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Microbiology
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Bacteriology C/S
Plate sample on blood agar plate others
Incubate 350 30C o!ernight " # $% hours &
'ead plate (or pathogens
)o *or+,up to identi(y pathogens
)o sensiti!ity testing i( a!ailable
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-ram Stain
)i((erential staining process used in microscopyo( specimens and bacterial colonies
Bacteria di!ided into . groups o( -ram positi!e" deep blue or purple & and -ram negati!e " redor pin+ &
Can be used to di((erentiate epithelial andin(lammatory cells
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S+in lora
ransient
Microbes that happen to be deposited on the s+in but do not
multiply there1 Maybe remo!ed by a thorough *ash *ith soap and *ater
'esident
Colonise the s+in1
Cannot be remo!ed by *ashing *ith soap and *ater
Can be reduced to small numbers by disin(ectants
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ransient Bacteria
2ogenous in origin
4ocated on the s+in sur(ace
2amples areS.aureus, E.coli
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Staphylococcus
hey are -ram,positi!e cocci that appear
microscopically li+e a bunch o( grapes
S.aureus is coagulase positi!e
Coagulase negati!e staphylococci are many
in number eg1S. saprophyticus
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2pidemiology o( Staphylococcus
S.aureus is ubi6uitous1
Colonise " nares aillae perineumetc & about 308 o(humans1
Person,to,person spread by hands " common & nasaldischarges and aerosol " rare &
C7S are ubi6uitous on s+in and mucosal sur(aces1
In(ection usually endogenous and is common cause o(nosocomial line in(ections
Bacteria has lo* pathogenicity but cause in(ection inpatients *ith (oreign bodies
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Pathogenesis o(S.aureus in(ection
Colonisation usually precedes in(ection
Ma9or reser!oir !aries eg1 nose (or dialysis patients oropharyn (orintubated patients
Some (actors that promote colonisation :
Prolonged hospitalisation
)iabetics
2c;ema
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Pathogenesis o( C7S
Seldom occur among healthy indi!iduals
Important host (actors are de(ects in mucosal membrane/s+in
immunosupression and presence o( (oreign body
Patients *ith systemic or localised de(ects in opsonophagocyticacti!ity are at increased ris+ o( in(ection
In neonates administration o( I= lipid emulsion is anindependent ris+ (actor
Preceeding antibiotic therapy
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C7S In(ections
Single most important (actor associated
*ith C7S in(ections is the presence o( a
(oreign body eg1 ind*elling catheters
intra!ascular catheters CS shunts
prosthetic 9oints etc1
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Staphylococci produce disease in . *ays :
)irectly by in!asion and subse6uent :
tissue destruction *hether locally or byhaematogeneous spread
hrough the e((ects o( toins
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In(ections produced byS. aureus
)irect in!asion
)issemination " haematogenous &
oin mediated
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)irect In!asion byS. aureus
$1 Super(icial
Pyoderma including impetigo paronychia
S+in and so(t tissue in(ections eg1 boilscellulitis
.1 )eep Septic arthritis
>steomyelitis
Pyomyositis
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oin MediatedS.aureus In(ection
S+in disease eg1 staphylococcal scalded,s+in syndrome
-astrointestinal disease eg1gastroenteritis
Multisystem disease eg1 toic shoc+syndrome
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=irulence actors o(S.aureus
2n;ymes eg1 catalase hyaluronidase lipase
oins eg1 ?,toins leu+ocidin enterotoin SStoin $
Immune system (actors eg1 antigen,antibodycomplees superantigens
Cell *all components eg1 acti!ated C tn( othercyto+ines @ mediator systems
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Se6uence o( 2!ents in SeriousS.aureus In(ections
Coloni;ation carriage toin production
Barrier breach or brea+
In!asion
Bacteremia or septicaemia
Syndrome o( se!ere sepsis " acti!ated C
cyto+ines toin other mediators & Complications " suppurati!e and in(lammatory &
)eath
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Streptococcus
-ram,positi!e cocci in chains
Can be beta " clear & alpha " greenish & or non,haemolytic on blood agar plate
-roup A beta,haemolytic streptococci orS.pyogenes
=ancomycin resistant enterococci " ='2 & is animportant nosocomial pathogen
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2pidemiology o(S.pyogenes "$&
Common cause o( community,ac6uired
pharyngitis and s+in in(ections1
Carriage in throat s+in rectum " $8 &
and !agina " $8 &
4i+ely that besides contact transmission
there is airborne transmission in SSI
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2pidemiology o(S.pyogenes ".&
Implicated in burn *ound in(ections
necrotising (asciitis puerperal and
neonatal in(ections
Important as cause Acute
glomerulonephritis and Acute 'heumatic
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2pidemiology o( 2nterococci
7ormal habitat in gastrointestinal tract
'eser!oir sites are *ounds s+in " inguinalantecubital (ossa & chronic decubital ulcers!agina and perineal or meatal areas o(hospitalised males
Most important method o( spread o( ='2 isthrough transient carriage on hands o(
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Pathogenesis o( Streptococcal
oic Shoc+ Syndrome " SS &
Initial (ocus is the s+in and so(t tissues o(pre!iously healthy indi!iduals
Strains ha!e a high propensity to initiate in!asi!edisease
Pathogenesis not de(initely elucidated1 Mostinterest on pyrogenic eotoins " SP2s&
>ther !irulence properties in!ol!ed eg1 M proteinen;ymes
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Pathogenesis o( 7osocomial
In(ection by 2nterococci
-enerally enterococci are part o( normal (lora and ha!elittle pathogenic potential in normal host
>pportunistic pathogens in the elderlyimmunocompromised or *hen in!asi!e procedures aredone
4ittle +no*n about !irulence (actors
Cause DI bacteremia endocarditisintraabdominal/pel!ic in(ections s+in/so(t tissuein(ections etc1
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-ram,negati!e Bacteria
ermenters eg1Escherichia coli
7on,(ermenters , -ram , negati!e
bacteria that do not utili;e carbohydrates
as a source o( energy or degrade them
through metabolic path*ays other than(ermentation eg1Acinetobacter baumannii
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2nterobacteriaceae
amily o( (ermentati!e -7B commonly
isolated (rom clinical specimens and are
there(ore also important nosocomialpathogens1
acultati!e anaerobes that *ith (e* eceptions(erment glucose reduce nitrate to nitrite and
are oidase negati!e1
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2nterobacteriaceae eamples
Escherichia coli
Klebsiellaspecies (pneumoniae)
Enterobacterspecies
Proteus mirabilis
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Pathogenesis o( 7I caused by
2nterobacteriaceae
$1 Pathogen,speci(ic (actors
Adhesion
Capsules
Iron chelators
>ther (actors and ropisms
.1
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Adhesion
Bacterial adhesion attachment to sur(aces
colonisation o!ergro*th tissue in!asion1
Mediated by both (imbrial and non(imbrial
adhesins that are encoded on plasmids and on
the bacterial genome eg1 P (imbrae , can anchor
bacteria to uroepithelial cells cause
pyelonephritis in adults and children1
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Capsules
Can partly protect the bacteria against
the bactericidal e((ect o( serum andagainst phagocytosis eg1Klebsiellaspp1
Can also directly suppress the hostimmune response1
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Iron Chelators
Ability o( some -7B to ac6uire iron (or gro*th
becomes an important (actor in many in(ections1
Almost all the iron in the human body is bound to
!arious proteins eg1
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>ther Pathogen actors @ ropisms
=irulence (actors eg1 motility gro*th in al+aline p
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2pidemiology o( 7I caused by
2nterobacteriaceae
'eser!oir eg1 -I and oropharyngeal
actors controlling colonisation1
-astric p
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