BACTERIAL EYE PATHOGENS
Dr. WILLIAM J. BENJAMINEye Physiology & Ocular Prosthetics Laboratory
University of Alabama at BirminghamUniversity of Alabama at BirminghamSchool of Optometry
Presented at the UAB School of Optometry as Part ofMIC 200: MICROBIOLOGY and IMMUNOLOGY
O t b 30 & N b 3 2008October 30 & November 3, 2008
GRAM (+) POSITIVE COCCIGRAM (+) POSITIVE COCCIEYE PATHOGENS
Staphylococcus aureus & epidermidisMicrococcus speciesStreptococcus pneumoniae (diplococcus)Streptococcus pyogenese & agalactiaeStreptococcus pyogenese & agalactiaeStreptococcus viridans & equisimilus
GRAM (+) POSITIVE BACILLIGRAM (+) POSITIVE BACILLIEYE PATHOGENS
Bacillus cereus & 4 other speciesCorynebacterium diphtheriae (w/o phage B)Propionibacterium acnes (Acne)Clostridium perfringens (Gangrene)Listeria monocytogenesListeria monocytogenes
GRAM (–) NEGATIVE COCCIGRAM (–) NEGATIVE COCCIEYE PATHOGENS
Neisseria gonorrhoeae (diplococcus)Neisseria meningitidisMoraxella (Branhamella) catarrhalis
GRAM (–) NEGATIVE BACILLIGRAM (–) NEGATIVE BACILLIEYE PATHOGENS
Pseudomonas aeruginosaHaemophilus influenzaeHaemophilus aegyptius (Koch-Weeks Bacilli)Moraxella lacunata (diplobacillus)Moraxella lacunata (diplobacillus)Proteus species (esp. Proteus mirabilis)Serratia marcescensSerratia marcescens
GRAM (–) NEGATIVE BACILLIGRAM (–) NEGATIVE BACILLIEYE PATHOGENS
Escherichia coliKlebsiella speciesAzotobacter speciesFusobacterium speciesFusobacterium speciesPasteurella speciesYersinia speciesYersinia speciesBacteroides fragilis
COCCOBACILLICOCCOBACILLIEYE PATHOGENS
Acinetobacter speciesBrucella species (Brucellosis)Francisella tularensis (Tularemia)
* sometimes also, Haemophilus species sometimes also, Haemophilus species
SPIROCHETESPIROCHETEEYE PATHOGENS
Treponema pallidum (Syphilis)Borrelia burgdorferi (Lyme Disease)Leptospira interrogans (Leptospirosis)
BACTERIAL MECHANISMS TO HEIGHTEN VIRULENCE AND
RESISTANCE
PHYSIOLOGICAL ADAPTATIONS TO DRUGPENICILLIN RESISTANCE: Beta LactamaseCELL WALL: Most Gram (–), Some Gram (+)CAPSULE or SLIME COAT of PolysaccharideCAPSULE, or SLIME COAT of PolysaccharideBIOFILM FORMATION (Exopolysaccharide)COAGULASE: Fibrin Coat / Staph. aureusCOAGULASE: Fibrin Coat / Staph. aureus
BACTERIAL MECHANISMS TO HEIGHTEN VIRULENCE AND
RESISTANCE
FLAGELLA: Some Rods, All SpirochetesPILI (FIMBRIAE): Most Gram (–) RodsCYST FORMATION: Azotobacter speciesSPORE FORMATION: Bacillus speciesSPORE FORMATION: Bacillus speciesBACTERICINSCYTOTOXINS: Fibroblasts, Epithelial CellsCYTOTOXINS: Fibroblasts, Epithelial Cells
Leukocidins
BACTERIAL MECHANISMS TO HEIGHTEN VIRULENCE AND
RESISTANCE
ENDOTOXINS: Within Cell Walls of Gram (–)EXOTOXINS: Clostridium botulinum & tetaniPROTEASES and LIPASESCollagenase Sphingomyelinase “IgA ase”Collagenase Sphingomyelinase IgA -aseElastase Phospholipidase StreptokinaseHemolysin Lecithinase HyaluronidaseHemolysin Lecithinase HyaluronidaseCatalase Esterase Fibrinolysin
HOW BACTERIA BECOME RESISTANT TO
ANTIBACTERIALS
CELL WALL and MEMBRANE ALTERATIONSMutations Decrease Drug Transport
PRODUCE ENZYMES TO INACTIVATE DRUGSplit Molecule or Add GroupsSplit Molecule or Add Groups
RIBOSOMAL ALTERATIONSDecrease Drug Binding at 30S RibosomeDecrease Drug Binding at 30S Ribosome
INCREASE BIOFILM PRODUCTION
HOW BACTERIA BECOME RESISTANT TO
ANTIBACTERIALS
DNA / RNA RELATED ALTERATIONSReduce Binding To Polymerase, Gyrase
METABOLIC PATHWAY ALTERATIONSKey Metabolites Obtained Thru Diff PathKey Metabolites Obtained Thru Diff Path
SPREAD OF VIRULENT PROPERTIESPlasmid Exchange Between BacteriaPlasmid Exchange Between Bacteria
INCREASED PURULENCE: PABA in Puru-lence a Contraindication to Sulfonamides
HOW ANTIBACTERIALS WORK
INHIBIT CELL WALL SYNTHESISCell Lysis or Alters Cell ShapeIron Acquisition Proteins in Cell WallElectron Transport System in Cell WallEXAMPLES: Penicillins CephalosporinsEXAMPLES: Penicillins, Cephalosporins
Bacitracin, VancomycinINHIBIT DNA / RNA SYNTHESIS
Bind DNA Polymerase or DNA GyraseEXAMPLE: Rifamycin
HOW ANTIBACTERIALS WORK
INHIBIT CELL MEMBRANE FUNCTIONLeakage of Cell ContentsIntracellular Build-up of Toxic Byproducts“Starve” Cell of Nutrients, MetabolitesEXAMPLE: PolymixinsEXAMPLE: Polymixins
INHIBIT PROTEIN SYNTHESISAt the Ribosome (30S)At the Ribosome (30S)Blocks tRNA from Forming ProperlyEXAMPLE: Aminoglycosides
CULTURING OF BACTERIA FROM THE CONJUNCTIVA AND
EYELIDS
STERILE SALINE; NO ANESTHETICDACRON SOAKED IN CALCIUM ALGINATEDACRON SOAKED IN CALCIUM ALGINATEDACRON OR COTTON TIP APPLICATORSSWAB INNER LID MARGIN
Lower Preferred, but …..STREAK MARKED AGAR PLATE & DISPOSESWAB PALP CONJ & C-d-SSWAB PALP CONJ & C-d-S
Lower Preferred, but …..STREAK MARKED AGAR PLATE & DISPOSE
CULTURING OF BACTERIA FROM THE CONJUNCTIVA AND
EYELIDS
INCUBATE AT 35 DEGREES FOR 24-48 Hrs.OR SEND TO MICRO LABORATORYOR SEND TO MICRO LABORATORY
DO NOT WAIT TO START ANTIBIOTICSKEY AGAR PLATES FOR THE O.D. OFFICEBlood Agar: Use for EverythingChocolate Agar: If Suspect Neisseria, etc.Sabouraud’s Agar: Fungi; 25 Deg 2-10 DaysSabouraud s Agar: Fungi; 25 Deg, 2-10 DaysCULTURE TRANSPORT PACKS: Not Good,
but sometimes necessary
CULTURING OF BACTERIA FROM THE CONJUNCTIVA AND
EYELIDS
OCULAR PATHOGENS REQUIRINGCHOCOLATE AGAR + COCHOCOLATE AGAR + CO2
Neisseria gonorrhoeae*Haemophilus sp.Moraxella lacunata
* Other Neisseria also grow better this way
CULTURE TRANSPORT PACKS: Not Good, but sometimes necessaryy
CULTURING OF BACTERIACULTURING OF BACTERIA FROM CORNEAL ULCERS
STERILE SALINE; ANESTHETIC REQUIREDKIMURA SPATULA but not CYTOBRUSHDACRON SOAKED IN CALCIUM ALGINATEDACRON OR COTTON TIP APPLICATORSSCRAPE CENTER AND LEADING MARGINSCRAPE CENTER AND LEADING MARGIN
CORNEAL PATHOGENSCORNEAL PATHOGENSWITH SPECIAL AFFINITY FOR
CORNEAL EPITHELIUM
Streptococcus pneumoniaeStreptococcus pneumoniaePrefers Corneal Epithelial Cells in generalBe sure to scrape the “leading edge”
Pseudomonas aeruginosaPrefers Basal Corneal Epithelial CellsBe sure to scrape the center at bottomBe sure to scrape the center at bottom
Staphylococcus aureus
CULTURING OF BACTERIACULTURING OF BACTERIA FROM CORNEAL ULCERS
STREAK AGAR PLATEDISPOSE OR FLAME: Be sure to let coolINCUBATION AT 35 DEGREES FOR 24-48 Hr.
OR SEND TO MICRO LABORATORY50% of Microbial Ulcers WON’T GROW OUT50% of Microbial Ulcers WON T GROW OUT
CULTURING OF BACTERIACULTURING OF BACTERIA FROM CORNEAL ULCERS
50% of Microbial Ulcers WON’T GROW OUTTherefore, many attempts are “Culture-Negative”
CULTURING OF BACTERIACULTURING OF BACTERIA FROM CORNEAL ULCERS
50% of Microbial Ulcers WON’T GROW OUTUlcers should not be called “Sterile”
CULTURING OF BACTERIACULTURING OF BACTERIA FROM CORNEAL ULCERS
50% of Microbial Ulcers WON’T GROW OUTSuch an Ulcer is a “Culture-Negative Ulcer”
but is not necessarily a “Sterile Ulcer”but is not necessarily a Sterile Ulcer
CULTURING OF BACTERIACULTURING OF BACTERIA FROM CORNEAL ULCERS
Culture-Negative Macular Keratitis turned Ulcer
Started on TobramycinStarted on Tobramycin Ophthalmic Drops every 2
hours as dual Macular Keratitis with Anterior
Chamber Reaction
Intensified to dual Ulcers overnight with greater ACRovernight with greater ACR and Corneal Edema, VA ↓
Fortified Tobramycin and F tifi d V iFortified Vancomycin
alternating every half hour
IDENTIFICATION OF BACTERIAIDENTIFICATION OF BACTERIA FROM CULTURES
GRAM STAIN FOR (+) or (–), CELL MORPHOL.DIFF QUIK or GIEMSA STAIN SMEARS FOR
HOST INFLAMMATORY CELLSCOLONY MORPHOLOGY, COLOR, ODOR,COLONY MORPHOLOGY, COLOR, ODOR,
AFTER GROWTH ON AGAR PLATESIF GRAM (+) COCCI, GO TO CATALASE TEST
Micro Labs do same automated quickerMicro Labs do same, automated, quickerIF GRAM (–) BACILLI, GO TO STRIP TESTS
Micro Labs do same, automated, quicker
IDENTIFICATION OF BACTERIAIDENTIFICATION OF BACTERIA FROM CULTURES
GRAM STAIN FOR (+) or (–), CELL MORPHOL.DIFF QUIK or GIEMSA STAIN SMEARS FOR
HOST INFLAMMATORY CELLSCOLONY MORPHOLOGY, COLOR, ODOR,COLONY MORPHOLOGY, COLOR, ODOR,
AFTER GROWTH ON AGAR PLATESIF GRAM (+) COCCI, GO TO CATALASE TEST
Micro Labs do same automated quickerMicro Labs do same, automated, quickerIF GRAM (–) BACILLI, GO TO STRIP TESTS
Micro Labs do same, automated, quicker
IDENTIFICATION OF BACTERIAIDENTIFICATION OF BACTERIA FROM CULTURES
GRAM STAIN FOR (+) or (–), CELL MORPHOL.DIFF QUIK or GIEMSA STAIN SMEARS FOR
HOST INFLAMMATORY CELLSCOLONY MORPHOLOGY, COLOR, ODOR,COLONY MORPHOLOGY, COLOR, ODOR,
AFTER GROWTH ON AGAR PLATESIF GRAM (+) COCCI, GO TO CATALASE TEST
Micro Labs do same automated quickerMicro Labs do same, automated, quickerIF GRAM (–) BACILLI, GO TO STRIP TESTS
Micro Labs do same, automated, quicker
IDENTIFICATION OF BACTERIAIDENTIFICATION OF BACTERIA FROM CULTURES
IF GRAM (+) BACILLI, SEND TO EXPERTIF GRAM (–) COCCI, MUST BE Neisseria-
related BUT SEND TO EXPERT ANYWAYIF COCCOBACILLI, SEND TO EXPERTIF COCCOBACILLI, SEND TO EXPERT
Micro Labs do these last three categories by hand, plus any strange Gram (+) Cocci and Gram (–) Bacilli
IDENTIFICATION OF BACTERIAIDENTIFICATION OF BACTERIA FROM CULTURES
QuadFerm Test for Neisseria-related organisms
IDENTIFICATION OF GRAM (+)IDENTIFICATION OF GRAM (+) COCCI
CATALASE TESTCatalase (+) = Staphylococcus speciesCatalase (–) = Streptococcus species
COAGULASE TEST / MANNITOL FERMENT.Coagulase (+) = Staphylococcus aureusCoagulase ( ) Staphylococcus aureusCoagulase (–) =
Staphylococcus epidermidis, et al
IDENTIFICATION OF GRAM (+)IDENTIFICATION OF GRAM (+) COCCI
Mannitol fermentation = Coagulase test (+) and (–)
IDENTIFICATION OF GRAM (+)IDENTIFICATION OF GRAM (+) COCCI
GAMMA (NO) HEMOLYSIS (Nonhemolytic)Group D Streptococcus sp. (Enterococci)
BETA (COMPLETE) HEMOLYSISBETA (COMPLETE) HEMOLYSISA DISC (Bacitracin) Sensitive (+)
Group A: Streptococcus pyogenesp p py gA DISC (Bacitracin) Insensitive (–)
Non Group A, Beta Hemolytic Strept.species (Streptococcus agalactiae)species (Streptococcus agalactiae)
A Disc = Bacitracin
IDENTIFICATION OF GRAM (+)IDENTIFICATION OF GRAM (+) COCCI
Streptococcus pyogenes
(Strong ß hemolysis A disc sensitive)(Strong ß hemolysis, A disc sensitive)
IDENTIFICATION OF GRAM (+)IDENTIFICATION OF GRAM (+) COCCI
Streptococcus agalactiae
(Weak ß hemolysis,A disc insensitive)A disc insensitive)
ID OF GRAM (+) COCCI:ID OF GRAM (+) COCCI:Strong vs. Weak ß Hemolysis
CAMP Test: Staph. aureus, Strept. agalactiae, & Strept. pyogenes
IDENTIFICATION OF GRAM (+)IDENTIFICATION OF GRAM (+) COCCI
ALPHA (INCOMPLETE) HEMOLYSISP DISC (Optochin) Sensitive (+)
Streptococcus pneumoniaeP DISC (Optochin) Insensitive ( )P DISC (Optochin) Insensitive (–)
Streptococcus viridans or Group D
P Disc = optochin = ethyl hydrochloride
IDENTIFICATION OF GRAM (+)IDENTIFICATION OF GRAM (+) COCCI
Streptococcus pneumoniae
(α hemolysis P disc sensitive)(α hemolysis, P disc sensitive)
IDENTIFICATION OF GRAM (+)IDENTIFICATION OF GRAM (+) COCCI and GRAM (–) BACILLI
AUTOMATED IDENTIFICATION
IDENTIFICATION OF GRAM (+)IDENTIFICATION OF GRAM (+) COCCI and GRAM (–) BACILLI
AUTOMATED IDENTIFICATION
BACTERIAL SUSCEPTIBILITY TO ANTI-BACTERIALS
DISC DIFFUSION METHOD
LARGE QUANTITY OF BACTERIUM NEEDEDPLACE IN THIOGLYCOLLATE BROTH, MIXSTANDARDIZED MUELLER-HINTON AGAR
MH+5% Sheep Blood for Strept. pneumo.MH 5% Sheep Blood for Strept. pneumo.MH Chocolated for Neisseria, Moraxella,
& Haemophilus speciesSTREAK EVENLY OVER ENTIRE SURFACESTREAK EVENLY OVER ENTIRE SURFACEPLACE SET OF DISCS WITH DIFF AGENTS
BACTERIAL SUSCEPTIBILITY TO ANTI-BACTERIALS
DISC DIFFUSION METHOD
INCUBATE 24 Hrs. AT 35 DEGREESDIAMETERS OF INHIBITORY ZONES IN mmCOMPARE DIAM’s TO STANDARD CHARTTHIS PROCEDURE HASTHIS PROCEDURE HAS
BEEN AUTOMATED, COMPUTERIZED FORMueller Hinton AgarMueller-Hinton Agar
BACTERIAL SUSCEPTIBILITY TO ANTI-BACTERIALS
DISC DIFFUSION METHOD
A i b i l fAnti-bacterials for Streptococcus pneumoniae
BACTERIAL SUSCEPTIBILITY TO ANTI-BACTERIALS
SERIAL DILUTION METHOD
TEST TUBES WITH BROTH & AGENTAGENT IN DIMINISHING CONCENTRATIONLOWEST CONC. TO DENY VISIBLE GROWTH
Minimum Inhibitory Concentration (MIC)Minimum Inhibitory Concentration (MIC)LOWEST CONC. TO KILL 99.9% INOCULUM
Minimum Bactericidal Concentration (MBC)Minimum Bactericidal Concentration (MBC)
BACTERIAL SUSCEPTIBILITY TO ANTI-BACTERIALS
SERIAL DILUTION METHOD
AUTOMATED SERIAL DILUTION vs. LIMITED AGENTS COMBINED WITH ID OF GRAM (+) and ( )AGENTS COMBINED WITH ID OF GRAM (+) and (–)
BACTERIAL SUSCEPTIBILITY TO ANTI-BACTERIALS
EPSILOMETER METHOD
LARGE QUANTITY OF BACTERIUM NEEDEDMIX IN THIOGLYCOLATE BROTHSTANDARDIZED MUELLER-HINTON AGAR
MH+5% Sheep Blood for Strept. pneumo.MH 5% Sheep Blood for Strept. pneumo.MH Chocolated for Neisseria, Moraxella,
& Haemophilus speciesSTREAK EVENLY OVER ENTIRE SURFACESTREAK EVENLY OVER ENTIRE SURFACE
BACTERIAL SUSCEPTIBILITY TO ANTI-BACTERIALS
EPSILOMETER METHOD
PLACE SET OF “E TEST” STRIPS WITH DIFF. ANTIMICROBIAL AGENTSANTIMICROBIAL AGENTS
EACH AGENT IN DIMINISHING CONCENTRA-TION ALONG E TEST STRIP
INCUBATE 24 Hrs. AT 35 DEGREESASSESS INHIBITION FOR MINIMUM INHIBIT-
ORY CONCENTRATION (MIC)ORY CONCENTRATION (MIC)
CLINICAL PEARLS ABOUTCLINICAL PEARLS ABOUT BACTERIAL SUSCEPTIBLITYBACTERIA IN EYE MAY ALTER PHYSIOLOG-
ICALLY AFTER TREATMENT IS BEGUNGROWTH ON AGAR PLATE in vitro MAY BEGROWTH ON AGAR PLATE in vitro MAY BE
DIFFERENT THAN BACTERIA in vivoSUSCEPTIBILITY TESTS MAY NOT INDICATE
SUSCEPTIBILITY OF BACTERIA IN EYEANTIBACTERIALS MUST BE USED FULL 10
to 14 DAYS TO KILL RESISTANT STRAINSto 14 DAYS TO KILL RESISTANT STRAINSDON’T “TAPER OFF” ANTIBACTERIALS
CLINICAL PEARLS ABOUTCLINICAL PEARLS ABOUT BACTERIAL SUSCEPTIBLITY
SAVE THE NEW, MORE POTENT ANTIBACT-ERIALS UNTIL THEY ARE NECESSARY?
CLINICAL DILEMMA: The FlouroquinolonesCLINICAL DILEMMA: The FlouroquinolonesCiprofloxacin (Alcon Ciloxan) Cipro 38.9%Ofloxacin (Allergan Ocuflox) Floxacin 0.8%Norfloxacin (Merck Chibroxin) Noroxin ~0%Norfloxacin (Merck Chibroxin) Noroxin ~0%Levofloxacin (Santen Quixin) Levaquin 40.9%Gatifloxacin (Allergan Zymar) Tequin 8.3%Moxifloxacin (Alcon Vigamox) Avelox 10 8%Moxifloxacin (Alcon Vigamox) Avelox 10.8%
FOLLOW THE EXAMPLE OF TOBRAMYCIN?USE TOPICALS NOT USED SYSTEMICALLYUSE TOPICALS NOT USED SYSTEMICALLY
Systemic use creates resistant strains
CLINICAL PEARLS ABOUTCLINICAL PEARLS ABOUT BACTERIAL SUSCEPTIBLITY
Farhi & Kowalski(2007) Tested 1161
DRUG SUSCEPT-IBILITY
COST
Moxifloxacin 86% $73.38Conj’itis Isolates vs.11 Antibacterials
Ofloxacin 86% $46.75Ciprofloxacin 84% $49.18Gatifloxacin 84% $70.38% $Sulfacetamide 84% $13.11PolyTrim 80% $22.18Gentamicin 74% $14 68Gentamicin 74% $14.68Bacitracin 70% $10.82Tobramycin 68% $15.13
Erythromycin 62% $11.17
CLINICAL PEARLS ABOUTCLINICAL PEARLS ABOUT BACTERIAL SUSCEPTIBLITY
Sodium sulfacetamide, a bacteriostatic agent, with 84% in vitro coverage of all isolates, and an average cost of $13.11, appeared to be most cost-effectivecost of $13.11, appeared to be most cost effective for empirical coverage of bacterial conjunctivitis.The fluoroquinolones, although more expensive and of recent introduction gave only similar coverageof recent introduction, gave only similar coverage.
PERHAPS RESISTANCE FADED AWAY AFTER 20PERHAPS RESISTANCE FADED AWAY AFTER 20 YEARS OF DISUSE FOR SODIUM SULFACETAMIDE!
Will there be a 20-year recycling effort?
MICROORGANISMS THAT CAN INFECT (PENETRATE ?) THE
INTACT CORNEA
Neisseria gonorrhoeaeStreptococcus pneumoniaeCorynebacterium diphtheriae (+ other sp.)Haemophilus sp (H aegyptius H influenzae)Haemophilus sp. (H. aegyptius, H. influenzae)Listeria sp. ( L. monocytogenes)
BACTERIA THAT CAUSE MAJORITY OF
CONJUNCTIVITIS IN CHILDREN
Streptococcus pneumoniae (< 5 years old)Haemophilus aegyptius (< 5 years old)Staphylococcus aureus (> 5 years old)
INSTANCES WHEN MICRO LABINSTANCES WHEN MICRO LAB STUDIES ARE MANDATORY
NEONATAL CONJUNCTIVITISHYPERACUTE CONJUNCTIVITISMEMBRANEOUS CONJUNCTIVITISCORNEAL ULCERS not obviously HerpeticCORNEAL ULCERS not obviously HerpeticPOSTOPERATIVE EYE INFECTIONSSEVERE LONG-STANDING CONJUNCTIVITISSEVERE LONG STANDING CONJUNCTIVITISSUSPECTED FUNGAL EYE INFECTION
MICROORGANISMS CAUSING CONJUNCTIVAL MEMBRANES orCONJUNCTIVAL MEMBRANES or
PSEUDOMEMBRANES
Neisseria gonorrhoeaeStreptococcus pneumoniaeCorynebacterium diphtheriaeStreptococcus speciesStreptococcus speciesAdenovirusHerpes simplex virusHerpes simplex virusChlamydia trachomatis
BACILLUS CEREUS
UBIQUITOUS; SPORE FORMING G(+) RodEXOTOXIN: Highly Virulent PathogenPENETRATING EYE TRAUMAMETASTATIC INFECTION OF DRUG ADDICTMETASTATIC INFECTION OF DRUG ADDICTPOST-TRAUMATIC ENDOPHTHALMITISCORNEAL RING ABCESS WITHIN 24 Hrs.CORNEAL RING ABCESS WITHIN 24 Hrs.EYE IS BLIND WITHIN 72 Hrs. OF INFECTION
NEISSERIA GONORRHOEAE
G(–) COFFEE BEAN SHAPED DIPLOCOCCUSOPHTHALMIA NEONATORUMYOUNG, SEXUALLY ACTIVE ADULTSATTACKS MUCOSAL EPITHELIUMATTACKS MUCOSAL EPITHELIUMACUTE COPIOUSLY PURULENT CONJ’ITISCAN PENETRATE INTACT CORNEAL EPITH.CAN PENETRATE INTACT CORNEAL EPITH.UNTREAT: CORN. ULCER, PERFORATIONREQUIRES CHOCOLATE AGAR + CO2
NEISSERIA GONORRHOEAE
IgA -ase, OUTER MEMBRANE ADHESINSPILI (FIMBRIAE)IRON ACQUISITION PROTEIN IN CELL WALLQUICKLY KILLED BY HEAT DRYING SUNQUICKLY KILLED BY HEAT, DRYING, SUNMUTATED VERSIONS HAVE RESISTANCE:
Beta Lactamase ProductionBeta Lactamase ProductionAltered Cell Wall Structure
CONJ. MEMBRANE or PSEUDOMEMBRANE
HAEMOPHILUS AEGYPTIUSHAEMOPHILUS AEGYPTIUS(Koch-Weeks Bacillus)
G(–) ROD, SUBSPECIES OF H. influenzaeRARELY CAUSES SYSTEMIC ILLNESSACUTE CONJ’ITIS WITH BRIEF INCUBATIONMOST COMMON IN WARM MONTHS SOUTHMOST COMMON IN WARM MONTHS, SOUTHMUCOPURULENT DISCHARGE; Kids < 5 yrsINFERIOR LIMBUS ULCERATIONSINFERIOR LIMBUS ULCERATIONSSOME SCARRING OF INFERIOR CORNEA
HAEMOPHILUS AEGYPTIUSHAEMOPHILUS AEGYPTIUS(Koch-Weeks Bacillus)
PILI (FIMBRIAE)ENDOTOXINCAPSULEGROWTH ENHANCED AROUND Staph spGROWTH ENHANCED AROUND Staph. sp.CAN INFECT INTACT CORNEAL EPITHELIUMREQUIRES CHOCOLATE AGAR + CO2REQUIRES CHOCOLATE AGAR CO2
MORAXELLA LACUNATA
G(–) DIPLOBACILLUS with PILI (FIMBRIAE)ANGULAR BLEPHAROCONJ’ITIS (Temporal)CORNEAL ULCERATION with HYPOPYONRARE IN YOUNG CHILDRENRARE IN YOUNG CHILDRENMUST NOW DIFFERENTIATE FROM Staph.REQUIRES CHOCOLATE AGAR + CO2REQUIRES CHOCOLATE AGAR CO2
STREPTOCOCCUSSTREPTOCOCCUSPNEUMONIAE
G(+) DIPLOCOCCUS with PILI (FIMBRIAE)OPHTHALMIA NEONATORUMADULT DACRYOCYSTITISACUTE CATARRHAL CONJ’ITIS; Kids < 5 yrsACUTE CATARRHAL CONJ ITIS; Kids < 5 yrsCORNEAL ULCERATIONS with HYPOPYONSHOWS PREFERENTIAL ADHERENCE TOSHOWS PREFERENTIAL ADHERENCE TO
CORNEAL EPITHELIAL CELLSCONJ. MEMBRANE or PSEUDOMEMBRANE
STREPTOCOCCUSSTREPTOCOCCUSPNEUMONIAE
WELL ORGANIZED CAPSULE (SLIME COAT)BIOFILM (GLYCOCALYX)IgA -ase FibrinolysinHyaluronidase StreptokinaseHyaluronidase StreptokinaseHemolysin LeukocidinPNEUMOLYSIN: Inhibit Chemotaxis of PMNsPNEUMOLYSIN: Inhibit Chemotaxis of PMNsCAN INFECT INTACT CORNEAL EPITHELIUM
PSEUDOMONAS AERUGINOSA
UBIQUITOUS G(–) RODMOST VIRULENT CORNEAL PATHOGENCAN NOT PENETRATE INTACT EPITHELIUMCORNEAL ULCERATIONS AND KERATITISCORNEAL ULCERATIONS AND KERATITISCAN PERFORATE CORNEA IN 24 Hrs.CAN FEED ON FLUORESCEIN IN SOLUTIONCAN FEED ON FLUORESCEIN IN SOLUTIONCAN FEED ON CAMPHOR, NAPHTHALENECAN GROW IN DISTILLED WATER
PSEUDOMONAS AERUGINOSA
PILI (FIMBRIAE); BIOFILMPOLAR FLAGELLUMEndotoxin Elastase ProteasesExotoxins Phosphatase CollagenaseExotoxins Phosphatase CollagenaseHEMOLYSIN: Unusual for a Gram (–)BLUE-GREEN PURULENCE from BG PYACINBLUE GREEN PURULENCE from BG PYACINSHOWS PREFERENTIAL ADHERENCE TO
BASAL CORNEAL EPITHELIAL CELLS
STAPHYLOCOCCUS AUREUS
G(+) COCCI, NORMAL OCULAR FLORACOMMON & CHRONIC EYELID INFECTIONSHORDEOLUM: Nearly always the causeACUTE & CHRONIC CONJ’ITIS; Kids > 5 yrsACUTE & CHRONIC CONJ ITIS; Kids > 5 yrsKERATITIS AND OCCASIONAL ULCERATIONPOST-OPERATIVE ENDOPHTHALMITISPOST OPERATIVE ENDOPHTHALMITISMEIBOMIAN GLAND DYSFUNCTION: Most
common, with Propionibacterium acnes
STAPHYLOCOCCUS AUREUS
CELL WALL BINDING PROTEIN BINDS TO CORN EPITHELIAL SURFACE FIBRONECTINCORN. EPITHELIAL SURFACE FIBRONECTINCatalase Wax Esterase HemolysinCoagulase Cholesterol EsteraseCoagulase Cholesterol EsteraseExotoxins Cytotoxins LeukocidinsHyaluronidaseGROWS SLOWLY EVEN AT 5 DEGREES AND CAN CONTAMINATE REFRIDGERATED SOLN