Slide 1Slide 2Slide 3Listeria monocytogenesListeria monocytogenesListeria monocytogenesListeria monocytogenesListeria monocytogenesL. Monocytogenes Major Clinical SyndromesListeria monocytogenesListeria monocytogenesPreventionPrevention-High Risk PatientsPrevention-High Risk PatientsSlide 15CorynebacteriumC. diptheriaeC. diptheriaeC. Diptheriae -USAC. diptheriae - RussiaRussian OutbreakDiptheriaDiptheria – Clinical ManifestationsDiptheriaDiptheriaDiptheriaDiptheriaDiptheriaBacillus speciesBacillus anthracisAnthaxAnthraxAnthraxAnthaxAnthrax ToxinsAnthrax Toxins – PA, LF, EFSlide 37Cutaneous AnthraxSlide 39Slide 40Inhalational AnthraxWidened MediastinumAnthraxTreatmentGram Positive BacilliListeria, Corynebacteria, and BacillusAlan J. Lesse, M.D.Aerobic Gram Positive BacteriaChainsStreptococcusStaphylococcusCocci RodsLancefield GroupingGroup A S. pyogenesGroup B S. agalactiaeGroups ,C,D,F,G and othersNon-Lancefield GroupableViridans StreptococciStaphylococcus aureusEnterococcusListeriaCorynebacteriaBacillusErysipelothrixHemolysis classificationCatalase positiveCatalase negativeClustersEnterococcus faecalisEnterococcus faeciumEnterococus duransothersFormerly Group D StrepStreptococcus pneumoniaeCoagulase-negative staphylococciCoagulase positiveCoagulase negativeAerobic Gram Negative BacteriaCocciRodsNeisseriaN. gonorrhoeaeN. meningitidisMoraxellaMoraxella catarrhalisKingellaGrows on MacConkey AgarNon-enteric Growth RequirementsGlucose FermentorOxidaseLactose FermentorEscherichiaEnterobacterKlebsiellaSlow or variable lactoseCitrobacterSerratiaProteusProvidentiaSalmonellaShigellaYersiniaVibrio*Aeromonas*PseudomonasBurkholderiaAlcaligenesStenotrophomonasAcinetobacterHaemophilusActinobacillusCardiobacteriumEikenellaBordetellaBrucellaFrancisellaPasteurellaLegionellaYesYesNoYesNoPositiveNegativeNoListeria monocytogenesGram positive rodMore frequently seen in immunocompromised patientsHigh frequency of disseminated inections in pregnancySeen in neonates, elderly, and immunocompromisedFrequently causes a infections in the central nervous systemhttp://www.cdc.gov/nczved/divisions/dfbmd/diseases/listeriosis/Listeria monocytogenesMicrobiologyExhibits tumbling motility because of flagellaCan be mistaken for Gram negative rod with over-decolorizationRequires thorough pasteurizationListeria can multiply at 4˚C and survive frozenListeria monocytogenesEpidemiology▪Zoonosis▪Associated with milk and milk products, particularly soft cheese▪Any failure in pasteurization can lead to organisms that then multiply at 4˚C or survive in freeze▪2000 cases per year and around 400 deaths per year▪Infants younger than 1 month▪Adults older than 60 year▪ Pregnant women▪ Altered cell mediated immunity▪Recent large outbreak with Colorado cantaloupeListeria monocytogenesPathogenesisIngestion of organismsReplicates intracellularly▪S. typhi, M. tuberculosis, Legionella penumophila also doAttaches to intestinal epithelial cell and macrophagesOnce in phagolysosome secretes a hemolysin (listeriolysin) which allows escape from the phagosome and replication in the cytoplasmAlteration of cell shape and actin extruded processes allow for cell to cell spreadPredilection for the placental and central nervous systemLarge outbreaks, generally dairy productsCantaloupes???Listeria monocytogenesImmunityInnate and cellular immunity▪Pregnancy and neonate have lowered immunity▪Lymphoma, transplant patients on immunosuppressive, AIDS patients, patients on steroids, other cell mediated immune defects▪Patients receiving TNF blocking agents▪ElderlyL. MonocytogenesMajor Clinical SyndromesListeria monocytogenesPregnancy and NeonateWomen infect placenta and fetus in utero – vertical transmissionMeningitis and EncephalitisTransplant patients, AIDS, ElderlyBacteremiaTransplant patients, AIDS, ElderlyListeria monocytogenesTreatmentAmpicillinTrimethorim-sulfamethoxasolePreventionThoroughly cook raw food from animal sources, such as beef, pork, or poultry. Wash raw vegetables thoroughly before eating.Keep uncooked meats separate from vegetables and from cooked foods and ready-to-eat foods.Avoid unpasteurized (raw) milk or foods made from unpasteurized milk.Wash hands, knives, and cutting boards after handling uncooked foods.Consume perishable and ready-to-eat foods as soon as possiblehttp://www.cdc.gov/nczved/dfbmd/disease_listing/listeriosis_gi.html#preventedPrevention-High Risk PatientsDo not eat hot dogs, luncheon meats, or deli meats, unless they are reheated until steaming hotAvoid getting fluid from hot dog packages on other foods, utensils, and food preparation surfaces, and wash hands after handling hot dogs, luncheon meats, and deli meats.Do not eat soft cheeses such as feta, Brie, and Camembert, blue-veined cheeses, or Mexican-style cheeses such as queso blanco, queso fresco, and Panela, unless they have labels that clearly state they are made from pastuerized milk.http://www.cdc.gov/nczved/dfbmd/disease_listing/listeriosis_gi.html#preventedPrevention-High Risk PatientsDo not eat refrigerated pâtés or meat spreads. Canned or shelf-stable pâtés and meat spreads may be eaten.Do not eat refrigerated smoked seafood, unless it is contained in a cooked dish, such as a casserole. Refrigerated smoked seafood, such as salmon, trout, whitefish, cod, tuna or mackerel, is most often labeled as "nova-style," "lox," "kippered," "smoked," or "jerky." The fish is found in the refrigerator section or sold at deli counters of grocery stores and delicatessens. Canned or shelf-stable smoked seafood may be eaten.Aerobic Gram Positive BacteriaChainsStreptococcusStaphylococcusCocci RodsLancefield GroupingGroup A S. pyogenesGroup B S. agalactiaeGroups ,C,D,F,G and othersNon-Lancefield GroupableViridans StreptococciStaphylococcus aureusEnterococcusListeriaCorynebacteriaBacillusErysipelothrixHemolysis classificationCatalase positiveCatalase negativeClustersEnterococcus faecalisEnterococcus faeciumEnterococus duransothersFormerly Group D StrepStreptococcus pneumoniaeCoagulase-negative staphylococciCoagulase positiveCoagulase negativeCorynebacteriumCorynebacterium diptheriaeOther corynebacteriumC. diptheriaeDipthera - from the greek word for “leather”MicrobiologyGram positive bacillus – “Chinese letters”Grows on blood agar but use of tellurite agar improves