CHAPTER 5: MEDICALLY MOST IMPORTANT BACTERIA • Can be differentiated from another coagulase-

negative staphylococcus by its resistance to Novobiocin

SECTION 1. GRAM-POSITIVE COCCI
• Part of the normal human flora that colonizes the
Staphylococcaceae-cluster-forming cocci, nonmotile;
perineum, rectum, urethra, cervix, and gastrointestinal tract
catalase-positive.
• Second most common cause of community-acquired
urinary tract infections, after Escherichia coli.
STAPHYLOCOCCUS AUREUS
• The diagnosis of S. saprophyticus requires a confirmatory
• Gram-positive bacteria that are cocci-shaped and tend to be urine culture. A positive culture is indicated by greater than
arranged in clusters that are described as “grape-like” 100,000 colony-forming units per mL, with a
• On media, these organisms can grow in up to 10% salt, and sensitivity and specificity of more than 90%.
colonies are often golden or yellow
• These organisms can grow aerobically or anaerobically SECTION 1. GRAM-POSITIVE COCCI
(facultative) and at temperatures between 18 C and 40 C Streptococcaceae- chain-forming cocci and
• Typical biochemical identification tests include catalase diplococci, nonmotile, catalase-negative
positive, coagulase positive, novobiocin, mannitol
fermentation positive. STREPTOCOCCUS PYOGENES
•Found in the environment and is also found in normal
human flora, located on the skin and mucous membranes of • A gram-positive, catalase-negative, oxidase negative, β-
most healthy individuals hemolytic streptococci that occur in pairs or chains
•A major bacterial human pathogen that causes a wide • It is a facultative anaerobe, grows best in 5 to 10% carbon
variety of clinical manifestations dioxide, and forms pinpoint colonies on blood agar plates
• Does not normally cause infection on healthy skin; • S. pyogenes usually colonizes, pharynx, anus, and genital
however, if it is allowed to enter the bloodstream or internal mucosa
tissues, these bacteria may cause a variety of • Infections caused by S. pyogenes are highly contagious.
potentially serious infections Transmission can occur through airborne droplets, hand
• Transmission is typically from direct contact contact with nasal discharge or with objects or surfaces
• Are the causative agents of multiple human infections, contaminated with bacteria, skin contact with contaminated
including bacteremia, infective endocarditis, skin and soft lesions, or contaminated food sources.
tissue infections (e.g., impetigo, folliculitis, furuncles, • GAS strains may lead to erysipelas or cellulitis, infection in
carbuncles, cellulitis, scalded skin syndrome, and others), muscle and fascia resulting in myositis and necrotizing fascitis
osteomyelitis, septic arthritis, prosthetic device infections, usually following a mild trauma and can result in toxic shock
pulmonary infections (e.g., pneumonia and empyema), syndrome
gastroenteritis, meningitis, toxic shock syndrome, and urinary • A leading cause of pharyngitis in children and adolescents
tract infections. • The global burden of severe S. pyogenes infections is 18.1
million cases, with 1.78 million new cases per year.
STAPHYLOCOCCUS EPIDERMIDIS
STREPTOCOCCUS PNEUMONIAE
• A gram-positive bacterium, belongs to the group of
coagulase-negative staphylococci • A lancet-shaped, gram-positive, facultative anaerobic
• Common bacterial colonizers of the skin and mucous organism that typically occurs in pairs or short chains
membranes of humans and other mammals • Encapsulated S. pneumonia is pathogenic for humans, and
• Analysis of the species genome indicated that the species the capsular polysaccharide is the basis for which the
is well equipped with genes assumed to provide protection organism is classified. As of 2011, a total of 92 separate
from the harsh conditions encountered in its natural serotypes have been isolated.
habitat. • Infection typically occurs after the colonization of the
• As part of the human epithelial microflora, S. epidermidis oropharynx and nasopharynx of healthy individuals.
usually has a benign relationship with its host Inhalation of these colonies causes the infection of the lower
• It has been proposed that S. epidermidis may have a airways.
probiotic function by preventing colonization of more • Capsule helps in escaping phagocytosis by preventing the
pathogenic bacteria such as S. aureus access of granulocytes to the underlying cell wall; Second, its
• Now the most frequent cause of nosocomial infections, at a ability to adhere to the respiratory epithelium and invasion.
rate about as high as that due to its more virulent cousin
Staphylococcus aureus STREPTOCOCCUS AGALACTIAE
• Accounts for at least 22% of bloodstream infections in
intensive care unit patients in the USA, which occur in at least • A chain-forming cocci, group antigen B, β-hemolysis
4–5/1000 Central intravenous catheters (CVC) insertions • Also known as Group B Streptococcus
• Second only to S. aureus, S. epidermidis causes ~ 13% of • Skin and soft tissue infections attributed to GBS may
prosthetic valve endocarditis (PVE) infections, with a high rate manifest as cellulitis, abscesses, foot infection, or decubitus
of intracardiac abscesses (38%) and 24% mortality. ulcers. GBS pneumonia is implicated and may lead to
neurological disease. Meningitis is a severe manifestation of
STAPHYLOCOCCUS SAPROPHYTICUS invasive GBS disease. It is uncommon in adults but a common
manifestation of late onset GBS infection in neonates. UTIs is
• Gram-positive, coagulase-negative, non-hemolytic coccus also manifested with GBS infection.
that is a common cause of uncomplicated urinary tract
infections (UTIs) SECTION 1: GRAM-POSITIVE COCCI
Enteroccaceae- Chain-forming cocci and diplococci, a, b, or c- -The transmission of C. tetani is through the exposure of a
hemolysis, group antigen D, catalase-negative deep tissue wound to the spores which are present in soil or
fecal matter from animals or humans.
ENTEROCOCCUS FAECALIS
CLOSTRIDIUM BOTULINUM
• A gram-positive, aesculin-positive, growth in 6.5% NaCl, pH
9.6 bacterium that can cause a variety of nosocomial -An anaerobic gram-positive spore-forming rod with
infections of which urinary tract infections are the most subterminal spore
common -It is ubiquitous, widely distributed as a saprophyte in soil,
• Enterococcus faecalis, while normally a gut commensal, is a animal manure, vegetables, and sea mud
frequent cause of many serious human infections, including -Produces botulinum toxin and causes botulism, a rare
urinary tract infections, endocarditis, disease manifested as various clinical syndromes ranging
bacteremia, meningitis and wound infections from food poisoning, wound infection to infant botulism
-C. botulinum is non-invasive
ENTEROCOCCUS FAECIUM
CLOSTRIDIUM PERFRINGENS
• A Gram-positive, gamma-hemolytic or non-hemolytic
bacterium -Anaerobic Gram-positive spore-forming bacillus
• Commensal in gastrointestinal tract of human and other -With Type A toxin which is associated to food-poisoning and
animals non- foodborne diarrheal disease.
• Can be pathogenic causing disease like neonatal meningitis -May lead to acute gastrointestinal infection ranging in
and endocarditis severity from diarrhea to necrotizing enterocolitis and
• This bacterium has developed multi-drug antibiotic myonecrosis in human
resistance and uses colonization and secreted factors in -This pathogen posses an arsenal of toxins that are
virulence (e.g. Vancomycin-resistant E. faecium) responsible for disease pathogenesis and can form spores
that are resistant to environmental stress.
SECTION 2: ENDOSPORE-FORMING GRAM-
POSITIVE RODS CLOSTRIDIUM DIFFICILE

BACILLUS ANTHRACIS -Anaerobic Gram-positive spore-forming bacillus

-Occurs in the fecal flora of 1-4% of healthy adults and in 30-
-A large Gram positive, aerobic, spore bearing bacillus, 1–1.5 50% of children during the first year of life
× 3–10 μm in size, is the only obligate pathogen within the -Causes pseudomembranous colitis, symptoms can range
genus bacillus. from diarrhea to life-threatening damage to the colon
-Non-motile and non-haemolytic on horse (or sheep’s) blood -The pathological mechanism is based on formation of two
agar, grows at 37°C, and forms typical white colonies with toxins: Toxin A is an enterotoxin that causes a dysfunction
bee’s eye appearance (that is, oval, slightly granular but not characterized by increased secretion of electrolytes and
dry, about 2 mm in diameter), which are characteristically fluids, Toxin B is a cytotoxin that damages the mucosa of the
tacky on teasing with a loop. colon.

BACILLUS ANTHRACIS SECTION 3: REGULAR, NONSPORING, GRAM-

POSITIVE RODS
-90% of all human cases is cutaneous anthrax
-Anthrax meningitis can occur as an end stage process of any LISTERIA MONOCYTOGENES
of the forms of anthrax. The clinical
signs of meningitis, together with the appearance of blood in -Facultative, intracellular, Gram-positive rod, catalase positive
cerebrospinal fluid, are usually followed by loss of and beta- hemolytic when grow on blood agar
consciousness and death -Infections includes but not limited to sepsis, meningitis,
-The prognosis of this form of anthrax is extremely poor encephalitis, spontaneous abortion, or fever and self-limiting
gastroenteritis in a healthy adult
CLOSTRIDIUM TETANI -Common cause of meningitis in the young, elderly and
immunocompromised patient.
-Part of a genus of obligate anaerobic, saprophytic, gram-
positive organisms well known for its toxin-producing ability ERYSIPELOTHRIX RHUSIOPATHIAE
making it one of the most dangerous of its genus
-The source of infection in most people is a wound. In others, Slender, Gram-positive, catalase-negative, rod-shaped, non-
tetanus may develop from a burn injury, abscess following a spore-forming, non-motile bacterium
surgical procedure, intravenous drug abuse, or gangrene -Commensal or a pathogen in a wide variety of vertebrate
-All ages are susceptible to infection, and the case-fatality and invertebrate species including swine, sheep, turkeys,
rate can approach 100% if immediate medical intervention is ducks and fish but also dogs, cats, chickens and rodents. It
not available. has been isolated from flies, mites, lice and ticks
-Tetanus is characterized by severe, diffuse muscle -Most human cases are related to occupational exposure
contractions. The muscular rigidity and spasms of tetanus are (Occupational disease)
caused by tetanus toxins (tetanospasmin and tetanolysin) -The organism is communicable from animals to humans --
generally by direct cutaneous contact/dermal injuries
The occurrence of systemic infection that does not have an -One of the major causes of mortality, since two million
occupational link suggests that oropharyngeal or people die each year from this malady
gastrointestinal colonization may occur. -TB has many manifestations, affecting bone, the central
nervous system and many other organ systems
GARDNERELLA VAGINALIS -Initiated by the deposition of Mycobacterium tuberculosis,
contained in aerosol droplets, onto lung alveolar surfaces.
-Gram-positive, anaerobic, nonmotile, non-sporing,
nonencapsulated rod bacterium
-Normally, vaginal flora is predominated by the Lactobacilli
species, but when organisms such as Gardnerella begin to
overgrow and become the dominant species, this leads to MYCOBACTERIUM LEPRAE
bacterial vaginosis (BV)
-The bacteria are thought to be sexually transmitted between -Pathogenic acid-fast bacteria which is the causative agent of
partners Hansen’s disease (a.k.a. leprosy).
-BV is associated with preterm birth and increased risk for -Leprosy is a chronic infectious disease that damages
acquisition of HIV and other sexually transmitted infections. peripheral nerves and can affect the skin, eyes, nose and
muscles. Nerve injury can cause severe disabling
deformities and blindness
SECTION 4: IRREGULAR, NON-SPORING, GRAM- -Although it is often thought of as a disease of ancient times,
POSITIVE RODS it still occurs today and the WHO recorded 3.8 M new cases
of leprosy from 105 different countries in the
CORYNEBACTERIUM DIPHTHERIAE last decade.
-People with leprosy often suffer profound social stigma
-A nonmotile, non-capsulated, club-shaped, Gram-positive -Symptoms mainly affect the skin, nerves and mucous
bacillus membranes-presence of large, discolored lesion
-This bacteria is classified into biotypes according to colony -Can be recognized by appearance of patches of skin, for
morphology (mitis, intermedius and gravis) confirmation, the doctor will take a sample of the skin or
-Mitis – black colonies with a gray periphery nerve to look for the bacteria under microscope.
-Gravis – large, gray colonies
-Intermedius – small, dull gray to black MYCOBACTERIUM AVIUM
-This bacteria infects the nasopharynx or skin
-A non-motile, non-spore-forming, gram-positive acid-fast
ACTINOMYCES ISRAELI bacillus
-Ubiquitous and has been reported from the Americas, Asia
-A gram-positive, branching, anaerobic or microaerophilic and Europe
bacterium -Mycobacterium avium Complex is acquired by inhalation and
-Often present commensally on the gums, tonsils and teeth can also be ingested into the gastrointestinal tract, where it
and may be present in the intestines and vagina adheres to the mucosal epithelial cells and
-Disease is called actinomycosis which is a chronic localized or infects the macrophages
hematogenous anaerobic infection that may lead to local -Several clinical patterns include pulmonary disease, skin and
abscess with multiple draining sinuses, tuberculosis-like soft tissue infections, musculoskeletal infections,
pneumonitis and low-grade systemic symptoms. disseminated disease, catheter-associated disease and
lymphadenitis.
NOCARDIA ASTEROIDES
SECTION 6: GRAM-NEGATIVE AEROBIC COCCI AND
-An aerobic actinomycete, catalase-positive, Gram-positive COCCOBACILLI
bacillus, with a branching filamentous form
-Found worldwide in a myriad of environments and has been NEISSERIA GONORRHEAE
cultured from both fresh and saltwater, dust, soil, decaying
vegetation and decaying organic matter  Gram-negative, coffee-bean-shaped cocci
-Involved in the saprophytic digestion and recycling of plant  This bacteria may cause gonorrhea which is a
material in natural environment sexually transmitted disease
-The majority of Nocardia infections are thought to be due to  The pathogens penetrate the urogenital mucosa,
inhalation of bacteria via environmental sources, leading to causing a local purulent infection. In men, the
the most common form of the infection, pulmonary prostate and epididymis can also become infected
nocardiosis.  Hematogenous disseminated gonococci may also
cause arthritis or even endocarditis.
SECTION 5: ACID-FAST BACTERIA
NEISSERIA MENINGITIS
MYCOBACTERIUM TUBERCULOSIS
-Gram-negative, encapsulated, aerobic, non-motile, coffee-
-Pathogenic acid-fast bacteria which is the causative agent of bean-shaped cocci
tuberculosis (TB) -Meningococci are parasites of the nasopharynx
-First discovered by Robert Koch in 1882 and considered to be
one of the oldest known human disease
-Causes significant morbidity and mortality in children and SALMONELLA ENTERICA
young adults worldwide, regarded as a leading cause of
bacterial meningitis -Gram-negative, facultative anerobic rod-shaped bacteria and
-Onset of the meningitis is usually sudden, after an incubation motile by peritrichous flagella
period of two to three days, with severe headache, fever, -The main niche of Salmonella serovars is the intestinal tract
neck stiffness and severe malaise. Severe hemorrhagic sepsis of humans and farm animals, soil, bedding, litter and fecal
sometimes develops. matter commonly identified as sources of
Salmonella contamination in farms
EIKENELLA CORRODENS -Excreted in feces from which they may be transmitted by
insects and other animals to many places and are generally
-Gram-negative, microaerophilic bacillus that sometimes found in polluted water.
appear as coccobacillary which is a normal inhabitant of
human mucosal surfaces SHIGELLA DYSENTERIAE
-This bacteria may cause severe invasive disease in human
but an uncommon cause of infection -Gram-negative, non-motile, facultative anaerobic, non-
-It is found most often part of a mixed infections, particularly spore-forming rods
with streptococci, but is capable of independently causing -Infection is initiated by ingestion of shigellae usually via
serious infection in both normal and immunocompromised fecal-oral contamination
hosts. -Symptoms of shigellosis include abdominal pain, tenesmus,
- Cause head and neck infection, sinusitis, pulmonary watery diarrhea and/or dysentery (multiple scanty, bloody,
infection, arthritis, endocarditis, intraabdominal infection, mucoid stools). Other signs may include abdominal
pancreatic abscesses, skull infection, vertebral osteomyelitis tenderness, fever, vomiting, dehydration and convulsions.
and infection after human bite wounds. -Shigellosis is endemic in developing countries where
sanitation is poor
SECTION 7: GRAM-NEGATIVE FACULTATIVE -Shigellosis can be correctly diagnosed in most patients based
ANAEROBIC RODS on fresh blood in the stool. Neutrophils in fecal smears is also
a strongly suggestive sign. Any clinical
ESCHERICHIA COLI diagnosis should be confirmed by cultivation of the etiologic
agent from stools.
-Gram-negative, facultative anaerobic, rod-shaped, coliform
bacterium SECTION 8: GRAM-NEGATIVE AEROBIC RODS
-Commonly found in the lower intestine of warm-blooded
organisms PSEUDOMONAS AERUGINOSA
-Most E. coli strains are harmless, but some serotypes
(Enteropathogenic E. coli, Enterotoxigenic E. coli, etc.) can -Gram-negative, aerobic, rod-shaped bacteria and motility is
cause serious food poisoning in their hosts, even pneumonia by a single polar flagellum
and UTIs -Normally this inhabit soil, water and vegetation
-The harmless strains are part of the normal microbiota of the -Neutropenia in cancer patients and others receiving
gut, and can benefit their hosts by producing vitamin K2 and immunosuppressive drugs contributes to infection
preventing colonization of the intestine with pathogenic -Infection due to this bacteria is a serious problem in patients
bacteria, having a mutualistic relationship. hospitalized with cancer, cystic fibrosis and burns; fatality is
50%.
- Other infections caused include endocarditis, pneumonia,
and infections of the urinary tract, central nervous system,
wounds, eyes, ears, skin and musculoskeletal system
-Pseudomonas can be cultured in most-purpose media and
identified with biochemical media.

LEGIONELLA PNEUMOPHILA

-Gram-negative, aerobic, pleomorphic, flagellated, non-spore-

forming bacteria
-This is widely spread in nature, may reside in surface and
drinking water and are usually transmitted to humans in
aerosols
-This is not a member of the bacterial flora of humans
-Common presentation of this bacteria is acute pneumonia
(legionellosis).
-Fecal-oral transmission is the major route through which -Extrapulmonary disease like pericarditis and endocarditis is
pathogenic strains of the bacterium cause disease rare. Less often, disease presents as a non-pneumonic
-Symptoms are abdominal cramps, diarrhea, nausea and epidemic, influenza-like illness called Pontiac fever.
constant fatigue
BRUCELLA ABORTUS
SECTION 10: GRAM-NEGATIVE, SPIROCHETES,
-Gram-negative coccobacilli (short rods), non-spring, non- HELICAL BACTERIA
motile and lack capsules or flagella
-The reservoirs of brucellosis are various wild, feral and TREPONEMA PALLIDUM
domestic animals
-May cause acute febrile disease or a persistent disease with -A Gram-negative, microaerophilic, fastidious, corkscrew-
wide variety of symptoms shaped bacterium
-The onset is influenza-like with high fever, limb and back -Human are the only source of treponemal infection; there
pains are usually severe, however sweating and fatigue are are no known non-human reservoirs
marked. Splenomegaly may be the only finding on physical -Treponemes cause diverse clinical manifestation. In patients
examination. with acquired venereal syphilis, there is an initial genital tract
lesion (primary stage) followed by disseminated lesions
SECTION 9: GRAM-NEGATIVE, AEROBIC/MICROAEROPHILIC, (secondary stage) and, in approximately one-third of
HELICAL/VIBRIOID ROD BACTERIA untreated individuals, cardiovascular and neurologic
problems (tertiary stage). Infection during pregnancy
CAMPYLOBACTER JEJUNI (congenital syphilis) may result in fetal death or birth defects
-Treponema pallidum subsp pallidum causes venereal
-Gram-negative, spirally curved, microaerophilic bacterium syphilis; T pallidum subsppertenuecauses yaws; T pallidum
-Campylobacter causes an estimated 1.5 million illnesses each subsp endemicum causes endemic syphilis; andT carateum
year in the US People can get the infection by eating raw or causes pinta. Venereal syphilis is transmitted by sexual
undercooked poultry or eating something that touched it contact; the other diseases are transmitted by close
-Recognized as a significant cause of human enteritis and is nonvenereal contact.
associated with diarrheic illness in several animal species -Treponemes are highly invasive pathogens which often
including dogs, cats, cows, goats, pigs, etc. disseminate relatively soon after inoculation.

CAMPYLOBACTER FETUS BORRELIA BURGDORFERI

-A Gram-negative S-shaped rod bacterium which is highly -A Gram-negative, spirochete, microaerophilic, beta-
motile due to corkscrew-like movement galactosidase bacterium
-C. fetus subspecies fetus may cause reproductive disease in -Can be transmitted by tick
ruminants; associated with abortion in sheep and cattle and -May cause Lyme disease, a most common vector-borne
infertility of cattle. This same subspecies is a zoonotic disease in the United States
pathogen that has been reported to cause disease in -Symptoms of Erythema migrans (EM), may have vesicular or
immunocompromised humans necrotic areas in the center. It is often asymptomatic but may
-Infections are associated with gastroenteritis and, rarely, be pruritic or painful, and it may be accompanied by systemic
sepsis in people symptoms, such as fever, malaise, headache, stiff
-Clinically relevant transmission between humans generally neck, myalgia, or arthralgia
involve neonates.
LEPTOSPIRA INTERROGANS
CAMPYLOBACTER PYLORI
-A Gram-negative, spirochete, spiral-shaped bacterium with
-A Gram-negative, microaerophilic bacteria that is widely internal flagella
distributed in the animal kingdom -May cause Leptospirosis, which is a worldwide zoonosis
-This can cause diarrheal illnesses, systemic infection, chronic affecting many wild and domestic animals
superficial gastritis, peptic ulcer disease, and can lead to -Humans acquire the infection by contact with the urine of
gastric carcinoma infected animals. Human-to- human transmission is
-Symptoms experienced by individuals in developed countries extremely rare
are diarrhea, abdominal pain, fever, nausea and vomiting. A
cholera-like illness with massive watery diarrhea may also -Humans are accidental hosts in whom this disseminated
occur. disease varies in severity from subclinical to fatal.
-Campylobacter enteritis is hard to distinguish from enteritis -A multisystem, relapsing febrile disease with a rash and
caused by other pathogens. The presence of neutrophils or manifestations such as arthritis, carditis, and neuritis
blood in the feces of patients with acute diarrheal illnesses is -The clinical diagnosis is confirmed by serology and also by
an important clue to infection. The diagnosis is confirmed by microscopic visualization of the organism in blood of
isolating the organism from a fecal culture or, rarely, from a relapsing fever patients
blood culture. -Areas known to harbor infected ticks and lice should be
avoided. Tetracycline is an effective treatment. No vaccines
are available