ENTEROBACTERIACEAE I

Escherichia Coli Enterobacter (E. Klebsiella Serratia Proteus mirabilis Yersinia Yersinia pestis
cloacae & E. Pneumoniae marcescens enterocolitica
aerogenes)

Lab ● G- bacillus ● G- bacillus ● G- bacillus ● G- bacillus ● G- bacillus ● G- bacillus ● G- coccobaillus

Identificat ● encapsulated ● Motile ● Non Motile ● Motile ● Highly motile ● Motile at 25C ● Wright-Giemsa
● facultative ● Non-spore forming ● Non-spore forming ● Facultative ● Non-spore forming ● Non motile at 37C and Wayson
ion anaerobic ● Facultative ● Facultative anaerobic ● Facultative ● Facultative staining: bipolar
● catalase + anaerobic anaerobic (both ● Urease + anaerobic anaerobe staining only poles
● lactose fermenting ● Oxidase - but grows better ● Catalase + ● NON lactose ● Facultative are stained; like
(red of phenol > ● Urease + (urea with O2) ● FNase, Lipase, fermenter intracellular safety pin
yellow); agar + phenol red ● Urease + Gelatinase + (MacConkey: ● Non-spore forming ● Non motile
(MacConkey: pink) -> yellow to pink) ● Lactose fermenter ● SLOW lactose smooth colorless) ● Oxidase - ● Non spore forming
● Motile ● Lactose fermenting (MacConkey: fermenter ● Oxidase - ● NON lactose ● Facultative
● Eosin Methylene (MacConkey: pink) mucoid pink due (MacConkey: ● Urease + fermenter anaerobic
Blue agar: black w to abundant pink) ● BAP: ripples (MacConkey: ● Facultative
greenish black polysaccharide ● Prodigiosin: Red ● Hydrogen sulfide colorless) intracellular
sheen capsule) Pigment forming + (TSI-- lactose, ● CIN agar: white ● Oxidase -
red colonies if 25C glucose, sucrose, sharp-bordered, ● Urease -
iron, pH dye; black deep red center ● Catalase +
precipitate (iron + (bull’s eyes) ● Indole - (DO NOT
hydrogen sulfide)) ● Hydrogen Sulfide - tryptophan to
(TSI) indole)
● MacConkey agar
(colorless), sheep
blood agar
(opaque, yellow),
choc agar
● Hydrogen sulfide -
(TSI)
● Encapsulated but
is lost on flea gut

Pathogen ● Colonize Gut ● Virulence Factors: ● Oropharynx and ● Genus has 20 ● Virulence Factors: ● Cattle, deer, pigs ● plague
esis, harmlessly fimbriae attach to GI species, 8 flagella (can ,birds natural ● Transmission of
● Fimbriae attach to cells > hemolysins ● Virulence factors: infectious differentiate to hosts -> pet feces bacteria from
Toxins cell surface > holes > cell capsule (major), ● Virulence factors: short swimmer from dogs fleas: fleas get
● Serotypes damage LPS (avoid fimbriae, adherent cells to elongated ● YadA and Ail infected from
(antigens/virulence ● Endogenous: complement biofilms (made of swarm cells when adhesins bacteremic hosts
factors): prolong antibiotic mediated killing), EPS; make it in contact w solid) (attachment) then colonize gut
● Somatic O (cell ● Exogenous: water, Pili, Siderophore difficult for = Swarming ● Type III secretion > bites humans
membrane) soil, medical ● Iron: to thrive and antibiotics to Motility system (T3SS): place in wound >
● Capsular K equipment, etc produce reach bacteria) ● Catheter secrete Yersinia macrophages
● Fimbrial F siderophore introduced -> outer proteins come to kill
● Flagellar H (snatch iron to bladder to kidneys (Yops: block bacteria > capsule
● 5 Pathotypes host cells) -> uroepithelial secretion of F1 antiphagocytic
● STECShiga-like ● Use urease to cells in urinary proinflammatory lost in flea gut >
toxin-producing convert urea in tract -> use cytokines will survive in
E.Coli : urine -> ammoina fimbriae to attach TNF-alpha IL-8 macrophages >
● HUS hemolytic and co2 to cells -> inhibit carried to lymph
uremic syndrome ● Ammonia + hemolysin macrophage -> nodes >
PROCESS: after hydrogen -> ● ZapA protease: avoids lymphadenopathy
releasing toxin > ammonium INC destroy IgA and phagocytosis) ● In macrophages
bloodstream > urine pH > more IgG (tags bacteria ● Can replicate uses virulence
kidneys alkaline so neutrophil can inside Peyer’s factors: producing
(glomerulus) > ● Alkaline urine: destroy) it Patches (lyphoid capsular antigen
gaps allow proteins precipitation of P, neutralize first line tissue in gut wall) F1
to leak (proteinuria) Ca, Mg + of defense ● Needs Iron: ● Type III secretion
> inflammatory ammonium -> ● Alkaline urine: Siderosphore system T3SS,
response > clot STRUVITE precipitation of P, ● Enterotoxin Yst: Yersinia outer
formation > STONES -> Ca, Mg + diarrhea proteins (yops)
thrombocytopenia > KIDNEY STONES ammonium -> block secretion of
clots arterioles > STRUVITE proinflammatory
schistocytes, STONES -> cytokines TNF
microangiopathic KIDNEY STONES alpha IL-8 leading
hemolysis > RBC ● Urinary Stasis: to evasion
sliced > anemia > bacterial ● Siderophore
clots more multiplication -> called
arterioles > urinary Yersiniabactin:
ischemic kidney alkalinization -> goes on a hunt or
unable to filter deposition of new iron when
blood > uremia layers of struvite captured return to
● ETEC bacteria
enterotoxigenic E. ● Iron acquisition
Coli: heat labile NEED to thrive
and heat stable ● Macrophages then
enterotoxin > burst > bubonic,
intestinal septicemic,
inflammation > pneumonic
watery diarrhea ● Bubonic plague:
● EIEC spreads to lymph
enteroinvasive E. nodes and swells
Coli: bloody ● Buboes: swollen
diarrhea by lymph nodes
mechanical ● Septicemic
damage plague: in
● EPEC bloodstream, has
enteropathogenic capsular antigen
E. Coli : destroys F1 again so
cytoskeleton > neutrophils cant
intestinal epithelial destroy them.
cells flattens > Secretes
impairs water and endotoxins ->
nutrient absorption excessive
> watery diarrhea production of
● UPEC thrombin ->
 Uropathogenic E. disseminated
coli : live in GI > intravascular
gets out of colon by coagulation DIC ->
ffg defecation > tiny clots form ->
colonize perineum cuts blood flow
> urethra > urinary causing tissue
bladder (cystitis) > necrosis
alpha beta cells ● Septicemic plage
lyse urinary tract -> sepsis -> death
cells > move to ● Pneumonic plague
ureters and kidney ● (1) bacteria ->
> pyelonephritis bloodstream ->
lungs =
SECONDARY
Pneumonic
Plague
● (2) 2nd
Pneumonic
Plague sneezes ->
droplets that can
cause PRIMARY
mnemonic plague

Diagnosi ● Gram stain on stool ● Bacteria in a ● Bacteria in a ● Bacteria in a ● Bacteria in a ● Bacteria in a ● Bacteria in a
s or urine culture from blood, culture from blood, culture from blood, culture from urine culture from stool culture from blood,
● Bacteria culture on sputum, urine, pus sputum, urine sputum, urine or ● UTI: urinalysis ● Reactive arthritis: bubo aspirate and
Eosin Methylene ● UTI: urinalysis ● UTI: urinalysis CSF alkaline urine pH > synovial fluid sputum
Blue agar alkaline urine pH > alkaline urine pH > ● Pyuria: WBC 7 sample identifying ● Identifying
● HUS: shiga toxin in 7 7 ● Bacteriuria: ● Pyuria: WBC inflammatory cells bacteria in
blood ● Pyuria: WBC ● Pyuria: WBC bacteria in urine ● Bacteriuria: or bacteria peripheral blood
● Bacteriuria: ● Bacteriuria: ● Chest X Ray: bacteria in urine ● Increased titers of smear using
bacteria in urine bacteria in urine pneumonia and ● Complete Blood antibodies: tube Gram,
● Chest X Ray: ● Complete Blood abscess formation Count: agglutination or Wright-Giemsa or
respiratory infection Count: leukocytosis ● Lumbar puncture: pyelonephritis or ELISA Wayson staining
● Abdominal CT scan ● Chest X Ray: CNS infection prostatitis INC ● Ultrasound or CT: ● 4 fold increase in
or ultrasound pneumonia and ● Echocardiography leukocytosis or exclude antibody titer bw
● Echocardiography: abscess formation : endocarditis INC WBC appendicitis in serum probes
endocarditis ● Radiopaque on X pseudoappendici obtained 2 weeks
Ray: struvite tis apart
stones ● Rapid Antigen test
to identify F1
antigen in sputum
or serum
● Pneumonic
plague: chest
xray, white areas
or cavities
appears walled-off
lucent areas
Diseases ● Serotypes ● At risk diabetes ● At risk, diabetes ● At risk HIV+, ● UTIs common ● Ileum: terminal ● Bubonic plague:
/Sympto ● K1: neonatal ● Nosocomial ● Nosocomial diabetes found in elderly ileitis fever, chills,
meningitis infections infections ● Urinary Catheters: people ● Right colon: fatigue, buboes in
ms ● O157:H7: ● Urinary Catheters: ● Urinary Catheters: UTIs cystitis hospitalized enterocolitis inguinal or axillary
hemorrhagic colitis, UTIs cystitis UTIs cystitis (bladder), (catheterization or ● abdominal region
hemolytic uremic (bladder), (bladder), pyelonephritis, kidney or bladder mesenteric lymph ● Septicemic
syndrome, pyelonephritis, pyelonephritis, prostatitis disease) nodes: mesenteric plague:
diarrheal outbreaks prostatitis prostatitis ● UTIs: dysuria, ● Antibiotics, sexual lymphadenitis -> hypotension,
● 5 Pathotypes ● UTIs: dysuria, ● UTIs: dysuria, urinary frequency activity pseudoappendiciti malaise, purpuric
● STEC: bloody urinary frequency urinary frequency and urgency ● UTIs: urethritis, s skin lesions,
diarrhea, low grade and urgency and urgency ● Blood Vessel cystitis, prostatitis, ● Iron overload tissue necroses
fever ● Cystitis: ● Cystitis: Catheter: pyelonephritis conditions like black regions on
HUS: body swelling, Suprapubic pain Suprapubic pain bacteremia/sepsis ● Struvite kidney sickle-cell or limbs
confusion, nausea, ● Prostatitis: fever ● Prostatitis: fever ● Bloodstream stones beta-thalassemia: ● Pneumonic
vomiting chills prostate chills prostate infection: ● Xanthogranulom septicemia plague: dyspnea,
Anemia: paleness of swollen swollen hypotension, atous ● After infection can fever, chest pain,
eys conjunctiva ● Pyelonephritis: ● Pyelonephritis: tachycardia pyelonephritis: still have cough,
Hemolysis: Jaundice flank pain flank pain ● Bloodstream infected struvite associated hemoptysis
build up bilirubin ● Bloodstream ● Bloodstream infection: calculi cause sequelae (blood in sputum)
● ETEC: watery infection: infection: endocarditis chronic HLA-B27 antigen:
diarrhea, fever, hypotension, hypotension, ● Cellulitis: swelling, obstruction -> surface of
bloating tachycardia tachycardia erythema necrotic leukocytes
● EIEC: bloody ● Blood Vessel ● Blood Vessel ● Mechanically hemorrhagic causing delayed
diarrhea, chills Catheter: Catheter: ventilated: masses of kidney inflammatory
● EPEC: children bacteremia/sepsis bacteremia/sepsis pneumonia containing foamy response
watery diarrhea, ● Endocarditis: fever , endocarditis ● Burns or Surgical macrophages ● Ex. Reactive
dehydration, new heart murmurs (heart), meningitis Wounds:cellulitis, (confused as arthritis,
chronic, ● Cellulitis: swelling, (brain) fasciitis tumors) ● Erythema
malnutrition erythema (inflammation of ● Urethritis: dysuria, nodosum =
● UPEC: dysuria, ● Mechanically connective urinary frequency inflammation of fat
urinary frequency, ventilated: ● Diabetes & tissues), myositis, and urgency, cells because
flank pain (kidney) inflammation of Alcohol skin abscess pyuria (pus in delayed
trachea, bronchi, independence: ● Pneumonia: fever urine) hypersensitivity
pneumonia, lung lobar pneumonia chills ● Cystitis:suprapubi rxn to bacterial
abscess, pleural (lung abscess) ● Skin abscesses: c pain, UTI antigens reach fat
empyema (pus in high fever, chills, redness, heat, symptoms cells
pleural cavity) chest pain, red swelling ● Prostatitis: cystitis ● Enterocolitis:
● Burns or Surgical currant jelly ● Fasciitis: fever, symptoms, fever, fever, diarrhea
Wounds:cellulitis, sputum swelling, prostate swollen with blood and
fasciitis (productive cough excessive pain ● Pyelonephritis: mucus, ab pain
(inflammation of with blood-tinged ● Myositis: muscle UTI symptoms, ● Pseudoappendiciti
connective tissues), sputum) weakness flank pain s: fever, ab pain,
myositis, skin ● Cirrhosis & tenderness in right
abscess Ascites: peritoneal lower quadrant of
● Pneumonia: fever fluid cause ● Neurological ab
chills spontaneous Instrumentation ● Septicemia: fever,
● Skin abscesses: bacterial like chills,
redness, heat, peritonitis ventriculoperiton hypotension,
swelling ● Spontaneous eal shunt (divert tachycardia
● Fasciitis: fever, bacterial CSF away from ● Post-infectious
swelling excessive peritonitis: fever brain ventricles to sequelae
 pain chills extreme peritoneum to ● Reactive arthritis:
● Myositis: muscle abdominal pain lower intracranial joint pain, swelling
weakness pressure): ● Erythema
meningitis or nodosum: red or
cerebral purple painful
● Use of Intravenous abscesses lesions on legs
Drugs: Endocarditis ● Eye infection:
● Intestinal conjunctivitis;
perforation or keratitis (cornea)
surgery: peritonitis ● Meningitis and
● Tracheobronchitis: cerebral
wheezing abscesses: fever,
● Peritonitis: headache,
abdominal pain vomiting
● Conjunctivitis: eye
redness, pain,
burning eye
● Keratitis: eye
redness,
photophobia (eye
pain due to light
exposure)

Treatmen ● Diarrhea: ● Carbapenems, ● Beta-lactamase ● RESISTANT to ● TMP/SMX, ● 3rd gen ● Aminoglycosides

t rehydration and aminoglycosides, Production ampicillin, quinolones, cephalosporins, (gentamicin,
antibiotics fluoroquinolones, (cephalosporins, macrolides and fosfomycin TMP/SMX, streptomycin)
(doxycycline or polymyxins aminoglycosides, first gen ● Pyelonephritis: aminoglycosides, ● Doxycycline,
cotrimoxazole) fluoroquinolones, cephalosporins fluoroquinolones, fluoroquinolones tetracycline,
● HUS: dialysis, carbapenems) ● Aminoglycosides cephalosporins, and tetracyclines fluoroquinolones,
corticosteroids, ● ESBL production ● antipseudomonal gentamicin chloramphenicol
blood transfusions, (carbapenems) beta-lactams ● Surgery: struvite ● 10-14 days
plasmapheresis ● Carbapenemases ● Fluoroquinolone stones treatment
(exchange of blood production ● Carbapenems
plasma) (colistin ● Abscesses
● UTIs: ,tigecycline, drained
cotrimoxazole, fosfomycin)
nitrofurantoin or
fluoroquinolones
(ciproflaxin)