coci gram pozitiv ii - mgsii.files. · pdf fileenterocolita postantibiotice 4. sindromul de...
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![Page 1: coci Gram pozitiv II - mgsii.files. · PDF fileEnterocolita postantibiotice 4. Sindromul de soc toxic INFECTII PRODUSE. 7 INFECTII PRODUSE Caractere microscopice-coci Gram pozitivi](https://reader034.vdocuments.site/reader034/viewer/2022051105/5a99c7d67f8b9a9c5b8d9dd3/html5/thumbnails/1.jpg)
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COCI GRAM POZITIV
Genul Staphylococcus
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Caractere generale
• familia Micrococcaceae
• staphilos (gr.)= ciorchine
• aerobi (anaerobi facultativi)
• clorura de sodiu 7,5% (halotoleranţi)
• catalazo – pozitivi
• imobili
• in vivo majoritatea produc capsula
Reprezentati
• S. aureus - purtatori sanatosi: cavitatea nazala, faringe, tegumente, intestin
-30% dintre persoanele sanatoase
- 80-90% personalul din mediul spitalicesc
- responsabil de majoritatea infectiilor umane stafilococice
• S. epidermidis - microbiocenoza nazala, cutanata
=> infectii oportuniste la pacienti imunodeprimati:cistite, septicemii, endocardite, meningite
- infectii nosocomiale
• S. saprophyticus – oportunist
- infectii de tract urinar
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Factorii de patogenitate ai S. aureus
• numerosi factori de patogenitate => diversitatea
infectiilor stafilococice.
• determinism plasmidic sau fagic => variatiile in
virulenta observate la stafilococi.
I Antigene de suprafata
II Enzimele extracelulare
III Toxine
Infectiile stafilococice
I. Infectii superficiale, ale pielii
II. Infectii profunde
III. Infectii determinate de toxinele stafilococice
Majoritatea infectiilor au un caracter supurativ, stafilococul fiind prototipul de bacteriepiogena.
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Infectiile stafilococice
I. Infectii superficiale, ale pielii
Foliculite
Impetigo
Abcese
Furuncule
Carbuncule
Infectii ale plagilor postchirurgicale
Hidrosadenita
Panaritiu
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Infectiile stafilococice
II. Infectii profunde
Bronhopneumonie (dupa infectii virale, varstnici,
nosocomiale)
Bacteriemii, septicemii � abcese metastatice
Endocardite (! Proteze valvulare)
Mastite
Infectii de tract urinar
Infectii uterine (post-partum, post-abortum)
Osteomielita, artrita
Meningita, peritonita
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Infectiile stafilococice
III. Infectii determinate de toxinele stafilococice
1. Sindromul de piele oparita (n.n, copii ≤ 5 ani)
2. Toxinfectii alimentare (enterotoxinastafilococica)
3. Enterocolita postantibiotice
4. Sindromul de soc toxic
INFECTII PRODUSE
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INFECTII PRODUSE
Caractere microscopice
- coci Gram pozitivi
- asezati in gramezi
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GENUS STAPHYLOCOCCUS
pure culture pathological
product
Staphylococcus spp.
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Caractere de cultura
GelozaGeloza simplasimpla
((bacteriebacterie
nepretentioasanepretentioasa
nutritivnutritiv))
Pigment Pigment galbengalben
auriuauriu (S. (S. aureusaureus))
Caractere de cultura – pigmentpigment galben auriu- S. aureus pigment alb-
S.epidermidis
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Caractere de cultura- geloza sange
(hemoliza)hemoliza completa=hemoliza α
Caractere de cultura-hemoliza
hemoliza cald-rece =hemoliza β
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Mediul Chapman
Mediu selectiv şi
diferential (evidentiaza
o proprietate biochimica
a tulpinii)
Componente:geloza simpla + NaCl
7,5% + manitol + rosu fenol
Utilizare: selectiv pentru stafilococ
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S.aureus pe mediu solid hiperclorurat
cu manitol
S. saprophyticus pe mediu solid hipercloruratcu manitol
Mediul Chapman
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ANTIBIOGRAMA
β- lactamine !!!! (Oxacilina, Meticilina)
Aminoglicozide
Macrolide
Vancomicina
Genul Streptococcus
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Genul Streptoccocus
• grup heterogen
• numar mare de specii de streptococi:
– saprofite ale plantelor
– prezente in lapte si branzeturi (Streptococcuslactis),
– Comensale
• microbiocenoze normale: cavitatea nazala,
orofaringe, intestin, tegument.
– Patogene: Streptococcus pyogens, cel mai frecvent patogen izolat din infectiile umane.
Caractere generale
• Coci Gram pozitiv
• dispusi in lanturi de dimensiuni variabile
• capsula:
– acid hialuronic : Streptococii β-hemoliticigrup A
– polizaharide: Streptococcus pneumoniae
• catalazo - negativi
• aerob-anaerob facultativi;
• Streptococii anaerobi - genul Peptostreptococcus (5 specii)
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Clasificare – hemoliza pe geloza sange
• hemoliza β: clara, hematiile sunt lizate total
= streptococi β -hemolitici
• hemoliza αααα -incompleta, verzuie
• hemoliza alfa’-intermediara, intrehemoliza αααα şi β.
• streptococi γ -nehemolitici,
- nepatogeni(Streptococcus lactic)
Clasificare Rebecca Lancefield
• Polizaharidul (carbohidratul) “C” (din structura peretelui celular)
• Pe baza specificitatii antigenice a polizaharidului C,
• grupe de streptococi (Lancefield) A-T, alcatuitedin una sau mai multe specii.
• grupul A - cel mai important in patologia umana
• grupul D, B, C si G
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Streptococi αααα-hemolitici
• hemoliza incompleta, de culoare verde
• Streptococcus viridans:
- comensali
– endocardita
– Streptococcus mutans, salivarius - placa dentara
• Streptococcus pneumoniae (pneumococ)
- pneumonia bacteriana,
• Enterococcus (faecalis, faecium)
- infectii intraspitalicesti, in special infectii urinare.
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Hemoliza α (partiala)
Streptococi ββββ-hemolitici
• hemoliza completa, clara pe geloza sange
• Streptococcus pyogenes - streptococ β-hemolitic grup A Lancefield,
– responsabil pentru majoritatea bolilor streptococcice
• Streptococcus agalactiae - streptococ β-hemolitic grup B Lancefield,
– patogen pentru nou nascuti
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CLASIFICAREA STREPTOCOCILOR
Streptococcus pyogenes
• infectii piogene (supurative):
• Respiratorii– Faringita: cea mai frecventa infectie
streptococica,
– Otita medie, sinuzita, mastoidita,
– pneumonia (mai puţin uzuală)
• Cutanate - Piodermite
• Infectii generalizate– Scarlatina
– Bacteriemie
– Febra puerperala
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ANGINAANGINA SCARLATINA
Infectiile cutanate streptococice
• Piodermite
– Impetigo,
– Erizipel,
– Celulita,
– Fasceita necrozanta
• Eritem nodos• = hipersensibilizare fata de peptidoglicanul din
peretele celular bacterian
• noduli mici, eritematosi
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ERIZIPELERIZIPELERIZIPEL
Boli poststreptococice
1. Reumatismul poliarticular acut
2. Glomerulonefrita acutapoststreptococica
• Pot aparea la 2-6 saptamani dupa o infectie cu streptococ de grup A.
• diferente:– o infectie faringiana poate fi urmata de
oricare dintre aceste 2 boli
– o infectie cutanata poate fi urmata numai deglomerulonefrita.
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GENUL STREPTOCOCCUS- Caractere microscopice
Frotiu din cultura pura de
streptococFrotiu din produs patologic
Streptococcus spp
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Identificarea streptococilor
• Catalaza – negativ
– Bacitracina –diferentiaza strept. Grup A de altistreptococi
– Latex aglutinarea (Ag capsular)
Antibiograma
• !!!!
– Streptococul beta-hemolitic de grup A (Streptococcus pyogenes) este sensibil la Penicilina
– Eritromicina/efectuarea antibiogramei pt. pacientii alergici la P
– Antibiograma pe Muller-Hinton cu sange
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Streptococcus pneumoniaeProprietati generale
• coci ovalari Gram pozitivi,
• aspect de varf de lance sau flacara de lumanare,
• dispusi in diplo (diplococi),
• Pe geloza sange - hemoliza de tip alpha, incompleta
• la nivelul tractulului respirator superior
• purtatori sanatosi: 5-10% din populatia adulta, 20-40% dintre copii.
Boli produse
• Pneumonie franca lobara
• sinuzite, otite, mastoidite
• meningita
• osteomielita
• endocardita, pericardita
• artrita supurata
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Factori de patogenitate
• Capsula polizaharidica
– 90 tipuri capsulare
• Antigenul protector (PspA)
• Complex proteina A-colina (CbpA)
• Pneumolizina (Ply)
• Autolizina (LytA)
• Peroxidul de hidrogen
• Neuraminidaza
• Hialuronidaza
• Proteaze IgA: proteazặ IgA1, distruge IgA secretorii
Streptococcus pneumoniaeFROTIU DIN PRODUS
PATOLOGICSTRUCTURA
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Streptococcus pneumoniae
Geloza chocolat-- mediu complex ptr. bacterii
pretentioase nutritiv (pneumococ, Haemophilus)
GelozaGeloza sangesange
- mediu complex
pentru bacteriipretentioase
nutritiv
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TESTUL LA OPTOCHINIDENTIFICARE S.PNEUMONIAE
NEGATIV POZITIV
Identificarea pneumococilor
• Sensibilitatea la Optochin– diferentiaza S. pneumoniae (S) de S. viridans (R)
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PROPRIETATI DE CULTURA
ATMOSFERA DE
CO2 5-10%
Tratament - Antibiograma
• Penicilina G de electie, dar a aparut rezistenta=> AB grama
• Cefalosporine de generaţia III –Ceftriaxona
• Quinolone• Linezolid• Vancomicina
• Quinupristin / Dalfopristin (Synercid)
• Aminoglicozide
• Meningita: Vancomicina + Rifampicina
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Strepococi Viridans
• frecvent comensali: in faringe, cavitatea bucala,
• Implicati in etiologia abceselor dentare, S. mutans intervine in producerea cariei dentare
• S. mutans, S. sanguis, S. mitis
• endocardite subacute streptococice
– patrunderea streptococilor viridans in circulatie
(ex. dupa extractii dentare)
bacteriemie
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Streptococcus agalactiae
• Streptococcus Grup B
• flora normala genito-intestinala si a
tractului genital feminin,
– 5-35% dintre femeile gravide colonizate(vagin/rect)
– cauza majora de boala (pneumonii, meningite, septicemii) la n.n.
– infectii post partum la femei
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ANTIBIOGRAMA�E-TEST