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Diagnosis of important bacterial diseases


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Diagnosis of important bacterial diseases

  1. 1. Diagnosis of Important Bacterial Diseases Effective treatment can be initiated sooner if diagnostic results can be made quickly available to the clinician treating a disease outbreak. Bhoj R Singh Section of Epidemiology, CADRAD, IVRI, Izatnagar-243122, India
  2. 2. Activity (range) of various antimicrobial classes (Prescott and Baggot) Group of Antibiotics Activity of antimicrobial against Bacteria Mycoplasma Rickettsia Chlamydia Protozoa Aminoglycosides + + Beta-lactams + Chloramphenicol + + + + Lincosamides + + + Macrolides + + + Pleuromutilins + + + Tetracyclines + + + + Quinolones + + + + Sulfonamides + + + + Trimethoprim + +
  3. 3. Scope Bacterial infections affect  the skin; the eye; the ear; the mouth; the nose  the reproductive system  the digestive system  the respiratory system  the urinary system  the nervous system  the circulatory system  the locomotion organs
  4. 4. Bacteria  Definition  Single-celled microorganisms which can exist either as independent (free-living) organisms or as parasites (dependent upon another organism for life)  Invade tissues  May produce  Pus  Harmful or poisonous waste
  5. 5.  Live in a wide range of conditions  Live on and in the bodies of all animals  More numerous than the cells of the body  Useful in production of foods such as cheese and sauerkraut  Many can be harmful  Invade the cells of an animal’s body  May harm the animal by feeding off the body cells or secreting a material known as a toxin
  6. 6.  Bacteremia  Blood  Septicemia  Harmful waste products in blood  Toxemia  Toxins in blood  Toxico infection  Intoxications Effects
  7. 7. Types of Bacteria Cocci:  Round spherical shaped bacteria  Some forms of pneumonia and sepsis are caused by this bacteria Bacilli:  Rod shaped  Single, pairs, or arranged in chains  Cause many serious diseases in animals Spirila  Shaped like spirals or corkscrews  Very motile  Require moist atmosphere to live  Live very well in the reproductive tracts of animals  Leptospirosis  Vibrosis and spirochetosis
  8. 8. Why diagnosis is needed?  To administer the treatment  For prognosis  To initiate appropriate control measures  To take suitable preventive steps  To understand epidemiology  To know the disease history  For certification in International trade  To export  For import  To know who is at risk
  9. 9. Antibiotics  Once thought to be able to eliminate/ cure all pathogenic Bacterial infections.  MDR in pathogens lead to failure.  Antibacterial drug resistance is more natural than induced. Principles of Antibiotic use  1. Either not use or try to avoid unless very much essential.  2. Not use many at a time.  3. Use specific antibiotics rather than broad-spectrum.  4. Complete the course.  5. Never use antibiotics reserved for human use.
  10. 10. What is needed for diagnosis  Sound knowledge about the diseases  Knowledge about the host animal  Knowledge about the environment  Sound clinical experience  Right material (Sample)  Diagnostic facilities  Laboratory expert
  11. 11.  Diagnosis responsibility and need of a veterinarian.  Diagnostic tests may be performed by a technician.  Diagnostic techniques, history, clinical examination, and other information considered.  Diagnostic techniques: radiography, anatomical pathology, necropsy, microscopic examination of tissue sections, clinical pathology, microbiology, hematology, blood chemistry, immunoserology, parasitology and urinalysis
  12. 12. Diagnosis  Pen-side  At clinic  At laboratory
  13. 13. Recommended Diagnostics Disease Diagnostic tests Anthrax Demonstration of organism, Agent id Leptospirosis MAT, Agent Id Brucellosis BBAT, CFT, FPA, MRT, STAT, ELISA, Agent id, FAT, Brucellin TB Tuberculin test, ELISA, Agent id JD Johnin test, Agent id, ELISA Q-fever CFT, Agent id Tularemia Agent id Salmonellosis STAT, ELISA, Agent id CBPP CFT, ELISA, Agent id CEM Agent id Glanders CFT, Agent id, Mallein Campylobacteriosis Agent id Listeria Agent id Escherichia coli Agent id Strangles Agent id
  14. 14. Steps in Diagnosis of Bacterial diseases  Clinical Signs  Laboratory examination 1- Microscopy 2- Culture techniques 3- Biochemical reactions 4- Serological identification: 5- Molecular biology techniques 6- Bacteriophage typing
  15. 15. Pre-requisite for laboratory Examination  Suitable sample  Proper dispatch of sample to reach the laboratory along with all the relevant history of disease (morbidity, mortality, contagiousness etc.), signs and treatment.  In-time arrival at Laboratory  Proper laboratory facility  In-time processing at the Laboratory by the trained personnel
  16. 16. Site of sampling  Sterile sites  Blood  Cerebrospinal fluid (CSF)  Body fluids (Peritoneal and pleural)  Non-sterile (normal flora)  Respiratory tract  Ear, eye and mouth  Skin (wound and abscess)  Urine (mid-stream)  Feces
  17. 17. Microscopy Microorganisms can be examined microscopically for: a- Bacterial motility: Hanging drop method: A drop of bacterial suspension is placed between a cover slip and glass slid b- Morphology and staining reactions of bacteria: Simple stain: methylene blue stain Gram stain: differentiation between Gm+ve and Gm–ve bacteria . Primary stain (Crystal violet) . Mordant (Grams Iodine mixture) . Decolorization (ethyl alcohol) . Secondary stain ( Saffranin) Ziehl-Neelsen stain: staining acid fast bacilli . Apply strong carbol fuchsin with heat . Decolorization (H2SO4 20% and ethyl alcohol . Counter stain (methylene blue)
  18. 18. Sample for Bacterial Isolation  Prevent drying of the sample or swab.  Culture container must contain fluid/ semisolid transport medium to keep bacteria alive for 24 hrs.  Some media for swab transportation:  Liquid  Liquid transport medium  Campylobacter transport medium  Brucella transport medium  Semisolid  Stuart transport medium  Carry and Blair transport Medium with and without charcoal  Amies transport medium
  19. 19. Culture for bacteria  Sample is inoculated for culture and identification either in pre- enrichment or selective enrichment for broth culture. Incubated at suitable temperature for suitable time in proper environment  Streaked on either selective, differential or both type of agar media for suitable time in proper environment  Individual colonies are picked and grown as a pure culture.  Tentative ID made based on colony shape and staining.  Definitive ID requires biochemical, serological, and various tests.
  20. 20. Culture Techniques * Culture media are used for: - Isolation and identification of pathogenic organisms - Antimicrobial sensitivity tests * Types of culture media: a- Liquid media: - Nutrient broth: meat extract and peptone - Peptone water for preparation sugar media - Growth of bacteria detected by turbidity b- Solid media: - Colonial appearance - Hemolytic activity - Pigment production
  21. 21. Types of solid media 1- Simple media: Nutrient agar 2- Enriched media: media of high nutritive value . Blood agar . Chocolate agar . Loffler’s serum 3- Selective media: allow needed bacteria to grow . Lowenstein–Jensen medium . MacConkey’s agar . Mannitol Salt Agar 4- Indicator media: to different. between lact. and non lact. ferment . MacConkey's medium . Eosine Methylene blue Agar 5- Anaerobic media: for anaerobic cultivation . Deep agar, Robertson’s Cooked Meat Medium
  22. 22. Colonial appearance on culture media * Colony morphology: . Shape . Size . Edge of colony . Color * Growth pattern in broth: . Uniform turbidity . Sediment or surface pellicle * Pigment production: . Endopigment production (Staph. aureus) . Exopigment production (Ps. aeruginosa) * Haemolysis on blood agar: . Complete haemolysis (Strept. pyogenes) . Partial haemolysis (Strept. viridans) * Growth on MacConkey’s medium: . Rose pink colonies (Lactose fermenters) . Pale yellow colonies (Non lactose fermenters)
  23. 23. Biochemical Reaction Use of substrates and sugars to identify pathogens: a- Sugar fermentation: Organisms ferment sugar with production of acid only Organisms ferment sugar with production of acid and gas Organisms do not ferment sugar b- Production of indole: Depends on production of indole from amino acid tryptophan Indole is detected by addition of Kovac’s reagent Appearance of red ring on the surface e- H2S production: Depends on production H2S from protein or polypeptides Detection by using a strip of filter paper containing lead acetate
  24. 24. Biochemical Reaction (cont.) c- Methyl red reaction (MR): Fermentation of glucose with production of huge amount of acid Lowering pH is detected by methyl red indicator d- Voges proskaur’s reaction (VP): Production of acetyl methyl carbinol from glucose fermentation Acetyl methyl carbinol is detected by addition KOH Color of medium turns pink (positive) e- Action on milk: Fermentation of lactose with acid production Red color if litmus indicator is added
  25. 25. Biochemical Reaction (cont.) f- Oxidase test: Some bacteria produce Oxidase enzyme Detection by adding few drops of colorless Oxidase reagent Colonies turn deep purple in color (positive) g- Catalase test: Some bacteria produce catalase enzyme Addition of H2O2 lead to production of gas bubbles (O2 production) h- Coagulase test: Some bacteria produce coagulase enzyme Coagulase enzyme converts fibrinogen to fibrin (plasma clot) Detected by slide or test tube method i- Urease test: Some bacteria produce urease enzyme Urease enzyme hydrolyze urea with production of NH3 Alkalinity of mediaand change color of indicator from yellow to pink
  26. 26. Bacteria are of many types  With Cell Wall  Gram +  Staphylococcus, Streptococcus, Clostridium, Bacillus  Gram -  Enteric, respiratory and others  Acid-fast  Mycobacterium  Wall-less  Mycoplasma  Unusual  Obligate intracellular  Rickettsia, Chlamydia G+ G- AF WL IC Bacteria
  27. 27. Bacteria Gram+ Gram- Acid Fast Intra Cellular Wall Less Cocci Rod CocciRodSpiral Staph. Strep. Non-spore Spore Straight Curve +O2 -O2+/-O2 Other S. a. S. e. S. s. A B Pn Vir Fil Rod A.i. C.d. L. m. M.t. +O2 -O2 B.a. B.c. C.b. C.t. C.p. C.d. Treponema Borrelia Leptospira Neisseria Moraxella P.a. Enteric Bact. Resp. Zoo GU Bordetella. H. influenzae Legionella Yersinia Pasteurella Brucella Francisella H. ducreyi Gardnerella Calymmatobacterium Rickettsia Coxiella Erlichia Chlamydia Mycoplasma Vibrio Campylobacter Helicobacter
  28. 28. Gram negative Straight rods Curved rods Lactose+ Lactose- Citrate+ Citrate- H2S+ H2S- Klebsiella E. coli Salmonella Shigella Campy blood agar 42o C+ 25o C- Campylobacter TCBS agar Yellow Oxidase+ Vibrio
  29. 29. Animal pathogenicity * Animal pathogenicity test: Animals commonly used are guinea pigs, rabbits, mice * Importance of pathogenicity test: - Differentiate pathogenic and non pathogenic - Isolation organism in pure form - To test ability of toxin production - Evaluation of vaccines and antibiotics
  30. 30. Serological identification A- Direct serological tests: - Identification of unknown organism - Detection of microbial antigens by using specific known antibodies - Serogrouping and serotyping of isolated organism B- Indirect serological tests: - Detection of specific and non specific antibodies (IgM & IgG) by using antigens or organisms
  31. 31. SEROLOGICAL DIAGNOSIS OF INFECTIOUS DISEASES  Infectious Disease Indicators, Non-specific  Acute phase reactants  Limulus lysate assay  Detects trace amounts of endotoxin from all gram (-) bacteria  Presence in CSF = gram (-) bacterial meningitis  Rapid clearance from blood makes serum test unreliable
  32. 32. Molecular Diagnosis  Ribotyping  Restriction fragment length polymorphism (RFLP)  DNA hybridization  PCR, RT-PCR and RAPD  Nucleic acid sequence analysis  PFGE  Phage-GFP (TB)  Plasmid profile analysis:
  33. 33. Advantages  Reduce reliance on culture  Faster  More sensitive  More definitive  More discriminating  Techniques adaptable to all pathogens
  34. 34. Leading uses for nucleic acid based tests  Nonculturable agents  Fastidious, slow-growing agents  Mycobacterium tuberculosis  Legionella pneumophilia  Highly infectious agents that are dangerous to culture  Francisella tularensis  Brucella species  In situ detection of infectious agents  Helicobacter pylori  Toxoplasma gondii  Organisms present in small volume specimens  Intra-ocular fluid  Forensic samples
  35. 35. Leading uses for nucleic acid based tests  Differentiation of antigenically similar agents  May be important for detecting specific serovars of bacteria associated with infection  Non-viable organisms  Organisms tied up in immune complexes  Molecular epidemiology  To identify point sources for hospital and community-based outbreaks  To predict virulence  Culture confirmation
  36. 36. Disadvantages of a molecular test?  Technically demanding  Relatively expensive  Provides no information if results are negative  So specific that must have good clinical data to support infection by that organism before testing is initiated.  Will miss new organisms unless sequencing is done as we will be doing in the lab for our molecular unknowns (not practical in a clinical setting).  May be a problem with mixed cultures – would have to assay for all organisms causing the infection.  Too sensitive? Are the results clinically relevant?
  37. 37. OIE ad hoc Group on Diagnostic Tests in Relation to New and Emerging Technologies The following new molecular diagnostic methodologies have been identified:  Direct diagnostic assays  • PCR-based assays  o Real time;  o Rapid detection in a disease outbreak;  o Multiplex;  o PCR robotics.  • Isothermal amplification assays;  • Microarray technologies;  • Rapid sequencing technologies, phylogenic analysis/bioinformatics;  • Genomic technologies to determine virulence;  • Complete full length genome sequencing technologies;  • Pen-side test technologies (lateral flow devices);  • Portable PCR technologies for field use;  • Nanotechnology;  • Proximity ligation technologies;  • In-situ hybridisation;  • Proteomics (detection of proteins). Source:
  38. 38. OIE ad hoc Group on Diagnostic Tests in Relation to New and Emerging Technologies The following new molecular diagnostic methodologies have been identified:  Indirect diagnostic test (antibody-based assays)  • Bioluminometry;  • Fluorescence polarisation;  • Chemoluminescence technologies;  • Biosensors;  • Biomarkers;  • Recombinant proteins;  • Synthetic proteins;  • Improved monoclonals for enzyme-linked immunosorbent assays (ELISA). Source:
  39. 39. World Association of Veterinary Laboratory Diagnosticians Mission Statement  The mission of the WAVLD is to improve animal and human health by facilitating the availability of quality laboratory testing provided through veterinary diagnostic laboratories around the world. This mission is accomplished by:  Disseminating the latest information relating to the diagnosis of animal diseases through outstanding educational symposia.  Facilitating the organization of associations of veterinary laboratory diagnosticians in all countries of the world.  Providing consulting assistance to countries wishing to build and operate state-of-the-art veterinary diagnostic laboratories.  Supporting other activities to improve the health and welfare of man and animals throughout the world. Source:
  40. 40. 1. McCurnin, D.M. Clinical Textbook for Veterinary Technicians. W.B. Sanders, Philadelphia, PA, 1994. 2. Pratt, P.W. Laboratory Procedures for Veterinary Technicians. Mosby, St. Louis, MO, 1996. 3. Singh, B.R. Labtop for Microbiology Laboratory. Lambert Academic Press, 2009. Further Reading
  41. 41. Questions