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Gram Positive (purple/blue)

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1 Gram Positive (purple/blue)
Cocci Rods (bacilli) CLOSTRIDIUM (anaerobe) LISTERIA BACILLUS CORYNEBACTERIUM Capsule S. PNEUMONIA Catalse (+) STAPH Catalse (-) STREP α No Capsule VIRIDANS STREP Coagulase (+) S. AUREUS Coagulase (-) Group A S. PYOGENES Hemolysis β Group B S. AGALACTAIE Novobiocin (+) S. EPIDERMIDIS Novobiocin (-) S. PNEUMONIAE ENTEROCOCCUS PEPTOSTREPTOCOCCUS γ

2 Gram Negative (pink) Cocci Rods “Coccoid” Rods H. FLU PASTURELLA
BRUCELLA BORDETELLA PERTUSSIS Maltose Fermenter NEISSERIA MENINGITIDIS Non Fermenter NEISSERIA GONORRHOEAE Fast lactose Fermenter KLEBSIELLA E. COLI ENTEROBACTER Slow Fermenter CITROBACTER SERRATIA Lactose Nonfermenter Oxidase Negative SHIGELLA SALMONELLA PROTEUS Oxidase Positive PSEUDOMONAS

3

4 Viva the Difference Gram positive Gram negative 2 envelope layers:
1) cytoplasmic membrane 2) thick peptidoglycan layer 3 envelope layers: 2 )thin peptidoglycan layer 3) phospholipid/LPS Low lipid content High lipid content No endotoxin Endotoxin No periplasmic space Periplasmic space Teichoic Acid O Specific Side chain

5 Metabolic Characteristics
Love oxygen Need it to grow Have all 3 enzymes Obligate aerobes Facultative anaerobes Microaerophilic bacteria Obligate Anaerobes Like oxygen /doesn’t require it Can use anaerobic fermentation Catalase and Superoxide Dismutase Like small amounts of oxygen Aerotolerent anaerobes Superoxide Dismutase Obligate aerobes-love oxygen and need it to grow use oxygen just as we do-Kreb TCA cycle, elctron transport shian Have all 3 enzymes Facultative anaerobes-like oxygen but can grow without it prefer aeorbic but have the faculuties to grow in an anaerobic environment by using fermentation (like a human muscle) have catalase and super dimutase Microaerophilic bacteria-like small amounts of oxygen also called aero tolerant anaerobes use fermentation (no electron transport) no catalase but has superoxide dismutase Obligate Anaerobes-doesn’t like oxygen No enzymes-hate oxygen Don’t like oxygen No enzymes to counter act

6 Gram Positive Pathogens
Cocci Staphylococci Streptococci Rods (bacilli) Spore formers Bacillus Clostridium Nonspore formers Nonfilamentous Corynebacterium Listeria [Mycobacterium-kind of] Filamentous Actinomyces Nocardia

7 Gram Positive Pathogens
Streptococcus Cocci-catalase test Streptococci-negative Staphylococci-positive Staphylococcus

8 Genus: Staphylococci Gram Positive Cocci in groups and clusters
Catalase positive Coagulase Test for differentiation S. Aureus-positive S. Epidermidis-negative S. Saprophyticus-negative Virulence factors Surface protein A binds to Fc portion of IgG (prevents opsonization) Enterotoxin and TSST-1 toxins

9 Staphylococcus Aureus Direct infection
Impetigo MRSA

10 Staphylococcus Aureus diseases due to toxins
TSST-1 Enterotoxin Very stable Scalded Skin Syndrome

11 Genus: Staphylococcus
Staph epidermidis, and Staph saprophyticus-> FYI causes many different diseases especially in an immune compromised patient. Opportunistic infections UTI and colonizing catheters Staph Epidermidis

12 Genus: Streptococcus Catalase Negative Gram Positive Cocci in pairs and chains

13 Genus: Streptococcus S. pyogenes S. agalactiae S. pneumoniae
Enterococcus

14 Genus: Streptococcus Lancefield Antigens
Lancefield antigens denote cell wall carbohydrates The presence of Lancefield antigens defines the pyogenic streptococci Groups A through T A,B, C and D are most important Some Streptococcus are not assigned (they do not possess) Lancefield antigens

15 Genus: Streptococcus Hemolysis on BAP
The hemolysis is defined as alpha, beta and gamma No Complete Partial

16 Genus: Streptococcus Strep Pyogenes Group A Beta Strep
Strep throat, scarlet fever, rheumatic fever, acute glomerulonephritis, impetigo Strep Agalactactiae Group B Beta Strep Perinatal sepsis, meningitis and/or pneumonia Strep Pneumoniae Pneumococcus Optichin Sensitive Otitis media, pneumonia, meningitis Enterococcus Group D UTI

17 Genus: Streptococcus Group A Beta Strep S. pyogenes Strep Throat
Strawberry tongue Lancefield Antigen Hemolysis on BAP Group A Beta Strep S. pyogenes Strep Throat Scarlet Fever Rheumatic Fever Post Streptococcal Glomerulonephritis Impetigo Chromatographic Immunoassay Pharyngitis

18 Genus: Streptococcus Strep Agalactactiae Group B Beta Strep
Perinatal sepsis, meningitis and/or pneumonia Early Sepsis within one week of birth Late Sepsis from 7days to 3 months of birth

19 Genus: Streptococcus Alpha hemolysis Optichin Sensitive
Gram positive Lancet Shaped Diplococci Strep Pneumoniae Pneumococcus (nickname) Otitis media, pneumonia, meningitis Significant sequalae Right lower lobe pneumonia encapsulated

20 Genus: Streptococcus Enterococcus Group D Virulence Factors
Abx resistant due to PBP Acquired Resistance Enzymes Adherence factors Biofilm formation UTI, catheter related infections

21 Gram Positive Spore Forming Rods
Bacillus (Fac. Anaerobe) Clostridium (Strict Anaerobe)

22 Genus: Bacillus Fac. Anaerobe G + Spore Forming Rod Bacillus
B. Anthracis Cutaneous Respiratory Intestinal BAP Respiratory B. Anthracis

23 Genus: Clostridium Anaerobic G + Rod Spore formers Clostridium
C. Perfringens C Tetni C. Botulinum C. Difficile Target hemolysis on BAP ~ two zones due to production of 2 toxins Virulence Factors Spore Former TOXINS Myonecrosis/ gas gangrene

24 Genus: Clostridium Anaerobic G + Rod Spore formers Clostridium C Tetni
Neurotoxin binds to presynaptic terminals in prevents transmission of inhibitory neurotransmitters Anaerobic G + Rod Spore formers Clostridium C. Perfringens C Tetni C. Botulinum C. Difficile Virulence Factors Spore former Toxin production Terminal Spore Tennis Racket DTP and DTaP

25 Genus: Clostridium Anaerobic G + Rod Spore formers Clostridium
C. Perfringens C Tetni C. Botulinum C. Difficile Toxin ingestion (usual) Virulence factors Spores Toxins Infantile Botulism caused by spore ingestion with endogenous toxin production Spores

26 Genus: Clostridium Anaerobic G + Rod Spore formers Clostridium
C. Perfringens C Tetni C. Botulinum C. Difficile Endoscopic view of Psuedomembranous colitis Plain film of abdomen showing bowel wall thickening, loss of haustral markings (thin arrow) and dilation of the ascending and transverse colon (thick arrow)

27 Gram Positive Nonspore Forming Rods
Nonfilamentous Corynebacterium Listeria [Mycobacterium-kind of]

28 Genus: Corynebacterium
Gram Positive Nonspore Forming Rods Immobile Nonencapsulated Nonfilamentous Corynebacterium C. Diphtheriae Pseudomembrane of throat and/or nasal cavity Virulence Factor Toxin DTP and DTaP Pallisades/ Chinese Letter Arrangements Barred appearance (metachromatic granules)

29 Genus: Listeria Gram Positive Nonspore Forming Coccobacilus
Tumbling motility at 25 degrees Celsius Nonfilamentous Listeria L. Monocytogenes Transplacental and birth canal transmission Raw milk, soft cheeses, ice cream, raw vegetables, raw or cooked poultry, raw meat, raw or smoked fish Beta hemolysis

30 Genus: Mycobacterium Divides every 15 to 20 hours
Gram Positive Nonfilamentous Nonspore Forming Rods Strict aerobe Very slow growing Weakly gram positive Acid Fast-waxy cell wall-mycolic acid [Mycobacterium -kind of] M. Tuberculosis M.Leprae Divides every 15 to 20 hours Acid fast gram positive bacteria PPD

31 Genus: Mycobacterium Nine banded Armadillo Incubation is 2-20 years
Gram Positive Nonfilamentous Nonspore Forming Rods Waxy coating->acid fast Aerobic/ nonmotile Can not grow in artificial culture [Mycobacterium -kind of] M. Tuberculosis M.Leprae Leprosy Hanson’s Disease Nine banded Armadillo Incubation is 2-20 years

32 Gram Positive Filamentous Nonspore Forming Rods
Aerobic to Fac. Anaerobe Opportunistic Actinomyces A. Israelii Nocardia

33 Genus: Actinomyces Gram Positive Filamentous Nonspore Forming Rods
Aerobic to Fac. Anaerobe Non acid fast Opportunisitic Actinomyces A. Israelii Actinomycoses infections are polymicrobial Lumpy Jaw

34 Genus: Nocardia Gram Positive Filamentous Branching Weakly acid fast
Primary source is soil Colonies smell like wet dirt Genus: Nocardia Gram Positive Filamentous Branching Weakly acid fast Strict aerobe Catalase positive Nonspore Forming Rods Nocardia Low virulence opportunistic infection

35 Now on to Gram Negatives

36 Gram Negative Cocci Neisseria N. Meningitidis N. Gonnorhea Moraxella
Branhemella Cattorhalis Both are members of the family neisseriaceae

37 Ferments maltose and glucose like meningitis
Gram Negative Cocci Kidney bean shape Ferments maltose and glucose like meningitis Oxidase and catalase positive Endotoxin production Neisseria N. Meningitidis Meningiococcus (nickname) Meningitis, septic shock N. Gonnorhea Kidney bean shape Virulence Factors Lipopolysaccharide endotoxin Pilli for adherence Not B Nonblanching petechial rash Direct or from cultured specimen

38 Ophthalmia Neonatorum
Gram Negative Cocci Kidney bean shaped Neisseria N. Gonorrhea Gonorrhea Ophthalmia Neonatorum Culture is the gold standard $$$ Virulence factors Pili and proteins adhere to mucous membrane Nucleic Acid Amplification Tests Ophthalmia Neonatorum

39 Branhemella Catorrhalis
Otitis media Gram Negative Cocci Aerobic Moraxella Branhemella Catorrhalis Otitis media, sinusitis sinusitis Both are members of the family neisseriaceae Moraxella-otitis media, COPD exacerbations and some other respiratory infections subgenera Branhemella resistant to PCN A genus of gram-negative, aerobic bacteria occurring as rods (subgenus moraxella) or cocci (subgenus branhamella). Its organisms are parasitic on the mucous membranes of man and other warm-blooded animals. Although the commensal status of M catarrhalis in the nasopharynx is still accepted, the organism is a common cause of otitis media and sinusitis and an occasional cause of laryngitis. M catarrhalis causes bronchitis and pneumonia in children and adults with underlying chronic lung disease M catarrhalis also expresses specific proteins for iron uptake that act as receptors for transferrin and lactoferrin. United States M catarrhalis is the third most common cause of otitis media and sinusitis in children (following Streptococcus pneumoniae and Haemophilus influenzae).

40 Gram Negative Spirochetes
Treponema T. Pallidum Borrelia B. Burgdorfi B. Recurrentis Leptospira Spirochetes are divided into these three genera

41 Gram Negative Spirochetes
Too small for gram stain Can not be cultured from clinical specimen Dark field microscopy of clinical sample Treponema T. Pallidum Syphillus-acquired and congenital Nontreponemal tests Treponemal tests Electron Micrograph Secondary stage

42 Gram Negative Spirochetes
western black-legged tick (Ixodes) Microaerophilic Geimsa or Wright stain Borrelia B. Burgdorfi Erythema migrans

43 Gram Negative Spirochete
Aerobic Motile G –cell envelope Animal reservoirs Flexible spirochete Not seen on gram stain Dark field microscopy Leptospira L. Interrigans Fine spirals with hooked ends Water transmission Petichial rash

44 Many Many Gram Negative Bacilli
Respiratory Heamophilus Bordetella Legionella Gardnerella Zoonotics Yersinia Franicisella Brucella Pasteurella Bartonella Enterics Many many

45 Respiratory Gram Negative Bacilli
small pleomorphic, gram-negative coccobacillus. Nonmotile non–spore-forming fastidious facultative anaerobe Heamophilus H. Influenzae H. Ducryi

46 Respiratory Gram Negative Bacilli
Small pleomorphic, gram-negative coccobacillus. Nonmotile non–spore-forming Fastidious-X &V factor facultative anaerobe Heamophilus H. Influenzae HIb Epiglottitis, otitis media, meningitis, pneumonia H. Ducryi Otitis media Epiglottitis Insp. Stridor Virulence factors Polysaccharide Capsule (typable) Satelliting around Staph. conjugated

47 Respiratory Gram Negative Bacilli
small pleomorphic, gram-negative coccobacillus. Nonmotile non–spore-forming Fastidious-X &V factor Dies quickly outside of body facultative anaerobe Heamophilus H. Ducryi “soft chancre” Culture is difficult chancroid Painful genital ulcer

48 Respiratory Gram Negative Bacilli
Small aerobic G- Coccobacilllus Singly and in pairs Nicotinamide required for (slow) growth Bordetella B. Pertussis Whooping cough ELISA or PCR assays Bordet-Gengou medium DTP & DTaP Paroxysmal cough with an inspiratory whoop

49 Respiratory Gram Negative Bacilli
Nicotinamide required for (slow) growth Bordetella B. Pertussis Whooping cough ELISA or PCR assays Virulence factors Pili and surface protein for adhesion Pertussis toxin Enzyme that disrupts immune response Peptidoglycan injury to ciliated trachea cells DTP & DTaP Bordet-Gengou medium

50 Respiratory Gram Negative Bacilli
Poorly staining Facultative Intracellular parasite Compromised host Aerobic Legionella L. Pneumophila Legionnaires' disease Pneumonia Paired serum sample Urinary antigen Sputum culture

51 NONRespiratory Gram Negative Bacilli
cervicitis Presumptive Identification Clue Cells KOH Does not require X & V factors Gardnerella G. Vaginalis Bacterial Vaginosis (BV), preterm labor Whiff Test Clue cells

52 Zoonotic Gram Negative Bacilli
Yersinia Y. Pestis Franicisella F. Tulerensis Brucella B. Suis B. Meltensis B. Abortus B. Canis Pasteurella P. Multicida Bartonella B. Henselae B. Quintana

53 Zoonotic Gram Negative Bacilli
Nonmotile G- rod Yersinia Y. Pestis Bubonic Plague bubo Virulence factors Capsular protein is antiphagocytic Pneumonic Plague

54 Zoonotic Gram Negative Bacilli
G- bacillus Aerobic Low infecting dose Vector->tick or deer fly Special media Immunoflourescence Serum Serology (>1:40) Franicisella F. Tularensis Pneumonia Glandular ulceroglandular pneumonia

55 Zoonotic Gram Negative Bacilli
Nonmotile Non-acid fast Nonsporeforming Small G- coccobacillus Catalase, oxidase and urease positive Brucella Brucellosis Blood culture Recurrent flu-like symptoms with granulomas

56 Zoonotic Gram Negative Bacilli
Small G- coccobacillus Nonspore forming Oxidase positive Ferments CHO Nonmotile PCN susceptible Bacteriophage encoded toxin Pasteurella P. Multocida Cellulitis associated with animal bites Bipolar staining Grows on BAP Well demarcated cellulitis P

57 Zoonotic Gram Negative Bacilli
Pediculus humanus fastidious pleomorphic aerobic gram-negative bacillus Bartonella B. Henselae Cat Scratch Fever B. Quintana Trench fever Urban Trench Fever Cat scratch fever Paired sera

58 Family: Enterobacteriacea
Escherichia Coli Shigella Salmonella Yersinia Klebsiella Proteus Enterobacter Serratia Enterics live in the gut-> are members of the family of Enterobacteriacea O antigen is lipopolysaccaride K antigen is polysaccharide capsule H-flagellar antigen

59 Enterics Facultative Anaerobe Large G- Rods Nonsporeformers
Normal Flora Escherichia Coli E. Coli (nickname) E. Coli 0157:H7 or 0157 UTI, Sepsis, Enteric E.Coli, Respiratory illness, multiple opportunistic infections Motile strains with peritrichous flagella Enterics live in the gut-> are members of the family of Enterobacteriacea Virulence factors Shiga toxin Alpha hemolysin Labile toxin Stable toxin Adhere through pili UTI/ Pyelonephritis

60 Enterics Shigella Facultative Anaerobe Large G- Rods Nonsporeformers
Relatively inert Shigella S. Sonnei S. Flexneri S. Dysenteriae Shigillosis The O antigens (LPS) define the four species of Shigella

61 Enterics G- Rod Nonsporulating, Facultative anaerobe Ferment glucose
Reduce nitrate Peritrichous flagella when motile Produce gas upon sugar fermentation Salmonella S. Typhi Typhoid Fever S. Enteritidis Gastroenteritis Eggs & Enteritidis Carrier states

62 Enterics Nonmotile G - rods Prominent polysaccharide capsule
Encapsulated/ multi drug resistant Nonmotile G - rods Prominent polysaccharide capsule Multi Drug Resistant Recently important in nosocomial infections Normal flora Klebsiella K. Pneumoniae Pneumonia in debilitated, UTI, etc etc. Virulence factors Encapsulated LPS inhibits complement

63 Enterics Gram Negative Rod Normal Flora
Hydrolyzes Urea (struvite stone formation) Proteus P. Mirabilis Opportunistic infections including UTI Highly motile

64 Enterics G-Rod Multi drug resistance Enterobacter E. Aerogenes
E. Cloacae UTI,Endocarditis, opportunistic infection

65 Enterics G-rods Opportunistic infection Serratia S. Marcescens

66 Other Gram Negative Rods
Vibrio Helicobacter Pseudomonas Bacteroides

67 Other Gram Negative Rods
Vibrio V. Cholerae

68 Other Gram Negative Rods
Helicobacter H. Pylori

69 Other Gram Negative Rods
Helicobacter Campylobacter Jejuni

70 Other Gram Negative Rods
Pseudomonas Ps. Aeruginosa

71 Other Gram Negative Rods
Bacteroides B. Fragilis

72 Weird Bugs Chlamydia Rickettsia Coxiella Ehrlichia

73 Weird Bugs Chlamydia C. Trachomatis

74 Weird Bugs Obligate intercellular gram negative coccobacilli Vector
Dermacentor variabilis (dog tick) East US Dermacentor andersoni Rocky Mountain region and Canada Rickettsia R. Ricketseii Peticheal rash

75 Weird Bugs Obligate intercellular gram negative coccobacilli
Coxiella Brunetti

76 Weird Bugs Ehrlichia E. chaffeensis E. ewingii
Ehrlichea in white tail deer fawn Distribution of Amblyomma americanum [Lone Star Tick] Amblyomma americanum Nymph left ; adult right

77 Genus: Mycoplasma Pleomorphic No cell wall Mycoplasma M. Pneumoniae
Atypical pneumonia

78 The Inevitable Exceptions
Mycobacteria Weakly gram positive Better seen with acid fast stain Spirochetes Too small for light microscopy Need Dark field microscopy Mycoplasma No cell wall Neither G+ or G-

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