1.Pathogeniccocci2.Otherbacteria1.PathogeniccocciConceptofpathogenicbacteria13minStaphylococcus(Esp.,S.aureus)

56minStreptococcus(Esp.,S.pyogenes)38minEnterococcusspeciesandVRE5minNeisseriameningitidesNeisseriagonorrhoeae13min2.OtherbacteriaPseudomonasaeruginosa10min

HighlightsofcontentUptoeverypathogen,thefollowingwillbetalked:BiologicalpropertiesPathogenicityImmunityMicrobiologicaldetectionsPreventionandtreatmentPustule(膿皰)

byS.aureusParonychia(甲溝炎)

byS.aureusSorethroat(咽喉炎)

byS.pyogenesUntreatederysipelas(丹毒)byS.pyogenes

withskinsloughingandnecrosis

Chestx-rayFilm1justafewhoursofrigorsandproductivecough

Chestx-rayFilm212hourslaterconsolidationintherightupperlobe

Lobarpneumonia(大葉性肺炎)byS.pneumoniaeMeningococcalsepticemia(腦膜炎球菌性敗血癥)byN.meningitidis,widespreadecchymoses

Gonococcalconjunctivitis(淋菌性結(jié)膜炎)

byN.gonorrhoeae

Whatis

Pathogeniccocci?

alsocalled

—

Pyogeniccocci

(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

(GroupAStreptococci,S.pyogenes)

(A群鏈球菌or化膿性鏈球菌)

---Streptococcuspneumoniae

(肺炎鏈球菌)

---Neisseriagonorrhoeae

(淋病奈瑟菌)---Neisseriameningitidis

(腦膜炎奈瑟菌)

Importantcocci

Gramstain

Bacterialgenera

G+

Genusstaphylococcus

Genus

streptococcus

G-

GenusNeisseria

(N.meningitides

N.gonorrhoeae)StaphylococcusaureusImportantpyogeniccoccusLeadingpathogenofwoundinfections

(includingotherstaphylococci)

Antigenicstructure

StaphylococcalproteinA

(SPA)

OnekindofsurfaceproteinincellwallSinglechainpeptide

Actions—

Binds(bacterium)

tohost’sIgG1,IgG2&IgG4

coagglutinationtest

Competesw/Fcreceptorsofphagocytes

resistsphagocytosis

SPAmayresistphagocytosisbycompetivelybindingwithFcreceptorsofphagocytes

Capsule

Teichoicacid(polysaccharide)polysaccharideA—

S.aureus

polysaccharideB—

S.epidermidisPhasesofphagocytosisImportant

Propertiesof3Main

SpeciesofStaphylococciCoagulase,Fibrinolysin,Heatstablenuclease,Hyaluronidase,&LipaseEnzymesPathogenicsubstancesCytotoxins(Staphylolysin,,,&,Leukocidin),

Exfoliatin,Enterotoxins,&TSST-1ToxinsAdhesin,Capsule,&PeptidoglycanOthersCoagulaseFreeCoagulaseFreeCoagulase

staphylothrombin(游離凝固酶)

(葡萄球菌凝血酶)FibrinogenFibrinPlasmatobecloted

Tubecoagulasetestactivatedconvertleukocidin殺白細(xì)胞素killsordegranulatesneutrophils¯ophages

includingtypeA&typeBcausesstaphylococcalscaldedskinsyndrome

(SSSS)Exfoliatin(表皮剝奪毒素)includingserotypeA,B,C1-3,D,E,G,&Hresponsibleforfoodpoisoning(食物中毒)

mainlycausevomiting

alsoactsassuperantigen(超抗原)Enterotoxin(腸毒素)causestoxicshocksyndrome

(TSS)

onekindofsuperantigensToxicshocksyndrometoxin1(TSST-1)

(毒性休克綜合征毒素-1)Othersheat-stablenuclease(耐熱核酸酶)ClinicaldiseasesInvasivediseasesToxin-mediateddiseasesPyogenicinfections

-localinfections-systemicinfections-foodpoisoning-staphylococcalscaldedskinsyndrome(SSSS)-toxicshocksyndrome

(TSS)Folliculitis(毛囊炎)byS.aureusBullousImpetigobyS.aureusAS.aureusinfectionona12-year-oldchild'scheekPathogenesisofstaphylococcalinfectionsMicrobiologicaldiagnosisAnimaltestSamplesPus,blood,food,orvomitusIsolationCoagulasetestMannitefermentationHeat-stablenucleaseSmearµscopyG+staphylococciColonypigments&hemolysisBiochemicalreactionsEnterotoxinsdetectionIdentificationofpathogenicstaphylococci

Coagulase

(+)

Heat-stablenuclease(+)

Goldenpigment(+)

Hemolyzation

(+)

Mannitefermentation(+)Prevention&treatmentPreventionpreventingnosocomialinfectionTreatmentantibioticssensitivitytestpersonalhygienesterilisation&detentionself-bacterialvaccinetherapypreventingdrugresistanceMethicillin-resistantS.aureus,MRSA

(耐甲氧西林金黃色葡萄球菌)Coagulase-negativestaphylococci(CNS)

(凝固酶陰性葡萄球菌)Comparethefeaturesofcommonpyogenicbacteria.DiscussthepathogenicfeaturesandidentificationpointsofStaphylococcusaureus.Questions:Streptococci

G+,

spherical,elliptical,arrangedinchain

Growwellonnutrientmediumw/bloodBiologicalpropertiesShape,Stain&CultureAntigenicstructureProteinantigen

—surfaceAg,outsideCantigen—type-specific—includingM,T,R,SinGroupA

Polysaccharidantigen

—C

Ag—group-specific

Nucleoprotein

—P

Ag—non-specific

CellcytoplasmCellmembranePeptidoglycanCapsuleCellwallClassificationAccordingto

-hemolytic

Streptococcus

-hemolytic

Streptococcus

-StreptococcusHemolysis

groupA-V,total20groupsamongpathogenicstreptococci

90%isgroupA

over100typesaccordingtoM

Ag

groupB,C,D,&GoccasionallyAntigenicstructurePathogenicityGroupAStreptococci

(S.pyogenes)Pathogenicsubstances

ProteinG:

similartoProteinA

adhesins

-lipoteichoicacid(LTA)

-fibronectinbindingprotein(FBP,proteinF)

(纖絲蛋白結(jié)合蛋白,F蛋白)

-proteinMBacterialstructure

Streptolysin(SL,鏈球菌溶素)

Streptococcalpyrogenicexotoxin

(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&enzymesStreptolysinS(SLS,鏈球菌溶素S)

-lowMWglycopeptide

-oxygen-stable

-causes-hemolysisonBloodAgarplate

-non-antigenicStreptolysinO(SLO,鏈球菌溶素O)

-proteinw/SHgroup

-oxygen-labile

-destroysmanykinds

ofcells

-anti-SLOtest(ASOtest)helpfulfordiagnosisStreptolysin-codedbylysogenicbacteriophage-proteinsincludingserotypeA,B,C-causesscarletfever

(猩紅熱)-onekindofsuperantigens-also

causesTSSStreptococcalpyrogenicexotoxin(SPE)

(鏈球菌致熱外毒素)Streptokinase

(SK,鏈激酶)-alsocalledasstreptococcalfibrinolysin

(鏈球菌溶纖維蛋白酶)Streptodornase(SD,鏈道酶)-hydrolyzesDNAHyaluronidase(透明質(zhì)酸酶)-alsocalledas

spreadingfactor(擴(kuò)散因子)-hydrolyzeshyaluronicacidinconnectivetissue-helpfulforspreadingofbacteriaClinicaldiseasesPyogenicinfectionsToxin-mediateddiseasesAllergicdiseases(latecomplications)-scarletfever

(猩紅熱)-Streptococcaltoxin-mediatedTSS-rheumaticfever

(風(fēng)濕熱)-acuteglomeruloniphritis

(急性腎小球腎炎)Erysipelas(丹毒)byS.pyogenesCellulitis(蜂窩組織炎)

byS.pyogenes"Honey-crust"lesiontypicalofS.pyogenesimpetigoPathogenesisofS.pyogenesinfectionsSamplesPus,Blood,NasopharynxswabIsolationw/bloodagarplatedistinguishingfromS.pneumoniaeSmearµscopyG+streptococcidistinguishingfromstaphylococciOtherstreptococci-hemolysisAssist-diagnosisforrheumaticfever-hemolysisASOtestMicrobiologicaldiagnosis

S.pneumoniae

GroupBstreptococci

GroupDstreptococci

Viridans(-hemolytic)streptococciStreptococcussuis(豬鏈球菌)Enterococcusspecies(腸球菌)&

VREOtherstreptococciEnterococcusspeciesandVREEnterococcusspp.(腸球菌)Previouslyclassifiedas

GroupDstreptococciIn1984,namedasgenusEnterococcusGram+cocciinpairsorshortchainsMostarefacultativeanaerobesComplexnutritionalrequirementsGroupDspecificteichoicacidantigenEnterococcusspp.viewedbydirectfluorescentantibody(FA)reactionEnterococcusspp.Commonlyfoundintheintestinesofnormalhealthyindividuals(humansandanimals).2importanthumandiseases-relatedspp.

E.faecalis(糞腸球菌)

andE.faecium(屎腸球菌)

CauseUrinarytractinfectionsBacteremia&septicaemiaSubacuteendocarditisWoundinfectionsFoodbornediseasesMeningitisNosocomialinfectionsOneofimportantlife-threatening

nosocomialpathogens

VancomycinResistantEnterococci

(VRE,耐萬(wàn)古霉素腸球菌)Since1986,VREinfectionshasbecomeagrowingproblem1.DiscussthepathogenicfeaturesofStreptococcuspyogenes.2.Discussidentificationpointsbetweenhemolyticstreptococciandotherpyogenicbacteria.Questions:Neisseriagonorrhoeae

(淋病奈瑟菌)BiologicalpropertiesShapeandstain

-G-diplococciinoronPMNsonpussmear

-Noendospore&flagellum,&w/capsule&piliCulture

-Obligateaerobes,need5%CO2whileprimaryisolation

-Highnutritionalrequirement

“ChocolateBloodAgarPlate”

Antigenicstructureandclassification

-Pilusproteinantigens

-Outermembraneproteinantigens：PI,PII,&PIII

-LOS(lipooligosaccharide,脂寡糖),

LPS-likeN.gonorrhoeaecoloniesonChocolateBloodAgarPlatePathogenesisVirulentfactors-Pili-Outermembraneproteins-LOS-IgA1protease-OthersClinicalfindings-Gonorrhea-GonococcalconjunctivitisGonorrheasymptoms-Urethritis-Vaginitis-Cervicitis-Salpingitis-Pelvicinflammation-AnorectalGonorrhea-GonococcalPharyngitis-GonococcalConjunctivitis-GonococcalArthritisinWomen-Urethritis-Epididymitis-Prostatitis-AnorectalGonorrhea-GonococcalPharyngitis-GonococcalConjunctivitis-GonococcalArthritisinMenClinicalmanifestationsofN.

gonorrhoeaeinfection

Immunity

Humoralimmunitymoreeffective

Nopersistentimmuneresponses

Infectiontrendto

-chronic&repeatedoccurrenceMicrobiologicaldetectionsNucleicacidsdetection,&soonSamplesPussecretafromgenito-urinarytracts,eyes,&othersIsolationOxidasetestSugarfermentationtestImmunofluorescenceassaySmearµscopyG-diplococciinoronPMNs

ColoniesµscopicfindingsBiochemicalreactions&serologictestsOthertestsPrevention&treatment

Takepreventionsasmainmeasure

Choose

penicillin

asNo.1drug，takecareofproblemsofdrugs-resistantbacterialstains1.Wh