病原性球菌課件-2

1、 1. Pathogenic cocci 2. Other bacteria 1. Pathogenic cocci1. Pathogenic cocciConcept of pathogenic bacteria 13minStaphylococcus (Esp., S. aureus) 56minStreptococcus (Esp., S. pyogenes) 38minEnterococcus species and VRE 5minNeisseria meningitides Neisseria gonorrhoeae 13min2. Other bacteriaPseudomona

2、s aeruginosa 10min Highlights of content1. Pathogenic cocciHighlights Up to every pathogen, the following will be talked: Biological properties Pathogenicity Immunity Microbiological detections Prevention and treatmentUp to every pathogen, the follPustule (膿皰) by S. aureusPustule (膿皰) by S. aureusPu

3、stule (膿皰) by S. aureusParonychia (甲溝炎) by S. aureusPustule (膿皰) by S. aureusParonSore throat (咽喉炎) by S. pyogenesSore throat (咽喉炎) by S. pyogenUntreated erysipelas (丹毒) by S. pyogenes with skin sloughing and necrosis Untreated erysipelas (丹毒) by Necrotizing Fasciitis (壞死性筋膜炎)by flesh-eating bacteri

4、a (S. pyogenes, anaerobic bacteria, etc.), and insects (bee, etc.) stingingNecrotizing Fasciitis (壞死性筋膜炎)Chest x-ray Film 1just a few hours of rigors and productive cough Chest x-ray Film 212 hours laterconsolidation in the right upper lobe Lobar pneumonia (大葉性肺炎) by S. pneumoniaeChest x-ray Film 1C

5、hest x-ray Meningococcal septicemia (腦膜炎球菌性敗血癥) by N. meningitidis, widespread ecchymoses Meningococcal septicemia (腦膜炎球Gonococcal conjunctivitis (淋菌性結(jié)膜炎) by N. gonorrhoeae Gonococcal conjunctivitis (淋菌性Causative agents of above clinical diseases?Pathogenic cocciCausative agents of above clin What i

6、s Pathogenic cocci ? also called Pyogenic cocci (化膿性球菌) Including -Staphylococcus (S. aureus & S. epidermidis) (金黃色葡萄球菌與表皮葡萄球菌 ) -Streptococcus (Group A Streptococci, S. pyogenes) (A群鏈球菌 or 化膿性鏈球菌) -Streptococcus pneumoniae (肺炎鏈球菌) -Neisseria gonorrhoeae (淋病奈瑟菌) -Neisseria meningitidis (腦膜炎奈瑟菌) What

7、 is Pathogenic cocci ? In Important cocci Gram stain Bacterial genera G+ Genus staphylococcus Genus streptococcus G- Genus Neisseria ( N. meningitides N. gonorrhoeae ) Important cocci Gram stain Staphylococcus aureusImportant pyogenic coccusLeading pathogen of wound infections (including other staph

8、ylococci)Staphylococcus aureusImportant Shape, Stain & Culture spherical, elliptical, irregular grape-like cluster Gram+ (G+) Grow well on basic mediumBiological properties Shape, Stain & CultureBiologi病原性球菌課件_2病原性球菌課件_2 Antigenic structure Staphylococcal protein A (SPA) One kind of surface protein

9、in cell wall Single chain peptide Actions Binds (bacterium) to hosts IgG1, IgG2 & IgG4 coagglutination test Competes w/ Fc receptors of phagocytes resists phagocytosis Antigenic structureCoagglutination test with inert particles (e.g., heat-killed S. aureus or latex beads) Coagglutination test with

10、inerSPA may resist phagocytosis by competively binding with Fc receptors of phagocytesSPA may resist phagocytosis by Capsule Teichoic acid (polysaccharide) polysaccharide A S. aureus polysaccharide B S. epidermidisPhases of phagocytosis CapsulePhases of phagocytosisImportant Properties of 3 Main Spe

11、cies of StaphylococciImportant Properties of 3 MainPathogenicity & immunityPathogenicity & immunityCoagulase, Fibrinolysin, Heat stable nuclease, Hyaluronidase, & LipaseEnzymesPathogenic substancesCytotoxins (Staphylolysin , , , & , Leukocidin), Exfoliatin, Enterotoxins, & TSST-1ToxinsAdhesin, Capsu

12、le, & PeptidoglycanOthersCoagulase, Fibrinolysin, Heat Coagulase Free CoagulaseFree Coagulase staphylothrombin (游離凝固酶) (葡萄球菌凝血酶)Fibrinogen Fibrin Plasma to be cloted Tube coagulase test activatedconvertCoagulase Free Coagulaseactiva Virulence Protection actions Infection localized Bound coagulase(結(jié)合

13、凝固酶) or clumping factor(凝聚因子) plasma to be cloted or bacteria to coagulate Slide coagulase test Virulence Bound coagulase(結(jié)合凝 classified into -, -, -, & -toxin -toxin makes pores in cell membranesStaphylolysin(葡萄球菌溶素) classified into -, -, -, &leukocidin殺白細胞素 kills or degranulates neutrophils & macr

14、ophagesleukocidin kills or degranulat including type A & type B causes staphylococcal scalded skin syndrome (SSSS)Exfoliatin (表皮剝奪毒素) including type A & type BExfo including serotype A, B, C1-3, D, E, G, & H responsible for food poisoning(食物中毒) mainly cause vomiting also acts as superantigen(超抗原)Ent

15、erotoxin(腸毒素) causes toxic shock syndrome (TSS) one kind of superantigensToxic shock syndrome toxin 1 (TSST-1) (毒性休克綜合征毒素-1 ) including serotype A, B, C1-3病原性球菌課件_2Othersheat-stable nuclease (耐熱核酸酶)Othersheat-stable nuclease (耐熱病原性球菌課件_2病原性球菌課件_2Clinical diseasesInvasive diseasesToxin-mediated disea

16、sesPyogenic infections -local infections-systemic infections-food poisoning-staphylococcal scalded skin syndrome (SSSS)-toxic shock syndrome (TSS)Clinical diseasesInvasive diseFolliculitis (毛囊炎) by S. aureusFolliculitis (毛囊炎) by S. aureuBullous Impetigo by S. aureusBullous Impetigo by S. aureusA S.

17、aureus infection on a 12-year-old childs cheek A S. aureus infection on a 12-Pathogenesis of staphylococcal infectionsPathogenesis of staphylococcalMicrobiological diagnosisAnimal testSamplesPus, blood, food, or vomitusIsolationCoagulase testMannite fermentationHeat-stable nucleaseSmear & microscopy

18、G+ staphylococciColony pigments & hemolysisBiochemical reactionsEnterotoxins detectionMicrobiological diagnosisAnimaIdentification of pathogenic staphylococci Coagulase (+) Heat-stable nuclease (+) Golden pigment (+) Hemolyzation (+) Mannite fermentation (+)Identification of pathogenic sPrevention &

19、 treatmentPreventionpreventing nosocomial infectionTreatmentantibiotics sensitivity testpersonal hygienesterilisation & detentionself-bacterial vaccine therapy preventing drug resistancePrevention & treatmentPreventiMethicillin-resistant S. aureus, MRSA (耐甲氧西林金黃色葡萄球菌)Coagulase-negative staphylococci

20、 (CNS) (凝固酶陰性葡萄球菌)Methicillin-resistant S. aureuCompare the features of common pyogenic bacteria.Discuss the pathogenic features and identification points of Staphylococcus aureus.Questions:Compare the features of commonStreptococciStreptococci G+, spherical, elliptical, arranged in chain Grow well

21、on nutrient medium w/ bloodBiological propertiesShape, Stain & Culture G+, spherical, elliptical, ar病原性球菌課件_2病原性球菌課件_2Antigenic structure Protein antigen surface Ag, outside C antigen type-specific including M,T,R,S in Group A Polysaccharid antigen C Ag group-specific Nucleoprotein P Ag non-specific

22、 Cell cytoplasm Cell membranePeptidoglycanCapsuleCell wallAntigenic structure Protein anClassificationAccording to -hemolytic Streptococcus -hemolytic Streptococcus -StreptococcusHemolysis group A-V, total 20 groups among pathogenic streptococci 90% is group A over 100 types according to M Ag group

23、B, C, D, & G occasionallyAntigenic structureClassificationAccording to -hPathogenicityPathogenicityGroup A Streptococci (S. pyogenes)Group A Streptococci (S. pyogPathogenic substances Protein G: similar to Protein A adhesins -lipoteichoic acid (LTA) -fibronectin binding protein (FBP, protein F) (纖絲蛋

24、白結(jié)合蛋白, F 蛋白) -protein MBacterial structurePathogenic substances Protein Streptolysin (SL, 鏈球菌溶素) Streptococcal pyrogenic exotoxin (SPE, 鏈球菌致熱外毒素) Hyaluronidase (透明質(zhì)酸酶) Streptokinase (SK, 鏈激酶) Streptodornase (SD, 鏈道酶)Toxins & enzymes Streptolysin (SL, 鏈球菌溶素)ToxinStreptolysin S (SLS, 鏈球菌溶素S) -low MW g

25、lycopeptide -oxygen-stable -causes -hemolysis on Blood Agar plate -non-antigenicStreptolysin O (SLO, 鏈球菌溶素O) -protein w/ SH group -oxygen-labile -destroys many kinds of cells -anti-SLO test (ASO test) helpful for diagnosisStreptolysinStreptolysin S (SLS, 鏈球菌溶素S)St-coded by lysogenic bacteriophage-pr

26、oteins including serotype A, B, C-causes scarlet fever (猩紅熱)-one kind of superantigens-also causes TSSStreptococcal pyrogenic exotoxin (SPE) (鏈球菌致熱外毒素)-coded by lysogenic bacteriophStreptokinase (SK, 鏈激酶)-also called as streptococcal fibrinolysin (鏈球菌溶纖維蛋白酶) Streptodornase (SD, 鏈道酶)-hydrolyzes DNAHy

27、aluronidase (透明質(zhì)酸酶)-also called as spreading factor (擴散因子)-hydrolyzes hyaluronic acid in connective tissue-helpful for spreading of bacteriaStreptokinase (SK, 鏈激酶)Strepto病原性球菌課件_2Clinical diseasesPyogenic infectionsToxin-mediated diseasesAllergic diseases (late complications)-scarlet fever (猩紅熱)-Str

28、eptococcal toxin-mediated TSS-rheumatic fever (風濕熱)-acute glomeruloniphritis (急性腎小球腎炎)Clinical diseasesPyogenic infeErysipelas (丹毒) by S. pyogenesErysipelas (丹毒) by S. pyogenesCellulitis (蜂窩組織炎) by S. pyogenesCellulitis (蜂窩組織炎) by S. pyogeHoney-crust lesion typical of S. pyogenes impetigoHoney-crust

29、 lesion typical oPathogenesis of S. pyogenes infectionsPathogenesis of S. pyogenes inSamplesPus, Blood, Nasopharynx swabIsolation w/ blood agar platedistinguishing from S. pneumoniaeSmear & microscopyG+ streptococcidistinguishing from staphylococciOther streptococci-hemolysisAssist-diagnosis for rhe

30、umatic fever-hemolysisASO testMicrobiological diagnosisSamplesPus, Blood, Nasopharynx S. pneumoniae Group B streptococci Group D streptococci Viridans (-hemolytic) streptococci Streptococcus suis (豬鏈球菌) Enterococcus species (腸球菌) & VRE Other streptococci S. pneumoniaeOther streptococEnterococcus spe

31、cies and VRE Enterococcus species and VRE Enterococcus spp.(腸球菌) Previously classified as Group D streptococci In 1984, named as genus Enterococcus Gram+ cocci in pairs or short chains Most are facultative anaerobes Complex nutritional requirements Group D specific teichoic acid antigenEnterococcus

32、spp. Previously cEnterococcus spp. viewed by direct fluorescent antibody (FA) reactionEnterococcus spp. viewed by diEnterococcus spp. Commonly found in the intestines of normal healthy individuals (humans and animals). 2 important human diseases-related spp. E. faecalis (糞腸球菌) and E. faecium (屎腸球菌)

33、Cause Urinary tract infections Bacteremia & septicaemia Subacute endocarditis Wound infections Foodborne diseases Meningitis Nosocomial infectionsEnterococcus spp. Commonly fou One of important life-threatening nosocomial pathogens Vancomycin Resistant Enterococci (VRE, 耐萬古霉素腸球菌) Since 1986, VRE inf

34、ections has become a growing problem One of important life-threate1. Discuss the pathogenic features of Streptococcus pyogenes.2. Discuss identification points between hemolytic streptococci and other pyogenic bacteria.Questions:1. Discuss the pathogenic featNeisseria gonorrhoeae (淋病奈瑟菌)Neisseria go

35、norrhoeaeBiological properties Shape and stain -G- diplococci in or on PMNs on pus smear -No endospore & flagellum, & w/ capsule & piliBiological properties Shape an病原性球菌課件_2 Culture -Obligate aerobes, need 5% CO2 while primary isolation -High nutritional requirement “Chocolate Blood Agar Plate” Ant

36、igenic structure and classification -Pilus protein antigens -Outer membrane protein antigens：PI, PII, & PIII -LOS (lipooligosaccharide, 脂寡糖), LPS-like Culture Antigenic structure aN. gonorrhoeae colonies on Chocolate Blood Agar PlateN. gonorrhoeae colonies PathogenesisVirulent factors-Pili-Outer mem

37、brane proteins-LOS-IgA1 protease-OthersPathogenesisVirulent factorsClinical findings -Gonorrhea -Gonococcal conjunctivitisClinical findingsGonorrhea symptoms-Urethritis-Vaginitis-Cervicitis-Salpingitis-Pelvic inflammation-Anorectal Gonorrhea-Gonococcal Pharyngitis-Gonococcal Conjunctivitis-Gonococca

38、l Arthritis in Women-Urethritis-Epididymitis-Prostatitis-Anorectal Gonorrhea-Gonococcal Pharyngitis-Gonococcal Conjunctivitis-Gonococcal Arthritisin MenGonorrhea symptoms-UrethritisiClinical manifestations of N. gonorrhoeae infection Clinical manifestations of N. Immunity Humoral immunity more effec

39、tive No persistent immune responses Infection trend to -chronic & repeated occurrenceImmunity Humoral immunity moreMicrobiological detectionsNucleic acids detection, & so onSamplesPus secreta from genito-urinary tracts, eyes, & othersIsolationOxidase testSugar fermentation testImmunofluorescence ass

40、aySmear & microscopyG- diplococci in or on PMNs Colonies & microscopic findingsBiochemical reactions & serologic testsOther testsMicrobiological detectionsNuclPrevention & treatment Take preventions as main measure Choose penicillin as No. 1 drug，take care of problems of drugs-resistant bacterial stainsPrevention & treatment Take pr1. What are the main differences between Neiss