V. A.

Bacterial Diseases

A. Airborne Bacterial Diseases B. Foodborne & Waterborne Bacterial Diseases C. Soilborne Bacterial Diseases D. Arthropodborne Bacterial Diseases E. Sexually Transmitted Bacterial Diseases F. Miscellaneous Bacterial Diseases

V. A.

Airborne Bacterial Diseases

1. Streptococcal Diseases

2. Diphtheria
3. Pertussis 4. Meningococcal Infections

5. Haemophilus influenzae Infections

6. Tuberculosis 7. Pneumococcal Pneumonia

8. Primary Atypical Pneumonia

9. Legionellosis

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V. A. 1. Streptococcal Diseases
Properties of the Genus Streptococcus
General Properties
Gram-positive Cocci in Chains or Pairs Catalase Negative

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V. A. 1. Streptococcal Diseases
Properties of the Genus Streptococcus (cont.)
Hemolytic Reactions
Detected by Blood Agar Cultures
Beta Hemolysis
Complete Hemolysis

Clear Zone Around Colonies on Blood Agar

Alpha Hemolysis
Incomplete Hemolysis Greenish Zone Around Colonies on Blood Agar

Gamma Reaction
Absence of a Hemolytic Reaction No Change Around Colonies on Blood Agar
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V. A. 1. Streptococcal Diseases
Properties of the Genus Streptococcus (cont.)
Lancefield Groups
Based on Serological Groupings Also may be distinguished by Biochemical Testing or Antibiotic Sensitivity Group A
Streptococcus pyogenes The most virulent human pathogen of the genus Beta hemolytic Often identified by rapid serological tests or by antibiotic resistance
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V. A. 1. Streptococcal Diseases
Properties of the Genus Streptococcus (cont.)
Lancefield Groups (cont.)
Group B
Streptococcus agalactiae

Mildly to moderately virulent; esp. in children & elderly

Usually beta or alpha hemolytic; some strains are gamma

Detected biochemically

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V. A. 1. Streptococcal Diseases
Properties of the Genus Streptococcus (cont.)
Lancefield Groups (cont.)
Group D
Includes the fecal streptococci (enterococci)

Normal colon flora in humans & other animals

Genus Enterococcus Several species; eg. Enterococcus faecalis Occasionally pathogenic; often in urinary tract infections Usually gamma reactive Detected biochemically
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V. A. 1. Streptococcal Diseases
Diseases Associated with Streptococcus pyogenes
Respiratory Symptoms
Upper Respiratory Tract Pharyngitis

Systemic Symptoms
Septicemia Internal infections

Scarlet fever Due to strains that produce an erythrogenic toxin

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V. A. 1. Streptococcal Diseases
Diseases Associated with Streptococcus pyogenes (cont.)
Immune-Related Complications
Rheumatic fever

Glomerulonephritis

Other Conditions/Portals of Entry

Erysipelas Necrotizing fasciitis Puerperal sepsis
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V. A. 2. Diphtheria
Cause: Corynebacterium diphtheriae
Properties of the Genus Corynebacterium
Gram-positive rods; non-sporeforming Coryneform (diphtheroid) arrangement

Snapping division
Metachromatic Granules Several different species

Frequently found in soil & in the skin flora

Only virulent strains of Corynebacterium diphtheriae are considered pathogenic
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V. A. 2. Diphtheria
Cause: Corynebacterium diphtheriae
Properties of Corynebacterium diphtheriae
Virulent strains contain a extra gene that encodes for the diphtheria exotoxin The exotoxin is a cytotoxin that inhibits protein synthesis -- kills host cells

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V. A. 2. Diphtheria
Transmission & Symptoms
Airborne; contact with infected persons Upper Respiratory Infection

Pseudomembrane Formation
May Spread into Bloodstream Cardiovascular damage Vaccination with diphtheria toxoid vaccine

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V. A. 3. Pertussis
Cause: Bordetella pertussis
Gram-negative aerobic rod Found among the respiratory flora of humans & other animals

Transmission and Symptoms

Airborne contact with infected persons
Upper respiratory tract infection; may be severe in children & elderly

Difficulty breathing; staccato cough (whooping cough)

Usually does not spread into bloodstream
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V. A. 4. Meningococcal Infections
Cause: Neiserria meningitidis
Properties of the Genus Neiserria
Gram-negative cocci in pairs Several species; some of which are normal colon flora Fastidious nutritional requirements Grow best on chocolate agar

Notable pathogenic species

Neiserria meningitidis Neiserria gonorrhoeae
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V. A. 4. Meningococcal Infections
Transmission & Symptoms
Airborne contact with infected persons
Often associated with children & with persons in close or crowded quarters eg. schools, daycare, etc.

Upper respiratory tract symptoms Septicemia Meningitis

Headache and stiff neck Listlessness; dizziness; disorientation
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Seizures; coma; death

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V. A. 5. Haemophilus influenzae Infections

Cause: Haemophilus influenzae
Properties of the genus Haemophilus
Gram-negative rod

Facultatively anaerobic
Fastidious -- requires chocolate agar for growth Several species; common among the respiratory flora

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V. A. 5. Haemophilus influenzae Infections

Cause: Haemophilus influenzae (cont.)
Notable species
Haemophilus influenzae: Several strains; common in the upper respiratory tract. Type b is associated with some cases of bacterial meningitis; type III is sometimes the cause of certain eye infections

Haemophilus ducreyii: Causative agent of chanchroid

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V. A. 5. Haemophilus influenzae Infections

Transmission & Symptoms
Infections most frequently associated with the virulent strain, type b Upper respiratory tract symptoms
Rhinitis and Sinusitis Otitis media

Epiglottitis

Septicemia and Meningitis Prevented by HIB vaccine

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V. A. 6. Tuberculosis
Cause: Mycobacterium tuberculosis
Properties of the genus Mycobacterium
Acid-fast rods Grow slowly; some species are difficult to culture Several species; some found in soil and among skin flora

Major pathogenic species:

Mycobacterium tuberculosis Mycobacterium avium-intracellulare Mycobacterium cheloni Mycobacterium scrofulaceum Mycobacterium leprae
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V. A. 6. Tuberculosis
Transmission & Symptoms
Transmission
Airborne Contact

Prolonged Exposure
Occasionally via skin contact or wounds

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V. A. 6. Tuberculosis
Transmission & Symptoms (cont.)
Symptoms
Lung Infection Destruction of alveoli

Cough; sputum
Tubercle Formation May remain dormant for years and then become active again May spread to other areas of the body: Miliary TB
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V. A. 6. Tuberculosis
Transmission & Symptoms (cont.)
Detection:
Microscopic examination Chest X-Ray

Culture
Tuberculin Skin Test

TB Vaccination

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V. A. 7. Pneumococcal Pneumonia
Cause: Streptococcus pneumoniae
Properties of the Genus -- See Earlier Notes
Formerly Known as Diplococcus pneumoniae No Lancefield classification Gram-positive diplococci; virulent strains are encapsulated Alpha Hemolytic A common cause of secondary bacterial pneumonia
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V. A. 7. Pneumococcal Pneumonia
Transmission & Symptoms
A frequent cause of secondary bacterial pneumonia Airborne transmission Lower Respiratory Tract Infection Pneumonia

Fluid Buildup in Lung

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V. A. 8. Primary Atypical Pneumonia

Cause: Mycoplasma pneumoniae
Properties of the Genus Mycoplasma
Small, irregular cells

Naturally cell wall deficient

Several species Common among respiratory flora in humans & other animals

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V. A. 8. Primary Atypical Pneumonia

Transmission & Symptoms
Airborne Transmission May be opportunistic

Frequently causes mild cases of primary pneumonia

Mycoplasma pneumoniae may also cause severe secondary pneumonia in immunocompromised patients
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V. A. 9. Legionellosis
Cause: Legionella pneumophila
Properties of the genus Legionella
Gram-negative rods Strictly aerobic

Found in highly aerated, moist environments eg. streams

May parasitize certain aquatic protozoa

Can contaminate building ventilation systems, air filters, etc.

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V. A. 9. Legionellosis

Transmission & Symptoms

Airborne Contact with infected persons or environments Mild to Moderate Pneumonia

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V. B.

Foodborne & Waterborne Bacterial Diseases

1. Foodborne Intoxications vs Infections

2. Botulism
3. Staphylococcal Food Poisoning 4. Clostridial Food Poisoning

5. Typhoid Fever
6. Salmonellosis 7. Shigellosis

8. Cholera
9. Diseases associated with Escherichia coli 10. Camphylobacteriosis and Helicobacteriosis
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V. B. 1. Foodborne Intoxications vs Infections

Foodborne intoxications: Caused by the exotoxin secreted by bacteria in contaminated food
Foodborne infections: Caused by the ingestion of live bacteria that colonize the digestive tract

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V. B. 2. Botulism
Cause: Clostridium botulinum
Properties of the genus Clostridium
Gram-positive rod Strictly anaerobic

Spore-former
Widely distributed, especially in soil

Important species:
Clostridium botulinum Clostridium perfringins Clostridium tetani
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V. B. 2. Botulism
Transmission & Symptoms
Transmitted via contaminated food

Botulinum toxin:
A neurotoxic exotoxin Heat sensitive Inhibits synaptic transmission at motor neuron end plates Causes flaccid paralysis

Very deadly: Death due to respiratory & cardiac failure

Treatment: Administration of antitoxin
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V. B. 2. Botulism
Transmission & Symptoms (cont.)
Other mechanisms of transmission:
Wound botulism

Animal botulism
Infant botulism

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V. B. 3. Staphylococcal Food Poisoning

Cause: Staphylococcus aureus
Properties of the genus Staphylococcus
Gram positive coccus in clusters Catalase positive

Two major species

Staph. aureus is more virulent & is coagulase positive

Staph epidermidis is more common & is coagulase negative

Both are common skin & upper RT flora
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V. B. 3. Staphylococcal Food Poisoning

Transmission & Symptoms
Certain strains of Staph. aureus: Produce staphylococcal enterotoxin Toxin is secreted in contaminated food Causes abdominal pain, nausea, diarrhea, for a few hours

Staph. aureus enterotoxin is unusually heat-resistant

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V. B. 4. Clostridial Food Poisoning

Cause: Clostridium perfringins
Certain strains secrete an enterotoxic exotoxin

Transmission & Symptoms

Similar to staphylococcal food poisoning, except that the clostridial enterotoxin is not as heat-stable

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V. B. 5. Typhoid Fever
Cause: Salmonella typhi
Properties of the genus Salmonella
A member of the family Enterobacteriaceae Colon flora; sometimes carried asymptomatically Gram negative rods Facultatively anaerobic

Salmonella typhi
Most virulent member of the genus

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V. B. 5. Typhoid Fever
Transmission & Symptoms
Transmission via oral route
often associated with contact with infected persons, either symptomatic or carriers sewage flies

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V. B. 5. Typhoid Fever
Transmission & Symptoms
Invades intestinal epithelium tissue
ulceration bloody stools but little diarrhea

Blood invasion
fever; delirium blood vessel hemorrhaging

rose-colored spots on the abdomen

bowel perforation gall-bladder infection
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V. B. 6. Salmonellosis
Cause: Salmonella serotypes
Serotypes of the genus Salmonella other than S. typhi Hundreds of serotypes; species names exist but are often not reported Examples
Salmonella enteriditis Salmonella gallinarum Salmonella typhimurum
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V. B. 6. Salmonellosis
Transmission & Symptoms
Contaminated food
Meat Poultry products

Dairy products

Gastroenteritis
Cramps

Nausea
Vomiting Diarrhea
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V. B. 7. Shigellosis
Cause: Shigella species
Genus Shigella
A member of the family Enterobacteriaceae
Colon flora; sometimes carried asymptomatically Gram negative rods

Facultatively anaerobic

Species
Shigella sonnei Shigella dysenteriae Shigella flexneri Shigella boydii
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V. B. 7. Shigellosis
Transmission & Symptoms
Transmission:
Similar to salmonellosis

Gastroenteritis
Often with watery diarrhea Sometimes with bloody stools: Dysentery

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V. B. 8. Cholera
Cause: Vibrio cholerae
Genus Vibrio
Gram-negative curved bacteria comma-shaped facultatively anaerobic Normal flora in many animals

Notable Pathogenic Species

Vibrio cholerae Vibrio parahaemolyticus
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V. B. 8. Cholera
Transmission & Symptoms
Transmission:
Contaminated food
shellfish

vermin livestock

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V. B. 8. Cholera
Transmission & Symptoms (cont.)
Gastroenteritis with extensive severe diarrhea
Cholera enterotoxin Toxin blocks water reabsorption by inhibiting the anion active transport mechanism in large intestinal epithelium Rice water stools

Dehydration & death

Recent epidemic due to spread of new drugresistant strain

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V. B. 9. Diseases associated with Escherichia coli

Cause: Escherichia coli
Family Enterobacteriaceae Gram-negative rods Facultatively anaerobic Widely distributed among humans & animals Normal colon flora

Used as indicator of water & food contamination

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V. B. 9. Diseases associated with Escherichia coli

Transmission & Symptoms
Oral route
Extremely common normal flora

Different strains in different geographical regions

Colonize gut in infancy

Infantile diarrhea Traveler's diarrhea

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V. B. 9. Diseases associated with Escherichia coli

Transmission & Symptoms (cont.)
E. coli strain O157:H7
A rare, particular virulent & deadly strain Hemorrhagic E. coli disease Kidney damage in children

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V. B. 10.

Camphylobacteriosis and Helicobacteriosis

Camphylobacter jejuni
Gram-negative spirillum Microaerophilic Normal flora of colon Common cause of mild to moderate gastroenteritis

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V. B. 10.

Camphylobacteriosis and Helicobacteriosis

Helicobacter pylori
Gram-negative spirillum Microaerophilic Can colonize the stomach lining underneath the protective mucous layer Stomach irritation and ulcers

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V. C.

Soilborne Bacterial Diseases

1.
2.

Anthrax
Tetanus

3.
4. 5.

Gas Gangrene
Leptospirosis Listeriosis

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V. C. 1. Anthrax
Cause: Bacillus anthracis
Genus Bacillus Gram-positive rods

Facultatively anaerobic
Spore-forming Widely distributed in soil Many species; Bacillus anthracis is the most important human pathogen of the group
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V. C. 1. Anthrax
Transmission & Symptoms
Transmission
Contact with contaminated soil Livestock Through skin; wounds; abrasions Also through oral route or airborne

Skin anthrax Intestinal anthrax Pulmonary anthrax; Woolsorters disease

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V. C. 2. Tetanus
Cause: Clostridium tetani
Genus properties: See Botulism

Transmission & Symptoms

Wounds; esp. deep or puncture wounds Tetanospasmin: A neurotoxic exotoxin
Acts as a cholinesterase inhibitor
Short-circuits nerve synapses; esp. in the central nervous system

Causes rigid paralysis

Treatment: Antitoxins plus muscle relaxants Prevention: Vaccination with tetanus toxoid
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V. C. 3. Gas Gangrene
Often caused by Clostridium perfringins
Genus properties: See Botulism

Transmission & Symptoms

Wounds; esp. deep wounds Gangrene:
Tissue death due to reduced oxygen to tissue

Gas or moist gangrene: Gangrene accompanied by bacterial infection

Swelling; tissue death; blackish discoloration
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V. C. 4. Leptospirosis
Cause: Leptospira interrogans
A spirochete

Found in soil contaminated with animal waste

Transmission & Symptoms

Contact with contaminated soil or animals
Often enters through the feet

Spreads to several organs, including liver, kidney, meninges Jaundice may be present May have bloody vomit
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V. C. 5. Listeriosis
Cause: Listeria monocytogenes
Genus Listeria Small Gram-positive rods

Non-sporeforming
Found in soil; esp in soil contaminated with animal waste

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V. C. 5. Listeriosis
Transmission & Symptoms
Contact with contaminated soil Also possibly transmitted via contaminated food

Listeric meningitis
Blood infection with high white count Uterine infections; miscarriage or congenital damage

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V. D.

Arthropodborne Bacterial Diseases

Plague
Lyme Disease Rocky Mt. Spotted Fever Epidemic Typhus Endemic Typhus

1.
2. 3. 4. 5.

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V. D. 1.

Plague

Cause: Yersinia pestis

Gram-negative, facultatively anaerobic rods in Family Enterobactereaceae; however, not normally found in colon Characterized by bipolar staining

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V. D. 1.

Plague

Transmission & Symptoms

Vector: Fleas, esp. rodent fleas
Bubonic plague: Infection of lymph node tissue; swelling; hemorrhaging; buboes

Septicemic plague
Pneumonic plague Cases of airborne transmission among humans have been noted

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V. D. 2.

Lyme Disease

Cause: Borrelia burgdorferi

A spirochete Transmitted by deer ticks First noted in Northeastern US

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V. D. 2.

Lyme Disease

Transmission & Symptoms

Vector: Ticks of the genus Ixodes (deer ticks); may be transmitted by both immature & mature ticks Incubation period of several weeks Initial symptoms
Flu-like symptoms Rash: Erythema chronicum migrans (ECM)

Several weeks/months later

Joint pain/swelling Arthritis-like symptoms Cardiovascular & nervous system damage
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V. D. 3. Rocky Mt. Spotted Fever

Cause: Rickettsia rickettsii
A rickettsia: Small, gram-negative bacterium Obligately intracellular parasite Detected by serological testing, eg. the Weil-Felix test (Reaction of serum to Proteus OX19)

Transmission & Symptoms

Vector: Ticks Macropapipular rash begins on palms & soles then spreads to other parts of the body High fever & other flu-like symptoms
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V. D. 4.

Epidemic Typhus

Cause: Rickettsia prowasekii

Genus properties: See Rocky Mt. Spotted Fever

Transmission & Symptoms

Vector: Human Louse
Epidemics; often in areas with reduced sanitation High fever; high fatality rate Rash begins on trunk of body & spreads to extremities
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V. D. 5.

Endemic Typhus

Cause: Rickettsia typhi

Genus properties: See Rocky Mt. Spotted Fever

Transmission & Symptoms

Vector: Fleas; esp. rodent fleas Endemic in many areas Often with mild or no symptoms

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V. E.

Sexually Transmitted Bacterial Diseases

Syphilis Gonorrhea

1. 2.

3.
4.

Chlamydia
Chanchroid

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V. E. 1.

Syphilis

Cause: Treponema pallidum

A spirochete Cannot be cultured on lab medium Detected microscopically or serologically

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V. E. 1.

Syphilis

Transmission & Symptoms

Transmission: Sexual contact or congenitally

Primary Syphilis
Few days after contact
Hard Chancre

Secondary Syphilis
Several weeks after chancre disappears
Fever; flu-like symptoms Rash

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V. E. 1.

Syphilis

Transmission & Symptoms (cont.)

Tertiary Syphilis
Months or years later Gummae: Lesions on skin & mucous membranes Damage to internal organs Cardiovascular & central nervous system damage

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V. E. 2.

Gonorrhea

Cause: Neiserria gonorrhoeae

Genus Properties: See Neiserria meningitidis

Transmission & Symptoms

Transmission: Sexual contact or congenital Urinary Tract Symptoms
Urethritis: Burning sensation; discharge Cystitis; kidney infection

Male Reproductive Tract Symptoms

Prostatitis Inflammation of epididymis & testes; sometimes sterility
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V. E. 2.

Gonorrhea

Transmission & Symptoms (cont.)

Female Reproductive Tract Symptoms
Uterine Infections Fallopian Tube inflammation; blockage; occasional sterility Pelvic Inflammatory Disease

Other Infections
Gonococcal Eye Infections Respiratory Tract Infections

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V. E. 3.

Chlamydia

Cause: Chlamydia trachomatis

Genus Properties
A small, Gram-negative bacterium

Obligately intracellular parasite; similar to Rickettsia

Occasionally carried subclinically as part of the normal vaginal flora

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V. E. 3.

Chlamydia

Transmission & Symptoms

Very similar to gonorrhea: Often mistaken for gonorrhea
Important to distinguish because the treatment is different from gonorrhea Identified by serological testing Transmission: Sexual contact or congenital Urinary and Reproductive Tract Symptoms Respiratory Tract and Eye Infections
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V. E. 4.

Chanchroid

Cause: Haemophilus ducreyii

Genus Properties: See Haemophilus influenzae
Haemophilus ducreyii is occasionally found among the vaginal flora or under the prepuce in males

Transmission & Symptoms

Transmission: Sexual contact Symptoms
Painful soft chancre; sometimes mistaken for syphilis Urethritis; occasional pelvic inflammation
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V. F.

Miscellaneous Bacterial Diseases

Leprosy Staphylococcal Infections

1. 2.

3.

Pseudomonas aeruginosa Infections

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V. F. 1.

Leprosy

Cause: Mycobacterium leprae

Genus Properties: See Tuberculosis Cannot be cultured; detected by skin biopsy

Transmission & Symptoms

Skin contact; not particularly contagious
Whitish skin lesions Loss of sensation due to nerve damage Disfiguration

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V. F. 2. Staphylococcal Infections
Cause: Staphylococcus aureus
Genus Properties: See Staph. Food Poisoning

Transmission & Symptoms

Skin contact; opportunistic Skin Infections
Acne; boils; pimples Abscesses; carbuncles Impetigo Scalded Skin Syndrome

Toxic Shock Syndrome

Septicemia & High fever
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V. F. 3. Pseudomonas aeruginosa Infections

Cause: Pseudomonas aeruginosa
Genus Pseudomonas
Gram-negative rods

Nonfermentative metabolism
Most species are strictly aerobic Widely distributed in aquatic & moist soil environments Can contaminate moist aerated surfaces: water faucets; respiration equipment
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V. F. 3. Pseudomonas aeruginosa Infections

Transmission & Symptoms
Frequently an opportunistic or a nosocomial infection Respiratory tract infections Urinary tract infections Infections in burn patients

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