1. PSEUDOMONAS AERUGINOSA BY NEEMA SHAH 10/24/05

2. Objectives  Upon presentation and visual aids student will be able to: 1. Identify Pseudomonas aeruginosa under microscope with 100% accuracy 2. Recognize Pseudomonas aeruginosa on any lab media. 3. Describe and list the virulence factors of P.aeruginosa. 4. List the causes and symptoms of P.aeruginosa. 5. List the treatment and prevention of P.aeruginosa.

3. Introduction Pseudomonas aeruginosa is a strictly aerobic gram negative rod organism that can be found in soil, water, plants and animals. Pseudomonas aeruginosa is a strictly aerobic gram negative rod organism that can be found in soil, water, plants and animals. P.aeruginosa is an opportunistic pathogen, which means organism do not ordinarily cause disease, but multiply freely in persons whose immune systems are weekend by illness or medication (immunocompromised). P.aeruginosa is an opportunistic pathogen, which means organism do not ordinarily cause disease, but multiply freely in persons whose immune systems are weekend by illness or medication (immunocompromised). Patients with AIDS have an increased risk of developing serious infection. Patients with AIDS have an increased risk of developing serious infection. Of the two million nosocomial infections each year, 10% are caused by P.aeruginosa. Of the two million nosocomial infections each year, 10% are caused by P.aeruginosa. The bacterium is the second most common cause of nosocomial pneumonia and the most common cause of intensive care unit (ICU) pneumonia. The bacterium is the second most common cause of nosocomial pneumonia and the most common cause of intensive care unit (ICU) pneumonia.

4. Why P.aeruginosa is a strong opponent? Several factors make P.aeruginosa a strong opponent. These factors include: Several factors make P.aeruginosa a strong opponent. These factors include: 1. The ability to stick to cells 2. Minimal food requirements 3. Resistance to many antibiotics 4. Production of proteins that damage tissue 5. A protective outer coat 6. Ability to produce toxins 7. Antiphagocystic surface properties 8. Defense against immune responses

5. Infections and Route of Transmission P.aeruginosa is able to infect many different parts of the body. P.aeruginosa is able to infect many different parts of the body. 1. Heart and blood: P.aeruginosa is the fourth most common cause of bacterial infections of the blood (bacteremia). It infects the heart valves of IV drug abusers and persons with artificial heart valves. 2. Bone and joints: Pseudomonas infections in these parts of body can result from injury. Persons at risk include diabetics, IV drug abusers, and bone surgery patients. 3. Central nervous system: P.aeruginosa can cause meningitis and brain abscesses. These infections may result from brain injury or surgery, and the spread of infection from other body parts.

6. Continue Infections and Transmission 4. Eye and Ear: P.aeruginosa can cause infection of external ear canal, so called swimmer’s ear that usually disappears without treatment. The organism can cause a more serious infection in elderly patients, leading to hearing problems, facial paralysis, or even death. The bacteria can cause ulcers of the cornea that may cause rapid tissue destruction and blindness. The major risk factor for pseudomonas eye infection include: wearing soft extended contact lenses, using topical corticosteroid eye medication, being in coma, having extensive burns. 5. Urinary tract infection: Can cause by catheterization, medical instrument, and surgery.

7. Continue Infections and Transmission 6. Skin and soft tissue: Even healthy persons can develop a pseudomonas skin rash following exposure to the bacterium in contaminated hot tubs, water park, whirlpools, or spas. This skin disorder is called folliculitis, and is often confused with chickenpox. 7. Lung: Risk factors for P.aeruginosa pneumonia include: cystic fibrosis, chronic lung disease, immunocompromised condition, being on antibiotic therapy or a respirator, and congestive heart failure. Patients with cystic fibrosis develops pseudomonas infection as children and suffer recurrent attacks of pneumonia.

8. Diseases and Symptoms  Burn wound Infections: usually occur one to two weeks after the burn and cause discoloration of the burn scab, destruction of the tissue below the scab, early scab loss, bleeding, swelling, and a blue-green drainage.  Cystitis (UTI): dysuria, frequent urination, inflammation, chills, and superpubic pain.  Bronchitis and Pneumonia in Cystic fibrosis patient: Pneumonia is marked by chills, fever, productive cough, difficult breathing, and blue-tinted skin. On the other side bronchitis is marked by coughing, decreased appetite, weight loss, tiredness, wheezing, rapid breathing, fever, blue-tinted skin, and abdominal enlargement.

9. Continue Diseases and Symptoms  Folliculitis: characterized by red itchy rash, headache, dizziness, earache, sore eyes, nose, throat, breast tenderness, and stomach pain.  Swimmer’s ear (Otitis externa): associated with pain, ear drainage, facial paralysis, and reduced hearing.  Keratitis: symptoms are corneal inflammation, corneal ulcers, pain, reduced vision, swelling of the eyelids, and pus accumulation within the eye.  Brain Abscess (rare): characterized by fever, headache, nausea, vomiting, and focal neurological deficit.  Septicemia (Immunocompromised patients): symptoms include fever, shock, skin lesion, jaundice, skin discoloration, hypotension, rapid breathing, and acute confusion.

10. Continue Diseases and Symptoms  Endocarditis: symptoms include fever, night sweats, chills, malaise, fatigue, joint pain, swelling, weight loss, weakness, anorexia, heart murmur, and systemic emboli.

11. Diagnosis  Blue-green colonies on Blood agar. The organism grows readily in lab media; results are usually available in two to three days, depending on location of the infection.  Metallic sheen on colonies (oil on water).  Fruity aroma, able to grow at 42 C  Oxidase +, Cetrimide +  Lactose negative  Fluorescence under UV light  Pyocyanin (blue pigment) or Pyoverdin (green pigment).

12. Prognosis Most Pseudomonas infection can be successfully treated with antibiotics and surgery. In immunocompromised patients, however P.aeruginosa have a high mortality rate. Mortality rate range from 15 to 20 % of patients with severe ear infections to 89% of patients with infections of the left side of the heart. Most Pseudomonas infection can be successfully treated with antibiotics and surgery. In immunocompromised patients, however P.aeruginosa have a high mortality rate. Mortality rate range from 15 to 20 % of patients with severe ear infections to 89% of patients with infections of the left side of the heart.

13. Risk Factors P.aeruginosa can be sudden and severe, or slow in onset and cause mild pain. P.aeruginosa can be sudden and severe, or slow in onset and cause mild pain. Risk factors for acquiring infection include: Risk factors for acquiring infection include: 1. Having serious illness 2. Being hospitalized 3. Undergoing an invasive procedure such as surgery 4. Having a weakened immune system 5. Being treated with broad-spectrum antibiotics

14. Treatment P.aeruginosa is commonly resistant to antibiotics. P.aeruginosa is commonly resistant to antibiotics. Many strains are susceptible to gentamicin, tobramycin, colistin, and amikacin, but some resistant forms have developed. Many strains are susceptible to gentamicin, tobramycin, colistin, and amikacin, but some resistant forms have developed. Infections are usually treated with two antibiotics at once. The combination of gentamicin and carbenicillin is frequently used to treat severe Pseudomonas infection. Infections are usually treated with two antibiotics at once. The combination of gentamicin and carbenicillin is frequently used to treat severe Pseudomonas infection. Most antibiotics are administered intravenously or orally for 2-6 weeks. Most antibiotics are administered intravenously or orally for 2-6 weeks. Eye infection requires local application of antibiotic drops. Eye infection requires local application of antibiotic drops. Several types of vaccines are being tested, but none is currently available for general use. Several types of vaccines are being tested, but none is currently available for general use.

15. Prevention/Epidemiology Most hospitals have programs for the prevention of nosocomial infections. Most hospitals have programs for the prevention of nosocomial infections. Patients with cystic fibrosis may be given periodic doses of antibiotics to prevent episodes of Pseudomonas infections. Patients with cystic fibrosis may be given periodic doses of antibiotics to prevent episodes of Pseudomonas infections. Skin infections can be prevented by avoiding hot tub with cloudy water, public swimming pool at the end of the day, removing wet swimming suit as soon as possible, taking bath after sharing a hot tub or using a public pool, and also using appropriate amount of chlorine in the water. Skin infections can be prevented by avoiding hot tub with cloudy water, public swimming pool at the end of the day, removing wet swimming suit as soon as possible, taking bath after sharing a hot tub or using a public pool, and also using appropriate amount of chlorine in the water.

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