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Altamash classification & staphylococci

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  • MRSA/Staph is often misdiagnosed as spider or insect bites . • MRSA/Staph spreads by infected skin to healthy skin contact as well as infected objects to healthy skin. It can enter healthy, clean, undamaged skin through such contact. • Washing your hands with soap and warm water can prevent the spread of MRSA/Staph. • MRSA/Staph lives on skin and survives on objects, such as towels and exercise equipment for 24 hours or longer. • If you think you may have MRSA/Staph, consult your doctor or healthcare provider. • For all skin infections, dispose of bandages properly and wash your hands frequently to avoid spreading germs to others.
  • Transcript

    • 1. SYSTEMIC BACTERIOLOGY
    • 2. CLASSIFICATION OF BACTERIA
    • 3.
      • TAXONOMY
      • Includes
      • Classification
      • Identification
      • Nomenclature
    • 4.
      • CLASSIFICATION
      • Is the arrangement of organisms into taxonomic groups on the basis of similarities or relationships (i.e. common properties).
      • IDENTIFICATION:
      • Is the practical use of a classification scheme to : Isolate & identify the causative agent of a disease.
      • NOMENCLATURE
      • Is naming of an organism by international rules according to its characteristics. Genera – Species – Sub species .
    • 5. CLASSIFICATION OF MEDICALLY IMPORTANT BACTERIA BACTERIA RIGID THICK-WALLED CELLS FLEXIBLE, THIN-WALLED CELLS WALL-LESS CELLS
    • 6. CLASSIFICATION OF MEDICALLY IMPORTANT BACTERIA RIGID THICK-WALLED CELLS FREE LIVING (EXTRACELLULAR ) NON FREE LIVING (OBLIGATE INTRACELLULAR PARASITES)
    • 7. FREE LIVING BACTERIA GRAM POSITIVE BACTERIA GRAM NEGATIVE BACTERIA ACID-FAST BACTERIA COCCI
        • RODS
      SPOREFORMING NONSPOREFORMING COCCI RODS
    • 8. TETANUS CLOSTRIDIA (b)ANAEROBIC ANTHRAX BACILLUS (a) AEROBIC SPORE FORMING RODS (AEROBIC/ ANAEROBIC) RODS (SPORE FORMING RODS/ NON SPORE FORMING RODS) PNEUMONIA, PHARYNGITIS CELLULITIS STREPTOCOCCI ABSCESS SKIN & OTHER ORGANS STAPHYLOCOCCI COCCI DISEASE GENUS CHARACTERISTICS GRAM POSITIVE BACTERIA (COCCI/ RODS) CLASSIFICATION OF MEDICALLY IMPORTANT BACTERIA
    • 9. GONORRHEA MENINGITIS NEISSERIA COCCI GRAM NEGATIVE BACTERIA (COCCI/RODS) NOCARDIOSIS NOCARDIA ACTINOMYCOSIS ACTINOMYCES FILAMENTOUS MENINGITIS LISTERIA DIPHTHERIA CORYNEBACTERIUM NON FILAMENTOUS NON-SPORE FORMING RODS CLASSIFICATION OF MEDICALLY IMPORTANT BACTERIA
    • 10. BRUCELLOSIS BRUCELLA
      • ZOONOTIC
      • ORGANISMS
      LEGIONELLA PNEUMONIA WHOOPING COUGH BORDETELLA MENINGITIS HAEMOPHILUS
      • RESPIRATORY
      • ORGANISMS
      STRAIGHT RODS ( RESPIRATORY/ZOONOTIC/ENTERIC) DISEASE GENUS CHARACTERISTICS ANAEROBIC RODS AEROBIC RODS FACULTATIVE RODS (STRAIGHT/ CURVED) GRAM NEGATIVE RODS
    • 11. PNEUMONIA KLEBSIELLA ENTEROCOLITIS TYPHOID SALMONELLA UTI ENTEROBACTER UTI, DIARRHEA ESCHERICHIA
      • ENTERIC & RELATED ORG.
      PLAGUE YERSINIA CELLULITIS PASTEURELLA TULAREMIA FRANCISELLA ZOONOTIC DISEASE GENUS CHARACTERISTIC
    • 12. TB, LEPROSY MYCOBACTERIUM ACID FAST BACTERIA PERITONITIS BACTEROIDES ANAEROBIC RODS UTI, PNEUMONIA PSEUDOMONAS AEROBIC RODS CHOLERA VIBRIO GASTRITIS, PEPTIC ULC HELICOBACTER ENTROCOLITIS CAMPYLOBACTER CURVED F. RODS DISEASE GENUS CHARACTERISTC
    • 13. CLASSIFICATION OF MEDICALLY IMPORTANT BACTERIA RIGID THICK-WALLED CELLS FREE LIVING (EXTRACELLULAR ) NON FREE LIVING (OBLIGATE INTRACELLULAR PARASITES)
    • 14. URETHRITIS, TRACHOMA, PSITTACOSIS CHLAMYDIA ROCKY MOUNTAIN SPOTTED FEVER RICKETSSIA DISEASE GENUS CHARACTERISTIC NON FREE LIVING (OBLIGATE INTRACELLULAR PARASITES)
    • 15. CLASSIFICATION OF MEDICALLY IMPORTANT BACTERIA BACTERIA RIGID THICK-WALLED CELLS FLEXIBLE, THIN-WALLED CELLS WALL-LESS CELLS
    • 16. LYME DISEASE BORRELIA LEPTOSPIROSIS LEPTOSPIRA SYPHILIS TREPONEMA DISEASE GENUS FLEXIBLE, THIN WALLED CELLS (SPIROCHETES )
    • 17. PNEUMONIA MYCOPLASMA DISEASE GENUS WALL-LESS BACTERIA
    • 18. Definitions
      • Epidemiology
        • The study of the transmission of disease
      • Communicable Disease
        • A disease that can be transmitted from one individual to another
      • Contagious Disease
        • A communicable disease that is easily spread from one individual to another
      • Noncommunicable Disease
        • A disease that is not transmitted from one individual to another
    • 19. III. A. Definitions
      • Epidemic Disease
        • A disease condition present in a greater than usual percentage of a specific population
      • Pandemic Disease
      • Endemic Disease
        • A disease condition that is normally found in a certain percentage of a population
        • An epidemic affecting a large geographical area; often on a global scale
    • 20. III. A. Definitions
      • Reservoir of Infection
        • The source of an infectious agent
      • Carrier
        • An individual who carries an infectious agent without manifesting symptoms, yet who can transmit the agent to another individual
      • Fomites
        • Any inanimate object capable of being an intermediate in the indirect transmission of an infectious agent
    • 21. III. A. Definitions
      • Animal Vectors
        • An animal (nonhuman) that can transmit an infectious agent to humans
        • Two types: mechanical and biological
          • Biological animal vectors: The infectious agent must incubate in the animal host as part of the agent’s developmental cycle; eg, the transmission of malaria by infected mosquitoes
          • Mechanical animal vectors: The infectious agent is physically transmitted by the animal vector, but the agent does not incubate or grow in the animal; eg, the transmission of bacteria sticking to the feet of flies
    • 22. GRAM POSITIVE COCCI
      • GENUS
      • STAPHYLOCOCCI
      • STREPTOCOCCI
      • GENERAL PROPERTIES
      • NON MOTILE, NON SPORE-FORMING
      • STAPHYLOCOCCI: CATALASE POSITIVE
      • IN CLUSTER
      • STREPTOCOCCI : CATALASE NEGATIVE
      • IN CHAINS
    • 23. STAPHYLOCOCCI
    • 24. INTRODUCTION
      • Staphyloccocci - derived from Greek “stapyle” (bunch of grapes)
      • Gram positive cocci arranged in clusters
      • Hardy organisms surviving many non physiologic conditions
      • Include a major human pathogen and skin commensals
    • 25.  
    • 26. Grouping for Clinical Purposes
      • 1. Coagulase positive Staphylococci
        • Staphylococcus aureus
      • 2. Coagulase negative Staphylococci
        • Staphylococcus epidermidis
        • Staphylococcus saprophyticus
    • 27. A. Staphylococcus aureus
      • Major human pathogen
      • Habitat - part of normal flora in some humans (nose , sometimes skin esp hospital staff and patients, vagina of 5% females) and animals
      • Source of organism - can be infected human host, carrier, fomite or environment
    • 28. DISEASES
      • Due to direct effect of organism
        • Local lesions of skin
        • Deep abscesses
        • Systemic infections
      • Toxin mediated
        • Food poisoning
        • toxic shock syndrome
        • Scalded skin syndrome
    • 29. IMPORTANT PROPERTIES
      • Gram positive cocci, arranged in clusters
      • Non spore forming, non motile
      • Catalase positive (breaks H2O2 into O2 & H2O)
      • S. aureus: Coagulase positive, Hemolytic, Ferments Mannitol.
      • Plasmid mediated Antibiotic resistance in S. aureus
      • Cell wall components of S. aureus
    • 30. Cell wall components & antigens of S.aureus
      • Protein A (binds to Fc portion of Ig G at complement binding site)
      • Teichoic acid (adherence, antibody formation)
      • Microcapsule (11 serotypes)
      • Peptidoglycan has endotoxin-like properties.
    • 31. Factors predisposing to S. aureus infections
      • Host factors
        • Breach in skin
        • Chemotaxis defects
        • Opsonisation defects
        • Neutrophil functional defects
        • Diabetes mellitus
        • Presence of foreign bodies
      • Pathogen Factors
        • Catalase (counteracts host defences)
        • Coagulase
        • Hyaluronidase
        • Lipases (Imp. in disseminating infection)
        • B lactasamase(ass. With antibiotic resistance)
    • 32. Factors predisposing to S. aureus infections
      • Toxins produced by S. aureus
      • Enterotoxin
      • Toxic shock syndrome toxin (TSST is a super antigen)
      • Exfoliatin (epidermolytic)
      • Leucocidins
      • Alpha toxin (tissue necrosis)
      • Staphylokinase
    • 33. SKIN LESIONS (Pyogenic)
      • Styes
      • Furuncles(infection of hair follicle)
      • Carbuncles (infection of several hair follicles)
      • Wound infections(progressive appearance of swelling and pain in a surgical wound after about 2 days from the surgery)
      • Impetigo(skin lesion with blisters that break and become covered with crusting exudate)
      • Cellulitis
    • 34. IMPETIGO
    • 35. SYMPTOMS OF STAPH INFECTIONS
      • The symptoms of a staph infection depends on where the infection is. The staph bacteria can cause:
      • Boils – an abscess, bump, or swelling within the skin. Also called a furuncle.
    • 36.
      • Cellulitis – a “flat” skin infection which can make the skin red, painful and warm but does not have pustules.
    • 37.
      • Folliculitis – an infection of the hair follicles
    • 38.
      • Impetigo – pustules (bulbous impetigo) or honey colored crusted lesions on the skin
    • 39.  
    • 40.  
    • 41. Staphylococcol Infection
    • 42. DEEP ABSCESSSES
      • Can be single or multiple
      • Breast abscess can occur in 1-3% of nursing mothers in puerperium
      • Can produce mild to severe disease
      • Other sites - kidney, brain from septic foci in blood
    • 43. Systemic Infections
      • 1. With obvious focus
        • Osteomyelitis, septic arthritis
      • 2. No obvious focus
          • heart (infective endocarditis)
          • Brain(brain abscesses)
      • 3. Ass. With predisposing factors
        • multiple abscesses, septicaemia (IV drug users)
        • Staphylococcal pneumonia (Post viral)
    • 44. B. TOXIN MEDIATED DISEASES
      • 1. Staphylococcal food poisoning
        • Due to production of entero toxins
        • Superantigen – IL-1 & 2
        • heat stable entero toxin acts on gut
        • produces severe vomiting, non bloody diarrhea following a very short incubation period
        • Resolves on its own within about 24 hours
    • 45. 2. Toxic shock syndrome
      • High fever, diarrhoea, shock and erythematous skin rash which desquamate
      • Mediated via ‘toxic shock syndrome toxin’– super antigen
      • 10% mortality rate
      • ass. With young women using tampones during menstruation & wound infection
    • 46.  
    • 47. 3. Scalded skin syndrome
      • Disease of young children
      • Mediated through minor Staphylococcal infection by ‘epidermolytic toxin’ producing strains
      • Mild erythema and blistering of skin followed by shedding of sheets of epidermis
      • Children are otherwise healthy and most eventually recover
    • 48. S. aureus -- Kawasaki syndrome
      • Unknown etiology
      • Vasculitis of medium & small sized arteries.
      • Strawberry tongue
    • 49. DIAGNOSIS
      • 1. In all pus forming lesions
        • Gram stain and culture of pus
      • 2. In all systemic infections
        • Blood culture
      • 3. In infections of other tissues
        • Culture of relevant tissue or exudate
    • 50. Diagnosis
      • Gram Stain: Gram positive cocci in clusters
      • Yellowish colonies , b-hemolytic on Blood agar
      • Catalase and coagulase positive
      • Mannitol fermenter
    • 51. Antibiotic sensitivity pattern
      • Very variable and not predictable
      • Very imp. In Pt. Management
      • Mechanisms
        • 1.B lactamase production - plasmid mediated
          • Has made S. aureus resistant to penicillin group of antibiotics - 90% of S. aureus (Gp A)
          • B lactamase stable penicillins (cloxacillin, oxacillin, methicillin) used
        • 2. Alteration of penicillin binding proteins
          • (Chromosomal mediated)
          • Vancomycin is the drug of choice
          • MRSA, NRSA, VISA
    • 52.
      • Tested in lab using methicillin
      • Referred to as methicillin resistant S. aureus (MRSA)
      • Emerging problem in the world
      • In Sri Lanka prevalence varies from 20- 40% in hospitals
      • Drug of choice - vancomycin
      • In Japan emergence of VIRSA (vancomycin intermediate resistant S. aureus)
      • No effective antibiotics discovered -We might have to discover
    • 53. 2. Staphylococcus epidermidis
      • Skin commensal
      • Has predilection for plastic material
      • Ass. With infection of IV lines, prosthetic heart valves, shunts
      • Causes urinary tract infection in cathetarised patients
      • Has variable ABS pattern , highly resistant
      • Treatment should be aided with ABST
      • Hospital acquired
      • Novobiocin sensitive
    • 54. 3. Stapylococcus saprophyticus
      • Skin commensal
      • Imp. Cause of UTI in sexually active young women
      • Usually sensitive to wide range of antibiotics
    • 55. GRAM POSITIVE COCCI S. aureus  hemolytic mannitol yellow + - Staphylococcus (Clusters) Streptococcus (pairs & chains) Catalase BETA: Bacitracin S. pyogenes (group A) CAMP/ Hippurate S. agalactiae (group B) Hemolysis Coagulase S. epidermidis nonhemolytic (usually) mannitol white ALPHA: Optochin /Bile Solubility S. pneumoniae GAMMA: Bile Esculin 6.5% NaCl Group D* Enterococcus Bile Esculin 6.5% NaCl Group D* Non- Enterococcus (*can also be alpha hemolytic) Note: S. viridans is Is alpha hemolytic and negative for all the tests below below + + + + + + + - - Summary Figure (Identification Scheme)

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