Bacteria Classification and Disease

BACTERIAL CLASSIFICATION
AND DISEASE Reuben Ramphal M.D.

Paul A. Gulig, Ph.D.
Denise Schain M.D.
Purpose
 To give an overview of how we think about

managing bacterial infections
 To alert you to the importance of bacterial
classification in treatment
 The importance of knowing the etiology of
organ system based infection and the gram
stain
How are bacteria classified?
 Bacterial classification is based on several

major properties
 Gram staining (and other stains)
 Morphology
 Metabolic behavior
 Infection patterns
 Intracellular vs extracellular
 Antigenic composition
 DNA sequence
Gram staining characteristics
 Natural classification scheme that reflects major
differences in cell wall structure and to some
extent the mechanisms involved in disease.
 Gram positive (blue): single membrane consisting
of a thick peptidoglycan layer – no
lipopolysaccharide
 Gram negative (pink): inner and outer membranes,
with outer membrane having lipopolysaccharide
molecules
Property discovered by Christian Gram 1883, a Danish botanist, while
attempting to differentiate bacteria from human tissue by different
staining methods. He noted differences in stain retention by bacteria.
One single publication on this subject that has become the cornerstone
of drug discovery and antibiotic therapy. Eventually became a
pharmacologist then an internist.
How is a gram stain done?
Gram Positive is blue or purple
gram positive cocci gram positive cocci

in clusters in chains
Gram negative is pink or red
Gram negative rods Gram negative cocci

Morphology
 Morphology
 Rods or cocci
 Curved or spiral
 Filamentous
 Some correlation between morphology and disease
 Spiral bacteria---Treponemes, Borrelias, Leptospiras, Spirillium
tend to cause systemic diseases
 Pathogenic filamentous bacteria Actinomyces, Nocardia,
Mycobacteria tend to cause chronic diseases
 Gram positive bacteria, Staphylococcus more likely to cause
skin infections, Streptococci skin and pneumonia
Metabolic Properties
 Metabolic properties may influence ability
type of disease caused but not the only factor
 Aerobe versus anaerobe (microaerophilic,
facultative aerobes)
 Anaerobes have a greater propensity to cause
abscesses
 Brain, lung, liver, intra-abdominal abscesses
Abscesses: may not always be pure anaerobic
bacteria – can mixed infections with both aerobic
and anaerobic organisms
Metabolic Properties
 May influence the type of disease caused
 Anaerobes have a greater propensity to cause
abscesses but rarely cause other types of
infection
 Mycobacterium tuberculosis is an obligate
aerobe – affects tissue tropism
 Acid fast organisms grow slowly - chronic
infections
 Vibrio vulnificus grows fast - rapid progression
 Obligate intracellular organisms – difference
between fever and heart rate
Anaerobes
Aerobes
Rods Cocci
Filamentous
G+ G-
Listeria Enterobacteria:
Corynebacteria Many genera
Bacillus primarily from
the gut G-
E. coli Gonococci
G+ G-
Meningococci
Nocardia Dental plaque bacteria
Pseudomonas
Hemophilus Wie series 1,2,3
Bordetella Type 1701
Yersinia Type 021N
G+ Microthrix parvicella
Pasteurella Staphylococci
Franciscella Streptococci
Brucella Enterococci
Anaerobes (Common)
Rods Cocci
G+ G- G+ G-
Clostridia Bacteroides Streptococci Veillonella
Fusobacterium Peptococci
Peptpstrepto
Filamentous cocci
G+ Gm-
Actinomyces Various gut organisms
How does an experienced physician
approach bacterial diseases?
 Organ system approach

 Which bacteria cause disease in a certain location
 Gram stain approach
 What does the gram stain show--used to treat
empirically before cultures are completed
 Requires that one is able to get a gram stain which
is not always the case
Organ system approach: which
organisms most commonly cause
infection at that site?
 Meningitis
 Pneumococci, Meningococci, Hemophilus influenzae, Listeria
 Sinusitis
 Pneumococci, H. influenzae, Moraxella
 Acute otitis media
 Pneumococci, H. influenzae, Moraxella
 Pharyngitis
 Group A streptococci
These are all aerobic bacteria

Now add in the Gram stain
 Gram negative rods seen in CSF in meningitis

 H. influenzae
 Gram positive cocci in meningitis
 Pneumococcus
 Gram positive cocci in sinusitis
 Pneumococcus or Staphylococcus
 Gram stain may suggest the organism --clusters or diplococci?
Gram stain may be a defining point in therapy

Chest cavity
 Pneumonia
 Pneumococcus, H. influenzae
 Pleural cavity
 Pneumococcus, Staphylococcus
 Endocarditis
 Streptococcus, Staphylococcus, Enterococci
Add in the Gram stain
 Pneumonia-sputum gram stain

 Gram positive diplococci as predominant organism
 Likely organism Pneumococcus--the most common
gram positive cocci found in pneumonia
 Therapy
 Endocarditis-blood culture positive
 Gram positive cocci on the stain
 May be Streptococci, Enterococci, or Staphylococci
 Treatment decision made on this basis- Vancomycin +
Abdomen
 Likely organisms in intraabdominal infections
come from the GI tract
 Therefore all enteric flora need to be considered
 Not respiratory flora as in Head and Chest
 Aerobic (Enterobacteriaceae) and anaerobic
(Bacteroides, Fusobacteria) gram negatives rods.
 Aerobic (Enterococci and Streptococci) and
anaerobic Gram positives cocci (Streptococci)
 Anaerobic Gram positive rods (Clostridia)
Add in the gram stain
 Peritonitis
 Primary – such as a perforated intestine or appendix
 Secondary – translocation of bacteria into ascites
 Liver abscesses
 Enteric organisms arrive at the liver via the portal
circulation
 Biliary tract infections
 Fewer types of organisms
 Aerobic Gram negative rods and Gram positive cocci
predominate
Skin infections
 Skin infections
 Skin flora-Gram positive cocci
 Staphylococcus aureus and Streptococcus pyogenes
 This is of immediate help in therapy
 Complex skin infections
 Skin flora plus enteric flora.
Urinary tract infection
 Because of proximity to GI tract enteric flora

are the prime suspects in most cases
 Unusual to find Staphylococci, streptococci, or
anaerobes
 Aerobic Enteric Gram negative rods
 Aerobic Gram positive cocci from the gut
 What are these?
Examples of possible life saving
decisions based on a knowledge of
classification
 After chemotherapy for leukemia a patient

developed neutropenia and a high grade fever. He
was placed a broad spectrum cephalosporin
antibiotic (gram positive and gram negative activity).
 48 hours later he was still febrile to 103°F and his
blood pressure was low 82/56. Blood cultures were
positive and a Gram stain was done on the culture
 Gram positive cocci in clusters seen
 What is the likely organism?
 Staphylococcus aureus
 Why did the patient not respond to broad
spectrum antibiotic therapy?
 What could these resistant virulent gram positive
cocci be?
 Methicillin resistant Staphylococcus aureus MRSA
 What therapy can be added?
 Vancomycin
Heart transplant patient
with pneumonia
 43 yo woman who had a heart transplant two
months ago and returns acutely ill with fever
and shortness of breath that has become
progressively worse over several weeks
Aspergillus
fumigatus
Mrs PJ felt better on her antifungal medication until one month
later when she returned with acute onset of fever and shortness
of breath, severe hypoxia and very low blood pressure.
Pseudomonas aeruginosa
UF undergraduate with
meningitis: “time is neurons”
 19 yo UF student was admitted with signs of
meningitis: a lumbar puncture was performed
 CSF gram stain was done urgently in micro lab
 What organism is likely to be the cause?
 H. influenzae , E. coli, S. pneumoniae, or…
Microbiology lab technician calls back having found a single
set of gram negative diplococci which is diagnostic of…
Neisseria meningitidis
Neisseria meningitidis
which if not treated IMMEDIATELY with the CORRECT antibiotics
will result in the patient suffering…
loss of limbs, permanent neurologic damage, and death.

Take home messages
 Classification boring but important for initial
therapy
 Know what organisms are common at the
various sites of infection
 Know what the gram stain and metabolic
properties are of the common bacteria found at
each organ system infection
 Don’t try to memorize all of this now…you will
hear it gain through the lectures and CMCs that
follow…
 so pay close attention
THANK YOU!

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BACTERIAL CLASSIFICATION

AND DISEASE Reuben Ramphal M.D.

 To give an overview of how we think about

 Bacterial classification is based on several

gram positive cocci gram positive cocci

Gram negative rods Gram negative cocci

 Organ system approach

These are all aerobic bacteria

 Gram negative rods seen in CSF in meningitis

Gram stain may be a defining point in therapy

 Pneumonia-sputum gram stain

 Because of proximity to GI tract enteric flora

 After chemotherapy for leukemia a patient

loss of limbs, permanent neurologic damage, and death.

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