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Microbio Lec 11 - Ecoli, Klebsiella Proteus, Citrobacter An

Microbio Lec 11 - Ecoli, Klebsiella Proteus, Citrobacter An

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MICROBIOLOGY LECTURE 11 \u2013 Escherichia Coli, Klebsiella-
Enterobacter Serratia Group
Notes from Lecture
USTMED \u201907 Sec C AsM

ESCHERICHIA COLI
Important Properties
\u2022
most abundant facultative anaerobe in the colon
\u2022
ferments lactose
\u2022
has 3 antigens
1. 0 \u2013 150
2. H \u2013 50
result in more than 1000
3. K \u2013 90
antigenic types
Virulence Factors
\u2022
Pili
\u2022
Capsule
\u2022
Endotoxin
\u2022
exotoxin (enterotoxin)
-
high molecular weight (heat labile)
-
low molecular weight (heat stable)
Pathogenesis of Diseases
A. Intestinal Tract Infection
\u2022
adherence of bacteria to the epithelial cells of jejunum
and ileum by means of pili
o
bacteria synthesize enterotoxin
o
(no inflammation nor invasion)
o
watery, non-bloody diarrhea (cells of the colon
are not susceptible probably because they lack
receptor for the toxin
\u2022
Enterotoxigenic E. coli is the most common cause of
traveler\u2019s diarrhea
\u2022

Enteropathogenic (enteroinvasive) strains cause disease not by enterotoxin formation but by invasion of the epithelium of the large intestine causing bloody diarrhea (dysentery) accompanied by inflammatory cells (nuetrophils) in the stools

\u2022

Enterohemorrhagic strains (O157:H7) produces verotoxin or Shiga-like toxin causing bloody diarrhea but does not cause inflammation, so neutrophils are not found in the stool

\u2022

Associated with outbreaks of diarrhea following ingestion of undercooked hamburgers at fast food restaurants and direct contact with animals (visit to farms and petting zoos)

\u2022

Some strain cause hemolytic-uremic syndrome (non- immune hemolytic anemia, thrombocytopenia, and acute renal failure

B. Systemic Infections
\u2022
Structures responsible for systemic disease are the
capsule and endotoxin
o

Capsule \u2013 prevents phagocytosis, enhancing the organism ability to cause infection in various organs (neonatal meningitis)

o

Endotoxin \u2013 a lipopolysaccharide which cause features of gram negative sepsis (fever, hypotension,

disseminated
intravascular
coagulation)
C. Urinary Tract Infections
\u2022
Factors favoring uropathic strains of E. coli to produce
infection
o

pili with adhesion protein or adhesin that binds to specific receptors (dimers of galactose) in the urinary tract epithelium

o
motility aids in the ability to ascend the
urethra into the bladder\u00e0 urether\u00e0 kidney
\u2022
E. coli is the leading cause of community acquired UTI
(occurs primarily in women)
\u2022
Reasons why it is more common in women:
o
short urethra
o
proximity of the urethra to the anus
o
colonization of the vagina by members of the
fecal flora
\u2022
also the most frequent cause of nosocomial (hospital \u2013
acquired) UTI
\u2022
occurs equally in both men and women
\u2022
associated with indwelling catheters
Clinical Presentation
\u2022
Cystitis \u2013 if only the bladder is involved (present with
dysuria and frequency)
\u2022
Pyelonephritis \u2013 characterized by fever, chills and flank
pains
Laboratory Diagnosis
\u2022
lactose
fermenters
forming pink colonies in
MacConkey agar
\u2022
greenish sheen on EMB
agar
\u2022
produces indole from
tryptophan
decarboxylates lysine
\u2022
uses acetate as its only
source of carbon
\u2022
motile
\u2022
ferments sorbitol (except E. coli 0.157:H7)
Treatment:
\u2022
Uncomplicated UTI \u2013 oral cotrimoxazole
\u2022
Complicated UTI and sepsis \u2013 parenteral antibiotics (3rd
generation
cephalosphorin
with
or
without
aminoglycosides)
\u2022
Toxigenic/traveller\u2019s diarrhea
o
self-limited (no antibiotic, only fluid and
electrolyte replacement)
KLEBSIELLA-ENTEROBACTER SERRATIA GROUP
Important Properties
\u2022
Frequently found in the large intestine but are also
present in soil and water
\u2022

Group has very similar properties and are usually disintiguished on the basis of biochemical reactions and motility

\u2022
Klebsiella pneumoniae has a very large capsule (giving
the colonies striking mucoid appearance)
\u2022
Serratia marcescens produces red pigmented colonies
Pathogenesis and Epidemiology
A. Klebsiella pneumoniae
\u2022
Most likely to be a primary non-opportunistic pathogen
(related to its antiphagocytic capsule)
\u2022
Predisposing factors
o
advanced age
o
chronic respiratory disease
o
diabetes
o
alcoholism
\u2022
10% of healthy people are carriers
B. Enterobacter /Serratia
\u2022
associated with hospital acquired infections sec to
invasive procedures
o
intravenous catheterization
o
respiratory intubation
o
urinary tract manipulation
\u2022

outbreaks of Serratia pnuemonia have been associated with contamination of the water in respiratory therapy devices

Clinical Findings/Disease
\u2022
UTI
\u2022
Bacteremia\u00e0 sepsis
\u2022
Meningitis
\u2022
Pneumonia
-

if due to Klebsiella, patient produces thick, bloody sputum (current-jelly) and can progress to necrosis and abscess formation

Laboratory Diagnosis
\u2022
Lactose fermenting colonies on differential agar
(MacConkey\u2019s or EMB
\u2022
Serratia \u2013 late lactose fermenter and can produce a
negative reaction
\u2022
Differentiated by the use of biochemical test
Treatment
\u2022
Frequently resistant to multiple antibiotics especially if
hospital acquired
\u2022
Empicic treatment with cephalosporin plus an
aminoglycosides pending result of sensitivity testing
Prevention
\u2022
Changing site of intravenous catheters
\u2022
Removing urinary catheters when they are no longer
needed
\u2022
Proper care of respiratory therapy devices
PROTEUS
Important Properties
\u2022
Produce the enzymes phenylalanine deaminase
(distinguish
them
from
other
members
of
Enterobacteriacea)
\u2022
Produce the enzyme urease
\u2022
Certain species are motile and produce swarming effect
on blood agar
\u2022

Cell wall O antigens (Ox-2, Ox-19, Ox-K) cross react with antigen of several species of rickettsiae in patient\u2019s serum (Weil- Felix reaction)

\u2022

Species of clinical importance- P. vulgaris, P. mirabilis, P. morganii (Morganella morganii) and P. rettgeri (Providencia rettgeri)

Pathogenesis and Epidemiology
\u2022
Organism present in human colon, soil and water
\u2022
their tendency to cause urinary tract infection is
probably due to their presence in the colon and to
colonization of the urethra, especially in women
\u2022
the vigorous motility of the organism may contribute to
their ability to invade the urinary tract
\u2022

produces urease which hydrolysis urea in urine to form ammonia, which changes the pH and encourage stone formation (struvite calculi) which obstruct urine flow, damage urinary epithelium, and serve as nidus for recurrent infection by trapping bacteria within the stone

Clinical Infection
\u2022
UTI
\u2022
Pneumonia
\u2022
Wound infection
\u2022
Septicemia
\ue000
Proteus mirabilis is the species of Proteus that causes
most community and hospital acquired infection.
Laboratory Diagnosis
\u2022
Non-lactose

fermenting colonies in MacConkeys or EMB agar

\u2022
\u201cSwarming\u201d on blood
agar/MacConkey
\u2022
P. vulgaris and P.

mirabilis produce H2S (blackers the butt of TSI agar)

\u2022
All proteus are indole
positive except P. mirabilis
Treatment
\u2022
For indole positive \u2013 cephalosporin (Cefotaxime)
\u2022
Most strains are sensitive to Aminoglycoside and
Cotrimoxazole
\u2022
P. mirabilis is frequently sensitive to Ampicillin
\u2022
P. rettgeri is frequently resistant to multiple antibiotics
CITROBACTER
\u2022
gram negative rods related to Salmonella and Arizona
\u2022
Occur in the environment and in human colon
\u2022
Causes sepsis in immuno-compromised host
PSEUDOMONAS
Important Properties
\u2022
gram-negative rods
\u2022
strict aerobes
\u2022
non-fermenters (do not ferment glucose)
\u2022
oxidase-positive
\u2022
able to grow in water containing only traces of nutrients
e.g. tap water
\u2022
Some species (aeruginosa and cepacia) have a

remarkable ability to withstand disinfectants (grows in exachlorophene- containing soap solution, in antiseptics, and in detergents.

Pseudomonas Aeruginosa
\u2022
Produces 2 pigments
1.Pyocyanin \u2013 color the pus in a wound blue
2.Pyoverdin \u2013 a yellow-green pigment that fluoresces
under ultraviolet light (can be used to detect early
infection in burn patient)
\u2022
strains of Pseudomonas with prominent shrine layer
(glycocalyx) give colonies a very mucoid appearance
\u2022

slime layer mediates adherence of the organism to mucous membrane of the respiratory tract and prevents antibody from binding to the organism

Epidemiology of P. Aeruginosa
\u2022
found chiefly in soil and water
\u2022
approximately 10% of people carry
\u2022
it in the normal flora of the colon
\u2022
found in the skin of moist areas
\u2022
can colonize the upper respiratory tract of hospitalized
patients
\u2022

grow in simple aqueous solutions (results in contamination of respiratory therapy and anesthesia equipment, intravenous fluids, and even distilled water)

Primarily an opportunistic pathogen that causes infections in
hospitalized patients
\u2022
those with extensive burns
\u2022
those with chronic respiratory disease
\u2022
those who are immunocompromised (neutrophil count
less than 500/uL)
\u2022
those with indwelling catheters
\u2022
10-20% of hospital-acquired infection are due to
Pseudomonas
\u2022
most common cause of gram negative nosocomial
pneumonia
Pathogenesis of P. Aeruginosa
\u2022
based on multiple virulence factors
1.Endotoxin \u2013 similar to those of other gram-negative
bacteria causing symptom of sepsis and septic
shock
2.Exotoxin A \u2013 causes tissue necrosis (inhibits
eukaryotic protein synthesis)
3.Enzymes (elastase and proteases) \u2013 histotoxic and
facilitates invasion of the organism into the
bloodstream
4.Pyocyanin \u2013 damages cilia and mucosal cells of the
respiratory tract
\u2022

Some strains with type III secretion system are significantly more virulent than those without this secretion system

\u2022

This secretion system transfer the exotoxin from the bacterium directly into the adjacent human cell, which allow the toxin to avoid neutralizing antibody

\u2022
This system is mediated by transport pumps in the
bacterial cell membrane
Clinical Findings
\u2022

can cause infection virtually anywhere in the body but urinary tract infections, pneumonia, and wound infections (burns) predominate

\u2022

can enter the blood causing sepsis causes endocarditis in IV drug users, severe external otitis (malignant otitis externa), skin lesion (folliculitis) from inadequately chlorinated

swimming
pools
and
hot

tubs, osteochondritis of the foot in those who sustain punctured wound through the soles of gym shoes, and corneal infection in contact lens users

\u2022
When bacteria spread to the skin, they cause black
necrotic lesions called ecthyma gangrenum

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