Gram staining

A Gram stain of mixed Staphylococcus aureus (S. aureus ATCC 25923, gram-positive cocci, in purple) and Escherichia coli (E. coli ATCC 11775, gram-negative bacilli, in red), the most common Gram stain reference bacteria

Gram staining, also called Gram's method, is a method of staining used to differentiate bacterial species into two large groups (gram-positive and gram-negative). The name comes from the Danish bacteriologist Hans Christian Gram, who developed the technique.

Gram staining differentiates bacteria by the chemical and physical properties of their cell walls by detecting peptidoglycan, which is present in a thick layer in gram-positive bacteria.[1] Gram-positive bacteria retain the crystal violet dye, while a counterstain (commonly safranin or fuchsine) added after the crystal violet gives all gram-negative bacteria a red or pink coloring.

The Gram stain is almost always the first step in the preliminary identification of a bacterial organism. While Gram staining is a valuable diagnostic tool in both clinical and research settings, not all bacteria can be definitively classified by this technique. This gives rise to gram-variable and gram-indeterminate groups.

History

The method is named after its inventor, the Danish scientist Hans Christian Gram (1853–1938), who developed the technique while working with Carl Friedländer in the morgue of the city hospital in Berlin in 1884. Gram devised his technique not for the purpose of distinguishing one type of bacterium from another but to make bacteria more visible in stained sections of lung tissue.[2] He published his method in 1884, and included in his short report the observation that the typhus bacillus did not retain the stain.[3]

Uses

Gram staining is a bacteriological laboratory technique[4] used to differentiate bacterial species into two large groups (gram-positive and gram-negative) based on the physical properties of their cell walls.[5] Gram staining is not used to classify archaea, formerly archaeabacteria, since these microorganisms yield widely varying responses that do not follow their phylogenetic groups.[6]

The Gram stain is not an infallible tool for diagnosis, identification, or phylogeny, and it is of extremely limited use in environmental microbiology. It is used mainly to make a preliminary morphologic identification or to establish that there are significant numbers of bacteria in a clinical specimen. It cannot identify bacteria to the species level, and for most medical conditions, it should not be used as the sole method of bacterial identification. In clinical microbiology laboratories, it is used in combination with other traditional and molecular techniques to identify bacteria. Some organisms are gram-variable (meaning they may stain either negative or positive); some are not stained with either dye used in the Gram technique and are not seen. In a modern environmental or molecular microbiology lab, most identification is done using genetic sequences and other molecular techniques, which are far more specific and informative than differential staining.

Gram staining has been suggested to be as effective a diagnostic tool as PCR in one primary research report regarding gonococcal urethritis.[7]

Medical

Gram stains are performed on body fluid or biopsy when infection is suspected. Gram stains yield results much more quickly than culturing, and is especially important when infection would make an important difference in the patient's treatment and prognosis; examples are cerebrospinal fluid for meningitis and synovial fluid for septic arthritis.[4][8]

Staining mechanism

Gram-positive bacteria have a thick mesh-like cell wall made of peptidoglycan (50–90% of cell envelope), and as a result are stained purple by crystal violet, whereas gram-negative bacteria have a thinner layer (10% of cell envelope), so do not retain the purple stain and are counter-stained pink by safranin. There are four basic steps of the Gram stain:

Crystal violet (CV) dissociates in aqueous solutions into CV+
 and chloride (Cl−
) ions. These ions penetrate through the cell wall and cell membrane of both gram-positive and gram-negative cells. The CV+
 ion interacts with negatively charged components of bacterial cells and stains the cells purple.

Iodide (I−
 or I−
3) interacts with CV+
 and forms large complexes of crystal violet and iodine (CV–I) within the inner and outer layers of the cell. Iodine is often referred to as a mordant, but is a trapping agent that prevents the removal of the CV–I complex and, therefore, color the cell.[11]

When a decolorizer such as alcohol or acetone is added, it interacts with the lipids of the cell membrane. A gram-negative cell loses its outer lipopolysaccharide membrane, and the inner peptidoglycan layer is left exposed. The CV–I complexes are washed from the gram-negative cell along with the outer membrane. In contrast, a gram-positive cell becomes dehydrated from an ethanol treatment. The large CV–I complexes become trapped within the gram-positive cell due to the multilayered nature of its peptidoglycan. The decolorization step is critical and must be timed correctly; the crystal violet stain is removed from both gram-positive and negative cells if the decolorizing agent is left on too long (a matter of seconds).

After decolorization, the gram-positive cell remains purple and the gram-negative cell loses its purple color. Counterstain, which is usually positively charged safranin or basic fuchsine, is applied last to give decolorized gram-negative bacteria a pink or red color.[12][13]

Some bacteria, after staining with the Gram stain, yield a gram-variable pattern: a mix of pink and purple cells are seen. The genera Actinomyces, Arthobacter, Corynebacterium, Mycobacterium, and Propionibacterium have cell walls particularly sensitive to breakage during cell division, resulting in gram-negative staining of these gram-positive cells. In cultures of Bacillus, Butyrivibrio, and Clostridium, a decrease in peptidoglycan thickness during growth coincides with an increase in the number of cells that stain gram-negative.[14] In addition, in all bacteria stained using the Gram stain, the age of the culture may influence the results of the stain.

Examples

Gram-positive bacteria

Gram-positive bacteria generally have a single membrane (monoderm) surrounded by a thick peptidoglycan. This rule is followed by two phyla: Firmicutes (except for the classes Mollicutes and Negativicutes) and the Actinobacteria.[5][15] In contrast, members of the Chloroflexi (green non-sulfur bacteria) are monoderms but possess a thin or absent (class Dehalococcoidetes) peptidoglycan and can stain negative, positive or indeterminate; members of the Deinococcus-Thermus group, stain positive but are diderms with a thick peptidoglycan.[5] [15]

Historically, the gram-positive forms made up the phylum Firmicutes, a name now used for the largest group. It includes many well-known genera such as Bacillus, Listeria, Staphylococcus, Streptococcus, Enterococcus, and Clostridium. It has also been expanded to include the Mollicutes, bacteria like Mycoplasma that lack cell walls and so cannot be stained by Gram, but are derived from such forms.

Normally, if Gram stain is done on acid-fast bacteria, they show up as if they are gram-positive, mostly because of their thick cell wall.

Gram-negative bacteria

Gram-negative bacteria generally possess a thin layer of peptidoglycan between two membranes (diderms). Most bacterial phyla are gram-negative, including the cyanobacteria, spirochaetes, and green sulfur bacteria, and most Proteobacteria (exceptions being some members of the Rickettsiales and the insect-endosymbionts of the Enterobacteriales).[5][15]

Gram-indeterminate bacteria

Gram-indeterminate bacteria do not respond predictably to Gram staining and, therefore, cannot be determined as either gram-positive or gram-negative; they tend to stain unevenly, appearing partially gram-positive and partially gram-negative, or unstained by either crystal violet or safranin. Examples include many species of Mycobacterium, including M. tuberculosis and M. leprae.[16][17]

Gram-indeterminate bacteria are best stained using acid-fast staining techniques. Staining older cultures (over 48 hours) can lead to false gram-variable results, probably due to changes in the cell wall with aging.

See also

References

  1. ↑ John G. Holt; Noel R. Krieg; Peter H.A. Sneath; James T. Staley; Stanley T. Williams (1994). Bergey's Manual of Determinative Bacteriology (9th ed.). Lippincott Williams & Wilkins. p. 11. ISBN 0-683-00603-7.
  2. ↑ Austrian, R. (1960). "The Gram stain and the etiology of lobar pneumonia, an historical note". Bacteriological Reviews 24 (3): 261–265. PMC 441053. PMID 13685217.
  3. ↑ Gram, H.C. (1884). "Über die isolierte Färbung der Schizomyceten in Schnitt- und Trockenpräparaten". Fortschritte der Medizin (in German) 2: 185–189..
    English translation in: Brock, T.D. (1999). Milestones in Microbiology 1546–1940 (2 ed.). ASM Press. pp. 215–218. ISBN 1-55581-142-6.
    Translation is also at: Brock, T.D. "Pioneers in Medical Laboratory Science: Christian Gram 1884". Hoslink. Retrieved 2010-07-27.
  4. 1 2 Ryan K.J., Ray C.G. (editors) (2004). Sherris Medical Microbiology (4th ed.). McGraw Hill. pp. 232f. ISBN 0838585299.
  5. 1 2 3 4 Madigan, M.T.; Martinko J.; Parker J. (2004). Brock Biology of Microorganisms (10th ed.). Lippincott Williams & Wilkins. ISBN 0-13-066271-2.
  6. ↑ Beveridge T.J. (2001). "Use of the Gram stain in microbiology". Biotechnic and Histochemistry 76 (3): 111–118. doi:10.1080/714028139. PMID 11475313.
  7. ↑ El-Garnal, A.H., Al-Otaibi, S.R., Alshamali, A., Abdulrazzaq, A., Najem, N., and Fouzan, A.A. Polymerase chain reaction is no better than Gram stain for diagnosis of gonococcal urethritis. Indian Journal of Dermatology, Venereology, and Leprology, (2009); 75, 101.
  8. ↑ Søgaard M., Nørgaard M., Schønheyder H. (2007). "First notification of positive blood cultures: high accuracy of the Gram stain report". Journal of Clinical Microbiology 45 (4): 1113–1117. doi:10.1128/JCM.02523-06. PMC 1865800. PMID 17301283.
  9. ↑ Microbiology; J.G. Black Prentice Hall, 1993.
  10. ↑ "Medical Chemical Corporation". med-chem.com. Retrieved 9 March 2016.
  11. ↑ "StainsFile - Stain theory - What a mordant is not". stainsfile.info. Retrieved 9 March 2016.
  12. ↑ Beveridge T.J., Davies J.A. (November 1983). "Cellular responses of Bacillus subtilis and Escherichia coli to the Gram stain". Journal of Bacteriology 156 (2): 846–58. PMC 217903. PMID 6195148.
  13. ↑ Davies J.A., Anderson G.K., Beveridge T.J., Clark H.C. (November 1983). "Chemical mechanism of the Gram stain and synthesis of a new electron-opaque marker for electron microscopy, which replaces the iodine mordant of the stain". Journal of Bacteriology 156 (2): 837–845. PMC 217902. PMID 6195147.
  14. ↑ Beveridge T.J. (March 1990). "Mechanism of Gram variability in select bacteria". Journal of Bacteriology 172 (3): 1609–1620. PMC 208639. PMID 1689718.
  15. 1 2 3 Don J. Brenner, Noel R. Krieg, James T. Staley (July 26, 2005) [1984]. George M. Garrity, ed. Introductory Essays. Bergey's Manual of Systematic Bacteriology 2A (2nd ed.). New York: Springer. p. 304. ISBN 978-0-387-24143-2. British Library no. GBA561951.
  16. ↑ Black, Jacquelyn (2012). Microbiology: Principles and Exploration (8th ed.). John Wiley & Sons. p. 68. ISBN 978-0-470-54109-8.
  17. ↑ Reynolds J., Moyes R.B., Breakwell D.P. (2009). "Differential staining of bacteria: acid fast stain". Current Protocols in Microbiology. Appendix 3: Appendix 3H. doi:10.1002/9780471729259.mca03hs15. PMID 19885935.

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