Morphology and Physiology: Nonmotile Gram-positive facultative anaerobic cocci (see WebLinked image; see WebLinked image; see

WebLinked image) Microscopically cells occur singly and in pairs, short chains, and grape-like clusters Both respiratory and fermentative metabolism; Nitrate often reduced to nitrite Capsule or slime layer (diffuse capsule) may be present more commonly in vivo; Particularly important in Staphylococcus epidermidis colonization Cell wall contains teichoic acid Ribitol teichoic acid (Polysaccharide A) in Staphylococcus aureus Glycerol teichoic acid (Polysaccharide B) in S. epidermidis Enzymes: Strongly catalase positive Differentiates staphyloccoci from streptococci Coagulase S. aureus is coagulase positive 1. Both free and bound coagulase 2. Bound coagulase = clumping factor All other staphyloccocci are coagulase negative Usually oxidase negative Protein A Uniformly coats surface of S. aureus Not present on coagulase-negative staphylococci

S. aureus ferments mannitol; Most other staphyloccocci are mannitol negative Halotolerant (grow in medium containing < 10% NaCl); Salt is useful as a selective constituent in isolation media Wide temperature range for growth (18oC - 40oC) Staphylococcal strains vary in pigmentation and susceptibility to antibiotics Clinical Syndromes: S. aureus: Cutaneous Infections: Folliculitis Furuncles (boils) Carbuncles Impetigo Bullous impetigo Pustular impetigo Wound infections Toxin-Mediated Infections: Scalded skin syndrome: neonates and children under the age of four Toxic-shock syndrome Food poisoning Other infections: Pneumonia Empyema Bacteremia (hospital-acquired)

Endocarditis Osteomyelitis: disease of growing bone Septic arthritis Septic embolization Metastatic infections S. epidermidis and other coagulase-negative staphylococci: Endocarditis: infections of either native or artificial heart valves Catheter and shunt infections Prosthetic joint infections Other opportunistic infections Staphylococcus saprophyticus: Urinary tract infections in sexually active young women Dysuria Pyuria Epidemiology: Staphylococci are common flora: skin, nasal cavity, oropharynx, gastrointestinal tract, genitourinary tract Transient colonization by S. aureus Transmission by direct contact or by fomite Carrier state: short or long-term, often colonizing the anterior nares Endemic and epidemic disease Nosocomial infections

Pathogenesis: Extracellular virulence factors: Enzymes: Coagulases: 1. bound (clumping factor) 2. free (coagulase-reacting factor) Hyaluronidase: "spreading factor" of S. aureus Nucleases: S. aureus; Cleaves DNA (DNase) and RNA (RNase) Fibrinolysin: staphylokinase Lipases: esterases Penicillinase Exotoxins: Cytotoxins (hemolysins): cytopathic and cytolytic for a broad range of affected cells, including erythrocytes, leukocytes, macrophages, hepatocytes, lymphocytes, l ymphoblasts,fibroblasts, neutrophils and platelets Alpha toxin Beta toxin: sphingomyelinase C (phospholipase) Delta toxin: detergent-like activity Gamma toxin: hemolytic activity Leukocidin Enterotoxins (A to E) Exfoliative toxin (epidermolytic toxin or exfoliatin) (A and B) Toxic shock syndrome toxin-1 (TSST-1) (formerly pyrogenic exotoxin C) Somatic virulence factors: Slime layer (capsule)

Protein A: binds Fc receptors of IgG Teichoic acid: binds fibronectin Laboratory Identification: Microscopy: gram reaction and morphology Culture and biochemical confirmation Serology Treatment and Prevention: Drain infected area Deep/metastatic infections: semi-synthetic penicillins; cephalosporins, erythromycin or clindamycin Endocarditis: semi-synthetic penicillin plus an aminoglycoside Carrier status prevents complete control Proper hygiene, segregation of carriers from highly susceptible individuals Good aseptic techniques when handling surgical instruments Control of nosocomial infections