Helicobacter, Campylobacter,

and Vibrio

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Helicobacter pylori (H. pylori)
 Curved Gram-negative bacilli; motile; non-sporing; non-capsulated;
microaerophilic.
Classification
 There are many Helicobacter species, each adapted to a particular
animal or niche. H. pylori is the species associated with man.
Epidemiology
 H. pylori infects human gastric epithelial cells and humans are the
main reservoir. The microorganism is acquired most commonly in
early childhood and usually becomes chronic, often life-long.
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 Transmission is by the faecal-oral or oral–oral routes and is
associated with close contact (intrafamilial) and poor sanitation.
 Prevalence is higher in countries with poor sanitation, with 50% of
over 50 year olds infected.
Morphology and identification
 H. pylori grows slowly at 37 C on enriched media in a
microaerophilic atmosphere (characteristic of gastric mucus).
 They have four to six mono-polar sheathed flagella that facilitate
motility through gastric mucus.
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Electron-micrograph

of a single H. pylori (1)

showing flagella (2).

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Pathogenicity and associated infections
 Urease is an important colonisation factor, enabling the
microorganism to neutralise gastric acid through the production
of ammonia from urea.
 Most subjects remain asymptomatic, but H. pylori is the most
common cause of duodenal ulceration and gastric cancer.
 H. pylori damages antral D cells that release somatostatin,
thereby interrupting the negative feedback inhibition of gastric
acid from the gastric corpus. Gastric acid thus increases.
 H. pylori can cause cancer.

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Diagnosis
 Invasive tests: Gastric biopsy to identify typical
histopathological appearance; culture of H. pylori on selective
medium in a microaerobic atmosphere;
 Non-invasive tests: The urea breath test is highly sensitive and
specific. 13C- or 14C-labelled urea is given to the patient; if H.
pylori is present, the urease splits the urea, producing labelled
CO2, which is detected in expired air.
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Treatment
 Combination treatment is required due to poor antibiotic
penetration into the gastric mucosa, gastric acidity and
increasing antimicrobial resistance.
 Clearance in 80% of patients can be attained with a proton
pump inhibitor, e.g. omeprazole, that reduces gastric acidity,
coupled with two antimicrobials

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Campylobacter
 Spirally curved, Gram-negative bacilli; motile with single
polar flagella; There are several species, eg: Campylobacter
jejuni infect humans (cause acute enterocolitis).
Epidemiology
 Campylobacter spp. are a leading cause of acute infective
diarrhoea worldwide.
 In most industrialised countries, they are the most common
cause of acute bacterial enterocolitis. The infection is a
zoonosis with a wide range of reservoirs. Chickens are a
major source, either through handling the raw product or
eating undercooked meat.
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Vibrio

Gram negative; comma-shaped

bacteria; grow in alkaline

conditions; and motile.

There are many species of medical

importance eg: Vibrio cholerae.

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Vibrio cholerae
 V. cholerae strains are subdivided according to O-antigens. V.
cholerae O1 is the cause of cholera.
Epidemiology
 Found in water contaminated with human faeces; no animal
reservoirs;
 Important cause of severe infection in developing countries,
where potable water and sewage systems are poor;
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 Transmitted via consumption of contaminated food or water.
Morphology and identification
 V. cholerae is characterised by an ability to grow in alkaline
conditions (pH>8.0). Alkaline broth is used to grow the
microorganism selectively from faecal samples.
 Serology and biochemical tests can be used for confirmation
Pathogenicity
 V. cholerae produces an enterotoxin that acts on intestinal
epithelial cells, stimulating adenyl cyclase activity.

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 This results in water and sodium ions passing into the gut
lumen to produce profuse, watery diarrhoea (rice-water
appearance).
Prevention
 Avoidance of contaminated food; oral vaccines suitable for
travellers.
Treatment
 Rehydration; ciprofloxacin shortens duration of illness.
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 Spirochaetes
 These bacteria are thin helical and weakly Gram-
negative.
 Treponema, Borrelia and Leptospira are three genera
which cause human diseases
 Laboratory diagnoses are based primarily on serological
tests, as few spirochaetes can be cultured readily in vitro.

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 Bacterial Shapes, Arrangements, and Sizes

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Treponema
 Gram-negative spiral bacteria; motile; non-culturable in vitro.
 Treponema species that cause human disease are Treponema
pallidum and other. T. pallidum subspecies pallidum causes
syphilis.
Morphology and identification
The microorganism is a thin spirochaete, which cannot be grown in
vitro and grows only slowly in vivo.
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Associated infection and epidemiology
Syphilis

Syphilis is a sexually transmitted disease. The bacteria infects the

genital area, lips, mouth, or anus of both men and women.

After the initial infection, the syphilis bacteria can remain

inactive (dormant) for decades before becoming active again.

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 Syphilis consists of four stages: primary, secondary, latent, and
tertiary.
 The infected person is considered to be in the latent stage of
syphilis when the symptoms of the primary and secondary
syphilis have disappeared. In the latent stage of syphilis,
laboratory testing is the only way to confirm diagnosis, as there
are no cutaneous manifestations.

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 Early syphilis can be cured, sometimes with a single shot
(injection) of penicillin. Without treatment, syphilis can
severely damage heart, brain or other organs, and can be
life-threatening.
 Syphilis can also be passed from mothers to unborn children.
 syphilis is re-emerging as a global public health problem,
particularly among men who have sex with men (MSM) in
high-income and middle-income countries.
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Borrelia
Gram-negative, spiral bacteria;
motile; require specialised media for
culture; anaerobic or microaerophilic.
Borrelia species are associated with
two important
human infections: relapsing fever and
Lyme disease
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Leptospira
Gram-negative, coiled bacteria; aerobes that grow slowly in enriched
media
Associated infections
 Leptospirosis ranges from a mild flu-like illness, to the potentially
life-threatening disease, with jaundice and renal damage.
 Occurs worldwide, particularly following periods of high rainfall
and flooding;
 Human infections occur mainly through exposure to water
contaminated with infected urine;
 Microorganisms can enter through broken skin, mucous
membranes or conjunctiva;
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P. aeruginosa (environmental Gram-negative bacilli)
 Pseudomonas aeruginosa is an important microorganism in
healthcare-associated infection.

 It is a normal commensal in the human gastrointestinal tract, but

may colonise other sites when host defences are compromised,
including burns and leg ulcers.

 P. aeruginosa, as with other members of the genus, has the

ability to grow with minimal nutrients, e.g. in water and in the
presence of some disinfectants; these properties are the key to
its role as a hospital pathogen.
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 It can be distinguished from the Enterobacteriaceae by its
oxidative metabolism (oxidase-positive).
Pathogenicity
 P. aeruginosa is relatively non-pathogenic; it characteristically
causes infections in hospitalised patients, particularly those
who are immunocompromised.
 P. aeruginosa principally causes opportunist infections in
many organs.
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 One of the characteristics of P. aeruginosa is resistance to
antibiotics;
 In hospital units where antibiotics are used frequently (e.g.
special care baby units, ICUs), P. aeruginosa isolates may become
resistant to these antibiotics.
 Isolation of patients colonised by multi-resistant P. aeruginosa
strains is an important part of controlling hospital infections.

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Gram-negative anaerobic bacteria
 The Gram-negative anaerobic bacilli include the genera
Bacteroides, and others.
 Unlike the Gram-positive anaerobic clostridia, they do not
form spores.
 Gram-negative anaerobes form a major component of the
normal flora of humans.
 Gram-negative bacilli; non-motile; non-sporing; strict
anaerobes; grow on complex media.
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Bacteroides
 Species of Bacteroides and related genera make up the largest
component of the bacterial flora of the human intestine, and
are an important part of the normal flora of the mouth and
genito-urinary tract.
 They protect against colonisation and infection by more
pathogenic bacteria; they can also cause infections.
Associated infections
 intra-abdominal abscesses, abscesses and surgical wound
infection; brain abscesses.

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Prevention
 Postoperative, intra-abdominal infections can be prevented
by good surgical technique and prophylactic antibiotics.
Treatment
 Antibiotics

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 Chlamydiaceae, Rickettsia, and
Mycoplasma

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Chlamydiaceae
 Chlamydiaceae are obligate intracellular bacteria.
 Chlamydia contains a human pathogen Chlamydia
trachomatis.
 C. trachomatis is the most common cause of sexually
transmitted infection in the developed world.
 The majority of C. trachomatis infections are genital and
sexually acquired.
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 Trachoma is the leading cause of preventable blindness in the
world (Trachoma)
Pathogenesis
C. trachomatis gains access via disrupted mucous Membranes.
Laboratory diagnosis
 Chlamydiaceae do not grow on bacterial culture media.
 Cell culture: swabs from the affected site, collected in a special
transport medium, are inoculated into tissue culture.
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Rickettsia
Rickettsiaceae cause a number of important human infections,
including typhus.
They are small, Gram-negative bacilli ; obligate intracellular
pathogens; grow only in tissue culture.
Epidemiology
Rickettsial infections are zoonoses with a variety of animal
reservoirs and insect vectors.
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Common
symptoms
include
fever,
headache,
and a rash.

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Mycoplasma
 Small Gram-negative microorganisms; pleomorphic with no
cell wall; grow slowly on enriched media.
 Only a few species have been identified as human pathogens,
including: Mycoplasma pneumoniae, and M. genitalium
Epidemiology
M. pneumoniae infection is common worldwide and is an
important cause of acute lower respiratory tract infections.

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Associated infections
 community-acquired pneumonia (M. pneumoniae) and other
type of other organs infections.
 Atypical pneumonia, also known as walking pneumonia (
atypical symptoms: No response to common antibiotics
Moderate amount of sputum, or no sputum at all (i.e. non-
productive). The patient looks better than the symptoms
suggest)
Laboratory diagnosis
 Culture (3 weeks!) and serology.
Treatment
 Antibiotics
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 Acid Fast Bacteria
 Acid-fast bacteria, also known as acid-fast bacilli or simply AFB,
is a group of bacteria sharing the characteristic of acid
fastness.
 Acid fastness is a physical property that gives a bacterium the
ability to resist decolorization by acids during staining
procedures.
 This means that once the bacterium is stained, it cannot be
decolorized using acids routinely used in the process.
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 This important and unique feature of certain bacteria
gives us the ability to classify and detect them using
relatively easy laboratory procedures such as
microscopy.
 Bacteria displaying acid fastness include:
o Genus Mycobacterium (M. leprae, M. Tuberculosis)
o Genus Nocardia

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 Tuberculosis (TB) is an ancient human disease caused by
Mycobacterium tuberculosis which mainly affects the lungs,
making pulmonary disease the most common presentation.
 However, TB is a multi-systemic disease.
 M. tuberculosis is a non-spore forming, non-motile, obligate-
aerobic, facultative, catalase negative, intracellular bacteria.
The organism is neither gram-positive nor gram-negative
because of very poor reaction with the Gram stain.
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 The organism has several unique features compared to other
bacteria such as the presence of several lipids in the cell wall
including mycolic acid, cord factor, and Wax-D.
 The high lipid content of the cell wall is thought to contribute
the following properties of M. tuberculosis infection:
I. Resistance to several antibiotics
II. Difficulty staining with Gram stain and several other stains
III. Ability to survive under extreme conditions such as
extreme acidity or alkalinity, low oxygen situation and
intracellular survival(within the macrophage)

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Leprosy
is also referred to as
Hansen disease. It is a
chronic granulomatous
infection generally
caused by
Mycobacterium leprae
and Mycobacterium
lepromatosis, both of
which primarily affects
the skin and peripheral
nerves.
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 Leprosy is of great concern in the medical community. This
disease is not highly contagious, contrary to belief, and
treatment is readily available for this ailment.
 Through awareness and early medical intervention,
significant reduction causing disability in the eyes, hands,
and feet is possible.
 Relapses tend to be rare, but any damage caused by
neuropathy is irreversible and may require lifelong care

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