Chapter 17: Antibacterial Agent

Term:

Chemotherapeutic agents
Antimicrobial Agents
Antibacterial spectrum
Broad spectrum
Narrow spectrum
Minimum bactericidal concentration (MBC)
Antibiotic combinations
Antibiotic synergism
Antibiotic antagonism
B-Lactamase
Penicillinases
Cephalosporinases
Carbapenemases
Paul Ehrlich
Alexander Fleming
Gerhard Domagk
Selman Waksman
Semi-synthetics
Synthetics
Selective toxicity
Peptidoglycan
B-lactams
Penicillins
Cephalosporins
Cephamycins
Carbapenems
Monobactams
B-lactam inhibitor
Vancomycin
Cycloserine
Bacitracin
Isoniazid
Ethionamide
Ethambutol
Polymyxin
Daptomycin
Aminoglycoside
Streptomycin
Kanamycin
Gentamicin
Tobramycin
Amikacin
Tetracyclines
Doxycycline
Minocycline
Glycylcyclines
Oxazolidinone

 Macrolides
Erythromycin
Azithromycin
Clarithromycin
Ketolides
Clindamycin
Lincosamide
Streptogramins
Quinolones
DNA gyrase - an enzyme that relieve strain while the double helix
DNA is being unwounded by helicase.
Fluoroquinolones - an example of quinolones
Rimfampin - antibiotics that prevent transcription by binding DNAdependent RNA polymerase
Rifabutin - antibiotics that prevent transcription by binding DNAdependent RNA polymerase
Metronidazole - antibiotics that disrupts bacteria DNA (is cytotoxic
compound)
Sulfonamides - is a structural analog of Para-aminobenzoic acid
(PABA). This antibiotics work by inhibiting dihydropteroate synthase and disrupt
folic acid synthesis.
PABA - compound that is used to make folic acid in bacteria
Dapsone - antibiotic that inhibit dihydropteroate synthase
Trimethoprim - antibiotic that inhibit dihydrofolate reductase and
disrupt folic acid synthesis
Ergosterol - sterol found in fungal membranes
Amphotericin B - antibiotic that attach to ergosterol in fungal
membranes
Azoles - antibiotics that inhibit ergosterol synthesis
Allylamines - antibiotics that inhibit ergosterol synthesis
Nucleotide analogs - molecules with structural similarities to the
normal nucleotide building block of nucleic acids
Acyclovir (ACV) - a nucleotide analog similar to guanosine
ddC (dideoxycytidine) - a nucleotide analog similar to cystidine
AZT (Azidothymidine) - a nucleotide analog similar to thymidine.
(anti-AIDS drug)
Adenosine Arabinoside - a nucleotide analog similar to
adenosine
Reverse transcriptase inhibitors - act against an enzyme HIV
uses in its replication cycle
Nalidixic acid - the narrow spectrum antibiotic of quinolones
Ciprofloxacin - the broad spectrum antibiotic of quinolones
Levofloxacin - the broad spectrum antibiotic of quinolones
Ofloxacin - the broad spectrum antibiotic of quinolones
Superinfection - second infection superimposed on an earlier
one
Diffusion Susceptibility test - also known as Kirby-Bauer tests,
involve uniformly inoculating a petri plate with a standardized amount of the
pathogen. Then small disks of paper containing standard concentrations of the

drugs to be tested are firmly arranged on the surface of the plate. After
incubation, the plates are examined for the presence of a zone of inhibition
Zone of inhibition - a clear area where bacteria do not grow
Kirby-Bauer Test - another name for the diffusion susceptibility
test
Minimum inhibitory concentration (MIC) - lowest concentration
that inhibits the growth of the organism
Minimum inhibitory concentration test - a standardized amount
of bacteria is added to serial dilutions ofantimicrobial agents in tubes containing
broth. After incubation, coudiness indicates bacterial growth; lack of cloudiness
inticate that the bacteria were either inhibited or killed by the antimicrobial agent.
Etest - involves placing a plastic strip containing a gradient of the
antimicrobial agent being tested on a plate uniformly inoculated with the
organism of interest. Combines aspects of Kirby-Bauer & MIC test.
Bacteriostatic activity - Level of antimicrobial activity that inhibits
the growth of an organism
Bactericidal activity - Level of antimicrobial activity that kills the
test organism.
Minimum bactericidal concentration test - in this test, a
samples taken from clear MIC tubes are transferred to plates containing a drugfree growth medium. The appearance of bacterial growth in these subcultures
after appropriate incubation indicates that at least some bacterial cellssurvived
and were able to grow. Lowest concentration of drug for which no growth occurs
in the subcultures is the minimum bactericidal concentration.
Topical or local administration - apply drug directly for external
infection.
Oral administration- requires no needles and is self administered
Parenteral administration - means any non-oral means of
administration
Intramuscular administration - delivers drug via needle into
muscle
Intravenous administration - deliver drug directly to bloodstream
Intrathecal administration - deliver drug via an injection into the
subanachnoid space so that it reaches the cerebrospinal fluid (CSF)
Sublingual administration - is when medication is placed under
the tongue to be absorbed by the body
Black hairy tongue - a harmless temporary condition caused by
metronidazole
R-plasmids - extrachromosomal pieces of DNA
MfpA protein - is produced by mycobacterium tuberculosis, bind
to DNA gyrase preventing the binding of fluoroquinolone
B-lactamase - enzyme that break the beta-latam rings of penicillin
& other similar molecules, rendering them inactive
Superbugs - strains of bacteria that are resistant to several types
of antibiotics
Cross resistance - resistance to one antimicrobial agent may
confer resistance to similar drugs

What are the differences between Chemotherapeutic & Antimicrobioal Agents?

Chemotherapeutic agents: drugs act against diseases
Antimicrobial agents: drugs that treat infections
What are the differences between broad spectrum & narrow spectrum
antibacterial drug?
Who discovered sulfanilamide?
Gerhard Domagk
Who found Penicillin?
Alexander Fleming
Which drugs constitute largest number and diversity of antimicrobial agents?
Antibacterial drugs
Name all the antibiotics that work by disruption of cell wall
Penicillins, Cephalosporins, Cephamycins, Carbapenems,
Monobactams, B-lactam/B-lactamase inhibitor, vancomycin, bacitricin,
cycloserine
Name the antibiotics that work by disruption of cell membrane
Daptomycin, bacitracin, polymyxins
Name the antibiotics that work by inhibiting mycolic acids
Isoniazid, ethionamide
Name the antibiotics that work by inhibiting protein synthesis
Aminoglycoside, tetracyclines, glycylcyclines, oxazolidinone,
macrolides, ketolides, clindamycin, streptogramins
Name the antibiotics that work by inhibiting nucleic acid synthesis
Quinolones, rifampin, rifabutin, metronidazole
Name the antibiotics that work as antimetabolites
Sulfonamides, dapsone, trimethoprim
Name the antibiotic that disrupt the 1st step of folic acid synthesis in bacteria
Sulfonamide
Name the antibiotic that disrupt the 2st step of folic acid synthesis in bacteria
Trimethoprim
Name the antibiotic that works by inhibiting bacterial cytoplasmic membrane and
movement of peptidoglycan precursors?
Bacitracin
Name the antibiotic that works by inhibiting bacterial membrane only?
Polymyxins
True or False: Tetracyclin is not part of Aminoglycoside
True
Name the antibiotic that works by blocking the docking site of 30S ribosome?
Name the board spectrum antimicrobial drugs fro quinolones
Ciprofloxacin, levofloxacin, ofloxacin
Name the narrow spectrum antimicrobial drugs fro quinolones
Nalidixic acid
List 6 characteristics of an ideal antimicrobial agent
Readily available
Inexpensive
Chemically stable
Easily administered
Nontoxic and nonallergenic
Selectively toxic against wide range of pathogens

 Know that more effective drug will have a larger zone of inhibition only if all
antimicrobials diffused at the same rate in the diffusion susceptibility test.
Know that tetracyclines form complexes with calcium that can become
incorporated into bones and developing teeth, causing malformation of the skull and
stained, weaken tooth enamel.
Name 2 ways that bacteria acquire resistance.
New mutations of chromosomal genes
Acquisition of R-plasmids via transformation, transduction, and
conjugation
Name six mechanisms of microbial resistance.
Production of enzyme that destroys or deactivate drug
Slow or prevent entry of drug into the cell
Alter target of drug so it binds less effectively
Alter their metabolic chemistry
Pump antimicrobial drug out of the cell before it can act
Mycobacterium tuberculosis produces MfpA protein
Binds DNA gyrase preventing the binding of
fluoroquinolone drugs
Name five ways of retarding/delaying resistance
Maintain high concentration of drug in patient for sufficient time
Use antimicrobial agents in combination
Use antimicrobials only when necessary
Develop new variations of existing drugs
Search for new antibiotics, semi-synthetics, synthetic
Chapter 18: Staphylococcus
Terms:
Staphylococcus - normal members of every humans microbiota;
low G+C bacteria; aerobic catalase-positive; gram positive cocci, nonmotile,
facultative anaerobe; salt-tolerant; tolerant of dessication
Streptococcus - Low G+C bacteria, aerobic catalase-negative
genera
Enterococcus - Low G+C bacteria, aerobic catalase-negative
genera
Bacillus - Low G+C bacteria
Clostridium - Low G+C bacteria
Listeria - Low G+C bacteria
Corynebacterium - high G+C bacteria
Mycobacterium - high G+C bacteria
Propionibacterium - high G+C bacteria
Nocardia - high G+C bacteria
Actinomyces - high G+C bacteria
Staphylococcus aureus - specie of staphylcoccus that colonizes
the anterior nares; this specie is commonly assiciated with diseases in humans;
have protein A + bound coagulase + synthesize slime layers
Staphylococcus capitis - specie of staphylcoccus that colonizes
sebaceous gland (ex: forehead)

 Staphylococcus haemolyticus - specie of staphylcoccus that

colonizes apocrine gland (ex: axilla)
Staphylcoccus hominis - specie of staphylcoccus that colonizes
apocrine gland (ex: axilla)
Staphylococcus epidermidis - specie of staphylcoccus that
colonizes human skin; this specie is commonly assiciated with diseases in
humans; have slime layers
Protein A - interferes with antibody immune responses by binding
to the Fc receptor of IgG; inhibits the complement cascade; found in the coating
of the cell surface of S. aureus.
Slime layer - inhibit leukocyte chomotaxis and phagocytosis;
facilitate attachment of staphylococcus to surfaces
Bound coagulase - an enzyme that converts the soluble blood
protein fibrinogen into long, insoluble fibrin molecules, which are threads that
form blood clots around the bacteria. Clots hide the bacteria from phagocytes
Penicillin-binding proteins - enzymes catalyzing construction of
peptidoglycan layer
mecA gene - gene in MRSA that codes for the new penicillinbinding protieins PBP2. Penicillin do not bind PBP2
Hyaluronidase - enzyme that break down hyaluronic acid
Staphylokinase - also called fibrinolysin, dissolves fibrin threads
in blood clots. Allows S. aureus to free itself from clots
Lipases - enzymes that digest lipids & allow staphylococcus to
grow on skin and in oil gland
Nuclease - enzyme that digest viscous DNA & help to destroy
neutrophil extracellular trap (NET)
B-lactamase - breaks down penicillin & allows bacteria to survive
treatment with B-lactam antimicrobial drugs
Cytolytic toxin - toxin released by S. aureus & S. epidermidis that
disrupt the cytoplasmic membrane of a variety of cells
Exfoliative toxin - toxin released by S. aureus & S. epidermidis
that affect desmoglein 1 (intercellular bridges in granulosum layer of epidermis).,
causing the patients skin cells to separate from each other and slough off the
body. These toxins are not associated with cytolysis or inflammation.
Toxic-shock syndrome toxin - toxin released by S. aureus & S.
epidermidis that cause menstruation-associated toxic shock
Enterotoxins - toxins released by S. aureus & S. epidermidis that
stimulate the intestinal muscle contractions, nausea, and intense vomiting
associated with staphylococcal food poisoning. These are heat stable, remaining
active when expose to gastric acids or jejunal enzymes.
Staphylococcal food poisoning - period of incubation = 4hrs;
symptoms last less than 24 hrs; servere vomitting, diarrhea, and abdominal pain,
but no fever. Treatment: relief of abdominal cramping, replacement of fluids, no
antibiotics
Staphylococcal scalded skin syndrome - or Ritter disease; a
cutaneous staphylococcal disease that has perioral erythema, spread over the
entire body within 2 days; positive Nikolsky sign; cutaneous bullae; blister with

clear fluid, & no bacteria, no WBCs; no scarring; primarily neonatal with mortality
rate of less than 5%; infection in adults occur in immunocompromised hosts with
mortality rate as high as 60%
Nikolsky sign - a skin finding in which the top layers of the skin
slip away from the lower layers when slightly rubbed.
Erythema - superficial reddening of the skin, usually in patches,
as a result of injury or irritation causing dilatation of the blood capillaries
Bullous impetigo - a cutaneous staphylococcal disease that has
localized blisters, erythema does not extend beyond borders of blister; no
Nilkolsky sign; highly communicable; primarily in infants and young children.
Pustular impetigo - a pyogenic staphylococcal infection that has
pus-filled vesicles (pustules), cursting after pustule ruptures
Pustules - a pus-filled vesicles
Folliculitis - a pyogenic staphylococcal infection of hair follicles
Stye - a folliculitis at the base of the eyelid
Furuncles - a folliculitis that extends beyond hair follicles
Carbuncles - furuncles that come together into a single mass
Toxic shock syndrome - a systemic staphylococcal disease that
includes desquamation of skin including palms and soles, fever, hypotension,
macular erythematous rash. The toxin stimulates release of cytokines. This
produces leakage of endothelial cells, which lead to loss of blood volume,
hypovolemic shock, and multiorgan failture.
Methicillin - a synthetic penicillin that is not inactivated by Blactamase. This antibiotic is used to treat staphylococcus.
Describe structure and physiology of staphylococcus
Gram-positive cocci, nonmotile, facultative anaerobes
Cells occur in grapelike clusters
Salt-tolerant
Tolerate salt on human skin
Tolerant of dessication
Survive on environmental surfaces (fomites)
Know that peptidoglycan has
Endotoxin-like activity
Stimulates production of endogenous pyrogen
Activation of complement
Production of IL1 from monocytes
Aggregation of polymorphonuclear leukocytes
What caused the epidemic of toxic-shock symdrome among menstruating
women in 1980?
S. aureus, because it grows exceedingly well in superabsorbent
tampons.
How can toxic-shock syndrome toxin cause toxic-shock syndrome?
The toxin stimulates release of cytokines. This produces leakage
of endothelial cells, which lead to loss of blood volume, hypovolemic shock, and
multiorgan failture.

What are the histologic changes to the jejunum when it is exposed to the
enterotoxins of staphylococus?

infiltration of neutrophils into epithelia and lamina propria of

stomach and jejunum
Loss of brush border in jejunum
Know that staphylococcal food poisoning cause intoxication rather than infection
Name the most commonly contaminated food for staphylococcus
Processed meats (salted meats)
Custard filled pasteries
Potato salad
Ice cream
How do we diagnose staphylococcus?
Detect Gram-positive bacteria in grapelike arrangements isolated
from pus, blood or other fluids
Golden colonies in culture and growth in mannitol-salt agar (MSA)
plates
Positive reactions to coagulase, protein A, heat-stable nuclease,
and mannitol fermentation
What are the treatment of MRSA infection?
Vancomycin, clindamycin, trimethroprim/sulfamethoxazol, or
doxycycline


Chapter 19 - Streptococcus & Chapter 20: Enterococcus
Terms:
Capnophiles - microorganisms that thrive in the presence of high
concentrations of carbon dioxide
Lancefield grouping - a method of grouping catalase-negative,
coagulase-negative bacteria based on the carbohydrate composition of bacterial
antigens found on their cell walls.
Alpha hemolysis - refers to the partial lysis of red blood cells and
hemoglobin. This results in a greenish-grey discoloration of the blood around the
colonies.
Beta hemolysis - the complete lysis of red blood cells and
hemoglobin. This results in complete clearing of the blood around the colonies.
Gamma hemolysis - No hemolysis. This results in no change in
the medium.
Streptococcus pyogenes - the type of streptococcus that forms
white colonies surrounded by zone of beta-hemolysis on blood agar plate. Can
cause suppurative & nonsuppurative diseases. Pathogenic strains often form a
capsule. Are considered group A streptococcus.
Suppurative - the formation or discharge of pus
Hyaluronic acid capsule - an antiphagocytic factor of
streptococcus pyogenes that interferes with opsonization & phagocytosis by
masking bacterial receptors
M protein - an antiphagocytic factor of streptococcus pyogenes
that binds factor H.
Factor H - a regulator of the alternate complement pathway.
Degrade C3b, an opsonin
C5a peptidases - enzymes of streptococcus pyogenes that
inactivates C5a, a chemoattractant of neutrophils and mac
Lipoteichoic acid - a factor of strep. pyogenes that facilitate
binding of host cells by complexing with fatty acid binding sites on fibronectin and
epithelial cells
F protein - an adhesin of strep. pyogenes that interacts with
specific host cell receptors
Streptococcal pyrogenic exotoxins (Spe) - is also called
erythrogenic toxins. This are toxins of streptococcus pyogenes that interact with
macrophages & helper T cells causing an increase of proinflammatory cytokines.
Responsible for clinical manifestations in necrotizing fasciitis, streptococcal toxic
shock syndrome, and rash of scarlet fever
erythrogenic toxins - another term for streptococcal pyrogenic
exotoxins
Streptolysins S - proteins of streptococcus pyogenes that lyse
RBC, WBC, and platelets. Non-immunogenic, oxygen-stable, cell-bound
hemolysin, responsible for the b hemolysis. Stimulate the release of lysosomal
enzymes after engulfment, with subsequent death of phagocytic cell

 Streptolysins O - proteins of streptococcus pyogenes that lyse

RBC, WBC, and platelets. Antibodies are readily formed. Irreversibly inhibited by
cholesterol of skin lipids
Streptokinases (A & B) - proteins of streptococcus pyogenes that
mediate cleavage of plasminogen, releasing plasmin, which degrades fibrin and
fibrinogen. Facilitates rapid spread of microbe in infected areas
Deoxyribonucleases - an enzyme of streptococcus pyogenes
that degrade DNA present in pus. Thus, reduces viscosity of the abscess
material, facilitating spread of the microbes. This is not cytolytic enxyme
Hyaluronidases - an enzyme of streptococcus pyogenes that is
considered spreading factor
Pharyngitis - is also called strep throat. Inflammation of the
posterior walls of pharynx. Period of incubation (PoI) = 2-4 d. Can be caused by
streptococcus pyogenes
Scarlet fever - the disease that is caused by streptococcus
pyogenes that diffuse erythematous rash that begins on the chest and spreads
across the body, blanches when pressed, disappears in a week followed by
desquamation. Circumoral pallor around the mouth;strawberry tongue; PoI = 1-2d
after pharyngitis
Strawberry tongue - a swollen, red tongue
Circumoral pallor - refers to a white area around the mouth,

contrasting vividly with the color of the face.

Pyoderma - is a confined, pus-producing leasion that usually
occurs on the exposed skin of the face, arms, or legs. Organisms are introduced
by a break in the skin (i.e., scratch, insect bite). Vesicles develop, followed by
pustules, then rupture and crust. Lymph nodes enlarged; systemic sign such as
fever are uncommon. One cause is streptococcus pyogenes
Erysipelas - the condition that occurs when a pyoderma also
involves surrounding lymph nodes and triggers pain, inflammation, and systemic
signs (chills, fever, leukocytosis); it is common in childrens faces
Streptococcal toxic shock syndrome - a streptococcus disease
that involves soft tissue inflammation at site of infection; fever, chills, nausea,
vomiting, diarrhea; disease progress to shock and severe multiple organ system
failure; in contrast with staphylococcal disease, streptococcal disease has
bacteremia and necrotizing fasciitis
Bacteremia - the presence of bacteria in the blood
Necrotizing fasciitis - a streptococcus pyogenes disease. Toxin
production destroys tissues (necrosis) and eventually muscle and fat tissue
(flesh eating bacteria); organism is introduced by a break in skin (minor cut,
vesicular viral infection, burn, surgery); multi-organ failure and death are
hallmarks. Treatments: antibiotic therapy and surgical debridement of infected
tissue
Steptococcal gangrene - an unusual form of necrotizing fasciitis with
fatal outcome

Rheumatic fever - a non-suppurative complication of S.

pyogenes pharyngitis. Inflammatory changes in heart, joints, blood vessels, and

subcutaneous tissue. Pancarditis, subcutaneous nodules, arthralgias, arthritis,

and damage to heart valves (specifically mitral AV valve). Class I M protein is
responsible for rheumatic fever. Dx: positive throat culture, group A antigen in
throat swabs, elevated anti-ASO, anti-Dnase, or anti-hyaluronidase antibodies
(absence is a strong evidence against rheumatic fever);antibiotic prophylaxis is
needed to prevent recurrence of the disease
Class I M protein - protein that is responsible for rheumatic fever
antibiotic prophylaxis - refers to the prevention of infection
complications using antimicrobial therapy
Glomerulonepritis - a non-suppurative complication of S.
pyogenes pharyngeal and pyodermal streptococcal infections. Acute
inflammation of the renal glomeruli and nephrons which obstruct blood flow
through the kidneys. Edema, hypertension, hematuria, and proteinuria;
progressive irreversible loss of renal function in adults
PYR test - measure hydrolysis of substrate PYR to test for group
A streptococcus
Streptococcus agalactiae - a group B streptococcus. Has groupspecific cell wall antigens. Form large buttery colonies. Smaller zone of betahemolysis. Resistant to bacitracin. Normally colonizes the lower gastrointestinal,
genital and urinary tracts
Polysaccharide capsule - Interferes with phagocytosis until
specific antibodies are developed. This explains their predilection for neonates. In
the absence of maternal antibodies (no breast feeding), the neonatal is at risk.
Often infects newborns without specific antibodies and whose mothers are
uninfected (and so, do not provide passive immunity)
Sialic acid - presence in some of the capsular polysaccharides,
inhibits activation of the alternate complement pathway, thus interfering with
phagocytosis
Neonatal bacteremia - invasive infection occurring during the
neonatal period
Septicemia - another term for bacteremia, meaning infection of
the blood
Endometritis
ELISA test - used to identify group B streptococcus
CAMP test - used to identify CAMP factor. Group B streptococci
produce a diffusible protein called CAMP factor. CAMP factor enhances the b
hemolysis of sphingomyelinase C by S. aureus. This creates an arrowhead in the
blood agar
Hippurate - an enzyme produced by S. agalactiae
Penicillin G - is the drug of choice to treat streptococcus
agalactiae
Viridan group - streptococci that are alpha-hemolytic. Many
produce a green pigment when grown on blood media. Inhabit mouth, pharynx,
GI tract, genital tract, and urinary tract. One cause of dental caries and dental
plaques. If enter the blood can cause meningitis and endocarditis

 Streptococcus pneumoniae - the most virulent member of

viridan streptococci. Encapsulated Gram-positive cocci that most commonly form
pairs or short chains. Form unpigmented, alpha-hemolytic colonies on blood agar
(anaerobic incubation produces beta-hemolytic colonies). Alpha-hemolytic
appearance is due to pneumolysin, an enzyme that degrades hemoglobin
producing a green product. Catalase negative. Normally colonizes the mouths
and pharynx but can cause disease if travels to the lungs. Disease is highest in
children and the elderly
Surface protein adhesin a virulence factor of streptococcus
pneumoniae that that bind to epithelial cells of oropharynx
IgA protease - a virulence factor of streptococcus pneumoniae
that destroy IgA. IgA traps bacteria in mucin by attaching Fc region to mucin &
Fab to bacteria
Pneumolysin - a virulence factor of streptococcus pneumoniae
that binds to cholesterol in host cell membranes and creates pores and lysis.
Activates the classical complement pathway producing C3a and C5a, inducers of
chemotaxis and inflammation
Teichoid acid - activate alternate complement pathway producing
C5a, which mediates the inflammatory process
Amidase - An enzyme that releases cell wall components
increasing cell destruction
Hydrogen peroxide - a virulence factor of streptococcus
pneumoniae that produced by S. pneumoniae lead to tissue damage by Reactive
oxygen species
Phosphocholine - a virulence factor of streptococcus
pneumoniae that is present in bacterial cell wall, can bind to receptors of
endothelial cells, WBC, platelets, and tissue cells and entering cells to avoid
opsonization and phagocytosis
Pneumococcal pneumonia - a disease caused by streptococcus
pneumoniae. This disease results when bacteria multiply in the alveoli of the
lower lung causing damage to the alveolar lining and producing an inflammatory
response. Patients usually have symptoms of viral respiratory tract infection 1-3
days before the onset. Productive cough; Pleurisy. Since it is associated with
aspiration, infection generally localized in lower lobes lobar pneumonia.
Pleurisy - involves inflammation of the tissue layers (pleura) lining
the lungs and inner chest wall
Pneumococcal meningitis - a disease caused by streptococcus
pneumoniae. Bacteria that have spread to the meninges after bacteremia,
infections of the ear and/or sinuses, and trauma of head that cause a
communication between subarachnoid space and nasopharynx. This disease is
uncommon in neonates
& it is the leading cause of disease in children and adults
Quellung reaction - a biochemical reaction in which antibodies
bind to the bacterial capsule of Streptococcus pneumoniae, Klebsiella
pneumoniae, Neisseria meningitidis, Haemophilus influenzae, Escherichia coli,
and Salmonella.

Pneumococcal C polysaccharide - an antigen of streptococcus

pneumoniae
Bile solubility test - distinguishes Streptococcus pneumoniae
from all other alpha-hemolytic streptococci.
Optochin - chemical that is toxic to some bacteria but harmless to
others. It is useful in the identification of Streptococcus pneumoniae.
Enterococcus - previously classified as Group D steptococci.
Reclassified as separate genus because the lacks of capsule, gas production
during fermentation of sugars, and gamma hymolytic colonies when grown on
blood agar. Is found in human colon. form s pairs or short chains. Its growth
conditions inhibit the growth of Streptococcus
Describe the unique characteristic of streptococcus
Gram-positive cocci, facultative anaerobes
Arranged in pairs or chains
Some are capnophiles
Require blood or a serum-enriched media
Carbohydrates are fermented resulting in lactic acid production
Catalase negative
Know how we classify the genus Streptococcus
Lancefield grouping
Based on cell wall carbohydrates acting as
antigens
Lancefield groups A through W
Groups A and B include the significant human
pathogens
Hemolytic pattern
Alpha hemolysis
Beta hemolysis
Gamma hemolysis
Biochemical (physiologic) properties
Describe the characteristics of steptococcus pneumoniae
Know how to diagnose & the treatment of streptococcus pyogenes
Diagnosis
Gram-positive bacteria in short chains or pairs
Streptococci are not part of normal microbiota of skin, thus Gram
+ cocci in pairs and/or chains, plus leukocytes is strong indication of positive
diagnosis
In contrast, streptococci are normally in the pharynx (thus, not
diagnostic)
Bacitracin susceptible (group A streptococcus)
PYR test (group A streptococcus)
Measures hydrolysis of substrate L-pyrrolidonyl-b-naphthylamide
(PYR)
b-naphthylamide + DMACA reagent forms a red compound
Know the treatment of streptococcus pyogenes
Penicillin is very effective
Cephalosporin for allergic persons to penicillin
If infection gets mixed with S. aureus, then treatment is better
with oxacillin or vancomycin

 Antibiotic therapy does not alter the course of glomerulonephritis

Know how to prevent streyptococcs pyogenes disease
Antibodies against M protein provide long-term protection against
S.pyogenes, but only if it is the same strain
Long term antibiotic prophylaxis for patients with history of
rheumatic fever
Since recurrent glomerulonephritis is not observed, prophylactic
antibiotic therapy is not indicated
Know the hydrolysis of hippurate can be used to diagnose streptococcus
agalactiae
What are the treatments for Streptococcus agalactiae?
Penicillin G is the drug of choice
MIC is approximately 10 times greater than that for S. pyogenes
Combination with an aminoglycoside is recommended
Vancomycin is a good alternative
Know that otitis is common in young children & bacterial sinusitis is found in all
age groups.
Know that bacteria is absent in blood of patients with sinusitis or otitis media
What are the treatments for Streptococcus pneumoniae?
Penicillin
Resistance strains have been reported
Use fluoroquinolone or vancomycin combined with ceftriaxone
How to prevent Streptococcus pneumoniaes disease?
Anticapsular vaccine
23-valent pneumococcal polysaccharide vaccine is recommended
for children older than 2 years old and adults
Very young children respond poorly
How to diagnose Enterococcus?
Gram +, diplococcus
Gram staining of Enterococcus looks similar to one
of S. pneumoniae
Catalase negative
Usually b hemolysis
PYR positive
The only Streptococcus that is PYR positive is S.
pyogenes
It is not dissolved when exposed to bile
Resistant to optochin
What are the treatment of Enterococcus?
Difficult to treat because Enterococci often resistant to most commonly used
antimicrobials
Ideal Tx is a synergistic combination of aminoglycoside and a cell wall inhibitor
25% of Entercocci are resistant to aminoglycosides
100% of E. faecium are resistant to ampicillin
The majority of E. faecium are resistant to vancomycin
Newer antibiotics are needed