BACTERIAL AGENTS OF

CARDIO-VASCULAR
DISEASES
Baedah Madjid
Bagian Mikrobiologi Fak. Kedokteran
Unhas
2004
BACTERIAL AGENT OF
CARDIOVASCULAR DISEASES
NO. BACTERIA CARDIO-VASCULAR
DISEASES
OTHER DISEASES
1. Chl. pneumoniae Coronary heart disea-
ses
Respiratory infect
2. Strept. pyogenes Acute Endocarditis,
Carditis
Skin, Pneumonia,
Septic arthritis. biliary
and intra-abdominal
infections, UTI, cellu-
litis, & wound infection.

3. Viridans
Streptococci
Subacute Endocarditis Other nosocomial
Infection

4. Staph. aureus Acute Endocarditis Skin, Respiratory &
others
STREPTOCOCCI

CLASSIFICATION OF
STREPPTOCOCCI

A. Phylogenic classification
Family : Streptococcaceae,
Genera : Streptococcus.
Species Strept. pyogenes, Strept.
agalactiae, Strept. faecalis, Strept. bovis
Strept. angionosus, Strep. mitis, Strept.
pneumaoniae.
CLASSIFICATION OF
STREPPTOCOCCI
B. Hemolytic pattern
-hemolytic streptococci
Streptococcus viridans groups
Strept. pneumoniae
-hemolytic streptococci
Streptococcus pyogenes
-hemolytic streptococci
Non-pathogenic streptococci
CLASSIFICATION OF
STREPPTOCOCCI
C. Lancefield system
C substance Ag structure of cell wall,
A H & K U groups.
Pathogenic Streptococci : A-D & G groups.
D. Serotypes : cell wall proteins
M, R & T proteins.
80 tipe.
E. Casular polysaccharide
Str. pneumoniae : 83 serotypes

CEL MORPHOLOGY

Round or oval,
form long chains.
non-capsulated or
capsulated
(polysaccharide or
hyaluronic acid)

OTHER PROPERTIES

Gram-positive
-hemolysis
facultative anaerob
some strict anaerobs
microaerophilic,
catalase-negative
fastidious

Streptococcus pyogenes
(A group - hemolytic
streptococci)
VIRULENCE FACTORS
A. M, F & G ProteinS .
B. Hyaluronic capsule
C. C Substance & sitolasmic
membrane antigen
D. Exotoxin
Erythrogenic toxin
Exotoxin A, connected
with TSST-1
Exotoxin B (cystein
protease)
cardiohepatic toxin
E. Hemolysin
Streptolysin-O
Streptolysin-S
F. Spreading factors :
hyaluronidase,
proteinase,
streptokinase, &
nuklease : streptodornase
(DNAse)
VIRULENCE FACTORS
CLINICAL MANIFESTATIONS
LABORATORY DIAGNOSIS
A. Specimens:
Blood
Throath swabs.
Pus & secrets
cerebro-spinal fluids
Other infections : urine, sputum, bile
Serum
LABORATORY DIAGNOSIS
B. Diagnosis
1. Direct preparation: Gram staining.
2. Isolation
3. Antibiotic sensitivity testing
4. Serotyping
5. Lab. Diagnosis for rheumatic fever & acute
glumerulo-nephritis .
- High ASO & DNAse Ab titer .
- Ab Strept. enzymes
- C3
VIRIDANS STREPTOCOCCI


CLASSIFICATION OF VIRIDANS
STREPTOCOCCI
Streptococcus viridans groups:
S. mutans, S. sanguis, S. salivarius, S. mutans,
S. mitis (mitior), S. anginosus (S. milleri, S.
intermedius, and S. constellatus)
Classified by fermentation patterns, cell wall
compotition and production of dextrose or
levans (fructose 2-6 polymers) from sucrose.
CLINICAL INFECTIONS
Frequently found in nasopharynx, mouth,
ginggival crevices, gastrointestinal tract.
Occasionally on the skin
Could invade blood stream after chewing,
dental manipulations, gastro-intestinal or
genitourinary instrumentation.
CLINICAL INFECTIONS
Also may occur: cellulitis or wound
infection, meningitis, sinusitis, biliary or
intra abdominal infections, or endocarditis
S. anginosus: Brain or liver abscesses
S. sanguis: single species cause bacterial
endocarditis

Staphylococcus aureus
CLASSIFICATION
A. Phylogenic
Family: Micrococcaceae.
Genera: Staphylococcus, Micrococcus,
Stomacoccus, and Planococcus
Species : Staph. aureus, Staph.
epidermidis, Staph. saprophyticus
CLASSIFICATION
B. Practical classification
Genera Staphylococcus: > 30 species:
Coagulase-positive staphylococci
Staph. aureus,
Coagulase-negative staphylococci
Staph. epidermidis, Staph. saprophyticus,
Other staphylococci: not in discussion
Staph. epidermidis: NF of skin, upper respiratory
tract, & GI tract.
Staph. aureus: 40-50 normal human.
GENERAL PROPERTIES
Clustered Gram-positive cocci
Catalase positive
Prever aerobic condition but may behave as facultative
anaerobes

DIFFERENTATING CHARACTERISTIC
OF STAPHYLOCOCCI
Characteristic S. aureus S. epidermiidis S. saprophyticus
Pigment Yellow to white White White to pale gray
Hemolysis + -
Coagulase
production
Yes No No
Mannitol
fermentation
Yes No No
Novobiocyn
sensitivity
Sensitive Sensitive Resistance
PROPERTIES OF
S. aureus
dry- and heat-resistent
Resistance to 9 sodium chloride,
Inhibit by hexachlorophene 3.
penicillinase-positive
Antibiotic resistance occur rapidly .
NF of upper respiratoru tract, skin & mocous
membrane
Human pathogen

VIRULENCE FACTORS
CLINICAL MANIFESTATION
LABORATORY DIAGNOSIS
Specimens
Skin or mucous sawabs, pus, blood,
tracheal/bronchial washing, or cerebrospinal
fluids.
Diagnosis
Direct-Gram preparation.
Isolation
Serology amd serotyping testing
Antibiotic sensitivity test
Chlamydia pneumoniae
GENERAL PROPERTIES OF
CHLAMYDIA

Very small bacteria,
Microscopically : inclusion body
Can grow only on tissue
-lactam antibiotic : no use.
Life cycle unique

LIFE CYCLES
CLASSIFICATION

Ordo: Chlamydiales,
Famili: Chlamydiaceae,
Genus : Chlamydia,
Species : Chl. trachomatis, Chl. psittaci, Chl.
pneumoniae, Chl. pecurium.
Chl. trachomatis: Prototype
CHARACTERISTIC OF CHLAMYDIA
SPECIES
Characteristic C.
trachomatis
C. psittaci C.
pneumoniae
Inclusion
morphology
Oval,
vacoular
Variable,
dense
Oval, dense
Elementary body
morph.
round round Pear-shape
Folate
biosynthesis
Pos Pos Neg
Glycogen in
inclusions
Pos Neg Neg
No. of serovars 15 NA 1
CLINICAL MANIFESTATION
Mild upper respiratory infection
Pneumonia in young adult
Coronaary heart diseases

EPIDEMIOLOGY

Reservoir and transmission
Chl. Pneumoniae: sstrictly human pathogen,
Transmission: man to man contact
No animal reservoir
Insidence.
US: 50% seropositive
Mostly subclinic
Reinfection with other strain
Epidemy easy happen in close related community
MIKROBIOLOGY DIAGNOSIS
Tissue culture
Antigen detection
Elisa Test
Direct fluorescence antibody
DNA detection
Serology
Complement fixation test
Elisa test
Microimmunofluorescence test