pathogeniccocci病原性球菌資料課件

1.

Pathogenic

cocci12.

Other

bacteria13min56min38min5min13minPathogenic

cocciConcept

of

pathogenic

bacteriaStaphylococcus

(Esp.,

S.

aureus)Streptococcus

(Esp.,

S.

pyogenes)Enterococcus

species

andVRENeisseria

meningitidesNeisseria

gonorrhoeaeOther

bacteriaPseudomonas

aeruginosa210minHighlights

of

contentUp

to

every

pathogen,

the

followingwill

be

talked:Biological

propertiesPathogenicityImmunityMicrobiological

detectionsPrevention

and

treatment3Pustule(膿皰)by

S.aureus4Pustule

(膿皰)by

S.

aureus5Paronychia

(甲溝炎)byS.aureusSore

throat

(咽喉炎)by

S.

pyogenes6Untreated

erysipelas

(丹毒)

by

S.pyogeneswith

skin

sloughing

andnecrosis7Necrotizing

Fasciitis(壞死性筋膜炎)by

flesh-eating

bacteria(S.

pyogenes,

anaerobicbacteria,

etc.),

andinsects

(bee,

etc.)stinging8Chest

x-ray

Film

19just

a

few

hours

of

rigorsand

productive

coughChest

x-ray

Film

212

hours

laterconsolidation

in

theright

upper

lobeLobar

pneumonia(大葉性肺炎)by

S.pneumoniaeMeningococcal

septicemia

(腦膜炎球菌性敗血癥)by

N.

meningitidis,

widespread

ecchymoses10Gonococcal

conjunctivitis

(淋菌性結(jié)膜炎)

by

N.gonorrhoeae11Causative

agents

of

above

clinical

diseases?Pathogenic

cocci12What

is

Pathogenic

cocci

?also

called

—Pyogenic

cocci

(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

(Group

A

Streptococci,

S.

pyogenes)(A群鏈球菌or

化膿性鏈球菌)---Streptococcus

pneumoniae

(肺炎鏈球菌)---Neisseria

gonorrhoeae

(淋病奈瑟菌)---Neisseria

meningitidis

(腦膜炎奈瑟菌)13Important

cocciGramstain Bacterial

generaG+G-Genus

staphylococcusGenus

streptococcusGenus

Neisseria(

N.

meningitidesN.

gonorrhoeae

)14Staphylococcus

aureusImportant

pyogenic

coccusLeading

pathogen

of

wound

infections(including

otherstaphylococci)15Shape,

Stain

&

Culturespherical,

elliptical,

irregular

grape-like

clusterGram+

(G+)Grow

well

on

basic

medium16Biological

properties1718Antigenic

structureStaphylococcal

protein

A

(SPA)One

kind

of

surface

protein

in

cell

wallSingle

chain

peptideActions

—Binds

(bacterium)

to

host’s

IgG1,

IgG2

&IgG4coagglutination

testCompetes

w/

Fc

receptors

of

phagocytes19Coagglutination

test

with

inert

particles(e.g.,

heat-killed

S.aureusorlatexbeads)20SPA

may

resist

phagocytosis

bycompetivelybinding

with

Fc

receptors

of

phagocytes21CapsuleTeichoic

acid

(polysaccharide)polysaccharide

A—

S.aureuspolysaccharide

B—

S.epidermidisPhases

ofphagocytosis22Important

Properties

of

3

Main

Species

ofStaphylococci23Pathogenicity

&

immunity24Coagulase,

Fibrinolysin,

Heatstable

nuclease,EnzymesPathogenic

substancesHyaluronidase,

&

LipaseCytotoxins

(Staphylolysin α,β,

γ,

&

δ,

Leukocidin),Exfoliatin,

Enterotoxins,ToxinsPeptidoglycan&

TSST-1OthersAdhesin,

Capsule,

&25CoagulaseFree

CoagulaseFree

CoagulasestaphylothrombinFibrinPlasma

to

beFibrinogenclotedTube

coagulase

testactivated(游離凝固酶)convert(葡萄球菌凝血酶)26Bound

coagulase(結(jié)合凝固酶)orclumping

factor(凝聚因子)plasma

to

be

clotedor

bacteria

tocoagulateSlide

coagulase

testVirulenceProtection

actionsInfection

localized27classified

into

α-,

β-,γ-,

&

δ-toxinα-toxin—

makes

pores

in

cellmembranesStaphylolysin(葡萄球菌溶素)28leukocidin殺白細(xì)胞素kills

or

degranulates

neutrophils

¯ophages29including

type

A

&

type

Bcauses

staphylococcal

scalded

skinsyndrome((SSSSSSSS))Exfoliatin

(表皮剝奪毒素)30Enterotoxin(腸毒素one

kind

ofsuperantigens)

including

serotype

A,

B,

C1-3,

D,

E,

G,&

Hresponsible

for

food

poisoning(食物中毒)mainly

cause

vomitingalso

acts

as

superantigen(超抗原)Toxic

shock

syndrome

toxin

1(TSST-1)(毒性休克綜合征毒素-1

)causes

toxic

shock

syndrome

(TSS)3132Others33heat-stable

nuclease

(耐熱核酸酶)35Clinical

diseasesInvasivediseasesPyogenic

infections-local

infections-systemic

infectionsToxin-mediated-fooddispeoaissoensing-staphylococcal

scalded

skin

syndrome(SSSS)36-toxic

shock

syndrome

(TSS)Folliculitis

(毛囊炎)by

S.aureus37Bullous

Impetigo

by

S.aureus38A

S.

aureusinfection

on

a

12-year-old

child'scheek39Pathogenesis

of

staphylococcal

infections40Microbiological

diagnosisSamplesPus,

blood,

food,

or

vomitusIsolationHeat-stablecleaseSmear

µscopyG+

staphylococciColony

pigments

&hemolysisCoagulase

testMannitefermentationBiochemicalreactionsnuEnterotoxinsdetectionAnimaltest41Identification

of

pathogenicstaphylococciCoagulase(+)Heat-stable

nuclease(+)Golden

pigment

(+)Hemolyzation

(+)Mannite

fermentation(+)42Prevention

&treatmentpreventingnosocomialinfectionPreventionTreatmentantibioticssensitivitytestpersonalhygienesterilisation

&detentionself-bacterialvaccinetherapypreventingdrugresistance43Methicillin-resistant

S.

aureus,

MRSA(耐甲氧西林金黃色葡萄球菌)Coagulase-negative

staphylococci

(CNS)(凝固酶陰性葡萄球菌)44Compare

the

features

ofcommonpyogenic

bacteria.Discuss

the

pathogenic

featuresandidentification

points

ofStaphylococcus

aureus.45Questions:Streptococci46Biological

propertiesShape,Stain

&CultureG+,

spherical,

elliptical,

arranged

in

chainGrow

well

on

nutrient

medium

w/

blood474849AntigenicstructureProtein

antigen—surface

Ag,outside

Cantigen—type-specific—includingM,T,R,Sin

GroupAPolysaccharid

antigen—C

Ag—group-specificNucleoprotein—P

Ag—non-specificCell

cytoplasmCell

membranePeptidoglycanCapsuleCellwall50ClassificationAccording

toα-hemolytic

Streptococcusβ-hemolytic

Streptococcusγ-StreptococcusHemolysisgroupA-V,

total

20groupsamongpathogenic

streptococci?90%is

group

A?over

100

typesaccording

to

M

Ag?group

B,C,D,&G

occasionallyAntigenicstructure51Pathogenicity52Group

A

Streptococci(S.

pyogenes)53PathogenicsubstancesProtein

G:

similar

to

Protein

Aadhesins-lipoteichoic

acid

(LTA)-fibronectin

binding

protein

(FBP,proteinF)(纖絲蛋白結(jié)合蛋白,

F 蛋白)-protein

MBacterialstructure54Streptolysin

(SL,

鏈球菌溶素)Streptococcal

pyrogenic

exotoxin(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

&enzymes55Streptolysin

S

(SLS, 鏈球菌溶素S)-low

MW

glycopeptide-oxygen-stable-causes

β-hemolysis

on

Blood

Agar

plate-non-antigenicStreptolysin

O

(SLO, 鏈球菌溶素O)-protein

w/

SH

group-oxygen-labile-destroys

many

kinds

ofcells-anti-SLO

test

(ASO

test)helpful

for

diagnosisStreptolysin56-coded

by

lysogenic

bacteriophage-proteins

including

serotype

A,

B,

C-causes

scarlet

fever

(猩紅熱)-one

kind

of

superantigens-also causes

TSSStreptococcal

pyrogenic

exotoxin(SPE)-coded

by

(鏈球菌致熱外毒素)57-hydrolyzes

DNAHyaluronidase

(透明質(zhì)酸酶)-also

called

as

spreading

factor

(擴(kuò)散因子)-hydrolyzes

hyaluronic

acid

in

connective

tissue-helpful

for

spreading

of

bacteriaStreptokinase

(SK,

鏈激酶)-also

called

as

streptococcal

fibrinolysin(鏈球菌溶纖維蛋白酶)Streptodornase

(SD,

鏈道酶)5859Clinical

diseasesPyogenicinfectionsToxin-mediateddiseases-scarlet

fever

(猩紅熱)-Streptococcal

toxin-mediated

TSSAllergic

diseases(late

complications)-rheumatic

fever

(風(fēng)濕熱)-acute

glomeruloniphritis

(急性腎小球腎炎)60Erysipelas

(丹毒)by

S.pyogenes61Cellulitis(蜂窩組織炎)by

S.pyogenes62"Honey-crust"

lesion

typical

of

S.

pyogenes

impetigo63Pathogenesis

of

S.

pyogenesinfections64SamplesPus,

Blood,

NasopharynxswabIsolation

w/blood

agarplatedistinguishing

fromS.

pneumoniaeSmear

µscopyG+

streptococciα-hemolysisAssist-diagnosis

forrheumatic

feverdistinguishingfromstaphylococciOtherstreptococciβ-hemolysisASO

testMicrobiological

diagnosis65S.pneumoniaeGroup

BstreptococciGroup

DstreptococciViridans

(α-hemolytic)

streptococciStreptococcus

suis

(豬鏈球菌)Enterococcus

species

(腸球菌)

&VREOther

streptococci66Enterococcus

species

andVRE67Enterococcus

spp.(腸球菌)Previously

classifiedasGroup

DstreptococciIn

1984,

named

as

genusEnterococcusGram+

cocci

in

pairs

or

shortchainsMost

are

facultative

anaerobesComplex

nutritional

requirementsGroup

D

specific

teichoic

acid

antigen68Enterococcus

spp.

viewed

by

directfluorescent

antibody

(FA)

reaction69Enterococcus

spp.Commonly

found

in

the

intestines

ofnormalhealthy

individuals

(humans

and

animals).2

importanthuman

diseases-relatedspp.E.

faecalis

(糞腸球菌)

and

E.

faecium(屎腸球菌)CauseUrinary

tract

infectionsBacteremia

&

septicaemiaSubacute

endocarditisWoundinfectionsFoodborne

diseasesMeningitisNosocomial

infections70Oneof

important

life-threateningnosocomial

pathogensVancomycin

Resistant

Enterococci(VRE,

耐萬(wàn)古霉素腸球菌)Since

1986,

VRE

infections

has

becomea

growingproblem71Discuss

the

pathogenic

featuresofStreptococcus

pyogenes.Discuss

identification

points

between hemolytic

streptococci

and

other pyogenic

bacteria.72Questions:Neisseria

gonorrhoeae73(淋病奈瑟菌)Biological

propertiesShape

and

stain-G-

diplococci

in

or

on

PMNs

on

pus

smear-No

endospore

&

flagellum,

&

w/

capsule

&pili7475Culture-Obligate

aerobes,

need

5%

CO2whileprimary

isolation-High

nutritional

requirement

?“Chocolate

Blood

Agar

Plate”Antigenic

structure

andclassification-Pilus

protein

antigens-Outer

membrane

protein

antigens：PI,

PII,

&

PIII-LOS

(lipooligosaccharide,

脂寡糖),

LPS-like76N.

gonorrhoeae

colonieson

Chocolate

Blood

Agar

Plate77PathogenesisVirulent

factors-Pili-Outer

membrane

proteins-LOS-IgA1

protease-OthersClinicalfindings-Gonorrhea-Gonococcalcconjunonjunccttiivviittiiss79Gonorrhea

symptoms-Vaginitis-Cervicitis-Salpingitis-Pelvic

inflammation-Gonococcal

Pharyngitis-Gonococcal

Conjunctivitis-Gonococcal

ArthritisinWomen-Urethritis-Epididymitis-Prostatitis-Anorectal

Gonorrhea-Gonococcal

Pharyngitis-Gonococcal

Conjunctivitis

-Anorectal

Gonorrhea-Gonococcal

Arthritisin

Men-UrethritisClinical

manifestations

ofN.

gonorrhoeae

infection81ImmunityHumoral

immunity

more

effectiveNo

persistent

immune

responsesInfection

trendto-chronic

&

repeated

occurrence82Microbiological

detectionsSamplesPus

secreta

from

genito-urinary

tracts,

eyes,

&

othersIsolationOxidase

testSugar

fermentation

testImmunofluorescenceassaySmear

µscopyG-diplococciin

or

onPMNsColonies

&

microscopic

findingsBiochemical

reactions&

serologic

testsOtherNucleic

acids

detection,

&

so

o83nPrevention

&

treatmentTake

preventions

as

main

measureChoose

penicillin

as

No.

1drug，takecare

ofproblemsofdrugs-resistantbacterial

stai