Bacterial Pathogens Cha Encry

Bacterial Pathogens Lecturer: Philip M.
Mutua, BSc|MPH|CPHO
Email: philipmutua6@gmail.com
BACTERIAL PATHOGENS
Pathogens are organisms that cause disease.
Normal Microbiota:
Refers to a population of microorganisms that live either inside or outside our bodies. They are
also known as normal flora.
They not only do us any harm but also benefit from us;
i. They protect us against diseases by preventing the overgrowth of harmful microbes.

ii. Some produce useful substances such as Vitamins B and K
NB: At some circumstances they may cause disease e.g., when they leave their anatomical
sites i.e., residence/habitat.
Bacterial pathogens refers to bacteria that cause diseases. They include:
1. Staphylococcus aureus
Different strains of S. aureus differ in the range of diseases they can cause, including boils and
pimples, wound infections, pneumonia, osteomyelitis, septicemia, food intoxication, and toxic
shock syndrome.
 These bacteria are spread by having direct contact with an infected person, by using a
contaminated object, or by inhaling infected droplets dispersed by sneezing or coughing.
 Skin infections are common, but the bacteria can spread through the bloodstream and infect
distant organs.
 Skin infections may cause blisters, abscesses, and redness and swelling in the infected area.
 The diagnosis is based on the appearance of the skin or identification of the bacteria in a
sample of the infected material.
 Thoroughly washing the hands can help prevent spread of infection.
 Antibiotics are chosen based on whether they are likely to be effective against the strain
causing the infection.
Staphylococcus aureus is present in the nose (usually temporarily) of about 30% of healthy adults
and on the skin of about 20%. The percentages are higher for people who are patients in a hospital
or who work there.
Bacterial Pathogens Lecturer: Philip M. Mutua, BSc|MPH|CPHO
The bacteria can spread from person to person by direct contact, through contaminated objects
(such as gym equipment, telephones, door knobs, television remote controls, or elevator
buttons), or, less often, by inhalation of infected droplets dispersed by sneezing or coughing.
Carriers are people who have the bacteria but do not have any symptoms caused by the bacteria.
Carriers can move the bacteria from their nose to other body parts with their hands, sometimes
leading to infection. People who are hospitalized or work in a hospital are more likely to be
carriers.
Types of staph infections

Staphylococcus aureus infections range from mild to life threatening.
The most common staphylococcal infections are
 Skin infections, often causing abscesses (pocket of pus)
However, the bacteria can travel through the bloodstream (called bacteremia) and infect almost
any site in the body, particularly heart valves (endocarditis) and bones (osteomyelitis).
The bacteria also tend to accumulate on medical devices in the body, such as artificial heart valves
or joints, heart pacemakers, and catheters inserted through the skin into blood vessels.
Certain staphylococcal infections are more likely in certain situations:

 Bloodstream infections: When a catheter that is inserted in a vein has remained in place
for a long time
 Endocarditis: When people inject illegal drugs or have an artificial heart valve or when a
catheter inserted in a vein is infected
 Osteomyelitis: When Staphylococcus aureus spreads to the bone from an infection in the
bloodstream or from an infection in nearby soft tissue, as may occur in people with deep
pressure sores or foot sores due to diabetes
 Lung infection (pneumonia): When people have had influenza (particularly) or a

bloodstream infection; when people are taking corticosteroids or drugs that suppress the
immune system (immunosuppressants); or when they are hospitalized because they need
tracheal intubation and mechanical ventilation (called hospital-acquired pneumonia)
Note: Corticosteroids are a class of drug that lowers inflammation in the body. They also reduce
immune system activity. They ease swelling, itching, redness, arthritis, asthma, and allergic
reactions
Staph toxins
There are many strains of Staphylococcus aureus. Some strains produce toxins that can
cause staphylococcal food poisoning, toxic shock syndrome, or scalded skin syndrome.
Toxic shock syndrome is also caused by toxins produced by some streptococci. This syndrome
causes rapidly progressive and severe symptoms that include fever, rash, dangerously low blood
pressure, and failure of several organs.
Risk factors for staph infections

Certain conditions increase the risk of getting a staphylococcal infection:
 Influenza
 Chronic lung disorders (such as cystic fibrosis or emphysema- damage to the walls of the
lung alveoli)
 Leukemia
 Tumors
 A transplanted organ, an implanted medical device (such as artificial heart valves, joints,
or heart pacemakers), or a catheter inserted into a vein for a long time
 Burns
 An open wound or sore
 Chronic skin disorders
 Surgery
 Diabetes mellitus
 A chronic kidney disorder requiring dialysis
 Drugs, such as corticosteroids, drugs that suppress the immune system
(immunosuppressants), or cancer chemotherapy
 Radiation therapy
 Injection of illegal drugs
 Newborns and breastfeeding mothers
2. Streptococcus pyogenes
Cause an array of suppurative diseases and toxinoses (diseases due to the production of a
bacterial toxin), in addition to some autoimmune or allergic diseases.
It is a normal flora in the upper respiratory tract.
It is the main streptococcal pathogen for man, most often causing tonsillitis/strep throat.
Streptococci also invade the skin to cause localized infections and lesions, and produce toxins that
cause scarlet fever and toxic shock.
Sometimes, as a result of an acute streptococcal infection, anomalous immune responses are started
that lead to diseases like rheumatic fever and glomerulonephritis, which are called post-
streptococcal sequelae.
Unlike the staphylococci, the streptococci have not developed widespread resistance to penicillin
and other antibiotics. Antibiotics are the drugs of choice for the treatment of acute streptococcal
infections.
3. Streptococcus pneumoniae
It is the most frequent cause of bacterial pneumonia in humans. It is also a frequent cause of otitis
media (infection of the middle ear) and meningitis.
The bacterium colonizes the nasopharynx and from there gains access to the lung or to the
Eustachian tube. If the bacteria descend into the lung they can impede engulfment by alveolar
macrophages if they possess a capsule which somehow prevents the engulfment process.
Encapsulated strains are able to invade the lung and are virulent (cause disease), and non-
capsulated strains, which are readily removed by phagocytes, are non-virulent.
4. Streptococcus agalactiae
Also known as Group B streptococcus (GBS). It is the leading cause of postpartum infection and
neonatal sepsis. Infection in healthy, non-pregnant adults is becoming more common, especially
among young to middle-aged women with diabetes.
GBS organisms colonize the vagina, gastrointestinal tract, and the upper respiratory tract in
healthy humans. In the frail elderly, GBS infection is strongly linked with congestive heart
failure.
Signs and symptoms of GBS infection:
 GBS pneumonia is infrequently encountered. It is primarily seen in older adults with
diabetes or with a variety of neurologic deficits; its presentation is the same as that of any
bacterial pneumonia (fever, shortness of breath, chest pain, pleuritic pain, and cough).
 GBS meningitis is usually restricted to neonates. In adults, GBS meningitis is associated

with a variety of anatomic abnormalities that are complications of neurosurgery. Common
manifestations include fever, headache, nuchal rigidity, and confusion.
 In patients with GBS bacteremia, the source of the bloodstream infection cannot usually be
identified. Clinical manifestations include fever, malaise, and confusion, and chest pain,
shortness of breath, myalgia, and arthralgia.
 Skin and soft-tissue infection, decubitus (prolonged pressure on the skin) ulcers, and
colonization of foot infections in patients with diabetes can also result from GBS infection.
Clinical manifestations include fever, malaise, localized pain, and cellulitis.
 Osteomyelitis & arthritis, may also occur; common manifestations include fever, malaise,
localized pain, cellulitis, arthralgia, arthritis, and weakness.
 Chorioamnionitis, endometritis, and urinary tract infections (ranging from asymptomatic
bacteriuria to cystitis and pyelonephritis with bacteremia) can cause fever, dysuria-
painful/difficulty in urination, flank pain, and pelvic pain.
5. Viridans streptococci
The viridans group streptococci (VGS) are a heterogeneous group of organisms that can be human
commensals, colonizing the gastrointestinal and genitourinary tracts in addition to the oral
mucosa. VGS are generally considered to be of low pathogenic potential in immune-competent
individuals. However, in certain patient populations, VGS can cause invasive disease, such as
endocarditis, intra-abdominal infection, and shock. Within the VGS, the rates and patterns of
antimicrobial resistance vary greatly depending upon the species identification and the patient
population.
They form part of the normal flora of the upper respiratory tract, all the regions of the
gastrointestinal tract, the female genital tract and are most commonly found in the oral cavity. In
the oral cavity they make up almost 50% of the culturable flora of the tongue and saliva and almost
30% of flora in dental plaque and gingival crevices. They are major cause of sub-acute
bacterial endocarditis
6. Enterococcus Species
Includes bacteria that causes enterococcal infections. These bacteria normally lives in the intestine
of healthy people but sometimes cause infection.
There are more than 17 species of enterococci. Many species normally occupy the intestinal tract
and do not usually cause disease. These bacteria, called resident flora, cause disease only under
certain circumstances—for example, when they enter other parts of the body.
Enterococcus faecalis and Enterococcus faecium are the species that most commonly cause
infections in people.
Enterococci typically cause the following:
 Urinary tract infections (UTIs)
 Bacteria in the bloodstream (bacteremia)
 Infection of the heart valves (endocarditis)
 Infections of the skin and tissues under the skin (cellulitis)
 Infection of the prostate (prostatitis)
 Wound infections
 Abscesses in the abdomen
Note: Symptoms depend on the location of the infection.

Doctors give antibiotics and drain any abscesses. Certain strains of enterococci have
become resistant to many antibiotics and can be difficult to treat
7. Bacillus anthracis
A gram-positive, rod-shaped bacteria that causes anthrax – a potentially fatal infection
 Infection in people usually results from skin contact but can result from inhaling anthrax
spores, eating contaminated meat, or rarely by injecting contaminated drugs.
 Anthrax spores are a potential biological weapon.
 Anthrax bacteria produce several toxins, which cause many of the symptoms.
 Symptoms include bumps and blisters (after skin contact), difficulty breathing and chest
pain (after inhaling spores), and abdominal pain and bloody diarrhea (after eating
contaminated meat).
 Symptoms suggest the infection, and identifying the bacteria in samples taken from
infected tissue confirms the diagnosis.
 People at high risk of being exposed to anthrax are vaccinated.
 Antibiotics and the vaccine must be given soon after exposure to reduce the risk of dying.
Anthrax can occur in wild and domestic animals that graze, such as cattle, sheep, and goats.
Anthrax bacteria produce spores that can live for years in soil. Grazing animals become infected
when they have contact with or consume the spores. Usually, anthrax is transmitted to people when
they have contact with infected animals or animal products (such as wool, hides, and hair). Spores
may remain in animal products for decades and are not easily killed by cold or heat. Even minimal
contact is likely to result in infection. Although infection in people usually occurs through the skin,
it can also result from inhaling spores (inhalation anthrax), eating contaminated, undercooked meat
(gastrointestinal anthrax), or rarely by injecting contaminated drugs.
Anthrax is a potential biological weapon because anthrax spores can be spread through the air
and inhaled. In the U.S. anthrax bioattacks of 2001, spores were spread in envelopes mailed via
the United States Postal Service.
Recently, injection anthrax has developed in people in northern Europe who inject contaminated
heroin. Anthrax that is spread in this way has not been seen in the United States.
Anthrax bacteria produce several toxins, which cause many of the symptoms.
Symptoms of Anthrax
Anthrax symptoms vary depending on how the infection is acquired:
 Through the skin (most cases)
 Through inhalation (most serious)
 Through the gastrointestinal tract (rare)
 Through injection (rare)
Skin anthrax
Most anthrax cases involve the skin. A painless, itchy, red-brown bump appears 1 to 10 days after
exposure. The bump forms a blister, which eventually breaks open and forms a black scab (eschar),
with swelling around it. Nearby lymph nodes may swell, and people may feel ill—sometimes with
muscle aches, headache, fever, nausea, and vomiting. It may take several weeks for the bump to
heal and the swelling to go down.
Skin Anthrax
Skin anthrax begins as a painless itchy, red-brown bump (top). Then, the bump forms a blister,
which breaks open and forms a black scab called an eschar (bottom).
*Images courtesy of the Centers for Disease Control and Prevention – CDC .*
8. Corynebacterium diphtheria
A gram-positive, rod-shaped bacteria that causes diptheria.
Diptheria is a contagious, sometimes fatal infection of the upper respiratory tract
 It is now rare in developed countries.
 Typical symptoms include a sore throat, general feeling of illness, and fever, sometimes
with swollen lymph nodes, and a tough, gray pseudomembrane forms in the throat.
 The diagnosis is based on symptoms, particularly a sore throat and the pseudomembrane,
and the results of a culture.
 Vaccination can help prevent this infection.
 People are hospitalized and given antibiotics to eliminate the infection.
Did You Know...

 Routine vaccination has made diphtheria rare in developed
countries.
The bacteria that cause diphtheria are usually spread in droplets of moisture coughed into the
air (droplet infection). Usually, the bacteria multiply on or near the surface of the mucous
membranes of the mouth or throat, where they cause inflammation. This form of diphtheria is
called respiratory diphtheria.
Some types of Corynebacterium diphtheriae release a potent toxin, which can damage the heart,
kidneys, and nervous system.
Symptoms of Diphtheria
The illness typically begins a few days (an average of 5 days) after exposure to the bacteria.
Diphtheria symptoms then begin over a few days, with sore throat, painful swallowing, hoarseness,
a general feeling of illness (malaise), and a low-grade fever (about 100.4 to 102° F, or 38 to 38.9°
C). Children may also have a fast heart rate, nausea, vomiting, chills, and a headache. The
lymph nodes in the neck may swell (called bull neck). The inflammation may make the throat
swell, narrowing the airway and making breathing extremely difficult.
A pseudomembrane forms near the tonsils or other parts of the throat. This membrane is a tough,
gray sheet of material made by the bacteria. It is composed of dead white blood cells, bacteria, and
other substances. The pseudomembrane narrows the airway. The roof of the mouth may be
paralyzed. When inhaling, the pseudomembrane may cause people to make a noisy gasping sound.
Also, the pseudomembrane may extend into the windpipe or airway or suddenly become detached
and block the airway completely. As a result, people may be unable to breathe.
The toxin produced by certain types of diphtheria bacteria sometimes affects certain nerves,
particularly those to the muscles of the face, throat, arms, and legs, causing symptoms such as
difficulty swallowing or moving the eyes, arms, or legs. The diaphragm (the most important
muscle used for inhaling) may become paralyzed, sometimes causing respiratory failure. These
symptoms take weeks to resolve.
Toxin effects on nerves can result in rapid heart rate, an abnormal heart rhythm, and low blood
pressure. The bacterial toxin may also cause inflammation of the heart muscle (myocarditis),
sometimes leading to abnormal heart rhythms, heart failure, and death.
Severe infection can also damage the kidneys.

If diphtheria affects only the skin, it causes what look like scrapes (abrasions) and sores that vary
in appearance. These sores appear on the arms and legs and resemble other skin disorders, such as
eczema. A few people have open sores that do not heal. Sores may be painful and red and may
ooze.
Images of Diphtheria
Pseudomembrane Due to Diphtheria (image courtesy of CDC)
This image shows a pseudomembrane (a sheet of material composed of dead white blood cells,
bacteria, and other substances). It can form near the tonsils or other parts of the throat. The
pseudomembrane narrows the airway and can make breathing difficult.
Swollen Neck Due to Diphtheria (Image courtesy of the CDC)

This image shows swollen lymph nodes in the neck (called bull neck) of a boy who has diphtheria.
Diphtheria Affecting the Skin (CDC)
Diphtheria infection of the skin can look like a red, scraped area, as on this person's neck.
Open Sore Due to Diphtheria (CDC)
Diphtheria infection of the skin can look like an open sore (ulcer), as on this person's leg.
Overall, about 3% of people with diphtheria die. The risk of dying is increased if
 People delay going to the doctor.
 Diphtheria affects the heart or kidneys.
 Diphtheria develops in children under 15 years old or in people over 40 years old.
Prevention of Diphtheria
The diphtheria vaccine protects only against the effects of the diphtheria toxin; it does not prevent
infection with diphtheria. The vaccine is given in combination with other vaccines. Which vaccine
is given depends on the person's age:
 Children under 7 years of age: The combination DTaP (diphtheria-tetanus-pertussis)

vaccine is part of routine childhood vaccination.
 Adolescents and adults: The combination Tdap (tetanus-diphtheria-pertussis) vaccine is

given as a booster shot at age 11 or 12 and a Td (tetanus-diphtheria) booster is given every
10 years after that.
After exposure to diphtheria

If people have close contact with a person who has diphtheria, they are tested for the infection and
given antibiotics for 7 days. Samples from their throat and nose are sent to a laboratory to be
cultured. If diphtheria bacteria are identified in the samples, these people must take antibiotics for
an additional 10 days (for a total of 17 days). This exposure regimen is done whether or not people
have been vaccinated because vaccinated people can still become infected with diphtheria.
Treatment of Diphtheria
 Diphtheria antitoxin
 Antibiotics
9. Listeria Monocytogenes
Gram positive bacteria that causes listeriosis.
Listeria monocytogenes resides in the intestine of people and many animals worldwide.
Most cases of listeriosis result from:

 Eating contaminated food
Listeriosis is usually acquired when contaminated food is eaten. In such cases, Listeria bacteria
can enter the bloodstream and spread to other organs. Rarely, Listeria bacteria infect the skin of
veterinarians, farmers, and other people who have direct contact with infected animals
(particularly during slaughter and handling of carcasses).
The bacteria grow in food at refrigerator temperatures and survive in the freezer.
Pasteurization of dairy products destroys the bacteria. Adequate cooking or reheating of food
kills the bacteria. However, they can reside in food-filled cracks and inaccessible areas in
commercial food preparation facilities and recontaminate food. If the food requires no further
cooking once purchased, the bacteria that remain are consumed with the food.
They can grow in refrigerated, packaged, ready-to-eat products (that require no cooking before
they are eaten) without changing the food’s taste or smell. Foods involved in previous outbreaks
of listeriosis include soft cheeses, salads, unpasteurized milk, cold cuts, hot dogs, shrimp, smoked
salmon, and undercooked chicken.
Invasive listeriosis
The bacteria sometimes enter the bloodstream from the intestine and invade certain organs (called
invasive listeriosis). Bacteria may spread to the following:
 The tissues covering the brain and spinal cord (causing meningitis)
 The eyes
 Heart valves (causing endocarditis)
 Joints
 In pregnant women, the uterus and fetus
Rarely, collections of pus (abscesses) form in the brain and spinal cord.
Risk factors
It is more common among the following:
 Pregnant women
 Fetuses and newborns
 People aged 60 or older
 People with a weakened immune system, such as those with human immunodeficiency
(HIV) infection
Pregnant women are about 10 to 20 times more likely to get listeriosis than the general population.
Listeriosis can cause miscarriage, stillbirth, and premature birth, but pregnant women rarely
become seriously ill or die. However, rarely, pregnant women with listeriosis pass the infection to
the fetus or newborn, who may then become seriously ill.
Did You Know...?

 Pregnant women are particularly susceptible to listeriosis, which
can harm the fetus or newborn.
Symptoms of Listeriosis
People with listeriosis typically have chills, fever, and muscle aches (resembling the flu), with
nausea, vomiting, and diarrhea. Usually, symptoms resolve in 1 to 7 days.
If meningitis develops, people have a headache and a stiff neck. They may become confused and
lose their balance.
If the uterus or placenta is infected in a pregnant woman, a miscarriage or stillbirth may result.
Two thirds of the surviving infants develop listeriosis, which may lead to a bloodstream infection
(sepsis) or meningitis. Up to one half of newborns infected near or at the end of the pregnancy die.
10.Clostridium perfringens
Bacteria that causes several disorders, including gastroenteritis. Some strains cause mild to
moderate gastroenteritis that gets better without treatment, whereas other strains cause severe
disease that can damage the small intestine and sometimes lead to death. Contaminated beef,
poultry, gravies, and dried or precooked foods are usually responsible for outbreaks of Clostridium
perfringens food poisoning. Some strains cannot be destroyed by cooking the food thoroughly,
whereas others can.
Symptoms of Clostridial Food Poisoning

The gastroenteritis starts about 6 to 24 hours after contaminated food is eaten. The most common
symptoms are watery diarrhea and abdominal cramps. Although usually mild, the infection also
can cause abdominal pain, abdominal expansion (distention) from gas, severe diarrhea,
dehydration, and a severe decrease in blood pressure (shock). Symptoms of Clostridium
perfringens food poisoning usually last about 24 hours.
Diagnosis of Clostridial Food Poisoning

 A doctor's evaluation
 Sometimes testing contaminated food or stool
A doctor usually suspects the diagnosis of Clostridium perfringens food poisoning when a local
outbreak of the disease has occurred. The diagnosis is confirmed by testing contaminated food or
stool samples from infected people for Clostridium perfringens.
Prevention of Clostridial Food Poisoning

 Prompt refrigeration and thorough reheating of leftovers
To prevent infection, leftover cooked meat should be refrigerated promptly and reheated
thoroughly before serving.
Treatment of Clostridial Food Poisoning

 Fluids and rest
The person is given fluids and is encouraged to rest. Antibiotics are not given.
11.Clostridium botulinum
Botulism is an uncommon, life-threatening poisoning caused by toxins produced by the anaerobic
Clostridium botulinum bacteria
They are anaerobes – they do not require oxygen to live.
The toxins that cause botulism, which are the most potent poisons known, can severely
impair peripheral nerve function. Botulism toxins paralyze muscles by preventing nerves from
releasing a chemical messenger (neurotransmitter) called acetylcholine. Acetylcholine interacts
with receptors on muscles (at the neuromuscular junction) and stimulates muscles to contract.
In very small doses, two types (A and B) of the botulism toxins can be used to relieve muscle
spasms (because it reduces muscle activity) and to reduce wrinkles.
Did You Know...

 The toxins that cause botulism are the most potent known poisons.
 In very small doses, two types (A and B) of these toxins can be used to control
muscle spasms and to reduce wrinkles.
Causes of Botulism
Clostridium botulinum bacteria form dormant cells called spores. These dormant spores are present
widely in the environment including in soil and in river and sea water. Like seeds, spores can exist
in a dormant state for many years, and they are highly resistant to destruction, for example, by
heat. When moisture and nutrients are present and oxygen is absent (as in the intestine or sealed
jars or cans), the spores develop into active bacteria and produce toxins. Some toxins produced
by Clostridium botulinum are not destroyed by stomach acid or the intestine’s protective enzymes.
It is common in the environment, and spores can be transported by air. Occasionally, cases of
botulism result from ingesting or inhaling small amounts of soil or dust that contain spores. Also,
the toxin can be used as a weapon. Spores can also enter the body through the eyes or a break in
the skin.
Botulism has rarely occurred after botulinum toxin injection for cosmetic reasons, such as for
wrinkles, or medical reasons, such as for migraine headaches.
However, most cases result from eating food that contains the toxins.
There are different forms of botulism, which have different causes. The most common forms are
 Foodborne botulism
 Wound botulism
 Infant botulism
i. Foodborne botulism
Foodborne botulism occurs when people eat food contaminated with botulinum toxin, produced
by Clostridium botulinum bacteria. Food may be contaminated if it is inadequately cooked before
it was stored.
The most common sources of foodborne botulism are
 Home-canned foods, particularly foods with a low acid content, such as asparagus, green
beans, beets, and corn
Other sources include chopped garlic in oil, chili peppers, and canned tomatoes, foil-wrapped
baked potatoes that have been left at room temperature too long, and home-canned or fermented
fish. However, about 10% of outbreaks result from eating commercially prepared foods—most
commonly, vegetables, fish, fruits, and condiments (such as salsa). Less commonly, botulism
results from eating beef, milk products, pork, poultry, or certain other foods.
Refrigerating food does not make food safe because Clostridia can produce some toxins at typical
refrigerator temperatures.
Botulinum toxin enters the bloodstream from the small intestine and is carried to nerves. This toxin
prevents nerves from sending signals to muscles.
ii. Wound botulism

Wound botulism occurs when Clostridium botulinum contaminates a wound or is introduced into
other tissues. Inside the wound, the bacteria produce toxins that are absorbed into the bloodstream.
Injecting drugs with needles that are not sterilized can cause this type of botulism, as can injecting
contaminated heroin into a muscle or under the skin (skin popping).
Symptoms of Botulism
The various forms of botulism cause many of the same symptoms:
 Dry mouth
 Blurred or double vision
 Drooping eyelids
 Difficulty focusing on nearby objects
 Pupils that do not constrict normally when exposed to light
 Slurred speech
 Difficulty swallowing
Nerve damage by the toxins affects muscle strength but not sensation. Also, the mind usually
remains clear.
Because swallowing is difficult, food or saliva may be inhaled (aspirated) into the lungs, causing
choking or gagging and increasing the risk of pneumonia (called aspiration pneumonia).
Diagnosis of Botulism
 Electromyography
 When possible, tests to detect toxins in food, blood, or stool
Doctors suspect botulism based on symptoms. However, other disorders can cause similar
symptoms, so additional information is needed.
Electromyography (electrical stimulation of muscles and recording of their electrical activity) may
be useful. In most cases of botulism, electromyography shows abnormal muscle responses after
electrical stimulation.
For foodborne botulism, a likely food source provides a clue. For example, when botulism occurs
in two or more people who ate the same food prepared in the same place, the diagnosis is clearer.
The diagnosis is confirmed when the toxins are detected in the blood or when the bacteria or toxins
are detected in a sample of stool. Toxins may also be identified in food that was eaten.
For wound botulism, doctors ask whether people have had an injury that broke the skin. Doctors
may inspect the skin for puncture marks suggesting use of an illicit drug. The diagnosis is
confirmed when the toxins are detected in the blood or when the bacteria are detected in a culture
of tissue from the wound.
Sometimes determining whether botulism developed from a wound or from food is impossible.
Prevention of Botulism
 Thorough cooking or heating of food
 Appropriate storage and handling of food
The spores of Clostridium botulinum are highly resistant to heat and may survive boiling for
several hours. However, the toxins are readily destroyed by heat. Stored foods can cause botulism
if they were inadequately cooked before they were stored. The bacteria can produce some toxins
at temperatures as low as 37.4° F (3° C), a typical refrigerator temperature, so refrigerating food
does not automatically make it safe.
Measures to prevent foodborne botulism:

 Cooking food at 176° F (79.9° C) for 30 minutes, which almost always destroys toxins
 Discarding canned foods that are discolored or smell spoiled
 Discarding cans that are swollen or leaking
 Refrigerating homemade oils infused with garlic or herbs and throwing away any of these
unused oils after 4 days
 Keeping potatoes that have been baked in aluminum foil hot until served
If people are unsure whether a can should be discarded, they can check it when they start to open
it. Before making the first puncture, they can place a few drops of water in the spot to be punctured.
If water is expelled rather than sucked into the can when the can is punctured, the can is
contaminated and should be discarded. If there is any question whether a can of food is safe, it is
better to discard it than risk getting botulism.
Treatment of Botulism
 Sometimes activated charcoal to prevent absorption of toxin consumed in food
 Antitoxin
 For breathing problems, use of a mechanical ventilator
12.Clostridium tetani
Anaerobic bacteria that causes tetanus.
Tetanus is common in areas of the world where immunization coverage is low. It can occur in
people of all ages, even infants.
Clostridium tetani is present in soil and animal feces and can live there for years. Tetanus bacteria
may enter the body through:
 Wounds contaminated with soil or feces (especially if the wound is not adequately cleaned)
 Skin punctures by contaminated needles (such as those used to inject illegal drugs or to
tattoo or do body piercing)
Sometimes the injury is so small that people do not even go to a doctor. Injuries that involve a
foreign body (such as a splinter, dirt, or bullet fragments) and dead tissue (such as burns, frostbite,
gangrene, or crush injuries) are more likely to cause tetanus.
Occasionally, tetanus results when the uterus is damaged during an induced abortion or childbirth.
Soil contamination of the stump of the umbilical cord, which may occur in parts of the world with
inadequate sanitation, can cause tetanus in newborns.
Tetanus bacteria produce spores. Spores are an inactive (dormant) form of bacteria. Spores enable
bacteria to survive when environmental conditions are difficult. When conditions are favorable,
spores grow into bacteria. Clostridium tetani bacteria produce tetanus toxins.
These toxins travel throughout the body and prevent certain nerves from sending signals to other
nerves. As a result, muscles contract involuntarily, causing stiffness and painful muscle
spasms.
Vaccination during childhood plus booster doses every 10 years during adulthood can prevent
tetanus. Thus, tetanus occurs mainly in people who have not been vaccinated or not kept their
vaccinations up to date.
The risk of developing tetanus is high in the following:
 People who inject drugs
 People over 60 because immunity decreases over time
 People who were never given the primary series of tetanus vaccines, which is part of routine
childhood vaccination
Symptoms of Tetanus
Tetanus symptoms usually begin about 5 to 10 days after the injury but may begin up to about 50
days later.
Muscle spasms are the characteristic feature of tetanus. Muscles contract involuntarily (spasm)
and become rigid. Spasms usually begin in the jaw (causing lockjaw) and throat (making
swallowing difficult), followed by the neck, shoulder, face, and then the abdomen and limbs. Such
spasms may interfere with breathing, sometimes so much that people turn blue.
The face may be frozen in a smile with the eyebrows raised. Back muscles contract, making the
back, neck, and legs arch backward. Spasms of sphincter muscles can lead to constipation and
difficulty urinating. Slight disturbances – such as noise, a draft, or the bed being jarred can trigger
painful muscle spasms throughout the body.
Other symptoms occur because tetanus affects the nervous system, including the part that
regulates internal body processes, such as how fast the heart beats. People with tetanus may have
a rapid heartbeat and a fever. They may sweat profusely. Blood pressure may go up and down.
People may inhale (aspirate) the contents of their mouth into their lungs, resulting in pneumonia.
People may be restless and irritable. However, even when the illness is severe, people usually
remain fully conscious.
In newborns, tetanus usually affects the whole body and is frequently fatal. Children who survive
may be deaf.
Did You Know...?

 Promptly and thoroughly cleaning dirty wounds can help prevent
tetanus.
Prevention of Tetanus
Preventing tetanus is far better than treating tetanus.
 Vaccination
Tetanus rarely develops in people who have completed a primary series of tetanus
vaccinations (three or more injections into a muscle) and had booster vaccinations every 10 years,
as recommended. The tetanus vaccine stimulates the body to produce antibodies that neutralize the
toxin. But it may take several weeks after vaccination for these antibodies to develop.
In young children, the tetanus vaccine is given as part of a series that includes the diphtheria and
pertussis (whooping cough) vaccines Adults who have completed the primary series of tetanus
vaccination should get tetanus boosters every 10 years.
Pregnant women are given the Tetanus, Diphtheria, and cellular Pertussis vaccine (TDaP)
during each pregnancy (preferably at 27 to 36 weeks gestation). This strategy prevents women and
newborns from getting tetanus. When pregnant women are vaccinated, antibodies to tetanus are
transferred from the mother to the fetus during pregnancy, and the newborn has antibodies to
tetanus at birth.
 After a wound
When people are injured, they can help prevent tetanus by promptly and thoroughly cleaning
wounds.
People who have wounds may be given one dose of tetanus vaccine to prevent tetanus from
developing.
13.Neisseria Meningitidis
Main pathogen that causes of bacterial meningitis – an inflammation of the meninges of the brain
and spinal cord.
Other bacteria that cause meningitis include Haemophilus influenzae, Staphylococcus

aureus and Escherichia coli.
Meningococcal meningitis differs from other causes in that it is often responsible for epidemics
of meningitis. It occurs most often in children aged 6 to 11 months, but it also occurs in older
children and in adults.
Meningococcal meningitis can be a rapidly fatal disease, and untreated meningitis has a mortality
rate near 50 percent. However, early intervention with antibiotics is highly effective, and with
treatment most individuals recover without permanent damage to the nervous system.
14.Escherichia coli
A group of gram-negative bacteria that normally reside in the intestine of healthy people, but some
strains can cause infection in the digestive tract, urinary tract, or many other parts of the
body.
Some strains of E. coli normally inhabit the digestive tract of healthy people. However, some
strains of E. coli have acquired genes that enable them to cause infection.
The most common infections due to E. coli are in the following:
 Digestive tract (causing gastroenteritis)
 Urinary tract
E. coli is the most common cause of bladder infection in women.
Other infections that can result from E. coli include the followings:
 Infection of the prostate gland (prostatitis)
 Gallbladder infection
 Infections that develop after appendicitis and diverticulitis
 Wound infections (including wounds made during surgery)
 Infections in pressure sores
 Foot infections in people with diabetes
 Pneumonia
 Meningitis in newborns
 Bloodstream infections
Many E. coli infections affecting areas outside the digestive tract develop in people who are
debilitated, who are staying in a health care facility, or who have taken antibiotics.
E. coli O157:H7 infection

Certain strains of E. coli produce toxins that damage the colon and cause severe inflammation
(colitis). E. coli O157:H7 is the most common among other strains that causes colitis. These strains
are sometimes collectively referred to as enterohemorrhagic E. coli (entero means intestinal,
and hemorrhagic means bleeding).
People are usually infected with these strains by doing the following:
 Eating contaminated ground beef that is not cooked thoroughly (one of the most common
sources) or drinking unpasteurized milk
 Going to a petting zoo and touching animals that carry the bacteria in their digestive tract
 Eating ready-to-eat food (such as produce at salad bars) that was washed with contaminated
water or contaminated by cattle manure
 Swallowing inadequately chlorinated water that has been contaminated by the stool of
infected people in swimming or wading pools
Did You Know...?

 E. coli is the most common cause of bladder infection in women.
Symptoms of E. coli Infections
E. coli symptoms depend on the part of the body affected and the strain of E. coli causing the
infection.
Traveler's diarrhea
People with traveler’s diarrhea have abdominal cramping and watery diarrhea and sometimes
nausea and vomiting. Symptoms are usually mild and resolve in 3 to 5 days.
E. coli O157:H7
Infections due to E. coli O157:H7 and other enterohemorrhagic E. coli typically begin with severe
abdominal cramps and watery diarrhea, which may become bloody within 24 hours. (This
disease is sometimes called hemorrhagic colitis.) People usually have severe abdominal pain and
diarrhea many times a day. They also often feel an urge to defecate but may not be able to. Most
people do not have a fever.
Because the infection is easily spread, people must often be hospitalized and isolated.
Prevention of E. coli Infections

 Avoiding unpasteurized milk and other dairy products made from unpasteurized milk
 Thoroughly cooking beef
 Thoroughly washing the hands with soap after using the toilet, changing diapers, and
having contact with animals or their environment and before and after preparing or eating
food
 Not swallowing water when swimming or when playing in lakes, ponds, streams, or
swimming pools
15.Shigella
Shigella is a gram-negative bacteria that causes shigellosis (bacillary dysentery). It results in
watery diarrhea or dysentery (the frequent and often painful passage of small amounts of stool that
contains blood, pus, and mucus)
Because stomach acid does not easily destroy these bacteria, ingesting even a small number of
them causes infection. In the large intestine, the bacteria cause inflammation, and because they are
then excreted in stool,
 Infection spreads easily from person to person when hands are soiled.
Infection is also spread through the following:

 Oral-anal sex
 Food contaminated by infected food handlers who do not wash their hands with soap after
using a toilet
 Water contaminated with human waste
 Swimming and wading pools that are inadequately chlorinated
Infection easily spreads among people who live together. Outbreaks also occur in places that are
overcrowded and have inadequate sanitation, such as:
 Day-care centers for children
 Long-term care facilities

 Refugee camps
 Institutions for the intellectually disabled
 Cruise ships
 Military camps
 Developing countries
Children are more likely to become infected and to have severe symptoms, such as seizures.
There are four species of Shigella. All cause diarrhea. However, one Shigella dysenteriae is more
likely to cause severe diarrhea, dysentery, and complications.
Symptoms of Shigellosis
Mild infections cause low-grade fever (about 100.4 to 102° F [38 to 38.9° C]) and watery
diarrhea 1 to 4 days after people ingest the bacteria. Some adults do not have a fever. Mild
infections in adults usually resolve in 4 to 8 days.
In adults, the first symptoms may be painful abdominal cramps and a frequent urge to defecate.
Passing stool may temporarily relieve the pain. These symptoms may become more severe and
occur more frequently as the infection progresses.
Severe infections may cause low-grade or moderate fever and watery diarrhea that progresses to
dysentery. In dysentery, bowel movements are frequent and contain blood, pus, and mucus. Severe
infections usually resolve in 3 to 6 weeks.
In young children, symptoms begin suddenly. Symptoms include fever, irritability or

drowsiness, loss of appetite, nausea or vomiting, diarrhea, and abdominal pain. Children may
frequently feel an urgent need to defecate. Within 3 days, blood, pus, and mucus appear in stool.
Unless complications develop, symptoms usually resolve by the second week.
Complications of shigellosis
Children, particularly young children, are most likely to have severe complications:
 High fever (up to 106° F [41° C]), sometimes with delirium, seizures, or coma
 Severe dehydration with weight loss
 20 or more bowel movements a day
 With severe diarrhea, protrusion of part of the rectum out of the body (rectal prolapse)
 Rarely, marked swelling of the intestine and tearing (perforation) of the large intestine
 Hemolytic-uremic syndrome if the infection is due to Shigella dysenteriae type 1
Severe dehydration can lead to shock and death, mainly in children under 2 years, in chronically
ill, malnourished, or debilitated adults, and in older people.
In hemolytic-uremic syndrome, red blood cells are destroyed, causing anemia with fatigue,
weakness, and light-headedness. Blood clots abnormally, causing the kidneys to stop functioning.
Seizures or strokes can also occur.
Prevention of Shigellosis
Prevention includes the following:
 Infected people should not prepare food for others.
 After using the toilet, infected people should wash their hands, and someone should clean
and disinfect the toilet before it is used again.
 People caring for people with shigellosis should wash their hands with soap and water,
particularly before they touch other people or handle food.
 Infected children with symptoms should not have contact with uninfected children.
 Diapers of infected children should be disposed of in a sealed garbage can, and the area
used to change diapers should be wiped with disinfectant after each use.
 Stool that contaminates clothing and bedclothes of infected people should be flushed away
in running water, and the soiled clothing and bedclothes should be washed in a washing
machine using the hot water cycle. When finished, surfaces of the sink, toilet, and washing
machine should be wiped down with a disinfectant, such as diluted chlorine bleach.
Currently, no vaccine is available.
Treatment of Shigellosis
 Fluids containing salt
 For severe infections, antibiotics
Water and salts lost because of diarrhea are replaced with fluids given by mouth or, if the infection
is serious, by vein.
Mild infections typically resolve within 4 to 8 days. Antibiotics are not routinely required for
healthy adults with mild infection.
Antibiotics are given to certain people, including those who:
 Are very young or very old

 Have a weakened immune system
 Have a moderate to severe infection
NOTE: Drugs to stop diarrhea may prolong the infection and should not be used.
16.Salmonellae
The gram-negative bacteria that cause diarrhea and sometimes cause a more serious infection –
typhoid fever.
Salmonella bacteria cause several types of infection. Most often, these bacteria
cause gastroenteritis, but they sometimes cause typhoid fever, a more serious infection.
There are over 2,000 different types of Salmonella bacteria.
Some Salmonella reside only in people. Other species of Salmonella normally reside in the
digestive tract of many wild and domestic animals, such as cattle, sheep, pigs, fowl, and reptiles
(including snakes, lizards, and turtles). Many of these can cause infections in people.
Salmonella bacteria are excreted in the feces of infected animals and people, leading to
contamination.
People are infected usually by eating undercooked poultry or eggs but sometimes by eating
undercooked beef and pork, unpasteurized dairy products, or contaminated seafood or fresh
produce. Salmonella bacteria can infect the ovaries of hens and thus infect the egg before the egg
is laid. Other foods may be contaminated by animal feces (for example, in slaughterhouses) or by
infected food handlers who do not adequately wash their hands after using a toilet. People can also
become infected if they drink contaminated water.
Because stomach acid tends to destroy Salmonella, a large number of these bacteria must be
consumed for infection to develop, unless people have a deficiency of stomach acid. Such a
deficiency may occur in
 Children under 1 year old
 Older people
 People taking antacids or drugs that inhibit stomach acid production, including histamine-
2 (H2) blockers (such as famotidine) or proton pump inhibitors (such as omeprazole)
Salmonella bacteria cause inflammation of the intestine (gastroenteritis) and thus are a common
cause of diarrhea.
Spread through the bloodstream

Sometimes the bacteria enter the bloodstream (causing bacteremia) and spread, causing infections
or collections of pus (abscesses) at distant sites, such as the bones, joints, urinary tract, and lungs.
Bacteria may collect and cause infection on artificial (prosthetic) joints or heart valves, on a blood
vessel graft, or on tumors. The lining of arteries, usually the aorta (the largest artery in the body),
may be infected. Abscesses and infected arteries can cause chronic bacteremia.
The infection is more likely to spread through the bloodstream in the following people:
 Infants
 Older people, especially those living in a nursing home
 People with disorders that affect red blood cells, such as sickle cell anemia or malaria
 People with a disorder that weakens the immune system, such as human immunodeficiency
virus (HIV) infection or cancer
 People who take drugs that suppress the immune system, such as those used to treat cancer
or prevent rejection of an organ transplant
Symptoms of Salmonella Infections

When the intestine is infected, symptoms usually start 12 to 48 hours after the bacteria are ingested.
Nausea and crampy abdominal pain occur, soon followed by watery diarrhea, fever, and
vomiting. Salmonella symptoms resolve in 1 to 4 days.
Long after symptoms are gone, carriers continue to excrete the bacteria in their stool. Such people
are called.
About 10 to 30% of adults develop reactive arthritis weeks to months after diarrhea stops. This
disorder causes pain and swelling, usually in the hips, knees, and Achilles tendon (which connects
the heel bone and calf muscle).
Prevention of Salmonella Infections

 Thoroughly cooking poultry, eggs, and ground beef
 Not eating or drinking foods that contain raw eggs or raw (unpasteurized) milk, such as
cookie dough, or certain homemade salad dressings
 Thoroughly washing produce
 Washing hands after going to the toilet or changing a diaper
 Washing hands, kitchen work surfaces, and utensils with soap and water immediately after
they have touched raw meat or poultry
 Washing hands with soap after touching reptiles, birds, or baby chicks and after contact
with feces of a pet
Special precautions are needed for people at high risk, such as young children. For example,
because reptiles (such as turtles), chicks, and other young birds are particularly likely to
have Salmonella, young children should not be allowed to handle these animals, and reptiles
should not be in the same house as infants.
Infected people should not prepare food for others.
17. Klebsiellae
Klebsiella, Enterobacter, and Serratia are closely related gram-negative bacteria that occasionally
infect the urinary tract or respiratory tract of people in hospitals or in long-term care facilities.
 These bacteria may infect the urinary or respiratory tract, intravenous catheters used to give
drugs or fluids, burns, wounds made during surgery, or the bloodstream.
 Identifying the bacteria in a sample taken from blood or from infected tissue confirms the
diagnosis.
 If the infection is acquired in the community, antibiotics can cure it, but if it is acquired in
a health care facility, it is difficult to treat because bacteria tend to be resistant to antibiotics.
Klebsiella, Enterobacter, and Serratia bacteria reside in the intestine of many healthy people and
rarely cause infection in them. Infections with these bacteria are often acquired in hospitals and
long-term care facilities. They usually occur in people whose resistance to infection is weakened
and/or who have a medical device (such as catheters, drains, and airway tubes) in their body.
These bacteria may infect different places in the body:
 Urinary or respiratory tract (causing pneumonia, bladder infections, or kidney infections)
 Catheters inserted into a vein (intravenous catheter), used to administer drugs or fluids
 Burns
 Wounds made during surgery
 Bloodstream (causing bacteremia or sepsis)
Rarely, Klebsiella bacteria cause pneumonia in people who live outside a health care facility (in
the community), usually in alcoholics, older people, people with diabetes, or people with a
weakened immune system. Typically, this severe infection causes cough, bringing up a sticky,
dark brown or dark red sputum, and collections of pus (abscesses) in the lungs or in the membrane
between the lungs and chest wall (empyema).
One species of Klebsiella produces a toxin that can cause inflammation of the colon and bleeding
(hemorrhagic colitis) after antibiotics are taken. This disorder is called antibiotic-associated colitis.
The antibiotics kill bacteria that normally reside in the intestine. Then Klebsiella bacteria are able
to multiply and produce the toxin. However, antibiotic-associated colitis usually results from
toxins produced by Clostridium difficile.
18.Proteus mirabilis
Gram negative bacterium that is a frequent cause of catheter-associated urinary tract infections
(CAUTIs). Its ability to cause such infections is mostly related to the formation of biofilms on
catheter surfaces.
They can block catheters. Bacteria embedded in crystalline biofilms become highly resistant to
conventional antimicrobials as well as the immune system.
19.Vibrio Cholerae
A gram-negative bacteria that causes a serious infection of the intestines that is characterized with
severe diarrhea, which can be fatal without treatment.
Several species of Vibrio bacteria cause diarrhea, but the most serious illness – cholera, is caused
by Vibrio cholerae. Cholera may occur in large outbreaks.
Vibrio cholerae infection is acquired by consuming water, seafood, or other foods contaminated
by the stool of infected people. Once infected, people excrete the bacteria in stool. Thus, the
infection can spread rapidly, particularly in areas where human waste is untreated.
Cholera is now largely confined to developing countries in the tropics and subtropics – Asia, the
Middle East, Africa, and South and Central America.
Large outbreaks of cholera continue to occur wherever there is poverty and people lack access to
clean drinking water and sanitary disposal of human waste.
For infection to develop, many bacteria must be consumed. Then, there may be too many for
stomach acid to kill, and some bacteria can reach the small intestine, where they grow and produce
a toxin. The toxin causes the small intestine to secrete enormous amounts of salt and water. The
body loses this fluid as watery diarrhea.
It is the loss of water and salt that causes death. The bacteria remain in the small intestine and do
not invade tissues.
Because stomach acid kills the bacteria, people who produce less stomach acid are more likely to
get cholera. Such people include
 Young children
 Older people
 People taking drugs that reduce stomach acid e.g., omeprazole
People living in endemic areas gradually acquire some immunity.
 Without treatment, more than one half of people with severe cholera die.
Symptoms of Cholera
Most infected people have no symptoms.
When cholera symptoms occur, they begin 1 to 3 days after exposure, usually with sudden,
painless, watery diarrhea and vomiting. Usually, people have no fever.
Diarrhea and vomiting may be mild to severe.
In severe infections in adults, more than 1liter of water and salts is lost per hour. The stool looks
gray and has flecks of mucus in it. It is described as rice-water stool.
Within hours, dehydration can become severe, causing intense thirst, muscle cramps, and
weakness. Very little urine is produced.
The eyes may become sunken, and the skin on the fingers may become much wrinkled. If
dehydration is not treated, loss of water and salts can lead to kidney failure, shock, coma, and
death.
In people who survive, cholera symptoms usually subside in 3 to 6 days.
Prevention of Cholera
The following are essential to cholera prevention:
 Purification of water supplies
 Appropriate disposal of human waste
In areas where cholera occurs, other precautions include
 Using boiled or chlorinated water
 Avoiding uncooked vegetables and undercooked fish and shellfish
Shellfish tend to carry other forms of Vibrio as well.
20.Pseudomonas
Any of several types of the gram-negative bacteria, e.g., Pseudomonas aeruginosa that can infect
different body parts especially in people who have serious medical problems or who are
hospitalized.
Pseudomonas bacteria, including Pseudomonas aeruginosa, are present throughout the world in
soil and water. These bacteria favor moist areas, such as sinks, toilets, inadequately chlorinated
swimming pools and hot tubs, and outdated or inactivated antiseptic solutions. Occasionally, these
bacteria are present in the armpits and genital area of healthy people.
Pseudomonas aeruginosa infections range from minor to serious, life-threatening disorders.

Infections occur more often and tend to be more severe in people who:
 Are weakened (debilitated) by certain severe disorders
 Have diabetes or cystic fibrosis

 Are hospitalized
 Have a disorder that weakens the immune system, such as human immunodeficiency virus
(HIV) infection
 Take drugs that suppress the immune system, such as those used to treat cancer or to
prevent rejection of transplanted organs
These bacteria can infect the blood, skin, bones, ears, eyes, urinary tract, heart valves, and lungs,
as well as wounds (such as burns, injuries, or wounds made during surgery). Use of medical
devices, such as catheters inserted into the bladder or a vein, breathing tubes, and mechanical
ventilators, increase the risk of Pseudomonas aeruginosa infections. These infections are
commonly acquired in hospitals – the bacteria are often present in sinks, antiseptic solutions, and
containers used to collect urine from a bladder catheters.
Symptoms of Pseudomonas Infections

Swimmer’s ear (external otitis): a mild external infection that can occur in otherwise healthy
people. Water containing the bacteria can enter the ear during swimming. Swimmer’s ear causes
itching, pain, and sometimes a discharge from the ear.
Malignant external otitis: a more severe external ear infection. It is most common among people
with diabetes. Tissues become swollen and inflamed, partly or completely closing the ear canal.
Symptoms may include fever, loss of hearing, inflammation of tissues around the infected ear,
severe ear pain, a foul-smelling discharge from the ear, and nerve damage.
Hot-tub folliculitis: Hair roots (follicles) become infected in people who use hot tubs or
whirlpools, particularly if the hot tubs and whirlpools are inadequately chlorinated. Spending a lot
of time in the water softens the follicles, making them easier for bacteria to invade. An itchy rash
consisting of tiny pimples develops. Pimples may have a drop of pus in their center.
Eye infections due to these bacteria may damage the cornea, often permanently. Enzymes
produced by the bacteria can rapidly destroy the eye. Infections usually result from injuries but
may result from contamination of contact lenses or contact lens solution.
Soft-tissue infections include those in muscle, tendons, ligaments, fat, and skin. These infections
can occur in deep puncture wounds (for example, stepping on a nail). Pseudomonas bacteria can
also infect pressure sores, burns, and wounds due to injuries or surgery. When these bacteria grow
in soiled dressings, the dressings turn green and smell like newly mowed grass. Fluids draining
from these wounds often have a sweet, fruity smell.
Severe pneumonia can develop in hospitalized people, especially those who need to use a
breathing tube and a mechanical ventilator. In people with HIV infection, Pseudomonas bacteria
commonly cause pneumonia or sinus infections.
Urinary tract infections usually develop in the following circumstances:
 After a procedure involving the urinary tract is done
 When the urinary tract is blocked
 When a catheter must remain in the bladder a long time
Bloodstream infections (bacteremia) often result when the following occur:
 Bacteria enter the bloodstream from an infected organ (such as the urinary tract).
 A contaminated illegal drug is injected into a vein.
 A contaminated needle or syringe is used to inject illegal drugs.
 A catheter in a blood vessel (called an intravascular catheter) is left in place.
Bone and joint infections usually occur in the spine, pubic bone, and/or the joint between the
collarbone and breastbone. The bacteria usually spread to bones and joints from the bloodstream,
particularly in people who use illegal intravenous drugs. Less often, the bacteria spread from
nearby soft tissues that have been infected after an injury or surgery.
Heart valve infections are rare. They usually occur in people who inject intravenous drugs and in
people with artificial heart valves. The bacteria usually spread to heart valves from the
bloodstream.
21.Brucella Species
Gram-negative bacteria that causes brucellosis – a disease characterized by fever and body-wide
symptoms.
Brucellosis is acquired mainly by
 Having direct contact with infected farm animals
 Consuming unpasteurized contaminated milk or other dairy products or undercooked

contaminated meat
People can also acquire brucellosis if they have contact with infected dogs, deer, moose, buffalo,
or other animals or if they inhale airborne particles containing the bacteria. Brucellosis is rarely
spread from person to person.
People at increased risk of getting brucellosis include laboratory workers and people who may
handle infected animals or animal tissue, including meat packers, veterinarians, farmers, and
livestock producers.
Inhaling only a few of the bacteria can cause infection.
Thus, the bacteria could be used in biological warfare.

Symptoms of Brucellosis
Symptoms of brucellosis can begin 5 days to several months after people are exposed
to Brucella bacteria.
People typically have
 A fever, which may return repeatedly for months and sometimes years
Symptoms may begin suddenly with chills, night sweats, a severe headache, low back pain, bone
and joint pain, and sometimes diarrhea. Or symptoms may begin gradually, with a feeling of being
slightly ill, muscle pain, headache, and pain in the back of the neck.
The fever may come and go for several weeks.
Later symptoms include loss of appetite, weight loss, severe constipation, abdominal pain, joint
pain, difficulty sleeping, weakness, irritability, and depression.
Sometimes infection develops in the brain, tissues that cover the brain and spinal cord (meninges),
back bones (vertebrae), long bones (such as the thighbone), joints, heart valves, or other organs.
Prevention of Brucellosis
The best way to prevent brucellosis is to avoid eating undercooked meat and unpasteurized dairy
products. Pasteurization involves heating raw milk to a high temperature for a short period of time.
This process destroys harmful bacteria that may be present in milk.
People who handle animals or animal tissues should wear goggles and rubber gloves.
Vaccination of domestic animals (cattle, sheep, and goats) helps control the disease.
There is no vaccine for people.
22.Haemophilus Influenzae
Gram-negative bacteria that can cause infection in the respiratory tract, which can spread to other
organs.
Many species of Haemophilus normally reside in the upper airways of children and adults and
rarely cause disease. One species causes chancroid, a sexually transmitted disease. Other species
cause infections of heart valves (endocarditis) and, rarely, collections of pus (abscesses) in the
brain, lungs, and liver. The species responsible for the most infections is Haemophilus influenzae.
Haemophilus influenzae can cause infections in children and sometimes in adults.
Risk of getting a Haemophilus influenzae infection is increased in the following:

 Children (particularly boys)
 Blacks
 People who attend or work at a day care center
 People who live in overcrowded conditions
 People with an immunodeficiency disorder, no spleen, or sickle cell disease
Infection is spread by sneezing, coughing, or touching infected people.
One type of Haemophilus influenzae, called type b, is more likely to cause serious infections.
In children, Haemophilus influenzae type b (Hib) can spread through the bloodstream
(causing bacteremia) and infect the joints, bones, lungs, skin of the face and neck, eyes, urinary
tract, and other organs.
The bacteria may cause two severe, often fatal infections:
 Meningitis
 Epiglottitis (infection of the flap of tissue over the voice box)
Some strains cause infection of the middle ear in children, the sinuses in children and adults, and
the lungs in adults, especially those with chronic obstructive pulmonary disease (COPD) or AIDS.
Symptoms vary depending on the part of the body affected.
Prevention of H. influenzae Infections

Children are routinely vaccinated against Haemophilus influenzae type b.
23.Treponema pallidum
Bacteria that causes syphilis.
Most people with syphilis are men – often men who have sex with men and those who are infected
with human immunodeficiency virus (HIV), and men who live in cities.
Risk Factors
 Being infected with HIV
 Practicing unsafe sex – for example, having many sex partners or not
using condoms correctly and regularly
 Being a man who has sex with men
People with syphilis often have other sexually transmitted diseases (STDs).
Syphilis causes symptoms in three stages:

 Primary syphilis
 Secondary syphilis
 Tertiary syphilis
The stages are separated by periods when no symptoms occur (latent stage).
Transmission of syphilis
Syphilis is highly contagious during the primary and secondary stages. It may be contagious early
in the latent stage.
Infection is usually spread through sexual contact. A single sexual encounter with a person who
has early-stage syphilis results in infection about one third of the time. The bacteria enter the body
through mucous membranes, such as those in the vagina or mouth, or through the skin. Within
hours, the bacteria reach nearby lymph nodes, then spread throughout the body through the
bloodstream.
Syphilis can also be spread in other ways. It can infect a fetus during pregnancy, causing birth
defects and other problems.
People can sometimes get syphilis by contact with infected skin sores. However, the bacteria
cannot survive long outside the human body so syphilis is not spread through contact with objects
(such as toilet seats, door handles) that have been touched by a person with syphilis.
Symptoms of Syphilis
Each stage of symptoms (primary, secondary, and tertiary) is progressively worse.
i. Primary syphilis
A painless sore (called a chancre) appears at the infection site – typically the penis, vulva, or
vagina. A chancre may also appear on the anus, rectum, lips, tongue, throat, cervix, fingers, or
other parts of the body. Usually only one chancre develops, but occasionally several develop.
Symptoms usually start 3 to 4 weeks after infection but may start from 1 to 13 weeks later.
The chancre begins as a small red raised area, which soon turns into a relatively painless, raised,
firm open sore. The chancre does not bleed and is hard to the touch. Nearby lymph nodes usually
swell and are also painless. About half of infected women and one third of infected men are
unaware of the chancre because it causes few symptoms. Chancres in the rectum or mouth, usually
occurring in men, are often unnoticed.
Syphilis—Primary: Chancre on the Genitals (CDC)
Primary Syphilis (Mouth Chancre)
(CDC)
The chancre usually heals in 3 to 12 weeks. Then, people appear to be completely healthy.
ii. Secondary syphilis

The bacteria spread in the bloodstream, causing a widespread rash, swollen lymph nodes, and, less
commonly, symptoms in other organs. The rash typically appears 6 to 12 weeks after infection.
About one fourth of infected people still have a chancre at this time. Usually, the rash does not itch
or hurt. It varies in appearance.
Unlike rashes caused by most other diseases, this rash commonly appears on the palms or soles. It
may be short-lived or may last for months. Even without treatment, the rash eventually resolves,
but it may recur weeks or months later. If a rash develops on the scalp, hair may fall out in patches,
making it appear moth-eaten.
Secondary-stage syphilis can cause fever, fatigue, loss of appetite, and weight loss.
Images of Secondary Syphilis
Syphilis – Secondary: Rash (CDC)

During the secondary stage of syphilis, a widespread rash may appear.
Syphilis – Secondary: Rash on the Back (CDC)
During the secondary stage of syphilis, a widespread rash may appear. The spots may be separate
or run together, as shown here.
Syphilis – Secondary: Rash on the Palms (CDC)
During the secondary stage of syphilis, a widespread rash may appear. Unlike rashes caused by
most other diseases, this rash commonly appears on the palms or soles.
Prevention of Syphilis
The following general measures can help prevent syphilis (and other STDs):
 Regular and correct use of condoms
 Avoidance of unsafe sex practices, such as frequently changing sex partners or having
sexual intercourse with prostitutes or with partners who have other sex partners
 Prompt diagnosis and treatment of the infection (to prevent spread to other people)
 Identification of the sexual contacts of infected people, followed by counseling or treatment

of these contacts
NB: Not having sex (anal, vaginal, or oral) is the most reliable way to prevent STDs but is often
unrealistic.
Did You Know...?

 A single sexual encounter with a person who has early-stage
syphilis results in infection about one third of the time.
Promptly and thoroughly cleaning dirty wounds can help prevent

tetanus.
Treatment of Syphilis
 Penicillin given by injection
 Another antibiotic for people who are allergic to penicillin
 Simultaneous treatment of sex partners
Penicillin given by injection into a muscle is the best antibiotic for primary, secondary, and early
latent syphilis.
 For primary, secondary, and early-latent stages of syphilis, one dose of a long-acting
penicillin is all that is needed.
 For late-latent stage and some forms of the tertiary stage, three doses are given,
separated by 1 week.
Treatment of sex partners

Because people with primary, secondary, and even early-latent syphilis can pass the infection to
others, they must avoid sexual contact until they and their sex partners have completed treatment.
If a person is diagnosed with syphilis, all of the person's sex partners are tested for syphilis. The
sex partners are treated in the following circumstances:
 They had sexual contact with the infected person during the 90 days before the diagnosis
was made, even if their test results are negative.
 They had sexual contact with the infected person more than 90 days before the diagnosis
was made but only if their test results are not immediately available and their return for a
follow-up visit is uncertain. If their test results are negative, no treatment is needed. If test
results are positive, they are treated.
24.Neisseria gonorrhoeae
One of the leading bacterial cause of sexually-transmitted disease – gonorrhea. Sometimes, in
females, the disease may be unrecognized or asymptomatic such that an infected mother can give
birth and unknowingly transmit the bacterium to the infant during its passage through the birth
canal.
The bacterium is able to colonize and infect the newborn eye resulting neonatal ophthalmia,
which may produce blindness. For this reason (as well as to control Chlamydia which may also be
present), an antimicrobial agent is usually added to the newborn eye at the time of birth.
25.Mycobacterium tuberculosis
This is the etiologic (causative) agent of tuberculosis (TB) in humans. Tuberculosis is the leading
cause of death in the world from a single infectious disease.
The bacterium is responsible for over 3 million deaths/year. Drug/multiple drug-resistant strains
have emerged – This increase in cases is attributable to changes in the social structure in cities, the
HIV epidemic, and patient failure to comply with treatment programs. A related
organism, Mycobacterium leprae, causes leprosy.
Mycobacterium tuberculosis Acid-fast stain. 1000X magnification. © Gloria J. Delisle and Lewis Tomalty,
Queens University, Kingston, Ontario, Canada. Licensed for use by ASM Microbe
Library http://www.microbelibrary.org.These bacteria were observed in a sputum sample from a patient
with active tuberculosis.
Table 1. Important Bacteria that Are Pathogens of Humans

Bacterial pathogen Disease(s) Transmission
Gram-negative bacteria
Escherichia coli Gastroenteritis, urinary tract infections, neonatal FWE
meningitis
E. coli O157:H7 Diarrhea, hemolytic uremic syndrome (HUS) F
Salmonella enterica Gastroenteritis FW
Salmonella typhi Typhoid fever FW
Shigella dysenteriae Bacillary dysentery FW

Yersina pestis Bubonic plague IV
Pseudomonas aeruginosa Opportunistic infections, swimmerï¿½s ear, hot tub S W C HA E
itch, cellulitis, pneumonia, more
Vibrio cholera Asiatic cholera W
Bordetella pertussis Whooping cough RC
Haemophilus influenzae Meningitis, pneumonia, sinusitis RC
Helicobacter pylori Gastric and duodenal ulcers F
Campylobacter jejuni Gastroenteritis FW
Neisseria gonorrhoeae Gonorrhea SC
Neisseria meningitidis Meningococcemia and meningitis RCE
Brucella abortus Undulant fever IA M
Bacteroides fragilis Anaerobic infections E
Gram-positive bacteria
Staphylococcus aureus Food poisoning, wound infections, toxic shock F C E HA IA
syndrome, more
Streptococcus pyogenes Strep throat, scarlet fever, mastitis, necrotizing C
fasciitis, more
Streptococcus pneumonia Pneumonia, otitis media, meningitis RC E
Bacillus anthracis Anthrax S IA
Bacillus cereus Food poisoning F
Clostridium tetani Tetanus S
Clostridium perfringens Food poisoning, gas gangrene, uterine infections FSE
Clostridium botulinum Botulism, infant botulism F
Clostridium difficile Antibiotic-associated diarrhea, pseudomembranous C HA E
colitis
Corynebacterium Diphtheria RC
diphtheria
Listeria monocytogenes Listeriosis F
Not typed by Gram stain
Mycobacterium TB (tuberculosis) RC M
tuberculosis
Mycobacterium leprae Leprosy C
Chlamydia trachomatis Chlamydia, lymphogranuloma venereum, trachoma SC C
Chlamydia pneumonia Pneumonia RC
Mycoplasma pneumoniae Atypical pneumonia RC
Rickettisas Rickettsiosis: typhus, RMSF IV
Treponema pallidum Syphilis SC
Borrelia burgdorferi Lyme disease IV
KEY TO TRANSMISSION. C = Contact E = Endogenous F = Food borne HA = Hospital Acquired

IA = Infected Animal IV = Insect Vector M = Milk RC = Respiratory Contact SC = Sexual Contact
S = Soil W = Water
BACTERIAL DISEASES OF HUMANS BY ANATOMICAL SITE OR TYPE
Infections of the oral cavity

Dental caries: Streptococcus mutans, S. oralis, S. sanguis, S. gordonii
Gingivitis
Periodontal disease
GI Tract
Gastric and duodenal ulcers: Helicobacter pylori
Gastroenteritis: Salmonella, Campylobacter, E. coli
Dysentery: Shigella
Antibioticï¿½associated diarrhea and pseudomembranous colitis: Clostridium difficile
Asiatic cholera: Vibrio cholerae
Food poisoning
Staphylococcus aureus
Bacillus cereus
Clostridium perfringens
Clostridium botulinum
Food infections
Salmonella
E. coli O157:H7
Campylobacter jejuni
Listeria monocytogenes: Listeriosis
Respiratory Tract
Sinusitis
Haemophilus influenzae
Pseudomonas aeruginosa
Strep throat: Streptococcus pyogenes
Diphtheria: Corynebacterium diphtheriae
Pneumonia
Streptococcus pneumoniae
Chlamydia pneumoniae
Mycoplasma pneumoniae
Whooping cough: Bordetella pertussis
Tuberculosis: Mycobacterium tuberculosis
Sexually-Transmitted Disease
Chlamydia: Chlamydia trachomatis
Gonorrhea: Neisseria gonorrhoeae
Syphilis: Treponema pallidum
Urinary Tract Infections

E. coli
Meningitis
Neisseria meningitidis
Streptococcus pneumoniae
Escherichia coli
Otitis
Otitis externa: Pseudomonas aeruginosa
Otitis media: Streptococcus pneumoniae, Haemophilus influenzae
Skin
Acne, boils, pimples, impetigo: Staphylococcus aureus
Hot tub itch, folliculitis, cellulitis: Pseudomonas aeruginosa
Necrotizing fasciitis: Streptococcus pyogenes
Zoonoses
Anthrax: Bacillus anthracis
Brucellosis: Brucella abortus
Leptospirosis: Leptospira
Arthropod borne
Lyme disease: Borrelia burgdorferi
Ehrlichiosis: Ehrlichia
Rickettsiosis (Typhus, Rocky Mountain Spotted Fever): Rickettsias
Plague: Yersinia pestis
Toxinoses
Toxic shock syndrome, Scalded skin syndrome: Staphylococcus aureus
Scarlet fever: Streptococcus pyogenes
Hemolytic Uremic Syndrome (HUS): E. coli O157:H7
Diphtheria: Corynebacterium diphtheriae
Anthrax: Bacillus anthracis
Tetanus: Clostridium tetani
Botulism: Clostridium botulinum
Hospital-acquired (nosocomial) infections

MRSA (methicillin-resistant Staphylococcus aureus)
Escherichia coli
Clostridium difficile
References
Todar's Online Textbook of Bacteriology. "The Good, the Bad, and the Deadly"
https://www.msdmanuals.com/home/infections

Bacterial Pathogens Cha Encry

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Bacterial Pathogens Cha Encry

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Bacterial Pathogens Lecturer: Philip M.

i. They protect us against diseases by preventing the overgrowth of harmful microbes.

Types of staph infections

Certain staphylococcal infections are more likely in certain situations:

 Lung infection (pneumonia): When people have had influenza (particularly) or a

Risk factors for staph infections

 GBS meningitis is usually restricted to neonates. In adults, GBS meningitis is associated

Note: Symptoms depend on the location of the infection.

Did You Know...

Severe infection can also damage the kidneys.

Pseudomembrane Due to Diphtheria (image courtesy of CDC)

Swollen Neck Due to Diphtheria (Image courtesy of the CDC)

Diphtheria Affecting the Skin (CDC)

Open Sore Due to Diphtheria (CDC)

 Children under 7 years of age: The combination DTaP (diphtheria-tetanus-pertussis)

 Adolescents and adults: The combination Tdap (tetanus-diphtheria-pertussis) vaccine is

After exposure to diphtheria

Most cases of listeriosis result from:

Did You Know...?

Symptoms of Clostridial Food Poisoning

Diagnosis of Clostridial Food Poisoning

Prevention of Clostridial Food Poisoning

Treatment of Clostridial Food Poisoning

Did You Know...

ii. Wound botulism

Measures to prevent foodborne botulism:

Did You Know...?

Other bacteria that cause meningitis include Haemophilus influenzae, Staphylococcus

E. coli O157:H7 infection

Did You Know...?

Prevention of E. coli Infections

Infection is also spread through the following:

 Long-term care facilities

In young children, symptoms begin suddenly. Symptoms include fever, irritability or

 Hemolytic-uremic syndrome if the infection is due to Shigella dysenteriae type 1

 Are very young or very old

Spread through the bloodstream

Symptoms of Salmonella Infections

Prevention of Salmonella Infections

Infected people should not prepare food for others.

These bacteria may infect different places in the body:

 Urinary or respiratory tract (causing pneumonia, bladder infections, or kidney infections)

 Wounds made during surgery

 Bloodstream (causing bacteremia or sepsis)

 People taking drugs that reduce stomach acid e.g., omeprazole

People living in endemic areas gradually acquire some immunity.

Most infected people have no symptoms.

Diarrhea and vomiting may be mild to severe.

In people who survive, cholera symptoms usually subside in 3 to 6 days.

The following are essential to cholera prevention:

 Purification of water supplies

 Appropriate disposal of human waste

In areas where cholera occurs, other precautions include

 Using boiled or chlorinated water

 Avoiding uncooked vegetables and undercooked fish and shellfish

Shellfish tend to carry other forms of Vibrio as well.

Pseudomonas aeruginosa infections range from minor to serious, life-threatening disorders.

 Have diabetes or cystic fibrosis

Symptoms of Pseudomonas Infections

 Consuming unpasteurized contaminated milk or other dairy products or undercooked

Thus, the bacteria could be used in biological warfare.

Risk of getting a Haemophilus influenzae infection is increased in the following:

Prevention of H. influenzae Infections

Syphilis causes symptoms in three stages: