Gram Negative Bacilli

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1. diverse in the environmental niches they gram negative bacilli

occupy (intestines, respiratory tract, soil,
water, zoonotics); all contain endotoxin!!
(important virulence factor which causes all
kinds of problems if too much in blood)

2. gram - rods; facultative anaerobes, but of- enterobacteriaceae (enteric

ten grown in aerobic environments; dis- bacteria or coliforms)
eases include bacteremia, UTIs, and gas-
troenteritis; ubiquitous in soil, water, vege-
tation, and are part of the bacterial flora of
animals and man; used as indices for fecal
contamination of drinking water

3. what are the virulence factors of enterobac- endotoxin (cytotoxic and in-
teriaceae? flammation - lipid A)
capsule
fimbriae
antigenic phase variations
exotoxins

4. motile, gram - rod; bile tolerant, lactose fer- E. Coli

menter; has O, H, and K antigens; part of
normal flora of GI tract; trasmitted via con-
tact or ingestion

5. types of diseases caused by E. coli UTIs

septicemia (bloodstream)
neonatal meningitis (brain lin-
ing)
gastroenteritis
different types of diarrhea
(enterotoxigenic, enterohem-
orrhagic, enteropathogenic,
enteroinvasive)

6. travelers diarrhea and infantile diarrhea; #1 enterotoxigenic E. coli

cause of infant death in developing coun- (ETEC)
tries; source is contaminated food and wa-

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ter; produces one or two enterotoxins (heat
labile toxin, LT, or heat-stable toxin, ST);
causes watery diarrhea, cramps, and nau-
sea for several days

7. first recognized in McDonalds outbreak; enterohemorrhagic E. coli

major epidemic at Jack in the Box; un- (EHEC)
dercooked ground beef is the source for
serotype O157:H7; MOST COMMON FORM
of e. coli diarrhea in the US; character-
ized by abdominal cramps and copious,
bloody diarrhea; hemolytic uremic syn-
drome (HUS) also caused by this verotoxin

8. what are the key virulence factors of EHEC? ability to adhere in intestinal
mucosa of colon
destruction of epithelial cells
in colon

9. maor cause of pediatric diarrhea; often as- enteropathogenic E. coli

sociated w/ combination of formula as re- (EPEC)
sult of poor hygiene; virulence factors in-
clude adherence to small instance and de-
struction of microvilli; causes watery diar-
rhea, fever, and vomiting

10. key virulence factor is ability to invade enteroinvasive E. coli (EIEC)

the epithelial cells lining the colon w/ de-
struction of mucosal epithelium cells lin-
ing colon; diarrhea caused by this strain
is indistinguishable from dysentery caused
by Shigella; blood, mucus, and WBCs are
present in scant stools and fever

11. most common cause of UTIs; virulence fac- E. coli

tors include pili and capsule

12. major pathogens causing meningitis in in- Group B strep and E. coli
fants

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13. gram - rod; bile tolerant, lactose fermenter; Klebsiella pneumoniae
part of normal flora of respiratory and GI
tracts of small % of healthy individuals; op-
portunistic pathogen associated w/ infec-
tion in compromised patients, usually hos-
pitalized

14. diseases caused by klebsiella pneumoniae lobar pneumonia (necro-

sis/hemorrhage of lung tis-
sue)
UTIs (catheters increase
chance)

15. motile (H antigen) w/ small capsule; main enterobacter

pathogens are E. cloacae and E. aerogenes;
cause nosocomial infections (pneumonia,
bacteremia) in hospitalized patients who
have received multiple antibiotics; antibi-
otic-resistance isolates often from consti-
tutive overproduction of AmpC beta-lacta-
mase

16. major opportunistic pathogen; produces Serratia marcescens

pink-red pigment; causes nosocomial in-
fections (pneumonia, bacteremia) in hospi-
talized patients who have received multiple
antibiotics; usually resistant to many antibi-
otics

17. gram - rods; urease positive; grows well at Proteus

alkaline pH; some O antigens are aggluti-
nated by sera from patients with rickettsial
diseases; major pathogens are P. mirabilis
and P. vulgaris

18. 2 major Proteus pathogens P. mirabilis = UTIs

P. vulgaris = nosocomi-
al infections (pneumonia,
baceteremia)

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19. gram - rods; non-motile; lactose non-fer- Shigella species
menter; 3 medically important species in-
clude dysenteriae, sonnei, and flexneri; hu-
man reservoir, hardy in nature, can survive
long time on bare floor; ingested orally;
acid-stable unlike Salmonella; attach to and
invade cells and replicate; spread cell to
cell; DO NOT spread through blood stream;
endotoxin causes inflammation; produces
Shiga toxin similar to EHEC but more potent

20. virulence factors of shigella -invasion/multiplication/inflam-

mation of epithelial cells of
colon
-neurotoxin causes serve
form of dysentery

21. disease caused by shigella; characterized shigellosis (bacillary dysen-

by abdominal pain, fever, and severe di- tery)
arrhea with mucous and blood; # of BM
may rapidly increase to 20 or more a day;
Hemolytic-Uremic Syndrome possible like
with EHEC; special precautions should be
taken with children/elderly since dehydra-
tion is more likely to occur

22. gram - rods; 5 major human pathogens, 2 of salmonella species

which are medically important (S. typhi and
S. enteritidis); worldwide problem; some
very host-specific; others can infect many
different animals; ingested orally and must
survive gastric acid; little known about vir-
ulence factors

23. humans are only reservoir; contaminated Salmonella typhi

food/water for most infections in adults;
food preparer has to wash hands thorough-
ly; fecal-oral transmission common in kids;
asymptomatic carriers are serious threat;

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can carry and shed to other people for
months and months

24. what are other sources of infections for undercooked poultry/beef

species of salmonella other than S. typhi? eggs
pet reptiles

25. what is the most common disease seen enteritis (enteric fever/diar-
with salmonella? it invades the cells of the rhea)
GI tract and increases cAMP, which caus-
es loss of water form cels giving rise to
watery diarrhea, fever, and cramps; sponta-
neous resolution in days to a week; DO NOT
TREAT WITH ANTIBIOTICS!

26. disease caused by S. typhi; pass all the typhoid fever

way through cells into bloodstream; picked
up by macrophages to liver, spleen, bone
marrow, ulceration, perforation, endotoxin
shock; high fever, diarrhea, cramps lasts
weeks; antiobiotic resistance increasing
and is linked to antibiotic use in livestock
feed

27. 3 diseases caused by salmonella enteritis

typhoid fever
septicemia

28. mainly cause pneumonia, UTI, and sur- non-enteric non-fermenters

gical site infections; primary pathogens
are Pseudomonas aeruginosa, Acinetobac-
ter baumannii, and Stenotrophomonas mal-
tophilia

29. gram - bacillus; strict aerobe; long and thin Pseudomonas aeruginosa
rods; pigmented growth on agar and dis-
tinct odor (green or red and smells like
grapes or juicy fruit gum); ubiquitous in en-
vironment, esp. in water; hardy, can survive
in extreme conditions; rarely part of normal
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flora; highly resistant to agents that typi-
cally kill other pathogenic microbes; major
cause of nosocomial infections in pt's with
compromised defense mechanisms, chron-
ic pulmonary disease, or immunocompro-
mised pt's

30. transmission of Pseudomonas aeruginosa swimming pools, hot tubs,

contact lens solution, cos-
metics, disinfectants, saline,
or moist areas; dissemination
from colonized body site to a
sterile body site

31. virulence factors of Pseudomonas aerugi- attached by fimbriae

nosa capsule is anti-phagocytic
endotoxin (inflammation)
exotoxin A
many other toxins/enzymes

32. causes opportunistic infections; require Pseudomonas aeruginosa

weak defense systems; colonize hospital-
ized pt's (respirators, IV solutions, cut flow-
ers, instruments); cystic fibrosis pt's have
difficult time fighting this pathogen; burn
victims at risk to rapidly lethal infections

33. diseases caused by Pseudomonas aerugi- -pulmonary infections (benign

nosa bronchitis to necrotic fatal
pneumonia)
-skin infections (most com-
mon in burn victims)
-folliculitis
-out ear infections (swimmers
ear)
-eye infections
-endocarditis (IV drug
abusers)
-UTIs

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34. various species of this genus are wide- acinetobacter
spread in nature and in hospitals; these
bacteria survive on moist areas, but also
on dry surfaces; they are commensals of
the respiratory tract in a low % of healthy
humans; despite low incidence, mortality is
high!

35. this genus was formerly classified as Stenotrophomonas maltophil-

Pseudomonas (and as Xanthomonas); this ia
species is widely distributed in nature and
a significant pathogen in certain types of
pt's; causes broad array of nosocomial in-
fections; resistant to many commonly used
antimicrobials

36. the 5 species of this genus were former- Burkholderia cepacia

ly classified as Pseudomonas; the mem-
bers share many of the characteristics
of Pseudomonas, such as colonization of
moist areas and propensity to cause oppor-
tunistic infections in hospitalized pt's

37. gram - rod; intracellular pathogen; zoonot- Yersinia pestis

ic infection; world-wide problem, India has
latest scare; associated w/ contact w/ squir-
rels and other urban animals; Bubonic
Plague/ Black Death caused by this!!!

38. caused by Yersinia pestis; can be caused Bubonic Plague (lymphatic

by a flea bite, bacilli then travel to lymph system)
nodes; infection results in swelling and
pain (bubo); also see high fever, chills,
headache, and nausea

39. caused by Yersinia pestis; spread via respi- Primary Pneumonic Plague
ratory droplets and does not have to involve (respiratory system)
fleas or animals; 1 bacilli can cause disease
in pt; more virulent and rare than bubonic
plague; causes severe hemorrhaging, death
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in hours; 100% mortality if untreated, or late
treatment

40. caused by Yersinia pestis; can penetrate Septicemic Plague

and invade bloodstream; all organic infect-
ed, if lungs, called secondary pneumonic
plague; so it is usually bubonic, then pneu-
monic; danger to close contacts; 50-75%
mortality when it goes to bloodstream; en-
dotoxin shock is primary problem - in-
travascular coagulation, multi-organ failure,
"bruising" on skin

41. this pathogen is usually acquired by the in- Yersinia enterocolitica

gestion of comtainated food; in most cases,
causes enterocolitis only; most common
complication of enterocolitis is the develop-
ment of severe arthritis

42. this genus includes the jejuni, coli, and Campylobacter

fetus species; gram - curved rods; mi-
croaerophilic; "seagull wing" shaped; oxi-
dase and catalase positive; motile; 80% of
poultry for human consumption is contam-
inated w/ this; found in human and animal
feces; animals serve as important reser-
voirs for these bacteria and transmission is
through zoonosis by ingestion of contami-
nated foods; poultry contributes to majority
of infections in US

43. first identified as a human diarrheal Campylobacter jejuni

pathogen in 1973; one of the leading caus-
es of bacterial diarrhea in US; during peak
of the enteritis, the pt may experience 10+
BM/daily; symptoms include blood diar-
rhea, abdominal cramps, and fever; usual-
ly occurs 2-5 days after ingestion of con-
taminated food/water; self-limiting and are

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not treated w/ antibiotics; infective dose is
small

44. complications of primary disease associat- meningitis

ed with Campylobacter jejuni
UTIs
septicemia
reactive arthritis (rare and
short-term)
Guillain-Barre Syndrome
(leading cause of acute paral-
ysis; develops 2-4 wks after
Campylobacter infection)

45. cholerae, vulnificus, and parahaemolyti- Vibrio

cus are most significant human pathogen
species; gram - curved (comma shaped)
aerobic rods; halophiles (grow in salt);
motile, and grow in alkaline environment,
killed in acidic environmen

46. serotypes 01 and 0139 are responsible for Vibrio cholerae

pandemics; habitat is human colon; trans-
mitted via consumption fecally contaminat-
ed water and/or ingestion of fecally contam-
inated shell fish that have not be adequately
cooked; causes Cholera

47. the toxin is not part of the bacterium but Cholera Toxin
actually that of a virus that got integrated
into the genome of the bacterium; normally
virus remains silent but during infection it
gets activated; vigorous viral multiplication
results in production of large amounts of
toxin causing severe diarrhea

48. caused by Vibrio cholerae; incubation peri- Cholera

od = 2-3 days; high infectious dose; abrupt
onset of vomiting and life threatening wa-
tery diarrhea; as more fluid is lost, fe-
ces-streaked stool changes to rice-water
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stools; severe diarrhea w/o inflammation of
GI tract or fever; if untreated, more than 50%
die as result of dehydration and electrolyte
imbalance

49. marine bacteria found in sea water of the At- Vibrio vulnificus
lantic, Pacific, and Gulf coasts; transmitted
to humans by consumption of raw or inad-
equately cooked shellfish or through skin
lesions or wounds while handling shellfish

50. diseases caused by Vibrio vulnificus -diarrhea

-wound infections (progress
rapidly w/ redness, swelling,
and formation of necrotic tis-
sue)
-septicemia

51. high risk conditions predisposing to Vibrio liver disease (alcohol intake,
vulnificus infection: viral hepatitis)
hemochromatosis
diabetes
GI disorders (gastric surgery,
achlorhydia)
malignancies
immune disorders (HIV)
long-term steroid use

52. gram - bacillus resembling members of En- Aeromonas

terobacteriaceae; motel species have sin-
gle polar flagellum; ubiquitous in fresh and
brackish water; acquired by ingestion of or
exposure to contaminated water/food; most
significant human pathogens = hydrophila,
caviae, veronii, and sobria

53. virulence factors of Aeromonas endotoxin

hemolysins
eneterotoxin
proteases
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siderophores
adhesins

54. diseases caused by Aeromonas GI disease - chronic diarrhea

in adults
severe disease in kids
resembles shigellosis w/
blood/leukocytes in stool
wound infections
systemic diseaes in immuno-
compromised pt's

55. gram - bacillus; part of normal flora of Eikenella corrodens

mouth in humans; often isolated from in-
fected wounds from human bites; most bite
wounds are mixtures of organisms

56. best studied species is L. pneumophila; ac- Legionella

counts for 85% of infections; motile, gram -
rod; complex nutritional requirements; ~50
species in genus; outbreak of pneumonia @
American Legion conference in Philly

57. ubiquitous in soil and freshwater; incidence Legionella pneumophila

increased dramatically w/ installation of
central AC in large builders b/c of cool-
ing towers/aerosols inhaled; contaminates
inhalation therapy devices, dust, liquid
aerosols from construction sites, whirlpool
spas, colonization of hot water tanks; trans-
mitted via inhalation of pathogen contam-
inated aerosol (penetrates alveolar region
of lungs; size of the bacterium allows its
entrance to resp. tract)

58. virulence factors of Legionella pneumophi- ability to survive in alveolar

la macrophages
blocks fusion of phagosomes
and lysosomes

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59. 2 diseases caused by Legionella pneu- Pontiac Fever
mophila Legionnaire's Disease

60. caused by Legionella pneumophila; Pontiac Fever

self-limited febrile illness in healthy individ-
uals; flu-like symptoms resolve w/in 5 days

61. caused by Legionella pneumophila; de- Legionnaires' Disease

velops 2-10 days after exposure; prima-
ry manifestation of disease is pneumonia;
pathogen often disseminates to multiple
sites (kidney, liver, CNS, GI tract); individ-
uals at greatest risk are elderly, immuno-
compromised, and those w/ pulmonary
diseases; early symptoms include lethar-
gy, headaches, high fever, chills, muscle
aches, anorexia; dry hacking cough devel-
ops; some have SOB and chest pain; can
also affect other areas of body w/ diarrhea,
nausea, and vomiting

62. small, intracellular aerobic gram - rods; Brucella

zoonotic; of 6 species of this genus, 4
may cause brucellosis in humans (abortus,
suis, melitensis, canis); worldwide preva-
lence and can cause serious problems in
herds; routes of transmission to humans
are varied (unpasteurized milk, slaughter-
houses, vets, livestock handlers) - contact
w/ infected tissue, blood, urine, or inhala-
tion

63. caused by Brucella genus; US cases mostly Brucellosis

in Cali, FL, TX, and VA; many cases associat-
ed with consumption of foreign cheese; has
many names! Malta Fever, Undulant Fever,
Mediterranean Fever, Rock Fever of Gibral-
tar, Gastric Fever; CAN BE USED AS BIO-
LOGICAL WEAPON!

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64. curved, gram - bacilli; motile (rapid Helicobacter pylori
corkscrew movement); urease, catalase,
and oxidase positive; up to 50% of humans
>60 yo harbor this bacteria; tends to col-
onize in stomach w/ increasing frequency
with age; once colonized, may persist to life;
often asymptomatic, but associated with
gastritis, gastric and duodenal ulcers, and
gastric carcinoma

65. gram - coccobacilli; non motile, oxidase Moraxella catarrhalis

postive, fermenters; commensals of the up-
per respiratory tract; causes sinusitis, otitis
media, and respiratory tract infections; for-
merly called Branhamella catarrhalis; typi-
cally this pathogen is B-lactamase positive

66. discovered 1892 during influenza pandem- Haemophilus influenzae

ic; originally thought to case common
cold; 1st living organism to have its en-
tire genome sequenced; thanks to vaccina-
tions, prevalence is down dramatically in
US; disease is common in other parts of
world though; name means "loves heme"
b/c of its nutritional requirements (hemin in
blood); no flagellum/motility; small gram -
coccobaccilli; in resp. tract of humans; has
encapsulated strains and non-encapsulat-
ed strains

67. virulence factors of Haemophilus influen- fimbriae

zae adhesins
polysaccharide capsule
(blocks opsonization by com-
plement and is antiphagocyt-
ic)
IgA protease (degrades se-
cretory IgA1)
lipopolysaccharide

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serotype B can survive within
macrophages

68. what is the pathogenesis of Haemophilus respiratory droplets; enters

influenzae? upper resp. tract and throat
and attaches to cells using
fimbriae; endotoxin stops res-
piratory tract cilia from clear-
ing; local spread and sys-
temic spread; endotoxin and
inflammation do the damage

69. diseases caused by Haemophilus influen- bronchitis, otitis media, si-

zae nusitis, epiglottitis, meningitis

70. prevention of Haemophilus influenzae; Hib Conjugate Vaccine

polysaccharide capsule is a T-idependent
antigen, during the prep of this vaccine, the
antigen is conjugated with the protein; Hib
conjugate vaccine is a T-dependent antigen
which stimulates IgM and IgC production;
3 conjugate vaccines licensed for use in
infants as young as 6 wks of age; all utilize
different carrier proteins; 2 combo vaccines
available that contain Hib vaccine; all con-
jugate Hib vaccines interchangeable for pri-
mary series and booster dose

71. this pathogen is the causative agent for Haemophilus ducreyi

a STD known as chancroid (soft chancre);
more common in Asia/Africa; males most
often present with painful, genital ulcers

72. small gram - pleomorphic coccobacilli; Pasteurella

zoonotic; resistance associated with de-
gree of encapsulation; P. multocida is most
common human pathogen; domestic pets
serve as major reservoir; commensals in
upper resp. tract of dogs, cats, etc.; human

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infection often related to animal bites or
scratches or shared food

73. diseases caused by Pasteurella multocida localized cellulitis and lym-

phadenitis (animal bite)
worsening of chronic pul-
monary disease
systemic infection
endocarditis
meningitis
peritonitis
endophthalmitis

74. aerobic encapsulated gram - coccobacil- Bordetella

li; medically important species include B.
pertussis, B. parapertussis, and B. bron-
choseptica; inhabits human resp tract;
highly communicable through resp droplets
of infected person

75. virulence factors include pertussis toxin Bordetella pertussis

(S2 and S1 subunit), dermonecrotic tox-
in, tracheal cytotoxin, lipopolysaccharide of
cell wall; pathogenesis is resp droplet expo-
sure, enters resp tract and attaches to cili-
ated epithelial cells; endotoxin inhibits cil-
ia clearance; replication on outside of resp
cells occurs, and cells die and release toxin

76. disease that bordetella pertussis causes; Whooping cough

humans are only reservoir; occurs primarily
in non-immune children; adults with waning
immunity sometimes get it; misdiagnosed
as cold or flu; has 3 stages including ca-
tarrhal stage, paroxysmal stage, and conva-
lescent stage

77. 1st stage of whooping cough; nonspecif- whooping cough - catarrhal

ic cold or flu-like symptoms, progressive stage
cough and low-grade fever; inflammation
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increases; MOST contagious stage since
many bacteria still alive and lots of cough-
ing/sneezing to spread it; duration is 1-2
weeks

78. 2nd stage of whooping cough; explosive whooping cough - paroxys-

cough episodes, followed by a "whoop"; mal stage
40-50 spells a day; coughing causes stom-
ach upset/vomiting; efforts to expectorate
secretions are impaired b/c the ciliated cells
have been destroyed; duration is 2-3 weeks

79. 3rd stage of whooping cough; gradual de- whooping cough - convales-
cline in cough; least infective stage; re- cent stage
quires 4-8 weeks for ciliated epithelial cells
to regenerate; life-long immunity; however,
there is far better method of immunity

80. several types of vaccines for treat- Whole cell vaccine (side ef-
ing whooping cough/Bordetella pertussis; fects in infants/children)
however, only effective in 85% of children; DTP (diphtheria tetanus per-
so still need to give antibiotics to contacts tussis)
DTPH (combo DTP + Hib)
DTaP (cellular pertussis that
uses DTP)

81. genus consists of multiple species, but Neisseriae

only 2 are pathogenic to humans; gram
- diplococci (kidney bean shaped); uti-
lize carbs oxidatively for energy (non-fer-
menters); specimens must be inoculated
onto culture media quickly after collection

82. habitat is genital tract; sexually transmit- Neisseria gonorrhoeae

ted from an asymptomatic carrier; neonates
can also contract it during birth; virulence
factors include pili, rapid antigenic varia-
tion, enzymes (IgA1 protease), acquisition
of 2 types of antibiotic resistance in the last
2 decades
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83. most common sites of osculation of Neis- cervix or vagina (cervicitis) of

seria gonorrhoeae female
urethra (urethritis) or penis of
male
oropharynx and anus

84. damage done by neisseria gonorrhoeae ciliated cells - done by endo-

toxin an fragments of murein
submucosal connectie tissue
- due to inflammatory re-
sponse

85. diseases associated with Neisseria gonor- acute infections in men (ure-
rhoeae thritis, pharyngitis, anorectal
infections)

acute infections in
women (cervictis, pharyngitis,
anorectal infections)

disease complications =
prostate infection, epididymi-
tis, pelvic inflammatory dis-
ease, acute salpingitis, sep-
tic arthritis, dermatitis en-
docarditis, meningitis, oph-
thalmia neonatorum

86. gram - diplococci; oxidase positive; Neisseria meningitidis

possesses a polysaccharide capsule -
serogroups of meningococci based on cap-
sule; pathogenic meningococci serotypes
include Types A, B, C, X, Y, and W-135; nor-
mal inhabitant of upper resp tract; humans
are only natural host for this pathogen;
transmitted via inhalation of resp droplets;
does not survive for long periods away from
resp tract; transmission most likely in indi-
viduals in confined areas
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87. virulence factors of Neisseria meningitidis ability to colonize the na-

sopharynx is mediated by pili
capsule
lipooligosaccharide (LOS)
endotoxin

88. disease caused by Neisseria meningitidis; meningococcemia (sep-

organism reaches bloodstream from na- ticemia)
sophyarnx; life-threatening disease; s/s =
fever, chills, malaise, prostration, petechial
rash on skin, disseminated intravascular
coagulation and circulatory collapse (Wa-
terhouse-Friderschsen Syndrome)

89. disease caused by Neisseria meningitidis; meningococcal meningitis

pathogen disseminates from bloodstream
to CNS; s/s = fever with severe headache,
stiffness of back and neck, nausea and
vomiting, coma, mortality is 100% if untreat-
ed but <15% with prompt antibiotic treat-
ment

90. commercially available product which Vaccine for Neisseria menin-

contains specific polysaccharides of gitidis
serogroups A, C, Y, and W135; serogroup B
is only weakly immunogenic and protection
oust be acquired naturally from exposure to
cross-reacting antigen

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