Bacterial Diseases

Gram-positive
Gram-negative
Rickettsias, Chlamydias, Spirochetes and Vibrios

Bacterial Diseases Classified by:

Airborne
Upper
Lower

Foodborne
Waterborne
Soilborne
Arthropodborne
Physical Contact
STD
Contact
Animal

Or, by..
Gram-positive
Gram-negative
Rickettsias, Chlamydias, Spirochetes and
Vibrios

Gram-positive bacteria

Staphylococcus aureus
grows in large, round,
opaque colonies
optimum temperature
37oC
facultative anaerobe
withstands high salt,
extremes in pH, & high
temperatures
produces many
virulence factors

Coagulase

Enzymes of S. aureus

coagulates plasma and blood

produced by 97% of human
isolates

Hyaluronidase
promotes invasion

Staphylokinase
digests blood clots

Dnase
digests DNA

Lipases
helps bacteria colonize oily
skin

Penicillinase
inactivates penicillin

Toxins of S. aureus
hemolysins
lyse RBCs

Leukocidin
damages cell membranes

Enterotoxins
act in the gastrointestinal tract

exfoliative toxin
separates epidermal layers

toxic shock syndrome toxin (TSST)

Epidemiology and Pathogenesis

Present in most environments frequented by
humans
Readily isolated from fomites
Carriage rate for healthy adults is 20-60%
mostly in anterior nares, skin, nasopharynx, intestine

Predisposition to infection include:

poor hygiene and nutrition, tissue injury, preexisting primary
infection, diabetes, immunodeficiency

Increase in community acquired methicillin

resistance
MRSA

Staphylococcal Disease
Range from localized to systemic
Localized cutaneous infections invade skin through
wounds, follicles, or glands
folliculitis
superficial inflammation of hair follicle
usually resolved with no complications but can progress

furuncle
Boil
inflammation of hair follicle or sebaceous gland progresses into abscess
or pustule

carbuncle
larger and deeper lesion created by aggregation and interconnection of
a cluster of furuncles

impetigo
bubble-like swellings that can break and peel away
most common in newborns

Staphylococcal Disease
Systemic infections
osteomyelitis
infection is established
in the metaphysis
abscess forms

bacteremia
primary origin is
bacteria from another
infected site or medical
devices
endocarditis possible

Staphylococcal Disease
Toxigenic disease
food intoxication
ingestion of heat stable
enterotoxins
gastrointestinal distress

staphylococcal scalded skin

syndrome
toxin induces bright red flush,
blisters, then desquamation of
the epidermis

toxic shock syndrome

toxemia leading to shock and
organ failure

Other Staphylococci
S. epidermidis
lives on skin & mucous
membranes
endocarditis, bacteremia, UTI

S. hominis
lives around apocrine sweat
glands

S. capitis
live on scalp, face, external
ear

S. saprophyticus
infrequently lives on skin,
intestine, vagina; UTI

Streptococci
Gram-positive spherical/ovoid
cocci arranged in long chains
Non-spore-forming, nonmotile
Can form capsules & slime layers
Facultative anaerobes
Do not form catalase, but have a peroxidase
system
Small, nonpigmented colonies
Sensitive to drying, heat & disinfectants
25 species

Streptococci
Lancefield classification
system based on cell wall Ag
17 groups (A,B,C,.)
Another classification system
is based on hemolysis
reactions
-hemolysis
A,B,C,G & some D strains

hemolysis

S. pneumoniae & others

collectively called viridans

-hemolysis
Enterococcus faecalis
does not induce hemolysis

Streptococci
Skin infections
Impetigo (pyoderma)
superficial lesions that break and form
highly contagious crust
often occurs in epidemics in school
children
associated with insect bites, poor
hygiene, and crowded living
conditions
Erysipelas
pathogen enters through a break in the
skin
eventually spreads to the dermis and
subcutaneous tissues

can remain superficial or become

systemic

Throat infections
Streptococcal pharyngitis
strep throat

-hemolytic S. pyogenes
Most serious
streptococcal pathogen
Inhabits throat,
nasopharynx, occasionally
skin
Produces Ccarbohydrates, M-protein
(fimbrae), streptokinase,
hyaluronidase, DNase,
hemolysins

S. pyogenes
GAS
Humans only reservoir
Transmission
contact, droplets, food, fomites

Skin infections
pyoderma, impetigo,
erysipelas

Systemic infections
strep throat, pharyngitis,
scarlet fever

S. pyogenes
Causes streptococcal
pharyngitis
Strep throat
enters the upper
respiratory tract through
respiratory droplets

Some patients with strep

throat may develop
scarlet fever
exhibiting a rash caused
by erythrogenic exotoxins

S. pyogenes
Strep throat and scarlet
fever can be treated by
antibiotics
Rheumatic fever
serious complication
affecting the joints and
heart
causes permanent heart
damage called rheumatic
heart disease

Acute glomerulonephritus
rare inflammatory
response to M proteins
may lead to renal damage

Group B: S. agalactiae
Regularly resides in human vagina, pharynx &
large intestine
can be transferred to infant during delivery &
cause severe infection
Most prevalent cause of neonatal pneumonia,
sepsis, & meningitis
Pregnant women should be screened & treated

wound and skin infections & endocarditis in

debilitated people

Typical Pneumonia Can Be Caused by

Several Bacteria:
80% of typical
pneumonia cases are
caused by
Streptococcus
pneumoniae
Others:
Haemophilus
influenzae
Staphylococcus aureus
Klebsiella pneumoniae

Streptococcus pneumoniae
Causes 60-70% of all
bacterial pneumonias
Small, lancet-shaped cells
arranged in pairs and short
chains
Culture requires blood or
chocolate agar
Growth improved by 5-10%
CO2
Lack catalase &
peroxidases
cultures die in O2

S. pneumoniae
All pathogenic strains
form large capsules
major virulence factor

Causes pneumonia &

otitis media
Vaccine available for
high risk people

S. Pneumoniae Epidemiology
5-50% of all people carry it as normal flora
in pharynx
Does not survive long outside of its habitat
Pneumonia occurs when cells are aspirated
into the lungs of susceptible individuals
Pneumococci multiply
induce inflammatory response

Traditionally treated with penicillin G or V

Increased drug resistance

Cultivation and Diagnosis

Gram stain of specimen
presumptive identification

hemolytic
Quellung test or capsular swelling
reaction

Bacillus
gram-positive
endospore-forming
motile rods
mostly saprobic
aerobic & catalase positive
versatile in degrading complex macromolecules
source of antibiotics
primary habitat is soil
2 species of medical importance
Bacillus anthracis
Bacillus cereus

Bacillus anthracis
facultative
large, block shaped
rods
central spores
develop under all
conditions except in the
living body

virulence factors
capsule & exotoxins

Bacillus anthracis
3 types of anthrax
Cutaneous
spores enter through skin,
black sore
least dangerous

Pulmonary
inhalation of spores

Gastrointestinal
ingested spores

treated with penicillin or

tetracycline
vaccine
toxoid 6X over 1.5 years
annual boosters

Bacillus cereus
common airborne &
dustborne
grows in foods, spores
survive cooking & reheating
ingestion of toxin-containing
food
causes nausea,
vomiting, abdominal
cramps & diarrhea
24 hour duration
no treatment
spores abundant in the
environment

Clostridium
gram-positive
spore-forming rods
anaerobic & catalase negative
120 species
oval or spherical spores produced only under anaerobic
conditions
cause wound & tissue infections and food intoxications
C. difficile
C. botulinum
C. perfrogens
C. tetanis

Clostridium difficile-Associated Disease

(CDAD)
Normal resident of colon, in low
numbers
Causes antibiotic-associated
colitis
relatively non-invasive
treatment with broad-spectrum
antibiotics kills the other bacteria
allowing C. difficile to
overgrow

Produces enterotoxins that

damage intestines
Major cause of diarrhea in
hospitals
Increasingly more common in
community acquired diarrhea

Clostridium botulinum
Anaerobic, endospore-forming, Gram-positive
bacillus
Common in soil and water
Botulism results when the endopsores germinate
and produce botulism toxins

Clostridium botulinum
Causes 3 diseases
1. food poisoning
o
o

spores are in soil, may contaminate vegetables

improper canning does not kill spores & they germinate
in the can producing botulinum toxin
toxin causes paralysis by preventing release of
acetylcholine

2. infant botulism
o

caused by ingested spores that germinate & release

toxin

3. wound botulism
o

spores enter wound & cause food poisoning symptoms

Clostridium botulinum
Diagnosis
Symptoms are diagnostic

Treatment
Administer neutralizing antibodies against botulism
toxin
Administer antimicrobial drugs in infant botulism cases

Prevention
Proper canning of food
Infants under 1 year should not consume honey

Clostridium perfringens
Gangrene
occurs when blood flow ceases to a part of
the body

Gas gangrene (myonecrosis)

caused when spores enter the body through a
severe open wound

Clostridium perfringens
Vegetative cells ferment
muscle carbohydrates and
decompose muscle proteins
Large amounts of gas
accumulate under the skin,
causing a crackling sound
-toxin damages and lyses
blood cells
Treatment involves:
Antibiotics
tissue debridement
Amputation
exposure in a hyperbaric
oxygen chamber

Clostridium tetani
Tetanus
Causes hyperactive muscle contractions
Spores can enter the body through a wound
produce toxins

Tetanospasmin inhibits compounds needed to

inhibit muscle contraction

Clostridium tetani
Symptoms of tetanus include:
Trismus (lockjaw)
involves spasms of the jaw muscle and clenching of the
teeth

Opisthotonus
involves muscle spasms that cause an arching of the back

Spasmodic inhalation and seizures in the diaphragm and

rib cage
reduces ventilation

Sedatives, muscle relaxants, and penicillin are

used in treatment
Tetanus toxoid is used in vaccination

Listeria monocytogenes
non-spore-forming gram-positive
ranging from coccobacilli to long filaments
1-4 flagella
no capsules
resistant to cold, heat, salt, pH extremes &
bile
primary reservoir is soil & water
can contaminate foods & grow during
refrigeration

Listeria monocytogenes
Listerosis
immunocompromised patients,
fetuses & neonates
affects brain & meninges
20% death rate

ampicillin &
trimethoprimsulfamethoxazole
Prevention
pasteurization & cooking

Mycoplasmas
M. pneumoniae
primary atypical
pneumonia
Walking pneumonia

pathogen slowly spreads

over interior respiratory
surfaces
causes fever, chest pain
and sore throat

Corynbacterium diptheriae
gram-positive irregular bacilli
produce catalase
2 stages of disease:
1. Local infection
upper respiratory tract inflammation
sore throat, nausea, vomiting,
swollen lymph nodes,
pseudomembrane formation
can cause asphyxiation

2. Diptherotoxin production and

toxemia
target organs primarily heart and
nerves

Epidemiology and Pathology

Reservoir of healthy
carriers
potential for diphtheria
is always present
Most cases occur in nonimmunized children living
in crowded, unsanitary
conditions
Acquired via respiratory
droplets from carriers or
actively infected individuals

Corynbacterium diptheriae
Diagnostic methods
Pseudomembrane and swelling indicative
Stains
Conditions, history
Serological assay

Treatment:
Antitoxin
Penicillin or erythromycin

Prevented by toxoid vaccine series and

boosters

Mycobacteria
gram-positive irregular bacilli
acid-fast staining
strict aerobes
produce catalase
possess mycolic acids & a unique type of
peptidoglycan
do not form capsules, flagella or spores
grow slowly
2 medically important:
Mycobacterium tuberculosis
Mycobacterium leprae

Mycobacterium tuberculosis
contain complex waxes
& cord factor
prevent destruction by
lysosomes of
macrophages

transmitted by airborne
respiratory droplets
only 5% infected people
develop clinical disease

Primary TB
infectious dose 10 cells
phagocytosed by
alveolar macrophages
multiply intracellularly

after 3-4 weeks

immune system
attacks, forming
tubercles
granulomas consisting
of a central core
containing bacilli
surrounded by WBCs

Secondary TB
reactivation of bacilli
tubercles expand & drain into the
bronchial tubes & upper respiratory tract
gradually patient experiences more
severe symptoms
violent coughing, greenish or bloody sputum,
fever, anorexia, weight loss, fatigue

untreated 60% mortality rate

Extrapulmonary TB
during secondary TB, bacilli disseminate
to regional lymph nodes, kidneys, long
bones, genital tract, brain, meninges
these complications are grave

Diagnosis
1. in vivo or tuberculin
testing
2. X rays
3. direct identification
of acid-fast bacilli in
specimen
4. cultural isolation
and biochemical
testing

Treatment of TB
6-24 months of at least 2 drugs from a list
of 11
one pill regimen called Rifater (isoniazid,
rifampin, pyrazinamide)
vaccine based on attenuated bacilli
Calmet-Guerin strain of M. bovis used in
other countries

Mycobacterium leprae
Hansens bacillus
strict parasite
slowest growing of all species
multiplies within host cells in large packets
called globi
causes leprosy
chronic disease that begins in the skin & mucous
membranes & progresses into nerves

Leprosy (Hansens Disease)

spread through direct inoculation
from leprotics
2 forms
tuberculoid
superficial infection without skin
disfigurement
damages nerves and causes loss of
pain perception

lepromatous
deeply nodular infection
causes severe disfigurement of the
face & extremities

Diagnosing
Combination of
symptomology,
microscopic
examination of
lesions, and patient
history
Detection of acid-fast
bacilli in skin lesions,
nasal discharges, and
tissue samples

Treatment and Prevention

Treatment by longterm combined
therapy
Prevention requires
constant surveillance
of high risk
populations
WHO sponsoring a
trial vaccine

Propionibacterium acnes
gram-positive rods
aerotolerant or
anaerobic
nontoxigenic
common resident of
sebaceous glands
causes acne

Actinomycetes
Filamentous Bacteria
Genera Actinomyces &
Nocardia are nonmotile
filamentous bacteria
related to mycobacteria
Actinomyces sp
responsible for diseases
of the oral cavity &
intestines

Nocardia brasiliensis
causes pulmonary
disease similar to TB

Gram-negative Cocci and Bacilli

Bacterial Meningitis
meninges of brain and
spinal cord
cross the blood-brain
barrier

can be caused by
several bacterial
species
Neisseria meningitides
Streptococcus
pneumoniae
Haemophilus influenzae

Neisseria
Gram-negative, bean-shaped, diplococci
none develop flagella or spores
capsules on pathogens
Strict parasites
do not survive long outside of the host

Residents of mucous membranes of warm-blooded

animals
Aerobic or microaerophilic
produce catalase
Pathogenic species require enriched complex media and
CO2
2 primary human pathogens
Neisseria gonorrhoeae
Neisseria meningitidis

Neisseria meningitidis
Virulence factors
capsule, pili, IgA protease

12 strains
serotypes A, B, C, cause most cases

Disease begins when bacteria enter bloodstream,

pass into cranial circulation, multiply in meninges
very rapid onset
endotoxin causes hemorrhage and shock
can be fatal

Treated with penicillin, chloramphenicol

Vaccines exist for group A and C

Clinical Diagnosis
Gram stain, CSF,
blood, or
nasopharyngeal
sample
Culture for
differentiation
Rapid tests for
capsular antigen

Neisseria gonorrhoeae
Causes gonorrhea
Virulence factors
pili, other surface molecules, IgA protease

Strictly a human infection

In top 5 STDs
Infectious dose 100-1,000
Does not survive more than 1-2 hours on
fomites
Infection is asymptomatic in 10% of males and
50% of females

Gonorrhea
Males
urethritis, yellowish
discharge, scarring &
infertility
Extragenital infections
anal, pharygeal,
conjunctivitis,
septicemia, arthritis

Gonorrhea
Females
vaginitis, urethritis,
salpingitis (PID) mixed
anaerobic abdominal
infection
common cause of
sterility & ectopic tubal
pregnancies

Gonorrhea in Newborns
Infected as they pass
through birth canal
Eye inflammation,
blindness
Prevented by
prophylaxis after birth

Diagnosis and Control

Gram stain
Gram-negative intracellular (neutrophils)
diplococci from urethral, vaginal, cervical, or
eye exudate

20-30% of new cases are penicillinaseproducing PPNG or tetracycline resistant

TRNG
Recurrent infections can occur
Reportable infectious disease

Enterobacteriaceae Family
Enterics
gram-negative bacteria
many members inhabit soil,
water, & decaying matter
all members are small, nonsporing rods
facultative anaerobes
grow best in air

cause diarrhea through

enterotoxins
divided into coliforms (lactose
fermenters) and non-coliforms
(non lactose fermenters)

Enterobacteriaceae Family
Coliforms in Normal Flora
Rapid lactose-fermenting enteric bacteria that are normal flora and
opportunistic
E. coli
Enterobacter
Serratia
Klebsiella
Hafnia
Citrobacter

Noncoliforms in Normal Flora

Lactose-negative bacteria that are opportunistic, normal gut flora
Proteus
Providencia
Morganella
Edwardsiella

Enterobacteriaceae Family
True Pathogenic Enterics
Salmonella typhi
S. cholerae-suis
S. enteritidis
Shigella dysenteriae
S. flexneri
S. boydii
S. sonnei
Yersinia enterocolitica
Y. pseudotuberculosis

True Pathogenic
Nonenterics
Yersinia pestis

Antigens and virulence factors of

typical enteric bacteria

Testing of Enterics
miniaturized, multichambered tube
inoculating rod pulled through length of
tube
carries an inoculum to all chambers

Coliform Organisms and Diseases:

Escherichia coli
most common aerobic & non-fastidious
bacterium in gut
@ 150 strains
Most not infectious

Escherichia coli
enterotoxigenic E. coli
causes severe diarrhea due to heat-labile toxin & heatstable toxin
stimulate secretion & fluid loss
also has fimbrae

enteroinvasive E. coli
causes inflammatory disease of the large intestine

enteropathogenic E. coli
linked to wasting from infantile diarrhea

Enterohemorrhagic E. coli
Newest strain
Can permanently damage kidney

Escherichia coli
pathogenic strains frequent agents of
infantile diarrhea
greatest cause of mortality among babies

causes ~70% of travelers diarrhea

causes 50-80% UTI
indicator of fecal contamination in water

Klebsiella pneumoniae
Coliforms
normal inhabitant of
respiratory tract
large capsule
cause of nosocomial
pneumonia, meningitis,
bacteremia, wound
infections & UTIs

Other Coliforms
Serratia marcescens
produces a red pigment
causes pneumonia,
burn & wound
infections, septicemia &
meningitis

Citrobacter
opportunistic UTIs &
bacteremia

Salmonella
Motile
ferments glucose
S. cholerae-suis
pigs

S. enteritidis
1,700 serotypes
salmonellosis
zoonotic
gastroenteritis 2-5 days

Typhoid Fever
caused by Salmonella enterica
serotype Typhi
(S. typhi)
typhoid fever
ingested bacilli adhere to small
intestine
cause invasive diarrhea that leads
to septicemia

S. Typhi is transmitted by the

five Fs:

Flies
Food
Fingers
Feces
Fomites

Shigella
shigellosis
incapacitating dysentery

S. dysenteriae, S. sonnei,
S. flexneri & S. boydii
produce H2S or urease
Nonmotile
nonencapsulated

Shigella
invades villus of large intestine
can perforate intestine or invade blood
enters Peyers patches & instigates inflammatory
response
endotoxin & exotoxins

treatment
fluid replacement & ciprofloxacin & sulfa-trimethoprim

Yersinia pestis
tiny, gram-negative rod
unusual bipolar staining & capsules
virulence factors
capsular & envelope proteins protect against
phagocytosis & foster intracellular growth
coagulase

Yersinia pestis
sylvatic plague
humans develop plague through contact with wild
animals

urban plague
domestic or semidomestic animals or infected humans

found in 200 species of mammals

rodents harbor the organism but do not develop the
disease

flea vectors
bacteria replicates in gut, coagulase causes blood
clotting that blocks the esophagus
flea becomes ravenous

Pathology of Plague
bubonic
bacillus multiplies in flea bite, enters lymph, causes
necrosis & swelling in groin or axilla
bubo

septicemic
progression to massive bacterial growth
virulence factors cause intravascular coagulation
subcutaneous hemorrhage & purpura
black plague

pneumonic
infection localized to lungs, highly contagious
fatal without treatment

Plague
Treatment
streptomycin,
tetracycline or
chloramphenicol

Killed or attenuated
vaccine

Pathogenic, Gram-Negative,
Facultatively Anaerobic Bacilli
The Pasteurellaceae
Haemophilus
Haemophilus
influenzae
Most strains have
capsule that resists
phagocytosis
H. influenzae type b is
most significant

Pathogenic, Gram-Negative,
Facultatively Anaerobic Bacilli
The Pasteurellaceae
Haemophilus
Sexually transmitted
Haemophilus
Caused by H. ducreyi
Causes genital ulcer
called chancroid
Often asymptomatic
in women

Bartonella
small gram-negative
Fastidious, cultured on blood agar
causes:
trench fever
spread by lice

cat-scratch disease
lymphatic infection associated with a clawing injury by
cats

bacillary angiomatosus in AIDS patients

tetracycline, erythromycin & rifampin

Brucella
Brucellosis, malta fever, undulant fever, & Bang
disease
zoonosis transmitted to humans from infected animals

aerobic coccobacilli
2 species
Brucella abortus (cattle)
Brucella suis (pigs)

fluctuating pattern of fever

weeks to a year

combination of tetracycline
& rifampin or streptomycin
animal vaccine available
potential bioweapon

Bordetella pertussis
aerobic coccobacillus
causes pertussis or whooping cough
communicable childhood affliction

acute respiratory syndrome

often severe, life-threatening complications in
babies
reservoir
apparently healthy carriers

transmission by direct contact or inhalation of

aerosols

Bordetella pertussis
virulence factors
receptors that recognize & bind to ciliated
respiratory epithelial cells
toxins that destroy & dislodge ciliated cells

DTaP vaccine
acellular vaccine contains toxoid & other Ags

Pseudomonas
small gram-negative bacilli
single polar flagellum
produce oxidase & catalase
highly versatile metabolism

Pseudomonas aeruginosa
intestinal resident in 10% normal people
resistant to soaps, dyes, quaternary
ammonium disinfectants, drugs, drying
Use aerobic respiration
do not ferment carbohydrates

Produce oxidase and catalase

Many produce water soluble pigments
Opportunistic

Pseudomonas aeruginosa
common cause of nosocomial infections in hosts
with burns, neoplastic disease, cystic fibrosis
complications include pneumonia, UTI,
abscesses, otitis, & corneal disease
grapelike odor
greenish-blue pigment (pyocyanin)
multidrug resistant

Francisella tularensis
causes tularemia
zoonotic disease of mammals (particularly rabbits)
endemic to the northern hemisphere

Aerobic bacilli
transmitted by contact with infected animals,
water & dust or bites by vectors
headache, backache, fever, chills, malaise &
weakness
10% death rate in systemic & pulmonic forms
intracellular persistence can lead to relapse
gentamicin or tetracycline
potential bioterrorism agent

Atypical Pneumonia Can Be Caused by

a Diverse Group of Bacterial Species
Mycoplasma pneumoniae
Legionella pneumophila
Coxiella burnetii
Chlamydia pneumoniae
Chlamydia psittaci

Legionella pneumophila
Legionellosis, Legionaires
disease
Motile aerobic bacilli
widely distributed in water
live in close association with
amebas
prevalent in males over 50
nosocomial disease in elderly
patients
fever, cough, diarrhea,
abdominal pain, pneumonia
fatality rate of 3-30%
azithromycin

Coxiella burnetti
Q fever
intracellular parasite
produces an unusual resistant spore
harbored by a wide assortment of vertebrates &
arthropods
transmitted by air, dust, unpasteurized milk, ticks
usually inhaled causing pneumonitis, fever,
hepatitis
tetracycline treatment
vaccine available

Rickettsias, Chlamydias,
Spirochetes and Vibrios

Rickettsia
obligate intracellular parasites
gram-negative cell wall
among the smallest bacteria
nonmotile pleomorphic rods or coccobacilli
ticks, fleas & louse are involved in their life cycle
bacteria enter endothelial cells & cause necrosis
of the vascular lining
treat with tetracycline & chloramphenicol

4 Types of Rickettsioses

1. epidemic typhus

R. prowazekii
carried by lice
starts with a high fever, chills, headache, rash
Brill-Zinsser is a chronic, recurrent form

2. endemic typhus

R. typhi
harbored by mice & rats
occurs sporadically in areas of high flea infestation
milder symptoms

4 Types of Rickettsioses
3. Rocky Mountain spotted fever

R. rickettsii
zoonosis carried by dog & wood ticks
most cases on eastern seaboard
distinct spotted rash

4 Types of Rickettsioses

4. Ehrlichia genus

contains 2 species of rickettsias

tickborne bacteria
Most humans recover rapidly
5% chronically ill patients die from
disseminated infection

Chlamydia
obligate intracellular
parasites
small gram-negative cell
wall
alternate between 2
stages
elementary body
small metabolically inactive,
extracellular, infectious form

reticulate body
grows within host cell
vacuoles

Chlamydia trachomatis
trachoma
attacks the mucous membranes of the
eyes, genitourinary tract & lungs
ocular trachoma
severe infection, deforms eyelid &
cornea, may cause blindness

inclusion conjunctivitis
occurs as babies pass through birth
canal
prevented by prophylaxis

STD
urethritis, cervicitis, scarring

lymphogranuloma venereum
disfiguring disease of the external
genitalia & pelvic lymphatics

Other Chlamydia
C. pneumoniae
causes an atypical pneumonia
serious in asthma patients

C. psittaci
causes ornithosis
zoonosis transmitted to humans from bird vectors
highly communicable among all birds

pneumonia or flulike infection with fever, lung

congestion

Treponema
Gram-negative spirochetes
live in the oral cavity, intestinal tract, &
perigenital regions of humans & animals
pathogens are strict parasites

Treponema pallidum
human is the natural host
extremely fastidious &
sensitive
cannot survive long outside
of the host

causes syphilis
infectious dose is
57 organisms!!

Pathogenesis and Host Response

Spirochete binds to epithelium, multiplies, and
penetrates capillaries.
Moves into circulation and multiplies
Untreated marked by stages
Primary
Secondary
Tertiary

Spirochete appears in lesions and blood during first

2 stages
communicable

Stages of Syphilis
Primary syphilis
appearance of hard
chancre at site of
inoculation
chancre heals
spontaneously

Secondary syphilis
fever, headache, sore
throat, red or brown rash
on skin, palms and soles
rash disappears
spontaneously

Stages of Syphilis
Tertiary syphilis
about 30% of infections enter
in tertiary stage
can last for 20 years or longer
neural, cardiovascular
symptoms, gummas develop

Congenital syphilis
nasal discharge, skin
eruptions, bone deformation,
nervous system abnormalities

Borrelia
Borrelioses
Gram-negative spirochetes
transmitted by arthropod vector
B. hermsii
relapsing fever

B. burgdorferi
Lyme disease

B. hermsii - Relapsing Fever

mammalian reservoirs
squirrels, chipmunks, wild rodents

tick-borne
after 2-15-day incubation, patients have high
fever, shaking, chills, headache, & fatigue
Nausea, vomiting, muscle aches, abdominal
pain
extensive damage to liver, spleen, heart, kidneys, &
cranial nerves

parasite changes & immune system tries to

control it
recurrent relapses

tetracycline

B. burgdorferi - Lyme Disease

transmitted by ticks
complex 2-year cycle
involving mice & deer
nonfatal, slowly
progressive syndrome
that mimics
neuromuscular &
rheumatoid conditions

B. burgdorferi - Lyme Disease

Symptoms:
70% get bulls eye rash
fever, headache, stiff neck,
& dizziness

if untreated can progress to

cardiac & neurological
symptoms, polyarthritis
tetracycline, amoxicillin
vaccine for dogs, human
vaccine discontinued
insect repellant containing
DEET

Leptospira
Gram-negative spirochetes
L. interrogans
causes leptospirosis
zoonosis
bacteria shed in urine
infection occurs by contact
targets kidneys, liver, brain, eyes

sudden high fever, chills, headache, muscle aches,

conjunctivitis, & vomiting

Vibrio cholera
Cholera
Curviform gramnegative
top 7 causes of
morbidity & mortality
ingested with food or
water
infectious dose 108

Vibrio cholera
infects surface of small intestine,
noninvasive
cholera toxin causes electrolyte & water
loss through:
secretory diarrhea, resulting dehydration leads
to muscle, circulatory, & neurological symptoms

Treatment
oral rehydration, tetracycline

vaccine

Campylobacter jejuni
important cause of bacterial
gastroenteritis
transmitted by beverages &
food
Curviform gram-negative

reach mucosa at the last

segment of small intestine
near colon
adhere, burrow through
mucus and multiply
symptoms of headache,
fever, abdominal pain, bloody
or watery diarrhea

Helicobacter pylori
Curviform gram-negative
discovered in 1979 in stomach biopsied
specimens
causes 90% of stomach & duodenal
ulcers
people with type O blood have a 1.5-2X
higher rate of ulcers
produces large amounts of urease

Miscellaneous

Alcaligenes
live primarily in soil & water
may become normal flora
A. faecalis
Aerobic, gram-negative bacilli
most common clinical species
isolated from feces, sputum, & urine
occasionally associated with
opportunistic infections
pneumonia, septicemia, & meningitis

Bacteria in Dental Disease

oral cavity is a
complex, dynamic
ecosystem
contains 400 species
dental caries
slow progressive
infection of irregular
areas of enamel
surface

Bacteria in Dental Disease

o begins with colonization by
slime-forming species
o Streptococcus
o cross adherence with
Actinomyces

o process forms layer of

plaque
o harbors masses of bacteria
which produce acid that
dissolves enamel

o If plaque is allowed to stay,

secondary invaders appear
o Lactobacillus, Bacteroides,
Fusobacterium,
Porphyromonas,
Treponema

o Acid dissolves tooth enamel

Peridontal disease
soft tissue disease
plaque becomes calcified
into calculus above and
below the gingiva
irritates tender gingiva
causing inflammation
gingivitis
pockets between tooth &
gingiva are invaded by
bacteria
tooth socket may be
involved
peridontitis

tooth may be lost