Staphylococcus aureus: Difference between revisions

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Staphylococcus aureus
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===Microbiology===
===Microbiology===


*Facultative anaerobic, [[Stain::Gram-positive]] [[Cellular shape::coccus]]
*Facultative anaerobic, [[Stain::Gram-positive]] [[Shape::coccus]]
*Catalase-[[Catalase::positive]] and coagulase-[[Coagulase::positive]]
*Catalase-[[Catalase::positive]] and coagulase-[[Coagulase::positive]]
*Microscopy: groups or clusters ("cluster of grapes")
*Microscopy: groups or clusters ("cluster of grapes")
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*See [[Staphylococcus aureus endocarditis]]
*See [[Staphylococcus aureus endocarditis]]


===Other Syndromes===
===Other Infectious Syndromes===


*[[Osteomyelitis]]
*[[Osteomyelitis]]
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**Post-surgical (ENT): more of historic with changes in packing
**Post-surgical (ENT): more of historic with changes in packing
**Surgical site infections, even without obvious signs of localized infection
**Surgical site infections, even without obvious signs of localized infection

=== ''Staphylococcus''-Associated Glomerulonephritis ===

* Occurs ''during'' acute infection
* See also [[Staphylococcus-associated glomerulonephritis]]


==Management==
==Management==

Latest revision as of 00:50, 22 February 2021

Background

Microbiology

  • Facultative anaerobic, Gram-positive coccus
  • Catalase-positive and coagulase-positive
  • Microscopy: groups or clusters ("cluster of grapes")
  • Colony morphology: large, round, golden yellow colonies, often hemolytic on blood agar

Pathophysiology

Virulence Factors

  • Surface proteins for fibrinogen and other substances (used for binding to host endothelial cells)
  • Membrane-damaging toxins (hemolysins), including Panton-Valentine leukocidin (PVL)
  • Exfoliative toxins (A and B) which disrupt the junction between epidermal cells, causing scalded skin syndrome
  • Superantigens that bind to MHC molecules and T-cell receptors, leading to release of huge amounts of cytokines

Antibiotic Resistance

  • Mechanisms of resistance are myriad
  • Common ones:
    • bla gene encodes penicillinase, conferring resistance to penicillin
    • mecA encodes PBP2a, conferring broad β-lactam resistance (MRSA)
    • vanA on a plasmid confers vancomycin resistance (VRSA)

Clinical Manifestations

Colonization

Skin and Soft Tissue Infections

  • Boils and carbuncles
  • Cellulitis, usually purulent

Scalded-Skin Syndrome

  • Aka Ritter disease
  • Caused by exfoliative toxin A or B
  • Essentially bullous impetigo
  • Sunburn-like, bullous rash that can lead to skin loss (most common in kids with Staph infections of the nasopharynx or skin)

Bacteremia

Infective Endocarditis

Other Infectious Syndromes

Superantigen-Related Syndromes

Staphylococcus-Associated Glomerulonephritis

Management

  • Duration depends on clinical syndrome

Methicillin-Susceptible Staphylococcus aureus (MSSA)

Methicillin-Resistant Staphylococcus aureus (MRSA)