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Gram-Positive Bacilli
Corynebacterium diphteriae
Morphology:
Rod-shape bacteria with irregular swellings at one end
(club-shaped appearance)
Individual bacteria in stained smears tend to lie parallel or
at acute angle (chinese characters appearance)
Colonies : on blood agar small, granular, have small
zones of hemolysis. In agar contain tellurite brown-black
with brown-black halo.
Gravis, mitis, intermedius colonies
Grow much more readily on Loeffler serum medium
Characteristics : aerobic, pathogenity derived from
bacteriophages which contain toxigenic genes.
Virulence increases when the concentration of Fe is
low
Pathogenesis :
Infected respiratorial mucose and skin (cutaneous)
Non-toxigenic strain sore-thrat; toxigenic strain
pseudomembranous tonsilopharyngitis
Produce exotoxin inhibits polypeptide chain
elongation by inactivating the elongation factor
EF2 abrupts arrest of protein synthesis
necrotizing and neurotoxic effects
Necrotizing tissues embedded in exuding fibrin
and RBC,WBC forms a grayish
pseudomembrane
Toxin also promotes proliferation of cellular
immunity regional lymph node hypertrophy
bull-neck appearance
Distant toxic damage can occur in several organs,
such as necrosis in heart muscle (myocarditis),
liver, tubular necrosis on kidney, sometimes
accompanied by gross hemorrhage
Toxin also conducts demyelination of peripheral
nerves paralysis of the soft palate, eye muscles,
or extremities
Wound diphteria tropical area, infects on
homeless individuals, distant toxic damages rarely
occurred.
Diagnostic Laboratory Tests
Clinical impression and epidemiologic significance
Dacron swabs before any antibiotics treatment
Inoculating on a blood agar plate and selective
medium (tellurite plate) 18-24 hours
PCR detection on the diphteriae toxin gene
(tox)
ELISA or immunochromographic strip assay on the
diphteriae toxin
Treatment :
Diphteria antitoxin effects on free-toxin only, given
when there is strong clinical suspicion of diphteriae
Penisillin G, erythromycin
Isolation of patient droplets are highly contagious
Epidemiology and Prevention:
Mainly disease of small children, at adult phase
mostly asymptomatic/sub-clinical
By age 6-8 years, aprrox 75% children in developing
countries have protective serum antitoxin levels
Active vaccinization fluid toxoid (DPT)
Listeria monocytogenes
Capable growing and surviving over a wide
range environment can survive on
refrigerator temperatures, low pH, and high
salt conditions food-borne disease
Morphology :
Short rod
Catalase positive
Motile
Characteristics :
Colonies grow well on blood agar, exhibit small
zone of hemolysis around and under.
Facultative anaerobe
Motile at room temperature
Pathogenesis :
Port dentry : GI tract after ingestion of
contaminated foods (cheese, vegetables)
The organism has several adhesin protein (ami,
Fbp A, and flagellin proteins) facilitate bacterial
binding to the host cells
Internalins A and B interact with cadherin
promoting phagocytosis into epithelial cells.
The organism can escape from enclosed
phagolysosome by producing listeriolysin O
ActA bacterial protein which can induce host
cell action polymerization move from cell to
cell without being exposed to antibodies or PMNs
Clinical Findings :
Perinatal human listeriosis granulomatosis
infantiseptica neonatal sepsis, pustular lesions,
granulomas containing bacteria in multiple organs
high mortality after delivery, late onset
syndrome meningitis
Listeria meningoencephalitis most commonly
on immunosupressed patients. On
immunocompetent patients symptomatic
febrile gastroenteritis after 6-48 hours
Treatment : Ampicillin, erythromycin,
cotrimoxazole iv
Erysipelothrix rhusiopathiae
Small, transparant glistening colonies
Alpha-hemolytic on blood agar
May appear singly, in short chains, randomly,
or in long non-branching filaments
Catalase, oxidase, indole negative
Grow on TSI agar produces H2S black
Difficult to differentiate from aerotoleran
lactobacilli (propionibacterium)
Animal-borne disease swine (most impact),
turkey, ducks, and sheep.
Most common infection erysipeloid
Occurs on the fingers by direct inoculation (seal
finger/whale finger)
After 2-7 days pain, swelling, violaceous lesion
without any production of pus
Solve within 3-4 weeks without AB
Treatment : Penicillin G, resistant to vancomycin
Actinomycetes
Large, diverse group of gram-positive bacilli
Morphology : filamentous/chains form
Related to mycobacteria slightly/partially
acid-fast bacilli
Consist of Nocardia, Gordonia, and
Tsukamurella
Nocardia
Has a broad range of diseases, found
worldwide in soil and water
Usual presentation subacute/chronic
pulmonary infection, but not transmitted from
person to person
Colony : develops heaped, irregular, waxy
colony with white to orange to red in color
Partially acid-fast bacilli, urease (+)
Pathogenesis and Clinical Findings :
Opportunistic infection in immunosupressant
patient
Symptoms similar with tuberculosa infection, but
doesnt develop formation of granuloma and
caseation (usually forms abscess)
It can spread from lung involves CNS
Diagnostics :
Gram-stained smears gram (+) with branching
filaments
Serologic tests arent useful
Treatment : Cotrimoxazole
Gordonia and Tsukamurella
Modified acid-fast bacteria
Frequently responsible for oppotunistic infections
among hospitalized immunocompromised patient
associated w/ invasive treatment
Colony : whitish to orange colonies
On Gram stain appear coryneform and dont
branch (straight)
Best way to be identified : cell wall fatty acid
analysis or 16S rRNA gene sequencing
Questions :
Three months ago, a 53-year-old woman had surgery and
chemotherapy for breast cancer. Four weeks ago, she developed a
cough occasionally productive of purulent sputum. About 2 weeks
ago, she noted a slight but progressive weakness of her left arm and
leg. On chest examination, rales were heard over the left upper
back when the patient breathed deeply. Neurologic examination
confirmed weakness of the left arm and leg. Chest radiography
showed a left upper lobe infiltrate. Contrast enhanced computed
tomography showed two lesions in the right hemisphere. Gram
stain of a purulent sputum specimen showed branching gram-
positive rods that were partially acid fast. Which of the following
organisms is the cause of this patients current illness?
(A) Actinomyces israelii
(B) Corynebacterium pseudodiphtheriticum
(C) Aspergillus fumigatus
(D) Nocardia farcinica
(E) Erysipelothrix rhusiopathiae
It is particularly difficult to differentiate Erysipelothrix
rhusiopathiae from
(A) Corynebacterium diphtheriae
(B) Bacillus cereus
(C) Actinomyces israelii
(D) Nocardia asteroides
(E) Lactobacillus species
Movement of Listeria monocytogenes inside of host
cells is caused by
(A) Inducing host cell actin polymerization
(B) The formation of pili (fimbriae) on the listeriae surface
(C) Pseudopod formation
(D) The motion of listeriae flagella
(E) Tumbling motility
An 8-year-old boy develops a severe sore throat. On examination, a
grayish exudate (pseudomembrane) is seen over the tonsils and pharynx.
The differential diagnosis of severe pharyngitis such as this includes group
A streptococcal infection, Epstein-Barr virus (EBV) infection, Neisseria
gonorrhoeae pharyngitis, and diphtheria. The cause of the boys
pharyngitis is most likely
(A) A gram-negative bacillus
(B) A single-stranded positive-sense RNA virus
(C) A catalase-positive gram-positive coccus that grows in clusters
(D) A club-shaped gram-positive bacillus
(E) A double stranded RNA virus
The primary mechanism in the pathogenesis of the boys disease
(Question above) is
(A) A net increase in intracellular cyclic adenosine monophosphate
(B) Action of pyrogenic exotoxin (a superantigen)
(C) Inactivation of acetylcholine esterase
(D) Action of enterotoxin A
(E) Inactivation of elongation factor 2
Which of the following aerobic gram-positive bacilli is
modified acid-fast positive?
(A) Nocardia brasiliensis
(B) Lactobacillus acidophilus
(C) Erysipelothrix rhusiopathiae
(D) Listeria monocytogenes