CLINICALLY IMPORTANT

PATHOGENIC BACTERIA AND

THEIR INFECTIOUS DISEASES

Prepared By: Anum Mukhtar

Clinical Microbiologist
INFECTIOUS DISEASES:

Infectious diseases (also known as transmissible diseases or communicable

diseases) are clinically evident illnesses caused by microorganisms, such as
bacteria, viruses, fungi, or parasites that can be spread - directly or indirectly -
from one vector to another. Some infectious diseases are caused by person -to-
person contact, others are passed via animal or insect bite, and still others are
caused by ingestion of infected, contaminated food, water, or other
environmental exposures. Many of the more well -known infectious diseases
are caused by bacteria.

WHAT ARE BACTERIA?

Bacteria (singular: bacterium) are a large domain of prokaryotic

microorganisms, generally a few micrometers in length. Bacteria have many
shapes, which range from rods to spirals to spheres, and were among the first
lifeforms to appear on earth. Bacteria live in almost every habitat on the
planet, in soil, hot springs, water, deep within the Earth, in radioactive wastes,
in addition to the living bodies of humans, plants, and animals. Bacteria, which
often are given a bad reputation thanks to the pathogenic bacteria that cause
infections, play a vital role in recycling nutrients in the environment. In
humans, it has been found that there are about ten times as many bacterial cells
inside the human body as there are human cells, with large numbers of bacteria
lining the gastrointestinal tract and living on the skin. Most of these bacteria
are rendered harmless by the immune system of the body, and others are
beneficial to the body. However, it's important to note that there are pathogenic
species of bacteria that can lead to infectious diseases.
BACTERIAL INFECTIOUS DISEASES:

While most species of bacteria are harmless, and others beneficial for us, there
are a number of disease-causing bacteria, which are called "pathogenic
bacteria." Pathogenic bacteria can contribute to many worldwide diseases,
including tuberculosis, cholera, anthrax, leprosy, the bubonic plague,
pneumonia, and food-borne illnesses. The most common fatal bacterial
infectious diseases are respiratory infections, with tuberculosis (caused by t he
bacteria Mycobacterium tuberculosis) killing approximately two million people
each year, generally in sub-Saharan Africa. Bacterial infections can be caused
by a wide range of bacteria which can lead to mild illness to life -threatening
illnesses (like bacterial meningitis), which require immediate hospital
interventions. Infections caused by bacteria are one of the leading causes of
death in both the very young and the very old. Under normal circumstances,
people are protected against bacterial infections by a healthy immune system.

HOW DOES BACTERIAL INVASION LEAD TO AN

INFECTION?

There is a difference between 'infection' and 'infectious disease'. When an

organism is able to lodge itself in or the tissue of the host and multiply, it is
called an infection. However, not every infection leads to a disease. The
immune system acts quickly and curbs the development of disease. When a
disease can be transferred from an infected person to a healthy individual,
resulting in a disease, it is termed as an infectious disease.
MODE OF INFECTION:

In order to cause disease in humans, the bacteria first has to break the barriers
of the skin and tissues. Only after it gets entry into the body, bacteria can
cause disease. There are different modes of transmission of bacteria as follows:

▪ CONTACT

When an infection spreads through direct or indirect contact, it may lead to an

infection. In order to differentiate between direct and indirect transmissions,
the term contagious disease is used to specify a disease that i s caused by direct
contact. Infectious disease is a term that is generally used to specify diseases
spread by other modes. Thus, sexually transmitted diseases are examples of
infections spread by direct contact. Infections spread by contact with infected
objects like pencils, glasses, towels, toys, etc. are termed as indirect infections
like in the case of diphtheria.

▪ INHALATION :

Most of the respiratory infections are spread through inhalation of the

infectious bacteria. These bacteria tend to be present in air in form of aerosols.
They are released in the environment by sneezing, coughing, talking, spitting,
etc. Most of the time these respiratory droplets dry off. However, some
bacteria are resistant to drying and can remain suspended in air for long
period. Thus, when a healthy person inhales these droplets, it may lead to
respiratory infection.
▪ INGESTION:

Gastrointestinal infections are usually caused by ingestion of the pathogens or

their toxins. Thus, giving rise to different illnesses like waterborne , food-borne
and hand-borne illnesses. These pathogens enter the gastrointestinal tract
through the mouth. Examples of diseases caused through ingestion include
cholera, dysentery and food poisoning.

▪ INOCULATION:

When bacteria is inoculated into the subcutaneous body tissue, it may lead to
infection. For example, a deep wound may give a chance to Clostridium tetani
a chance to cause a tetanus infection. Similarly, gangrene causing bacteria may
also cause cellular death and tissue decay.

▪ CONGENITAL:

Pathogens that are able to cross the placental barrier and infect the fetus in the
uterus are called congenital infections. These infections can lead to congenital
disorders in the baby.

BACTERIAL PATHOGENS OF HUMANS:

 STAPHYLOCOCCUS:

Staphylococcus aureus is a facultative anaerobic Gram-positive coccus. When

cultured on blood agar it exhibits hemolysis and it tests coagulase -positive and
catalase-positive. Staphylococcus aureus is part of normal skin flora (possibly
including nasal passages) in a large proportion of the human population,
without causing problems to the carrier. It may be passed from person to
person by direct contact or via surfaces, including door handles. It has been
shown to persist on hospital privacy curtains. It may cause disease if it enters
an open wound and it can become a major problem for people with damaged or
depressed immune systems, either from chronic disease, such as HIV, or in
those undergoing chemotherapy, which represses the activity of the immune
system. The related species Staphylococcus epidermidis (used to be known as
S. albus) also exists on skin and may play a protective role against S. aureus in
normal conditions.

Diseases:

Staphylococcus aureus may cause minor skin infections such as pimples and
boils, but these may become deep -seated, causing abscesses etc. If it enters the
blood it can cause a number of problems in the body: bacteremia and sepsis,
toxic shock syndrome (TSS), pneumonia, meningitis, osteomyelitis,
endocarditis. Some strains produce enterotoxins which can cause food
poisoning.

Staphylococcus aureus is likely to caus e problems in hospital patients;

pressure sores due to inactivity in bed, surgical wounds after operations such
as hip replacements or heart surgery, being treated with intravenous drips or
urinary catheters. All of these offer opportunities for bacteria to enter the body
from the skin surface and cause infection. If MRSA bacteria gain access to
internal body systems and cause a staph infection, the consequences could be
fatal. These bacteria can infect bones, joints, heart valves, and the lungs.

Resistance Problems:

Some bacteria by chance acquired the ability to break down and inactivate
penicillin, using the enzyme penicillinase, which breaks open the beta lactam
ring. Since these penicillin-resistant strains were not killed by it, they
reproduced and replaced the original (penicillin sensitive) strains of
Staphylococcus aureus.

The main current cause for concern is MRSA, a methicillin -resistant form of
Staphylococcus aureus. There is some variation in abundance and virulence of
MRSA from country to country, as well as between community and hospital
strains. It is also likely to be resistant to basic penicillin and more recently
developed forms. Other antibiotics, e.g. vancomycin, teicoplanin or linezolid,
may be used to treat MRSA, but they need to be (a) injected, either directly
into a vein or fed into the blood stream via a drip rather than by mouth and (b)
given at quite a high dose. Treatment is likely to invo lve several weeks in
hospital.

STREPTOCOCCUS:

Streptococci, commonly called strep, are a heterogeneous group of gram -

positive bacteria. In this group S treptococcus pyogenes (group A ẞ-hemolytic
streptococci) is one of the most important bacterial pathogens. The different
serotypes produce:

(1) Extracellular enzymes that break down host molecules

(2) Streptokinases, enzymes that activate a host -blood factor that dissolves
blood clots

(3) The cytolysins streptolysin O and streptolysin S, which kill host leukocytes
(4) Capsules and M protein that help retard phagocytosis. S. pyogenes is
widely distributed among humans, but usually people are asymptomatic
carriers.

Diseases:

Individuals with acute infections may spread the pathogen, and transmission
can occur through respiratory droplets, direct, or indirect contact. When highly
virulent strains appear in schools, they can cause sharp outbreaks of sore
throats and scarlet fever. Diagnosis of a streptococcal infection is based on
both clinical and laboratory findings. Several rapid tests are available .
Streptococcus causes cellulitis, impetigo, necrotizing fasciitis, toxic shock–
like syndrome (TSLS), rheumatic fever, scarlet fever, streptococcal sore throat,
and streptococcal pneumonia.

Treatment is with penicillin or erythromycin. Vaccines are not available for

streptococcal diseases other than streptococcal pneumonia because of the large
number of serotypes.

KLEBSIELLA PNEUMONIAE:

Klebsiella species are non-motile, rod-shaped, gram-negative, catalase-

positive, oxidase-negative, lactose fermenting, facultative anaerobic bacteria
with a prominent polysaccharide capsule. K. pneumoniae is part of normal
skin, mouth and gut flora - no problem to most healthy people. Klebsiella
pneumoniae ferments lactose and produces pink colonies on M acConkey agar.
The shiny (mucoid) colonies indicate the presence of the capsule.
Diseases:

When K. pneumoniae colonizes the respiratory system it can cause

bronchopneumonia or bronchial pneumonia - as distinct from lobar pneumonia
(see above). This results in the acute inflammation of the walls of the
bronchioles (small air passages leading from the windpipe and bronchi towards
the alveoli: the terminal air sacs) and consequent congestion with pus. Usually
there are several sites of infection, on both lungs. Endotracheal intubation
(insertion of a tube into the windpipe to assist breathing) sometimes results in
this infection. Bronchopneumonia may also be caused by Staphylococcus
aureus, E. coli, and Pseudomonas. Klebsiella pneumoniae can also cause
urinary tract infections often associated with catheters (UTIs) as well as
infecting surgical wound sites.

Resistance problems:

In healthcare settings, Klebsiella infections commonly occur among sick

patients who are receiving treatment for other conditions, especially those with
a weakened immune system or on long courses of certain antibiotics. Patients
on ventilators (breathing machines) or intravenous (vein) catheters, and urinary
catheters are most at risk for Klebsiella infections.

ESCHERICHIA COLI (E. COLI):

Escherichia coli is widely known as E. coli. It serves as an indicator of fecal

contamination of the environment and foods. It is a Gram-negative, facultative
anaerobic, rod-shaped bacterium. It is non-sporulating i.e. it does not produce
spores.
Some strains are motile i.e. they possess flagella, which are described as
peritrichous i.e. projecting outwards all-round the surface of the cell wall. The
harmless strains are part of the normal flora of the gut.

Disease:

Enteropathogenic forms of E.coli have recently become more well -known than
the "ordinary" forms. These cause severe stomach cramps, diarrhea (often
bloody), and vomiting and perhaps slight fever. They produce a toxin that can
attack the body in several areas: the gut (causing bloody diarrhea), the kidneys
(causing kidney failure), and sometimes the nervous system. One strain in
particular (known as O157, O157 H7, STEC, VTEC or EHEC) has been
responsible for most problems i.e outbreaks of E. coli infections around the
world. Other kinds of E. coli (called serogroups) can cause disease of varying
seriousness. These serotypes are based on antigens associated with various
components: (O: outer cell wall layer, H: flagellin, K: capsule).

The faecal-oral transmission route is the main way in which pathogenic strains
of the bacterium cause disease. Many incidences of holiday diarrhoea have
been attributed to it, especially after consuming food which has been
contaminated with faeces, either in preparation following poor lavatory
hygiene or as a result of the application of (animal or other) manure to land on
which crops are grown. Salads are especially suspect in this respect.
Unpasteurized (raw) milk, soft cheeses made from raw milk and undercooked
beef burgers are common sources of infection, as well as swallowing lake
water while swimming, visiting petting zoos and other animal exhibits.
Resistance problems:

Digestive system infections are not treated with antibiotics; recent strains e.g
O104:H4 are resistant to most antibiotics. This is likely to be due to previous
"environmental" exposure to them. Infections within other areas of the body
can cause a variety of problems: urinary tract infections (UTIs), which may
lead to: bacteremia (presence of bacteria in the blood - not quite the same as
"blood poisoning") - this may lead to: E. coli pneumonia (bronchopneumonia
of the lower lobes) - especially in patients weakened by other conditions e.g.
diabetes mellitus, alcoholism, chronic obstruc tive pulmonary disease
cholecystitis - inflammation of the gallbladder, acute bacterial meningitis in
newborn children (may also be caused by group B streptococcal infections)

Urinary tract infections by E. coli are more common in females than in males
because the ureter is shorter and nearer to the anus and is associated with
pregnancy and childbirth. Some strains possess P fimbriae (many short
proteinaceous appendages) that are used to adhere to human body cells,
especially epithelial cells of the urinary tract.

Trimethoprim is the drug of first choice for the treatment of uncomplicated

urinary tract infections although 10 -20% of E. coli infections will be resistant
to it. Other antibiotics which may be used as first -line agents if a patient is
allergic to trimethoprim include nitrofurantoin and cefalexin. Amoxicillin is
not used routinely as 50% of organisms will be resistant to it.

SALMONELLA:

Salmonella are gram-negative, straight, rod-shaped bacteria. The flagella

arranged around the outer shell make lively movements possible. They can
carry fimbria. They facilitate adhesion to the intestinal wall of the host. Some
strains also have so-called pili. They transmit genetic material (DNA) in
resistant strains.

Biochemical and serological tests can be used to distinguish between the two
species Salmonella enterica (S. enterica) and Salmonella bongori (S.bongori).
S. enterica has six sub-species. Salmonella isolates can be assigned to one of
more than 2,400 serovars (strains with the same antigens) according to the
Kauffmann-White method using "slide agglutination".

The growth needs of Salmonella are modest. They grow on simple nutrient
media and the optimum temperature is 37°C. In order to improve diagnosis a
series of special nutrient media was developed for Salmonella, which exploit
and display specific biochemical properties of Salmonella. After only 18 to 24
hours incubation typical, 1 -2 mm sized, round, slightly domed, shining
colonies already become visible. Most subspecies of Salmonella produce
hydrogen sulfide, which can readily be detected by growing them on media
containing ferrous sulfate, such as is used in the triple sugar iron test.

Diseases :

The infection dose is approximately 1,000 up to 10,000 pathogens . The

infection dose indicates from what number of ingested pathogens the onset of
the disease is possible. If only a few pathogens are ingested, the immune
system is normally able to destroy the germs without manifesting any
symptoms of disease. Most infections are due to ingestion of food
contaminated by animal feces; or by human feces .
Resistance:

Salmonella is notorious for its ability to survive desiccation and can persist for
years in dry environments and foods. The bacteria are not destroyed by
freezing. A hallmark of Salmonella pathogenesis is the ability of the bacterium
to survive and proliferate within phagocytes. Phagocytes produce DNA
damaging agents such as nitric oxide and oxygen radicals as a defense against
pathogens. Thus, Salmonella species must face attack by molecules that
challenge genome integrity.

CAMPYLOBACTER:

Campylobacters are mobile gram- negative as a rule spirally bent rods .

Campylobacteriosis is mainly caused by thermotolerant C. jejuni, C. coli. They
are transmitted to humans as faecal contamination of infected animals via
foods. Campylobacters cannot multiply on foods because of their exacting
growth conditions but they have a relatively hig h ability to survive there. A
main source of infection is insufficiently heated or contaminated poultry meat;
an infection can be caused in particular in the event of poor kitchen hygiene by
cross contamination. The reservoir of Campylobacter includes warm-blooded
wild, domestic animals and pets (birds and mammals) without the latter
showing clinical symptoms of a disease.

Disease:

Campylobacter is by now the most frequent bacterial pathogen for intestinal

infections. The infectious disease caused in humans by the germ is called
campylobacteriosis and mainly involves diarrhoea. Although these acute
symptoms are in most cases self-limiting, there are in rare cases late sequelae
such as arthritis and the so-called Guillen-Barré syndrome, an auto-immune
disease of the peripheral nervous system, which may lead to symptoms of
paralysis. Laboratory diagnosis is by culture in an atmosphere w ith reduced O2
and added CO2.

Resistance:

If the bacteria are exposed to unfavourable environmental conditions (such as

cold, acid, increased osmolarity, oxygen or nutrient limitation), the rods are
transformed into cocci which present all physiological ch aracteristics of living
cells.

SHIGELLA:

Shigellosis or bacillary dysentery is a diarrheal illness resulting from an acute

inflammatory reaction of the intestinal tract caused by the four species of the
genus Shigella (gram-negative, non-motile, facultative rods). The organism is
transmitted by the fecal-oral route—primarily by food, fingers, feces, and flies.
The infectious dose is only around 10 to 100 bacteria.

Disease:

The shigellae are facultative intracellular parasites that multiply within the
cells of the colon epithelium. The bacteria induce the mucosal cell to
phagocytose them and then disrupt the phagosome membrane. After
reproducing in the cytoplasmic matrix, the shigella invade adjacent mucosal
cells. They may produce both endotoxins and exotoxins but do not usually
spread beyond the colon epithelium. The watery stools often contain blood,
mucus, and pus. In severe cases the colon can become ulcerated.
Identification of isolates is based on biochemical characteristics and serology.
The disease normally is self-limiting in adults and lasts an average of 4 to 7
days; in infants and young children it may be fatal. Usually fluid and
electrolyte replacement are sufficient, and antibiotics may not be required in
mild cases. Treatment is with trimethoprim-sulfamethoxazole or
fluoroquinolones. Antibiotic-resistant strains are becoming a problem.

VIBRIO:

Vibrio cholerae cause cholera. Vibrio are gram-negative organisms. There are
many serogroups, only O1 and O139 have exhibited the ability to cause
epidemics. V. cholerae O1 is divided into two serotypes,Inaba and Ogawa,and
two biotypes, classic and El Tor. Cholera is acquired by ingesting food or
water contaminated by fecal material from patients or carriers. Once the
bacteria enter the body, the incubation period is from 24 to 72 hours.

The bacteria adhere to the intestinal mucosa of the small intestine . The patient
loses massive quantities of fluid and electrolytes, whi ch is associated with
abdominal muscle cramps, vomiting, fever, and watery diarrhea. The diarrhea
can be so profuse that a person can lose 10 to 15 liters of fluid during the
infection. Death may result from the elevated concentration of blood proteins,
caused by reduced fluid levels, which leads to circulatory shock and collapse .

PSEUDOMONAS AERUGINOSA:

Pseudomonas aeruginosa - also known as Pseudomonas pyocyanea - is a Gram-

negative, aerobic or facultatively anaerobic, rod -shaped bacterium. It is motile.
When grown on certain types of agar in the laboratory, it produces green
pigments.
Pseudomonas aeruginosa is widely distributed in the environment - in soil and
water, especially stagnant water. It may be found on the surface of human skin
and may be said to be part of the normal skin flora for some people.

Because it is quite flexible in its nutrition and respiration, it can colonize many
areas around the home and hospital, and (non -sterile areas) inside the human
body. This is seen as less of a problem than growth of P. aeruginosa in
normally sterile areas.

Disease:

Under some circumstances Pseudomonas aeruginosa may cause infections in

the body. It may be considered as an opportunistic, nosocomial pathogen of
immunocompromised individuals, including pre mature and newly-born babies.

These infections commonly involve the pulmonary tract, urinary tract

infections, burns, wounds, and other blood infections

It also commonly affects those with the condition cystic fibrosis, in which
thick mucus in the lungs restricts diffusion of oxygen, providing conditions
which favour its growth.

P. aeruginosa may also cause Hot tub folliculitis - a skin rash caused by
bacterial growth in hair follicles, when hygiene falls due to inadequate
treatment of water in these environments, and it has also been implicated in
osteomyelitis due to puncture wounds of the foot, resulting in direct
inoculation with P. aeruginosa via the foam padding found in tennis shoes.
Resistance:
Pseudomonas aeruginosa is not easily controlled by antibiotics, because it is
Gram-negative and has a fairly impermeable outer layer (envelope) and it can
also turn on "pumps" that remove antibiotics from the cell.

CLOSTRIDIUM DIFFICILE:

Clostridium difficile is a Gram-positive, anaerobic spore-forming rod-shaped

bacterium. Being anaerobic spore-formers. Clostridium difficile bacteria are
naturally found in the gut of some people. Some cells of Clostridium difficile
are transformed into spores. They also produce toxins which have adverse
effects on the human body. Other members of the genus Clostridium cause
tetanus (jockjaw), botulism, and gangrene.

Most bacteria form only vegetative cells, and although they grow quickly and
can cause different sorts of problems inside the body, outside the body they a re
easily killed by exposure to reasonably high temperature, dry conditions, and
certain sorts of chemicals - antiseptics and disinfectants.

The spores formed by Clostridium species are extremely resistant to these

conditions, and remain viable for months or years. In fact these spores can
withstand exposure to high temperatures and strong disinfectant chemicals.

As anaerobic organisms, they can cause problems within the body as they can
respire, function and reproduce in parts of the body that are not wel l supplied
with oxygen, such as in the gut or deep within muscles.
Disease:

Spores of Clostridium difficile entering the body can germinate and the
resulting vegetative bacterial cells can grow in number. This may cause flu-
like symptoms or mild colitis. Growth of C. difficile may cause more severe
diarrhoea - the condition being known as antibiotic -associated diarrhoea
(AAD). Toxins from C. difficile can cause severe inflammation of the colon -
pseudomembranous colitis may result. This may be treated usi ng completely
different antibiotics.

Resistance:

Clostridium difficile strains resistant to clindamycin and to fluoroquinolone

antibiotics (ciprofloxacin and levofloxacin) have been reported in the USA.

DO ALL BACTERIA CAUSE DISEASES?

No, not all bacteria cause diseases. You will be surprised to know, less
than 1% bacteria have the ability to cause diseases. There are a few
beneficial bacteria that help plants, animals as well as humans in various
ways. Many commensal bacteria are harmless organisms that liv e on or
within our body, without ever causing any kind of disease or infection.

REFERENCES:

1. https://www.livestrong.com/article/112167 -list-fungal-diseases/
2. http://www.biotopics.co.uk/g11/bacterial_problems.html
3. https://www.thoughtco.com/scary-diseases-caused-by-bacteria-373276
4. http://textbookofbacteriology.net/medical_3.html
5. https://www.microbiologyinpictures.com/introduction.html
6. http://www.bfr.bund.de/en/campylobacter-54347.html
7. https://en.wikipedia.org/wiki/Salmonella#Detection,_culture,_and_growth_c
onditions
8. http://www.bfr.bund.de/en/salmonella_and_their_importa nce_as_pathogens-
10638.html