MRSA and Staphylococcus
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Questions and Answers

What is the primary mechanism by which MRSA develops resistance to methicillin and related antibiotics?

  • Acquisition of the mecA and mecC genes (correct)
  • Overexpression of penicillin-binding proteins
  • Mutation of the bacterial cell wall structure
  • Production of enzymes that digest penicillin
  • What initial symptom did the 14-year-old boy display before the onset of systemic symptoms?

  • Headache
  • Pustule at the mouth (correct)
  • Shaking chills
  • Fever
  • In which year was MRSA first discovered?

  • 1950
  • 1961 (correct)
  • 1980
  • 1990
  • Which of the following antibiotics is MRSA resistant to?

    <p>Oxacillin (A)</p> Signup and view all the answers

    Which population is most likely to acquire community-associated MRSA infections?

    <p>Athletes and individuals in close contact sports (C)</p> Signup and view all the answers

    What is the primary characteristic of Staphylococcus species?

    <p>They form grape-like clusters. (D)</p> Signup and view all the answers

    Which of the following diseases is commonly associated with Staphylococcus aureus?

    <p>Scalded skin syndrome (C)</p> Signup and view all the answers

    Which feature distinguishes methicillin-resistant Staphylococcus aureus (MRSA) from other strains?

    <p>Resistance to methicillin (B)</p> Signup and view all the answers

    What role do Staphylococcus species play in the human body?

    <p>They are part of the normal microbiome of skin and mucous membranes. (D)</p> Signup and view all the answers

    Which Staphylococcus species is most commonly linked to opportunistic infections of medical devices?

    <p>S.epidermidis (C)</p> Signup and view all the answers

    Which of the following statements regarding Staphylococcus aureus is true?

    <p>It can cause food poisoning through toxin production. (D)</p> Signup and view all the answers

    What type of oxygen requirement do Staphylococcus species have?

    <p>Facultative anaerobes (B)</p> Signup and view all the answers

    Which of the following species is known to cause endocarditis?

    <p>S.lugdunensis (B)</p> Signup and view all the answers

    What is the main effect of the capsule produced by Staphylococcus aureus?

    <p>Inhibits chemotaxis and phagocytosis (C)</p> Signup and view all the answers

    Which of these is a virulence factor of Staphylococcus aureus that directly facilitates its spread in tissue?

    <p>Hyaluronidase (C)</p> Signup and view all the answers

    What role does Protein A play in the virulence of Staphylococcus aureus?

    <p>Inhibits antibody-mediated clearance (B)</p> Signup and view all the answers

    What is the primary laboratory method used for identifying Staphylococcus aureus in a clinical specimen?

    <p>Culture and Gram Stain (A)</p> Signup and view all the answers

    Which toxin produced by Staphylococcus aureus acts as a superantigen?

    <p>Toxic shock syndrome toxin-1 (C)</p> Signup and view all the answers

    What is the function of coagulase produced by Staphylococcus aureus?

    <p>Converts fibrinogen to fibrin (C)</p> Signup and view all the answers

    Which of the following toxins is associated with causing nausea and vomiting in Staphylococcus aureus infections?

    <p>Enterotoxins (D)</p> Signup and view all the answers

    In molecular detection methods for Staphylococcus aureus, which technique is commonly used?

    <p>PCR (Polymerase Chain Reaction) (A)</p> Signup and view all the answers

    What type of agar media is used for inoculating clinical specimens of Staphylococcus aureus?

    <p>Nutritionally enriched agar supplemented with sheep blood (D)</p> Signup and view all the answers

    What is the incubation temperature for Staphylococcus aureus during culture?

    <p>37°C (C)</p> Signup and view all the answers

    Which test distinguishes Staphylococcus aureus from other Staphylococcus species?

    <p>Coagulase test (B)</p> Signup and view all the answers

    What describes the typical colony appearance of Staphylococcus aureus after 24 hours of incubation?

    <p>Large, smooth colonies (D)</p> Signup and view all the answers

    Which of the following tests is used to identify Staphylococcus aureus through latex agglutination?

    <p>Rapid Latex Agglutination test (D)</p> Signup and view all the answers

    Which of the following is NOT a disease caused by Staphylococcus aureus?

    <p>Plague (A)</p> Signup and view all the answers

    Which of the following correctly describes the Gram stain results for Staphylococcus aureus?

    <p>Gram-positive cocci (B)</p> Signup and view all the answers

    What is the significance of the catalase test in identifying Staphylococcus species?

    <p>Differentiates between staphylococci and streptococci (C)</p> Signup and view all the answers

    What are common characteristics of MRSA skin infections?

    <p>They often appear as red, swollen, and painful wounds. (A)</p> Signup and view all the answers

    Which of the following conditions is NOT caused by MRSA?

    <p>Tuberculosis (A)</p> Signup and view all the answers

    What is the drug of choice for intravenous therapy of MRSA?

    <p>Vancomycin (A)</p> Signup and view all the answers

    Which statement about MRSA's antibiotic resistance is accurate?

    <p>MRSA is resistant to all β-lactam antibiotics. (B)</p> Signup and view all the answers

    How many nosocomial infections are reported annually due to MRSA in the U.S. hospitals?

    <p>Over 126,000 (A)</p> Signup and view all the answers

    Which alternative drugs are acceptable for treating non-life-threatening MRSA infections orally?

    <p>Trimethoprim-sulfamethoxazole and clindamycin (A)</p> Signup and view all the answers

    Which of the following correctly identifies a common inhabitant of human skin and mucous membranes?

    <p>Staphylococcus epidermidis (A)</p> Signup and view all the answers

    What is the estimated annual expenditure in the U.S. associated with MRSA infections?

    <p>$2.5 billion (D)</p> Signup and view all the answers

    Flashcards

    Staphylococcus

    A genus of Gram-positive cocci often found in clusters, known for being part of the normal flora of humans.

    S.aureus

    The most virulent species of Staphylococcus, causing a wide range of diseases from skin infections to bacteremia.

    S.epidermidis

    A part of skin flora, it can cause opportunistic infections, especially in hospital settings.

    S.saprophyticus

    A species of Staphylococcus linked to urinary tract infections, particularly in young women.

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    MRSA

    Methicillin-Resistant Staphylococcus aureus, known for causing serious infections, particularly in healthcare settings.

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    Diseases caused by S.aureus

    Includes food poisoning, scalded skin syndrome, toxic shock syndrome, and various skin and systemic infections.

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    Normal flora locations

    Staphylococcus species reside mainly on skin, mucous membranes, and in feces.

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    Opportunistic infections

    Infections that occur when the body's defenses are weakened, often linked to S.epidermidis and S.saprophyticus in hospitals.

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    Acquisition of mec A and mec C

    Genes that enable MRSA to resist penicillin by altering its binding site.

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    Symptoms of MRSA infection

    Common symptoms include fever, chills, redness, swelling, and pustules.

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    First discovery of MRSA

    MRSA was first identified in 1961 in England and reached the US in the 1980s.

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    Susceptible populations to MRSA

    Both hospital patients and community members are at risk for MRSA infections.

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    Staphylococcus aureus

    A pathogenic bacteria responsible for various infections, with significant virulence factors.

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    S. aureus virulence factors

    Components or substances that enhance S. aureus's ability to cause disease.

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    Capsule

    A protective layer that inhibits immune responses like chemotaxis and phagocytosis.

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    Exfoliative toxins

    Proteins that damage the skin's outer layer, leading to conditions like scalded skin syndrome.

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    Toxic shock syndrome toxin-1 (TSST-1)

    A superantigen that can cause severe shock and damage to blood vessels.

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    Coagulase

    An enzyme that converts fibrinogen to fibrin, aiding in clot formation.

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    Culture and Gram Stain

    Laboratory methods used to identify bacteria from clinical specimens for diagnosis.

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    MRSA skin infections

    Wounds that are red, swollen, painful, with pus or drainage.

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    MRSA complications

    Conditions caused by MRSA, including bacteremia, pneumonia, and surgical site infections.

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    MRSA prevalence in hospitals

    About 5% of U.S. hospital patients carry MRSA, causing ~126,000 infections and 5,000 deaths yearly.

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    MRSA treatment resistance

    MRSA strains resist all β-lactam antibiotics, including penicillins and cephalosporins.

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    Primary MRSA treatment

    Vancomycin is the preferred intravenous therapy for MRSA infections.

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    Alternatives to Vancomycin

    Daptomycin, tigecycline, and linezolid can also treat MRSA infections.

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    Coagulase-Negative Staphylococci (CoNS)

    Common skin and mucous membrane inhabitants, including S. epidermidis.

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    S. aureus culture media

    Inoculate clinical specimens onto nutritionally enriched agar with sheep blood for S. aureus growth.

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    Incubation temperature

    S. aureus is incubated at 37°C in an aerobic environment for optimal growth.

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    S. aureus colony appearance

    S. aureus colonies appear large, smooth and turn yellow after time on culture media.

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    Hemolysis on sheep blood agar

    All S. aureus isolates produce hemolysis when grown on sheep blood agar.

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    Catalase test importance

    The catalase test differentiates staphylococci (positive) from streptococci (negative) in gram-positive cocci.

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    Coagulase test purpose

    The coagulase test distinguishes S. aureus (positive) from other coagulase-negative staphylococci.

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    Rapid Latex Agglutination test

    This test identifies S. aureus and MRSA by detecting coagulase or protein A.

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    Study Notes

    Staphylococcus Overview

    • Staphylococcus is a gram-positive cocci bacteria
    • They appear in clusters, but can also be single cells (0.5-1.5 µm)
    • Staphylococcus species are facultative anaerobes (meaning they can survive with or without oxygen)
    • They are non-motile and non-spore forming
    • Catalase positive
    • There are ~80 species and subspecies of Staphylococcus

    Staphylococcus Objectives

    • Describe the classification of Staphylococcus and the key attributes of S. aureus, S. epidermidis, and S. saprophyticus
    • Link Staphylococcus species to the illnesses they cause
    • Identify places in the human body where Staphylococcus commonly resides
    • Explain the significance of methicillin-resistant Staphylococcus aureus (MRSA)

    Clinically Important Staphylococcus Species

    • S. aureus is the most virulent
    • S. epidermidis
    • S. saprophyticus
    • MRSA is a causative agent of serious infections in hospitalized individuals and those outside of hospitals, especially in previously healthy children and adults

    Common Staphylococcus Species & Diseases

    • S. aureus:
      • Toxin-mediated diseases (e.g., food poisoning, scalded skin syndrome, toxic shock syndrome)
      • Cutaneous infections (e.g., carbuncles, folliculitis, furuncles, impetigo, wound infections)
      • Other infections (e.g., bacteremia, endocarditis, pneumonia, empyema, osteomyelitis, septic arthritis)
    • S. epidermidis:
      • Bacteremia
      • Endocarditis
      • Surgical wounds
      • Opportunistic infections of catheters, shunts, and prosthetic devices
    • S. lugdunensis:
      • Endocarditis
    • S. saprophyticus:
      • Urinary tract infections

    Staphylococcus aureus: Biology

    • Part of normal microbiome of skin, mucous membranes, and feces
    • S. aureus is the species most often associated with serious infections

    Staphylococcus aureus: Virulence Factors

    • Structural Components:
      • Capsule: Inhibits chemotaxis and phagocytosis
      • Slime layer: Facilitates adherence to foreign bodies
      • Protein A: Inhibits antibody-mediated clearance
    • Toxins:
      • Cytotoxins: toxic to several cells
      • Exfoliative toxins (ETA, ETB): Increase intestinal peristalsis and fluid loss
      • Enterotoxins: Increase intestinal symptoms
      • Toxic shock syndrome toxin-1: Superantigen, triggers significant immune response that can be harmful
    • Enzymes:
      • Coagulase: Converts fibrinogen to fibrin
      • Hyaluronidase: Hydrolyzes hyaluronic acid
      • Lipases: Hydrolyze lipids
      • Nucleases: Hydrolyze DNA

    Staphylococcus aureus: Laboratory Testing

    • Specimen selection is critical for diagnosing S. aureus
    • Specimen type depends on the site of infection
    • Methods include:
      • Culture
      • Gram Stain
      • Molecular detection (e.g., PCR) for S. aureus and MRSA

    Staphylococcus aureus: Culture

    • Inoculate clinical specimens onto a sheep blood agar that is well supplemented.
    • Incubate at 37° Celsius in an aerobic environment
    • S. aureus grows as large, smooth colonies within 24 hours
    • Colonies often turn yellow (aureus or gold)
    • S. aureus usually results in distinct hemolysis on most sheep blood agars

    Staphylococcus Identification (cont.)

    • Gram staining: Gram-positive cocci in clusters.
    • Catalase test: Staphylococci are positive; streptococci are negative
    • Coagulase test: S. aureus is positive; other staphylococcus species are negative
    • Rapid Latex Agglutination test is used to identify S. aureus and methicillin-resistant S. aureus (MRSA), coagulase and/or protein A

    Diseases caused by Staphylococcus aureus

    • Skin and soft tissue infections
    • Osteomyelitis
    • Pneumonia
    • Food poisoning
    • Gastroenteritis
    • Toxic shock syndrome
    • Bacteremia
    • Endocarditis
    • Other infections (e.g., pneumonia, empyema, osteomyelitis, septic arthritis)

    Toxin factors of Staphylococcus aureus for intracellular survival

    • α-toxin: Pore-forming toxin that lyses cell membranes
    • β-toxin: Hydrolyzes sphingomyelin
    • PSMα: Helps escape from phagosomes
    • Leukocidins (D, E, M): Kill leukocytes

    S. aureus: Disseminated Diseases (Toxins)

    • Scalded skin syndrome (in infants)
    • Food poisoning (via enterotoxins)
    • Toxic shock syndrome (multisystem intoxication)

    S. aureus: Localized Diseases (Suppurative Infections)

    • Impetigo (localized cutaneous infection)
    • Folliculitis (impetigo involving hair follicles)
    • Furuncles/Boils (pus filled cutaneous nodules)
    • Carbuncles (coalescence of furuncles)
    • Other infections (e.g. pneumonia, empyema, osteomyelitis, septic arthritis)

    Bacteremia and Endocarditis

    • Spread of bacteria into blood from an infection site
    • Characterized by damage to the endothelial lining of the heart
    • Can result from certain wound and soft tissue infections

    Methicillin-Resistant S. aureus (MRSA)

    • First discovered in 1961 in England
    • First case in the US in the 1980s
    • Bacteria now resistant to methicillin, amoxicillin, penicillin, oxacillin, and other common antibiotics
    • Bacterial resistance stems from acquisition/gain of a gene (mec A and mec C) that encodes a penicillin-binding protein with low affinity for penicillin
    • MRSA may cause various infections such as:
      • Bacteremia
      • Pneumonia
      • Surgical site infections
      • Endocarditis
      • Bone and joint infections

    Coagulase-Negative Staphylococci

    • Common inhabitants of human skin and mucous membranes
    • S. epidermidis is frequently observed in infections, followed by S. hominis, S. haemolyticus, and S. capitis
    • S. epidermidis is a part of the flora of the new-born nasal mucosa and umbilicus.
    • Causes various infections, incl. wound infections, urinary tract infections, catheter/shunt infections and prosthetic device infections

    Staphylococcus epidermidis - the "accidental" pathogen

    • Normal microbiome of skin.
    • Catalase positive.
    • Coagulase negative staphylococci.
    • Low virulence.
    • Disease includes: Endocarditis, prosthetics, IV infections
    • Can cause a significant amount of nosocomial drain-related cases of meningitis

    Staphylococcus saprophyticus

    • Gram-positive, catalase positive, coagulase negative, non-hemolytic
    • Disease: Second most common cause of UTIs in young and sexually active women
    • Resistant to novobiocin
    • Nitrofurantoin (Macrobid) or Trimethoprim-sulfamethoxazole (Bactrim) are common treatment.

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