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 Gram-negative bacteria Gram-

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

GramGram-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 rodVibrios curved rods Spirochaetes - twisted filamentous rodrodshaped

GramGram-stained bacteria
GramGram-positive cocci
Clusters Chains Pairs

GramGram-positive bacilli (rods)

Short, long, branched, twisted

GramGram-negative cocci GramGram-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 Gram-

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 Gram-

S. pneumoniae

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

Viridans streptococci

Aerobic Gram-positive cocci GramEnterococcus E. faecalis Staphylococcus CoagulaseCoagulase-positive

 S. aureus

Hospital infections, urinary tract infection (UTI), IE Furunculosis (boil), carbuncles, abscesses, wound infection, osteomyelitis, septicemia DeviceDevice-associated infections, UTI, IE,

CoagulaseCoagulase-negative
 S. epidermidis, S. saprophyticus

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

Aerobic Gram-positive bacilli GramBacillus B. anthracis B. cereus Corynebacterium C. diphtheriae Nocardia N. asteroides
Anthrax FoodFood-poisoning

Diphtheria

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

Aerobic Gram-positive bacilli GramListeria 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 GramEnterobacteriaceae 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 GramPseudomonas spp: P. aeruginosa

VentilatorVentilator-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 GramBrucella spp. B. melitensis B. abortus Neisseria spp. N. gonorrheae N. meningitidis Brucellosis
Goats milk & cheese Cows milk & cheese

Gonorrhoea Meningitis

Aerobic Gram-negative bacilli GramHelicobacter H. pylori NonNon-dyspesia gastritis, duodenal and gastric ulcers, cancer

Campylobacter spp C. jejuni C. coli

Gastroenteritis

Aerobic Gram-negative bacilli GramVibrios V. cholerae V. parahemolyticus Legionella spp L. pneumophila Cholera FoodFood-poisoning

Legionnaires disease (atypical pneumonia)

Other Gram-negative bacteria GramSpirochetes

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) (Eh)
Measured in mV (-75 to -450 mV) (-

Resistant to aminoglycosides Majority are sensitive to metronidazole

Classification of anaerobes
SporeSpore-forming
Gram-positive rods GramClostridia

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

Anaerobic Gram-positive bacilli GramSporeSpore-forming:

Clostridium tetani Cl. perfringens Cl. difficile Tetanus FoodFood-poisoning, gas gangrene, septic abortion CDAD: AntibioticAntibioticassociated diarrhoea, AntibioticAntibiotic-associated colitis, Pseudomembranous colitis Botulism food-poisoning food-

Cl. botulinum

Anaerobic Gram-positive bacilli GramNonNon-sporing: Actinomyces

A. israelii Actinomycosis: cervicocervicofacial, thoracic, abdominal, cutaneous. Acute/chronic prostheses infection, prostatitis, acne

Propionibacterium P. acnes

Anaerobic Gram-negative bacilli GramNonNon-spore formers

Bacteroides spp B. fragilis PostPost-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 GramPorhyromonas spp P. gingivalis OroOro-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 Gram-

Culture non-selective and selective media nonNonNon-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