Medical Microbiology

Corynebacterium species:
- Small Gram positive rods, catalase positive, facultative anaerobes, aerobes
- Treatment: Penicillin and antitoxin (antibiotics have no effect on circulating toxin)
- Corynebacterium diphtheriae
Transmission: aerosols and hand-to-mouth
Multiply on epithelial cells, trigger inflammatory response and produce diphtheria toxin (local
Fe concentration inversely related to toxin production)
- Corynebacterium ulcerans
Diphtheria toxin, bovine mastitis
- Corynebacterium pseudotuberculosis
Dermonecrotic toxin
- Corynebacterium jeikeium
Skin flora, opportunist
Invasive procedures, prosthetic devices, catheterization, immunodeficiency
- Corynebacterium urealyticum
Slow grower, resistant
- Corynebacterium xerosis
Skin, mucous membranes
Associated with prosthetic devices, catheterization, post op wound infections, pneumonia
immunodeficiency
- Corynebacterium pseudodiphtheriticum
Nasopharynx

Listeria monocytogenes
-

Small gram positive rods, -hemolytic, catalase positive, facultative

Intracellular pathogen
Ubiquitous soil, feces, mucous membranes of nasal and genital tract, meats, diary products
Meningoencephalitis young children, elderly, immunocompromised
Pregnant women fever, headache, myalgia
Grows better at 4C: cold enrichment
Tx: Penicillin, aminoglycosides, macrolides

Rhodococcus equi
-

Gram positive coccobacillary to filamentous branching rods, aerobic, catalase positive

Slow grower, found in oil, salmon-pink colonies, intracellular pathogen
Humans: broncopneumonia in AIDS patients
Tx: increasing resistance problem. Rifampin/erythromycin currently effective.

Arcanobacterium

Gram positive coccobacilli often seen in coryneform arrangement, -hemolytic, catalase negative.
Found in nasopharynx
Pharyngitis

Arcanobacterium haemolyticum
Arcanobacterium pyogenes

Erysipelothrix rhusiopathiae

- Small Gram positive rod, often stain Grain variable or Gram negative, catalase positive, non-motile,
facultative, small -hemolytic, produces H2S
- Humans - skin disease: erysipeloid (usually on hands)
- Tx: Penicillin

Pathogenic Neisseria
- Gram negative diplococcci, oxidase positive, catalase positive
- Neisseria gonorrhoeae
Obligate human pathogen
Do not grow on blood agar
Frequent asymptomatic carriage: epididymitis
Disseminated infection: tenosynovitis, suppurative arthritis, skin eruptions
Virulence factors:
PilE: major fimbrial protein (initial binding to epithelial cells, highly variable composition
and expression within the population)
Opa (P.II): outer membrane protein (attachment, facilitates uptake by neutrophils,
variable)
Por (P.I): outer membrane porin (may prevent phagolysosome formation in neutrophils
and/or reduce oxidative burst)
LOS (lipooligosaccharide): peptidoglycan (inflammatory response, sialation resum
resistance)
Iron acquisition: Tbp1, Tbp2, Lbp (outer membrane resistance)
IgA protease
Treatment: Penicillin (-lactamase), -lactamase resistant cephalosporin (altered PBPs),
tetracycline and ceftriazone (IM) + azithromycin (PO)
- Neisseria meningitidis
Found only in humans (frequent asymptomatic colonization of nasopharynx)
Can grow in blood agar
Transmission: oral secretions, droplets, epidemics seen in areas of close confinement
Meningitis, sepsis
Virulence factors:
Capsule (antiphagocytic, serogroups B, C most common in US)
Transferrin, lactoferrin binding
LOS, peptidoglycan (grows to high density in blood, DZ outcome proportional to TNF-
LEVELS)
Neutrophil invasion: pili, LOS
Treatment: Penicillin, polyvalent vaccine (ineffective against type B)
Haemophilus

- Gram negative pleomorphic coccobacilli to rods, catalase positive, oxidase positive, facultative
anaerobes
- Obligates parasites (most species required V factor and/or X factor, or others as yet undefined
- Haemophilus influenzae
First genome to be sequenced
Unencapsulated (untypable): colonize adults, non-invasive/localized disease (pneumonia,
sinusitis, otitis media)
Encapsulated (typable): colonize children shortly after birth, 6 serotypes, invasive disease
(miningitis, cullulitis, arthritis, epiglottitis, septicemia)
Virulence factors:
Capsule
IgA proteases
Adherence
Outer membrane proteins
Lipooligosaccharide: inflammatory damage, inhibit ciliary clearance
- Haemophilus aegyptius
Conjunctivitis
- Haemophilus ducreyi
Buboes
- Treatment: Ampicillin, amoxicillin/clavulanate, ampicillin/sulbactam, second or third generation
cephalosporin, fluoroquinolones, trimethoprim/sulfonamide

Bacillus species
- Gram positive spore forming rods in sometimes filamentous chains, catalase positive, aerobic or
facultative, most species -hemolytic, most species motile
- Bacillus cereus
Food poisoning (can carry toxins: diarrheogenic toxin, emetic toxin)
Transmission: spores
- Bacillus anthracis
Non-hemolytic, non-motile, Gram positive rods in long chains, encapsulated cells with square
ends
Transmission: spores (can be found in soil and will survive up to 40 years, aerobic sporeformer: perform necropsy in well-contained area, burn and bury remains)
When infects blood, delays clotting
Human:
Cutaneous (entry of spores through cuts, abrasions, insect bites): papule, ring od
vesicles, dark central area
Intestinal (ingestion of spores): abdominal pain, nausea, vomiting, bloody diarrhea
Pulmonary (inhalation of spores): Woolsorters disease - initial phase: flu-like
symptoms; severe phase: respiratory distress, coma; complications: meningitis
Virulence factors:

Two virulence plasmids: pXO2 (capsule, carry the main toxin) and pXO2 (protective
antigen, lethal factor, edema factor)

Clostridium species
- Gram positive spore forming rods, anaerobic
- Invasive species colonization of deep wounds, gas gangrene
- Clostridium botulinum
Flaccid paralysis
- Clostridium tetani
Spastic paralysis
- Tetanus and botulinum toxins AB toxins
Attack in pre-synaptic vesicle membranes
A portion (toxic domains) remarkably similar
B domains target different receptors
TT (tetanus) attacks the CNS, inhibits release of GABA
TB (botulinum) attacks peripheral nerves, blocking release of neurotransmitters
- Clostridium difficile
Antimicrobial-associated diarrhea (AAD)
Toxin A enterotoxin (associated with diarrhea symptoms
Toxin B cytotoxin
Treatment: metronidazole and vancomycin
- Clostridium perfringens
Can also cause AAD
Gram negative Enteric Bacterial Pathogens
- Diarrhea: excessive water and electrolyte
- Dysentery: diarrheic stools contain blood, pus, mucus and tissue
Vibrio species
- Gram negative curved rods, motile, oxidase positive, facultative anaerobes, two chromosomes
- Very common in surfaces water (most species require NaCl)
- Vibrio cholerae
Cholera (rice water stools)
Transmission: water and food
Massive loss of water 20 liter/day
Rapidly fatal
Virulence factors:
Expression coordinated in host environment
Toxins: toxAB, Ace, Zot
Pili
Tox T (second regulatory protein): stimulates production of Cholera Toxin
Is sensitive to stomach acid

- Vibrio parahemolyticus
Bloody diarrhea
Raw seafood
- Vibrio vulnificus, Vibrio alginolyticus
Entry through skin wounds

Escherichia coli

- Gram negative rods, oxidase negative, facultative anaerobe, indole positive, lactose positive,
produce CO2 from glucose fermentation, peritrichous flagella
- Normal enteric flora
Pathogenic Escherichia coli
- Uropathogenic Escherichia coli (UTI)
Urethritis, cystitis, pyelonephritis
Transmission: introduction into urethra
- Enterotoxigenic Escherichia coli (ETEC)
Transmission: food, water, fecal-oral
Watery diarrhea
Virulence factors:
Plasmid-borne
Pili CFA-I, CFA-II
Heat-labile toxin (LT)
Heat-stable toxin
- Enteroaggregative Escherichia coli (EAggEC)
Persistent diarrhea in infants, AIDS patients
Virulence Factors: GVVPQ fimbriae thin fibrillar structures, enteroaggregative ST
- Enteroinvasive Escherichia coli (EIEC)
Transmission: food, water, fecal-oral
Dysentery
Afimbrial adhesin
Multiply in cells, cell destruction, lateral spread
- Enteropathogenic Escherichia coli (EPEC)
Transmission: food, water, fecal-oral
Virulence factors:
Bundle-forming pilli
Intimin (actin cytoskeleton rearrangement in host cells)
Inflammatory response
- Enterohemorrhagic Escherichia coli (EHEC)
Transmission: food, fecal-oral, zoonotic
Bloody diarrhea, hemolytic-uremic syndrome (HUS hemolytic anemia, thrombotic
thrombocytopenia, renal failure)
Low infection dose (10-100 organisms)

Acid tolerance
Virulence factors:
Type III secretion system
Intimin
Shiga-like toxins (SLT) I and II (cytotoxins intense inflammatory reaction, phageborne)
katP periplasm catalase- Identification: Culture, PCR, tissue culture assays