Bacterial Classification and Disease
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1 Bacterial Classification and Disease
2 Purpose To provide an overview of how physicians think when confronted with a bacterial infection To alert you to the importance of bacterial classification in treatment The importance of knowing the etiology of organ system based infection and the Gram stain
3 Purpose Some microbiology courses teach infectious diseases in a "bug parade" - Here are all of the gram-positive cocci, and here's what they do. Here are their random virulence factors,... That is not our philosophy (see Schaechter). This lecture provides that framework for students who want the bug parade organization.
4 Purpose The detail in this lecture is NOT to be memorized for exams. The principles ARE testable.
5 Bacterial Classification Based on several major properties Gram stain (and other stains) Morphology Metabolic behavior (e.g., oxygen) Infection patterns (e.g., zoonoses) Obligate intracellular Antigenic composition DNA sequence
6 Metabolic properties May influence the type of disease caused, but not necessarily Anaerobes have a greater propensity to cause abscesses Mycobacterium tuberculosis is an obligate aerobe affects tissue tropism Acid fast organisms grow slowly - chronic infections Vibrio vulnificus grows fast - rapid progression
7 Bacterial classification Cell morphology Shapes Rod Cocci Spiral Filamentous Associations Individual Diplo- Staphylo- Strepto- Filaments Bacteria G+ G- Acid Wall Intra fast less cellular Rod Cocci Rod Cocci Spiral
8 Bacteria Gram + Gram - Acid Fast Intra Cellular Wall Less Cocci Rod Staph.Strep. Entero Non-spore Spore coccus Fil Rod +O 2 -O 2 Spiral Treponema Borrelia Leptospira Rod Cocci Neisseria Moraxella M.t. M.l. N.c. Rickettsia Mycoplasma Coxiella Ureaplasma Erlichia Chlamydia S. a. S. e. S. s. A B Pn Vir A.i. C.d. L. m. B.a. B.c. C.b. C.t. C.p. C.d. +O 2 +/-O 2 -O 2 Straight Other Curve Vibrio Campylobacter Helicobacter P.a. Enteric Many! Bacteroides Resp. Zoonoses GU Bordetella Haemophilus Legionella Yersinia H. ducreyi Pasteurella Gardnerella Brucella Francisella Streptobacillus
9 Classification and Disease Gram-positive cocci - pyogenic Streptococcus pyogenes Staphylococcus aureus Gram-negative cocci - pyogenic Neisseria gonorrhoeae Neisseria meningitidis Spirals - chronic infections Treponema pallidum Borrelia burdorferi Leptospira
10 How a physician approaches bacterial diseases Organ system approach Which bacteria cause disease in a certain location The "usual suspects" Gram stain approach The Gram stain is used to treat empirically before cultures are completed Requires that one is able to get a Gram stain directly from a patient sample, which is not always the case (e.g., stool, sinus, endocarditis) The combination of these is ideal 1
11 Upper Respiratory Tract Pharyngitis mostly viral lots of normal flora (Gram stain little value) rapid test (e.g., Phadebact), culture If Streptococcus pyogenes (Group A strep) must treat - why? Other causes - young adult Mononucleosis Gonorrhea Diphtheria (not likely - why?)
12 Pneumonia Sputum Gram stain (and other stains) very helpful (why?) Coupled with chest X-ray Other signs, symptoms, history
13 Gram stain What is this? 2
14 Gram stain What is this?
15 Acid fast stain What is this?
16 Silver stain What is this?
17 Otitis media and Sinusitis Gram stain and culture not practical Otitis media - tympanostomy Sinusitis - must access sinus Usual suspect list (same) Streptococcus pneumoniae Haemophilus influenzae Moraxella catarrhalis Empiric therapy
18 Meningitis Gram stain practical and extremely important CSF sterile, few host cells Note bacteria and host cells Couple with age Neonate Child Adult
19 Meningitis Neonate E. coli K1 Group B streptococcus (S. agalactiae) Listeria monocytogenes Children and adults Streptococcus pneumoniae Neisseria meninigitidis
20 Meningitis
21 3 Meningitis
22 Meningitis
23 Endocarditis Gram stain not practical Can't access infection site! Bacteremia too low Usual suspects Oral streptococci Enterococci Staphylococci
24 Enteric infections Gram stain not practical Can't access infection site Too much stuff in stool Mostly viral Blood and pus indicators of disease
25 Abdomen Organisms come from the GI tract Gram-negative rods Facultative anaerobes (Enterobacteriaceae) Obligate anaerobes (Bacteroides, Fusobacterium) Sometimes gram positive cocci Aerobic (Enterococcus and Streptococcus) Anaerobic (Peptostreptococcus) Obligate anaerobic gram positive rods (Clostridium)
26 Skin Infections Skin flora - gram-positive cocci Staphylococcus aureus Streptococcus pyogenes Complex skin infections Skin flora plus enteric flora and environmental flora
27 Urinary tract infection Because of proximity to GI tract enteric flora are the prime suspects Facultative aerobic enteric gramnegative rods predominate (E. coli) Unusual to find staphylococci and streptococci or anaerobes
28 Sexually Transmitted Only a few bacteria Neisseria gonorrhoeae Chlamydia trachomatis Treponema pallidum
29 4 Sexually Transmitted
30 Sexually Transmitted
31 Sexually Transmitted Dark field 5
32 Take home messages Classification is boring but important for initial therapy. Know what organisms are common at the various sites of infection as you go through the course. Know the Gram stain and metabolic properties of the common bacteria found at each organ system infection. Don t memorize it for this lecture. It will be taught in the lectures that follow.
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