Methicillin Resistant Staphylococcus Aureus (MRSA)

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Computer generated Staphylococcus aureus. From: allposters [1]

Etiology/Bacteriology

Taxonomy

| Domain = Bacteria | Phylum = Firmicutes | Class = Bacilli | Order = Bacillales | Family = Staphylococcaceae | Genus = Staphylococcus | species = S. aureus

NCBI: Taxonomy Genome: Staphylococcus aureus

Description

Gram-stained Staphylococcus aureus. From: Microbeworld.org [2]

Staphylococcus aureus is a Gram-positive, non-spore forming, nonmotile, cocci bacterium that colonizes in yellow clusters. This facultative anaerobe is considered natural flora in 20-30% of humans, living in the anterior nares and on the skin and was first isolated in the 1890’s from the pus from a surgical abscess in a knee joint. S. aureus is the most common type of staphylococci to cause infections because of its ability to evade the immune system and many antibiotics. These “Staph infections” can cause bacteremia, endocarditis, soft tissue infections, pneumonia, bone and joint infections, CNS, toxic shock syndrome, and even food poisoning. The most notorious strain of Staphylococcus aureus was identified in the 1960's and is known as the methicillin resistant strain, commonly known for causing mild to severe skin infections resulting in death if not treated promptly. The most common place to contract Methicillin Resistant Staphylococcus aureus (MRSA) infection is typically in a hospital, but community outbreaks during the past decade have been widely observed, leading scientists to distinguish between Hospital-acquired Methicillin Resistant Staphylococcus Aureus (MRSA) and Community-Acquired Methicillin-Resistant Staphylococcus Aureus (CA-MRSA).

Pathogenesis

Transmission

Since S. aureus are a part of the natural flora in many humans’ nose and mouths, especially humans working in hospitals, the transmission of these bacteria can be difficult to prevent. Because the bacterium is nonmotile, S. aureus is most commonly spread through human-to-human contact or through contaminated surfaces./foods MRSA is typically spread from human-to-human by the hands. In a few cases MRSA can be transmitted through the cough of someone infected with MRSA pneumonia. This bacterium is most commonly transmitted horizontally rather than vertically.

Infectious dose, incubation, and colonization

S. aureus naturally colonizes in many parts of the body such as the nose, mouth, mammary glands, hair, upper respiratory tract and more. In most cases, S. aureus colonize these parts of the body harmlessly. These bacteria can survive in a wide range of temperatures ranging from 15-45 degrees Celsius and can also colonize in NaCl concentrations up to 15%. When ingested, the infectious dose of S. aureus is greater than 100,000 organisms, and the incubation period ranges from 30 minutes to 8 hours. The infectious dose and incubation period for other types of S. aureus infections can be hard to determine, as the bacteria can be carried for unknown amounts of time before causing infection, sometimes months. S. aureus can also be carried both chronically and intermittently.

Clinical features

Symptoms and Diagnosis

S. aureus can cause a whole host of different diseases and symptoms depending on where the infection is occurring in the body. The most well known Staph infection is that of the skin, but many other diseases are also caused by Staph infections as well. Diagnosis of the infection depends on where the bacteria has caused infection.

Bacteremia

Bacteremia, also known as "blood poisoning" can occur when bacteria enter into the blood stream and begin to colonize. In some cases, bacteremia is self-limiting and asymptomatic but in other cases is known to lead to septic shock, which is fatal. Bacteremia may be characterized by one of more of the following symptoms: fever, chills, malaise, abdominal pain, nausea, vomiting, diarrhea, anxiety, shortness of breath, and confusion. Bacteremia is diagnosed by culturing blood for bacteria. The blood might also reveal elevated white blood cell levels. (medical dictionary)

Endocarditis

Endocarditis occurs when the endocardium of the heart muscle is damaged, allowing bacteria in the blood stream to become lodged onto the heart valves or lining and cause infection. Endocarditis is not characterized by a single symptom, but can be detected by many symptoms such as a mild fever, chills, weakness, cough, trouble breathing, headaches, aching joints, and loss of appetite. It also causes heart murmurs and regurgitation in the heart valves. This disease usually affects people between the ages of 15-60. A risk that accompanies endocarditis is the formation of emboli. This occurs when bacteria break off from the site of colonization in clumps and become lodged in blood vessels. This can lead to organ failure as nutrients are blocked from accessing certain areas of the blood stream. Diagnosis of this is usually done by taking a sample of blood from the patient to test it for bacteria. Another way to diagnose Endocarditis is echocardiography, which uses ultrasound waves to make an image of the heart. This allows doctors to check for abnormalities like bacterial vegetation. (MD)

Soft tissue infections

Staph infections lead to several different kinds of soft tissue infections. Impetigo, abscesses, Necrotizing Fasciitis, erysipelas, and cellulitis are all examples of soft tissue infections caused by S. aureus. Each of these infections are caused by a bacterial invasion of the skin, usually through an open wound.

Pneumonia

When S. aureus infects the lungs, the resulting sickness is pneumonia. Pneumonia is the most common fatal infection contracted by those in the hospital. Symptoms of this infection include fever, cough, chest pain, shortness of breath, and increased respirations. Chills accompanying fevers are especially suspicious. Many patients with Pneumonia will also cough up sputum produced by the alveoli. Pneumonia is diagnosed through symptoms and a chest examination. Cultures of sputum and x-ray examinations may also be used to detect infection. (MD)

Meningitis

The meninges is the thin, membranous covering of the brain and spinal chord. Infection of this membrane is called meningitis and can be caused by bacteria, including S. aureus but it is rare. Meningitis caused by bacteria is typically the most serious and hard to treat. In many cases, meningitis can be fatal. Common symptoms of bacterial meningitis are fever, headache, vomiting, sensitivity to light, irritability, severe fatigue, stiff neck, and a reddish purple rash on the skin. Seizures, confusion, and an eventual coma are all possibilities if the infection remains untreated. The most reliable way to diagnose meningitis is a lumbar tap, where a sample of spinal fluid is taken from the lower spinal chord. The fluid is then examined under a microscope for signs of bacteria.

References

Created by Dehra McGuire, student of Tyrrell Conway at the University of Oklahoma.