CLASIFICAREA

AGENILOR PATOGENI =
Abecedarul bolilor infecioase

Prof. Dr. Victoria Aram

Institutul de Boli Infecioase Prof. Dr . Matei Bal
Secia Aduli III (Pav V/ et II)
dr.arama@mateibals.ro

CLASIFICAREA AGENILOR INFECIOI

Virusuri
Bacterii
Fungi
Parazii:
Protozoare
Metazoare
Ageni infecioi non-convenionali = prioni

BACTERII
Microorganisme unicelulare cu dimensiuni mari (MO)

Structur celular complet:

perete celular + capsul
membran citoplasmatic
citoplasm
nucleu
Posed ambii acizi nucleici / aparat enzimatic
Supravieuiesc / se multiplic extracelular
Se cultiv pe medii acelulare (artificiale)
Sensibilitate difereniat la antibiotice

VIRUSURI
Dimensiuni mici (ME)
Fr perete celular / aparat enzimatic
Posed un singur acid nucleic (ARN sau ADN)
Parazitism celular obligatoriu : supravieuire / multiplicare
intracelular
Se cultiv numai pe medii celulare
Insensibile la antibiotice

CHLAMYDII
Bacterii de dimensiuni mici

Bacterii atipice

Parazitism celular obligatoriu

Structur simpl: perete subire / ambii acizi nucleici
Sensibile la unele antibiotice (Tetracicline)

MYCOPLASME
Bacterii de dimensiuni mici

Bacterii atipice

Fr parazitism intracelular obligatoriu

Cresc pe medii acelulare (artificiale)
Fr perete celular rigid (pleomorfe)
Posed ambii acizi nucleici / aparat enzimatic
Sensibile la unele antibiotice (Macrolide)

RICKETTSII
Bacterii gram negative de dimensiuni mici

Bacterii atipice

Parazitism celular obligatoriu

Tropism pentru endoteliul vascular

Posed ambii acizi nucleici

Transmise la om prin intermediul artropodelor (paduchi, capuse)

Cresc pe medii celulare

Sensibile la unele antibiotice (Tetracicline)

BACTERII CLASIFICARE (1)

1. COCI GRAM - POZITIVI (violet) :
Aerobi:

- Streptococcus sp
S. pyogenes (S. -hemolitic grup A)
S. agalactiae (S.grup B)
S. grup D hemolitici) S. bovis, S. equinus
S. pneumoniae (pneumococ)
S. non-grupabli (-hemolitici / viridans): S. salivarius, sanguis, oralis, mutans
- Enterococcus sp: E. faecalis, E. faecium
- Staphylococcus sp:
S. coagulazo +: S. aureus
S. coagulazo - : S. epidermidis, haemolyticus, saprophyticus

Anaerobi: Peptococcus, Peptostreptoccoc

Clasificare clasic streptococi

dupa tipul de hemoliza produsa in jurul coloniilor
de streptococ pe geloza sange
Beta-hemoliz = hemoliza completa = clarificare completa.
Aici se includ majoritatea strept patogeni pt om: grup A,C,G
Alfa-hemolitici = viridans = hemoliza incompleta (col verde)
Aici se incadreaza strept viridans sau non-grupabili , care fac
parte din flora saprofita buco-nazo-faringiana.
Gama-hemolitici = non-hemolitic
Aici se incadreaza grupul D care face parte din flora saprofita
intestinala si genito-urinara.

Clasificare actual a streptococilor

Clasific Lancefield dupa Ag de perete polizah C (ag sp de grup):
18 serogrupuri: A-H i K-T.
Streptococii fara polizaharid C = non-grupabili
S. viridans
S. Pneumoniae (Pneumococul)

Clasific Griffith mparte Grupul A in peste 80 serotipuri, in functie de

proteina M = Ag sp de tip = principalul factor de virulenta.
Grupurile patogene pt om sunt A,B,C,G,D.

MICROSCOPIE OPTIC COCI GRAM - POZITIVI

S. pneumoniae

S.aureus

S.epidermidis

BACTERII CLASIFICARE (2)

2. COCI GRAM NEGATIVI (rosu):
Aerobi:
- Neisseria meningitidis (meningococ)
- Neisseria gonorrhoeae (gonococ)
- Moraxella catarrhalis

Anaerobi:
- Veillonella

BACTERII CLASIFICARE (3)

3. BACILI GRAM POZITIVI :
Aerobi:

Corynebacterium diphteriae
Corynebacterium non-diphteriae
Bacillus antracis (B.crbunos)
Bacillus cereus
Listeria monocitogenes
Erysipelothrix rhusiopathie (B. rujetului)

Anaerobi:

- Clostridium tetani
- Clostridium perfringens
- Clostridium botulinum
- Clostridium difficile
- Eubacterium
- Propionibacterium acnes
- Lactobacilus
- Actynomices israelli

LISTERIA MONOCITOGENES

Grupe la risc:
Nou nscut
Vrstnic
Gravide trim III
Imunodeprimai

Bacil mic Gram+, mobil, ubicuitar, rezistent (creste intre 0-45C, pH 4,5-9,5)
tropism intracelular, facultativ anaerob

BACTERII CLASIFICARE (4)

4. BACILI GRAM NEGATIVI AEROBI (BGN) :
Non enterici :
Brucella sp
Pasteurella sp (P. Multocida)
Bordetella sp (B. pertussis)
Legionella (L. pneumophila)
Haemophilus (H. influenzae)
Pseudomonas (P. aeruginosa = piocianic)
Aeromonas (A. hidrophila)
Acinetobacter (A. Baumanni)
Vibrio (V. cholerae)
Campylobacter / Helicobacter pilory

BACTERII CLASIFICARE (5)

4. BACILI GRAM NEGATIVI AEROBI (BGN) :
Enterici :
E. coli
Salmonella sp
Shigella sp (Sh Shiga, Sh Boydii, Sh Flexneri, Sh Sonnei)
Klebsiella sp (K. pneumoniae)
Enterobacter sp
Citrobacter sp
Serratia sp
Proteus sp (P. mirabilis . P vulgaris)
Yersinia sp (Y. Enterocolitica, Y pestis)

BGN

E.coli

Pseudomonas aeruginosa

Enterobacter cloacae

Klebsiella pn

Serratia marcescens

BACTERII CLASIFICARE (6)

4. BACILI GRAM NEGATIVI ANAEROBI :
Bacteroides (B. Fragillis)
Fusobacterium (F. necrophorum)

BACTERII CLASIFICARE (7)

5. Fam. Spirochaetaceae:
Treponema (T. palidum)
Leptospira (L. ictero-haemorrhagiae)
Borrelia (B. burgdorferi)
T.Palidum (MO camp intunecat)

6. Bacili acido-alcoolo-rezisteni:
Genul Mycobacterium:
M. tuberculosis (Bacil Koch)
M. bovis
M. leprae (Bacil Hansen)
M. atipice (M. avium, M. Kansassi)

Genul Nocardia
Sifilis primar

BACTERII CLASIFICARE (8)

7. Fam. Chlamydiaceae
C. Trachomatis (Trahom, Inf urogenitale)
C. Psittaci (Pneumonie atipica)
C. pneumoniae - TWAR (IACRS)
8. Fam. Rickettsiae
R. Prowazeki (Tifos exantematic)
R. Conori (Febra butonoasa)
Coxiella Burnetti (Febra Q)

TRAHOM

9. Fam. Mycoplasmataceae
Mycoplasma (M. pneumoniae) P. atipica
Ureaplasma (U. urealilyticum) Inf urogenitale

Boala Nicolas Favre

Uretrit

VIRUSURI CLASIFICARE

I. VIRUSURI ADN
II. VIRUSURI ARN

I. VIRUSURI ADN CLASIFICARE (1)

1. Fam. Herpesviridae (Latenta: primoinfectie si reactivari)
V. herpes simplex 1 (HSV1)
V. herpes simplex 2 (HSV2)
V. varicelo-zosterian (VZV)
V. Epstein Barr (EBV)
V. citomegalic (CMV)
V. herpes 6 (HHV6)
V. herpes 7 (HHV7)
V. herpes 8 (HHV8)

HSV1

Manifestri clinice ale

infeciei cu HSV 1
Virus

HSV 1

Primoinfecie

Gingivostomatit
Keratoconjunctivit
Encefalit
Eczema
herpeticum
Panariiu herpetic
Herpes genital
Herpes neonatal

Recurene la
imunocompeten
i

Boli cronice

H. labial
H. orofacial
Keratoconjunctivit Eritem polimorf

Panariiu
B. Alzheimer (?)
Encefalit
Schizofrenie (?)
Herpes genital
Paralizie facial
Bell

V. Aram, A. Streinu Cercel. Monografia - Infectii cu Herpesvirusuri, Ed Infomedica, 2001

Forme clinice ale infeciei cu

HSV-1
Oftalmic:
1%
Simptome severe

9%
Simptome
minore

Keratit

Sistemic:
Encefalit
Herpes
diseminat

Cutaneomuco
s:

Gingivostomatit

Herpes
90% asimptomatici
gladiatorum
Eczema
herpeticum
V. Aram, A. Streinu Cercel. Monografia - Infectii cu Herpesvirusuri, Ed Infomedica, 2001
Herpes genital

Topografia infeciei HSV

Clasic :
HSV1 produce herpes labial
HSV2 produce herpes genital
HSV2 / HSV1 in herpesul genital = 4 /
1

Azi:
topografia nu mai este respectat
crete implicarea HSV1 n
herpesul genital
CDC, 2002 30% din Herpesul genital
primar este produs de HSV1

Diferenierea celor 2 HSV n

herpesul genital nu se face de
rutin
V. Aram, A. Streinu Cercel. Monografia - Infectii cu Herpesvirusuri, Ed Infomedica, 2001

Manifestri clinice ale

infeciei cu HSV 2
Primoinfectie

HSV 2

Vulvovaginit
Balanit
Uretrit
Herpes neonatal
Gingivostomatit
Meningit
Panariiu

Recurene la
imunocompeteni

Herpes genital
Meningit
limfocitar
recurenta
Panariiu
Herpes orofacial

Boli cronice

Eritem
polimorf

V. Aram, A. Streinu Cercel. Monografia - Infectii cu Herpesvirusuri, Ed Infomedica, 2001

Sindroame clinice asociate infeciilor

cu HSV1 i HSV2
Sindrom clinic

HSV
1

HSV
2

Gingivostomatit

Herpes genital

Leziuni cutanante

Herpes neonatal

Keratoconjunctivit

Retinit

Esofagit

Pneumonie

Hepatit

Meningit

Encefalit

Mielit

HSV 2

VZV

Varicela

Hepes zoster oftalmic

CMV

Ochi de bufnita

Retinita CMV

EBV

Mononucleoza infectioasa: Frotiu sange periferic = limfocit atipic = limfoblastoid

Virus oncogen: Carcinom nazofaringian, Limfom Burkitt, Limfoproliferari maligne

HHV 6

Exantem subit al sugarului

HHV8

Sarcom Kaposi (in infectia HIV / SIDA)

I. VIRUSURI ADN CLASIFICARE (2)

2. Adenoviridae: Gen. Adenovirus (47 tipuri):
febra adeno-faringo-conjunctivala / Pneumonii virale
3. Papilomavirus (HPV) condilomatoza genital (oncogen)
HPV 16 + HPV 18 = responsabile de 80% din CC
4. Papovaviridae:
- Virus LEMP Leuco-encefalita multifocal progresiv
5. Parvovirus:
- Parvovirus B19 megaleritemul epidemic

Parvovirus B19

I. VIRUSURI ADN CLASIFICARE (3)

6. Fam. Poxviridae
V. vaccinal
V. variolic
V. orf (nodulii mulgtorilor)
V. moluscum contagiosum
7. Fam. Hepadnaviridae
V. hepatitei B (VHB)

II. VIRUSURI ARN CLASIFICARE (1)

1. Fam. Picornaviridae:
Gen. Enterovirus : sezon cald, focare epid, copii, tablou cl
polimorf
V. poliomielitice: 3 tipuri
V. Coxsackie (febra + mialgii):
A (24 tipuri)
B (6 tipuri)
V. ECHO (34 tipuri) febra + examtem

Gen. Heparnavirus :
V. hepatitei A (VHA)

Gen. Rhinovirus (100 tipuri)

II. VIRUSURI ARN CLASIFICARE (2)

2. Fam. Orthomyxoviridae - Gen. Influenza:
V. gripale A (H1-14, N1-9)
V. gripale B
V. gripale C
3. Fam. Paramyxoviridae
Gen. Paramyxovirus :
v. Urlian : oreion
v. parainfluenza (v. paragripale 1 4): IACRS ,
pneumonii
Gen. Morbilivirus : v. Rujeolic: rujeola (pojar)
Gen. Pneumovirus: v. sinciial respirator (VSR):
- sugar: bronsiolita acuta = catar sufocant ; adult: IACRS / P

II. VIRUSURI ARN CLASIFICARE (3)

4. Fam. Togaviridae
Gen. Alphavirus:
Gen. Rubivirus :

v. encefalitei ecvine
v. Rubeolic: rubeola (pojarel)

5. Fam. Flaviviridae:
Gen. Flavivirus :
v. amaril (v. febrei galbene)
v. Denga (Denga)
V. encefalitei japoneze
v. West Nile (meningoencefalita WN)

Gen. Hepacavirus : v. hepatitei C (VHC)

II. VIRUSURI ARN CLASIFICARE (4)

6. Fam. Reoviridae
Gen Reovirus
Gen. Rotavirus (gastroenterite la copil)

7. Fam. Bunyaviridae
Gen. Bunyavirus
Gen. Hantavirus (febr hemoragic cu sindrom renal)

8. Fam. Rhabdoviridae
Gen. Rabdovirus: v. Rabic: rabie (turbare)

9. Fam. Coronaviridae
Gen. Coronavirus (SARS- sindrom respirator acut sever)

II. VIRUSURI ARN CLASIFICARE (5)

10. Fam Arenaviridae, Gen. Arenavirus:
V. coriomeningitic (Armstrong): meningita virala
V. febrei de Lassa
11. Fam Retroviridae:
Oncoviridae: leucemii i limfoame T / paralizii spastice
HTLV 1 (Human T Leukemia virus 1): Japonia, Caraibe, Africa,
HTLV2 (Human T Leukemia virus 2): America de Sud, Europa
Sud

Lentiviridae (SIDA):
HIV1
HIV2

II. VIRUSURI ARN CLASIFICARE (6)

12. Fam. Filoviridae (Febre hemoragice)
V. Ebola
V. Marburg

13. Caliciviridae
V. Norwalk (gastroenterite)
V. hepatitei E (VHE)

14. Deltavirus:
Virusul hepatitei D (VHD)

FUNGI PATOGENI
1. Micoze sistemice (imunodeprimai):
Candida sp:

Canadida spp

albicans
non-albicans: glabrata, tropicalis, krusei, parapsilosis

Aspergillus fumigatus
Cryptococcus neoformans
Histoplasma capsulatum

2. Micoze superficiale:
Candida albicans
Trichophyton rubrum
Microsporum
Epidermophyton
Malassezia furfur (pitiriazis verzicolor)

Aspergillus sp

PARAZII - CLASIFICARE
A. Protozoare (1)
1. AMOEBE
Entamoeba histolytica

2. FLAGELATE
Leishmania
Trichomonas vaginalis
Giardia intestinalis (G. lamblia)
Trypanosoma

3. CILIATE
Balantidium coli

PARAZII - CLASIFICARE
A. Protozoare (2)
4. SPOROZOARE:
Plasmodium :
P. falciparum
P. vivax
P. ovale
P. malariae

Toxoplasma gondii
Cryptosporidium parvum
Isospora belli

PARAZII - CLASIFICARE
B. Metazoare (1)
Nematode intestinale (Nematelmini):
Enterobius vermicularis

- Oxiuroza

Ascaris lumbricoides

- Ascaridioza

Trichiuris trichiura
Ankylostoma duodenale
Schistosoma haematobium
Strongyloides stercoralis
Trichinella spiralis
Toxocara (T. Canis, T. Cati)

- Tricocefaloza
- Ankilostomatoza
- Bilharioza
- Strongiloidoza

PARAZII - CLASIFICARE
B. Metazoare (2)
2. Platelmini segmentai (cestode):
Taenia saginata, Tenia solium

- Teniaza

Echinococcus granulosus

- Hidatidoza (Chist hidatic)

Hymenolepis nana

- Himenolepiaza

Diphyllobotrium latum

- Botriocefaloza

Wuchereria bancrofti

- Filarioza

PARAZII - CLASIFICARE
B. Metazoare (3)
3. Platelmini nesegmentai (trematode):
Fasciola hepatica
Fasciolopsis buski
Paragonimus westermani

PRIONI :
ageni transmisibili non-convenionali
Ageni infecioi non - convenionali care produc
encefalopatii subacute spongiforme transmisibile,
mortale:
Boala Creutzfeldt Jakob
Boala Kuru
Sindromul Gerstmann Straussler
Scheinker
Insomnia familial fatal

CARACTERISTICI PRIONI (1):

proteine infecioase
dimensiuni mici (15-40 nm)
ci de contaminare:
digestiv: esut nervos infectat (animal / uman)
extracte hipofizare umane (hormoni de cretere)
material neurochirurgical contaminat
grefe de cornee / dura mater
rezisten mare la cldur, ageni chimici i enzimatici

CARACTERISTICI PRIONI (2):

absena rspuns imun specific detectabil
absena teste serologice de diagnostic
tropism pentru esutul nervos (creier, mduva spinrii) i
limfatic
neuronii infectai produc n exces proteina Pr P (Protease
resistant Protein), codificat pe cromozomul 20
funcie necunoscut
n formele familiale de boal: mutaie la nivelul genei PrP

FLORA SAPROFIT A OMULUI

SNTOS

Orofaringe

Streptococi viridans
Streptococcus pneumoniae
Streptococcus pyogenes (grup A)
Staphylococcus epidermidis
Staphylococcus aureus
Moraxella catarrhalis
Neisserii saprofite
Lactobacilus
Corynebacterii saprofite
Haemophilus sp.
Bacterii anerobe:
Veillonella
Bacteroides
Fusobacterium
Peptococ / peptostreptococ
Enterobacteriaceae
Candida albicans

++++
++
+
+++
+
++
++
++
++
+
++++
++
++++
+
+
++

FLORA SAPROFIT (2)

Nazofaringe Staphylococcus epiderimidis
Staphylococcus aureus
Neisserii saprofite
Streptococcus pneumoniae
Streptococcus pyogenes
Haemophilus

++++
+
++
+
+
+

FLORA SAPROFIT (3)

Conjunctiv

Staphylococcus epidermidis
Staphylococcus aureus
Haemophilus sp.

+++
+
+

FLORA SAPROFIT (4)

Piele

Staphylococcus epidermidis
Corynebacterii saprofite
Propionibacterium acnes
Staphylococcus aureus
Streptococcus pyogenes
Malassezia furfur
Candida

++++
++++
++++
++
+
++++
+

FLORA SAPROFIT (5)

Colon

Bacterii anaerobe (95%)

Bacteroides
Fusobacterium
Peptococi / peptostreptococi
Clostridium
Enterobacteriaceae
E. Coli
Klebsiella
Proteus
Enterococcus
Lactobacillus
Streptococcus grup B
Pseudomonas
Staphilococcus epiderm. / aureus
Candida albicans
Lamblia

++++
++++
++++
++++
++++
+++
+++
++
+++
++
+
+
+
+

FLORA SAPROFIT (6)

Vagin

Lactobacillus
Bacilul Doderlein
Bacterii anaerobe:
Peptococi / peptostreptococi
Clostridium
Veilonella
Staphylococcus epidermidis
Streptococcus
Corynebacterii saprofite
Enterococcus
Gardnerella vaginalis
Neisserii saprofite
Candida albicans
Trichomonas vaginalis

++++
++++
+++
++
+
+
+
++
+
+
+
++
+

FLORA SAPROFIT (7)

Organe genitale Flora saprofit a pielii

externe / uretr Ureaplasma urealyticum
Enterococ
Enterobacteriaceae
Bacterii anerobe
Trichomonas vaginalis

++++
+
+
+
+
+