Microbiology 1-2

FPGEE Preparation Basem Sayed March 10, 2013

Introduction
Type of Cells Prokaryotes : No Nucleus, No Organelles
o Examples: Bacteria, spirochetes, chlamydia, rickettsia

Eukaryotes : Well-defined nucleus and membrane bound organelles

o Examples: Animal and plant cells Fungi, Protozoa, metazoa

Prokaryotes

Eukaryotes

Simplicity
Example

More simple cells

Bacteria Genetic material scattered

More advanced- complicated

Fungi Protozoa Plant cells Genetic material inside the

Genetic Material
Genetic material is circular

nucleus
Linear

Exist in all Prokaryotes, except Plant cell wall composed of

mycoplasms
Cell wall Peptido Protein)

composed
(Sugar

of Pectin and Cellulose

+ Fungi Cell wall is composed of Chitin

glycan

Division
Reproduction Ribosomes (are

Binary Fission
Asexual different 70 S (30S-50S)

Meiosis and Mitosis

Sexual or asexual 80S (40S-60S)

between prok and eukar)

Viruses
They are extremely small microbes that are essentially fragments of nucleic acid (DNA or RNA) packaged in a protein shell Viruses are seen with electronic microscope only Viruses are not living organisms. They are acellular (April 2012).

MCQ Questions
Mycoplasms: Smallest free living microbes Lack bi-layered cyotplasmic membrane They do not required host cells for replication (different from viruses) Do not have a cell wall they are just limited by lipid membrane They are different from all bacteria that they are obligate intracellular parasite

Chylamedia and Rickettsiae species

They are also small mycoplasmas They have cell walls prokaryotes but larger than

Classification Obligate aerobes

Characteristics Require oxygen Have no fermentative pathways Generally produce superoxide dismutase Requires low but not full oxygen tension

Important Genera Mycobacterium

Pseudomonas
Campylobacter Helicobacter

Microaerophilic

Facultative anaerobes

Will respire aerobically until oxygen is depleted and then ferment or respire anaerobically 1. Lack superoxide dismutase 2. Generally lack catalase 3. Are fermenters 4 Cannot use 0 2 as terminal electron acceptor

Most bacteria, e.g., Enterobacteriaceae

Obligate anaerobes

Bacteroides Clostridium Actinomyces

Factors affect bacterial growth

Aerobic or anaerobic conditions Temperature Most bacteria grow at temperature between 35C 42C pH conditions Most bacteria favor neutral pH Most acidic food like vinegar are rarely contaminated with bacteria Salinity Light conditions Availability of water and organic materials

Bacterial Replication
Bacteria are replicated asexually and exponentially by binary fission

Bacterial Growth curve

Shapes of Bacteria

Differences between Gm+ve and GM-ve bacteria

Gm +ve Capsule

Gm -ve

Both have polysaccharide protective capsule except Anthrax which has polypeptide capsule absent Hydrophobic membrane: LPS = endotoxin Lipid A= toxic moiety PS = immunogenic portion Thin Present Both

Outer membrane (above the cell wall)

Cell wall Periplasmic space Cytoplasmic membrane

Thick and contain Teichoic acid Absent

Endospores
Some bacteria tend to form spores from vegetative cells Survival not reproductive (One bacterium gives one spore) Spores are resistant to chemicaJs, dessiccation, radiation, freezing, and heat. They germinate again in favorable conditions.

What are the differences between endotoxin and Exotoxin

Endotoxins: Endotoxin (Lipopolysaccharide = LPS) LPS is part of the gram-negative outer membrane Exotoxins Are protein toxins, generally quite toxic and secreted by bacterial cells (some gram+, some gram-) Can be modified by chemicals or heat to produce a toxoid that still is immunogenic but no longer toxic so can be used as a vaccine Exotoxins may be subclassed as enterotoxins, neurotoxins, or cytotoxins

MCQs
Any microorganism can become pathogenic in such individuals. the likelihood of a particular infectious pathogen causing disease is a function of the following variables: 1. the level of host resistance. 2. the aggressiveness of the invading organism, which is known as virulence. Toxins produced by the pathogens can also increase their virulence. 3. the absolute number of the microbes in some instances (dose) or (inoculum).

MCQs
Reservoirs Environments or hosts that support growth of infectious organisms. Reservoirs can be water, soil, or animals. A carrier It is a host that has recovered from an infectious disease but continues to shed the pathogen. Vectors They do not cause infectious diseases but carry pathogens from one host to another. Mosquitoes are vectors for malaria, yellow fever, West Nile virus, and Dengue fever. Ticks are vectors for Lyme disease, Rocky Mountain spotted fever, and Q fever. fleas are vectors for the plague.

Classifications of diseases and infections

Infections are classified as : Primary infections: if the initial disease is caused by the invading organism. Secondary infection: it generally occurs because of a weakened immune system or because of the use of antimicrobials. Infectious diseases can also be referred to by their geographic site of onset community acquired hospital acquired infection develop after admission to a health care institution (nosocomial infection).

Communicable diseases
Communicable infectious diseases refer to those that can be transmitted from host to host. All communicable diseases are infectious, but not all infectious diseases are communicable; if an infectious disease is highly communicable it is said to be contagious. Communicable infectious diseases can be: endemic, which refers to a low level of disease within a select geographic area. An epidemic refers to an explosive outbreak of a disease within a population. pandemic indicates a disease that is worldwide.

Staphylococcus
Genus Features Gram-positive cocci in clusters Species of medical Importance S. aureus S. epidermidis: normal flora S. saprophyticus: The only species of staph able to cause UTI N.B. All staph species are Catalase positive (streptococci are catalase negative)

Staphylococcus aureus
Distinguishing Features Small, yellow colonies on blood agar Bhemolytic Coagulase positive (all other Staphylococcus species are negative) Reservoir Normal flora : Skin Nasal mucosa (25% of population are carriers) Transmission Hands Sneezing Surgical wounds Contaminated food Potato salad Canned meats

 Pathogenesis Toxic Shock syndrome toxin-1 (TSST-1): superantigen Entertoxins: fast acting and heat stable Exfolatins: skin exfoliating toxin involved in scaled skin syndrome (SSS) Diseases Toxic shock syndrome: Fever, hypotension, sun burn like rash that desquamates on palms and soles.

Continue diseases of staph. A.

Gastroenteritis (food poisoning): Enterotoxin is ingested with food. 2- 6 hours after ingesting toxin: nausea, abdominal pain, vomiting, followed by diarrhea Impetigo Erythematous papules because of Coagulase, and exfoliatins toxin.

Treatment
Gastroenteritis is self-limiting. Nafcillin/oxacillin are drugs of choice because of widespread antibiotic resistance as staph is a huge nosocomial infectious agents. For methicillin-resistant Staphylococcus aureus (MRSA): vancomycin is the drug of choice For vancomycin-resistant Staphylococcus aureus (VRSA) or vancomycin-intermediate S. aureus (VISA): quinupristin/dalfopristin (Synercid)R

GENUS: STREPTOCOCCUS
Genus Features Gram-positive cocci in chains Catalase negative Species of Medical Importance S. pyogenes S. agalactiae (group B streptococci; GBS) S. pneumoniae Viridans streptococci

Streptococcus pyogenes
Reservoir Human throat Skin Transmission Direct contact Respiratory droplets

 Virulence factors Streptokinase: breaks down fibrin dot Exotoxins A-C (pyrogenic or erythrogenic exotoxins) Cause fever and the rash of scarlet fever. Diseases 1. Pharyngitis Abrupt onset of sore throat, fever, malaise, and headache; tonsillar abscesses and tender anterior cervical lymph nodes 2. Scarlet fever blanching "sandpaper'' rash (palms and soles are usually spread), strawberry tongue, and nauea and vomiting

Sequelae of Streptococcal infections

Disease Rheumatic fever Sequelae of
Pharengitis with Strept. Pyogenes

Mechanisms/Sympt oms
Antibodies to heart tissue/ 2 weeks post pharyngitis, fever, joint inflammation. type II hypersensitivity Immune complexes bound to glomeruli, pulmonary edema and hypertension, smoky" urine (type III hypersensitivity)

Acute glomerulonephritis

Pharyngitis or skin infection

Cont. S.Pyogenes
Treatment Beta lactam drugs Macrolides arc used in the case of penicillin allergy. Prevention Prophylactic antibiotics (B-lactams and macrolides) should be considered in patients for at least 5 year post acute rheumatic fever.

Streptococcus pneumoniae
Distinguishing Features Lancet-shaped diplococci Alpha hemolytic Reservoir human upper respiratory tract Transmission Respiratory droplets Virulence factors Polysaccharide capsule is the major virulence factor

Diseases of Streptococcus pneumoniae

Most common cause of the following diseases Adult Typical pneumonia (community acquired pneumonia): (especially in sixth decade of life) Adult meningitis Otitis media and sinusitis in children--most common cause Laboratory Diagnosis Quellung reaction: positive (swelling of the capsule with the addition of type-specific antiserum) Treatment Bacterial pneumonia: macrolides Adult meningitis: Ceftriaxone or cefotaxime. Vancomycin is added if penicillin-resistant S. pneumoniae has been reported in the community Otitis media and sinusitis in children: amoxicillin, erythromycin

 Prevention: 1. Antibody to the capsule 2. Vaccine Pediatric (PCV, pneumococcal capsular vaccine)
o Conjugated to diphtheria toxoid

Adult (PPV, pneumococcal polysaccharide vaccine) Recommended for all adults 65 years of age and any at-risk individuals

GENUS: CLOSTRIDIUM
Genus features Gram positive rods Spore forming Anaerobic Species of Medical Importance Clostridium tetani Clostridium botulinum Clostridium perfringens Clostridium difficile

Clostridium tetani
Reservior Soil Transmission Puncture wounds from rusty nails Pathogenesis Spores germinate .in the tissues, producing tetanus toxin (exotoxin also called tetanospasmin). Binds to ganglioside receptors Blocks release of inhibitory mediators (glycine and GABA) at spinal synapses.

 Disease Tetanus: characterized by risus sardonicus, Opisthotonus and extreme muscle spasms. Treatment of Actual Tetanus Hyperimmune human globulin (TIG) to neutralize toxin plus metronidazole or penicillin Spasmolytic drugs (diazepam); debridement delay closure of wound Prevention Toxoid is formaldehyde-inactivated toxin. Wound care

Clostridium botulinum
Reservoir soil/dust Transmission foodborne/traumatic Pathogenesis Spores survive in soil and dust; germinate in moist, warm, nutritious anaerobic conditions Release Botulinum toxin (polypeptide neurotoxin ) Heat labile (unlike staph), 10 minutes 60.0C Blocks release of acetylcholine at the myoneuronal junction resulting in a reversible flaccid paralysis

Forms of botulism
Adult botulism Infant botulism

Acquisition

Preformed toxin ingested (toxicosis) Poorly canned alkaline vegetables (green beans), smoked fish
1-2 day onset of Symptoms: weakness, blurred vision, flaccid paralysis (reversible), diarrhea Respiratory support, Trivalent (A-B-E) antitoxin Proper food canning

Spores ingested: household dust, honey

Symptoms

flaccid paralysis, weak feeding/crying; may lead to respiratory arrest

Treatment

Respiratory support and hyperimmune human serum No honey first year

Prevention

Clostridium perfringens
Distinguishing Features Large gram-positive, spore-forming rods (spores rare in tissue), "stormy fermentation" in milk media Double zone of hemolysis Reservoir soil and human colon Transmission traumatic implantation

Pathogenesis
Spores germinate under anaerobic conditions in tissue. Vegetative cells produce: Alpha toxin (phospholipase C) is a lecithinase. It disrupts membranes, damaging RBCs, platelets, WBCs, endothelial cells which results in tissue destruction and myonecrosis. Identified by Nagler reaction: egg yolk agar Twelve other toxins damage tissues. Enterotoxin produced in intestines in food poisoning: watery diarrhea, cramps (similar to E. coli); resolution <24 hours.

Disease
Gas gangrene (myonecrosis) Contamination of wound with soil or feces Acute and increasing pain at wound site Tense tissue (edema, gas) and exudate Systemic symptoms include fever and tachycardia Rapid, high mortality Treatment of Gangrene Debridement, delayed closure of wound, clindamycin and penicillin, hyperbaric chamber

Clostridium difficile
Reservoir human colon/gastrointestinal tract Transmission Endogenous Pathogenesis Toxin A; enterotoxin damaging mucosa leading to fluid increase; granulocyte attraction Disease(s) pseudomembranous colitis (yellow plaques on colon antibiotic-associated (clindamycin, cephalosporin, amoxicillin, ampicillin diarrhea, colitis, or)

 Diagnosis Culture is not diagnostic because organism is part of normal flora Stool exam for toxin production Treatment Severe disease--metronidazole (vancomycin): use only if no other drug available. Mild disease--discontinue other antibiotic therapy