: Staphylococci are
,Gram positive cocci-
,Occur in grape like clusters-
.They are non motile and non sporing-
A few strains possess capsules-
Produce pigments-
:Cultural Characteristics
i) On nutrient agar- The colonies are large,
,circular
convex, smooth, shiny, opaque . Most strains
.produce golden yellow pigments
ii) On MacConkey’s agar- The colonies are small
.& pink in colour
iii) On blood agar- Most strains produce β-
.haemolytic colonies
:CLASSIFICATION
:A) Based on coagulase production
Coagulase positive: Eg- S. aureus .1
Coagulase negative: Eg- S. epidermidis .2
S. saprophyticus
:B) Based on pathogenicity
Common pathogen: Eg- S. aureus .1
:Opportunistic pathogens .2
Eg- S. epidermidis ,S. saprophyticus
Non pathogen: Eg- S. homonis .3
:CULTURE
-: Media used
,i) Non selective media: Nutrient agar
,Blood agar
.MacConkey’s agar
,ii) Selective media: Salt-milk agar
:Biochemical reactions
.Catalase test- Positive )1
-Coagulase test )2
.i) Slide coagulase test- Positive
.ii) Tube coagulase test- Positive
SLIDE COAGULASE TEST TUBE COAGULASE TEST
.Reduces nitrate to nitrite )3
Ferments mannitol anaerobically with acid )4
.only
.Urea hydrolysis test- Positive )5
.Gelatin liquefaction test- Positive )6
.Produces Lipase )7
.Produces Phosphatase )8
.Produces nuclease )9
: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
Cell wall polysaccharide .1
Teichoic acid .2
Capsular polysaccharide .3
:b) CELL SURFACE PROTEINS
Protein A .1
Clumping factor (bound coagulase) .2
Structure of Staphylococcal cell wall
B) EXTRACELLULAR FACTORS
a) Enzymes
b) Toxins
:a) Enzymes
Free coagulase .1
Catalase .2
Lipase .3
Hyaluronidase .4
DNAase .5
Thermonuclease .6
Staphylokinase (Fibrinolysin) .7
Phosphatase .8
:b) Toxins
Cytolytic toxins .1
i) Haemolysins
Alpha haemolysin
Beta haemolysin
Gamma haemolysin
Delta haemolysin
ii) Leucocidin (Panton-Valentine toxin)
Enterotoxin .2
Toxic shock syndrome toxin (TSST) .3
Exfoliative (epidermolytic toxin) .4
.
:Disease
Diseases produced by Staphylococcus aureus
:is studied under 2 groups
A) Infections
B) Intoxications
:A) INFECTIONS
:Mechanism of pathogenesis
Cocci gain access to damaged skin, mucosal or
tissue site
Colonize by adhering to cells or extracellular
matrix
Evade the host defense mechanisms and
multiply
Cause tissue damage
:Common Staphylococcal infections are
Skin and soft tissue: Folliculitis, furuncle (boil), )1
carbuncle, styes, abscess, wound infections,
.impetigo, and less often cellulitis
Folliculitis
Folliculitis
Furuncle
(boil)
Carbuncle
Styes Abscess
Impetigo Paronychia
Wound infection Cellulitis
.Musculoskeletal: Osteomyelitis, arthritis )2
Respiratory: Tonsillitis, pharyngitis, sinusitis, )3
otitis, bronchopneumonia, lung abscess, rarely
.pneumonia
Central nervous system: Abscess, )4
.,meningitis
Endovascular: Bacteremia, septicemia, )5
,pyemia, endocarditis
.Urinary: Urinary tract infection )6
: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 types
Food poisoning
Toxic shock syndrome
Staphylococcal scalded skin syndrome
:Food poisoning )1
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
.diarrhoea
The illness is usually self limited, with recovery
.in a day or so
:Staphylococcal Toxic shock syndrome (STSS) )2
STSS is associated with infection of mucosal or
sequestered sites by TSST( formerly known as
.enterotoxin type F) producing [Link]
It is fatal multisystem disease presenting with
fever, hypotension, myalgia, vomiting,
diarrhoea, mucosal hyperemia and
erythematous rash which desquamates
.subsequently
Staphylococcal scalded skin )3
:syndrome (SSSS)
Exfoliative toxin produced by [Link] is
.responsible for this
It is a skin disease in which outer layer of
epidermis gets separated from the underlying
.tissues
: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
II) Culture:
a) Media used:
b) Cultural Characteristics:
c) Gram staining:
Smears are
examined from the
culture plate and
reveals Gram
positive cocci(1μm 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
:EPIDEMIOLOGY
Staphylococci are primary parasites of human
.beings and animals
Hospital infections caused by staphylococci
deserve special attention because of their
frequency & they are caused by strains
.resistant to various antibiotics
Staphylococci are the common cause of
postoperative wound infection and other
.hospital cross infections
:PREVENTION
.Isolation & treatment of MRSA patients
Detection of carriers among hospital staff, their
.isolation & treatment
.Avoid indiscriminate usage of antibiotics
:Coagulase Negative Staphylococci( CoNS )
Two species of coagulase negative
-Staphylococci can cause human infections
Staphylococcus epidermidis .1
Staphylococcus saprophyticus .2
: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
:[Link]
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
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