STAPHYLOCOCCI

1
STAPHYLOCOCCI

• RNDr. Irena Hanovcová, CSc.
• ÚKM LF UK
• Hradec Králové

2
staphylococci

• basic properties
• classification
• antigenic structure
• exoproducts
• staphylococcal diseases
• pathogenesis
• laboratory diagnostics
• treatment of staphylococcal infections
• prophylaxis

3
STAPHYLOCOCCUS sp.

• Gram-positive cocci
• non motile
• non spore forming
• non capsulated
• facultative anaerobic
• catalase-positive
• resistant to higher osmotic pressure

4
STAPHYLOCOCCUS spp.most often found as origin of
human diseases

• coagulase-positive
• S. aureus

• coagulase-negative
• S. epidermidis
• S. saprophyticus
• S. haemolyticus
• S. lugdunensis
• S. schleiferi
• S. warneri

5
S. aureus - antigenic structure

• capsule polysaccharide
  inhibition of C, Ab, phagocytosis phage
  adsorption
• adhesins proteins
  colonisation f. bound to fibronectine,
  fibrinogen, collagen, laminin, sialoprotein
• protein A 4 identical domens
  bound to peptidoglycan, reaction with Fc
  fragment of IgG, inhibition of opsonization
  and pfagocytosis, species specific

6
S. aureus - antigenic structure

• aglutinogens proteins and polysaccharides
• teichoic acid ribitolphosphate
  polysaccharideA bound to
  peptidoglycane phage
  receptor genus specific
• peptidoglycane polymer of N-acetyl-muramic acid
  and N-acetyl-glukosamine
  macrophages activation

7
S. aureus - exoproteins

• hemolysins impairment of membrane,
  cytotoxic for phagocytes and
  tissue cells
• leukocidin impairment of membrane,
  cytotoxic for phagocytes and
  tissue cells
• epidermoly- serin proteases, blistering of skin
  tic toxin
• TSST multisystems effects
• enterotoxins vomiting, diarrhoea

8
S. aureus - exoproteins

• coagulase conversion of fibrinogen
  into fibrin
• hyaluronidase degradation of hyaluronic acid
• staphylokinase fibrinolysis
• lipases degradation of lipids
• phospholipases degradation of phospholipids
• DNAse degradation of DNA
• proteases proteolysis

9
1 normal microflora
2impetigo
8 meningitis
11 respiratory infections
3 furuncle, carbuncle
6 osteomyelitis
4 wound inf., abscesses5 spread via lymphatic
and blood ways
7 endocarditis
10nephritis
9 enteritis food poisoning
1 normal microflora
1 normal microflora
10
S. aureus - infections

• pyogenic infections
• foliculitis, furunculo- sis, carbunculosis
• wound infections
• impetigo
• abscesses
• mastitis
• septicaemia
• osteomyelitis
• pneumonia

• intoxication
• scalded skin syndrome
• pemphigus neonatorum
• toxic shock syndrome
• food poisoning

11
coagulase-negative staphylococciinfections

• urinary tract (S. saprophyticus, S.
  epider-midis, S. haemolyticus, S. warneri)
• systemic (usually from infected prostheses and
  implants - S. epidermidis)
• ventriculitis (S. epidermidis)
• peritonitis (S. epidermidis, S. haemolyticus)
• septicaemia (S. epidermidis, S. lugdunensis, S.
  schleiferi)
• endocarditis (S. epidermidis, S. lugdunensis)

12
staphylococcal inf. of oral cavity

• mucosa and submucosa - S.aureus - sialadenitis
  (inflammation of parotic glands) - cheilitis
  angularis (inflammation of lips) - S. aureus
  Candida spp. - stomatitis (inflammation of
  palate and tongue)
• dentoalveolar abscesses, periapical abscesses
• acute, chronic osteitis
• osteomyelitis (mandibula)
• gingivitis, periodontitis

13
staphylococci pathogenesis

• acute inflammation- usually uncomplicated
  infection localized in portal of entry
• - sometimes spread generalised inf.
• acute toxaemia- result of absorption of
  extracellular products preformed by
  staphylococci in the place of infection or
  outside

14
staphylococci pathogenesis

• portals of entry - disrupted skin- mucose
  membrane (influenced by pathologic process)-
  sometimes also sterile cavity (bladder)
• factors influencing origin of infection-
  produced by bacterium
• - local or total immunosupression

15
S. aureus - nosicství

• zdravá populace
• nos 20 - 40
• krk 4 - 64 (sezonní)
• axily 10
• perineum 20
• meziprstí 5
• stolice 20
• pacienti s koním onemocnením
• nos, kue 80

16
staphylococci
17
staphylococci - laboratory diagnostic

• microscopy Gram staining
• cultivaton BA, salt agar
• biochemical tests
• phagotyping

18
staphylococci - laboratory diagnostics

• S. aureus
  coag.- staph.
• b-hemolysis on BA -
• yellow pigmentation -
• coagulase
  -
• DNAse
  -
• phosphatase
  -
• mannitol
  -

19
staphylococci - phagotyping

• in five phage groups we distinguish single
  phagotypes
• Strains isolated from some diseases may be often
  seen in certain phage groups
• gr.I - furunculosis, TSST
• gr.II - impetigo, pyomyositis, scalded skin
  syndrome
• gr.III - multirezistant strains, producers of
  enterotoxin

20
staphylococci - therapyalways according results
of sensitivity tests !

• penicillins
• cephalosporins
• aminoglycosides
• tetracyclines
• macrolides

• linkosamides
• glycopeptides
• fluoroquinolons
• chloramphenicol
• trimethoprim

21
staphylococci - rezistance

• penicilins b-lactamase plasmid
• methicilin alternated binding
  chromos.
• cephalosporins protein
  chromos.
• streptomycine alternated rib. protein
  chromos.
• aminoglycosides modification of plasmid
  enzymes
• tetracyclines reduced intake
  plasmid
• macrolides methylation of plasmid
  ribosome
  
• chloramphenicol acethyltransferase
  plasmid
• quinolons alternated
  DNA-gyrase chromos. increased elimination
  chromos.
• without methicilin, nafcillin,
  isoxazolylpenicillin
• including nafcillin, isoxazolylpenicillin

22
(No Transcript)
23
prophylaxis

• reduction of S. aureus around the patient
• to decrease the transfer to the patient
• eliminate factors contributing to the development
  of infection
• active immunization

24
pus staphylococci (intracellulary)
staphylococci
leukocytes
25
sputum - staphylococci pneumococci
staphylococci
leukocytes
pneumococci
26
S. aureus growth on blood agaru
b- hemolysis
27
staphylococci - growth on salt agar