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Staphylococcus Epidermidis
Staphylococcus Epidermidis
• DEFINITION OF STAPHYLOCOCCUS
• FAMILY: MICROCOCCACEAE
• GENUS: STAPHYLOCOCCUS
• SPECIES : S. aureus, S. epidermidis, S. saprophyticus, S. simulans,
• S. capitis, S. xylosus, S. warneri, S. cohnii,
• S. haemolyticus, S. hominis, S. saccharolyticus.
• 32 species.
• Some possess the ability to produce – coagulase, protein A,
• Cell associated clumping
• Factor.
• They are called STAPHYLOCOCCUS AUREUS.
• All others are called coagulase- negative staphylococci.
• 60% - 90% of coagulase – negative staphylococci from humans
• are STAPHYLOCOCCUS EPIDERMIDIS.
STAPHYLOCOCCUS
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STAPHYLOCOCCUS
STAPHYLOCOCCUS AUREUS
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STAPHYLOCOCCUS AUREUS
• PHYSIOLOGY AND STRUCTURE
• Peptidoglycan – 10 to 12 alternating chains of amino sugars.
(N-acetyl muramic acid, N-acetyl glutamic acid )
• . side chains of tetrapeptide
• . cross-linkage with pentapeptide, L- lysine to L- alanine
• . activates complement
STAPHYLOCOCCUS AUREUS
• PHYSIOLOGY AND STRUCTURE
• Protein A.
• . Staph. aureus only
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STAPHYLOCOCCUS AUREUS
• PHYSIOLOGY AND STRUCTURE
• Teichoic Acid
• . phosphate polymers
• . co-valently bound to peptidoglycan and
cytoplasmic membrane
•
• . ribitol teichoic acid - Staph. aureus
STAPHYLOCOCCUS AUREUS
• PHYSIOLOGY AND STRUCTURE
• Clumping Factor ( Bound Coagulase )
• . fibrinogen to fibrin
• Cytoplasmic Membrane
• . osmotic barrier
• . anchor for biosynthetic and respiratory enzymes
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STAPHYLOCOCCUS AUREUS
• PATHOGENIC MECHANISMS
• Enzymes
• . coagulase - abscess, fibrin layer
• . catalase - H2 O2 to water
• . hyaluronidase - mucopolysaccharide in
connective tissue
• . fibrinolysin ( staphylokinase ) dissolves fibrin clots
• . lipase - abscesses in sebaceous areas
• . nuclease DNA
• . penicillinase
STAPHYLOCOCCUS AUREUS
• PATHOGENIC MECHANISMS
• Toxins
• . cytotoxins - alpha, beta, gamma, leukocidin disrupt
smooth muscle of blood vessels, haemolysins
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STAPHYLOCOCCUS AUREUS
• EPIDEMIOLOGY
• WHO, WHAT, WHERE, WHEN, HOW?
• . all are colonized with Staph. epidermidis - skin, hair
• . Staph. aureus in moist folds – groin, perineum
• . oropharynx - both
• . anterior nasopharynx 15% Staph. aureus
• . GI tract, uroepithelium
• More persistent carriage
• . medical personnel
• . eczema
• . IV drug abusers
• . diabetics - insulin use
• . haemodialysis patients
• . allergy desensitizing shots
STAPHYLOCOCCUS AUREUS
• CLINICAL SYNDROMES
• STAPH. AUREUS
• . equipped to produce toxin diseases
• . equipped to cause tissue invasion and destruction
• . colonizes foreign bodies – catheters, shunts, prostheses
• . patients with impaired chemotaxis and phagocytosis –
• susceptible - Job syndrome, Wiscott – Aldrich, Chronic
Granulomatous Disease.
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STAPHYLOCOCCUS AUREUS
STAPHYLOCOCCUS AUREUS
• CLINICAL SYNDROMES
• STAPH.AUREUS
• 2. Bullous Impetigo
• . localized
• . infants and older children
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STAPHYLOCOCCUS AUREUS
• CLINICAL SYNDROMES
• STAPH. AUREUS
• 4. Staphylococcal Food Poisoning: Preformed toxin – vomiting
• and diarrhoea
STAPHYLOCOCCUS AUREUS
• LABORATORY DIAGNOSIS
• Microscopy - single, diplococci or clusters
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STAPHYLOCOCCUS AUREUS
• TREATMENT
• Antibiotic susceptibility - Penicillin G
• Penicillinase - Penicillinase- resistant penicillins-
Isoxazole pens – methicillin, oxacillin, nafcillin.
STAPHYLOCOCCUS EPIDERMIDIS
4.LOCAL RESOURCES.
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STAPHYLOCOCCUS
• DEFINITION OF STAPHYLOCOCCUS
• FAMILY: MICROCOCCACEAE
• GENUS: STAPHYLOCOCCUS
• SPECIES : S. aureus, S. epidermidis, S. saprophyticus, S. simulans,
• S. capitis, S. xylosus, S. warneri, S. cohnii,
• S. haemolyticus, S. hominis, S. saccharolyticus.
• 32 species.
• Some possess the ability to produce – coagulase, protein A,
• Cell associated clumping
• Factor.
• They are called STAPHYLOCOCCUS AUREUS.
• All others are called coagulase- negative staphylococci.
• 60% - 90% of coagulase – negative staphylococci from humans
• are STAPHYLOCOCCUS EPIDERMIDIS.
STAPHYLOCOCCUS EPIDERMIDIS
• PROBLEMS WITH STAPH. EPIDERMIDIS AS A PATHOGEN
• . Link with disease- 1. A variety of infections of prosthetic
• devices.
• 2. Native valve infection – IV DRUGS
•
• 3. Eye infections.
• Distinguish normal skin flora from infective agent.
• Specimen quality, source. Bone , cement.
• Methods to distinguish strains of S. epidermidis –
• Biochemical, antibiogram, phage typing – not sensitive
• Molecular techniques – PCR, PFGE.
• . Biofilm ( glycocalyx ) - adherence, fibronectin
• multilayered clusters
• exopolysaccharide matrix
• Protects organism from antibiotics and phagocytic cells.
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STAPHYLOCOCCUS EPIDERMIDIS
• CLINICAL SYNDROMES
• STAPH. EPIDERMIDIS
• . prosthetic material – valves, graphs, shunts
• . endocarditis
• STAPH. SAPROPHYTICUS
• . urinary tract infections
STAPHYLOCOCCUS EPIDERMIDIS
• PROBLEM WITH STAPH. EPIDERMIDIS AS A PATHOGEN
. Antibiotic Resistance.
• Nosocomial Pathogens – high resistance rates
• Plasmids abound – encode for resistance to all
• Groups – penicillins, macrolides
• Tetracyclines,
• Aminoglycosides,
• Trimethoprim,
• Chloramphenicol.
• Can be mobilized to take up other resistance genes.
• ( disinfectants ).
•
• Transfer by conjugation – rapid increase in rates.
• Well known association with antibiotic resistance.
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STAPHYLOCOCCUS EPIDERMIDIS
• PROBLEMS WITH STAPH. EPIDERMIDIS AS A PATHOGEN.
• Methicillin Resistance ( MRSE )
• - penicillin resistance -betalactamase 80%-90% all Staph
• - methicillin – PBP 2 – 2’ MecA gene
• - Heterotypy – different patterns of resistance in
• Individual members of a colony.
• Technical problems – salt, temp, antibiotic- ox. Plate.
• May miss MRSEs.
• Broth dilution may miss MIC >4.
• Suggestion of lower threshold.
• MecA, MecR, MecI genes
• . Susceptible
• Vancomycin, Rifampicin, ciprofloxacin- resistance.
• Streptogramins, oxazolidinones(linezolid).
• Synergistic combinations.
STAPHYLOCOCCUS EPIDERMIDIS
• LOCAL RESOURCES
• Technical Education
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