Staphylococcus

General characteristics
Gram positive spherical cells arranged in grape-like clusters normally grow on skin and mucous membrane non-motile non spore-forming facultative anaerobes active fermenters produce pigment hence colonies appears white to deep yellow

Virulence Factors
Toxins Exotoxins - Cause necrosis Alpha toxin (hemolysin) Beta toxin - Degrades sphingomyelin and RBC Leukocidin Exfoliative toxin Toxic shock syndrome toxin Enterotoxins

Virulence factors
Enzymes Coagulase - Clots plasma Catalase - Converts hydrogen peroxide into water and oxygen Others: hyaluronidase or spreading factor, staphylokinase (fibrinolysis), lipases, nucleases

Pathology
Cutaneous infections
Characterized by suppuration (abscess) E.g. acne, impetigo, scalded skin syndrome Heals quickly when pus is drained Spread via the blood and lymphatics to other parts of the body causing:
Pneumonia Meningitis Osteomyelitis Bacteremia

Impetigo

Pathology
Food poisoning -Incubation period: 1-8 hrs -S/S: nausea, vomiting, diarrhea, no fever

Pathology
Toxic Shock Syndrome (TSS) - Common in menstruating women with tampons S/S: Fever, vomiting, diarrhea, hypotension, rash, multiple organ system involvement

Clinical Findings
Staphylococcus aureus Staphylococcus epidermidis
- causes cutaneous infections, food poisoning, toxic shock syndrome - causes infection on prosthetic devices

Staphylococcus saprophyticus
causes urinary tract infections

Laboratory Diagnosis
Culture
Blood agar Manittol Salt Agar (MSA)

Catalase Test Coagulase Test Serological And Typing Tests

Epidemiology
Ubiquitous - Mode of transmission: droplets, lesion drainage - Control:
cleanliness, hygiene and aseptic management of lesions aerosols ultraviolet irradiation antiseptics

Treatment
Penicillin G Vancomycin

Blood Agar Medium

Purpose: To determine the ability to lyse RBC Principle: Types of hemolysis: Alpha - incomplete or partial hemolysis (with greening) Beta - complete lysis (with colorless, clear zone) Gamma - non-hemolytic

Hemolysis on Blood Agar Medium

Manittol Salt Agar (MSA)

Purpose: Selective and differential medium for
the isolation of Staphylococcus sp.

Principle: Contains high level of NaCl, mannitol

and phenol red indicator

Interpretation:
Growth without fermentation: plate is pink or red with no yellow halo surrounding growth Growth with fermentation: yellow halos surrounding growth

MSA

Catalase Test
Purpose: To determine the ability to
convert hydrogen peroxide into water and oxygen

Principle: To differentiate
Interpretation

Staphylococcus (+) from Streptococcus (-)

(+): rapid and continuous bubble (-): lack of bubble formation 30 seconds later

Catalase Test

Coagulase Test
Purpose: Differentiates S. aureus (+) from
S. epidermidis and S. saprophyticus (-)
fibrin (clot)

Principle: Coagulase converts fibrinogen to Interpretation

(+): formation of fibrin clot (-): no clot formation

Coagulase Test
Two forms of coagulase:
Bound (clumping factor) - detected in coagulase slide test

Free - detected in coagulase tube test

 Procedures
Coagulase Slide Test Place a drop of plasma on a slide Place a drop of sterile saline or distilled water on a separate area of the slide. Using a sterile inoculating loop, emulsify a suspension of the organism on the saline or water. This is the negative control. Emulsify a suspension of the organism in the plasma. Coagulase Tube Test Add 0.5 ml of plasma on a sterile test tube. Add one loopful of the organism or 0.1 ml of the broth Incubate at 35-37OC for 4 hrs

Coagulase Test