Gram Positive (purple/blue) CocciRods (bacilli) CLOSTRIDIUM (anaerobe) LISTERIA BACILLUS...

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Gram Positive (purple/blue) Cocci Rods (bacilli) CLOSTRIDIUM (anaerobe) LISTERIA BACILLUS CORYNEBACTERIUM Catalse (+) STAPH Catalse (-) STREP Coagulase (+) S. AUREUS Coagulase (-) Novobiocin (+) S. EPIDERMIDIS Novobiocin (-) S. PNEUMONIAE Hemolysis α β γ Capsule S. PNEUMONIA No Capsule VIRIDANS STREP Group A S. PYOGENES Group B S. AGALACTAIE ENTEROCOCCUS PEPTOSTREPTOCOCCUS

Transcript of Gram Positive (purple/blue) CocciRods (bacilli) CLOSTRIDIUM (anaerobe) LISTERIA BACILLUS...

Page 1: Gram Positive (purple/blue) CocciRods (bacilli) CLOSTRIDIUM (anaerobe) LISTERIA BACILLUS CORYNEBACTERIUM Catalse (+) STAPH Catalse (-) STREP Coagulase.

Gram Positive (purple/blue)

Cocci Rods (bacilli)CLOSTRIDIUM (anaerobe) LISTERIABACILLUSCORYNEBACTERIUM

Catalse (+)STAPH

Catalse (-)STREP

Coagulase (+)S. AUREUS

Coagulase (-)

Novobiocin (+)S. EPIDERMIDIS

Novobiocin (-)S. PNEUMONIAE

Hemolysis

α

β

γ

CapsuleS. PNEUMONIA

No CapsuleVIRIDANS STREP

Group AS. PYOGENESGroup BS. AGALACTAIE

ENTEROCOCCUSPEPTOSTREPTOCOCCUS

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Gram Negative (pink)

Cocci Rods

“Coccoid” RodsH. FLUPASTURELLABRUCELLABORDETELLA PERTUSSISMaltose Fermenter

NEISSERIA MENINGITIDISNon FermenterNEISSERIA GONORRHOEAE

Fast lactose FermenterKLEBSIELLAE. COLIENTEROBACTER

Slow FermenterCITROBACTERSERRATIA

Lactose Nonfermenter

Oxidase NegativeSHIGELLASALMONELLAPROTEUS

Oxidase PositivePSEUDOMONAS

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Page 4: Gram Positive (purple/blue) CocciRods (bacilli) CLOSTRIDIUM (anaerobe) LISTERIA BACILLUS CORYNEBACTERIUM Catalse (+) STAPH Catalse (-) STREP Coagulase.

Gram positive Gram negative

2 envelope layers: 1) cytoplasmic membrane 2) thick peptidoglycan layer

3 envelope layers: 1) cytoplasmic membrane 2 )thin peptidoglycan layer

3) phospholipid/LPS Low lipid content High lipid contentNo endotoxin Endotoxin No periplasmic space Periplasmic space

Teichoic Acid O Specific Side chain

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Metabolic Characteristics

• Obligate aerobes

• Facultative anaerobes

• Microaerophilic bacteria

• Obligate Anaerobes

•Love oxygen •Need it to grow•Have all 3 enzymes

•Like oxygen /doesn’t require it

•Can use anaerobic fermentation

•Catalase and Superoxide Dismutase

•Like small amounts of oxygen•Aerotolerent anaerobes•Superoxide Dismutase

•Don’t like oxygen•No enzymes to counter act

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Gram Positive Pathogens• Cocci

– Staphylococci– Streptococci

• Rods (bacilli)– Spore formers

• Bacillus • Clostridium

– Nonspore formers• Nonfilamentous

– Corynebacterium– Listeria– [Mycobacterium-kind of]

• Filamentous– Actinomyces– Nocardia

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Gram Positive Pathogens

Staphylococcus

StreptococcusCocci-catalase test

Streptococci-negative

Staphylococci-positive

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Genus: Staphylococci• Gram Positive Cocci in groups and clusters• Catalase positive• Coagulase Test for differentiation

– S. Aureus-positive– S. Epidermidis-negative– S. Saprophyticus-negative

Virulence factors

•Surface protein A binds to Fc portion of IgG (prevents opsonization)

•Enterotoxin and TSST-1 toxins

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Staphylococcus AureusDirect infection

Impetigo

MRSA

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Staphylococcus Aureus diseases due to toxins

Scalded Skin Syndrome

Enterotoxin

Very stable

TSST-1

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Genus: Staphylococcus

Staph Epidermidis

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Genus: Streptococcus

Catalase Negative Gram Positive Cocci in pairs and chains

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Genus: Streptococcus

• S. pyogenes• S. agalactiae• S. pneumoniae • Enterococcus

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Genus: Streptococcus

• Lancefield Antigens– Lancefield antigens denote cell wall carbohydrates– The presence of Lancefield antigens defines the

pyogenic streptococci– Groups A through T

• A,B, C and D are most important

– Some Streptococcus are not assigned (they do not possess) Lancefield antigens

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Genus: Streptococcus

• Hemolysis on BAP• The hemolysis is defined as alpha, beta and gamma

No Complete Partial

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Genus: Streptococcus• Strep Pyogenes

– Group A Beta Strep– Strep throat, scarlet fever, rheumatic fever, acute

glomerulonephritis, impetigo• Strep Agalactactiae

– Group B Beta Strep– Perinatal sepsis, meningitis and/or pneumonia

• Strep Pneumoniae– Pneumococcus– Optichin Sensitive– Otitis media, pneumonia, meningitis

• Enterococcus – Group D– UTI

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Genus: Streptococcus

• Group A Beta Strep– S. pyogenes

• Strep Throat• Scarlet Fever• Rheumatic Fever• Post Streptococcal Glomerulonephritis• Impetigo

Strawberry tongue

Pharyngitis

Lancefield Antigen Hemolysis on BAP

Chromatographic Immunoassay

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Genus: Streptococcus

• Strep Agalactactiae– Group B Beta Strep– Perinatal sepsis, meningitis and/or

pneumonia• Early Sepsis within one week of birth• Late Sepsis from 7days to 3 months of

birth

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Genus: Streptococcus• Alpha hemolysis• Optichin Sensitive• Gram positive Lancet Shaped Diplococci • Strep Pneumoniae

– Pneumococcus (nickname)– Otitis media, pneumonia, meningitis

Right lower lobe pneumoniaencapsulated

Significant sequalae

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Genus: Streptococcus

• Enterococcus – Group D– Virulence Factors

• Abx resistant due to PBP• Acquired Resistance• Enzymes• Adherence factors• Biofilm formation

– UTI, catheter related infections

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Gram Positive Spore Forming Rods

• Bacillus (Fac. Anaerobe)• Clostridium (Strict Anaerobe)

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Genus: Bacillus

• Fac. Anaerobe• G + Spore Forming Rod • Bacillus

– B. Anthracis• Cutaneous• Respiratory• Intestinal

RespiratoryB. Anthracis

BAP

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Genus: Clostridium

• Anaerobic G + Rod• Spore formers• Clostridium

– C. Perfringens– C Tetni– C. Botulinum– C. Difficile

Target hemolysis on BAP ~ two zones due to production of 2 toxins

Myonecrosis/ gas gangrene

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Genus: Clostridium• Anaerobic G + Rod• Spore formers• Clostridium

– C. Perfringens– C Tetni– C. Botulinum– C. Difficile

Terminal Spore

Tennis Racket

Neurotoxin binds to presynaptic terminals in prevents transmission of inhibitory neurotransmitters

DTP and DTaP

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Genus: Clostridium

• Anaerobic G + Rod• Spore formers• Clostridium

– C. Perfringens– C Tetni– C. Botulinum– C. Difficile

Infantile Botulism caused by spore ingestion with endogenous toxin production

Spores

Toxin ingestion (usual)

Page 26: Gram Positive (purple/blue) CocciRods (bacilli) CLOSTRIDIUM (anaerobe) LISTERIA BACILLUS CORYNEBACTERIUM Catalse (+) STAPH Catalse (-) STREP Coagulase.

Genus: Clostridium• Anaerobic G + Rod• Spore formers• Clostridium

– C. Perfringens– C Tetni– C. Botulinum– C. Difficile

Plain film of abdomen showing bowel wall thickening, loss of haustral markings (thin arrow) and dilation of the ascending and transverse colon (thick arrow)

Endoscopic view of Psuedomembranous colitis

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Gram Positive Nonspore Forming Rods

• Nonfilamentous– Corynebacterium– Listeria– [Mycobacterium-kind of]

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Genus: Corynebacterium• Gram Positive Nonspore Forming Rods• Immobile• Nonencapsulated• Nonfilamentous• Corynebacterium

– C. Diphtheriae

Pallisades/ Chinese Letter Arrangements

Barred appearance (metachromatic granules)

Pseudomembrane of throat and/or nasal cavity

DTP and DTaP

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Genus: Listeria

• Gram Positive Nonspore Forming Coccobacilus• Tumbling motility at 25 degrees Celsius• Nonfilamentous

– Listeria• L. Monocytogenes

Beta hemolysis

Raw milk, soft cheeses, ice cream, raw vegetables, raw or cooked poultry, raw meat, raw or smoked fish

Transplacental and birth canal transmission

Page 30: Gram Positive (purple/blue) CocciRods (bacilli) CLOSTRIDIUM (anaerobe) LISTERIA BACILLUS CORYNEBACTERIUM Catalse (+) STAPH Catalse (-) STREP Coagulase.

Genus: Mycobacterium• Gram Positive Nonfilamentous Nonspore Forming Rods• Strict aerobe• Very slow growing• Weakly gram positive• Acid Fast-waxy cell wall-mycolic acid

– [Mycobacterium -kind of]• M. Tuberculosis• M.Leprae

Divides every 15 to 20 hours

Acid fast gram positive bacteria

PPD

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Genus: Mycobacterium• Gram Positive Nonfilamentous Nonspore Forming Rods• Waxy coating->acid fast• Aerobic/ nonmotile• Can not grow in artificial culture• [Mycobacterium -kind of]

– M. Tuberculosis– M.Leprae

• Leprosy• Hanson’s Disease

Nine banded Armadillo

Incubation is 2-20 years

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• Gram Positive Filamentous Nonspore Forming Rods

• Aerobic to Fac. Anaerobe• Opportunistic• Actinomyces

– A. Israelii• Nocardia

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Genus: Actinomyces

• Gram Positive Filamentous Nonspore Forming Rods

• Aerobic to Fac. Anaerobe• Non acid fast• Opportunisitic• Actinomyces

– A. Israelii Lumpy Jaw

Actinomycoses infections are polymicrobial

Page 34: Gram Positive (purple/blue) CocciRods (bacilli) CLOSTRIDIUM (anaerobe) LISTERIA BACILLUS CORYNEBACTERIUM Catalse (+) STAPH Catalse (-) STREP Coagulase.

Genus: Nocardia• Gram Positive Filamentous • Branching• Weakly acid fast• Strict aerobe• Catalase positive• Nonspore Forming Rods

– Nocardia

Primary source is soil

Colonies smell like wet dirt

Low virulence opportunistic infection

Page 35: Gram Positive (purple/blue) CocciRods (bacilli) CLOSTRIDIUM (anaerobe) LISTERIA BACILLUS CORYNEBACTERIUM Catalse (+) STAPH Catalse (-) STREP Coagulase.

Now on to Gram Negatives

Page 36: Gram Positive (purple/blue) CocciRods (bacilli) CLOSTRIDIUM (anaerobe) LISTERIA BACILLUS CORYNEBACTERIUM Catalse (+) STAPH Catalse (-) STREP Coagulase.

Gram Negative Cocci

• Neisseria– N. Meningitidis– N. Gonnorhea

• Moraxella– Branhemella Cattorhalis

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• Gram Negative Cocci • Kidney bean shape• Ferments maltose and glucose like

meningitis• Oxidase and catalase positive• Endotoxin production• Neisseria

– N. Meningitidis• Meningiococcus (nickname)• Meningitis, septic shock

– N. Gonnorhea

Nonblanching petechial rash

Kidney bean shape

Not B

Direct or from cultured specimen

Page 38: Gram Positive (purple/blue) CocciRods (bacilli) CLOSTRIDIUM (anaerobe) LISTERIA BACILLUS CORYNEBACTERIUM Catalse (+) STAPH Catalse (-) STREP Coagulase.

• Gram Negative Cocci• Kidney bean shaped • Neisseria

– N. Gonorrhea• Gonorrhea• Ophthalmia Neonatorum

Culture is the gold standard

Nucleic Acid Amplification TestsOphthalmia Neonatorum

$$$

Page 39: Gram Positive (purple/blue) CocciRods (bacilli) CLOSTRIDIUM (anaerobe) LISTERIA BACILLUS CORYNEBACTERIUM Catalse (+) STAPH Catalse (-) STREP Coagulase.

• Gram Negative Cocci • Aerobic• Moraxella

– Branhemella Catorrhalis• Otitis media, sinusitis

sinusitis

Otitis media

Page 40: Gram Positive (purple/blue) CocciRods (bacilli) CLOSTRIDIUM (anaerobe) LISTERIA BACILLUS CORYNEBACTERIUM Catalse (+) STAPH Catalse (-) STREP Coagulase.

Gram Negative Spirochetes

• Treponema– T. Pallidum

• Borrelia– B. Burgdorfi– B. Recurrentis

• Leptospira

Page 41: Gram Positive (purple/blue) CocciRods (bacilli) CLOSTRIDIUM (anaerobe) LISTERIA BACILLUS CORYNEBACTERIUM Catalse (+) STAPH Catalse (-) STREP Coagulase.

Gram Negative Spirochetes• Too small for gram stain• Can not be cultured from clinical specimen• Dark field microscopy of clinical sample• Treponema

– T. Pallidum• Syphillus-acquired and congenital

– Nontreponemal tests– Treponemal tests

Electron Micrograph

Secondary stage

Page 42: Gram Positive (purple/blue) CocciRods (bacilli) CLOSTRIDIUM (anaerobe) LISTERIA BACILLUS CORYNEBACTERIUM Catalse (+) STAPH Catalse (-) STREP Coagulase.

Gram Negative Spirochetes

• Microaerophilic• Geimsa or Wright stain• Borrelia

– B. Burgdorfi

Erythema migrans

western black-legged tick (Ixodes)

Page 43: Gram Positive (purple/blue) CocciRods (bacilli) CLOSTRIDIUM (anaerobe) LISTERIA BACILLUS CORYNEBACTERIUM Catalse (+) STAPH Catalse (-) STREP Coagulase.

Gram Negative Spirochete• Aerobic• Motile• G –cell envelope• Animal reservoirs• Flexible spirochete• Not seen on gram stain• Dark field microscopy• Leptospira

– L. Interrigans

Petichial rash

Fine spirals with hooked ends

Water transmission

Page 44: Gram Positive (purple/blue) CocciRods (bacilli) CLOSTRIDIUM (anaerobe) LISTERIA BACILLUS CORYNEBACTERIUM Catalse (+) STAPH Catalse (-) STREP Coagulase.

Many Many Gram Negative Bacilli• Respiratory

– Heamophilus – Bordetella– Legionella– Gardnerella

• Zoonotics– Yersinia– Franicisella– Brucella– Pasteurella– Bartonella

• Enterics – Many many

Page 45: Gram Positive (purple/blue) CocciRods (bacilli) CLOSTRIDIUM (anaerobe) LISTERIA BACILLUS CORYNEBACTERIUM Catalse (+) STAPH Catalse (-) STREP Coagulase.

Respiratory Gram Negative Bacilli

• small pleomorphic, gram-negative coccobacillus. • Nonmotile• non–spore-forming• fastidious• facultative anaerobe• Heamophilus

– H. Influenzae– H. Ducryi

Page 46: Gram Positive (purple/blue) CocciRods (bacilli) CLOSTRIDIUM (anaerobe) LISTERIA BACILLUS CORYNEBACTERIUM Catalse (+) STAPH Catalse (-) STREP Coagulase.

Respiratory Gram Negative Bacilli

• Small pleomorphic, gram-negative coccobacillus. • Nonmotile• non–spore-forming• Fastidious-X &V factor• facultative anaerobe• Heamophilus

– H. Influenzae• HIb• Epiglottitis, otitis media, meningitis, pneumonia

– H. Ducryi

Otitis media

Satelliting around Staph.

Epiglottitis

Insp. Stridor

conjugated

Page 47: Gram Positive (purple/blue) CocciRods (bacilli) CLOSTRIDIUM (anaerobe) LISTERIA BACILLUS CORYNEBACTERIUM Catalse (+) STAPH Catalse (-) STREP Coagulase.

Respiratory Gram Negative Bacilli

• small pleomorphic, gram-negative coccobacillus.

• Nonmotile• non–spore-forming• Fastidious-X &V factor

– Dies quickly outside of body

• facultative anaerobe Heamophilus – H. Ducryi

• “soft chancre”• Culture is difficult• chancroid

Painful genital ulcer

Page 48: Gram Positive (purple/blue) CocciRods (bacilli) CLOSTRIDIUM (anaerobe) LISTERIA BACILLUS CORYNEBACTERIUM Catalse (+) STAPH Catalse (-) STREP Coagulase.

Respiratory Gram Negative Bacilli

• Small aerobic G- Coccobacilllus• Singly and in pairs• Nicotinamide required for (slow)

growth• Bordetella

– B. Pertussis– Whooping cough

Bordet-Gengou medium

ELISA or PCR assays

DTP & DTaP Paroxysmal cough with an inspiratory whoop

Page 49: Gram Positive (purple/blue) CocciRods (bacilli) CLOSTRIDIUM (anaerobe) LISTERIA BACILLUS CORYNEBACTERIUM Catalse (+) STAPH Catalse (-) STREP Coagulase.

Respiratory Gram Negative Bacilli

• Nicotinamide required for (slow) growth• Bordetella

– B. Pertussis– Whooping cough

Virulence factors•Pili and surface protein for adhesion•Pertussis toxin•Enzyme that disrupts immune response•Peptidoglycan injury to ciliated trachea cells

Bordet-Gengou medium

ELISA or PCR assays

DTP & DTaP

Page 50: Gram Positive (purple/blue) CocciRods (bacilli) CLOSTRIDIUM (anaerobe) LISTERIA BACILLUS CORYNEBACTERIUM Catalse (+) STAPH Catalse (-) STREP Coagulase.

Respiratory Gram Negative Bacilli

• Poorly staining• Facultative Intracellular parasite• Compromised host• Aerobic• Legionella

– L. Pneumophila• Legionnaires' disease

– Pneumonia

Urinary antigenSputum culture

Paired serum sample

Page 51: Gram Positive (purple/blue) CocciRods (bacilli) CLOSTRIDIUM (anaerobe) LISTERIA BACILLUS CORYNEBACTERIUM Catalse (+) STAPH Catalse (-) STREP Coagulase.

NONRespiratory Gram Negative Bacilli

• Presumptive Identification– Clue Cells– KOH

• Does not require X & V factors• Gardnerella

– G. Vaginalis• Bacterial Vaginosis (BV), preterm labor

cervicitis

Whiff TestClue cells

Page 52: Gram Positive (purple/blue) CocciRods (bacilli) CLOSTRIDIUM (anaerobe) LISTERIA BACILLUS CORYNEBACTERIUM Catalse (+) STAPH Catalse (-) STREP Coagulase.

Zoonotic Gram Negative Bacilli• Yersinia

• Y. Pestis– Franicisella

• F. Tulerensis– Brucella

• B. Suis• B. Meltensis• B. Abortus• B. Canis

– Pasteurella• P. Multicida

– Bartonella• B. Henselae• B. Quintana

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Bubonic Plague

Zoonotic Gram Negative Bacilli• Nonmotile• G- rod• Yersinia

• Y. Pestis

Pneumonic Plague

bubo

Page 54: Gram Positive (purple/blue) CocciRods (bacilli) CLOSTRIDIUM (anaerobe) LISTERIA BACILLUS CORYNEBACTERIUM Catalse (+) STAPH Catalse (-) STREP Coagulase.

•G- bacillus•Aerobic•Low infecting dose•Vector->tick or deer fly•Special media•Immunoflourescence•Serum Serology (>1:40)•Franicisella

• F. Tularensis• Pneumonia• Glandular

Zoonotic Gram Negative Bacilli

ulceroglandular

pneumonia

Page 55: Gram Positive (purple/blue) CocciRods (bacilli) CLOSTRIDIUM (anaerobe) LISTERIA BACILLUS CORYNEBACTERIUM Catalse (+) STAPH Catalse (-) STREP Coagulase.

Zoonotic Gram Negative Bacilli

• Nonmotile• Non-acid fast• Nonsporeforming• Small G- coccobacillus• Catalase, oxidase and urease positive• Brucella

– Brucellosis

Blood culture

Recurrent flu-like symptoms with granulomas

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Zoonotic Gram Negative Bacilli

• Small G- coccobacillus• Nonspore forming• Oxidase positive• Ferments CHO• Nonmotile• PCN susceptible• Bacteriophage encoded toxin• Pasteurella

– P. Multocida• Cellulitis associated with

animal bites

Well demarcated cellulitis

Grows on BAP

Bipolar staining

Page 57: Gram Positive (purple/blue) CocciRods (bacilli) CLOSTRIDIUM (anaerobe) LISTERIA BACILLUS CORYNEBACTERIUM Catalse (+) STAPH Catalse (-) STREP Coagulase.

Zoonotic Gram Negative Bacilli

• fastidious • pleomorphic • aerobic • gram-negative bacillus • Bartonella

– B. Henselae• Cat Scratch Fever

– B. Quintana• Trench fever• Urban Trench Fever

Cat scratch fever

Pediculus humanus

Paired sera

Page 58: Gram Positive (purple/blue) CocciRods (bacilli) CLOSTRIDIUM (anaerobe) LISTERIA BACILLUS CORYNEBACTERIUM Catalse (+) STAPH Catalse (-) STREP Coagulase.

Family: Enterobacteriacea• Escherichia Coli• Shigella• Salmonella• Yersinia• Klebsiella• Proteus• Enterobacter • Serratia

•Enterics live in the gut-> are members of the family of Enterobacteriacea•O antigen is lipopolysaccaride•K antigen is polysaccharide capsule•H-flagellar antigen

Page 59: Gram Positive (purple/blue) CocciRods (bacilli) CLOSTRIDIUM (anaerobe) LISTERIA BACILLUS CORYNEBACTERIUM Catalse (+) STAPH Catalse (-) STREP Coagulase.

Enterics• Facultative Anaerobe• Large G- Rods• Nonsporeformers• Normal Flora• Escherichia Coli

– E. Coli (nickname)– E. Coli 0157:H7 or

0157– UTI, Sepsis, Enteric

E.Coli, Respiratory illness, multiple opportunistic infections

UTI/ Pyelonephritis

Motile strains with peritrichous flagella

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Enterics• Facultative

Anaerobe• Large G- Rods• Nonsporeformers • Relatively inert

• Shigella– S. Sonnei– S. Flexneri– S. Dysenteriae

• Shigillosis

The O antigens (LPS) define the four species of Shigella

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Enterics• G- Rod• Nonsporulating,• Facultative anaerobe• Ferment glucose• Reduce nitrate• Peritrichous flagella when

motile• Produce gas upon sugar

fermentation Salmonella– S. Typhi

• Typhoid Fever– S. Enteritidis

• Gastroenteritis

Carrier states

Eggs & Enteritidis

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Enterics• Nonmotile• G - rods • Prominent

polysaccharide capsule

• Multi Drug Resistant• Recently important

in nosocomial infections

• Normal flora• Klebsiella

– K. Pneumoniae• Pneumonia in

debilitated, UTI, etc etc.

Encapsulated/ multi drug resistant

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Enterics• Gram Negative Rod• Normal Flora• Hydrolyzes Urea (struvite

stone formation)• Proteus

– P. Mirabilis• Opportunistic infections

including UTI

Highly motile

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Enterics• G-Rod• Multi drug

resistance• Enterobacter

– E. Aerogenes– E. Cloacae

• UTI,Endocarditis, opportunistic infection

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Enterics• G-rods• Opportunistic

infection Serratia– S. Marcescens

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Other Gram Negative Rods• Vibrio• Helicobacter• Pseudomonas• Bacteroides

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Other Gram Negative Rods• Vibrio

– V. Cholerae

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Other Gram Negative Rods• Helicobacter

– H. Pylori

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Other Gram Negative Rods• Helicobacter

– Campylobacter Jejuni

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Other Gram Negative Rods

• Pseudomonas– Ps. Aeruginosa

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Other Gram Negative Rods

• Bacteroides – B. Fragilis

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• Chlamydia• Rickettsia • Coxiella• Ehrlichia

Weird Bugs

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• Chlamydia – C. Trachomatis

Weird Bugs

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• Obligate intercellular gram negative coccobacilli

• Vector– Dermacentor variabilis (dog

tick) East US– Dermacentor andersoni

Rocky Mountain region and Canada

• Rickettsia– R. Ricketseii

Weird Bugs

Peticheal rash

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• Obligate intercellular gram negative coccobacilli

• Coxiella Brunetti

Weird Bugs

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• Ehrlichia– E. chaffeensis– E. ewingii

Weird Bugs

Amblyomma americanum

Nymph left ; adult right

Ehrlichea in white tail deer fawn

Distribution of Amblyomma americanum

[Lone Star Tick]

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Genus: Mycoplasma

• Pleomorphic• No cell wall• Mycoplasma

– M. Pneumoniae• Atypical pneumonia

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The Inevitable Exceptions

• Mycobacteria– Weakly gram positive – Better seen with acid fast stain

• Spirochetes– Too small for light microscopy– Need Dark field microscopy

• Mycoplasma– No cell wall– Neither G+ or G-