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Enteric bacteria (**)


last lecture I have mentioned the importance of special type of media called mackonky agar to differentiate between lactose fermenter and lactose non fermenter which is useful to separate certain type of enteric bacteria which are often the causative agent of diarrhea such as salmonella , shigella, in addition to non lactose fermenter like proteus and some of the( 00:51) like serratia . Under the term of choliform we have all types of lactose fermenter whether rapid or slow lactose fermenter. Rapid: within 24 hrs slow: at least 48 hrs the first group of enteric bacteria, which is found commonly in our intestinal tract, is E. coli. The second group is klebsiella-enterobacter species which are very related species and we consider them as one group these gram negative bacteria associated with animal& human intestine tract ,as you can see, this group has mutual clinical manifestation with E.coli ending with sepsis, meningitis. Klebsiella pneumonia *can be transmitted by respiratory equipment used in hospital. *capsulated *cause severe pneumonia as nosocomial infection the third group is Proteus- Providencia *lactose non fermenter *found in intestinal tract of animal * might under certain condition associated with (3:18) etc. The fourth group called Pseudomonas *subdivided at least into 20 species *lives in nature, in association with water, and to some extent in intestinal tract but in less amount than choliform bacteria.


This group is represented by one of the most common hospital acquired disease called P.aeruginosa. Aeruginosa: production of a dye called pyocyanin which ranges from blue to green in addition to this colored wound the organism produce a special odor. * not a part of choliform bacteria *the family is pseudomonasea *can be found in intestine following the administration of antibiotics *we use aminoglycoside & fluroquinolones *pseudomonas manages to develop multi resistance, so considered as a selective pressure * highly pathogenic due to production of enzymes & toxins * survive in the environment more than choliform bacteria diagnosis of all above bacteria can be done by macConky agar, CLED, and blood agar. To know exactly the bacteria family we have to do full biochemical test, but this doesn't help in determination of bacteria species so we should do (8:15) test. in relation to figure , E.coli have fibriae & pili which contribute in the appearance non specific IgE antibody against sera lactose !!,while Klebsiella capsule are well demonstrated in capsule stain Salmonella *name comes from the scientist who discovered them * normally not found in human intestinal flora *gram negative * lactose fermenter *facultative anaerobes bacilli *we use either a) selective media called Hekton-Enteric agar which inhibits other bacteria b) S S agar : shigella salmonella agar salmonella appears colorless and produce H2S while the others appears orange salmonella cause 2 types of disease the first :salmonella-food poisoning or gastroenteritis *these bacteria once reach the intestine begin to release cytotoxin causing diarrhea and to less extent vomiting Staph.aureus infection starts with vomiting while in salmonella starts with diarrhea

classification is difficult ; we have more than 2000 serotypes each one associated with production of specific anti body which can be detected by o somatic antigen. the second : salmonella enterica(non typhodal salmonella) * the major serotype is enteritidis *originated from animal intestine and chickens * incubation period 8 -24 hrs (short) ,but it depends also on number of ingested bacteria *hamburger out break happened in JU area due to salmonella *infection associated with diarrhea , vomiting, abdominal pain *infection in healthy carrier is often self limited self limited : no need for antimicrobial drug because it delay the excretion of bacteria in such cases *in infants it might reach blood stream and cause septicemia-meningitis the same story applied on immune deficient patients *the flagella of salmonella contribute in adherence to large intestine mucosa so inflammation takes place typhodal salmonella * more dangerous * can infect all age groups typhoid fever is very serious disease , and was one of the important disease before 1960s due to 1) poor vaccine coverage 2) polluted water the general group called salmonella enterica which contains S.Typhi & S.para typhi A,B,C, so we have 4 serotypes typhodal fever arises from fecal oral contamination, and from vegetables & water with incubation period 1-3weeks,once reaches the intestine , it is carried by lymphatics to the liver and gall bladder in which it begins second replication ;it results in fever,coma,and death if reaches the blood stream .

Infection started with few number of bacteria in contrast with non typhodal fever in which the patient has ingested large number of bacteria


death associates with a)liver and spleen megaly ( hepatospenomegaly) b)damage in the bowel (intestinal proliferation) c)endotoxic shock *30% of infected individuals die *healthy carrier, who has the organism with no symptoms, transmits the organism via stool in community especially his/her family. *Salmonella typhi & para typhi infect human not animal *lab diagnosis is the same as salmonellosis in addition we can isolate the organism not only from stool but also urine, blood, CSF, bone marrow. If the test result is negative, we do specific antibody test!!! (25:40) by Widal test we determine exactly the level of antibody against O somatic antigen >160 while against H antigen double or more. We move to another group of enteric bacteria called shigella *the name originated from the scientist name * gram negative bacilli * not easily recognized as lactose non fermenter * we use selective media *in contrast to salmonella, shigella is susceptible to dryness, environmental condition; acidity of stool can kill shigella, so we should do tests as fast as possible. Shigella cause localized macro and micro intestinal abscess with bloody diarrhea, and abdominal pain. Transmition by vegetables, polluted water, waste water, and direct contact. Few number of shigella is enough to develop an infection shigella species; S.sonnei, S.boydii, S.dysenteriae. S.dysenteriae is the most dangerous because it produces neurotoxin which absorbed in bowel, and affect CNS giving a false impression of meningitis or encephalitis. shigella itself rarely reaches the blood stream in contrast with salmonellosis shigella must be treated with antimicrobial drug which reduces the severity of infection ,pain ,and dissemination among people.

There is a vaccine against typhodal fever & shigella but it is not used because (33:14) cholera *still causes morbidity & mortality in developing countries especially those in contact with rivers such as India and Bangladesh due to poor hygiene condition and not clean tap water *vibrio: curved rod *like any enteric bacteria cholera can contaminates water & vegetables complication: *severe watery diarrhea *hypotension due to loss of large amount of fluid *cardiac arrest, kidney failure ,shock ,death. life & death in cholera can be in few hrs ,so we have to supply the patient with water, and electrolytes intravenously . types: V. cholerae -0.1 in relation to (36:45) produce only one toxin known as cholera toxin similar to toxin produced by endogenous E.coli except it is more potent ,and more in quantity. Cholera cannot be found in single case while typhodal fever can V.cholrae El-Tor in relation to El-Tor mountain easier to spread due to emolysin enzyme few number is enough to produce clinical features selective TCBS agar which has alkaline pH 8-9 done by : Mohammad Ihmeidan