Yersinia pestis Dr Kamran Afzal Classified Microbiologist
Yersinia - species <ul><li>Yersinia pestis </li></ul><ul><ul><li>Plague </li></ul></ul><ul><li>Yersinia enterocolitica </l...
Characteristics <ul><li>Family – Enterobacteriaceae </li></ul><ul><li>GNR - pleomorphic </li></ul><ul><li>Giemsa stain –  ...
Characteristics <ul><li>Blood and MacConkey agars </li></ul><ul><li>Temp 27 0 C </li></ul><ul><li>Capsulate at 37 0 C </li...
Virulence factors <ul><li>Protein capsular antigen </li></ul><ul><ul><li>Resists phagocytosis – protective </li></ul></ul>...
Epidemiology <ul><li>Plague – The ‘Black Death’ </li></ul><ul><li>Pandemic -  From Asia to Europe in 14 th  century </li><...
The Culprits Black Rat:  Rattus rattus Flea:  Xenopsylla cheopsis Yersinia pestis
Transmission   Flea drinks rat blood  that carries the  bacteria Flea’s gut clogged with bacteria Bacteria multiply in fle...
 
Pathogenicity   <ul><li>Yersinia pestis </li></ul><ul><ul><li>Bubonic Plague </li></ul></ul><ul><ul><li>Pneumonic Plague <...
Bubonic Plague <ul><li>Localized infection – pestis minor </li></ul><ul><li>Enlarged and intensely painful Lymph nodes – ‘...
Lancing a Buboe
Pneumonic Plague <ul><li>Inhalation of droplets infected with  Y. pestis </li></ul><ul><li>From patients with P. plague or...
 
Septicemic Plague <ul><li>As a complication of B. or P. plague </li></ul><ul><li>Rapidly developing septicemia </li></ul><...
Lab Diagnosis <ul><li>Specimens </li></ul><ul><li>Direct microscopy </li></ul><ul><li>Culture and sensitivity </li></ul><u...
Treatment   <ul><li>Patient isolated </li></ul><ul><li>Respiratory precautions </li></ul><ul><li>Antibiotic therapy starte...
Control   <ul><li>Rats – rat poison </li></ul><ul><li>Fleas – insecticides  </li></ul><ul><li>Rat proof houses and warehou...
 
30 years old female Accidentally got burnt in her house Treated with wound dressings I/V Vancomycin + Ceftriaxone
Gram stain   from wound pus
 
Pseudomonas aeruginosa
Characteristics <ul><li>Gram negative rod </li></ul><ul><li>NLF </li></ul><ul><li>Oxidase and Catalase  + </li></ul><ul><l...
<ul><li>Two forms   </li></ul><ul><ul><li>Planktonic and Biofilm </li></ul></ul><ul><li>Some strains produce diffusible pi...
Colony types Small rough colonies Large smooth colonies Mucoid colonies Three types of colonies
Transmission in hospital <ul><li>Ubiquitous to soil, water, and vegetation </li></ul><ul><li>Introduced in hospitals on th...
Virulence factors
Pathogenicity <ul><li>Endocarditis </li></ul><ul><li>Respiratory infections </li></ul><ul><li>Bacteremia and Septicemia </...
Bacterial Endocarditis <ul><li>IV drug users  </li></ul><ul><li>Prosthetic heart valves </li></ul><ul><ul><li>Bacteremia <...
Respiratory Infections <ul><li>Pneumonia  </li></ul><ul><ul><li>Bacteremic pneumonia commonly occurs in neutropenic cancer...
Bacteremia and Septicemia <ul><li>Primarily in immunocompromised patients </li></ul><ul><li>Predisposing conditions  </li>...
CNS   Infections <ul><li>Meningitis </li></ul><ul><li>Brain abscess </li></ul><ul><li>Portal of Entry </li></ul><ul><ul><l...
Ear infections <ul><li>Otitis externa </li></ul><ul><ul><li>&quot;swimmer's ear&quot; </li></ul></ul>
Eye infections <ul><li>Bacterial keratitis </li></ul><ul><li>Neonatal ophthalmia </li></ul><ul><li>Contaminated contact le...
Bone and Joint Infections <ul><li>Particular tropism for fibro-cartilagenous joints of the axial skeleton </li></ul><ul><u...
Urinary Tract Infections <ul><li>Usually hospital-acquired  </li></ul><ul><ul><li>UT catheterization, instrumentation or s...
Gastrointestinal infections <ul><li>The GI tract is also an important portal of entry in Pseudomonas septicemia </li></ul>...
Skin and Soft tissue infections <ul><li>Wound infections, pyoderma and dermatitis </li></ul><ul><li>Localized and diffuse ...
Treatment <ul><li>Pseudomonas aeruginosa  is frequently resistant to many commonly used antibiotics </li></ul><ul><li>Many...
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Pseudo+Yersinia+Plague

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  • Pseudomonas aeruginosa has very simple nutritional requirements. It is often observed &amp;quot;growing in distilled water&amp;quot; which is evidence of its minimal nutritional needs.  In the laboratory, the simplest medium for growth of Pseudomonas aeruginosa consists of acetate for carbon and ammonium sulfate for nitrogen. It is tolerant to a wide variety of physical conditions, including temperature.  It is resistant to high concentrations of salts and dyes, weak antiseptics, and many commonly used antibiotics.
  • Primary pneumonia occurs in patients with chronic lung disease and congestive heart failure. Lower respiratory tract colonization of cystic fibrosis patients by mucoid strains of Pseudomonas aeruginosa is common and difficult, if not impossible, to treat.
  • Most Pseudomonas bacteremia is acquired in hospitals and nursing homes. Pseudomonas accounts for about 25 percent of all hospital acquired Gram-negative bacteremias.
  • The bacterium is infrequently found in the normal ear, but often inhabits the external auditory canal in association with injury, maceration, inflammation, or simply wet and humid conditions.
  • Pseudomonas can colonize the ocular epithelium by means of a fimbrial attachment to sialic acid receptors. If the defenses of the environment are compromised in any way the bacterium can proliferate rapidly and, through the production of enzymes such as elastase, alkaline protease and exotoxin A, cause a rapidly destructive infection that can lead to loss of the entire eye.
  • Pseudomonas aeruginosa has a particular tropism for fibrocartilagenous joints of the axial skeleton.
  • As in the case of E. coli urinary tract infection can occur via an ascending or descending route.
  • As in other forms of Pseudomonas disease, those involving the GI tract occur primarily in immunocompromised individuals.
  • Several types of vaccines are being tested, but none is currently available for general use.
  • Pseudo+Yersinia+Plague

    1. 1. Yersinia pestis Dr Kamran Afzal Classified Microbiologist
    2. 2. Yersinia - species <ul><li>Yersinia pestis </li></ul><ul><ul><li>Plague </li></ul></ul><ul><li>Yersinia enterocolitica </li></ul><ul><ul><li>Acute enteritis </li></ul></ul><ul><li>Yersinia pseudotuberculosis </li></ul><ul><ul><li>Acute ileitis and mesenteric lymphadenitis </li></ul></ul><ul><ul><li>Small whitish nodules in viscera </li></ul></ul>
    3. 3. Characteristics <ul><li>Family – Enterobacteriaceae </li></ul><ul><li>GNR - pleomorphic </li></ul><ul><li>Giemsa stain – </li></ul><ul><ul><li>‘ Bi-polar’ staining </li></ul></ul><ul><ul><li>‘ Safety pin appearance’ </li></ul></ul><ul><li>Immunofluorescence </li></ul>
    4. 4. Characteristics <ul><li>Blood and MacConkey agars </li></ul><ul><li>Temp 27 0 C </li></ul><ul><li>Capsulate at 37 0 C </li></ul><ul><li>Motile </li></ul><ul><li>Non-motile at 37 0 C </li></ul><ul><li>Anaerogenic </li></ul><ul><ul><li>No gas from glucose </li></ul></ul>
    5. 5. Virulence factors <ul><li>Protein capsular antigen </li></ul><ul><ul><li>Resists phagocytosis – protective </li></ul></ul><ul><li>LPS </li></ul><ul><ul><li>Endotoxin – terminal septicemia </li></ul></ul><ul><li>Plasminogen activator </li></ul><ul><li>Fibrinolysin </li></ul>
    6. 6. Epidemiology <ul><li>Plague – The ‘Black Death’ </li></ul><ul><li>Pandemic - From Asia to Europe in 14 th century </li></ul><ul><li>1347 – 1353, left 25,000,000 dead </li></ul><ul><li>1994 India, left 900 dead </li></ul><ul><li>2002 New York , 2 infected </li></ul><ul><li>Biological warfare agent </li></ul>
    7. 7. The Culprits Black Rat: Rattus rattus Flea: Xenopsylla cheopsis Yersinia pestis
    8. 8. Transmission Flea drinks rat blood that carries the bacteria Flea’s gut clogged with bacteria Bacteria multiply in flea’s gut Flea bites human and regurgitates blood into human wound Human is infected!
    9. 10. Pathogenicity <ul><li>Yersinia pestis </li></ul><ul><ul><li>Bubonic Plague </li></ul></ul><ul><ul><li>Pneumonic Plague </li></ul></ul><ul><ul><li>Septicemic Plague </li></ul></ul>
    10. 11. Bubonic Plague <ul><li>Localized infection – pestis minor </li></ul><ul><li>Enlarged and intensely painful Lymph nodes – ‘Buboes’ </li></ul><ul><li>Inguinal, axillary or cervical regions </li></ul><ul><li>+ Septicemia </li></ul>
    11. 12. Lancing a Buboe
    12. 13. Pneumonic Plague <ul><li>Inhalation of droplets infected with Y. pestis </li></ul><ul><li>From patients with P. plague or cultures in lab </li></ul><ul><li>Severe bronchopneumonia </li></ul><ul><li>Sputum – thin and blood stained, bacilli +++ </li></ul><ul><li>Highly contagious, invariably fatal </li></ul>
    13. 15. Septicemic Plague <ul><li>As a complication of B. or P. plague </li></ul><ul><li>Rapidly developing septicemia </li></ul><ul><li>Invariably fatal, even in treated cases </li></ul><ul><li>DIC </li></ul><ul><li>Purpura in skin – ‘Black Death’ </li></ul>
    14. 16. Lab Diagnosis <ul><li>Specimens </li></ul><ul><li>Direct microscopy </li></ul><ul><li>Culture and sensitivity </li></ul><ul><ul><li>Blood and MacConkey agars </li></ul></ul><ul><ul><li>Cold enrichment </li></ul></ul><ul><li>Identification </li></ul><ul><ul><li>Biochemical reactions </li></ul></ul><ul><li>Immunofluorescence Definitive diagnosis </li></ul><ul><li>PCR </li></ul>
    15. 17. Treatment <ul><li>Patient isolated </li></ul><ul><li>Respiratory precautions </li></ul><ul><li>Antibiotic therapy started without confirmation of lab diagnosis </li></ul><ul><li>Resistant to Penicillin </li></ul><ul><li>Susceptible to </li></ul><ul><ul><li>Aminoglycosides – I/M Streptomycin </li></ul></ul><ul><ul><li>Chloramphenicol </li></ul></ul><ul><ul><li>Co-trimoxazole </li></ul></ul><ul><ul><li>Tetracyclines </li></ul></ul>
    16. 18. Control <ul><li>Rats – rat poison </li></ul><ul><li>Fleas – insecticides </li></ul><ul><li>Rat proof houses and warehouses </li></ul><ul><li>Vaccination </li></ul><ul><ul><li>Killed virulent strains – protection against Bubonic Plague, but not against Pneumonic or Septicemic Plagues </li></ul></ul>
    17. 20. 30 years old female Accidentally got burnt in her house Treated with wound dressings I/V Vancomycin + Ceftriaxone
    18. 21. Gram stain from wound pus
    19. 23. Pseudomonas aeruginosa
    20. 24. Characteristics <ul><li>Gram negative rod </li></ul><ul><li>NLF </li></ul><ul><li>Oxidase and Catalase + </li></ul><ul><li>Motile </li></ul><ul><li>Obligate aerobe </li></ul><ul><li>Non-fermentative </li></ul><ul><li>Non-Enterobacteriaceae </li></ul><ul><li>Optimum growth </li></ul><ul><ul><li>37˚C, can grow in 42˚C </li></ul></ul><ul><ul><li>Minimal nutritional requirements </li></ul></ul>
    21. 25. <ul><li>Two forms </li></ul><ul><ul><li>Planktonic and Biofilm </li></ul></ul><ul><li>Some strains produce diffusible pigments </li></ul><ul><ul><li>Pyocyanin (blue) </li></ul></ul><ul><ul><li>Fluorescein (yellow) </li></ul></ul><ul><ul><li>Pyorubin (red) </li></ul></ul><ul><li>Grape-like odor </li></ul><ul><li>Blue-green pus and colonies </li></ul><ul><li>Broad antibiotic resistance </li></ul>
    22. 26. Colony types Small rough colonies Large smooth colonies Mucoid colonies Three types of colonies
    23. 27. Transmission in hospital <ul><li>Ubiquitous to soil, water, and vegetation </li></ul><ul><li>Introduced in hospitals on the soles of shoes, on ornamental plants and flowers </li></ul><ul><li>Persist in dampness or standing water </li></ul><ul><li>Sinks, taps and mops </li></ul><ul><li>Respiratory and other hospital equipment </li></ul><ul><li>Contaminates soaps, ointments, eye drops, disinfectants </li></ul><ul><li>Resistant to weak antiseptics and many commonly used antibiotics </li></ul>
    24. 28. Virulence factors
    25. 29. Pathogenicity <ul><li>Endocarditis </li></ul><ul><li>Respiratory infections </li></ul><ul><li>Bacteremia and Septicemia </li></ul><ul><li>C N S infections </li></ul><ul><li>Ear infections- otitis externa </li></ul><ul><li>Eye infections </li></ul><ul><li>Bone and joint infections </li></ul><ul><li>Urinary tract infections </li></ul><ul><li>Gastrointestinal infections </li></ul><ul><li>Skin and soft tissue infections- wound infections, pyoderma and dermatitis </li></ul>
    26. 30. Bacterial Endocarditis <ul><li>IV drug users </li></ul><ul><li>Prosthetic heart valves </li></ul><ul><ul><li>Bacteremia </li></ul></ul>
    27. 31. Respiratory Infections <ul><li>Pneumonia </li></ul><ul><ul><li>Bacteremic pneumonia commonly occurs in neutropenic cancer and CCF patients </li></ul></ul><ul><li>Cystic fibrosis </li></ul><ul><ul><li>Lower resp tract colonization of cystic fibrosis patients by mucoid strains of Pseudomonas aeruginosa </li></ul></ul><ul><ul><li>Characteristics </li></ul></ul><ul><ul><li>Production of very viscid bronchial secretions </li></ul></ul><ul><ul><li>Tends to lead to stasis in the lungs </li></ul></ul><ul><ul><li>Predisposes to infection </li></ul></ul>
    28. 32. Bacteremia and Septicemia <ul><li>Primarily in immunocompromised patients </li></ul><ul><li>Predisposing conditions </li></ul><ul><ul><li>Hematologic malignancies </li></ul></ul><ul><ul><li>Immunodeficiency relating to AIDS </li></ul></ul><ul><ul><li>Neutropenia </li></ul></ul><ul><ul><li>Diabetes mellitus </li></ul></ul><ul><ul><li>Severe burns </li></ul></ul><ul><li>Ecthyma gangrenosum </li></ul>
    29. 33. CNS Infections <ul><li>Meningitis </li></ul><ul><li>Brain abscess </li></ul><ul><li>Portal of Entry </li></ul><ul><ul><li>Inner ear or paranasal sinus </li></ul></ul><ul><ul><li>Inoculated directly </li></ul></ul><ul><ul><ul><li>Surgery </li></ul></ul></ul><ul><ul><ul><li>Invasive diagnostic procedures </li></ul></ul></ul><ul><ul><li>May spread from another site of infection like the urinary tract </li></ul></ul>
    30. 34. Ear infections <ul><li>Otitis externa </li></ul><ul><ul><li>&quot;swimmer's ear&quot; </li></ul></ul>
    31. 35. Eye infections <ul><li>Bacterial keratitis </li></ul><ul><li>Neonatal ophthalmia </li></ul><ul><li>Contaminated contact lenses </li></ul>
    32. 36. Bone and Joint Infections <ul><li>Particular tropism for fibro-cartilagenous joints of the axial skeleton </li></ul><ul><ul><li>Direct inoculation of the bacteria </li></ul></ul><ul><ul><li>Hematogenous spread </li></ul></ul><ul><li>Osteo-chondritis </li></ul><ul><ul><li>Puncture wounds of the foot </li></ul></ul>
    33. 37. Urinary Tract Infections <ul><li>Usually hospital-acquired </li></ul><ul><ul><li>UT catheterization, instrumentation or surgery </li></ul></ul><ul><li>3 rd leading cause of hospital-acquired UTIs </li></ul><ul><li>Most adherent to the bladder uroepithelium </li></ul><ul><li>Pseudomonas can invade the bloodstream from the urinary tract </li></ul><ul><ul><li>Source of nearly 40 % of Pseudomonas bacteremias </li></ul></ul>
    34. 38. Gastrointestinal infections <ul><li>The GI tract is also an important portal of entry in Pseudomonas septicemia </li></ul><ul><li>Any part of the gastrointestinal tract </li></ul><ul><ul><li>Perirectal infections </li></ul></ul><ul><ul><li>Pediatric diarrhea </li></ul></ul><ul><ul><li>Gastroenteritis </li></ul></ul><ul><ul><li>Necrotizing enterocolitis </li></ul></ul>
    35. 39. Skin and Soft tissue infections <ul><li>Wound infections, pyoderma and dermatitis </li></ul><ul><li>Localized and diffuse skin infections </li></ul><ul><ul><li>‘ Jaccuzzi rash’ or ‘Whirlpool rash’ </li></ul></ul><ul><li>Common predisposing factors </li></ul><ul><ul><li>Breakdown of the integument </li></ul></ul><ul><ul><ul><li>Burns, trauma or dermatitis </li></ul></ul></ul><ul><ul><li>AIDS and other IC states </li></ul></ul>
    36. 40. Treatment <ul><li>Pseudomonas aeruginosa is frequently resistant to many commonly used antibiotics </li></ul><ul><li>Many strains are susceptible to </li></ul><ul><ul><li>3 rd and 4th gen Cephalosporins, aminoglycosides, fluoroquinolones, carbapenems and colistin, but resistant forms have developed </li></ul></ul><ul><li>Aminoglycoside + ceftazidime is frequently used to treat severe Pseudomonas infections </li></ul><ul><li>4 th gen Cephalosporin or Carbapenem as monotherapy </li></ul>

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