BACTERIAL EYE PATHOGENS - UAB School of Optometry year/Micro/powerpoint... · BACTERIAL EYE PATHOGENS Dr. WILLIAM J. BENJAMIN Eye Physiology & Ocular Prosthetics Laboratory University

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 (+) POSITIVE BACILLIGRAM (+) POSITIVE BACILLIEYE PATHOGENS

Propionibacterium acnes

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


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


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


EYELIDS

Staphylococcus aureus


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


EYELIDS


EYELIDS


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


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


EYELIDS


EYELIDS

CULTURING OF BACTERIA FROM THE CONJUNCTIVA,

AND EYELIDS


EYELIDS

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


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


50% of Microbial Ulcers WON’T GROW OUTTherefore, many attempts are “Culture-Negative”


50% of Microbial Ulcers WON’T GROW OUTUlcers should not be called “Sterile”


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


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

CULTURING OF BACTERIA:CULTURING OF BACTERIA: The Hospital Micro Laboratory

CULTURING OF BACTERIA:CULTURING OF BACTERIA: The Hospital Micro Laboratory

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









Serratia marcescens


Pseudomonas aeruginosa







IDENTIFICA-TION OF

BACTERIAFROMFROM

CULTURES:GRAM (+)

COCCI

IDENTIFICATION OF BACTERIAIDENTIFICATION OF BACTERIA FROM CULTURES: GRAM (–) RODS

IDENTIFICATION OF BACTERIAIDENTIFICATION OF BACTERIA FROM CULTURES: AUTOMATION

IDENTIFICATION OF BACTERIAIDENTIFICATION OF BACTERIA FROM CULTURES: ANAEROBES


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


QuadFerm Test for Neisseria-related organisms

ID OF GRAM (+) COCCI

(continued … )( )

ID OF GRAM (+) COCCI( … continued)

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


Mannitol fermentation = Coagulase test (+) and (–)


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


Streptococcus pyogenes

(Strong ß hemolysis A disc sensitive)(Strong ß hemolysis, A disc sensitive)


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


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


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



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



Anti-bacterials for Gram (+)



Anti-bacterials for Gram (–)



A i b i l fAnti-bacterials for Streptococcus pneumoniae


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)


SERIAL DILUTION METHOD

AUTOMATED SERIAL DILUTION vs. LIMITED AGENTS COMBINED WITH ID OF GRAM (+) and ( )AGENTS COMBINED WITH ID OF GRAM (+) and (–)


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


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)


EPSILOMETER METHOD


EPSILOMETER METHOD


EPSILOMETER METHOD

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


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


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

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


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

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


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


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


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

STREPT. VIRIDANS

STAPH EPIDERMIDISSTAPH. EPIDERMIDIS

LINE-UP: CAN YOU IDENTIFY THE PERPETRATOR ?THE PERPETRATOR ?

BACTERIAL EYE PATHOGENS - UAB School of Optometry year/Micro/powerpoint... · BACTERIAL EYE PATHOGENS Dr. WILLIAM J. BENJAMIN Eye Physiology & Ocular Prosthetics Laboratory University

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