bacteriology tree

  • Gram +: PG is blue from crystal violet stain + stain-sealing iodine, not washed away by acetone
    • Cocci:
      • Catalase+:  breaks down H2O2
        • Staphylococcus:  grape-like clusters
          • Coagulase+:
            • Staph. aureus (beta hemolytic, yellow on mannitol salt agar; protein A inhib. phagocytosis by binding Ig Fc and destroys GI epithelium’s ability to regulate water/electrolytes  diarrhea; common in nose; prosthetics → osteomyelitis)
          • coagulase-:
            • Novobiocin-resistant:
              • Staph. saphtophyticus (“honeymoon cystitis”)
            • novobiocin-sensitive:
              • Staph. epidermidis (skin → acute endocarditis; prosthetics → osteomyelitis)
      • catalase-:
        • alpha-hemolytic:  partial hemolysis = greenish on blood agar
          • Optochin-resistant:
            • Strep. viridans
          • optochin-sensitive:
            • Strep. pneumoniae (IgA protease to survive on mucosal surface; MCC meningitis in 6mo-60+)
        • beta-hemolytic: complete hemolysis = yellowish/clear on blood agar (*Streptococcus is usually in pairs or chains)
          • Bacitracin-resistant:
            • Strep. agalactiae (GBS)
          • bacitracin-sensitive:
            • Strep. pyogenes (GAS; M protein of capsule helps S.py evade humoral immunity and phagocytosis by binding fibrinogen; C5a peptidase inactivates anaphylatoxin decreasing inflammatory response; Strep throat and Rheumatic Fever)
        • gamma-hemolytic:
          • Strep. bovis
          • Enterococcus (GDS; cocci in chains; black on bile esculin agar)
          • Peptostreptococcus
    • Bacillus:
      • Spore-forming:
        • Aerobic:
          • Bacillus (chains; virulence factors are capsule and toxin)
            • B. cereus (fried rice; enterotoxin destroys GI epithelium’s ability to regulate water/electrolytes  diarrhea)
            • B. anthracis (exotoxin “edema factor” obtained via plasmid increases cAMP)
        • anaerobic:
          • Clostridium
            • C. botulinum (botulinum toxin blocks ACh release causing flaccid paralysis; C2 enterotoxin obtained via phage destroys GI epithelium’s ability to regulate water/electrolytes  diarrhea)
            • C. tetanus (tetanospasmin obtained via plasmid blocks glycine release causing spastic paralysis)
            • C. perfringens (gas gangrene; enterotoxin destroys GI epithelium’s ability to regulate water/electrolytes  diarrhea)
            • C. difficile (pseudomembranous colitis caused by Clindamycin, etc and treated by Metronidazole; enterotoxin destroys GI epithelium’s ability to regulate water/electrolytes  diarrhea)
      • non-spore-forming:
        • Aerobic:
          • Corynebacterium (club/”Chinese-letter”-shaped; acid-fast; black on Tellurite agar, Loeffler’s coag. serum)
          • Lactobacillus (in breast milk and birth canal; causes gingivitis)
          • Listeria (Catalase+, beta hemolytic, grows in low temperatures, facultative INTRACELLULAR organism, listeriolysin O to escape phagolysosome; tumbles in broth; found in soft-cheeses and meats; beware in pregnancies  meningitis)
          • Nocardia (filamentous, branching; weakly acid-fast)
        • anaerobic:
          • Actinomyces (filamentous, branching; “Farmer’s Lung”)
  • gram -:  pink from Saffranin added after acetone wash
    • Cocci:
      • Neisseria (pairs/”kidney bean”-shaped; Catalase+, Oxidase+; ferments glucose; chocolate agar; Lipid A of capsule → septic shock; IgA protease to survive on mucosal surface)
        • N. gonorrhea (Thayer-Martin; Type IV secretion system; septic arthritis in young pts)
        • N. meningitidis (2nd MCC of meningitis to Strep. pnemo in 6mo-60yo; Type V secretion system)
      • Acinetobacter (doesn’t ferment carbs)
      • Moraxella (Oxidase+, causes otitis media, pneumonia)
    • Bacillus:
      • Enterobacteriaceae: has capsule, O Ag, flagella (H Ag), ferments glucose, Nitrite+, oxidase-, makes endotoxin
        • Lactose-fermenting:  pink on MacConkey, blue on Eosin-Methylene Blue
          • Serratia (opportunistic, DNAse+)
          • Enterobacter (opportunistic)
          • Escherichia (MCC UTI; Type I secretion of alpha-hemolysin and heat stable enterotoxin; enterotoxins destroy GI epithelium’s ability to regulate water/electrolytes  diarrhea)
            • ETEC (toxins obtained via plasmid increases cAMP)
              • Heat stable (ST):  increases cGMP
              • heat labile (LT):  increases Gs activity
            • EHEC (0157:H7 targets 60S and inhibits protein synthesis  HUS)
          • Klebsiella (polysaccharide capsule; UT and GI infections, ankylosing spondylitis; non-motile water organism)
        • non-lactose-fermenting:
          • H2S-producing: turns black on Hektoen enteric agar
            • Proteus (Urease+; swarming motility; UTI and alkaline “staghorn” kidney stones)
            • Salmonella (motile, animal reservoir, Type III secretion system (direct injection); causes osteomyelitis in Sickle Cell patients)
          • does not produce H2S: turns green on Hektoen enteric agar
            • Shigella (small infectious dose, non-motile; Shiga toxin targets 60S  inhibits protein synthesis and causes bloody diarrhea, HUS)
            • Yersinia (Wright-Giemsa shows bipolar-staining, “safety-pin” shape; reservoir = rats → Bubonic plague)
      • Non-enterobacteriaceae:
        • Successful opportunist:
          • Pseudomonas (Oxidase+, motile; cetramide agar; silver stain; ventilator-associated pneumonia; osteomyelitis in diabetics and drug addicts; pneumonia in CF patients; necrotizing enterocolitis, gangrene, and septic shock in neutropenic patients; quorum-sensing biofilm; treat with antipseudomonal penicillins, quinolones (“floxacins”), aztreonam, carbapenems (“penems”), etc)
        • Curved and spiral rods:
          • Campylobacter (“m”/”gull-wing” shaped, incubate in warm 42C, microaerophilic)
            • C. jejuni (causes Guillian-Barre)
          • Helicobacter (Urease+, microaerophilic)
            • H. pylori (type IV secretion of CAG-A  gastric cancer)
          • Vibrio (Oxidase+, Type II secretion, “comma”-shaped, on water surfaces; grown on thiosulfate citrate bile salt sucrose (TCBS) agar; toxins destroy GI epithelium’s ability to regulate water/electrolytes  diarrhea)
            • V. cholera (“rice-water” diarrhea; increases cAMP)
            • V. parahemolyticus (oyster and clam shells)
        • Respiratory pathogens: fastidious
          • Bordetella (single/pairs; blood and charcoal media)
            • B. pertussis (Whooping Cough; pertussis toxin inhibits Gi, ribosylates ADP, and increases cAMP)
          • Haemophilus (Catalase+, chocolate agar + V (NAD) + X (heme); non motile, look like “rice-grains”; IgA protease to survive on mucosal surface)
          • Legionella (BCYE charcoal agar, silver stain; facultative intracellular organism)
        • Zoonoses:
          • Bartonella (Giemsa/Warthin-Starry silver nitrite stain shows pleomorphic rods; slow-culture and difficult to isolate; causes Oroya fever
            • B. henselae (Cat-Scratch disease)
          • Brucella (Urease+, pleomorphic rod, from animal contact or unpasteurized milk, causes Undulent fever)
          • Francisella (coccobacillus, requires Cysteine; rabbits, causes Tularemia)
          • Pasturella (Oxidase+, bipolar-staining coccobacillus, facultative anaerobe, from dog/cat bite)
  • Poorly staining:
    • Spirochetes: gram- wall, helical, endoflagella within periplasm, seen via dark-field microscopy
      • Borellia (facultative intracellular)
        • B. burgdoferi (Lyme disease, from Ixodes tick)
      • Leptospira (silver stain)
      • Treponema (not cultured)
        • T. pallidum (Syphilis; antibodies attack cardiolipin)
    • Obligate intracellular: gram- wall, unable to produce own ATP
      • Anaplasma (aerobic, arthropod-born; infects PMNs/leukocyte → morulae; prevents lysosomal fusion and remains in vacuole)
      • Chlamydia (spore-like elementary body, no PG)
        • C. trachomatis (STD and Reiter’s syndrome (“can’t see, can’t pee, can’t climb a tree”))
      • Coxiella (in vagina and unpasteurized food; zoonoses via PLACENTA/lactating animals; causes Q fever)
      • Ehrlichia (infects monocytes; prevents lysosomal fusion and remains in vacuole)
      • Rickettsia (escapes into endothelial cell cytoplasm and multiplies; arthropod-born; causes Rocky Mountain Spotted Fever and Typhus)
    • Mycobacteria: mycolic acid wall makes mycobac acid-fast, Auramine rhodamine/Ziehl-Neilson stain; infects macrophages; slow-growing and resistant to drying, chemicals, and germicides
      • Mycobacterium tuberculosis (facultative intracellular)
      • Mycobacterium leprae (obligate intracellular)
    • Mycoplasma and (“fried-egg”-looking) Mollicutes: sterolx3 instead of cell wall, pleomorphic; sensitive to environment; cold (IgM) agglutination; resistant to beta-lactam Abx b/c has no PG (must do Ab serological test to find)
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