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1、 1. Pathogenic cocci 2. Other bacteria1. Pathogenic cocciConcept of pathogenic bacteria 13minStaphylococcus (Esp., S. aureus) 56minStreptococcus (Esp., S. pyogenes) 38minEnterococcus species and VRE 5minNeisseria meningitides Neisseria gonorrhoeae 13min2. Other bacteriaPseudomonas aeruginosa 10min H
2、ighlights of contentUp to every pathogen, the following will be talked: Biological properties Pathogenicity Immunity Microbiological detections Prevention and treatmentPustule ( (脓疱脓疱) ) by S. aureusPustule ( (脓疱脓疱) ) by S. aureusParonychia ( (甲沟炎甲沟炎) ) by S. aureusSore throat ( (咽喉炎咽喉炎) ) by S. pyo
3、genesUntreated erysipelas ( (丹毒丹毒) ) by S. pyogenes with skin sloughing and necrosis Necrotizing Fasciitis Necrotizing Fasciitis ( ( ( (坏死性坏死性坏死性坏死性筋膜炎筋膜炎筋膜炎筋膜炎) ) ) )by by flesh-eating bacteriaflesh-eating bacteria ( (S. pyogenesS. pyogenes, , anaerobic anaerobic bacteria, etc.bacteria, etc.), and
4、), and insects (bee, etc.) insects (bee, etc.) stingingstingingChest x-ray Film 1Chest x-ray Film 1just a few hours of rigors just a few hours of rigors and productive coughand productive cough Chest x-ray Film 2Chest x-ray Film 212 hours later12 hours laterconsolidation in the consolidation in the
5、right upper loberight upper lobe Lobar pneumonia Lobar pneumonia ( (大叶性大叶性肺炎肺炎) ) by by S. pneumoniaeS. pneumoniaeMeningococcal septicemia Meningococcal septicemia ( ( ( (脑膜炎球菌性败血症脑膜炎球菌性败血症脑膜炎球菌性败血症脑膜炎球菌性败血症) ) ) ) by by N. meningitidisN. meningitidis, , w widespread ecchymosesidespread ecchymoses G
6、onococcal conjunctivitis ( (淋菌性结膜炎淋菌性结膜炎) ) by N. gonorrhoeae Causative agents of above clinical diseases?Pathogenic cocci What is Pathogenic cocci ? also called Pyogenic cocci ( (化脓性球菌化脓性球菌) ) Including -Staphylococcus (S. aureus & S. epidermidis) ( (金黄色葡萄球菌与表皮葡萄球菌金黄色葡萄球菌与表皮葡萄球菌 ) ) -Streptococcus
7、(Group A Streptococci, S. pyogenes) ( (A群链球菌群链球菌 or 化脓性链球菌化脓性链球菌) ) -Streptococcus pneumoniae ( (肺炎链球菌肺炎链球菌) ) -Neisseria gonorrhoeae ( (淋病奈瑟菌淋病奈瑟菌) ) -Neisseria meningitidis ( (脑膜炎奈瑟菌脑膜炎奈瑟菌) ) Important cocci Gram stain Bacterial genera G+ Genus staphylococcus Genus streptococcus G- Genus Neisseria
8、 ( N. meningitides N. gonorrhoeae )Staphylococcus aureusImportant pyogenic coccusLeading pathogen of wound infections (including other staphylococci) ShapeShape, Stain , Stain & Culture Culture spherical, elliptical, irregular grape-like cluster Gram+ (G+) Grow well on basic mediumBiological propert
9、ies Antigenic structureAntigenic structure Staphylococcal protein A (SPA)(SPA) One kind of surface protein in cell wall Single chain peptide Actions Binds (bacterium) to hosts to hosts IgG1, IgG2 & IgG1, IgG2 & IgG4IgG4 coagglutination testcoagglutination test Competes w/ Fc receptors of phagocytesw
10、/ Fc receptors of phagocytes resists phagocytosisresists phagocytosis Coagglutination test with inert particles Coagglutination test with inert particles (e.g., heat-killed (e.g., heat-killed S. aureus S. aureus oror latex beadslatex beads) ) SPA may resist phagocytosis by competively binding with F
11、c receptors of phagocytes Capsule Teichoic acid (polysaccharide)(polysaccharide) polysaccharide A S. aureus polysaccharide B S. epidermidisPhases of phagocytosisImportant Properties of 3 Main Species of StaphylococciPathogenicity & immunityCoagulaseCoagulase, Fibrinolysin, Heat , Fibrinolysin, Heat
12、stable nuclease, stable nuclease, Hyaluronidase, & LipaseHyaluronidase, & LipaseEnzymesPathogenic substancesCytotoxins Cytotoxins (Staphylolysin (Staphylolysin , , , , , & , & , , Leukocidin), Leukocidin), Exfoliatin, Enterotoxins, Exfoliatin, Enterotoxins, & TSST-1& TSST-1ToxinsAdhesin, Capsule, &
13、Adhesin, Capsule, & PeptidoglycanPeptidoglycanOthersCoagulaseCoagulase Free CoagulaseFree Coagulase staphylothrombinstaphylothrombin ( ( ( (游离凝固酶游离凝固酶游离凝固酶游离凝固酶) ) ) ) ( ( ( (葡萄球菌凝血酶葡萄球菌凝血酶葡萄球菌凝血酶葡萄球菌凝血酶) ) ) )Fibrinogen Fibrin Plasma to be Plasma to be cloted cloted Tube coagulase test Tube coagula
14、se test activatedconvert Virulence Protection actions Infection localized Bound coagulase( (结合凝固酶结合凝固酶) ) or clumping factor( (凝聚因子凝聚因子) ) plasma to be cloted or bacteria to coagulate Slide coagulase testSlide coagulase test classified into -, -, -, & -toxin -toxin makes pores in cell membranesStaph
15、ylolysin( (葡萄球菌溶素葡萄球菌溶素) )leukocidin杀白细胞素杀白细胞素 kills or degranulates neutrophils & macrophages including type A type A & type B type B causes staphylococcal scalded skin staphylococcal scalded skin syndromesyndrome (SSSS)Exfoliatin ( (表皮剥夺毒素表皮剥夺毒素) ) including serotype A, B, C1-3, D, E, G, serotype
16、A, B, C1-3, D, E, G, & H H responsible for food poisoning( (食物中毒食物中毒) ) mainly cause vomiting also acts as superantigen( (超抗原超抗原) )Enterotoxin( (肠毒素肠毒素) ) causes toxic shock syndrometoxic shock syndrome (TSS) one kind of superantigensToxic shock syndrome toxin 1 (TSST-1) ( (毒性休克综合征毒素毒性休克综合征毒素-1 )-1
17、)Othersheat-stable nuclease ( (耐热核酸酶耐热核酸酶) )Clinical diseasesInvasive Invasive diseasesdiseasesToxin-mediated Toxin-mediated diseasesdiseasesPyogenic infections - -local infections- -systemic infections- -food poisoning- -staphylococcal scalded skin syndromestaphylococcal scalded skin syndrome (SSSS
18、)- -toxic shock syndrome (TSS)Folliculitis ( (毛囊炎毛囊炎) ) by S. aureusBullous Impetigo by S. aureusA S. aureus infection on a 12-year-old childs cheek Pathogenesis of staphylococcal infectionsMicrobiological diagnosisAnimal testSamplesSamplesPus, blood, food, or vomitusIsolatiIsolationonCoagulase test
19、Coagulase testCoagulase testCoagulase testMannite Mannite Mannite Mannite fermentationfermentationfermentationfermentationHeat-stable Heat-stable Heat-stable Heat-stable nucleasenucleasenucleasenucleaseSmear Smear & microscopymicroscopyG+ staphylococciColony pigments & hemolysisBiochemical reactions
20、Enterotoxins detectionIdentification of pathogenic staphylococci Coagulase (+) Heat-stable nuclease (+) Golden pigment (+) HemolyzationHemolyzation (+) Mannite fermentation (+)Prevention & treatmentPreventionPreventionpreventing preventing preventing preventing nosocomial nosocomial nosocomial nosoc
21、omial infectioninfectioninfectioninfectionTreatmentTreatmentantibiotics antibiotics antibiotics antibiotics sensitivity sensitivity sensitivity sensitivity testtesttesttestpersonal personal personal personal hygienehygienehygienehygienesterilisatsterilisatsterilisatsterilisation & ion & ion & ion &
22、detentiondetentiondetentiondetentionselfselfselfself- -bacterial bacterial bacterial bacterial vaccine vaccine vaccine vaccine therapy therapy therapy therapy preventing preventing preventing preventing drug drug drug drug resistanceresistanceresistanceresistanceMethicillin-resistant S. aureus, MRSA
23、 ( (耐甲氧西林金黄色葡萄球菌耐甲氧西林金黄色葡萄球菌) )Coagulase-negative staphylococci (CNS) ( (凝固酶阴性葡萄球菌凝固酶阴性葡萄球菌) )1.Compare the features of common pyogenic bacteria.2.Discuss the pathogenic features and identification points of Staphylococcus aureus.Questions:Streptococci G+, spherical, elliptical, arranged in chainin
24、chain Grow well on nutrient medium w/ bloodBiological propertiesShape, Shape, Stain Stain & CultureCultureAntigenic Antigenic structurestructure Protein antigen surface Agsurface Agsurface Agsurface Ag, outside C antigen, outside C antigen type-specifictype-specific including including M M M M,T,R,S
25、 in Group A,T,R,S in Group A Polysaccharid antigen C C C C AgAgAgAg group-specificgroup-specific Nucleoprotein P P P P AgAgAgAg non-specificnon-specific Cell cytoplasm Cell cytoplasm Cell membraneCell membranePeptidoglycanPeptidoglycanCapsuleCapsuleCell wallCell wallClassificationAccording According
26、 toto -hemolytic Streptococcus -hemolytic Streptococcus -StreptococcusHemolysis group A-V, total 20 groupsgroup A-V, total 20 groups among among pathogenic pathogenic pathogenic pathogenic streptococcistreptococcistreptococcistreptococci 90% is group A90% is group A over 100 types over 100 types acc
27、ording to according to M M M M AgAgAgAg group B, C, D, & G occasionallygroup B, C, D, & G occasionallyAntigenic structurePathogenicityGroup A Streptococci (S. pyogenes)Pathogenic Pathogenic substancessubstances Protein GProtein G: : similar to Protein Asimilar to Protein A adhesinsadhesins - - - -li
28、poteichoic acid (LTA)lipoteichoic acid (LTA) - - - -fibronectin binding protein (FBP, fibronectin binding protein (FBP, protein F) protein F) ( ( ( (纤丝蛋白结合蛋白纤丝蛋白结合蛋白纤丝蛋白结合蛋白纤丝蛋白结合蛋白, F , F , F , F 蛋白蛋白蛋白蛋白) ) ) ) - - - -protein Mprotein MBacterial structure Streptolysin (SL, (SL, 链球菌溶素链球菌溶素) ) Strep
29、tococcal pyrogenic exotoxin (SPE, (SPE, 链链球菌致热外毒素球菌致热外毒素) ) Hyaluronidase ( (透明质酸酶透明质酸酶) ) Streptokinase (SK, (SK, 链激酶链激酶) ) Streptodornase (SD, (SD, 链道酶链道酶) )Toxins & enzymesStreptolysin S (SLS, (SLS, 链球菌溶素链球菌溶素S)S) - - - -low MW glycopeptidelow MW glycopeptide - - - -oxygen-stableoxygen-stable - -
30、 - -causes causes - -hemolysis on Blood Agar platehemolysis on Blood Agar plate - - - -non-antigenicnon-antigenicStreptolysin O (SLO, (SLO, 链球菌溶素链球菌溶素O)O) - - - -protein w/ SH groupprotein w/ SH group - - - -oxygen-labileoxygen-labile - - - -destroysdestroys many kinds many kinds of cellsof cells -
31、- - -anti-SLO test (ASO test)anti-SLO test (ASO test) helpful for diagnosis helpful for diagnosisStreptolysin- -coded by lysogenic bacteriophage- -proteins including serotype A, B, Cserotype A, B, C- -causes scarlet fever ( (猩红热猩红热) )- -one kind of superantigens- -also causes TSSStreptococcal pyroge
32、nic exotoxin (SPE) ( (链球菌致热外毒素链球菌致热外毒素) )Streptokinase (SK, (SK, 链激酶链激酶) )- -also called as streptococcal fibrinolysin ( (链球菌溶纤维蛋白酶链球菌溶纤维蛋白酶) ) Streptodornase (SD, (SD, 链道酶链道酶) )- -hydrolyzes DNAHyaluronidase ( (透明质酸酶透明质酸酶) )- -also called as spreading factor ( (扩散因子扩散因子) )- -hydrolyzes hyaluronic a
33、cid in connective tissue- -helpful for spreading of bacteriaClinical diseasesPyogenic infectionsToxin-mediated diseasesAllergic diseases (late complications)- -scarlet fever ( (猩红热猩红热) )- -Streptococcal toxin-mediated TSS- -rheumatic fever ( (风湿热风湿热) )- -acute glomeruloniphritis ( (急性肾小球肾炎急性肾小球肾炎) )
34、Erysipelas ( (丹毒丹毒) ) by S. pyogenesCellulitis ( (蜂窝组织炎蜂窝组织炎) ) by S. pyogenesHoney-crust lesion typical of S. pyogenes impetigoPathogenesis of S. pyogenes infectionsSamplesPus, Blood, Nasopharynx swabIsolation w/ Isolation w/ blood agar blood agar plateplatedistinguishdistinguishing from ing from S
35、. pneumoniaeS. pneumoniaeSmear Smear & microscopymicroscopyG+ streptococcidistinguishing distinguishing from from staphylococcistaphylococciOther streptococciOther streptococci -hemolysisAssist-diagnosis for rheumatic fever -hemolysisASO ASO testtestMicrobiological diagnosis S. pneumoniae Group B st
36、reptococci Group D streptococci Viridans ( -hemolytic) streptococci Streptococcus suis ( (猪链球菌猪链球菌) ) Enterococcus species ( (肠球菌肠球菌) ) & VRE Other streptococciEnterococcus species and VRE Enterococcus spp.( (肠球菌肠球菌) ) Previously classified as Group D streptococci In 1984, named as genus Enterococcu
37、s Gram+ cocci in pairs or short chains Most are facultative anaerobes Complex nutritional requirements Group D specific teichoic acid antigenEnterococcusEnterococcus spp. viewed by direct spp. viewed by direct fluorescent antibody (FA) reactionfluorescent antibody (FA) reactionEnterococcus spp. Comm
38、only found in the intestines of normal Commonly found in the intestines of normal healthy individuals (humans and animals). healthy individuals (humans and animals). 2 important human diseases-related spp. 2 important human diseases-related spp. E. faecalis E. faecalis ( ( ( (粪肠球菌粪肠球菌粪肠球菌粪肠球菌) ) ) )
39、 andand E. faecium E. faecium ( ( ( (屎肠球菌屎肠球菌屎肠球菌屎肠球菌) ) ) ) Cause Cause Urinary tract infections Urinary tract infections Bacteremia & septicaemia Bacteremia & septicaemia Subacute endocarditis Subacute endocarditis Wound infections Wound infections Foodborne diseases Foodborne diseases Meningitis
40、Meningitis Nosocomial infections Nosocomial infections One of important life-threatening nosocomial pathogens Vancomycin Resistant Enterococci (VRE, 耐万古霉素肠球菌耐万古霉素肠球菌) Since 1986, VRE infections has become a growing problem1. Discuss the pathogenic features of Streptococcus pyogenes.2. Discuss identi
41、fication points between hemolytic streptococci and other pyogenic bacteria.Questions:Neisseria gonorrhoeae ( (淋病奈瑟菌淋病奈瑟菌) )Biological properties Shape and stain Shape and stain - -G- - diplococci in or on PMNs on pus smear - -No endospore & flagellum, & w/ capsule & pili Culture Culture - -Obligate
42、aerobes, need 5% CO2 while primary isolation - -High nutritional requirement “Chocolate Blood Agar Plate” Antigenic structure and Antigenic structure and classificationclassification - -Pilus protein antigens - -Outer membrane protein antigens：PI, PII, & PIII - -LOS (lipooligosaccharide, LOS (lipool
43、igosaccharide, 脂寡糖脂寡糖脂寡糖脂寡糖), ), LPS-likeLPS-likeN. gonorrhoeae colonies on Chocolate Blood Agar PlatePathogenesisVirulent factorsVirulent factors- -Pili- -Outer membrane proteins- -LOS- -IgA1 protease- -OthersClinical Clinical findingsfindings - -Gonorrhea - -Gonococcal conjunctivitisGonorrhea symp
44、toms-Urethritis-Urethritis-Vaginitis-Vaginitis-Cervicitis-Cervicitis-Salpingitis-Salpingitis-Pelvic inflammation-Pelvic inflammation-Anorectal Gonorrhea-Anorectal Gonorrhea-Gonococcal Pharyngitis-Gonococcal Pharyngitis-Gonococcal Conjunctivitis-Gonococcal Conjunctivitis-Gonococcal Arthritis -Gonococ
45、cal Arthritis in Women-Urethritis-Urethritis-Epididymitis-Epididymitis-Prostatitis-Prostatitis-Anorectal Gonorrhea-Anorectal Gonorrhea-Gonococcal Pharyngitis-Gonococcal Pharyngitis-Gonococcal Conjunctivitis-Gonococcal Conjunctivitis-Gonococcal Arthritis-Gonococcal Arthritisin MenClinical manifestati
46、ons of N. gonorrhoeae infection Immunity Humoral immunity more effective No persistent immune responses Infection trend to - -chronic & repeated occurrenceMicrobiological detectionsNucleic acids detection, & so onNucleic acids detection, & so onSamplesSamplesPus secreta from genito-urinary tracts, e
47、yes, & othersPus secreta from genito-urinary tracts, eyes, & othersIsolatiIsolationonOxidase testOxidase testSugar fermentation testSugar fermentation testImmunofluorescenceImmunofluorescence assay assaySmear Smear & microscopymicroscopyG G- - diplococci diplococci in or on PMNsin or on PMNs Colonie
48、s & microscopic findingsColonies & microscopic findingsBiochemical reactions & serologic testsOther Other teststestsPrevention & treatment Take Take preventionspreventions as as main measuremain measure Choose penicillinpenicillin as No. 1 drug，take care of problems of drugs-resistant bacterial stai
49、ns1. What are the main differences between Neisseria meningitides and Neisseria gonorrhoeae.Question:Pseudomonas aeruginosa( (铜绿假单胞菌铜绿假单胞菌) )P190 Shape, Stain Shape, Stain & Culture Culture G bacili single terminal flagellum appears capsule in some bacterial strains grows readily and rapidly on many
50、 media produces several kinds of water-soluble pigmentsBiological propertiesPseudomonas aeruginosa colonies on agar platesPathogenicity & immunity adhesins pilus non-pilus adhesin polysaccharide capsule endotoxin lipopolysaccharide (LPS)Pathogenic Pathogenic substancessubstances exotoxins exotoxin A
51、 -mode of action similar to diphtheria toxin exotoxin S (exoenzyme S)(exoenzyme S) -inhibits phagocytosis -acts in vitro in the same way as the toxins of Vibrio cholerae elastase ( (弹性蛋白酶弹性蛋白酶) ) -Las-A( (丝氨酸蛋白酶丝氨酸蛋白酶) ) Las-B( (锌金属蛋白酶锌金属蛋白酶) ) phosphoesterase C ( (磷脂酶磷脂酶 C C) ) pyocyanin ( (绿脓菌素绿脓菌
52、素) ) Cytolysin: e.g. leukocidinClinical Clinical diseasesdiseasesOpportunistic pathogen infections following burn hospital-acquired infectionsPulmonary infectionsPrimary skin infectionsUrinary infectionsPrimary skin infections of Pseudomonas aeruginosa 1. Discuss the pathogenic features of Pseudomonas aeruginosa.Question:
