Studied by 9 people
bordetella parapertussis
less severe whooping cough in children with a shorter duration
brownish discoloration on media
b. bronchiseptica
opportunistic pathogen for pneumonia and wound infections
kennel cough in dogs (vaccine required)
milder symptoms, grows on MAC
b. pertussis/parapertussis transmission
aerosols (bacteria adhere/grow on ciliated resp epi cells
highly contagious: 90% exposed contract disease; adults can be transient carriers
b. pertussis/parapertussis virulence factors
FHA: attach to epi cells
pertussis toxin (PT): inc cAMP = inc resp secretions/mucus
adenylate cyclase toxin: inc cAMP, inhibits chemotaxis, phagocytosis
tracheal cytotoxin: ciliostasis (cilia cannot clear airway)
whooping cough
1-2wks incubation period
catarrhal: flu like, sneezing, runny nose 1-2 wks; highly contagious
paroxysmal: sudden, severe cough followed by whoop
inc lymphs (looks like viral or leukemia)
in kids: cyanosis, very serious, need help breathing
convalescent: 4 wks after symptoms; dec coughing but can be wks-mos before recovery
what specimen is needed for whooping cough dx?
nasopharyngeal: aspirate of fluid
calcium alginate or dacron swabs as deep as possible
cotton oils toxic to bordetella
how to culture bordetella?
bordet gengou: potato infusion + glycerol + sheep blood
regan lowe agar: charcoal with 10% horse blood, cephalexin
also BAP, MAC, CHOC (r/o haemophilus)
incubate 35C, no CO2, 7 days, adequate moisture with gauze
morphology of b. pertussis
GN rods/ccb
bordet gengou: small, domes, glistening (bisected pearls) often beta
regan lowe: smooth, silver, pinpoint (mercury droplets)
DFAs
b. pertussis: used for confirmation; requires larger amt of organism for agglutiantion test
francisella: safer
legionella: can cross react with p. aeruginosa
how to treat b. pertussis
1 month: erthryomycin, clarithromycin, azithromycin
<1 month: azithromycin (erythro assoc with infantile hypertrophic pyloric stenosis)
STX alternative for > 2months
brucellosis (undulant fever)
reoccurring fever at regular intervals for days/mos/yrs
fever at night that goes away during day
wt loss
acquired from livestock contact (unpasteurized milk)
transmission of brucella
undercooked meat, unpasteurized/raw milk
breathing in bacteria (dust, droplets) (lab workers)
thru skin wounds/abrasions/mucous membranes
slaughterhouse, meat packing, veterinarians
b. melitensis
goats/sheep
most common isolate
severe disease, acute suppurative, granulomatous lesions
thionin and fuchsin
b. abortus
cattle
mild sporadic disease, chronic granulomas in RE system organs
causes infectious abortions in cattle (bangās disease)
fuchsin, H2S, capno
b. canis
dogs
similar disease to b. abortus
thionin
b. suis
pigs
destructive suppurative lesions; prolonged disease with granulomas mimicking TB
H2S, thionin
specimens for brucella isolation
RES predilection = bone/BM
sterile BFs and urine also possible
brucella characteristics
strict aerobes (some capno)
slow grower (21 days); brucella blood agar
non spore forming, w GN ccb (extend safranin stain time)
non motile, no capsule, intracellular
agent of bioterrorism = work in BSC
brucella biochemicals
ox pos, cat pos
H2S and urease help speciate
submit acute/convalescent sera for sero testing
where is francisella found?
wild animals: rabbits, muskrats, beavers
outbreaks lead to lots of deaths of these animals
ground water
francisella transmission
zoonotic: tick/deer fly = primary vector
skin contact, ingestion/inhalation of contam water, dust, aerosols
hunters: handling carcasses, bitten, aerosols
mowing lawn
lab workers at risk
rabbit fever = francisella
acute febrile, granulomatous disease with rapid onset and flu like symptoms
5 presentations depending on site of infection:
ulceroglandular
glandular
oculoglandular
oropharyngeal
pneumonic
francisella growth characteristics
facultative intracellular
non motile, small GN ccb
strict aerobe
lab dx - francisella
culture not recommended
Lcystine, animal serum, egg yolk
cystine BAP
slow grow CHOC, no MAC growth
cystine heart dextrose = clear, pearlescent, convex, drop like colonies
sub to BCYE to keep alive
DFA, IHC, PCR, serology
pasteurella srouce
URT and GI tract of mammals/birds (dog/cat scratches/bites OR inhaled)
pasteurella diseases
local: cellulitis, abscesses, osteomyelitis, septic arthritis
resp: URTIs, pneumonia, tracheobronchitis, lung abscesses
cardiovascular: endocarditis, bacteremia, sepsis
CNS: rare meningitis (licks/bites to face in old ppl)
GI, ocular, UTIs
p. multocida growth characteristics
GN pleomorphic ccb with bipolar staining (oval, short rods, longer filaments)
BAP, CHOC, no MAC
small gamma, mucoid, narrow green/brown halo
musty, mushroom, dogās breath odor
p. multocida biochemicals
ox pos, cat pos
nonmotile
weak acid from glucose ferm
pos indole, ODC
lack of rxns leads to misID on automated systems
klebsiella granulomatis
endemic in tropical/developing countries (rare US)
causes donovanosis: uncircumcised men with poor hygiene, spread via sexual contact, can spread to bone/liver, assoc w pregnancy/cervical infection
donovanosis
firm papule or subcut nodule that ulcerates at primary site of inoculation (genital area); swells lymphs nodes with lesions on skin above)
ulcerogranulomatous: hard, red, bleeds easily
hypertrophic or verrucous ulcer: dry, irregular edge
deep ulcer: necrotic, foul smelling
dry, sclerotic, cicatricial lesion: scarring
donovanosis dx
no cultures
based on pt hx and disease presentation
confirmed with donovan bodies (intracellular) on tissue smears in macros, occ encapsulated
PCR not FDA approved
IFA thru ref labs
capnocytophaga
normal oropharyngeal flora (some in humans, some in dogs/cats)
not speciated in lab
capnocytophaga diseases
more septicemia than endocarditis (pts with neutropenia)
juvenile periodontal disease
fulminant, life threatening disease following dog/cat bite
growth characteristics of capnocytophaga
GN rod fusiform (resembles fusobacterium (anaerobe))
facultatively anaerobic
CO2, BAP, CHOC after 2 days, no MAC growth
TM or ML agar (resistant to antimicrobials in these plates)
gliding motility on agar (like swarming)
capnocytophaga biochemicals
negative for most
motile
pos nitrate, esculin
ferm: glu, mal, lac, suc
legionella spp
intracellular parasite: enter and multiply within host cells (bronchoalveolar macros)
predisposed in:
immuno comp, chronic lung disease, alcoholics, heavy smokers
how to contract legionnairesā disease
inhalation of aerosols (not person to person)
sporadic - community acquired
epidemic: AC, cooling towers, fountains, windshield washers
nosocomial in IC: resp equipment, nebulizers, humidifiers, spas, ice machines
legionnairesā disease
range from asymptomatic to deadly
2-10 day incubation
nonproductive cough, fever, headache, myalgia, bloody/purulent sputum, rales, difficultly breathing, shaking chills
dissemination to kidneys, heart, liver, CNS, lymphatics
damage to organs = death
mortality 15-30% sometimes 50%
most are serogroup 1
pontiac fever
2 day incubation
flu like symptoms: fever, headache, myalgia 2-5 days
spontaneous recovery, milder form, low mortality
reservoirs of legionella
lakes, rivers, springs, man made water treatment systems (chlorinated water okay)
heating/cooling towers of buildings; fountains
can live at 20-43C up to 60C
adheres to pipes, rubber, plastics
intracellularly in protozoa
specimen collection for legionella
resp: BAL, sputum, bronchial washings
urine for Ag test
found in urine for serogroup 1; stays pos for long time
legionella lab ID
direct examination: pleomorphic thin w GNRs inside macros/neutros and extracellularly
urine Ag test
DFA test
check serotypes or DNA detection
how to culture legionella
aerobically, requires L cysteine (no primary media)
BCYE: small pinpoint colonies
acid wash to remove normal flora
biplate: cystine/without cysteine (growth only on one side)
35-37C 7 days; gray white or blue green convex, wet looking, will fluoresce
how to treat legionella
erythromycin (alone or with rifampin)
alt: doxy, STX, new macrolides, fluoroquinolones
streptobacillus moniliformis diseases
rat bite fever: bite/scratch from infected animal
haverhill fever: ingestion of contam material
abrupt onset fever, chills, headache, myalgia
maculopapular, petechial, pustular rash in extremities
joint swelling/pain
can progress to endocarditis, myocarditis, meningitis, pneumonia, sepsis
s. moniliformis lab ID
specimen: primary lesion, lymph node, blood, joint fluid, pus
pleomorphic GNR; bulbous string of pearls/L shapes with age
enrich media with whole blood, serum, ascitic fluid
SPS in blood cx inhibits
gray, smooth, glistening, fried egg with L phase
spirillum minus
rat bite fever (sodoku)
fever, ulcer, swelling, lymphadenopathy, rash on palms/soles, headache, vomiting
GN spiral rods with 2-3 coils, motile, stain with wright giemsa
cannot be cultures (dx on symptoms/microscopy)
b. henselae
cat flea = cat scratch disease
fever, lymphadenopathy, papule/pustule at infection site
eye infections, severe muscle pain, encephalitis
b. quintana
body louse = trench fever
fever (recurrent), headache, rash, bone pain in shins/neck/back
b. bacilliformis
sand fly = carrions disease in western south america
oroya fever: fever, headache, myalgia, abd pain, severe anemia
verruga peruana: peruvian warts; nodular lesions under skin that emerge, ulcerate, bleed
complications with bartonella
bacillary angiomatosis (BA): henselae, quintana
bacillary peliosis: henselae
lesions in skin, subcut tissue, bone, liver, spleen
HIV/IC
SBE: does not show up in culture
growth characteristics of bartonella
cx from skin, lesion biopsy, occ blood
standard media but takes weeks to grow
dx of bartonella
CSD: symptoms, hx, sero, PCR
trench fever: blood cx, sero
carrions: blood cx, blood smears in acute phase (oroya)
endocarditis: sero, PCR, cx heart tissue
Note
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