Bacteria of Medical Importance

Foundation Course
Prof V. O. Rotimi

Objectives
At the end of this lecture the students should be able to: Recall the characteristics of a bacterium Grasp the basis of classification of bacteria of medical importance Name important bacteria of clinical importance Give examples of the infection they cause Understand the basis of lab investigation

General characteristics
Single cell prokaryotes DNA forms a long circular molecule, not contained in a defined nucleus May or may not be motile or encapsulated Contains a complex cell wall Reproduce by binary fission Wide range of metabolic patterns, aerobic and anaerobic Uses phenotypic and genotypic data for classification

Classification
Distinguished by morphology and staining reaction Gram stain separates most bacteria into 2 great divisions:
Gram-positive bacteria Gram-negative bacteria

Classification
Main structural component of cell wall is PEPTIDOGLYCAN (mucopeptide or murein) Gram-positive
Peptidoglycan is a thick layer external to the cell membrane

Gram-negative
Peptidoglycan is thin and covered by an outer membrane (OM) Molecules of OM lipopolysaccharide & lipoprotein

True bacteria
Classified on the basis of shape: Cocci spherical Bacilli relatively straight, rod-shaped Vibrios curved rods Spirochaetes - twisted filamentous rodshaped

Gram-stained bacteria
Gram-positive cocci
Clusters Chains Pairs

Gram-positive bacilli (rods)

Short, long, branched, twisted

Gram-negative cocci Gram-negative bacilli

Metabolic classification
Aerobes
Utilizes oxygen for respiration

Facultative aerobes
Survives with or without O2

Anaerobes
Cannot survive in the presence of O2

Aerobic Gram-positive cocci

Streptococcus - occur in chains or pairs S. pyogenes (GAS)

Clinical infections
Tonsillitis/pharyngitis, cellulitis, rheumatic heart fever, acute glomerulonephritis Neonatal sepsis: meningitis, pneumonia. Infections in diabetics

S. agalactiae (GBS)

Aerobic Gram-positive cocci

S. pneumoniae

Pneumonia, meningitis, septicemia, septic shock, acute otitis media Infective endocarditis (IE), abscesses, dental caries

Viridans streptococci

Aerobic Gram-positive cocci

Enterococcus E. faecalis Staphylococcus Coagulase-positive
S. aureus

Hospital infections, urinary tract infection (UTI), IE

Furunculosis (boil), carbuncles, abscesses, wound infection, osteomyelitis, septicemia Device-associated infections, UTI, IE,

Coagulase-negative
S. epidermidis, S. saprophyticus

Gram-positive cocci
Anaerobic
Peptostreptococcus (anaerobic cocci) Peptococcus Lower respiratory tract infections Female genital tract infections Post-operative wound infections Brain abscess

Aerobic Gram-positive bacilli

Bacillus B. anthracis B. cereus Corynebacterium C. diphtheriae Nocardia N. asteroides
Anthrax Food-poisoning

Diphtheria

Atypical pneumonia, abscesses, S.c infections in immunocompromized pt

Aerobic Gram-positive bacilli

Listeria L. monocytogenes Mycobacterium M. tuberculosis
Neonatal sepsis, meningitis

Tuberculosis (atypical pneumonia), spinal osteomyelitis, brain abscess

Atypical pneumonia in immunocompromized pts

MOTT

Aerobic Gram-negative bacilli

Enterobacteriaceae E. coli

UTI, septicemia/septic shock, meningitis, wound infection, diarrhea

UTI, pneumonia, septic shock UTI, septicemia/septic shock

Klebsiella spp.

Enterobacter/Citrob acter spp

Aerobic Gram-negative bacilli

Pseudomonas spp: P. aeruginosa
Ventilator-associated pneumonia, cystitic fibrosis, burn wound infection, septicemia
Meningitis, pneumonia, otitis media (OM), septicemia, epiglottitis Whooping cough

Haemophillus spp: H. influenzae

Bordetella B. pertussis

Aerobic Gram-negative bacilli

Brucella spp. B. melitensis B. abortus Neisseria spp. N. gonorrheae N. meningitidis Brucellosis
Goats milk & cheese Cows milk & cheese

Gonorrhoea Meningitis

Aerobic Gram-negative bacilli

Helicobacter H. pylori

Non-dyspesia gastritis, duodenal and gastric ulcers, cancer

Campylobacter spp C. jejuni C. coli

Gastroenteritis

Aerobic Gram-negative bacilli

Vibrios V. cholerae V. parahemolyticus

Cholera Food-poisoning

Legionella spp L. pneumophila

Legionnaires disease (atypical pneumonia)

Other Gram-negative bacteria Spirochetes

Treponema spp
T. pallidum T. pertenue Syphilis Yaws

Borrelia spp.
B. recurrentis B. duttoni B. burgdorferi Epidemic relapsing fever Endemic relapsing fever Lyme disease Leptospirosis

Leptospira spp.

Anaerobes
Cannot tolerate molecular oxygen Lack superoxide dismutase Requires low redox potential (Eh)
Measured in mV (-75 to -450 mV)

Resistant to aminoglycosides Majority are sensitive to metronidazole

Classification of anaerobes
Spore-forming
Gram-positive rods
Clostridia

Non-spore-forming
Gram-positive cocci Gram-positive rods Gram-negative cocci Gram-negative rods Peptostreptococcus Actinomyces Veillonella Bacteroides, Prevotella, Fusobacterium, Porphyromonas

Anaerobic Gram-positive bacilli

Spore-forming:
Clostridium tetani Cl. perfringens Cl. difficile Tetanus Food-poisoning, gas gangrene, septic abortion CDAD: Antibioticassociated diarrhoea, Antibiotic-associated colitis, Pseudomembranous colitis Botulism food-poisoning

Cl. botulinum

Anaerobic Gram-positive bacilli

Non-sporing: Actinomyces
A. israelii Actinomycosis: cervicofacial, thoracic, abdominal, cutaneous. Acute/chronic prostheses infection, prostatitis, acne

Propionibacterium P. acnes

Anaerobic Gram-negative bacilli Non-spore formers

Bacteroides spp B. fragilis Post-surgical wound infections, abscesses, brain abscess, liver abscess, soft tissue infections Wound infections, abscesses, lung abscesses, soft tissue infections

Prevotella P. melaninogenica P. intermedia

Anaerobic Gram-negative bacilli

Porhyromonas spp P. gingivalis Oro-dental infections: periodontitis, gingivitis, soft tissue infection of the mouth, aspiration pneumonia, lung & brains abscess As above

Fusobacterium spp
F. nucleatum F. necrophorum

Laboratory diagnosis
Specimens
Collection Transportation Processing Gram-stain, ZN stain

Culture non-selective and selective media Non-cultural techniques

Serology EIA, ELISA, Immunofluorescence Molecular, e.g. PCR

Recommended text book

Medical Microbiology:
A Guide to Microbial Infections, Pathogenesis, Immunity, Laboratory Diagnosis and Control By David Greenwood, Richard Slack, John Peuther Published by Churchill Livingstone, 15th Edition, London