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231 Cards in this Set

  • Front
  • Back
What are 4 groups of Gram Positive cocci that you need to know?
1. Staphylococci
2. Streptococci
3. Enterococci
4. NS Anaerobes
What is the first step when confronted with a clinical case?
Create a problem list
After you create a problem list, what should you do?
Create a list of differential diagnoses for each of the problems.
When you make a problem list what are 3 things you should definitely consider?
-the location of each problem
-the body system(s) involved
-Prioritize the list based on the most common diagnoses statistically
How do you differentiate b/w diagnoses?
-Tests
-Tx in some cases (if it works, then you diagnose that way)
What two things are increased in turbid fluid?
# of cells
amount of protein
How do most pathogens cause pathology?
By causing inflammation
What must be seen in order to suspect infectious disease?
evidence of inflammation
T/F: All inflammations is caused by microorganisms.
False.
What are the first 2 stains usually applied to smears that may contain bacteria?
1. Diff Quik
2. Gram stain
What kind of stain is Diff Quik?
hematologic
Name 2 hematologic stains.
1. Diff Quik
2. Wright-Giemsa
What is the significance of seeing lots of neutrophils in a sample?
They are there to destroy antigens by phagocytosis
If you find bacteria in a sterile site, do you need to determine what they are? Why?
Yes, b/c it will change how you treat the animal and may affect the prognosis
What questions should you ask as you are interpreting a culture of bacteria?
-What does this mean?
-Is this significant?
-How do you know that it's significant?
-How is it significant?
T/F: All Staphylococcia are pathogenic.
False
How many joints are there in a horse's hock?
5: tarsocrural, proximal intertarsal, distal intertarsal, tarso-metatarsal, tarlo-calcaneal
What does a "pure culture" mean?
Only 1 type of bacteria is grown from a clinical sample
Why do you need to know something about bacterial pathogens?
-evidence of whether the isolated bacteria is likely to be causing the disease
-provides you with confidence to treat/control the disease
What type of bacteria are Staphylococcus?
Gram positive cocci that form clusters
About how many species of Staphylococci are there?
~35
How many Staphylococci species have veterinary importance?
5
Which species can be infected by Staphylococci aureus?
humans, horses, ruminants, pigs, cats, (dogs)
Name 4 Staphylococci species that are coagulase positive.
1. S. aureus
2. S. intermedius
3. S. schleiferi ss coagulans
4. S. hyicus
5. S. epidermis
Which species can be infected by Staphylococci intermedius?
dogs, (cats, cattle)
Which species can be infected by Staphylococci schleiferi ss coagulans?
dogs
What species of Staphylococci sometimes infect the ears of dogs?
Staphylococci schleiferi ss coagulans
What species can be infected by Staphylococci hyicus?
pigs
What species can be infected by Staphylococci epidermidis?
humans, cattle, dogs, horses, (cats)
Which 2 species of Staphylococi have major importance and in which animal species?
1. S. aureus (humans and other domestics)
2. S. intermedius (dogs)
Which 2 species of Staphylococci cause a wide range of diseases in animals and humans?
1. S. aureus
2. S. intermedius
What is one disease commonly caused by Staphylococci?
septic arthritis (Case: "Used to Run Fast")
T/F: Both S. aureus and S. intermedius are coagulase positive.
True
T/F: Species that are coagulase positive are also generally pathogenic.
True
T/F: Species that are coagulase negative are also generally pathogenic.
False: Species that are coagulase negative are also generally NON-pathogenic.
Where are coagulase-positive Staphylococci found?
-Skin (especially near muccocutaneous junctions)
-Moist areas of the body
-Distal nasal passage and external nares
-Animal products
-in the environment
How long can coagulase-positive Staphylococci live in the environment?
Relatively long
T/F: Both coagulase-negative and coagulase-positive Staphylococci may be found on the skin.
True
Which Staphylococci are normal skin flora?
Both coagulase-negative and coagulase-positive.
T/F: Animals can acquire Staphylococci infections both by endogenous and exogenous routes.
True
When an infection is endogenous, what does that mean?
The animal got the infection from normal flora on its own skin.
When an infection is exogenous, what does that mean?
The animal got the infection from the skin of other animals (e.g. humans) or the environment.
What kind of pathogens are Staphylococci?
opportunistic
What do opportunistic pathogens require in order to cause an infection?
There must be an underlying alteration in the host-pathogen interaction. Either the host becomes immuno-deficient in some capacity or the pathogen becomes a true pathogen by obtaining a strong virulence factor.
Which Staphylococci species is commonly isolated from infections? Why?
S. aureus
Because it is a good pathogen that requires only a small infectious dose and a little host compromise to cause infection.
Which Staphylococci species are rarely isolated from infections? Why?
S. epidermis
Because they are poor pathogens that require a lot of host compromise and a large dose to cause disease.
Why would administering a corticosteroid in a joint assist the establishment of infection?
Corticosteroids are anti-inflammatory drugs and would suppress local immunity within the joint.
What are some virulence factors that help pathogenic Staphylococci cause disease?
-capsule or pseudocapsule
-exotoxins (cytotoxins/hemolysins)
-intracellular survival
Do all Staphylococci have the same virulence factors?
No, there is strain variation
In what way are capsules virulence factors?
They have anti-phagocytic properties
T/F: Coagulase-negative Staphylococci are easily phagocytosed and killed.
True.
T/F: Haemolysins are important for virulence.
True
Why are haemolysins important for virulence?
They are cytotoxic and lethal
T/F: Haemolysins assist in the identification of pathogenic Staphylococci species.
True
What is leucocidin and what does it do?
It is an exotoxin of some Staphylococci species that kills phagocytes, thereby helping the bacteria evade the immune system.
T/F: Staphylococcus aureus can survive intracellularly.
True
Are all Staphylococci species able to survive intracellularly?
No
From what 2 things does intracellular survival protect bacteria from?
-immune system
-antibiotics
T/F: Intracellular survival results in persistence of infection.
True
T/F: Intracellular survival does NOT result in increased chronicity.
False: Intracellular survival results in persistence of infection (chronicity).
What are the gram reaction, morphology and atmospheric requirements of Staphylococci?
Gram positive cocci, facultatively anaerobic
What feature/test do we use to differentiate pathogenic from non-pathogenic Staphylococci?
coagulase test
Where do Staphs normally hang out?
Normal flora of skin, nares (muco-cutaneous junction, environment)
T/F: Staphs are facultative intracellular bacteria.
True
Which cells do Staphylococci predominantly survive in?
Macrophages
Give an example of obligate intracellular bacteria.
Anaplasma
Name 3 geni of pyogenic bacteria.
Staphylococci
Streptococci
Corynebacteria
What are 3 clinical signs of Staphylococci infection?
1. suppuration (pus)
2. abscess formation
3. fever
What does pyogenic mean?
producing pus
T/F: Both Staphylococci and Streptococci can survive intracellularly.
False: Only Staphylococci can survive intracellularly.
T/F: Abscesses involving Streptococci may be chronic.
False: Abscesses involving STAPHYLOCOCCI may be chronic because of their ability to survive intracellularly.
What is the pathogenesis of pus?
-When pyogenic bacteria invade tissues, they first cause vascular dilateion and a marked exudation of neutrophils from blood vessels.
-Within the tissues, the neutrophils move towards bacteria engulf them.
-Pathogenic bacteria are antiphagocytic and produce toxins that kill cells, including phagocytic cells.
-Enzymes liberated from dead neutrophils bring about additional tissue destruction.
-This results in partial liquefaction of the dead tissue and phagocytic cells. This becomes visible as thick, usually yellow, pus
-Pus is viscous due to the large amount of DNA from the nuclei of dead cells.
What is one result of pyogenic infections?
pus
T/F: Staphylococci are always associated with chronic infection.
False: Staphylococci MAY be associated with chronic infections.
What species is the most common cause of pyoderma in dogs?
Staphylococci intermedius
What bacterial species can cause otitis externa in dogs?
Staphylococci intermedius
What is necessary in order to control staphylococcal infections?
Must identify the underlying problem that gives Staphylococci the opportunity to cause infection
What Staphylococci species causes pyoderma in species other than dogs?
S. aureus
What does "Bumble Foot" refer to?
S. aureus pyoderma in birds
What is cellulitis?
A diffuse inflammatory process within solid tissues, characterized by edema, redness, pain, and interference with infection.
Which staphylococci species can cause cellulitis in species other than dogs?
S. aureus
What is a potential sequela of Staphylococci aureus infection in horses?
Cellulitis
Is cellulitis difficult to treat? Why?
Yes, because it involves the infection penetrating deeper tissues
What is "Greasy Pig Disease" caused by?
Staphylococci hyicus ss hyicus
Which pigs are most likely to get "Greasy Pig Disease"?
Piglets under 7 weeks of age
What are potential sequela of "Greasy Pig Disease"?
It frequently becomes systemic, involving lung, lymph nodes, kidney and brain involvement
What is exudative dermatitis of piglets called?
"Greasy Pig Disease"
What do Staphylococci intermedius commonly cause in dogs?
cystitis
What is cystitis?
inflammation of the urinary bladder
What are potential sequelae of cystitis when it is caused by Staphylococci intermedius?
pyelonephritis or prostatitis
T/F: Staphylococci intermedius is frequently associated with acidic urine in dogs, causing the formation of urate crystals.
False: Staphylococci intermedius is frequently make the urine more alkaline, causing struvite crystals and calculi in dogs.
How can Staphylococci infections spread?
Haematogenously and by direct innoculation
From what can Staphylococci infections spread haematogenously?
From cystitis, dermatitis, endocarditis, dental disease, etc.
What are 3 joint/bone diseases that Staphylococci can cause?
1. Discospondylitis
2. Osteomyelitis
3. Septic Arthritis
T/F: Staphylococci aureus is a minor cause of mastitis in dairy cows, sheep, and goats.
False: Staphylococci aureus is a MAJOR cause of mastitis in dairy cows, sheep, and goats.
T/F: Mastitis infections caused by Staphylococci aureus are easy to treat.
False: Infections can be VERY difficult to treat.
T/F: S. aureus mastitis can be sub-clinical, acute, gangernous, or chronic.
True
T/F: Mastitis caused by S. aureus is always due to endogenous infection.
False: Infections can go from cow-to-cow.
T/F: Coagulase-negative Staphylococci spp may be involved in implant (catheters, bone hardware, etc) infections.
True
Why are implant infections associated with coagulase negative Staphylococci infections?
Because implants are associated with significant, local host compromise.
What virulence factor may be associated with implant infections?
Glycocalyx may be involved in adhesion
How does the host get rid of Staphylococci infections?
1. Antibody-Mediated immunity
2. Cell-Mediated immunity
Explain how staphs are killed by antibody-mediated immunity
Staphs are killed by antibody (opsonization) with phagocytosis or complement-mediated killing
Which staph infections are associated with cell-mediated immune response?
Chronic (intracellular) infections
T/F: Hosts do not develop mechanisms to remain immune to staphylococci for long periods of time.
True. Most staphs are normal flora, so the host doesn't need to develop long-lived immunity, it just needs to get rid of the initial infection and repair the primary cause of immune compromise.
What 4 criteria must be fulfilled to place any significance on an isolation of Staphylococci from a clinical sample?
1. Sample must be collected appropriately from actual site of infection
2. Must be evidence of inflammation in the sample
3. Must be evidence of bacteria in the sample
4. The bacteria isolated must have the opportunity and be capable of causing this disease.
T/F: Many strains of Staphylococci have an unpredictable sensitivity pattern.
True
What does NPS mean?
not predictably sensitive
What species might MRSA colonise?
horse and pigs
Why should sensitivity testing be performed when you are figuring out how to treat Staphylococci infections?
Because many strains of Staphylococci have an unpredictable sensitivity pattern. You want to be sure that the infectious strain is not resistant to the antibiotic that you choose.
In which cases, should you be sure to test sensitivity of Staphylococci strains when you are preparing to treat infections?
-Recurrent disease
-Compromised host/site
What are the benefits of vaccination in relation to staph infections?
-Controlled clinical evaluations are lacking and associated benefits are dubious!!!
T/F: Inter-species spread of Staphylococci is common.
False: Inter-species spread of Staphylococci is RARE, but of concern with multi-resistant strains (e.g. MRSA)
For which species are Streptococci MAJOR pathogens?
horses
What is the gram reaction and cellular morphology of Streptococci?
Gram positive cocci in chains
Do you need to know which species of Streptococci are causing an infection? Why?
Yes, because it will change the treatment protocol and affect how the disease is controlled.
What are the atmospheric requirements of Streptococci?
Facultatively anaerobic
What are the major virulence factors of Streptococci?
haemolysins,
M protein
capsule
Name 2 major haemolytic patterns. How are these clinically relevant?
Beta and alpha hemolysis.
Most of the important streptococci diseases in domestic species are beta-hemolytic.
Alpha-hemolytic streptococci species are important in cattle, humans, and becoming so in dogs.
Non-hemolytic Streptococci are usually non-pathogenic
What are the 3 species of Streptococci that are most likely to infect horses?

What are their hemolysis patterns?
Which Lancefield group are they in?
1. S. equi ss equi
2. S. equi ss zooepidemicus
3. S. dysgalactiae ss equisimilis

All 3 are Beta-hemolytic and in Group C.
What is the most common species of Streptococci that infect dogs and cats? What is it's hemolytic pattern and Lancefield group?
S. canis

Beta-hemolysis and Group G
What are the 4 species of Streptococci that are most likely to infect cattle?

What are their hemolysis patterns?
Which Lancefield group are they in?
1. S. agalactiae (Group B)
2. S. dysgalactiae ss dysgalactiae (Group C)
3. S. uberis (no group)
4. S. canis (alpha-hemolysis, Group G)
5. S. porcinus (Group E)

All but #4 are beta-hemolytic
What 3 systems are used to classify Streptococci?
Hemolytic patterns
Lancefield grouping
Species level
What are two streptococci species commonly isolated from infections?
S. equi zooepidemicus or S. canis
What are two streptococci species rarely isolated from infections?
S. uberis or Enterococci
What is the general rule of Lancefield groups?
The hemolytic streptococci from different animal species belong to different Lancefield groups:
Group C = horses
Group G = dogs
In which domestic species is it important to determine which strep species and/or subspecies are involved in clinical situations?
-infections of horses (lymphadenitis)
-infections of cattle (mastitis)
Where can streptococci be found normally?
-May be found in the environment.
-Most commonly found as commensals on animals and humans:
on mucous membranes, on skin
T/F: Most pathogenic streptococci can be carried on healthy animals.
True
T/F: Some strep species are obligate parasites.
True
Give an example of a strep species that is an obligate parasite.
S. agalactiae
Give an example of a strep species that is NOT an obligate parasite, but can cause mastitis in a herd of cows.
S. uberis
Where do Streptococci equi ss equi hang out on carrier animals?
In the guttural pouch of horses.
How are Streptococci equi ss equi transmitted between animals?
Through aerosol droplets that are inhaled.
When is Steptococci agalactiae transmitted between cows?
During milking
What are the primary virulence factors of streptococci?
-Avoid phagocytosis (decrease chemotaxis)
-Kill phagocytes
For which bacteria is M Protein a MAJOR virulence factor?
Streptococci
What virulence factor is used in current strep vaccines?
M Protein
T/F: All strep species have capsules
False: Only some strep strains and species have capsules
What are 2 mechanisms by which strep kill phagocytes?
1. exotoxins
2. hemolysins
In staphylococci, describe alpha and beta hemolysis.
Alpha: clear
Beta: Partial
In streptococci , describe alpha and beta hemolysis.
Alpha: Green
Beta: Clear
T/F: Streptococcal diseases tend to be chronic.
False: Streptoccocal diseases tend to be ACUTE.
How are streptococcal diseases cleared by the host?
Via the production of protective antibodies
How can antibody production against streptococci cause disease?
Type III hypersensitivity reactions
T/F: Streptococcal diseases that cause Type III hypersensitivity reactions in their hosts result in chronic disease.
True
What are 3 sequelae to streptococcal diseases that are accompanied by type III hypersensitivity reactions?
1. rheumatic fever
2. PURPURA HEMORRHAGICA
3. glomerulonephritis
What are the clincal signs of purpura hemorrhagica?
-Diffuse swelling of legs due to leakage of fluid from damaged blood vessels (edema)
-Severe cases: sloughing of skin and exudation due to intravascular thrombosis and necrosis
What 2 bacteria are VERY common isolates in disease situations?
Staph and Strep
What specific diseases do Streptococci cause?
1. Strangles
2. Mastitis
3. Pneumonia
4. Neonatal Septicemia
5. Necrotising Fasciitis
6. Other infections
T/F: Strangles is a highly contagious disease among horses world-wide.
True
Which horses are most susceptible to strangles?
young horses
What are 4 clinical signs of strangles?
1. fever
2. nasal discharge
3. anorexia
4. abscess formation
T/F: There is both high morbidity and high mortality due to strangles?
False: Strangles has high morbidity (occurrence), but low mortality (death)
What are 3 complications of strangles?
1. Guttural pouch empyema
2. "Bastard Strangles"
3. Purpura Hemorrhagica
In what species is cervical lymphadenitis seen and which bacteria are associated with this disease?
Pigs: Strep porcinus
Cats: Strep canis
What is the term for strangles when it is seen in pigs or cats?
Cervical lymphadenitis
What are 3 strep species that may be involved in mastitis?
1. S. agalactiae
2. S. dysgalactiae
3. S. uberis
T/F: Streptococci are involved in both upper and lower respiratory tract infections.
True
T/F: Stressors are usually required in order for streptococcal pneumonia to occur in animals.
True
In which animal species can streptococci cause neonatal septicemia?
foals, piglets, puppies, and kittens
Strep neonatal septicemia often results in dissemination of infection to what other sites?
joints, kidneys, heart (endocarditis) and meningitis
What bacteria can cause necrotising fasciitis in dogs and cats?
Group G Streptococci (S. canis)
What is the difference b/w infectious and contagious?
Infectious = caused by a micro-organism
Contagious = infection capable of being transmitted from animal to animal
What is a test that you can use to differentiate streptococci from staphylococci?
catalase test
What part of the respiratory tract is considered sterile?
"Sterile" after the larynx
Which hemolytic pattern of strep is most commonly associated with pathogenic strains?
Beta hemolysis
T/F: Antibodies to strep are serotype specific.
True
T/F: Immunity to strep is mostly long-lived.
True, but not for vaccinated animals
T/F: In cattle with mastitis, no useful immunity will develop.
True. Therefore cows with mastitis must be treated.
How are streptococcal infections treated?
1. Ancillary therapy (drainage, supportive care, +/-anti-inflammatory agents)
2. Antibiotics
T/F: Beta-hemolytic strep have an unpredictable sensitivity pattern.
False. Beta-hemolytic strep have a predictable sensitivity pattern.
What antibiotic are streptococci predictable sensitive to?
penicillin
What antibiotics are streptococci frequently RESISTANT to?
fluoroquinolones, aminoglycosides, and tetracyclines
T/F: Alpha-hemolytic and enterococci strep commonly have broader resistance to antibiotics including penicillin.
True
When are antibiotics recommended for treatment of strangles?
1. Very early in the disease when the animal only has a fever
2. When the disease is life-threatening (like an abscess that could cause asphyxiation)
3. With "Bastard Strangles"
For how long can streptococci survive in the environment and under what conditions?
Weeks to months in dry, dusty conditions
T/F: Streptococci are readily killed by most disinfectants
True
How long should horses with strangles be isolated/quarantined?
For 3-6 weeks or until the culture is negative.
What kinds of strangles vaccines are available for horses and pigs?
-Whole cell bacterin
-Live avirulent vaccines (intranasal)
-M protein (experimental)
Why is there controversy over live strangles vaccines?
-Induction of disease
-Induction of purpura
-Also induces better immunity
Which horses should be vaccinated against strangles?
Horses that regularly have contact with horses owned by others or where there is a history of strangles on the farm
What are the geni of pathogenic Gram negative cocci?
There are NONE
Do Gram positive rods tend to cause "diseases" or "syndromes"?
syndromes
What information provides a good presumptive diagnosis for gram positive rods?
History, Signalment, and clinical signs
What is the cellular morphology of Bacillus anthracis?
Large, square-ended rods
Gram positive
Capsules in vivo
Spore forming (aerobic conditions)
What should you do when you suspect anthrax?
NOTIFY APPROPRIATE AUTHORITIES!!! Don't do postmortem
What are the atmospheric requirements of Bacillus anthracis?
facultatively anaerobic
What are the only spore-forming gram positive rods?
Bacillus and Clostridia
Which Bacilli cause mastitis in cattle?
B. cereus
T/F: Other than B. anthracis and B. cereus, Bacillus spp are ubiquitous.
True
What are the 3 toxins of Bacillus anthracis?
1. Protective antigen
2. Edema Factor
3. Lethal Factor
T/F: Different animal species have different clinical signs associated with anthrax. Explain.
True. Different species have different susceptibility to B. anthracis infection and toxins.
Which animals are most susceptible to anthrax?
Ruminants
What toxin causes localised edema in B. anthracis infections?
Edema Factor
What is the most common sign of B. anthracis infection in ruminants?
Sudden death
What are 3 common signs of B. anthracis infection in ruminants?
1. Sudden death
2. Tarry blood from body orifices which fail to clot
3. absence of rigor mortis
Which 3 domestic species are the least susceptible to anthrax?
PIGS, dogs/cats
T/F: Pigs may get asphyxiation due to anthrax. Explain.
True. Anthrax infection does not usually become septicemic in pigs, but the localised edema may be enough to cause asphyxiation due to pharyngeal swelling.
What are the clinical signs of severe anthrax in horses and goats?
Colic/septicemia
What are the clinical signs of mild anthrax in horses and goats?
local edema
Which bacterial species is most known for causing gangrenous mastitis in cows?
Bacillus cereus
What is the color of milk from an udder with gangrenous mastitis?
"Port Wine"
What can Bacillus cereus cause in cows?
Severe sickness, abortion, death
T/F: Bacillus cereus causes opportunistic infection.
True.
How can you achieve a presumptive diagnosis of anthrax beyond just clinical signs?
Collect blood from ear vein, aqueous humor, or edema fluid and do a gram stain and a capsule stain.
How do you treat Bacillus anthracis infections?
QUICKLY
1. Antibiotics: Penicillin/Streptomycin for ruminants (also, tetracyclines, fluoroquinolones)
2. Antiserum (against Edema and Lethal Factors)
How do you control Bacillus anthracis infections?
YOU DON'T - Notify authorities!!! There are strict protocols for any anthrax outbreaks.
What is the morphology, gram reaction, and environmental requirement of Clostridiium?
Gram positive rods, motile, gas producing, endospore-forming, strict anaerobes
Where do clostridia love to live?
In niches with low oxidation-reduction potential
How do clostridium cause disease?
Production of various exotoxins (neurotoxin, enterotoxin, cytotoxin)
What are 2 neurotoxic clostridial diseases?
1. Botulism
2. Tetanus
What are 2 histotoxic clostridial diseases?
1. Malignant edema/gas gangrene
2. Black disease
What are 2 enterotoxemic clostridial diseases?
1. Enterotoxemia
2. Enteritis
What is the primary clinical symptom of Clostridium tetani infection? What is it caused by?
Spastic paralysis caused by the neurotoxin, tetanospasmin
Which animal species are most susceptible to C. tetani?
Horse
Which animal species are highly susceptible to C. tetani?
Horses, guinea pigs, humans, mice, rabbits
Which animal species are less susceptible to C. tetani?
dogs, cats, cattle, pigs, sheep, goats
Which animal species are extremely resistant to C. tetani?
most birds and cold-blooded animals
How does C. tetani cause death?
Spasm of muscles involved in respiration
What clinical signs are associated with C. tetani?
Increased temperature (due to excess muscular activity), increased (or decreased) heart rate, increased respiratory rate, increased salivation, "sawhorse stance" (extensor rigidity), convulsive contractions of voluntary muscles, protrusion of 3rd eyelid and enopthalmus
What 3 features of all Clostridia facilitate their survival and contribute to the diseases they cause?
1. endospores
2. exotoxins
3. gas
Where are Clostridia found?
soil, GI tract, water
How do we treat C. tetani infections?
-Vigorously clean + debride wound
-Antibiotics (metronidazole, penicillin G)
-Antitoxin (equine)
-Sedatives
Can C. botulinum be treated with antibiotics?
No. They don't work
What is the atmospheric requirement of peptococcus and peptostreptococcus?
Strict anaerobes
What is the morphology and atmospheric requirement of Enterococci?
Gram positive cocci
Facultative anaerobes
Are Enterococcus spp normal flora? Where can they be found?
They are normal flora of the GI tract
Are Micrococcus spp normal flora? Where can they be found?
They are normal flora of the skin.
T/F: Micrococcus spp can either be pathogens or common contaminants.
False. Micrococcus spp are NEVER pathogenic, but they are common contaminants
How do you interpret Gram negative cocci in a gram stain?
You mucked up!
You have gram positive cocci that are now staining gram negative - either due to bad staining technique or due to some change/damage to their cell wall