Pseudomonas

Wewedru I ,MSc (ID)

Introduction
• Family affiliation - Pseudomonadaceae,

• Pseudomonas has a large number of species,

• Pseudomonas aeruginosa is the most important species and causes most of the
infections,

• Most Pseudomonas species are seen as colonizers and contaminants,

• Other Pseudomonas species cause opportunistic infection s.

Introduction…
• Common diseases caused include: bacteremia, arthritis, abscesses,
conjunctivitis, and UTIs.
Pseudomonas aeruginosa
• P.aeruginosa is an aerobic, motile rod, more pale staining than
members of family enterobacteriaceae
• Pigment producer and,
• Resistant to many antimicrobials
Cultural characteristics
• Grows aerobically with minimal requirements
• Requires nitrogen and carbon from ammonia and carbon dioxide
sources
• Wide growth temperature range: 200 - 400 C.
• Some strains use nitrate as a terminal electron acceptor to enable
anaerobic growth
• Uses oxidative energy producing mechanisms and with high level of
cytochrome oxidase ( Ox +ve)
Cultural characteristics…
• Luxuriant growths on common isolation media
• Confluent growth shows characteristics metallic sheen and emits an
intense ‘fruity; odour
• Haemolytic on BA
• Pyocyanin (blue) pigment is only produced by Ps. Aeruginosa
• Oxidase positivity plus production of blue, yellow and rust-coloured
pigments differentiate this bacterium from other Gram negative rods
from the family of enterobacteriaceae.
• Pyocyanin and flurorescein produced diffuse into medium to give bright
green colour.
Structure
• LPS present in the outer membrane protein , as are porin proteins,
making it less permeable to a wide range of molecules, including
antibiotics.
• Possesses pili made of pilin structural protein
• Possesses polar flagellum
• Secretes alginate to form a mucoid exopolysaccharides slime outside
the cell wall
• All Ps.euroginosa strains produce moderate amount of alginate
• Some strains over produce alginate making the colonies too mucoid.
Extracellular products
• Most strains of Ps.euroginosa produce multiple extracellular
enzymes/products ( exotoxin A, enzymes with haemolytic lecitninase,
collagenase or elastase activity)
• Exotoxin A action is the same as diphtheria toxin
• Exoenzyme S, ( ADP-ribosylated) functions as surface - bound
adhesion
• Elastase acts on a variety of biologically Important substrates, e.g.
elastin , human IgA and IgG, complement components and some
collagens.
Diseases caused
• Produces infections at a wide range of pulmonary, urinary and tissue
sites just other members of enterobacteriaceae
• Clinical manifestations of the infections reflect organ system involved
• Diseases caused are often virulent and not easy to treat
• Diseases are common in patients with some debilitation or immuno-
suppression
Epidemiology
• Primary inhabitant is environment ( e.g. water, soil, vegetation)
• Colonizes humans;
o Isolated from throat and stool of 2 – 10 % of healthy persons
o Colonization rate is higher in hospitalized patients with underlying disease
conditions such as leukaemia, cystic fibrosis (CF), and extensive burns
• Multiplies in humidifiers of respirators, solutions, medications and
some disinfectants.
• Risk of infections for immunocompromised person is high.
• Respiratory colonization of CF patients become chronic
Pathogenesis
• Ps.aeruginosa is an opportunistic pathogen
• Needs a break in first line – defense ( wounds or route past them
( contaminated solution or intratracheal tube) to initiate infections
• Attachment to epithelial cells is mediated by pili, flagella and
extracellular polysaccharide slime.
• Receptors include sialic acid , N-acetyl-glucosamine , borne by cell
surface glycolipids
• Loss of surface fibronectin favours attachment
Pathogenesis…
• Virulence involves extracellular enzymes (exotoxin A, exotoxin S and
elastase) injected into host cells by ‘contact selection system’
• Exotoxin A is cytotoxic and immunogenic
• Exotoxin Sis associated with dissemination from burn wounds and
with active destructive to cells , including cytoskeleton
• Elastase acts on elastin found at infection site such as lungs and
blood vessels ( haemorrhaegic distruction of blood vessels)
Ps.aeruginosa & Cysric fibrosis
• Ps.aeruginosa persists in CF patients
• Increased receptors provided for the Ps.aeruginosa
• Defects in epithelial cells of CF patients may also retard their
clearance by desquafation
• In colonized bronchi the organisms remain and form biofilm
containing microcolonies of the bacteria ( collectively called a
glycocalyx)
• Glycocalyx biofilm protects the bacteria
Virulence regulation Immunity
• Multiple virulence factors are • Humaoral and cellular immune
regulated by cell – to -cell responses both important.
signaling.
Clinical manifestations
• Infects burns and environmentally contaminated wounds
• Ps.aeruginosa pneumonia is aggressive in immunocompromised and
chronic in CF.
• Associated with alveolar necrosis, vascular invasive infarcts, and
bacteremia
• Common cause of otitis externa
• Contamination of contact lens which leads to keratitis
• Bcateremia may cause ‘ecthyma-gangrenosum’ (direct invasion and
destruction of blood vessel walls)
Diagnosis
• Specimens: pus, spt, bl, urine, etc
• Aerobic organisms, however possible growth in presence of nitrate
• Growth at 420 C, distinguishes it from other species
• Pigment production (Pyocyanin and Fluorescein)
• Oxidase positivity
• Fruity odour
Antibiotics/Treatment
• Multidrug resistance is by restricting permeability (due to porin)
• Regularly resistant to P, PN,Cephalothin, TE, S3, S, KA
• Active against newer aminoglycosides; AK, CN, Tobramycin, ( despite
mutational and plasmid-mediated resistance), third generation
cephalosporins ( CAZ, Cefipime, Cefokerazone), carbapenems ( IMI
and MER) and monbactams ( aztreonam) and fluoroquinolones ( CIP)
• Effective oral agents are scarce.