudotuberculosis via bacteriophage
  lysogenic conversion
• A-B protein B phragment binding on the cell
  surface enable enter of A phragment to the cell.
  A phragment is enzymatically active - blocking
  synthesis of proteins prolngation of peptid
  chain on ribosomes
• Skin test detection of neutralising antibodies
  in vivo - i.d. application of diphtheric toxin

10

• Phospholipase D - dermonecrotic toxin enable
  spread by increasing vascular permeability .
  ulcerans, C. pseudodiphthericum
• Urease - C. urealyticum alkalinisation of urine
  and urine calculi forming
• ATB resistence selection of resistent strains -
  C. urealyticum, C. jeikeium resistent to
  commonly used ATB in UT infection

11
Diphtheria

• Clinical presentation depends on state of
  immunity and place of infection - asymptomatic
  colonisation, mild respiratory infection,
  fulminant diphtheria
• Difphtheria URT infectionwith low grade fever,
  toxin induce local damage adherent pseudomembrane
  on tonsils, pharynx, nose and general symptoms of
  intoxication. Myocarditis.
• Skin diphtheria transmission via skin contact
  from infected persons, colonisation and enter via
  small injurie - papules and chronic ulcers with
  membrane and general signs of intoxication, less
  sever,

12
Diphtheria
13
Laboratory diagnosis

• Microscopy detection of metachromatic granules
  methylen blue staining not important
• Cultivation on common media (blood agar),
  special media Loffler
  medium,
  - tellurit agar gray
  brown colonies
• 3 types of colonies - gravis (big, irregular,
  gray), mitis (small, convex,round, black),
  intermedius (small, plate, gray) connected with
  importance and virulence not considered more
• Biochemical identification
• Detection of toxigenicity - Eleks test -
  immunodiffusion, - antitoxic test on annimal
  model.,

14
Arcanobacterium

• A.haemolyticum - colonise human, responsible for
  pharyngitis (/- scarlet fever-like rash),
  cutaneusinf., endocarditis, meningitis - in older
  patients
• Missdiagnosed as Str. pyogenens, grows slowly,
  weak hemolysis
• 2 toxins - hemolysin and phospholipase D
• enzymes neuraminidase

15
Erysipelotrix

• E. rusiopathiae G non spore forming facultative
  anaerobic bacillus, worldwide distribution in
  animals
• Cultivation in reduced oxygen athmosphere, small
  grayish, alfa hemolytic colonies, 2-3 days,
  sample from deep tissue or deep aspirates.
• Erysipeloid - occupational disease (butchers,
  meat processors) after subcutaneous innoculatio
  -localised skin infection
  
  -generalised
  cutaneous forme
  
  -septicaemia - associated with endocarditis
  (undamaged heart valve - aortic)
• Therapy PNC, ERY,CLI (sulfonamids, vancomycin,
  aminoglycosides - resistent)

16
Listeria

• 7 species, most important L. monocytogenes
  facultatively anaerobe neonporeforming G rod
• meningoencephalitis, bacteraemia, endocarditis
• New borne, older gravid women, immunocompromised
  patients (after transplantation
• Frequently transfer via milk and row milk
  products, row vegetable
• Able to grow in wide range of pH a and low
  temperature 22C , faible beta hemolysis, motile
  in liquid media

17
Clinical syndroms

• Newborne listeriosis - infection in utero -
  granulomatosis infantiseptica, devasting disease,
  diseminated abscesses and granulomes multiorgan
  involvement
  
  - late listeriosis - 2-3 weaks after delivery -
  meningitis, septicaemia
• Meningitis of adults in immunocompromised,after
  transplantation
• Bacteraemia, Endocarditis
• Dg. Microckopy of CSF usually negat.- few
  bacteria, Cultivation and indentification
• Therapy - penicillin /- combination with
  aminoglycosids

18
Rhodococcus

• G, obligate aerobic, red-pigmented, acid fast,
  mycolic acid. Veterinary pathogen. Present in
  soil
• Intracellular - surviving in macrophages
• Granulomatous inflammation with abscess formation
  (lung,lymph nodes, menings, pericardium, skin) -
  immnosupressed
• Cultivation - nonselected media, aerobically,
  pigmented colonies after 4 and more days
• Therapy prolonged - multiple ATB able to
  penetrate into macrophages

19
Gardnerella

• Morphologically resembles gram negative bacilli,
  has cell wall structure of gram , nonmotile, not
  capsule
• part of normal vaginal flora
• present in bacterial vaginosis together with
  obligate anaerobes - Mobiluncus,
  Peptostreptococcus,absence of Lactobacillus.
  Present in postpartum bacteremia, endometritis,
  vaginal abscesses
• Lab. dg. - simple isolation is not prooving,
  importance of microscopic examination - clue
  cells - epitelial cells covered with G variable
  bacilli (Gardnerella) and G- small curved bacilli
  (Mobiluncus), absence of G bacilli
  (Lactobacilli)
• Therapy ampicilin, metronidasol

20
Actinomyces

• G filamentous rods, 5-10CO2,
• Actinomyces israeli, A. meyeri, A. naeslundii,
  A.odontolyticus
• chronical disease with abscess, tissue
  destruction and sulphur granules in tissue (mass
  of mycelia surrounded by protein, polysaccharide
  and bacteria)
• cervicofacial forme(endogenous, after tooth
  extraction) - abdominal,( starting in appendix
  and diverticules) -pelvic forme (from
  IntraUterinDevices)
• hematogenous disemination
• Lab. Dg. - pus with sulphur granuls - Ziehl
  Neelsen - microscopy, cultivation - agar with
  heart brain infusion - 10 days, colony shape -
  mollar tooth

21
Nocardia

• Gstrictly aerobe rods. Similar to quickly
  growing mycobacteria, saprophytes in environment.
  Acid fast., Mycolic acid
• Nocardia asteroides, N. brasiliensis, N. madurae
• pneumonia - with confluent abscess formation,
  exogenous inhalation
• skin infection - Actinomyces brasilinensis -
  localised celulitis, purulent sinuses with
  chronical granulomatous inflamation - mycetoms
• Madurmycosis - chronical granulomatous infection
  of bone and soft tissue, deformations, (Sudam,
  Northern Africa, East India)
• diseminated - CNS - brain abscesses, in
  immunocompromised
• Lab. Dg. - microscopy - modified Ziehl Neelsen,
  Gram , cultivation - standard media -2-30 days,
  colonies adherent to agar, cream, orange rose
  color, chalky consistence
• Therapy surgeryATB 3 months sulphonamids,
  amikacin, imipenem, broad spectrum to be
  effective if fungal ethiology

22
Anaerobic bacteriae

• Gcocci
  polymicrobial
• G-cocci
  endogenouse
• G-rod
  mixture
• Grod nonspores forming fac.patogenic
  
• 
  
• sporeforming patogens,
• 
  clinical units
  

23
Gcocci anaerobic

• Peptostreptococcus, -Peptococcus,- Sarcina (fac.
  anaerobic) -
  Coprococcus, - Ruminococcus
  -
  colonisation of the skin and mucouse membrane
  GIT, UGT, -
  oportunistic patogens in connection with foreign
  bodies cultivation require special grow
  conditions, slowly growing
  
  
  Clinical symptoms - pleuropneumonia
  following aspiration, sinusitis, brain absces
  spreading from oropharynx or lung,
  
  - intraabdominal infection and sepsis
  spreading from colon,
  - pelvic infections (endometritis, absces,
  puerperal sepsis, bacterial vaginosis)
  
  
  - infection of soft tissue (celulitis),
  endocarditis, osteomyelitis
• Laboratory diagnosis colonising bacteria or
  ethiological agent, sampling and transport under
  anaerobic conditions, prolonged cultivation on
  enriched media
• Th - PNC, cefalosporins, imipenem, CMP -
  polymicrobial ethiology.

24
G-cocci

• anaerobic
• Veillonella, Megasphera present in oropharynx,
  low virulence, in cultivation usually part of
  polymicrobial mixture

25
G-rod anaerobic

• Bacteroides fragilis
  
  obligatory anaerobic rod, not sporeforming,
  
  - most important part of
  fysiological flora in oropharynx, UGT, GIT.
  
• Clinical symptomes - pleuropneumonia,
  intraabdominal abscess, genital infections.
  
• Endogenous and polymicrobial infections,
  absceses after break down of physiological
  barieres.
• Lab.dg. strictly anaerobic sampling, transport
  and cultivation
  stimulation of the growth by 20 cholic
  acid.
  
  
• Th surgery intervention ATB, - B.producesa
  betalactamase, Metronidasol
• B(G). stearothermophilus- spores used for testing
  efficiency of sterilisation devices
• Prevotella, Porphyromonas, Fusobacterium,
  Leptotricha, Wolinella colonisation of
  orofarynx, GIT, UGT, part of physiological flora,
  pathogenic after the breakdown of natural
  barieresr e.g.. Surgical intervention
• They produce histolytical enzymes,
• absceses and polymicrobial infection (CNS,
  UGT,intraabdominal)
• Production of betalaktamase resistente to
  PNC.
• Lab. dg. Anaerobic sampling and transport,
  prolonged cultivation

26
Grods aerobic

• Spores forming
  
  - Bacillaceae - Bacillus cereus,
  B. antracis - flagella, facultative anaerobes or
  strict aerobes. Production of toxins.
• Nonsporesforming
  
  - Listeria
  monocytogenes - motile, aerobic, surviving 22C
  and broad interval of pH, infecting annimals
  
  -
  Corynebacteriaceae -aerobic nonmotile slightly
  curved, forming picture of alphabet letters,
  irregularly stainable Containing metachromatic
  granules, production of toxin -
  lysogenic conversion - toxigenicita of strains
  - Eleks test.
  
  Corynebacterium diphtheriae, C.
  pseudodiphtericum,
  
  Erysipelotrix rusiopathiae - facult. anaerobic,
  transmission from annimals, grey colonies, alfa
  hemolysis,
  
  
  Nocardiaceae Nocardia asteroides
  contain lipid in the cell wall modified Ziehl
  Neelsen staining, nonmotil, filamentous form in
  microscopy, prolonged cultivation

27
Grods anaerobic nonsporesforming

• - Actinomycetaceae Actionomyces israeli,
  A.naeslundii
• Clinical signs cerebral, cerevicofacial,
  abdominal, thoracal actinomycosis,
• chronical pyogenic infection with absceses.
  
  
• Lab.dg. Sampling from the depth of sinus or
  abscess containing sulphur granules, typical
  colonies looking like tooth molar, requiring,
  long cultivation.
  
• Th surgery ATB prolonged PNC
  
  -Propionibacteriaceae
  Propionibacterium acnes
  
• colonisation of skin, external ear, conjunctiva,
  orofarynx, female external genital tract.
• Clinical symptomes Acne and opportunistic
  infections in patients with foreign bodies.
• Lab. dg. On common media, prolonged cultivation
  
  - Mobiluncus
  ---gram variable, structue of G, curved, growth
  reqirements, colonisation of fem.external genital
  in case of dysmicrobia - vaginosis
  
  
  -Bifidobacteriaceae, Eubacteriaceae,-
  Lactobacillaceae . part of physiological flora

28
Anaerobic Gram sporesforming rodsClostridium
sp.

• strictly anaerobic, spores typically localised in
  the cell enlarging the body, proteolytical
  ensymes, production of toxins,
• C. tetaní tetanus traumatic
• - newborne
• C. botulinum - botulizmus newborne
  
• -
  wound
  
• - food
  borne
• C. septicum - nontraumatic myonecrosis, patients
  immunocompromised - Ca of colon
  
  - breakdown of the integrity of colon, spread of
  clostridia in tissues, hyperacute course
• C. difficile - pseudomembranouse colitis
  connected with broad spectrum ATB therapy,
  
  
  produces 2 toxins, part of FF,
  exposition to ATB taht eliminate colon bacterial
  flora overgrowth of C. difficile and its spores

29
Anaerobic gram spores forming rodsClostridia
of anaerobic traumatoses

• Clostridia - 100 species, some of them can be
  aerotolerantné
  
  - C. histolyticum can looks like gram
  negatívne, spores not constantly detectable.
  Commonly present in soil, water, GIT of annimal
  and human.
• C. perfringens - Bacteraemia, myonecrosis gas
  gangrene, infection of soft tissue, necrotising
  enteritis

30
Clostridium tetani

• Motile rod, spores forming, spores enlarging
  cell,squash rocket, transiently gram negative.
  Very sensitive to oxygen, metabolically very
  active.
• Produces 2 toxins - Termolabil neurotoxin-
  tetanospasmin released from lysing cells. AB
  toxin - blocking neurotransmitters in CNS on na
  inhibation synapsesh nonregulation of
  excitation synaptic activity - spastic paraysis,
  convulsions.
  -
  tetanolysin
• Present in soil and GIT of annimal. Vegetative
  formes are very sensitive on oxygen. Spores are
  surviving years
• Generalised tetanus, - localised tetanus, -
  nexborne tetanus, - tetanus of drug abusers
• Therapy - PNC, antitoxin, - toxin bound on
  synapses is not neutralisable and ATB are active
  agains viable cells (not toxin) Symptomatic
• Vaccination

31
(No Transcript)
32
Clostridium botulinum

• Heterogennous group, nutritionnaly requiring
  spores forming rods. 4 groups I
  - IV based on proteolytical aktivity a type of
  toxin.
• Producing 7 antigenically different botulotoxines
  A,B,C alfa, D, E, F, G - A,B,E most frequent. AB
  toxin , termolabil toxin - 20minutes/80C
• Blocking transmission on nervemuscular platelet
  on synapses of periferic nerves.
• Food borne, wound botulisme, infant botulisme
• Blurred vision, dilatation of pupils, dry tongue,
  constipation, bilateral muscular weakness
  complete restoration after months or years
  
• Wound botulisme very rare
  
  
• Infant botulisme - 1976 - in vivo production of
  neurotoxin in colon colonising clostridia (age of
  6mnth - 1 y) progresive paralysis, respiration
  failure - mortality 1 - frequently cause of SIDS
• Dg. - clinical, detection of clostridium or toxin
  
  
• Th. lavage of stomach antitoxin,
  
  
• PNC, destruction of spores and
  prevention of spores germination

33
Clostridium botulinum
34
Clostridium perfringens

• Colonisation or sever disease, spores are seen
  scarecely, hemolysis, metabolic aktivity.
• Production of letal toxins (alfa, beta, epsilon,
  iota, termolabil enterotoxin) with sever life
  threating biological activity, ensymes. Types
  A-E A in environment, B-E in colon,
  A gas
  gangrene and intoxication, C necrotizing
  enteritis
• Microscopy - Grods without leu in clinical
  samples Th
  surgery in traumatoses, high doses of PNC,
  antitoxin, hyperbaric room for oxygen therapy

35
Clostridium perfringens

• Bacteraemia usually not significant, transient
  from skin contaminant.
• Gas gangrene life threating, histotoxic
  clostridia, after injury, devitalised tissue
  gas production. (C. septicum, histolyticum,
  novyi)
  
  
• Celulitis, fasciitis after colonisation of the
  wound, oftently not important or rapidly
  progressing destruction of tissue (C. septicum)
  
  
• Necrotizing enteritis small intestine, typ C,
  50 letality
  Food borne intoxication short
  incubation time, spasmes, watery diarrhoe
  ingestion of contaminated food, toxin -
  termolabil protein