An Atlas of the Clinical Microbiology of Infectious Diseases, Volume 1: Bacterial Agents PDF
Preview An Atlas of the Clinical Microbiology of Infectious Diseases, Volume 1: Bacterial Agents
Prelims.qxd 1/2/08 11:11 AM Page 1 An Atlas of the CLINICAL MICROBIOLOGY OF INFECTIOUS DISEASES Volume 1 Bacterial Agents Prelims.qxd 1/2/08 11:11 AM Page 2 Prelims.qxd 1/2/08 11:11 AM Page 3 THE ENCYCLOPEDIA OF VISUAL MEDICINE SERIES An Atlas of the CLINICAL MICROBIOLOGY OF INFECTIOUS DISEASES Volume 1 Bacterial Agents Edward J. Bottone, PhD, Diplomate ABMM Mount Sinai School of Medicine New York Foreword by Gary V. Doern, PhD Section Director,Clinical Microbiology University of Iowa College of Medicine,Iowa The Parthenon Publishing Group International Publishers in Medicine, Science & Technology A CRC PRESS COMPANY BOCA RATON LONDON NEW YORK WASHINGTON, D.C. CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2008 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works Version Date: 20130415 International Standard Book Number-13: 978-0-203-49161-4 (eBook - PDF) This book contains information obtained from authentic and highly regarded sources. While all reasonable efforts have been made to publish reliable data and information, neither the author[s] nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made. The publishers wish to make clear that any views or opinions expressed in this book by individual editors, authors or contributors are personal to them and do not necessarily reflect the views/opinions of the publishers. 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Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com Prelims.qxd 1/2/08 11:11 AM Page 5 Contents Foreword 7 1 Gram-positive, branching and non-branching, non-acid-fast, 9 bacillary species 2 Gram-positive, aerobic, branching, partially acid-fast species 25 3 Acid-fast bacilli: Mycobacterium 31 4 Fermenting, Gram-negative, facultative anaerobic bacilli 45 5 Non-fermenting, Gram-negative aerobic bacilli 65 6 Anaerobes 73 7 Fastidious, Gram-negative bacilli 83 8 Gram-positive, catalase-positive cocci 109 9 Gram-positive, catalase-negative cocci 113 10 Gram-negative cocci 127 11 Curved and spiral species 133 12 Intracellular bacterial species 143 Bibliography 149 Index 155 5 Prelims.qxd 1/2/08 11:11 AM Page 6 This Atlas is dedicated to the many mentors, colleagues, and students who, upon entering my life, paused in transit, left their indelible imprimatur, and enriched its passage. For the past 42 years,my journey has been cradled and embraced by the unwavering love and devotion of my wife IdaMarie. Without her constant inspiration and clarity of vision,this effort and life’s true essence would be without meaning. My daughters Laura and Rina,son-in-law Robert and grandchildren Lauren, Vincent, and Camille continue to illuminate my days with the radiance of their being. Lastly,to my parents Lili and Salvatore, although deceased,for the humanity that,through poverty and perseverance, distinguished their lives and transcends time. Prelims.qxd 1/2/08 11:11 AM Page 7 Foreword In this text, An Atlas of the Clinical Microbiology of largely as a consequence of increased reliance on Infectious Diseases, Volume 1, Bacterial Agents, Dr instrumentation and other forms of technology, Edward J.Bottone has done practicing clinical micro- expertise in more traditional aspects of clinical biologists a huge service. Drawing on over 35 years microbiology, such as use of cellular and colony of experience, he has compiled an extraordinary morphology as means for presumptive if not defini- collection of photos and photomicrographs pertain- tive microorganism identification,has clearly eroded. ing to the laboratory diagnosis of a vast number of This reality is problematic in so far as morphology different bacterial infectious disease problems. The remains the cornerstone of the laboratory diagnosis material is presented in a coherent and logical of infectious diseases. An Atlas of the Clinical manner. The quality of the images in this Atlas is Microbiology of Infectious Diseases represents an exceptional. As an added feature, pursuant to each elegant reminder of this reality. pathogen, Dr Bottone provides text which clearly This text will quickly become an invaluable and and concisely delineates important features related practical resource for individuals working in clinical to cellular and colony morphology,growth patterns, microbiology laboratories. An Atlas of the Clinical microbiological characteristics, pathogenesis and Microbiology of Infectious Diseases is one of those disease manifestations. books that will not collect dust on the shelf;it will be The practice of clinical microbiology during the referred to constantly in the laboratory. In addition, past 20 years has undergone remarkable change. training programs for medical technologists, pathol- What was once strictly a manual endeavor,more art ogy residents and infectious disease fellows will than science, has increasingly embraced various undoubtedly lean heavily on this text as an impor- forms of instrumentation in the day-to-day provision tant tool for teaching. Dr Bottone is to be of diagnostic services. This trend will certainly commended on this wonderful addition to the clini- continue as we enter the exciting new age of molec- cal microbiology literature. ular infectious disease diagnosis. Unfortunately, Gary V.Doern,PhD September,2003 7 Ch 1 final.qxd 12/22/07 10:49 AM Page 9 1 Gram-positive, branching and non-branching, non-acid-fast, bacillary species ACTINOMYCES Culture characteristics Actinomyces are Gram-positive filamentous bacteria Actinomycesspecies are microaerophilic to anaerobic. which are part of the resident oral flora, colonizing The optimum temperature for growth is 37ºC.With especially the gingival crevices and the tonsils in the the exception of A. viscosus and A. neuii, absence of clinical disease. Actinomyces may also Actinomyces species are catalase-negative. colonize the vagina and gastrointestinal tract. Proprionibacterium acnes, however, a Gram-positive Actinomycosis is a chronic disease caused by several anaerobic bacterium which resides on the human species of Actinomyces, the most common of which skin,and which also forms branching bacillary forms, are A. israelii, A. gerencseriae, A. naeslundi, A. is also catalase-positive and must be differentiated viscosus, A. odontolyticus and A. meyeri. Actino- from A.viscosus and A.neuii. mycosis develops when the microorganism is intro- duced into surrounding tissue and is characterized by BACILLUS SPECIES the formation of suppurative abscesses that usually result in draining sinuses.Because of radial growth of Members of the genus Bacillus are Gram-positive to the bacterium,colonies form in tissue,surrounded by Gram-variable, aerobic, rod-shaped bacteria which a marked inflammatory response which gives rise to firm yellowish granules (‘sulfur granules’). These may be extruded with draining pus. While three major categories of infection (cervicofacial,thoracic, abdominal) are well recognized, actinomycosis may develop in any organ or body site, e.g. the eye (lacrimal canaliculitis) and the female pelvis in asso- ciation with the presence of an intrauterine contra- ceptive device.Actinomycosis may occur in conjunc- tion with other bacterial species such as Actinobacillus actinomycetemcomitans and Eikenella corrodens. Morphology Actinomyces (‘ray fungus’) species are Gram-positive bacteria that occur as branching,beaded,filamentous Figure 1 Actinomyces Gram stain of cervicofacial abscess drainage showing beaded filaments and filament rods which fragment into short ‘diphtheroid’ and fragments,many of which are slightly curved with clubbed coccoid forms.Often,the filaments of A.israeliihave ends bearing a morphological resemblance to a swollen,clubbed terminus. Corynebacterium(‘diphtheroids’) species 9 Ch 1 final.qxd 12/22/07 10:49 AM Page 10 AN ATLAS OF THE CLINICAL MICROBIOLOGY OF INFECTIOUS DISEASES Figure 2 Actinomyces Gram stain of 48-h agar Figure 5 Actinomyces ‘Spider’ colony as viewed culture showing predominance of branching,beaded fila- microscopically (1000x) after 48-h incubation showing ments with rounded or clubbed ends radiating, branched filaments with clubbing emanating from a central inoculum Figure 3 Actinomyces Radiating, intertwining, beaded filaments in Gram stain of pus from brain abscess. Figure 6 Actinomyces Mature colony of A. israelii Note (lower left) presence of small Gram-negative with irregular contours and ‘molar tooth’ central coccobacilli morphologically consistent with Actinobacillus depression actinomycetemcomitans Figure 4 Actinomyces Characteristic ‘sulfur granule’ Figure 7 Actinomyces Discrete granular growth 1 cm in hematoxylin and eosin stain of lung biopsy. Granule beneath thioglycolate broth surface. Each granule comprised of dense filamentous bacterial mass surrounded represents a single colony by prodigious inflammatory response,which together can inhibit antibiotic penetration into granule (colony) center 10 Ch 1 final.qxd 12/22/07 10:49 AM Page 11 GRAM-POSITIVE, BRANCHING AND NON-BRANCHING, NON-ACID-FAST, BACILLARY SPECIES Figure 8 Actinomyces Microscopic (1000x) observa- Figure 11 Actinomyces Ramifying filaments with tion of crushed granule from broth culture showing clubbed termini in phase-contrast-enhanced examination ramifying filaments analogous to those seen in crushed of wet preparation of crushed sulfur granule extruded into sulfur granule gauze dressing of patient with thoracic actinomycosis. Note the presence of inflammatory cells Figure 9 Actinomyces Extruded washed ‘sulfur granules’ from chest wall drainage Figure 10 Actinomyces ‘Sulfur’ granules in gauze Figure 12 Actinomyces Cervicofacial actinomycosis dressing containing purulent drainage from patient with with draining sinus tract thoracic actinomycosis 11
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