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Lec.4
Dr. Adawia Alzubiadi
Medicine college
Diyala University
Genera: Micrococcus, Staphylococcus, & Rothia
are catalase positive. Genera: Streptococcus &
enterococcus are catalase negative. Staphylococci Family
are the most commonly isolated micrococcaceae
from human & veterinary clinical specimens. Micrococcaceae
G+ bacteria. It usually arranged in grape-like
clusters. Single or pairs may also found. Colonies
are white to gray, and sometimes golden yellow,
entire and smooth surface. They grow readily on
many types of media. Some are normal flora of the
skin and mucous membrane of human. Other
causes suppuration, abscesses formation and a
variety of pyogenic infections and even fatal . The
main 3 species of staphylococci are:
Staphylococcus aureus
Staphylococcus epidermidis (albus)
Staphylococcus saprophyticus
S. aureus is coagulase positive which differentiate
them from other species. It is the major pathogen for
human. The coagulase negative staphylococci are
normal flora and occasionally causing infection in
human (Opportunistic pathogen).
Morphology: Staphylococci are spherical in shape usually arranged in
clusters.
Culture: Staphylococcus aureus
-They readily grow on different media under aerobic or
microaerophilic conditions.
-Colonies on solid media are round smooth and glistening.
-S. aureus only produce gray to deep golden yellow colonies.
-S. epidermidis produce gray to white colonies.
- Staphylococci are catalase positive which differentiate them from
streptococci.
Pathogenesis :
The nasal carriage among normal healthy population occurs in 40%-
50% of humans. Nasal carriage in children is higher than in adults.
While the rate of skin carriage was about 20%.
10% of normal non-pregnant women carries S. aureus in their vagina.
S. aureus can enter to the body through a number of routes (mouth,
nose, vagina, wounds, burns …etc). It can establish a variety of
pyogenic infections as well as food intoxication. The pathogenic
capacity of S. aureus is aided by toxins and enzymes they produced
together with the invasive properties of the bacteria and their ability
to resist a wide range of antibiotics.
Antimicrobial resistance is chromosomal & plasmid mediated.
Pathogenicity factors of S. aureus :
S. aureus has three features that make it distinct among most other clinically important bacteria. It can
express a variety of virulence factors, it has the ability to develop and expand resistance to a broad
spectrum of antimicrobial drug classes, and its wide distribution in human, animal and environment.
Toxins and Enzymes of S. aureus:
Staphylococci can produce many extracellular enzymes and toxins. These substances enable the
bacteria for multiplying and spread widely in the tissues.
Catalase: which convert hydrogen peroxide into water and oxygen.
Coagulase: May deposit fibrin on the surface of staphylococci and thus protect them from phagocytosis.
Enterotoxin: It is a heat-stable toxin responsible for food intoxication of S. aureus.
Exotoxins: which includes leukocidin, exfoliative toxin and toxic shock syndrome.

S.aureus on blood agar, the complete hemolysis of RBCs is very clear

 S. aureus virulence factors:

Capsule: inhibit phagocytosis, Promote adherence

Piptidoglycan: leukocyte chemoatractant, decomplementation
Toxins: Antiphagocytic, cytotoxic
Exfoliative toxin: split cellular bridges
Enterotoxin: nauseogenic, diarrheagenic
TSST: endothelial damage
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Coagulase: Convert fibrinogen into fibrin
Hyaluronidase: Hydrolyzes hyaluronic acid in connective tissues
Lipase: hydrolyzes lipids
Nuclease: Hydrolyzes DNA
Another pathogenicity factors:
B-lactamase production: The majority of S. aureus isolates produce the B-lactamase
enzyme which break down the B-lactam ring, & thus it is responsible for the
resistance of S. aureus against penicillins & cephalosporines.
Biofilm formation: A biofilm is an aggregate of microbes in which cells adhere to each
other and/or to a surface. These adherent cells are frequently embedded within a self-
produced matrix of extracellular polymeric substance. Biofilm protect the microbe from
the immune response & increase the antimicrobial resistance. High percentage of S.
aures are biofilm former
 Clinical infections caused by S. aureus:
clinical
S. aureus is the most common species of Staphylococcus to infections
cause Staph infections and is a successful pathogen due to
a combination of nasal carriage and bacterial
immunoevasive strategies. S. aureus can cause a range of
illnesses, from minor skin infections, such as pimples,
impetigo, boils, cellulitis, folliculitis, carbuncles,
scalded skin syndrome, and abscesses, to life-threatening
diseases such as pneumonia, meningitis, osteomyelitis,
endocarditis, toxic shock syndrome, bacteremia, and sepsis
. Its incidence ranges from skin, soft tissue, respiratory,
bone, joint, endovascular to wound infections. It is still one
of the five most common causes of
hospital-acquired infections and is often the cause of
post=surgical wound infections.
Atopic dermatitis:
S. aureus is extremely prevalent in persons with atopic dermatitis. It is
mostly found in fertile, active places, including the armpits, hair, and
scalp. Large pimples that appear in those areas may exacerbate the
infection if lacerated. This can lead to
staphylococcal scalded skin syndrome. A severe form of this,
Ritter's disease, can be observed in neonates. The presence of S. aureus in
persons with atopic dermatitis is not an indication to treat with oral
antibiotics, as evidence has not shown this to give benefit to the patient..
The relationship between S. aureus and atopic dermatitis is unclear.
Evidence shows that attempting to control S. aureus with oral antibiotics is
not efficacious.
S. aureus food intoxication:
Food poisoning due to S. aureus enterotoxin is characterized by a short
incubation period (1-8 hrs.), violent nausea, vomiting and diarrhea. There
is no fever. The enterotoxin is heat-stable (resist boiling for 30
minutes)and resistant to the action of Gut enzymes. The emetic effect of
enterotoxin is probably result from CNS stimulation (vomiting center).
Toxic shock syndrome:
Most strains of S. aureus isolated from patients with toxic shock syndrome
produced a toxin called toxic shock syndrome toxin (TSST). In human the toxin is
associated with fever, shock and multisystem involvement, including desquamative
1. Skin & soft tissue infection (impetigo in S. aureus
2.
children)
Upper & lower respiratory tract infection
Infections in
3. Urinary & genital tract infections human
4. Food intoxication
5. Bone & joint infections
6. Septicemia
7. Eye infection
8. CNS infections
9. Nosocomial infections
10. Burn infections
1.Specimens: Pus, blood, urine, sputum, CSF, wound Laboratory
swab, burn swab, seminal fluid, vaginal secretion and so
on diagnosis
2. Smears: Stained with Gram’s stain to see the typical
appearance of the bacteria.
3. Culture: On blood agar plates to identify bacterial
colonies and differentiate them through; Coagulase test,
Catalase test, and Biochemical tests.
Culture on special media: Mannitol salt agar (with 6.5%
Nacl) to differentiate S. aureus than other staphylococci.
S. aureus is widely distributed in the nature and causing a
wide range of pyogenic infections. Furthermore it is
responsible for community acquired as well as nosocomial Epidemiology
infections (Hospital infections particularly among
immunocompromised patients) due to its wide distribution in
hospital settings including health care workers. On the other
hand, S. aureus is one of the well-known bacteria that
develop multiple antibiotic resistance.
Methicillin resistant S. aureus (MRSA):
According to its susceptibility to Methicillin, S.
aureus was divided into:
1. Methicillin resistant (MRSA): which is highly
prevalent in the community (CA-MRSA) causing a
wide range of infection including community
acquired pneumonia . Beside that it is highly
distributed in the hospitals Hospital environment
and fomites) causing (HA-MRSA) infections
among patients. MRSA isolates usually multi-drug
resistant. High prevalence of MRSA was found
among HCWs
2. Methicillin sensitive S. aureus (MSSA)
Thanks for
your
attention
Synovial fluid : relating to or denoting a type of joint that is surrounded by a thick
flexible membrane forming a sac into which is secreted a viscous fluid that
lubricates the joint.
TSST : Toxic shock syndrome toxin