Bacterial Agents
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Bacterial cell structure
Bacteria are single celled organisms
which typically range in size 0.3µm to 14µm (1µm = 1/1000 of a
millimetre). Whilst exceedingly small they are fully functioning
organisms, obtaining their nutrition from their environment, and able
to manufacture the complex substances necessary for life and
reproduction. The cell structure is simpler than that of other
organisms as there is no nucleus nor are there membrane bound
organelles. Instead their control centre containing the genetic
information is contained in a single loop of DNA. Some bacteria have
an extra circle of genetic material called a plasmid. The plasmid
often contains genes that give the bacterium some advantage over other
bacteria. For example it may contain a gene that makes the bacterium
resistant to a certain antibiotic.
Bacteria vary enormously in the substances which they can utilise as
food and the environments they can survive in, from high altitude to
the bottom of the deepest seas, to hot sulfur springs and even storage
pools for nuclear waste. Whilst some organisms can survive in a wide
range of situations, others are extremely specific.
Microbiologists classify bacteria by a variety of means
including: shape, motility, reactions to various stains, whether or
not they need oxygen to survive, their ability to utilise different
energy sources, their appearance when grown in the laboratory, whether
or not they ferment certain sugars and the temperatures at which they
live. The cell diagram at the top of the page shows the major features
of a bacterial cell, however not all bacteria show all features.
Bacterial morphology
Bacteria are, in part, classified
into groups according to their basic shapes or morphology: spherical
(cocci), rod (bacilli), spiral (spirilla), comma (vibrios) or
corkscrew (spirochaetes). They can exist as single cells, in pairs,
chains or clusters.
Staining methods are also used in identifying bacteria. The best known
staining methods for bacteria are Gram's stain and Ziehl-Neelsen
acid-fast staining. Other common methods include Albert's, Giemsa,
negative and silver stains
Gram's stain
Hans
Christian Gram developed what is perhaps the most famous of
bacteriological stain in 1884. Gram's stain divides all bacteria into
one of two groups, gram positive and gram negative. There are numerous
variations of the Gram staining method, in fact it was the subject of
the first research project I conducted back in 1966. Fundamentally a
film of bacteria is spread on a microscope slide and then heat fixed
by passing through a flame three or four times. The method may also be
used on histological sections, with some minor variations of
technique. The film, is then flooded with a solution of crystal violet
for a few seconds. Next the slide is washed and then flooded with
dilute iodine solution. Following this an attempt is made to remove
the stain using 70% ethanol (some methods use acetone or an
acetone/ethanol mixture), this only lasts about 10 seconds. The smear
is then counter-stained with a red or yellow stain. Bacteria that
retain the crystal violet/iodine complex and appear blue/black are
said to be Gram positive.
Ziehl-Neelsen stain
This
method was developed by Franz Ziehl and Friedrich Neelsen in the mid
1890s. In acid fast staining bacteria are differentiated according
to whether or not, after staining, they can be decolourised by
dilute sulfuric or hydrochloric acid, the best known of these
staining methods is Ziehl-Neelsen. A heat killed smear or
histological section is first stained with carbol-fuchsin (solution
of the red dye fuchsin in a solution of phenol. The slide is then
washed in water, and an attempt to remove the stain is made using
either dilute hydrochloric or sulfuric acid or acidified alcohol.
The preparation is then counter-stained with either a blue or green
stain, typically methylene blue. Acid-fast organisms show up as red.
Potential Bacterial agents
The letters in (brackets) represent
the NATO military codename(s). The letters in [square brackets]
represent the National Center for Emerging and Zoonotic Infectious
Diseases (NCEZID) classification of organisms.
Bacillus anthracis causes
anthrax and is one of the most deadly agents to have been used as a
biological weapon. It is classified by the US Centers for Disease
Control and Prevention (CDC) as a Category A agent, posing a
significant risk to national security. The gram-positive, rod-shaped
anthrax spores are found naturally in soil, can be easily cultured in
a laboratory, and last for many years, as spores, in the environment.
Anthrax has been used as a biological weapon for about a century.
Letters containing powdered anthrax spores were intentionally mailed
through the US postal system in 2001 affecting 22 people of which five
died. Experiments with the use of anthrax have been undertaken by all
countries attempting to use biological weapons.
Brucella abortus causes
contagious abortion in ruminants and brucellosis in humans. Brucella
abortus is a Gram-negative rod shaped bacteria that is non-motile, nor
does it create capsule slime. It does produce endospores, which enable
survival under long-term starvation and dessication. This
heterotrophic bacterium carries out either aerobic or anaerobic
respiration. This bacterium, as an intracellular pathogen, enters
phagocytes, such as macrophages, in humans and in cows. It attaches to
the endoplasmic reticulum of these cells. In humans brucellosis has
both an acute and a chronic phase. The chronic phase will last as long
as the host is alive without treatment. Acute symptoms include fever,
chills, headache, backache, weakness, and weight loss. The chronic
symptoms are usually recurring joint pain, fatigue, and headaches.
There is an antibiotic regimen for humans who come in contact with the
disease that includes the antibiotics rifampin and doxycycline
together.
Brucella melitensis is a
Gram-negative coccobacillus bacterium from the Brucellaceae family.
The bacterium causes ovine and caprine brucellosis. It affects
primarily sheep and goats, but cases have also been observed in
cattle, yaks, water buffalo, camels, alpacas, dogs, horses and
pigs. Humans can become infected. B. melitensis is the
most pathogenic of the brucellae, for humans.
Brucella suis, the cause
of porcine brucellosis, can also infect humans. Brucella suis
is a Gram-negative, facultative, intracellular coccobacillus, capable
of growing and reproducing inside of host cells, specifically
phagocytic cells. They are not spore-forming, capsulated, or motile. B.
suis was the first biological agent weaponized in 1952 in the
USA, and was field-tested with B. suis-filled bombs called
M33 cluster bombs. It is, however, considered to be one of the agents
of lesser threat because many infections are asymptomatic and the
mortality is low, but it is used more as an incapacitating agent.
Burkholderia mallei is the
cause of glanders, a zoonotic disease that primarily affects horses,
donkeys, and mules, but can also be seen in other animals e.g. goats,
dogs, and cats. Glanders is rare in humans. B. mallei is a
Gram-negative, coccobacillius it is non-motile and aerobic. During
World War I, the Germans used B. mallei to infect animals
that were being sent from neutral countries to the Allies with
glanders.
Burkholderia pseudomallei the
cause of melioidosis in humans also known as Whitmore's disease. B.
pseudomallei is practically identical to B. mallei
(they share about 99% of their DNA), to the extent that it is very
difficult to tell them apart, and some authorities regard them as
different strains of the same organism. B. pseudomallei is a
Gram-negative, coccobacillius, it is non-motile and aerobic. There are
several types of melioidosis infection, each with their own set of
symptoms. It is important to note that melioidosis has a wide range of
signs and symptoms that can be mistaken for other diseases such as
tuberculosis or more common forms of pneumonia.
Chlamydophila psittaci
is a lethal intracellular bacterial species that may cause endemic
avian chlamydiosis, epizootic outbreaks in mammals, and respiratory
psittacosis in humans. C. psittaci undergoes several
transformations during its lifecycle it exists as an elementary body
(EB) between hosts The EB is not biologically active, but is resistant
to environmental stresses and can survive outside a host. The
lifecycle of C. psittaci is divided between the elementary
body which is able to infect new hosts, but cannot replicate, and the
reticulate body, which replicates, but is not able to cause new
infection.
Clostridium botulinum is
a Gram-positive, rod-shaped, spore-forming bacterium, its toxins cause
botulism. It is an obligate anaerobe, meaning that oxygen is poisonous
to the cells. However, C. botulinum tolerates traces of
oxygen due to the enzyme superoxide dismutase, which is an important
antioxidant defense in nearly all cells exposed to oxygen. C.
botulinum forms protective spores when conditions for survival are
poor. The spore has a hard protective coating that encases the key
parts of the bacterium and has layers of protective membranes. Within
these membranes and the hard coating, the dormant bacterium is able to
survive for years. C. botulinum produces seven neurotoxins
(types A-G). These are the most potent toxins known (as little as 30
ng is sufficient to cause illness and possibly death), and are
responsible for botulism, a severe and often fatal neuroparalytic
intoxication. Two related organisms Clostridium
butyricum and Clostridium
baratii may also produce the same toxins.
Corynebacterium diphtheriae
the cause of diphtheria, is a nonmotile, aerobic, noncapsulated,
club-shaped, Gram-positive rod-shaped bacterium. Some strains produce
a potent exotoxin. C. diphtheriae is only able to produce
its exotoxin when the bacterium is infected by a bacteriophage which
provides it with the toxin-producing gene. The symptoms of
diphtheria include pharyngitis, fever, swelling of the neck or area
surrounding the skin lesion. Diphtheritic lesions are covered by a
pseudomembrane. The toxin is distributed to distant organs by the
circulatory system and may cause paralysis and congestive heart
failure.
Coxiella burnetii is an
obligate intracellular bacterial pathogen, and is the causative agent
of Q fever. C. burnetii is a small Gram-negative,
cocco-bacillary bacterium that is highly resistant to environmental
stresses such as high temperature, osmotic pressure, most
disinfectants and ultraviolet light. C. burnetii was
originally classified as a rickettsia, but when differences from other
rickettsia became apparent it was assigned its own genus. C.
burnetii is one of the most infectious organisms known,
only 1-10 organisms are needed to infect 50% of the population. C.
burnetii is one of seven biological organisms that were
weaponised by the USA during their biological warfare programme.
Escherichia coli is a
Gram-negative, facultative anaerobic, rod-shaped, coliform bacterium
of the genus Escherichia that is commonly found in the lower intestine
of warm-blooded organisms. Most E. coli strains are
harmless, but virulent strains can cause gastroenteritis, urinary
tract infections, neonatal meningitis, hemorrhagic colitis, and and
has been implicated in Crohn's disease. The harmless strains are part
of the normal microbiota of the gut, and can benefit their hosts by
producing vitamin K2, and preventing colonisation of the intestine
with pathogenic bacteria. Under favorable conditions, it takes as
little as 20 minutes to reproduce.
Francisella tularensis is
the cause of tuluraemia, also known as Pahvant Valley plague, rabbit
fever, deer fly fever, and Ohara's fever. Tularaemia is a bacterial
zoonotic disease of the northern hemisphere. F. tularensis
is an aerobic Gram-negative coccobacillus. It is a non-sporing and
non-motile organism. In nature, the disease may be spread in a number
of ways, person to person by droplet infection, by arthropod vector,
or contact with infected animals, or ingestion of contaminated water
or food. The Soviet Red Army used F. tularensis against German troops
in the battle of Stalingrad during World War II.
Listeria monocytogenes is
a facultative anaerobic, Gram positive, rod-shaped, motile,
non-spore forming bacterium. It can grow and reproduce inside the
host's cells and is one of the most virulent food-borne pathogens: 20
to 30% of foodborne listeriosis infections in high-risk individuals
may be fatal. L. monocytogenes is able to reproduce at 0°C.
Invasive infection by L. monocytogenes causes the disease
listeriosis. When the infection is not invasive, any illness as a
consequence of infection is termed febrile gastroenteritis. The
manifestations of listeriosis include sepsis, meningitis (or
meningoencephalitis), encephalitis, corneal ulcer, pneumonia, and
intrauterine or cervical infections in pregnant women, which may
result in spontaneous abortion in the second to third trimester or
stillbirth.
Mycobacterium tuberculosis
the cause of tuberculosis has an unusual, waxy coating on its cell
surface primarily due to the presence of mycolic acid. This coating
makes the cells impervious to Gram staining, and as a result, M.
tuberculosis can appear either Gram-negative or Gram-positive.
Acid-fast stains such as Ziehl-Neelsen, or fluorescent stains such as
auramine are used instead to identify M. tuberculosis
microscopically. M. tuberculosis is rod-shaped, a strict aerobe, is
non-sporing, and is non-motile. M. tuberculosis is unusually
slow growing, reproducing by binary fission every 18-24 hours.
Primarily a pathogen of the mammalian respiratory system, it normally
infects the lungs. M. tuberculosis is a member of a group of
closely related organisms comprising: M. tuberculosis, M.
paratuberculosis (the cause of Johne's disease in ruminants, M.
africanum, M. orygis. M. bovis (the primary cause of bovine
tuberculosis) and the Bacillus Calmette-Guérin strain (used in
vaccination against tuberculosis), M. microti, M. canetti, M.
caprae, M. pinnipedii, M. suricattae, and M. mungi.
M. tuberculosis is an unlikely BW agent because of its slow
growth, and the fact that the majority of the population have been
immunised.
Rickettsia prowazekii is
a small, Gram-negative, obligately intracellular, rod-shaped
bacterium. R. prowazekii is the causative agent of
epidemic typhus, also called louse-borne typhus. Epidemic typhus is
spread to people through contact with infected body lice. Symptoms of
epidemic typhus begin within 2 weeks after contact with infected body
lice. Signs and symptoms may include: fever and chills, headache,
rapid breathing, body and muscle aches, rash, cough, nausea, vomiting,
and confusion. Some people can remain infected, without symptoms, for
years after they first get sick.
Rickettsia rickettsii the
cause of Rocky Mountain spotted fever (RMSF), is a Gram-negative,
intracellular, coccobacillus bacterium that is around 0.8 to 2.0 μm
long. R. rickettsii is one of the most pathogenic of
Rickettsia. The most common cause of infection is bites by infected
ticks. The most common hosts for R. rickettsii are
ticks in the family Ixodidae. Typical symptoms of RMSF can
appear 2 - 14 days after exposure and include fever, headache,
depression, nausea, vomiting, and a skin rash called purpura or
petechiae. Sometimes the rash occurs 2 to 5 days after the onset of
the fever. Serious cases of RMSF can include central nervous system,
pulmonary, or hepatic injuries.
Rickettsia typhi is a
small, Gram-negative, rod-shaped, obligately intracellular bacterium.
R. typhi is the cause of murine or endemic typhus. R.
typhi is transmitted primarily by the rat flea, Xenopsylla
cheopis, although lice and mites are also potential vectors.
Rodents (mainly Rattus norvegicus, and Rattus rattus)
are considered the main reservoir of bacteria, but other vertebrate
hosts may serve as reservoir including house mice, shrews, opossums,
skunks, and cats. Murine typhus symptoms are similar to those of
epidemic typhus, although the former is usually less severe. The
incubation period is usually more prolonged than that of epidemic
typhus. Symptoms include headache, arthralgia and ill feeling, with or
without a low grade fever. Onset is characterized by persistent
headache, a high grade fever, and a cutaneous rash predominating on
the trunk. The rash is usually less apparent than in epidemic typhus,
and occasionally absent.
Salmonella enterica
- are rod-shaped, motile, facultative aerobic, Gram-negative bacteria.
S. enterica contains a large number of serovars or serotypes, which
can infect a broad range of vertebrate hosts. The individual members
range from being highly host-adapted to those displaying a broad host
range The most significant serovars as far as human disease is
concerned are: Enteritidis, Hadar, Heidelberg,
Infantis, Paratyphi, Typhi, and Typhimurium.
In fact there are more than 2,500 serovars. Of these the last
three are considered to be potential BW agents.
- S.
enterica Paratyphi, there are three
varieties of S. enterica Paratyphi, A, B, & C. They
cause paratyphoid, a potentially severe and occasionally
life-threatening bacteraemic illness. While fever and
gastrointestinal symptoms are common, the clinical presentation
varies, including mild and atypical infections. Infections caused
by Salmonella enterica serotypes Paratyphi A, B
(tartrate negative), and C are often characterized by insidious
onset of sustained fever, headache, malaise, anorexia, relative
bradycardia, constipation or diarrhea, and non-productive cough.
However, mild and atypical infections may occur.
- S.
enterica Typhi, is the cause of typhoid fever a
systemic infection, usually through ingestion of contaminated food
or water. The acute illness is characterized by prolonged fever,
headache, nausea, loss of appetite, and constipation or sometimes
diarrhoea. Symptoms are often non-specific and clinically
non-distinguishable from other febrile illnesses. However,
clinical severity varies and severe cases may lead to serious
complications or even death.
- S.
enterica Typhimurium, is the cause of
paratyphoid fever a life-threatening illness. The acute
illness is characterised by a sustained fever that can be as high
as 39 - 40°C, weakness, abdominal pain, headache, diarrhea or
constipation, cough, loss of appetite. Some people with
paratyphoid fever develop a rash of flat, rose-colored spots.
Shigella spp. cause the
infectious, intestinal human disease shigellosis, they are non-spore
forming, non-motile, rod-shaped Gram-negative bacteria. Most who are
infected with Shigella develop diarrhea, fever, and stomach cramps
starting a day or two after they are exposed to the bacteria.
Shigellosis usually resolves in 5 to 7 days. Some people who are
infected may have no symptoms at all, but may still pass the Shigella
bacteria to others. Members
of the genus are highly infectious, and cause 1 million deaths
annually worldwide.
- S. dysenteriae
serogroup A causes deadly epidemics mainly in developing
countries,
- S. boydii serogroup C
is restricted to the Indian subcontinent,
- S. flexneri serogroup
B and is responsible
for the worldwide endemic form of shigellosis
- S. sonnei serogroup D
are prevalent in developing and developed countries, respectively.
Vibrio cholerae - the
cause of cholera, is a Gram-negative, comma-shaped, halophilic, a
facultatively anaerobic, highly motile bacterium. Cholera is a
diarrheal disease, easily mistakable for several others; however,
there are some clinical features that are characteristic and can help
make the diagnosis. The presence of watery diarrhea with the
appearance of rice wter is characteristic. This is even more
impressive when associated with acute severe dehydration. Other
symptoms may include: abdominal pain, vomiting, cramping rectal pain
and other cramps, abnormally slight or infrequent urination, dry
mucosae, fever is less common, mental status alteration, from
alert to restless, somnolent and even comatose
Yersinia pestis the cause
of plague is a gram-negative, non-motile, non-sporing, rod-shaped,
facultatively anaerobic, coccobacillus bacterium. Symptoms of plague
include fever, weakness and headache. Usually this begins one to seven
days after exposure. There are three forms of the disease. In the
bubonic form there is also swelling of lymph nodes, while in the
septicemic form tissues may turn black and die, and in the pneumonic
form shortness of breath, cough and chest pain may occur. Bubonic and
septicemic plague are generally spread by flea bites or handling an
infected animal. The pneumonic form is generally spread person to
person through the air via infectious droplets.
- Bubonic plague - When
an infected flea bites a human and contaminates the wound with
regurgitated blood, the plague-causing bacteria are passed into
the tissue. Y. pestis can reproduce inside cells, so
even if phagocytosed, they can still survive. Once in the body,
the bacteria can enter the lymphatic system. Y. pestis
spreads through the lymphatic vessels of the infected person until
it reaches a lymph node, where it causes acute
lymphadenitis. The swollen lymph nodes form the
characteristic buboes associated with the disease. If the lymph
node is overwhelmed, the infection can pass into the bloodstream,
causing secondary septicemic plague and if the lungs are seeded,
it can cause secondary pneumonic plague.
- Septicemic plague -
The lymphatic system ultimately drains into the bloodstream, so
the plague bacteria may enter the blood and travel to almost any
part of the body. In septicemic plague, bacterial endotoxins cause
disseminated intravascular coagulation (DIC), causing tiny clots
throughout the body and possibly ischemic necrosis (tissue death
due to lack of circulation) from the clots. DIC results in
depletion of the body's clotting resources, so that it can no
longer control bleeding. Consequently, there is bleeding into the
skin and other organs, which can cause red and/or black patchy
rash and haemoptysis an haematemesis. There are bumps on the skin
that look somewhat like insect bites; these are usually red, and
sometimes white in the center. Untreated, septicemic plague is
usually fatal. People who die from this form of plague often die
on the same day symptoms first appear.
- Pneumonic plague - The
pneumonic form of plague arises from infection of the lungs. It
causes coughing and thereby produces airborne droplets that
contain bacterial cells and are likely to infect anyone inhaling
them. The incubation period for pneumonic plague is short, usually
two to four days, but sometimes just a few hours. The initial
signs are indistinguishable from several other respiratory
illnesses; they include headache, weakness and spitting or
vomiting of blood. The course of the disease is rapid; unless
diagnosed and treated soon enough, typically within a few hours,
death may follow in one to six days; in untreated cases mortality
is nearly 100%.