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Review on Microbiology

ภญ.รศ.ดร.โพยม วงศภ์วูรกัษ์

24 มี.ค.578.45-9.45 น.

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การรายงานของผลการตรวจเชื�อเบื�องตน้ของหอ้ง labEx. Gram positive diplococci, Enterobaceteriace,Coagulase negative Staphylococci, Lactose fermenter bacilli

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การแบ่งประเภทสิ�งมีชีวติที�ทาํให้เกดิโรคในมนุษย์:Prions, Viruses, Prokaryotics, Eukaryotics

1. Prions: infectious particles 2. Viruses: not cell, obligate intracellular,

no organelles 3. Prokaryotic: bacteria; no organelles, no nuclear

membrane: Typical vs. Atypical 3.1.Typical bacteria: no sexual growth cycle,

may have asexual spores, have cell wall

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3.2. Atypical bacteria: มี cell membrane3.2.1. Mycoplasmas: smallest bacteria,

no cell wall แบ่งตัวได้เอง ไม่ต้อง อาศัย ATP จาก host cells

อยู่ได้ทั Qงในเซลล์ & นอกเซลล์3.3.2. Rickettsia: obligate intracellular,

มี cell wall ไม่สามารถแบ่งตัวได้เอง ต้องอาศัย ATP จาก host cell

3.3.2. Chlamydiae: obligate intracellular มี cell wall คล้าย gm-ve วงจรการเจริญเตบิโต ซับซ้อน ต้องอาศัย ATP จาก host cell

ยาที�มีฤทธิ� ยบัยั �งการสร้างผนังเซลล-์รกัษา mycoplasma ได้ไหม ?

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การแบ่งประเภทสิ�งมีชีวติที�ทาํให้เกดิโรคในมนุษย์

4. Eukaryotic cells : มี organelles และ nucleus ที�มีเยื�อหุ้ม ส่วนใหญ่ไม่มีผนังเซลล์ (ยกเว้น เซลล์พชืและ fungi)

4.1.Fungi (kingdom: Fungi) มี complex carbohydrate cell wall: yeast / filamentous mold, dimorphic

4.2. Protozoa (kingdom: Protista) - parasites ที�ทาํให้เกดิโรคในคน

4.3. Arthropods แมลง

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Obligate aerobic (oxygen need): Pseudomonas,

Nocardia,

Mycobacteria

Legionella

Obligate anaerobic: (destroyed by O2) Bacteroides, Clostridium Peptostreptococci

Facultative anaerobe: (มี O2 ดีกว่าไม่มี แต่ ไม่มี O2

ก็อยูได้) E.coli, Corynebacteria, Listeria

Microaerophile: (ต้องการ O2 เพียงเล็กน้อย)

Helicobacter, Campylobacter Borrelia,

Aerotolerant: มีหรอื ไม่มี

O2 ก็อยู่ได้)Streptococcus pyogenes Enterococcus faecalis

บางตําราจดัไว้ใน Facultative

http://en.wikipedia.org/wiki/Anaerobic_organism

Respiratory met Fermentation met Fermentation metabolismRespiratoy & Fermentation

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The Classification and Identification of Bacteria of Medical Importance

Gram-positive cocci, bacilli - Aerobe - Anaerobe

Gram-negative cocci, bacilli - Aerobe- Anaerobe

- Facultative anaerobe - Microaerophilic Bacteria บางชนิดไม่สามารถย้อม Gram stain ได้ หรือ

ย้อมได้ยาก: Borrelia, Treponema, Mycobacterium, etc. http://www.thailabonline.com/bacteria8.htm

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Coccus Diploccoci Diploccoci Encapsulated Pneumococci

Staphylococci

StreptococciSarcina (รวมกนัเป็นก้อน) Tetrad

Enlarged rod: Fusobacterium

Vibrio Comma’s form, Bdelllovibrio

Coccobacillus Bacillus

Diplobacilli Pallisades

Streptobacilli

Hypha Stalk

Club rod: Corynebacteriace

Helico form: Helicobacter pyroli Campylobacter jejuny

Cork screw from: Borrelia burgdorferi

Filamentous Spirochete

Coccus

Bacilli

Others

Budding and appendaged bacteria

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Pyogenic Cocci ทําให้มีหนอง

Suppurative (pus-producing) infections -Gram-positive cocci: Staphylococcus aureus,

Streptococcus pyogenes Streptococcus pneumoniae

-Gram-negative cocci: Neisseria gonorrhoeae N. meningitidis

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Gram positive bacteria

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Bacterial morphology

Filamentous: Nocardia Actinomycetes

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POSITIVE

CocciBacilli

Cluster Staphylococcus

Coagulase positive S. aureus

Coagulase negative S. epidermidis S. saprophyticus S. hominis S. hemolyticus S. warneri

Pairs (diplococci) Pneumococci S. pneumoniae

Small Listeria Propionibacteria Corynebacteria Gardnerella

Large Spore forming Clostridium Bacillus

Nonspore Lactobacillus

Filamentous Nocardia Actinomycetes ErysipelothrixBacteria

Chain Streptoccus

Beta-hemolytic (clear) S. pyogenes (gp A)S. agalactiae (gp B)Strep group C,F,G

Alpha-hemolytic Viridans Strep.(green) S. pneumoniae

Non-hemolytic Strep gp D Enterococci Non-enterococci gp D

POSITIVE

Cocci

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AerobicGram

positive cocci

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Common gram positive aerobic bacteria

and diseases caused by these bacterias

Aerobic, Gram-positive cocciStaphylococcus aureus (Coagulase-positive)Staphylococcus epidermidis (Coagulase-negative)

Staphylococcus spp. (Other coagulase-negative) Streptococcus pyogenes (group A)

Streptococcus agalactiae (group B)Streptococcus pneumoniae (Viridans group)

Enterococcus spp. : Group D, Non-group D

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1.1. Golden yellow colonies

Coagulase test +ve (plasma clot)

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Coagulase test -ve staphylococci Staphylococcus epidermidis

Staphylococcus capitis

Staphylococcus saprophyticus

Staphylococcus albus

1. Staphylococcus aureus:

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Staphylococcus aureus (Coagulase +ve) Normal flora: skin, nasal membranes, GI tract

-Produce leukotoxin (kill WBC), toxins-Leading cause nosocomial infections by Gram-positive bacteria

Pyogenic: boils, acne, wound infections, food poisoning, systemic infection: sepsis, pneumonia, osteomyelitis, toxic shock syndrome

MRSA (Methicillin resistant Staphylococcus aureus)

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VRSA (Vancomycin resistant Staphylococcus aureus)

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2.Staphylococcus albus :Coagulase negative : virulence < S.aureus

Common- intravascular devices Prosthetic joints infection,

Wound, Osteomyelitis

Endocarditis

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S. epidermidis, S. capitis, S. saprophyticus,

S. haemolyticus, S. hominis

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clearComplete hemolysis

Non- group D: S.bovis, S.equinus

Viridan gr.

http://en.wikipedia.org/wiki/Streptococcus

S.pneu-

moniae

S.

viridansS.pyogenes

Gr. AS.agalactiae

Gr. B

Enterococcus(Streptococcus)

E. faecalis

E. faecium

Gr. D

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Streptococci-Beta-haemolytic streptococci: complete breakdown

-Alpha-haemolytic streptococci: partial blood breakdown "viridans" streptococci (viridis is Latin for green)

-Gamma-haemolytic-non-haemolytic streptococci (Enterococci)

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. "Lancefield Group A“ : Streptococcus Group A: S. pyogenes: normal flora ในทางเดนิหายใจ

Streptococcus pyogenes

Dz: tonsillitis scarlet fever (toxin), erysipelas, toxic shock syndrome post-streptococcal sequelae (immune) rheumatic fever, glomerulonephritis

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Carriers: female vaginal tract, bowel, bladder, throat Common: sepsis, meningitis, pneumonia in newborns Pregnant women- bladder infections, amnionitis,

endometritis, stillbirth Men & women (not pregnant): sepsis,

skin or soft tissue, pneumonia

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Streptococcus agalactiae, group B: (GBS):

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Viridans group -Streptococcus pneumoniae

-Streptococcus viridans

2. Alpha-haemolytic streptococci:

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Streptococcus pneumoniae

Encapsulated, gram +ve coccoid "lancet shape,”Colonizes - Nasopharynx lung

- Eustachian tube lung

Dz: URI, LRI pneumonia, laryngitis, otitis media, sinusitis Leading causes of bacterial meningitis

Invasive pneumococcal disease (IPD)

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Normal habitat in the mouth

Involves in dental caries

Serious: non-oral conditions:

septicaemia,

infective endocarditis

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Streptococcus viridans: (Oral Streptococci)

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Group D Streptococci / Enterococci Normal habitats - intestine, vagina

Enterococci : E. faecalis, E. faecium,

(Early 1990's- classified in the genus Streptococcus)

VRE –vancomycin resistant enterococcus Non-enterococcal group D: S. bovis (ววั ควาย), S. equinus (ม้า)

3. Non-haemolytic streptococci

Dz: UTI, endocarditis, biliary tract infections,suppurative abdominal lesion, peritonitis

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Gram-positive rods: Endospore-formingBacillus anthracis: Anthrax Aerobe

Bacillus cereus:

Clostridium botulinum Clostridium difficile AnaerobeClostridium perfringens Clostridium tetani

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Bacillus: endosporePathogens of animals, - production of toxinsBacillus anthracis: - anthrax

Bacillus cereus: causes food poisoning

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Gram-positive

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Clostridium botulinum

Clostridium botulinum- food poisoning -neurotoxinอาหารกระป๋อง, หน่อไม้ปีa บ-น่าน-มีนาคม พ.ศ. 2549

ชนิด A, B, E และ F - botulism ในมนุษย ์

ชนิด C และ D- botulism ในสตัวป์ีก ววัควาย และปลา

ชนิด G พบในอาหารประเภทปลา

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Clostridium difficile grows slowly and is difficult to culture

Normal intestinal flora C. difficile is the major cause of

pseudomembranous colitis and antibiotic associated diarrhea

Clostridium perfringens: -gas gangrene

C. C. botulinumbotulinum

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Gram-positive rods: Nonspore-forming, AerobicListeria monocytogenes Erysipelothrix rhusiopathiae

Gardnerella vaginalis

Corynebacterium diptheriae

Propionibacterium acnes

Nocardia spp.Gram-positiverods: Nonspore, AnaerobeActinomyces israelii

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Listeria monocytogenes

No endospores: found in soil, vegetation, water, in the gastrointestinal tract of animals

Listeriosis: serious infection -contaminated food -pregnant women - แท้งลูก

-newborns vaginal delivery : sepsis + meningites-adults with immunocompromise

Cephalosporin resistant

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Nocardia spp. filamentous bacteria: soils

Nocardia brasiliensis : common - chronic mycetomaNocardiosis: acute, subacute, chronic suppurative

infection caused by Nocardia

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Gram-positive, obligate aerobic

mycetoma

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Anaerobic, Gram-positive rodsActinomyces sp. fungus-like bacteria -filamentousActinomyces israeli, A.gerencseriae.

In man,-most in cervicofacial region, jawDental caries หากสาํลกัเชื�อจากในปากเข้าสู่ปอดได้

Actinomycosis- multiple abscesses, granulomata

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Peptostreptococcus sp. (formerly known as Peptococcus)

P. magnus : most commonly isolated anaerobic cocci:

Infection Oral RTI Skin & soft Abscess GI Genitourinary

P. anaerobius ���� ���� ���� P. magnus ���� ���� ���� ����

P. micros ���� ���� ���� ���� ����

P. asaccharolyticus ���� ����

P. vaginalis ���� ����

P. tetradius ���� 55

Commensal in mouth, gut flora, skin, urinary tract

Anaerobic, Gram +ve cocci

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Gram negative bacteria

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Lactose ferment ของ gram negative bacilli / helical

คุณสมบัต ิ ferment lactose ได้หรือไม่ เลี Qยงแบคทเีรียบน MacConkey agar (มี lactose)

Lactose fermenter ����กรด -pH วุ้นตํ�า โคโลนีสีแดง/ชมพ ู Non- lactose fermenter:

Neutral red

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NEGATIVE

BacilliCocci

Neisseria

N. gonorrhoea N. meningitides

Veillonella

Lactose fermenter Aeromonas Pasteurella Vibrio vulnificus

E.coli Klebsiella spp. Enterobacter spp. Citrobacter spp.

Bacteria

Bacilli

Non Lactose fermenter Pseudomonas spp. Falvobacterium spp. Achromobacter spp. Moraxella spp. Proteus spp. Serratia spp. Morganella spp. Samonella spp. Shigella spp. Stenotrophomonas Acinetobacter calcoaceticus Vibrio chlorerae

Coccobacilli A.baumanii Hemophilus influenza Moraxella spp.

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NEGATIVE

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Common gram negative aerobic bacteria

and diseases caused by these bacteria

Aerobic, Gram-negative cocci

Neisseria gonorrhoeae

Neisseria meningitidis

Moraxella catarrhalis

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Niesseria

Most Neisseriae : normal flora- mucous membranes.

Humans-common residents- throat, upper resp. tract. Neisseria gonorrhoeae Neisseria meningitidis

Eikenella corrodens: Rod / coccobacilli, (M. Eiken พบในปี 1958) เป็น normal flora ที�เหงอืก, ลาํไส้

Kingella kingae: Rod / coccobacilli, เป็น normal flora ในปาก

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Neisseria meningitidisไข้กาฬหลงัแอ่นBacterial meningitis

Meningococcal meningitis- rapidly fatal disease, untreated meningitis -mortality rate 50 %

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HACEK: fastidious, gram-ve, aerobic bacilli Haemophilus spp. เช่น H. aphrophilus,

Actinobacillus actinomycetemcomitans, Cardiobacterium hominis,

Eikenella corrodens, Kingella kingae

HACEK: normal flora: respiratory tract Local infection in the mouth,

Native valve endocarditis

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Moraxella catarrhalis (Micrococcus catarrhalis, Neisseria catarrhalis; Branhamella catarrhalis) – Coccobacilli

commensal (อิงอาศยั): upper respiratory tract: nasopharynx nosocomial infections

Common cause: otitis media, sinusitis Occasional cause: laryngitis.

Bronchitis / pneumoniaimmunocompromised host : bacteremia, osteomyelitis,

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Acinetobacter spp. Commonly found in soil and waterAcinetobacter baumannii -hospital acquired infection Highly resistant (HR) Acinetobacter baumannii :

severe nosocomial infectionsCauses of Nosocomial pneumonia

CAPD-associated peritonitis, Meningitis, Wound infection,

Catheter-associated bacteruria Septicemia

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Coccobacillary rods

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Enterobacteriaceae = group of gram-negative, facultatively anaerobic rod bacteria; natural habitat in the intestinal tract :

Citrobacter, Enterobacter,E.coli,Klebsiella,

Samonella, Shigella, Serratia, Proteus, Providencia,Morganella, Yersinia

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E. coli : commonly found in lower intestine

Intestinal tract infections Uncomplicated urinary tract infections Neonatal meningitis:Peritonitis Sepsis

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Enterobacter spp. Enterobacter cloacae, Enterobacter aerogenes:

Important nosocomial pathogens ““ICU bugs” -multiple resistance

Source of infection: endogenous (colonization skin, GI, UT)

exogenous จากเชื�อที�มีอยู่ทั �วไปDiseases: bacteremia, lower respiratory tract infections, skin and soft tissue infections, urinary tract infections (UTIs), endocarditis, intra-abdominal infections, septic arthritis,

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Citrobacter spp.

พบได้ทกุแห่ง ในดิน ในนํ�า ในลาํไส้คน

Infections in neonates, immunocompromised hostsCitrobacter freundii and C. diversus (C. koseri) –

Urinary tract infection, Respiratory tract infection

C. koseri- cause of sepsis and meningitis leading to central nervous system (CNS) abscesses in neonates and young infants

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Klebsiella pneumoniae

Opportunistic pathogen: environment, mucosal surfaces(human: skin, pharynx, GI tract)

K. pneumoniae : community-acquired pathogen

Hospital-acquired pathogen- UTI, nosocomial pneumonia, intra-abdominal infections

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Proteus spp Enterobacteriaceae

Indole test negative: P. mirabilis กินซากสารอินทรีย์ : community-acquired infection

Indole test positive: P. vulgaris:normal flora ในลาํไส ้ผวิหนงั เยื:อบุเมือก

long-term care, compromised immune

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P.mirabilis - sensitive to ampicillin and 1st gen cephalosporins

P. vulgaris is not sensitive to ampicillin & 1st gen cephalosporins antibiotics

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Serratia marcescens only pathogenic species of Serratia

Colonize -respiratory and urinary tracts Adult: Nosocomial infections: blood, LRT, UTI,

surgical wounds, skin and soft tissues Pediatric: Outbreaks of meningitis,

wound infections, arthritis

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VibrioVibrio : พบในนํ�า โดยเฉพาะนํ�าทะเล

Vibrio parahaemolyticus (VP): (Pasteurella parahemolytica) - "summer diarrhea” Vibrio vulnificus: กินอาหารทะเลที�มีเชื�อ,

มีแผลเปิดแล้วเล่นนํ�าทะเล

Vibrio vulnificus : ระยะฟักตวั 4-96 ชม.หลงักิน เกิดอาการ ~ 15 ชม.หลงัรบัเชื�อ เกิด septicemia -เสียชีวิต

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Hemophilus influenzae

Most virulent strain: H. influenzae type b (Hib) main pathogenic form coccobacilli

Direct contact -respiratory droplets

Hib: Major cause: lower RTI in infants & children Bacteremia, meningitis

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Pseudomonas aeruginosa

Nosocomial infections, ทาํให้ตดิเชื Qอได้ทั�วร่างกายพบมากในปอด, ไต, ทางเดนิปัสสาวะ, ในเลือด รวมทั Qงในตา เชื Qอนี Qดื Qอยามาก

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รปูแท่งตรงหรือโค้ง สรา้งสี fluorescent

เคลื�อนไหวได้ พบในดนิ นํ Qาและสิ�งแวดล้อมทั�วไป

Gram-negative aerobic rods or coccobacilli

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Burkholderia (Pseudomonas)Burkholderia pseudomallei: Melioidosis

อยู่ในนํ Qาและดนิ เข้าสู่ร่างกายโดยตรง

Melioidosis: Southeast Asia: endemic

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Legionella pneumophila

Intracellular bacterium- ชอบอยู่ในนํ�าและที�ชื�น

Opportunistic infection -immunocompromised, เดก็เลก็, คนชรา

Legionaires' pneumonia

นํ�าในเครื�องปรบัอากาศ มกราคม 50 - ภเูกต็

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Bacteroides fragilis :

florae of mucous membranes Bacteroides infections can occur in all body sites

Anaerobic, Gram-negative rod

Infection: CNS, head, neck, chest, abdomen, pelvis, skin, soft tissues

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Fusobacterium sp. Fusobacterium nucleatum: พบในช่องปาก (dental

plaque), upper respiratory tract-periodontal diseases, infections of head, neck, chest, lung, liver, abdomen

Fusobacterium necrophorum: liver abscess

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Campylobacter sp.ปนเปื� อนในเนื�อสตัวป์ีกที�ดิบ: ไก่-สตัวน์ํ�าที�มีเปลือก: หอยนางรม นํ�าดื�มไม่สะอาด

Campylobacter jejuni - traveler diarrhea ในไทย

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Microaerophilic, helical/vibrioid Gram-negative rod

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Helicobacter pylori

colonize gastric mucosal cells of humans

Cause of peptic ulcer involvement in adenocarcinoma ใน GI

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Bacterial morphology

Filamentous: Nocardia Actinomycetes

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