Documente Academic
Documente Profesional
Documente Cultură
&
USEP ABDULLAH HUSIN
DEPT. OF MICROBIOLOGY
MEDICAL FACULTY
PADJADJARAN UNIVERSITY
INTRODUCTON
Urinary tract infections (UTIs) : cause
of morbidity and health care in persons
of all ages
Sexually active young women are
affected, but several other populations,
including :
elderly persons and those undergoing
genitourinary instrumentation or
catheterization, are also at risk
SUNARYATI SUDIGDOADI
INTRODUCTON
An estimated 40 percent of
women report having had a
UTI at some point in their lives
UTIs are the leading cause of
Gram negative bacteremia
Microbes usually enter the
urinary system through the
urethra
SUNARYATI SUDIGDOADI
NORMAL MICROBIOTA
SUNARYATI SUDIGDOADI
DEFENSE MECHANISM OF THE
URINARY TRACT
1. Urine factor :
Urea concentration and high
osmolarity
Low pH of urine kill bacteria
2. Hydrokinetic factor :
Periodic urinary flow
Dilution of rest urine cause of urinary
flow from kidney
Bladder emptying
SUNARYATI SUDIGDOADI
3. Mucosal factor :
SUNARYATI SUDIGDOADI
CLINICAL MANIFESTATION
LOWER URINARY TRACT INFECTIONS
Acute cystitis : a superficial inflammation of the
bladder and urethra
Acute prostatitis occurs when bacteria invade
the prostate
SUNARYATI SUDIGDOADI
ETIOLOGY
Escherichia coli, which is responsible for 80 % of
infections that are acquired outside of hospitals
Other Gram-negative rods such as Klebsiella,
Enterobacter, and Proteus spp. are relatively
common, each accounting for
3 to 5 % of infections
Within the hospital environment, Pseudomonas
aeruginosa, Serratia marscesens, and other
Gram positive bacteria such as Enterococcus
faecalis, and Staphylococcus epidermidis are
more resistant, common hospital-acquired
pathogens
SUNARYATI SUDIGDOADI
ETIOLOGY
Gram-positive organisms, particularly
coagulase-negative staphylococci and
enterococci, cause some infections
Staphylococcus saprophyticus
causes about 10 % of UTI in young
women
Candida albicans is also a frequent
pathogen in hospitalized patients,
particularly if diabetes is present
SUNARYATI SUDIGDOADI
SUNARYATI SUDIGDOADI
ETIOLOGY
Anaerobes and fastidious organisms rarely
cause urinary infections
A number of viruses, particularly mumps
virus, cytomegalovirus, and coxsackieviruses,
can be present in the kidneys and urine,
but rare
A number of sexually transmitted pathogens
(e.g., Neisseria gonorrhoeae) may invade
the urethra. Chlamydia trachomatis and
herpes simplex can present with symptoms
that mimic acute cystitis in both men and
women
SUNARYATI SUDIGDOADI
PATHOGENESIS
SUNARYATI SUDIGDOADI
B. Host factors
The larger number of UTI's present in women than
in men is probably due to the much shorter urethra
and the much closer association of the urethra to
the anus
Sexual intercourse contributes to the increased
number of UTI's seen in women
Any anatomic obstruction, or neurological disorder
leading to the failure to completely eliminate the
urine can lead to UTI
Men in their 40's have problems with the prostate
gland enlarging resulting in obstruction of the
urethra followed by incomplete elimination of urine
from the bladder and UTI's
SUNARYATI SUDIGDOADI
C. Bacterial factors
The most important virulence factor of
bacteria is the enhanced ability to adhere to
uroepithelial cells. This attachment is mediated
by specific pilus adhesins on the surface of E
coli.
Pseudomonas infections are both invasive and
toxinogenic
S. aureus expresses many potential virulence
factors such as proteins, enzymes and toxins
SUNARYATI SUDIGDOADI
D. Spread to the kidney
SUNARYATI SUDIGDOADI
Escherichia coli
Member of the normal intestinal flora
Motile, possess polysaccharide capsule
Grow on nonselective media
Red colonies on Mac Conkey agar
An isolate from urine can be identified by
its hemolysis on blood agar
Temperature for growth : 15 – 450C
Some strains more resistant to heat
viable at 600 C, 15 minutes
550 C, 60 minutes
SUNARYATI SUDIGDOADI
E. coli - URINARY TRACT
INFECTION
The most common cause of UTI
Accounts approximately 80 % of
first UTI in young women
UTI can result in bacteremia with
clinical signs of sepsis
Nephropathogenic E. coli typically
produce hemolysin
SUNARYATI SUDIGDOADI
PATHOGENESIS
The organisms are propelled into the
bladder from the periurethral region
during sexual intercourse.
With the aid of specific adhesins they are
able to colonize the bladder.
The adhesin that has been most closely
associated with uropathogenic E. coli is
the P fimbria (or pyelonephritis-
associated pili [PAP] pili).
SUNARYATI SUDIGDOADI
Klebsiella pneumoniae
The most clinically important species This
bacterium produces large sticky colonies when
plated on nutrient media
Klebsiella's pathogenicity can be attributed to
its production of a heat-stable enterotoxin
K. pneumoniae urinary tract infections are
common in catheterized patients
In fact, K. pneumoniae is second only to E. coli
as a urinary tract pathogen.
SUNARYATI SUDIGDOADI
ENTEROBACTER
Previously : Aerobacter, similar
characteristics to Klebsiella,
differ in motility
The organisms has small capsule
E. aerogenes may be found free-
living as well as in the intestinal
tract
E. aerogenes & E. cloacae causes
UTI & sepsis
SUNARYATI SUDIGDOADI
PROTEUS
Infection in humans only when bacteria
leave the intestinal tract
Found in UTI, produce bacteremia,
focal lesions in debilitated patients or
receiving i.v infusions
P. vulgaris & M. morganii
important nosocomial pathogens
SUNARYATI SUDIGDOADI
PROTEUS
P. mirabilis UTI, occasionally
other infection
Produces a typical “swarming”
growth on blood agar
Is primarily an opportunist,
transmitted via catheters
Produces a powerfull urease that
hydrolyzes urea to ammonia and CO2
Results in stones and calculi, leading
to urinary tract obstruction
SUNARYATI SUDIGDOADI
SERRATIA
S. marscescens : is common
opportunistic pathogen in hospitalized
patient
Causes pneumonia, UTI, meningitis,
wound infections, bacteremia &
endocarditis especially in narcotics
addicts & hospitalized patients
Often multiply resistant to
aminoglycosides & penicillins
Infections can be treated with 3rd
generation cephalosporins
SUNARYATI SUDIGDOADI
CHARACTERISTICS
Gram negative rods
Motile with peritrichous
flagella, or nonmotile
Grow on peptone or meat
extract media without
addition NaCl or other
supplements
Grow well on Mac Conkey’s
agar, aerobically/
facultative anaerobes
Ferment rather than
oxidize glucose, often with
gas production
SUNARYATI SUDIGDOADI
CHARACTERISTICS
Facultative anaerobes or
aerobes
Ferment a wide range of
carbohydrates
Possess a complex antigenic
structure
Produce a variety toxins & other
virulence factors
SUNARYATI SUDIGDOADI
Pseudomonas aeruginosa
Opportunistic pathogen of humans.
The bacterium almost never infects
uncompromised tissues, yet there is hardly any
tissue that it cannot infect, if the tissue defenses
are compromised in some manner
Pseudomonas aeruginosa is a Gram-negative,
aerobic rod, belonging to the bacterial family
Pseudomonadaceae
SUNARYATI SUDIGDOADI
CHARACTERISTICS
P. aeruginosa isolates may produce three colony types.
SUNARYATI SUDIGDOADI
P. aeruginosa produces two types of soluble
pigments, pyocyanin and (fluorescent)
pyoverdin.
The latter is produced abundantly in media
of low-iron content, and could function in
iron metabolism in the bacterium.
Pyocyanin (from "pyocyaneus") refers to
"blue pus" which is a characteristic of
suppurative infections caused by
Pseudomonas aeruginosa.
SUNARYATI SUDIGDOADI
BACTERIAL PRODUCTS
COLICINS (BACTERIOCINS)
Bactericidal, produced by certain strains of bacteria,
active against some other strains of the same or
closely related species
Their production is controlled by plasmid
Colicins : produced by E. coli
Marcescins : produced by serratia
Pyocins : produced by pseudomonas
TOXINS & ENZYMES
Endotoxins : have a variety of pathophysiologic effects
Many bacteria also produce exotoxins of clinical
importance
SUNARYATI SUDIGDOADI
Staphylococcus
Staphylococci are Gram-positive spherical bacteria
that occur in microscopic clusters resembling grapes
Taxonomically, the genus Staphylococcus is in the
bacterial family Micrococcaceae
Staphylococci are facultative anaerobes
The bacteria are catalase-positive and oxidase-
negative, can grow at a temperature range of 15 to
450C and at NaCl concentrations as high
as 15 %
SUNARYATI SUDIGDOADI
Staphylococcus
S. aureus forms a fairly large yellow
colony on rich medium; often hemolytic
on blood agar
Nearly all strains produce the enzyme
coagulase
S. epidermidis has a relatively small white
colony, non hemolytic, nearly all strains
lack the coagulase enzyme
S. saprophyticus
Is non hemolytic if culture on blood agar,
coagulase-negative, novobiocin-
resistant.
Lacks protein A
SUNARYATI SUDIGDOADI
Enterococcus faecalis
The enterococci are facultative anaerobes,
produce a small gray colony after 24 hour
incubation at 35°C on sheep blood agar
The enterococci are catalase-negative or (more
commonly) weak positive,
A small gray colony that is slightly or -
hemolytic and sometimes β-hemolysis, weakly
catalase-positive is a typical presentation for
Enterococcus
Microscopically, Gram-positive cocci occurring in
chains or pairs with individual cells being
somewhat elongated can be presumed to be
streptococci or enterococci
SUNARYATI SUDIGDOADI
The enterococci do bear the Lancefield
Group D antigen, but Enterococcus is a
genus separate from Streptococcus
Like Group D streptococci, Enterococcus is
able to grow in the presence of 40% bile and
to hydrolyze esculin, while other
streptococci are not
Unlike Group D streptococci, Enterococcus
produces a positive PYR test (red color
produced after addition of N,N methyl
aminocynnamaldehyde reagent after
exposure to L-pyrrolidonyl-beta-
naphthylamide (PYR) substrate), and can be
identified by these tests.
SUNARYATI SUDIGDOADI
Microbiological diagnosis
Interpretation
Susceptibility testing of isolated bacteria
SUNARYATI SUDIGDOADI
The aim of culture is to find if the concentration
exceeds the value 105 cfu/ml that is significant for
infection
SUNARYATI SUDIGDOADI
DIAGNOSIS
The diagnosis of UTI : based on a quantitative
urine culture : > 100,000 colony-forming
units (105 CFU) per ml of urine, was termed
"significant bacteriuria."
This value was chosen because of its high
specificity for the diagnosis of true infection,
even in asymptomatic persons.
However, several studies have established
that one third or more of symptomatic women
have CFU counts below this level (low-
coliform-count infections).
They have also shown that a bacterial count
of 100 CFU per mL of urine has a high positive
predictive value for cystitis in symptomatic
women
SUNARYATI SUDIGDOADI
Bacteriuria indicate UTI
Criteria of UTI
1. Bacteriuria with quantitative >100.000 cfu/ml
2. Bacteriuria with quantitative <100.000 cfu/ml and
lekocyturia
3. Bacteriuria with quantitative <100.000 cfu/ml in
repeated culture, and same kind of bacteria was
found
4. Bacteriuria with quantitative <100.000 cfu/ml, only
one species of bacteria, with definite clinical
symptoms
5. If the result of culture is > 1000 cfu of fungus/ ml
indicate fungal infection
SUNARYATI SUDIGDOADI
Sexually Transmitted Infections
Bacteria
Neisseria gonorrhoeae
Yeasts and fungi
Chlamydia trachomatis Candida albicans
Treponema pallidum Candida glabrata
Haemophilus ducryei
(chancroid) Candida tropicalis
Lymphogranuloma
Mycoplasma
Ureaplasma Parasites
Calymmatobacterium Trichomonas
granulomatis
vaginalis
Gardnerella vaginalis
Viruses Entamoeba
Herpes simplex II histolytica
Hepatitis B Giardia lamblia
Hepatitis C
Sarcoptes scabiei
HIV
Papillomavirus Phitirius pubis
SUNARYATI SUDIGDOADI
NEISSERIA GONORRHOEAE
General characteristics :
oxidase-positive, gram-
negative diplococcus,
a”kidney bean”
morphologic appearance
SUNARYATI SUDIGDOADI
Virulence factor
1. Capsule
2. Pili
3. Cell-wall protein
4. Lipopolysaccharide
5. IgA protease
SUNARYATI SUDIGDOADI
Classification
1. N. gonorrhoeae does not use maltose,
which distinguishes it from Neisseria
meningitidis.
SUNARYATI SUDIGDOADI
Pathogenicity
Produces IgAase that degrades IgA1; this
antibody probably plays a key early role
in mucosal infections. (IgAase is also
found in Haemophilus and streptococcal
organisms).
Possesses a plasmid that codes for
penicillinase production.
Possesses pili, which are protein surface
fibrils that mediate attachment to the
mucosal epithelium.
SUNARYATI SUDIGDOADI
Pathogenicity
1. Pili undergo phase variation (on/off
switch of pili production). Nonpiliation
greatly reduces virulence.
SUNARYATI SUDIGDOADI
Pathogenicity
Possesses outer membrane proteins that
form porins (PI and PIII) and that determine
-
clumping (PII) or opacity. PII strains are
isolated from disseminated forms. Pili and
PII play major roles in adherence
Trachoma
• Serovars A, B, Ba,C (hyperendemic blinding)
• Inclusion conjunctivitis (newborn)
• Neonatal pneumonia
• Urethriti
• Serovars D-K •
•
Cervicitis
Pelvic inflammatory disease
• Association with cervical cancer
Chlamydia pneumoniae
•Pneumonia
(TWAR strain)
SUNARYATI SUDIGDOADI
PHYSIOLOGY AND STRUCTURE
A. Elementary bodies (EB) - EB are the small (0.3 -
0.4 µm) infectious form of the chlamydia.
Possess a rigid outer membrane, extensively
cross-linked by disulfide bonds
Resistant to harsh environmental conditions
encountered when the chlamydia are outside of
their eukaryotic host cells
Bind to receptors on host cells and initiate infection
SUNARYATI SUDIGDOADI
B. Reticulate bodies (RB) - RB are the non-
infectious intracellular from of the chlamydia.
SUNARYATI SUDIGDOADI
CHLAMYDIA LIFE CYCLE
SUNARYATI SUDIGDOADI
TREPONEMA PALLIDUM
General characteristics
is a corkscrew-shaped, motile organism with
unusual morphologic appearance of the outer
envelope, three axial filaments, a cytoplasmic
membrane-cell wall complex with endotoxin, and a
protoplasmic cylinder.
causes chronic, painless infections that may last 30
to 40 years if untreated.
decreases in number as host defenses are
stimulated, causing disappearance of symptoms;
subsequently, organisms multiply and symptoms
reappear.
SUNARYATI SUDIGDOADI
MYCOPLASMA & UREAPLASMA
1. Mycoplasma hominis
2. Mycoplasma genitalium
3. U. urealyticum is a prokaryote that lacks
a cell wall and can be cultured in the lab.
However, this organism is often seen in
normal individuals and culturing the
organism has questionable value in
diagnosing NGU.
SUNARYATI SUDIGDOADI
GARDNERELLA VAGINALIS
G. vaginalis is a rod
shaped gram
variable bacteria
which more
commonly causes
vaginitis but can
on occasion cause
NGU in males.
SUNARYATI SUDIGDOADI
Diagnosis
SUNARYATI SUDIGDOADI
SUNARYATI SUDIGDOADI
Haemophilus ducreyi
Chancroid or soft
chancre disease is an
acute sexually
transmitted disease
characterized by genital
ulceration and
suppuration
Ducrey's bacillus) is a
Gram(-) rod which grows
in chains.
SUNARYATI SUDIGDOADI
Gram-negative bacilli, intra- and extracellularly
dispersed, with "school of fish" distribution (see arrows).
SUNARYATI SUDIGDOADI
Pathology and pathogenesis
The organism enters the body through
skin abrasions.
It induces a papule or vesicle which
ulcerates.
There is a dense inflammatory exudate
with PMNs but not mononuclear cells.
Incubation period of 1-14 days after
exposure before you get the development
of the characteristic lesion, the soft
chancre. SUNARYATI SUDIGDOADI
Calymmatobacterium granulomatis
Granuloma inguinale (also called lupoid
ulceration granuloma of the pudenda and
granuloma contagiosa) is a chronic, indolent,
ulcerative, granulomatous disease of the
skin and lymphatics.