Documente Academic
Documente Profesional
Documente Cultură
Gram Stain
images.MD
S. James Booth
Aerobic Rods
Pseudomonas
Others: Stenotrophomonas, etc.
Burkholderia
Legionella
Brucella
Bordetella
Bartonella
S. James Booth
S. James Booth
Microaerophilic rods
Anaerobic rods
(Separate Lecture)
Campylobacter
Helicobacter
Bacteroides
Porphyromonas
Prevotella
Fusobacterium
S. James Booth
S. James Booth
Gram Stain
Escherichia coli
Enterobacteriaceae
Facultative Anaerobic Rods
Escherichia
Salmonella
Shigella
Klebsiella
Enterobacter
Yersinia
Proteus
Others: Serratia, Edwardsiella, Providencia, Morganella,
Citrobacter, ~40 more
http://biology.clc.uc.edu/fankhauser/Labs/Microbiology/Gram_Stain/Gram_stain_images/index_gram_stain_images.html
S. James Booth
Enterobacteriaceae: Characteristics
Antigens
Cell wall (O Ag)
Flagella (H Ag)
Capsule (K, Vi)
Habitat
Normal GI flora (humans/animal)
oxidase positive
Pseudomonas
aeruginosa
Salmonella
Shigella
Physiology
Facultative anaerobes
Ferment glucose
Oxidase negative
Reduce nitrate
Escherichia coli
- +
Pseudomonas
others
Shigella
H2 S
lactose fermentation
- +
others
E. coli
others
- indole +
E.coli
Salmonella
S. James Booth
Lactose-Positive Colonies
on MacConkey Agar
S. James Booth
Red/pink Colonies
http://biology.clc.uc.edu/fankhauser/Labs/Microbiology/Gram_Stain/Gram_stain_images/index_gram_stain_images.html
http://www.rmit.edu.au/browse/About%20RMIT%2FHelp%2FMedia%20Assets%2FImage%2Fby%20subtype%2FPhotograph%20of%20culture%2F;ID=smyfchkof1ej1.JPG;STATUS=A
Indole Test
E. coli
E. coli Infections
Urinary tract
Neonatal meningitis
Neg
Gastrointestinal
Pos
Red ring
UTI
Cystitis (bladder):
Dysuria, frequency of urination, urgency
Epidemiology
Pyelonephritis (kidney):
Virulence
Community acquired
Nosocomial
P (pyelonephritis-associated) pili
Diagnosis
Culture
Quantitation
S. James Booth
Urine Culture:
Pour Plate for Quantitation
>100,000 colony
forming units/mL of
urine in asymptomatic
patient is diagnostic;
Pregnant patients should
be treated for UTI;
elderly should not
Urine Culture:
Volumetric Loop
http://gold.aecom.yu.edu/id/micro/index.html
E. coli GI Infections
Enterotoxigenic E. coli
Travelers/Infant diarrhea
Enteroaggregative E. coli also common cause of
travelers diarrhea
adenylate
cyclase
Gm1 ganglioside
receptor
Enterohemorrhagic E. coli
(EHEC)
Shiga toxin (Verotoxin; lysogenic)
cAMP
ADP-ribose
A subunit (1)
Cl2 + H2O
B subunits (5)
S. James Booth
S. James Booth
Enterohemorrhagic E. coli
EHEC Disease
Epidemiology
Hemorrhagic colitis
Up to 5% mortality
S. James Booth
S. James Booth
Be aware of:
Enteroinvasive E. coli (EIEC; bacillary dysentery)
Enteropathogenic E. coli (EPEC; childhood
diarrhea)
Enteroaggregative E. coli (EAggEC; travelers
diarrhea; childhood diarrhea)
Enteroadherent E. coli (EAEC; travelers diarrhea;
childhood diarrhea)
S. James Booth
S. James Booth
E. coli Gastroenteritis
E. coli Gastroenteritis
Therapy
Laboratory diagnosis
Enterohemorrhagic (EHEC):
Re-hydration
role of antibiotics uncertain
http://www.ukneqasmicro.org.uk/pics1661.html
S. James Booth
S. James Booth
Lactose-Positive Colonies
on MacConkey Agar
Neonatal Meningitis
Escherichia coli ~29%
Streptococcus agalactiae ~ 34%
Signs/Symptoms
Red colonies
S. James Booth
S. James Booth
Gram Stain
Shigella
Lactose-Negative colonies on
MacConkey Agar
Nonmotile Enterobacteriaceae
Colorless
(non-red)
colonies
Shigella
Yersinia
SYK
Klebsiella
S. James Booth
Shigella
Shigella happens
By MARK ANDERSEN / Lincoln Journal Star
More than 30 probable cases of shigella, the parasitic
infection associated with prolonged and often
severe diarrhea, have been identified in Lancaster
County over the past two weeks.
S. James Booth
Shigellosis
Shigellosis
Person to person
Low infecting dose
Shiga toxin (lysogenic)
Watery bloody
Sweden
Fever, cramps
PMNs, blood, and mucus in stool
No bacteremia
Treatment
Self-limiting, but
Fluids
Antibiotics to decrease duration of illness & person-to-person spread
S. James Booth
Gram Stain
Salmonella
Salmonella Taxonomy
Confusing!
CDC and WHO
2 species
S. James Booth
Salmonellosis
Two gastrointestinal forms
Gastroenteritis
Localized
S. enterica: S. typhimurium, S. enteritidis
> 2400 other serotypes (O, H, Vi antigens)
Animal hosts
Salmonella Gastroenteritis
(salmonellosis; enterocolitis; enteritis)
Salmonella Gastroenteritis
Most Common Serotypes
Enterocolitis Pathophysiology
Infectious dose > 100,000
Localized invasion of epithelium of small/large
intestines
Infection limited to lamina propria/adjacent mesenteric
lymph nodes
Results in inflammation and watery diarrhea
Bacteremia rare (infants, immunosuppressed)
Salmonella Enterocolitis
Incubation period: 8-48 hours (1-2 days)
Nausea, vomiting, progressing to abdominal
cramping and diarrhea
Enterocolitis
Diagnosis/Therapy/Prevention
Stool Culture
Lactose neg, H2S +
Serogrouping: In U.S., serogroups B, C, D responsible for most
infections
S. enteritidis and S. typhi are serogroup D
Self-limiting
may be bloody
Fluids/electrolytes
Antimicrobials for immunosuppressed, young children, elderly
Sanitation
Epidemiology: 2005 U.S. ~ 45,000 cases
NE ~ 219 cases
MacConkey Agar
Salmonella
Black = H2S
positive
S. James Booth
Typhoid Fever
(enteric fever)
Human-to-human
Contaminated food/beverages handled by persons
shedding S typhi from stools (less commonly
urine) or water from sewage contaminated with
S typhi
Shellfish from water polluted by raw sewage
Canned meat produced using faulty canning
processes may cause outbreaks
http://sprojects.mmi.mcgill.ca/tropmed/disease/typhoid/geo.htm
Peyer Patches
Typhoid Fever
Incubation period: 1-2 weeks
Fever usually begins 1 week postexposure
http://www.bu.edu/histology/p/12006loa.htm
Rose spots
may appear
typically on anterior chest wall
http://www.rcai.riken.go.jp/eng/group/epi/image/01.jpg
Rose Spots
Typhoid Fever
Diagnosis
Culture: blood or bone marrow
Serology: Widal test (agglutination)
DNA probes/PCR
Therapy
A fluoroquinolone or ceftriaxone
Use of antimicrobials mortality from ~20% to near 0
Prevention
http://www.medicalhealthcareinfo.com/content/Symptoms_of_typhoid_fever_may_1.php
http://www.mmc.org.au/image.php?id=000031
Sanitation
Vaccination (high risk travel)
Control of carriers
Gram Stain
Klebsiella pneumoniae
Mucoid Colonies
Klebsiella pneumoniae
S. James Booth
http://www.austin.cc.tx.us/microbugz/03morphology.html
Source unknown
Pneumonia
Diseases: K. pneumoniae
Lobar pneumonia
Bronchopneumonia
S. James Booth
Bronchopneumonia
MedPix
http://www.studentbmj.com/issues/00/02/education/13.php
http://rad.usuhs.mil/medpix/medpix_home.html?#top
Shaking chills
Fever
Chest pain
Cough (often productive)
Shortness of breath (dyspnea)
S. James Booth
10
Urease
K. pneumoniae
Epidemiology: NF
Virulence factors: Capsule
Signs/Symptoms
O
H2N C NH2
urease
NH4+ + CO2
http://www.foodsubs.com/Fruitpre.html
S. James Booth
Urease Test
Enterobacter
Nosocomial UTIs
Immunocompromised
Multiple antimicrobial resistance common
Dont learn therapy
Negative
Positive
S. James Booth
S. James Booth
Gram Stain
Proteus
Proteus
Swarming
Urease +
P. mirabilis (most common)
UTI (#2 most common; usually nosocomial)
Therapy: dont need to know (ampicillin)
S. James Booth
S. James Booth
11
Swarming: Proteus
Swarming: Proteus
Note rings
Note rings
Swarming: Proteus
Yersinia
Note rings
Y. enterocolitica
Enterocolitis (especially pediatric)
Watery diarrhea
Y. pestis
Plague
Black Board: See handout for learning objectives
S. James Booth
S. James Booth
Gram Stain
Vibrio cholerae
Vibrio cholerae
Electron Micrograph
Note
curved
rods
Single polar
flagellum
Curved
rod
S. James Booth
Source unknown
12
Vibrio cholerae
Human to human
Enterotoxin: similar m.o.a. as LT (E. coli)
8 in cAMP 8 fluid/electrolyte secretion
Vibrio parahaemolyticus
Sea food associated gastroenteritis
Occasionally V. vulnificus
Vibrio vulnificus
Sea water associated wounds
Occasionally V. parahaemolyticus
http://www.visualdx.com/vibrio/
Aeromonas
Gram-negative facultative anaerobe
A. caviae, A. hydrophila, A. schubertii, A.
veronii, others
Wound infections
doi:10.1016/j.injury.2005.05.016
Haemophilus
H. influenzae
Encapsulated: meningitis
Nonencapsulated: conjunctivitis, otitis media,
sinusitis
H. ducreyi
Chancroid
http://www.who.int/csr/resources/publications/drugresist/en/IAMRmanual.pdf
13
Chocolate Agar
Haemophilus influenzae
Supplemented
with X and V
S. James Booth
Quad Plate
Haemophilus influenzae
H. Influenzae
will grow only
in this quadrant
X+V
Haemophilus influenzae
S. James Booth
Haemophilus influenzae
Other diseases: Hib (encapsulated)
Acute epiglottitis
Septic arthritis (< 2 y.o.)
Cellulitis (<2 y.o.)
Nonencapsulated (non-typable)
http://education.med.nyu.edu/courses/microbiology/courseware/infect-disease/Gram_Neg_Bacilli5.html
Haemophilus ducreyi
Chancroid
A sexually transmitted disease characterized by
painful genital ulceration & inflammatory inguinal
adenopathy
2005: U.S. 17 cases
Conjunctivitis
Otitis media: #2-3; St. pneumo. #1; Staph. aureus #2-3)
Sinusitis: H. influ & St. pneumo.
14
Pasteurella multocida
http://knowledge.emedicine.com/splash/shared/pub/cotw/0014answer.html
Francisella tularensis
Tularemia
Black Board: See handout for learning
objectives
15