Documente Academic
Documente Profesional
Documente Cultură
• Introduction
• Identification
• Diagnostic laboratory findings
• Pathogenesis and Pathology
• Clinical findings
• Treatment
• Epidemiology, Prevention and Control
GRAM NEGATIVE
ENTERIC ORGANISMS
Gram Negative Enteric Organisms
• Members:
1. Family Enterobacteriaceae
2. Family Vibrionaceae
3. Family Pseudomonaceae
4. Family Bacteroidaceae
Family
Enterobacteriacea
Family Enterobacteriacea
• Clinically significant
– 20-25 species
1. Biochemical Reactions
2. Serologic antigenic structures
3. Molecular
Enterobacteriacea
Biochemical Reactions
1. Triple Sugar Iron (TSI) -Contains glucose, sucrose and lactose (fermentable sugars)
-Phenol red (pH indicator)
-Peptone (carbon/nitrogen source)
-Sodium thiosulfate(sulfur source)
-Ferric ammonium sulfate(hydrogen sulfide indicator)
6. Motility
Urease
Urea ----------------------> Ammonia ( pH )
Carbon Dioxide & Water
pH
Phenol Red ---------------------> PINK
Deaminase
Lysine ---------------------------------> Cadaverine ( pH) -------------------------> Purple butt
Decarboxylase
Lysine ---------------------------------> alpha-ketocarobxylic acid ( pH) -------> Red Slant
Enterobacteriacea
Biochemical Reactions
2. Opportunistic pathogen
Escherichia coli
Escherichia coli
Escherichia coli
Methyl Red
Lysine Decarboxylation (K/A on LIA)
Lactose Fermentation (A/A on TSI)
Produce gas from Acid
Mannitol Fermentation
Malonate utilized as source of carbon
B-glucoronidase using the substrate 4-
methylkumbelliferyl-B-glucoronide(MUG)
Escherichia coli
Pathogenesis and Clinical Findings
Escherichia coli
Pathogenesis and Clinical Findings
Symptoms may occur only 1 to 7 days after exposure (within 3 to 4 days)
1. Diarrheal Disease
- classified by the characteristic of their virulence properties
Organism Virulence Factors Spectrum of Disease
Enteroaggregative Heterogenous, exact mechanism not Acute and chronic diarrhea (>14
E.coli (EAEC) known days duration)
-Binding by pili Food-borne illnesses in
-ST-like and hemolysin like toxin industrialized countries ; have been
associated with traveler’s diarrhea;
persistent diarrhea in HIV patients
Escherichia coli
Pathogenesis and Clinical Findings
Diarrheal Disease
Virulence:
1. O antigen types (Uropathogenic E.coli) – produce hemolysin
cytotoxicity and tissue invasion
2. K antigen (causes pyelonephritis) – elaborate P fimbrae that
binds to the P blood group antigen
Escherichia coli
Pathogenesis and Clinical Findings
3. Sepsis
- Most common cause gram negative sepsis
- Newborns are highly susceptible due to lack of
IgM antibodies
- May occur secondary to UTI
4. Meningitis
- E.coli along with group B streptococci are the
leading causes of Meningitis in infants.
- K1 antigen in seen in 75% o cases, cross reacts
with the group B capsular polysaccharide
Klebsiella-Enterobacter-
Serratia group
Usually Opportunistic
pathogens
Nosocomial infections
– UTI and Pneumonia
Klebsiella spp.
• Cultural Characteristics
1. MacConkey Agar
• K. pneumoniae Lactose positive
colonies (pink mucoid colonies)
• Pink colonies
Klebsiella spp.
Cronobacter sakazakii
- Associated with bacteremia,
meningitis and necrotizing colitis in
neonates
Hafnia alvei Formerly E. hafnia Associated with gastrointestinal
Infections
Motile, non-lactose fermenter
Often identified in patients sever
underlying illnesses (malignancies)
or after surgery or trauma
Serratia spp.
Characteristics
• Generally non-pigment
• 10% produce pigments
• Motile
• Slow lactose fermenter
• Positive for DNAase
• Positive for Orthonitrophenyl galactoside (ONPG)
• Virulence: Endotoxin
Serratia spp.
Characteristics
Species Characteristics
Serratia marcescens Produce red colonies due to prodigiosin pigment
Species Characteristics
Serratia marcescens Ranked 12th most commonly isolated organism in
Serratia rubidea pediatric patients in north America, Latin America
and Europe
Serratia odorifera
Transmission maybe person-to-person, but is often
associated with medical devices – urinary catheters,
respirators, intravenous fluids and other medical
solutions.
– Pathogenecity:
1. Urease production stone formation (Struvite)
2. Motility – H Antigen
Proteus spp. -Providencia spp.-
Morganella Group
• Normal inhabitants of the gastrointestinal tract
• “Swarming growth” on culture media
• “Chocolate cake” or “Burnt Chocolate” smell
Species H2S Indole Ornithine
production Decarboxylation
Proteus mirabilis + - +
Proteus vulgaris + + -
Providencia rettgeri - + +
(Formerly Proteus rettgeri)
Morganella morganii - + -
(Formerly Proteus morganii)
Antibodies are proteus against certain strains and used to diagnose Rickettsial
infections
Proteus mirabilis – OX-K Proteus vulgaris – OX-K, OX-2 and OX-9
Proteus spp. -Providencia spp.-
Morganella Group
Clinical Manifestations
Species Clinical manifestation
Proteus mirabilis Often associated with Urinary Tract Infection and
Proteus vulgaris Struvite stone formation
• Proper sanitation
• Frequent Hand washing
• Rigorous asepsis, sterilization of equipment,
disinfection, restraint in intravenous therapy
Biochemical Differentiation of Important Gram – negative Rods.
Organisms Oxi NR & Indole MR VP Citrate Ureas PD LD GL Motility
dase Catalase e
E. coli - + + + - - - - +/- - +
Klebsiella - + - +/- + + + - + - -
pneumoniae
oxytoca - + + +/- + + + + + - -
Salmonella - + - + - - - - + - +
typhi
paratyphi A - + - + - - - - - - +
cholerasuis - + - + - + - - + - +
Shigella spp. - + D + - - - - - - -
Proteus - + + + - D + + - + +
vulgaris
mirabilis - + - + +/- D + + - + +
Produces odor “
Sweet” or“ Grapelike” or “Corn-taco-like”
Pseudomonas aeruginosa
Cultural characteristics
Biochemical Reactions
Positive Negative
Oxidase Indole
Catalase Methyl Red
Nitrate reduction Voges-Proskauer
Citrate Urease
Prevention
• Ensure appropriate control guidelines are followed
• Sterilization and decontamination of medical supplies
• Sensitive to:
Heat, killed at 550C in 1 hour
Acid, beta glutaraldehyde, Strong phenolic disinfectants
• Resistant to:
Usual Chemical agents
Common antiseptics – ammonium compound, hexachorophane
ATYPICAL PNEUMONIA
I. Mycoplasma spp.
• Pleomorphic
• no toxins
Differentiation of Mycoplasma spp.
Pathogenesis:
1. Chlamydia trochomatis
Other tests:
• Direct Fluorescent Antibody tests (DFAT) –
detects antibodies
• Serologic tests:
1. complement fixation
• CFT titer of 1:64 – presumptive diagnosis of
LGV
• CFT titer of >1:32 – presumptive of psittacosis
• CFT titer of >1:512 IgG or >1:16 IgM –
diagnosis of C. pneumoniae
2. Immunofluorescent tests
• Microimmunofluorescence test – for C.
pneumoniae
Clinical Differentiation of Chlamydiaceae
Organism Reservoir Transmission Disease Treatment
Chlamydia Birds & Inhalation of dried Psittacosis – viral like atypical Tetracycline
psittaci poultry bird feces pneumonia (fatal)
(Avian) (no human
transmission)
Chlamydophila Humans 1. Direct personal 1. Serotype A,B,C Tetracycline
trochomatis contact Trachoma - corneal scarring and and
2. Perinatal blindness erythro
transmission mycin
2. Serotype D to K
- Inclusion conjunctivitis in
neonates
- Infant interstitial pneumonia
- Non – gonococcal urethritis,
cervicitis and pelvic inflammatory
disease
- Non – gonoccocal urethritis,
epididymitis and prostatitis in
men.