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Staphylococcus aureus

ALL STAPHYLOCOCCI are:


1. Gram-positive
2. Cocci
3. Clusters (Grape clusters)
Greek; staphyle - Bunch of grapes

CLASSIFICATION:

A) Based on coagulase production:


1. Coagulase positive: Eg- S. aureus
2. Coagulase negative: Eg- S. epidermidis
S. saprophyticus

B) Based on pathogenicity:
1. Common pathogen: Eg- S. aureus
2. Opportunistic pathogens: Eg- S.
epidermidis
S.
saprophyticus
3. Non pathogen: Eg- S. homonis

STAPHYLOCOCCUS AUREUS
MORPHOLOGY:

These are spherical


cocci.
Approximately 1m
in diameter.
Arranged
characteristically in
grape like clusters.
They are non motile
and non sporing.
A few strains
possess capsules.

CULTURE:
Media used :i) Non selective media: Nutrient agar,
Blood agar,
MacConkeys
agar.
ii) Selective media: Salt-milk agar,
Ludlams medium

Cultural Characteristics:
i) On nutrient agar- The colonies are large,
circular,
convex, smooth, shiny, opaque and easily
emulsifiable. Most strains produce golden
yellow
pigments.

ii) On MacConkeys agar- The colonies


are small & pink in colour.
iii) On blood agar- Most strains produce
- haemolytic colonies.

Biochemical reactions:
1) Catalase test- Positive.

3) Reduces nitrate to nitrite.


4) Ferments mannitol anaerobically with acid
only.
5) Urea hydrolysis test- Positive.
6) Gelatin liquefaction test- Positive.
7) Produces Lipase.
8) Produces Phosphatase.
9) Produces Thermostable nuclease.

PATHOGENICITY:
Source of infection:
A) Exogenous: patients or carriers
B) Endogenous: From colonized site
Mode of transmission:
A) Contact: direct or indirect( through
fomites)
B) Inhalation of air borne droplets

Virulence factors:
These include
A) Cell associated factors
B) Extracellular factors

A) CELL ASSOCIATED FACTORS:


a) Cell associated polymers
b) Cell surface proteins
a) CELL ASSOCIATED POLYMERS
1. Cell wall polysaccharide
2. Teichoic acid
3. Capsular polysaccharide
b) CELL SURFACE PROTEINS:
1. Protein A
2. Clumping factor (bound coagulase)

B)

EXTRACELLULAR
FACTORS

a) Enzymes
b) Toxins

a) Enzymes:
1. Free coagulase
2. Catalase
3. Lipase
4. Hyaluronidase
5. DNAase
6. Thermonuclease
7. Staphylokinase (Fibrinolysin)
8. Phosphatase

b) Toxins:
1. Cytolytic toxins
i) Haemolysins
Alpha haemolysin
Beta haemolysin
Gamma haemolysin
Delta haemolysin

ii) Leucocidin (Panton-Valentine toxin)


2. Enterotoxin
3. Toxic shock syndrome toxin (TSST)
4. Exfoliative (epidermolytic toxin)
.

Disease:
Diseases produced by Staphylococcus
aureus
is studied under 2 groups:
A) Infections
B) Intoxications

Common Staphylococcal infections are:


1) Skin and soft tissue: Folliculitis,
furuncle (boil), carbuncle, styes,
abscess, wound infections, impetigo,
paronychia and less often cellulitis.

Folliculitis

Impetigo

Wound infection

Paronychia

Cellulitis

2) Musculoskeletal: Osteomyelitis,
arthritis, bursitis, pyomyositis.

osteomyelitis

3) Respiratory: Tonsillitis, pharyngitis,


sinusitis, otitis, bronchopneumonia, lung
abscess, empyema, rarely pneumonia.

4) Central nervous system: Abscess, meningitis,


intracranial thrombophlebitis.
5) Endovascular: Bacteremia, septicemia,
pyemia, endocarditis.

Endocarditis

6) Urinary: Urinary tract infection.

B) INTOXICATIOINS:
The disease is caused by the bacterial
exotoxins,
which are produced either in the infected host
or preformed in vitro.
There are 3 types1. Food poisoning
2. Toxic shock syndrome
3. Staphylococcal scalded skin syndrome

1) Food poisoning:

Enterotoxin is responsible for manifestations


of staphylococcal food poisoning.

Eight types of enterotoxin are currently


known, named A, B, C1-3, D, E, and H.

It usually occurs when preformed toxin is


ingested with contaminated food.

The toxin acts directly on the autonomic


nervous system to cause the illness, rather
than gut mucosa.

The common food items responsible are milk and milk products, meat, fish and ice
cream.
Source of infection- food handler who is
a carrier.
Incubation period- 2 to 6 hours.
Clinical symptoms- nausea, vomiting
and diarrhea.
The illness is usually self limited, with
recovery in a day or so.

2) Staphylococcal Toxic shock


syndrome (STSS):
STSS is associated with infection of
mucosal or sequestered sites by
TSST( formerly known as enterotoxin
type F) producing S.aureus.
It is fatal multisystem disease presenting
with fever, hypotension, myalgia,
vomiting, diarrhoea, mucosal hyperemia
and erythematous rash which
desquamates subsequently.

3) Staphylococcal scalded skin


syndrome (SSSS):
Exfoliative toxin produced by S.aureus is
responsible for this.
It is a skin disease in which outer layer
of epidermis gets separated from the
underlying tissues.

Types of SSSS:
Severe form

Milder

form
In new born

- Ritters disease - Pemphigus

neonatorum
In older patients - Toxic epidermal necrolysis
impetigo

Bullous

Ritters disease

Toxic epidermal necrolysis

Pemphigus neonatorum

Bullous impetigo

Virulence Factors: Exotoxins


Cytolytic

(cytotoxins; cytolysins)

Alpha toxin - hemolysin


Reacts with RBCs

Beta toxin
Sphingomyelinase

Gamma toxin
Hemolytic activity

Delta toxin
Cytopathic for:

RBCs
Macrophages
Lymphocytes
Neutrophils
Platelets

Enterotoxic activity
Leukocidin

LAB DIAGNOSIS:
Specimens collected: Depends on the type of
infection.
Suppurative lesion- Pus,
Respiratory infection- Sputum,
Bacteremia & septicemia- Blood,
Food poisoning- Feces, vomit & the remains of
suspected food,
For the detection of carriers- Nasal swab.

Methods of examination:
I) Direct microscopy:

Direct microscopy
with Gram stained
smear is useful in
case of pus, where
cocci in clusters are
seen.

This is of no value for


specimen like
sputum where
mixed flora are
normally present.

II) Culture:
a) Media used:
b) Cultural Characteristics:
c) Gram staining:
Smears are examined
from the culture plate
and reveals Gram
positive cocci(1m in
diameter) arranged in
grape like clusters.

d) Biochemical reactions:
III) Antibiotic sensitivity tests done as a
guide to treatment.
IV) Bacteriophage typing is done for
epidemiological purposes.
V) Serological tests are not useful.

TREATMENT:
Drug resistance is common.
Benzyl penicillin is the most effective
antibiotic, if the strain is sensitive.
Cloxacillin or Methicillin is used
against
beta-lactamase producing strains.
Methicillin Resistant Staphylococcus
aureus (MRSA) strains have become
common.
Vancomycin is used in treatment of
infections with MRSA strains.

Coagulase Negative
Staphylococci( CoNS ):
Two species of coagulase negative
Staphylococci can cause human
infections1. Staphylococcus epidermidis
2. Staphylococcus saprophyticus

S. epidermidis:
It is a common cause of stitch abscesses.
It has predilection for growth on implanted
foreign bodies such as artificial valves,
shunts, intravascular catheters and
prosthetic appliances leading to bacteraemia.
In persons with structural abnormalities of
urinary tract, it can cause cystitis.
Endocarditis may be caused, particularly in
drug addicts.

S.saprophyticus:
It causes urinary tract infections,
mostly in sexually active young
women.
The infection is symptomatic and may
involve the upper urinary tract also.
Men are infected much less often.
It is one of the few frequently isolated
CoNS that is resistant to Novobiocin.

Novobiocin sensitivity test