Todar's Online Textbook of Bacteriology

Dedication to Hans Zinsser

Welcome to Todar's Online Textbook of Bacteriology .This textbook has evolved from lectures
presented in my bacteriology courses at the University of Wisconsin-Madison. Its contents are suitable
for reading or presentation in courses or course modules concerning general microbiology and medical
bacteriology at the college and advanced high school levels of education. As an electronic text, new
material is constantly being added, and current material is constantly being revised and updated. This is
an inherent advantage of the web-based text over the tree-burner.

The textbook will never be complete, as the rate of production of new information in microbiology far
outruns the author's ability to acquire and properly present it. If you have suggestions, comments or
criticisms regarding the textbook or its contents, or the idea of this type of textbook, please send email
to me at the address below.

Kenneth Todar
University of Wisconsin
Department of Bacteriology
Madison, Wisconsin 53706

1
General Bacteriology

Overview of Bacteriology

Structure and Function of Procaryotes

Nutrition and Growth of Bacteria

Growth of Bacterial Populations

Control of Microbial Growth

The Diversity of Procaryotic Metabolism

Regulation and Control of Metabolic Activities

Procaryotes in the Environment

Important Groups of Procaryotes

Bacterial Relationships with Animals

The Nature of Host-Parasite Interactions

The Bacterial Flora of Humans

Mechanisms of Bacterial Pathogenicity

Bacteria of Medical Importance

The Constitutive Host Defenses

The Immune Defenses

Principles of Bacterial Pathogenesis

Bacterial Structure in Relationship to Pathogenicity

Colonization and Invasion by Bacterial Pathogens

Bacterial Defense against Phagocytosis

Bacterial Defense against Immune Responses

Bacterial Protein Toxins

Bacterial Endotoxin

Antimicrobial Agents Used in the Treatment of Infectious Disease

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Bacterial Resistance to Antimicrobial Agents

Bacterial Pathogens and Diseases of Humans

Staphylococcus

Streptococcus

Streptococcus pneumoniae and Pneumococcal Pneumonia

Listeria monocytogenes and Listeriosis

Neisseria: Gonorrhea and Meningitis

Haemophilus influenzae

Opportunistic Infections Caused by Pseudomonas aeruginosa

Whooping Cough (Pertussis)

E. coli: Gastroenteritis, Urinary Tract Infections and Neonatal Meningitis

Cholera

Salmonella and Salmonellosis

Shigella and Shigellosis

Pathogenic Clostridia, including Tetanus and Botulism

Bacillus cereus Food Poisoning

Bacillus anthracis and Anthrax

Diphtheria

Tuberculosis

Lyme Disease

Rickettsial Diseases, including Rocky Mountain Spotted Fever

Emerging Pathogens

Vibrio vulnificus

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Important Groups of Procaryotes

The Genus Bacillus

Pseudomonas and Related Bacteria

The Enteric Bacteria

Kenneth Todar is currently on the teaching faculty of the Department of Bacteriology at the University
of Wisconsin-Madison. He received a PhD degree from The University of Texas at Austin in 1972.
Since 1970, he has taught microbiology at The University of Texas, University of Alaska, and
University of Wisconsin. His main teaching interests are in bacterial diversity, microbial ecology and
pathogenic bacteriology. Teaching materials associated with three of the courses taught at University of
Wisconsin are on the web at

Bacteriology 100: The Microbial World

Bacteriology 303: Procaryotic Microbiology

Bacteriology 330: Host-Parasite Interactions

WEB TEXT REVIEW (SCIENCE Magazine VOL 304 04 JUNE 2004

1421)
"The Good, the Bad, and the Deadly"
"The pearly droplets in this photo are colonies of Bacillus anthracis, the bacterium
that causes anthrax. The bugs exude a goopy coating that repels immune system
assaults and allows them to establish a foothold in the body. Learn more about the
tricks bacteria use to prosper almost everywhere on Earth in this Web text from
microbiologist Kenneth Todar of the University of Wisconsin, Madison. High school
and college students can absorb the basics of bacterial structure, physiology,
classification, and ecology.The book emphasizes medical microbiology, exploring
how bacteria hitch a ride from host to host, how the body tries to corral invading
microbes, and how the bugs elude these defenses. For example, the cholera
bacterium releases a toxin that induces intestinal cells to spill ions and water,
producing potentially lethal diarrhea."
textbookofbacteriology.net
4
 Todar's Online Textbook of Bacteriology

Overview of Bacteriology
© 2005 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

The Scope of Bacteriology

The Bacteria are a group of single-cell microorganisms with procaryotic cellular configuration. The
genetic material (DNA) of procaryotic cells exists unbound in the cytoplasm of the cells. There is no
nuclear membrane, which is the definitive characteristic of eukaryotic cells such as those that make
up plants and animals. Until recently, bacteria were the only known type of procaryotic cell, and the
discipline of biology related to their study is called bacteriology. In the 1980's, with the outbreak of
molecular techniques applied to phylogeny of life, another group of procaryotes was defined and
informally named "archaebacteria". This group of procaryotes has since been renamed Archaea and
has been awarded biological Domain status on the level with Bacteria and Eukarya. The current
science of bacteriology includes the study of both Domains of procaryotic cells, but the name
"bacteriology" is not likely to change to reflect the inclusion of archaea in the discipline. Actually,
many archaea have been studied as intensively and as long as their bacterial counterparts, but with the
notion that they were bacteria.

Figure 1. The cyanobacterium Anabaena. American Society for Microbiology. Two (not uncommon) exceptions that
procaryotes are unicellular and undifferentiated are seen in Anabaena: 1. The organism lives as a multicellular
filament or chain of cells. Procaryotes are considered "unicellular organisms" because all the cells in a filament or
colony are of the same type, and any one individual cell can give rise to an exact filament or colony; 2. The
predominant photosynthetic (bright yellow-green) cells do differentiate into another type of cell: the obviously large
"empty" cells occasionally seen along a filament are differentiated cells in which nitrogen fixation, but not
photosynthesis, takes place.

The Origin of Life

When life arose on Earth about 4 billion years ago, the first types of cells to evolve were procaryotic
cells. For approximately 2 billion years, procaryotic-type cells were the only form of life on Earth. The
oldest known sedimentary rocks, from Greenland, are about 3.8 billion years old. The oldest known
fossils are procaryotic cells, 3.5 billion years in age, found in Western Australia and South Africa. The
nature of these fossils, and the chemical composition of the rocks in which they are found, indicate that
lithotrophic and fermentative modes of metabolism were the first to evolve in early procaryotes.
Photosynthesis developed in bacteria at least 3 billion years ago. Anoxygenic photosynthesis
(bacterial photosynthesis, which is anaerobic and does not produce O2) preceded oxygenic
photosynthesis (plant-type photosynthesis, which yields O2). But oxygenic photosynthesis also arose
5
in procaryotes, specifically in the cyanobacteria, which existed millions of years before the evolution of
plants. Larger, more complicated eukaryotic cells did not appear until much later, between 1.5 and 2
billion years ago.

Figure 2. Opalescent Pool in Yellowstone National Park, Wyoming USA. K. Todar. Conditions for life in this
environment are similar to Earth over 2 billion years ago. In these types of hot springs, the orange, yellow and
brown colors are due to pigmented photosynthetic bacteria which make up the microbial mats. The mats are literally
teeming with bacteria. Some of these bacteria such as Synechococcus conduct oxygenic photosynthesis, while others
such as Chloroflexus conduct anoxygenic photosynthesis. Other non-photosynthetic bacteria, as well as thermophilic
and acidophilic Archaea, are also residents of the hot spring community.

The archaea and bacteria differ fundamentally in their cell structure from eukaryotes, which always
contain a membrane-enclosed nucleus, multiple chromosomes, and various other membranous
organelles, such as mitochondria, chloroplasts, the golgi apparatus, vacuoles, etc. Unlike plants and
animals, archaea and bacteria are unicellular organisms that do not develop or differentiate into
multicellular forms. Some bacteria grow in filaments or masses of cells, but each cell in the colony is
identical and capable of independent existence. The cells may be adjacent to one another because they
did not separate after cell division or because they remained enclosed in a common sheath or slime
secreted by the cells, but typically there is no continuity or communication between the cells.

The Universal Tree of Life

On the basis of small subunit ribosomal RNA (ssrRNA) analysis the Woesean tree of life gives rise
to three cellular domains of life: Archaea, Bacteria, and Eukarya (Figure 3). Bacteria (formerly
known as eubacteria) and Archaea (formerly called archaebacteria) share the procaryotic type of
cellular configuration, but otherwise are not related to one another any more closely than they are to the
eukaryotic domain, Eukarya. Between the two procaryotes, Archaea are apparently more closely
related to Eukarya than are the Bacteria. Eukarya consists of all eukaryotic cell-types, including
protista, fungi, plants and animals.

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Figure 3. The Universal Tree of Life as derived from sequencing of ssrRNA. N. Pace. Note the three major domains
of living organisms: Archaea, Bacteria and Eucarya (Eukarya). The "evolutionary distance" between two organisms
is proportional to the measurable distance between the end of a branch to a node to the end of a comparative
branch. For example, in Eucarya, humans (Homo) are more closely related to corn (Zea) than to slime molds
(Dictyostelium); or in Bacteria, E. coli is more closely related to Agrobacterium than to Thermus.

OFF THE WALL. It is interesting to note several features of phylogeny and evolution that are revealed in the
Unrooted Tree.

--Archaea are the least evolved type of cell (they remain closest to the common point of origin). This helps explain
why contemporary Archaea are inhabitants of environments that are something like the earth 3.86 billion years ago
(hot, salty, acidic, anaerobic, low in organic material, etc.).

--Eucaryotes (Eucarya) are the most evolved type of cell (they move farthest from the common point of origin).
However, the eucaryotes do not begin to diversify (branch) until relatively late in evolution, at a time when the
Bacteria diversify into oxygenic photosynthesis (Synechococcus) and aerobic respiration (Agrobacterium).

--Mitochondria and the respiratory bacterium, Agrobacterium, are derived from a common ancestor; likewise,
chloroplast and the cyanobacterium, Synechococcus, arise from a common origin. This is good evidence for the idea
of evolutionary endosymbiosis, i.e., that the origin of eukaryotic mitochondria and chloroplasts is in procaryotic cells
that were either captured by, or which invaded, eukaryotic cells, and subsequently entered into a symbiotic
association with one cell living inside of the other.

--Diversification in Eucarya is within the Protista (unicellular protozoa, algae, and including fungi). The only
multicellular eukaryotes on the Tree are Zea (plants) and Homo (animals). Since the protists, along with the
archaea and bacteria, constitute the microbial ("microorganismal") community of the planet, this helps to
substantiate the claim the microorganisms are the predominant and most diverse form of life on Earth.

--Humans (Homo) are more closely related to yeast (Saccharomyces) than they are to corn (Zea). There are more
genetic differences between E. coli and Bacillus than there are between humans and a paramecium. The protozoan
7
Trichomonas is more closely related to the archaea than it is to the protozoan Trypoanosoma. When the tree
branches are amplified there many other similar surprises to biologists.

--Most biology and anthropology students have been presented with fossil and other structural evidence that humans
(Homo) emerged a very short time ago on the evolutionary clock. The Tree confirms this evidence on the basis of
comparative molecular genetic analysis.

Genomic Timescale of Procaryotic Evolution

Comparison of protein sequences whose genes are common to the genomes of several procaryotes has
resulted in a "genomic timescale of procaryotic evolution" and establishes the following dates for some
major events in procaryotic evolution (Battistuzzi, et al. MC Evol Biol. 2004; 4: 44). The results are
consistent with most other phylogenetic schemes that recognize higher-level groupings of procaryotes.

Table 1. Genomic timescale for some major events in procaryotic evolution

Origin of life: prior to 4.1 billion years ago (Ga)

Origin of methanogenesis: 3.8 - 4.1 Ga
Origin of phototrophy: prior to 3.2 Ga
Divergence of the major groups of Archaea: 3.1 - 4.1 Ga
Origin of anaerobic methanotrophy: after 3.1 Ga
Colonization of land: 2.8 - 3.1 Ga
Divergence of the major groups of Bacteria: 2.5 - 3.2 Ga
Origin of aerobic methanotrophy: 2.5 - 2.8 Ga.

The time estimates for methanogenesis support the consideration of methane, in addition to carbon
dioxide, as a greenhouse gas responsible for the early warming of the Earths' surface.

Divergence times for the origin of anaerobic methanotrophy are compatible with carbon isotopic values
found in rocks dated 2.8 - 2.6 Ga.

The origin of phototrophy is consistent with the earliest bacterial mats and structures identified as
stromatolites, but a 2.6 Ga origin of cyanobacteria suggests that those structures (if biologically
produced) would have been made by anoxygenic photosynthesizers.

A well-supported group of three major lineages of Bacteria (Actinobacteria, Deinococcus, and

Cyanobacteria), that have been called "Terrabacteria", are associated with an early colonization of land.

Size and Distribution of Bacteria and Archaea

Most procaryotic cells are very small compared to eukaryotic cells. A typical bacterial cell is about 1
micrometer in diameter while most eukaryotic cells are from 10 to 100 micrometers in diameter.
Eukaryotic cells have a much greater volume of cytoplasm and a much lower surface : volume ratio
than procaryotic cells. A typical procaryotic cell is about the size of a eukaryotic mitochondrion. Since
procaryotes are too small to be seen except with the aid of a microscope, it is usually not appreciated
that they are the most abundant form of life on the planet, both in terms of biomass and total numbers

8
of species. For example, in the sea, procaryotes make up 90 percent of the total combined weight of all
organisms. In a single gram of fertile agricultural soil there may be in excess of 109 bacterial cells,
outnumbering all eukaryotic cells there by 10,000 : 1. About 3,000 distinct species of bacteria and
archea are recognized, but this number is probably less than one percent of all the species in nature.
These unknown procaryotes, far in excess of undiscovered or unstudied plants, are a tremendous
reserve of genetic material and genetic information in nature that awaits exploitation.

Procaryotes are found in all of the habitats where eukaryotes live, but, as well, in many natural
environments considered too extreme or inhospitable for eukaryotic cells. Thus, the outer limits of life
on Earth (hottest, coldest, driest, etc.) are usually defined by the existence of procaryotes. Where
eukaryotes and procaryotes live together, there may be mutualistic associations between the organisms
that allow both to survive or flourish. The organelles of eukaryotes (mitochondria and chloroplasts) are
thought to be remnants of Bacteria that invaded, or were captured by, primitive eukaryotes in the
evolutionary past. Numerous types of eukaryotic cells that exist today are inhabitated by endosymbiotic
procaryotes.

From a metabolic standpoint, the procaryotes are extraordinarily diverse, and they exhibit several types
of metabolism that are rarely or never seen in eukaryotes. For example, the biological processes of
nitrogen fixation (conversion of atmospheric nitrogen gas to ammonia) and methanogenesis
(production of methane) are metabolically-unique to procaryotes and have an enormous impact on the
nitrogen and carbon cycles in nature. Unique mechanisms for energy production and photosynthesis are
also seen among the Archea and Bacteria.

The lives of plants and animals are dependent upon the activities of bacterial cells. Bacteria and archea
enter into various types of symbiotic relationships with plants and animals that usually benefit both
organisms, although a few bacteria are agents of disease.

The metabolic activities of procaryotes in soil habitats have an enormous impact on soil fertility that
can affect agricultural practices and crop yields. In the global environment, procaryotes are absolutely
essential to drive the cycles of elements that make up living systems, i.e., the carbon, oxygen, nitrogen
and sulfur cycles. The origins of the plant cell chloroplast and plant-type (oxygenic) photosynthesis are
found in procaryotes. Most of the earth's atmospheric oxygen may have been produced by free-living
bacterial cells. The bacteria fix nitrogen and a substantial amount of CO2, as well.

Bacteria or bacterial products (including their genes) can be used to increase crop yield or plant
resistance to disease, or to cure or prevent plant disease. Bacterial products include antibiotics to fight
infectious disease, as well as components for vaccines used to prevent infectious disease. Because of
their simplicity and our relative understanding of their biological processes, the bacteria provide
convenient laboratory models for study of the molecular biology, genetics, and physiology of all types
of cells, including plant and animal cells.

STRUCTURE AND FUNCTION OF PROCARYOTIC CELLS

Procaryotic cells have three architectural regions (Figure 4): appendages (proteins attached to the cell
surface) in the form of flagella and pili; a cell envelope consisting of a capsule, cell wall and plasma
membrane; and a cytoplasmic region that contains the cell genome (DNA) and ribosomes and
various sorts of inclusions.

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Figure 4. Schematic drawing of a typical bacterium.

Surface Structures-Appendages

Flagella are filamentous protein structures attached to the cell surface that provide swimming
movement for most motile procaryotic cells. The flagellar filament is rotated by a motor apparatus in
the plasma membrane allowing the cell to swim in fluid environments. Bacterial flagella are powered
by proton motive force (chemiosmotic potential) established on the bacterial membrane, rather than
ATP hydrolysis which powers eukaryotic flagella. Procaryotes are known to exhibit a variety of types
of tactic behavior, i.e., the ability to move (swim) in response to environmental stimuli. For example,
during chemotaxis a bacterium can sense the quality and quantity of certain chemicals in their
environment and swim towards them (if they are useful nutrients) or away from them (if they are
harmful substances).

Figure 5.Vibrio choleraehas a single polar flagellum for swimming movement. Electron Micrograph of Vibrio
cholerae by Leodotia Pope, Department of Microbiology, University of Texas at Austin.

Fimbriae and Pili are interchangeable terms used to designate short, hair-like structures on the surfaces
of procaryotic cells. Fimbriae are shorter and stiffer than flagella, and slightly smaller in diameter. Like
flagella, they are composed of protein. A specialized type of pilus the F or sex pilus, mediates the
transfer of DNA between mating bacteria, but the function of the smaller, more numerous common pili
is quite different. Common pili (almost always called fimbriae) are usually involved in adherence
(attachment) of procaryotes to surfaces in nature. In medical situations, they are major determinants of
bacterial virulence because they allow pathogens to attach to (colonize) tissues and to resist attack by
phagocytic white blood cells.

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Figure 6.Fimbriae of Neisseria gonorrhoeaeallow the bacterium to adhere to tissues. Electron micrograph by David
M. Phillips, Visuals Unlimited, with permission.

The Cell Envelope

Most procaryotes have a rigid cell wall. The cell wall is an essential structure that protects the delicate
cell protoplast from osmotic lysis. The cell wall of Bacteria consists of a polymer of disaccharides
cross-linked by short chains of amino acids (peptides). This molecule is a type of peptidoglycan which
is called murein. In the Gram-positive bacteria (those that retain the purple crystal violet dye when
subjected to the Gram-staining procedure) the cell wall is a thick layer of murein. In the Gram-
negative bacteria (which do not retain the crystal violet) the cell wall is relatively thin and is composed
of a thin layer of murein surrounded by a membranous structure called the outer membrane. Murein
is a substance unique in nature to bacterial cell walls. Also, the outer membrane of Gram-negative
bacteria invariably contains a unique component, lipopolysaccharide (LPS or endotoxin), which is
toxic to animals. The cell walls of Archaea may be composed of protein, polysaccharides, or
peptidgolycan-like molecules, but never do they contain murein. This feature distinguishes the Bacteria
from the Archaea.

Although procaryotes lack any intracellular organelles for respiration or photosynthesis, many species
possess the physiologic ability to conduct these processes, usually as a function of the plasma
membrane. For example, the electron transport system that couples aerobic respiration and ATP
synthesis is found in the plasma membrane. The photosynthetic chromophores that harvest light energy
for conversion into chemical energy are located in the membrane. Hence, the plasma membrane is the
site of oxidative phosphorylation or photophosphorylation in procaryotes, analogous to the functions of
mitochondria and chloroplasts in eukaryotic cells. The procaryotic plasma membrane is also a
permeability barrier, and it contains a variety of different transportsystems that selectively mediate the
passage of substances into and out of the cell.

The membranes of Bacteria are structurally similar to the cell membranes of eukaryotes, except that
bacterial membranes consist of saturated or monounsaturated fatty acids (rarely polyunsaturated fatty
acids) and do not normally contain sterols. The membranes of Archaea form phospholipid bilayers
functionally equivalent to bacterial membranes, but archaeal lipids are saturated, branched, repeating
isoprenoid subunits that attach to glycerol via an ether linkage, as opposed to the ester linkage found in
glycerides of eukaryotic and bacterial membrane lipids. The structure of archaeal membranes is thought
to be an adaptation to their survival in extreme environments.

Most bacteria contain some sort of a polysaccharide layer outside of the cell wall or outer membrane.
In a general sense, this layer is called a capsule or glycocalyx. Capsules, slime layers, and glycocalyx
are known to mediate attachment of bacterial cells to particular surfaces. Capsules also protect bacteria
11
from engulfment by predatory protozoa or white blood cells (phagocytes) and from attack by
antimicrobial agents of plant or animal origin. Capsules in certain soil bacteria protect them from
perennial effects of drying or desiccation.

Importance of Surface Components

All of the various surface components of a procaryotic cell are important in its ecology since they
mediate the contact of the cell with its environment. The only "sense" that a procaryote has results from
its immediate contact with its environment. It must use its surface components to assess the
environment and respond in a way that supports its own existence and survival in that environment.
The surface properties of a procaryote are determined by the exact molecular composition of its plasma
membrane and cell wall, including LPS, and the function of surface structures such as flagella, fimbriae
and capsules. Some important ways that procaryotes use their surface components are (1) as
permeability barriers that allow selective passage of nutrients and exclusion of harmful substances; (2)
as "adhesins" used to attach or adhere to specific surfaces or tissues; (3) as enzymes to mediate specific
reactions on the cell surface important in the survival of the procaryote; (4) as "sensing proteins" that
can respond to temperature, osmolarity, salinity, light, oxygen, nutrients, etc.,resulting in a signal to the
genome of the cell that will cause a beneficial response to the new environment.

Figure 7. The complex surface of Streptococcus pyogenes.Electron micrograph of Streptococcus pyogenes by Maria
Fazio and Vincent A. Fischetti, Ph.D. with permission. The Laboratory of Bacterial Pathogenesis and Immunology,
Rockefeller University.

Cytoplasmic Constituents

The cytoplasmic constituents of bacteria invariably include the procaryotic chromosome and
ribosomes. The chromosome is typically one large circular molecule of DNA, more or less free in the
cytoplasm. Procaryotes sometimes possess smaller extrachromosomal pieces of DNA called plasmids.
The total DNA content of a cell is referred to as the cell genome. During cell growth and division, the
procaryotic chromosome is replicated in the usual semi-conservative fashion before for distribution to
progeny cells. However, the eukaryotic processes of meiosis and mitosis are absent in procaryotes.
Replication and segregation of procaryotic DNA is coordinated by the membrane, possibly by
mesosomes.

The distinct granular appearance of procaryotic cytoplasm is due to the presence and distribution of
ribosomes The ribosomes of procaryotes are smaller than cytoplasmic ribosomes of eukaryotes.
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Procaryotic ribosomes are 70S in size, being composed of 30S and 50S subunits. The 80S ribosomes of
eukaryotes are made up of 40S and 60S subunits. Ribosomes are involved in the process of translation
(protein synthesis), but some details of their activities differ in eukaryotes, Bacteria and Archaea.
Protein synthesis using 70S ribosomes occurs in eukaryotic mitochondria and chloroplasts, and this is
taken as a major line of evidence that these organelles are descended from procaryotes.

Often contained in the cytoplasm of procaryotic cells is one or another of some type of inclusion
granule. Inclusions are distinct granules that may occupy a substantial part of the cytoplasm. Inclusion
granules are usually reserve materials of some sort. For example, carbon and energy reserves may be
stored as glycogen (a polymer of glucose) or as polybetahydroxybutyric acid (a type of fat) granules.
Polyphosphate inclusions are reserves of PO4 and possibly energy; elemental sulfur (sulfur globules)
are stored by some phototrophic and some lithotrophic procaryotes as reserves of energy or electrons.
Some inclusion bodies are actually membranous vesicles or intrusions into the cytoplasm which
contain photosynthetic pigments or enzymes.

Figure 8. Bacterial colonies growing in a petri dish containing nutrients.

Hans Knoll Institute, Jena, Germany.

TAXONOMY AND CLASSIFICATION OF PROCARYOTES

Haeckel (1866) was the first to create a natural Kingdom for the microorganisms, which had been
discovered nearly two centuries before by van Leeuwenhoek. He placed all unicellular (microscopic)
organisms in a new kingdom, "Protista", separated from plants (Plantae) and animals (Animalia),
which were multicellular (macroscopic) organisms. The development of the electron microscope in the
1950's revealed a fundamental dichotomy among Haeckel's "Protista": some cells contained a
membrane-enclosed nucleus, and some cells lacked this intracellular structure. The latter were
temporarily shifted to a fourth kingdom, Monera (or Moneres), the procaryotes (also called
Procaryotae). Protista remained as a kingdom of unicellular eukaryotic microorganisms. Whittaker
refined the system into five kingdoms in 1967, by identifying the Fungi as a separate multicellular
eukaryotic kingdom of organisms, distinguished by their absorptive mode of nutrition.

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In the 1980's, Woese began phylogenetic analysis of all forms of cellular life based on comparative
sequencing of the small subunit ribosomal RNA (ssrRNA) that is contained in all organisms. A new
dichotomy was revealed, this time among the procaryotes: their existed two types of procaryotes, as
fundamentally unrelated to one another as they are to eukaryotes. Thus, Woese defined the three
cellular domains of life as they are displayed in Figure 3 (above): Eucarya, Bacteria and Archaea.
Whittaker's Plant, Animal and Fungi kingdoms (all of the multicellular eukaryotes) are at the end of a
very small branch of the tree of life, and all other branches lead to microorganisms, either procaryotes
(Bacteria and Archaea), or protists (unicellular algae and protozoa).

Although the definitive difference between Woese's Archaea and Bacteria is based on fundamental
differences in the nucleotide base sequence in the 16S ribosomal RNA, there are many biochemical and
phenotypic differences between the two groups of procaryotes. (Table 2). The phylogenetic tree
indicates that Archaea are more closely related to Eukarya than are Bacteria. This relatedness seems
most evident in the similarities between transcription and translation in the Archaea and the Eukarya.
However, it is also evident that the Bacteria have evolved into chloroplasts and mitochondria, so that
these eukaryotic organelles derive their lineage from this group of procaryotes. Perhaps the biological
success of eukaryotic cells springs from the evolutionary merger of the two procaryotic life forms.

Figure 9 (above) The structure of a typical procaryotic cell, in this case, a Gram-negative bacterium, compared with
(below) a typical eukaryotic cell (plant cell). The procaryote is about 1 micrometer in diameter and about the size of
the eukaryotic chloroplast or mitochondrion. Drawings by Vaike Haas, University of Wisconsin-Madison.

14
Table 2. Phenotypic properties of Bacteria and Archaea compared with Eukarya.
Property Biological Domain
Eukarya Bacteria Archaea
Cell configuration eukaryotic procaryotic procaryotic
Nuclear membrane present absent absent
Number of chromosomes >1 1 1
Chromosome topology linear circular circular
Murein in cell wall - + -
ester-linked glycerides; ester-linked glycerides; unbranched; ether-linked
Cell membrane lipids
unbranched; polyunsaturated saturated or monounsaturated branched; saturated
Cell membrane sterols present absent absent
Organelles (mitochondria and
present absent absent
chloroplasts)
Ribosome size 80S (cytoplasmic) 70S 70S
Cytoplasmic streaming + - -
Meiosis and mitosis present absent absent
Transcription and translation
- + +
coupled
Amino acid initiating protein
methionine N-formyl methionine methionine
synthesis
Protein synthesis inhibited by
- + -
streptomycin and chloramphenicol
Protein synthesis inhibited by
+ - +
diphtheria toxin

IDENTIFICATION OF BACTERIA

15
The criteria used for microscopic identification of procaryotes include cell shape and grouping, Gram-
stain reaction, and motility. Bacterial cells almost invariably take one of three forms: rod (bacillus),
sphere (coccus), or spiral (spirilla and spirochetes). Rods that are curved are called vibrios. Fixed
bacterial cells stain either Gram-positive (purple) or Gram-negative (pink); motility is easily
determined by observing living specimens. Bacilli may occur singly or form chains of cells; cocci may
form chains (streptococci) or grape-like clusters (staphylococci); spiral shape cells are almost always
motile; cocci are almost never motile. This nomenclature ignores the actinomycetes, a prominant
group of branched bacteria which occur in the soil. But they are easily recognized by their colonies and
their microscopic appearance.

Figure 10. Gram stain of Bacillus anthracis,the cause of anthrax. K. Todar.

Such easily-made microscopic observations, combined with knowing the natural environment of the
organism, are important aids to identify the group, if not the exact genus, of a bacterium - providing, of
course, that one has an effective key. Such a key is Bergey's Manual of Determinative Bacteriology,
the "field guide" to identification of the bacteria. Bergey's Manual describes affiliated groups of
Bacteria and Archaea based on a few easily observed microscopic and physiologic characteristics.
Further identification requires biochemical tests which will distinguish genera among families and
species among genera. Strains within a single species are usually distinguished by genetic or
immunological criteria.

A modification of the Bergey's criteria for bacterial identification, without a key, is used to organize the
groups of procaryotes for discussion in a companion chapter Major Groups of Prokaryotes

Figure 11. Size and fundamental shapes of procaryotes revealed by three genera of Bacteria (l to r):
Staphylococcus(spheres), Lactobacillus(rods), and Aquaspirillum(spirals).

16
 Figure 12. Chains of dividing streptococci.Electron micrograph of Streptococcus pyogenes by Maria Fazio and
Vincent A. Fischetti, Ph.D. with permission. The Laboratory of Bacterial Pathogenesis and Immunology, Rockefeller
University.

BACTERIAL REPRODUCTION AND GENETICS

Most bacteria reproduce by a relatively simple asexual process called binary fission: each cell
increases in size and divides into two cells. During this process there is an orderly increase in cellular
structures and components, replication and segregation of the bacterial DNA, and formation of a
septum or cross wall which divides the cell into two. The process is evidently coordinated by activites
associated with the cell membrane. The DNA molecule is believed to be attached to a point on the
membrane where it is replicated. The two DNA molecules remain attached at points side-by-side on the
membrane while new membrane material is synthesized between the two points. This draws the DNA
molecules in opposite directions while new cell wall and membrane are laid down as a septum between
the two chromosomal compartments. When septum formation is complete the cell splits into two
progeny cells. The time interval required for a bacterial cell to divide or for a population of cells to
double is called the generation time. Generation times for bacterial species growing in nature may be
as short as 15 minutes or as long as several days.

Genetic Exchange in Bacteria

Although procaryotes do not undergo sexual reproduction, they are not without the ability to exchange
genes and undergo genetic recombination. Bacteria are known to exchange genes in nature by three
processes: conjugation, transduction and transformation. Conjugation involves cell-to-cell contact
as DNA crosses a sex pilus from donor to recipient. During transduction, a virus transfers the genes
between mating bacteria. In transformation, DNA is acquired directly from the environment, having
been released from another cell. Genetic recombination can follow the transfer of DNA from one cell
to another leading to the emergence of a new genotype (recombinant). It is common for DNA to be
transferred as plasmids between mating bacteria. Since bacteria usually develop their genes for drug
resistance on plasmids (called resistance transfer factors, or RTFs), they are able to spread drug
resistance to other strains and species during genetic exchange processes. The genetic engineering of
bacterial cells in the research or biotechnology laboratory is often based on the use of plasmids. The
genetic systems of the Archaea are poorly characterized at this point, although the entire genome of
17
Methanosarcina has been sequenced recently which will certainly open up the possibilites for genetic
analysis of the group.

Evolution of Bacteria and Archaea

For most procaryotes, mutation is is a major source of variability that allows the species to adapt to
new conditions. The mutation rate for most procaryotic genes is approximately 10-8. This means that if
a bacterial population doubles from 108 cells to 2 x 108 cells, there is likely to be a mutant present for
any given gene. Since procaryotes grow to reach population densities far in excess of 109 cells, such a
mutant could develop from a single generation during 15 minutes of growth. The evolution of
procaryotes, driven by such darwinian principles of evolution (mutation and selection) is called
vertical evolution

However, as a result of the processes of genetic exchange described above, the bacteria and archaea can
also undergo a process of horizontal evolution. In this case, genes are transferred laterally from one
organism to another, even between members of different Kingdoms, which may allow immediate
experimentation with new genetic characteristics in the recipient. Horizontal evolution is being realized
to be a significant force in cellular evolution.

The combined effects of fast growth rates, high concentrations of cells, genetic processes of mutation
and selection, and the ability to exchange genes, account for the extraordinary rates of adaptation and
evolution that can be observed in the procaryotes.

ECOLOGY OF BACTERIA AND ARCHAEA

Bacteria and Archaea are present in all environments that support life. They may be free-living, or
living in associations with eukaryotes (plants and animals), and they are found in environments that
support no other form of life. Procaryotes have the usual nutritional requirements for growth of cells,
but many of the ways that they utilize and transform their nutrients are unique.

Nutritional Types of Organisms

In terms of carbon utilization a cell may be heterotrophic or autotrophic. Heterotrophs obtain their
carbon and energy for growth from organic compounds in nature. Autotrophs use C02 as a sole source
of carbon for growth and obtain their energy from light (photoautotrophs) or from the oxidation of
inorganic compounds (lithoautotrophs).

Most heterotrophic bacteria are saprophytes, meaning that they obtain their nourishment from dead
organic matter. In the soil, saprophytic bacteria and fungi are responsible for biodegradation of
organic material. Ultimately, organic molecules, no matter how complex, can be degraded to CO2.
Probably no naturally-occurring organic substance cannot be degraded by the combined activities of
the bacteria and fungi. Hence, most organic matter in nature is converted by heterotrophs to CO2, only
to be converted back into organic material by autotrophs that die and nourish heterotrophs to complete
the carbon cycle.

Lithotrophic procaryotes have a type of energy-producing metabolism which is unique. Lithotrophs

(also called chemoautotrophs) use inorganic compounds as sources of energy, i.e., they oxidize
compounds such as H2 or H2S or NH3 to obtain electrons to feed in to an electron transport system and
to produce ATP. Lithotrophs are found in soil and aquatic environments wherever their energy source
is present. Most lithotrophs are autotrophs so they can grow in the absence of any organic material.
18
Lithotrophic species are found among the Bacteria and the Archaea. Sulfur-oxidizing lithotrophs
convert H2S to So and So to SO4. Nitrifying bacteria convert NH3 to NO2 and NO2 to NO3;
methanogens strip electrons off of H2 as a source of energy and add electrons to CO2 to form CH4
(methane). Lithotrophs have an obvious impact on the sulfur, nitrogen and carbon cycles in the
biosphere.

Photosynthetic bacteria convert light energy into chemical energy for growth. Most phototrophic
bacteria are autotrophs so their role in the carbon cycle is analogous to that of plants. The planktonic
cyanobacteria are the "grass of the sea" and their form of oxygenic photosynthesis generates a
substantial amount of O2 in the biosphere. However, among the photosynthetic bacteria are types of
metabolism not seen in eukaryotes, including photoheterotrophy (using light as an energy source
while assimilating organic compounds as a source of carbon), anoxygenic photosynthesis, and unique
mechanisms of CO2 fixation (autotrophy).

Photosynthesis has not been found to occur among the Archaea, but one archaeal species of employs a
light-driven non photosynthetic means of energy generation based on the use of a chromophore called
bacteriorhodopsin

Responses to Environmental Conditions

Procaryotes vary widely in their response to O2 (molecular oxygen). Organisms that require O2 for
growth are called obligate aerobes; those which are inhibited or killed by O2, and which grow only in
its absence, are called obligate anaerobes; organisms which grow either in the presence or absence of
O2 are called facultative anaerobes. Whether or not a particular organism can exist in the presence of
O2 depends upon the distribution of certain enzymes such as superoxide dismutase and catalase that are
required to detoxify lethal oxygen radicals that are always generated by living systems in the presence
of O2

Procaryotes also vary widely in their response to temperature. Those that live at very cold temperatures
(0 degrees or lower) are called psychrophiles; those which flourish at room temperature (25 degrees)
or at the temperature of warm-blooded animals (37 degrees) are called mesophiles; those that live at
high temperatures (greater than 45 degrees) are thermophiles. The only limit that seems to be placed
on growth of certain procaryotes in nature relative to temperature is whether liquid water exists. Hence
growing procaryotic cells can be found in supercooled environments (ice does not form) as low as -20
degrees and superheated environments (steam does not form) as high as 120 degrees. Archaea have
been detected around thermal vents on the ocean floor where the temperature is as high as 320 degrees!

Symbiosis

The biomass of procaryotic cells in the biosphere, their metabolic diversity, and their persistence in all
habitats that support life, ensures that the procaryotes play a crucial role in the cycles of elements and
the functioning of the world ecosystem. However, the procaryotes affect the world ecology in another
significant way through their inevitable interactions with insects, plants and animals. Some bacteria are
required to associate with insects, animals or plants for the latter to survive. For example, the sex of
offspring of certain insects is determined by endosymbiotic bacteria. Ruminant animals (cows, sheep,
etc.), whose diet is mainly cellulose (plant material), must have cellulose-digesting bacteria in their
intestine to convert the cellulose to a form of carbon that the animal can assimilate. Leguminous plants
grow poorly in nitrogen-deprived soils unless they are colonized by nitrogen-fixing bacteria which can
supply them with a biologically-useful form of nitrogen.

19
Bacterial Pathogenicity

Some bacteria are parasites of plants or animals, meaning that they grow at the expense of their
eukaryotic host and may damage, harm, or even kill it in the process. Such bacteria that cause disease
in plants or animals are pathogens. Human diseases caused by bacterial pathogens include
tuberculosis, whooping cough, diphtheria, tetanus, gonorrhea, syphilis, pneumonia, cholera and typhoid
fever, to name a few. The bacteria that cause these diseases have special structural or biochemical
properties that determine their virulence or pathogenicity. These include: (1) ability to colonize and
invade their host; (2) ability to resist or withstand the antibacterial defenses of the host; (3) ability to
produce various toxic substances that damage the host. Plant diseases, likewise, may be caused by
bacterial pathogens. More than 200 species of bacteria are associated with plant diseases.

Figure 13. Borrelia burgdorferi. This spirochete is the bacterial parasite that causes Lyme disease. CDC.

APPLICATIONS OF BACTERIA IN INDUSTRY AND BIOTECHNOLOGY

Exploitation of Bacteria by Humans

In addition to other ecological roles, procaryotes, especially bacteria, are used industrially in the
manufacture of foods, drugs, vaccines, insecticides, enzymes, hormones and other useful biological
products. In fact, through genetic engineering of bacteria, these unicellular organisms can be coaxed to
produce just about anything that there is a gene for. The genetic systems of bacteria are the foundation
of the biotechnology industry.

In the foods industry, lactic acid bacteria such as Lactobacillus and Streptococcus are used the
manufacture of dairy products such as yogurt, cheese, buttermilk, sour cream, and butter. Lactic acid
fermentations are also used in pickling process. Bacterial fermentations can be used to produce lactic
acid, acetic acid, ethanol or acetone. In many parts of the world, various human cultures ferment
indigenous plant material using Zymomonas bacteria to produce the regional alcoholic beverage. For
example, in Mexico, a Maguey cactus (Agave) is fermented to "cactus beer" or pulque. Pulque can be
ingested as is, or distilled into tequila.

In the pharmaceutical industry, bacteria are used to produce antibiotics, vaccines, and medically-useful
enzymes. Most antibiotics are made by bacteria that live in soil. Actinomycetes such as Streptomyces
produce tetracyclines, erythromycin, streptomycin, rifamycin and ivermectin. Bacillus species produce
bacitracin and polymyxin. Bacterial products are used in the manufacture of vaccines for immunization
against infectious disease. Vaccines against diphtheria, whooping cough, tetanus, typhoid fever and
cholera are made from components of the bacteria that cause the respective diseases. It is significant to
note here that the use of antibiotics against infectious disease and the widespread practice of
vaccination (immunization) against infectious disease are two twentieth-century developments that
20
have drastically increased the quality of life and the average life expectancy of individuals in developed
countries.

Biotechnology

The biotechnology industry uses bacterial cells for the production of human hormones such as insulin
and human growth factor (protropin), and human proteins such as interferon, interleukin-2, and tumor
necrosis factor. These products are used for the treatment of a variety of diseases ranging from diabetes
to tuberculosis and AIDS. Other biotehnological applications of bacteria involve the genetic
construction of "super strains" of organisms to perform a particular metabolic task in the environment.
For example, bacteria which have been engineered genetically to degrade petroleum products can be
used in cleanup efforts of oil spills in seas or on beaches. One area of biotechnology involves
improvement of the qualities of plants through genetic engineering. Genes can be introduced into plants
by a bacterium Agrobacterium tumefaciens. Using A. tumefaciens, plants have been genetically
engineered so that they are resistant to certain pests, herbicides, and diseases. Finally, the polymerase
chain reaction (PCR), a mainstay of the biotechnology industry because it allows scientists to duplicate
genes starting with a single molecule of DNA, is based on the use of a DNA polymerase enzyme
derived from a thermophilic bacterium, Thermus aquaticus.

Thermus aquaticus,the thermophilic bacterium that is the source of taq polymerase.

L wet mount; R electron micrograph. T.D. Brock. Life at High Temperatures.

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 Todar's Online Textbook of Bacteriology

STRUCTURE AND FUNCTION OF PROCARYOTIC CELLS

© 2004 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

Procaryotes are unicellular organisms of relatively simple construction, especially if compared to

eukaryotes. Whereas eukaryotic cells have a preponderance of organelles with separate cellular
functions, procaryotes carry out all cellular functions as individual units. A procaryotic cell has five
essential structural components: a genome (DNA), ribosomes, cell membrane, cell wall, and some
sort of surface layer which may or may not be an inherent part of the wall. Other than enzymatic
reactions, all the cellular reactions incidental to life can be traced back to the activities of these
macromolecular structural components. Thus, functional aspects of procaryotic cells are related directly
to the structure and organization of the macromolecules in their cell make-up, i.e., DNA, RNA,
phospholipds, proteins and polysaccharides. Diversity within the primary structure of these molecules
accounts for the diversity that exists among procaryotes.

At one time it was thought that bacteria were essentially "bags of enzymes" with no inherent cellular
architecture. The development of the electron microscope, in the 1950s, revealed the distinct
anatomical features of bacteria and confirmed the suspicion that they lacked a nuclear membrane.
Structurally, a procaryotic cell (Figure 1 below) has three architectural regions: appendages
(attachments to the cell surface) in the form of flagella and pili (or fimbriae); a cell envelope
consisting of a capsule, cell wall and plasma membrane; and a cytoplasmic region that contains the
cell genome (DNA) and ribosomes and various sorts of inclusions. In this chapter, we will discuss the
anatomical structures of procaryotic cells in relation to their adaptation, function and behavior in
natural environments.

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Figure 1. Drawing of a typical procaryotic cell, by Vaike Haas, University of Wisconsin-Madison. Minimally, a
procaryote is composed of a cell wall and plasma membrane that surrounds its cytoplasm containing a chromosome,
ribosomes, enzymes, several classes of RNA, and small molecules (precursors).

23
Figure 2. Electron micrograph of an ultra-thin section of a dividing pair of group A streptococci (20,000X). The cell
surface fibrils, consisting primarily of M protein, are evident. The bacterial cell wall, to which the fibrils are
attached, is also clearly seen as the light staining region between the fibrils and the dark staining cell interior. Cell
division in progress is indicated by the new septum formed between the two cells and by the indentation of the cell
wall near the cell equator. The streptococcal cell diameter is equal to approximately one micron. Electron
micrograph of Streptococcus pyogenes by Maria Fazio and Vincent A. Fischetti, Ph.D. with permission. The
Laboratory of Bacterial Pathogenesis and Immunology, Rockefeller University.

Table 1. Summary: Characteristics of typical bacterial cell structures.

Structure Function(s) Predominant chemical composition

Flagella Swimming movement Protein

Pili
Sex pilus Mediates DNA transfer during conjugation Protein
Common pili or Attachment to surfaces; protection against phagotrophic
Protein
fimbriae engulfment
Capsules (includes Attachment to surfaces; protection against phagocytic
Usually polysaccharide; occasionally
"slime layers" and engulfment, occasionally killing or digestion; reserve of
polypeptide
glycocalyx) nutrients or protection against desiccation
Cell wall
Prevents osmotic lysis of cell protoplast and confers Peptidoglycan (murein) complexed with
Gram-positive bacteria
rigidity and shape on cells teichoic acids
Peptidoglycan prevents osmotic lysis and confers rigidity Peptidoglycan (murein) surrounded by
Gram-negative bacteria
and shape; outer membrane is permeability barrier; phospholipid protein-lipopolysaccharide
24
 associated LPS and proteins have various functions "outer membrane"
Permeability barrier; transport of solutes; energy
Plasma membrane Phospholipid and protein
generation; location of numerous enzyme systems
Ribosomes Sites of translation (protein synthesis) RNA and protein
Often reserves of nutrients; additional specialized Highly variable; carbohydrate, lipid,
Inclusions
functions protein or inorganic
Chromosome Genetic material of cell DNA
Plasmid Extrachromosomal genetic material DNA

Appendages

Figure 3. Salmonella enteritidis TEM about 10,000X. Salmonella is an enteric bacterium related to E. coli. The
enterics are motile by means of peritriochous flagella.

Flagella

Flagella are filamentous protein structures attached to the cell surface that provide the swimming
movement for most motile procaryotes. Procaryotic flagella are much thinner than eukaryotic flagella,
and they lack the typical "9 + 2" arrangement of microtubules. The diameter of a procaryotic flagellum
is about 20 nanometers, well-below the resolving power of the light microscope. The flagellar filament
is rotated by a motor apparatus in the plasma membrane allowing the cell to swim in fluid
environments. Bacterial flagella are powered by proton motive force (chemiosmotic potential)
established on the bacterial membrane, rather than ATP hydrolysis which powers eukaryotic flagella.
About half of the bacilli and all of the spiral and curved bacteria are motile by means of flagella. Very
few cocci are motile, which reflects their adaptation to dry environments and their lack of
hydrodynamic design.

The ultrastructure of the flagellum of E. coli is illustrated in Figure 4 below (after Dr. Julius Adler of
the University of Wisconsin). About 50 genes are required for flagellar synthesis and function. The
flagellar apparatus consists of several distinct proteins: a system of rings embedded in the cell
envelope (the basal body), a hook-like structure near the cell surface, and the flagellar filament. The
innermost rings, the M and S rings, located in the plasma membrane, comprise the motor apparatus.
The outermost rings, the P and L rings, located in the periplasm and the outer membrane respectively,
function as bushings to support the rod where it is joined to the hook of the filament on the cell surface.
As the M ring turns, powered by an influx of protons, the rotary motion is transferred to the filament
which turns to propel the bacterium.

25
Figure 4. The ultrastructure of a bacterial flagellum (after J. Adler). Measurements are in nanometers. The
flagellum of E. coli consists of three parts, filament, hook and basal body, all composed of different proteins. The
basal body and hook anchor the whip-like filament to the cell surface.The basal body consists of four ring-shaped
proteins stacked like donuts around a central rod in the cell envelope. The inner rings, associated with the plasma
membrane, are the flagellar powerhouse for activating the filament. The outer rings in the peptidoglycan and outer
membrane are support rings or "bushings" for the rod. The filament rotates and contracts which propels and steers
the cell during movement. Compare with Figure 21 below.

Flagella may be variously distributed over the surface of bacterial cells in distinguishing patterns, but
basically flagella are either polar (one or more flagella arising from one or both poles of the cell) or
peritrichous (lateral flagella distributed over the entire cell surface). Flagellar distribution is a
genetically-distinct trait that is occasionally used to characterize or distinguish bacteria. For example,
among Gram-negative rods, pseudomonads have polar flagella to distinguish them from enteric
bacteria, which have peritrichous flagella.

Figure 5. Different arrangements of bacterial flagella. Swimming motility, powered by flagella, occurs in half the
bacilli and most of the spirilla. Flagellar arrangements, which can be determined by staining and microscopic
observation, may be a clue to the identity of a bacterium. See Figure 6 below.

Flagella were proven to be organelles of bacterial motility by shearing them off (by mixing cells in a
blender) and observing that the cells could no longer swim although they remained viable. As the
flagella were regrown and reached a critical length, swimming movement was restored to the cells. The
flagellar filament grows at its tip (by the deposition of new protein subunits) not at its base (like a hair).

Procaryotes are known to exhibit a variety of types of tactic behavior, i.e., the ability to move (swim)
in response to environmental stimuli. For example, during chemotaxis a bacterium can sense the
quality and quantity of certain chemicals in its environment and swim towards them (if they are useful
nutrients) or away from them (if they are harmful substances). Other types of tactic response in
procaryotes include phototaxis, aerotaxis and magnetotaxis. The occurrence of tactic behavior
provides evidence for the ecological (survival) advantage of flagella in bacteria and other procaryotes.

26
Detecting Bacterial Motility

Since motility is a primary criterion for the diagnosis and identification of bacteria, several techniques
have been developed to demonstrate bacterial motility, directly or indirectly.

1. flagellar stains outline flagella and show their pattern of distribution. If a bacterium possesses
flagella, it is presumed to be motile.

Figure 6. Flagellar stains of three bacteria a. Bacillus cereus b. Vibrio cholerae c. Bacillus brevis.(CDC). Since the
bacterial flagellum is below the resolving power of the light microscope, although bacteria can be seen swimming in
a microscope field, the organelles of movenent cannot be detected. Staining techniques such as Leifson's method
utilize dyes and other components that precipitate along the protein filament and hence increase its effective
diameter. Fkagellar distribution is occasionally used to differentiate between morphologically related bacteria. For
example, among the Gram-negative motile rod-shaped bacteria, the enterics have peritrichous flagella while the
pseudomonads have polar flagella.

2. motility test medium demonstrates if cells can swim in a semisolid medium. A semisolid medium is
inoculated with the bacteria in a straight-line stab with a needle. After incubation, if turbidity
(cloudiness) due to bacterial growth can be observed away from the line of the stab, it is evidence that
the bacteria were able to swim through the medium.

OFF THE WALL. Julius Adler exploited this observation during his studies of chemotaxis in E. coli. He prepared a
gradient of glucose by allowing the sugar to diffuse into a semisolid medium from a central point in the medium.
This established a concentration gradient of glucose along the radius of diffusion. When E. coli cells were seeded in
the medium at the lowest concentration of glucose (along the edge of the circle), they swam up the gradient towards a
higher concentration (the center of the circle), exhibiting their chemotactic response to swim towards a useful
nutrient. Later, Adler developed a tracking microscope that could record and film the track that E. coli takes as it
swims towards a chemotactic attractant or away from a chemotactic repellent. This led to an understanding of the
mechanisms of bacterial chemotaxis, first at a structural level, then at a biomolecular level.

3. direct microscopic observation of living bacteria in a wet mount. One must look for transient
movement of swimming bacteria. Most uincellular bacteria, because of their small size, will shake back
and forth in a wet mount observed at 400X or 1000X. This is Brownian movement, due to random
collisions between water molecules and bacterial cells. True motility is confirmed by observing the
bacterium swim from one side of the microscope field to the other side.

27
Figure 7. A Desulfovibrio species. TEM. About 15,000X. The bacterium is motile by means of a single polar
flagellum. Of course, one can determine the presence of flagella by means of electron microscopy. Perhaps this is an
alternative way to determine bacterial motility, if you happen to have an electron microscope.

Fimbriae

Fimbriae and pili are interchangeable terms used to designate short, hair-like structures on the surfaces
of procaryotic cells. Like flagella, they are composed of protein. Fimbriae are shorter and stiffer than
flagella, and slightly smaller in diameter. Generally, fimbriae have nothing to do with bacterial
movement (there are exceptions, e.g twitching movement on Pseudomonas) . Fimbriae are very
common in Gram-negative bacteria, but occur in some archaea and Gram-positive bacteria as well.
Fimbriae are most often involved in adherence of bacteria to surfaces, substrates and other cells or
tissues in nature. In E. coli, a specialized type of pilus, the F or sex pilus, mediates the transfer of DNA
between mating bacteria during the process of conjugation, but the function of the smaller, more
numerous common pili is quite different.

Common pili (almost always called fimbriae) are usually involved in specific adherence (attachment)
of procaryotes to surfaces in nature. In medical situations, they are major determinants of bacterial
virulence because they allow pathogens to attach to (colonize) tissues and/or to resist attack by
phagocytic white blood cells. For example, pathogenic Neisseria gonorrhoeae adheres specifically to
the human cervical or urethral epithelium by means of its fimbriae; enterotoxigenic strains of E. coli
adhere to the mucosal epithelium of the intestine by means of specific fimbriae; the M-protein and
associated fimbriae of Streptococcus pyogenes are involved in adherence and to resistance to
engulfment by phagocytes (See Figure 1b above).

Figure 8. Fimbriae (common pili) and flagella on the surface of bacterial cells. Left: dividing Shigella enclosed in
fimbriae. The structures are probably involved in the bacterium's ability to adhere to the intestinal surface. Right:
dividing pair of Salmonella displaying both its peritrichous flagella and its fimbriae. The fimbriae are much shorter
and slightly smaller in diameter than flagella. Both Shigella and Salmonella are enteric bacteria that cause different

28
types of intestinal diarrheas.The bacteria can be differentiated by a motility test. Salmonella is motile; Shigella is
nonmotile.

Table 2. Some properties of pili and fimbriae.

Typical number Distribution on cell

Bacterial species where observed Function
on cell surface
mediates DNA transfer during
Escherichia coli (F or sex pilus) 1-4 uniform
conjugation
Escherichia coli (common pili or surface adherence to epithelial cells of
100-200 uniform
Type 1 fimbriae) the GI tract
surface adherence to epithelial cells of
Neisseria gonorrhoeae 100-200 uniform
the urogenital tract
Streptococcus pyogenes (fimbriae plus adherence, resistance to phagocytosis;
? uniform
the M-protein) antigenic variability
Pseudomonas aeruginosa 10-20 polar surface adherence
Sulfolobus acidocaldarius
? ? attachment to sulfur particles
(an archean)

The Cell Envelope

The cell envelope is a descriptive term for the several layers of material that envelope or enclose the
protoplasm of the cell. The cell protoplasm (cytoplasm) is surrounded by the plasma membrane, a
cell wall and a capsule. The cell wall itself is a layered structure in Gram-negative bacteria. All cells
have a membrane, which is the essential and definitive characteristic of a "cell". Almost all procaryotes
have a cell wall to prevent damage to the underlying protoplast. Outside the cell wall, foremost as a
surface structure, may be a polysaccharide capsule, or at least a glycocalyx.

Figure 9. Profiles of the cell envelope the Gram-positive and Gram-negative bacteria. The Gram-positive wall is a
uniformly thick layer external to the plasma membrane. It is composed mainly of peptidoglycan (murein). The
Gram-negative wall appears thin and multilayered. It consists of a relatively thin peptidoglycan sheet between the
plasma membrane and a phospholipid-lipopolysaccharide outer membrane. The space between the inner (plasma)
and outer membranes (wherein the peptidoglycan resides) is called the periplasm.

Capsules

Most procaryotes contain some sort of a polysaccharide layer outside of the cell wall polymer. In a
general sense, this layer is called a capsule. A true capsule is a discrete detectable layer of
polysaccharides deposited outside the cell wall. A less discrete structure or matrix which embeds the
cells is a called a slime layer or a biofilm. A type of capsule found in bacteria called a glycocalyx is a
thin layer of tangled polysaccharide fibers which is almost always observed on the surface of cells
growing in nature (as opposed to the laboratory).

29
Figure 10. Bacterial capsules outlined by India ink viewed by light microscopy. This is a true capsule, a discrete layer
of polysaccharide surrounding the cells. Sometimes bacterial cells are embedded more randomly in a polysaccharide
matrix called a slime layer or biofilm. Polysaccharide films that may inevitably be present on the surfaces of
bacterial cells, but which cannot be detected visually, are called glycocalyx.

Figure 11. Negative stain of Streptococcus pyogenes viewed by transmission electron microscopy (28,000X). The halo
around the chain of cells is the hyaluronic acid capsule that surrounds the exterior of the bacteria. The septa
between dividing pairs of cells may also be seen. Electron micrograph of Streptococcus pyogenes by Maria Fazio and
Vincent A. Fischetti, Ph.D. with permission. The Laboratory of Bacterial Pathogenesis and Immunology, Rockefeller
University.

Capsules are generally composed of polysaccharide; rarely they contain amino sugars or peptides (see
Table 3).

Table 3. Chemical composition of some bacterial capsules.

Bacterium Capsule composition Structural subunits

Gram-positive Bacteria
Bacillus anthracis polypeptide (polyglutamic acid) D-glutamic acid
Bacillus megaterium polypeptide and polysaccharide D-glutamic acid, amino sugars, sugars
Streptococcus mutans polysaccharide (dextran) glucose

30
Streptococcus pneumoniae polysaccharides sugars, amino sugars, uronic acids
Streptococcus pyogenes polysaccharide (hyaluronic acid) N-acetyl-glucosamine and glucuronic acid
Gram-negative Bacteria
Acetobacter xylinum polysaccharide (cellulose) glucose
Escherichia coli polysaccharide (colonic acid) glucose, galactose, fucose glucuronic acid
Pseudomonas aeruginosa polysaccharide mannuronic acid
Azotobacter vinelandii polysaccharide glucuronic acid
Agrobacterium tumefaciens polysaccharide (glucan) glucose

Capsules have several functions and often have multiple functions in a particular organism. Like
fimbriae, capsules, slime layers, and glycocalyx often mediate adherence of cells to surfaces.
Capsules also protect bacterial cells from engulfment by predatory protozoa or white blood cells
(phagocytes), or from attack by antimicrobial agents of plant or animal origin. Capsules in certain soil
bacteria protect cells from perennial effects of drying or desiccation. Capsular materials (e.g.
dextrans) may be overproduced when bacteria are fed sugars to become reserves of carbohydrate for
subsequent metabolism.

Figure 12. Colonies of Bacillus anthracis. The slimy or mucoid appearance of a bacterial colony is usually evidence of
capsule production. In the case of B. anthracis, the capsule is composed of poly-D-glutamate. The capsule is an
essential determinant of virulence to the bacterium. In the early stages of colonization and infection the capsule
protects the bacteria from assaults by the immune and phagocytic systems.

Some bacteria produce slime materials to adhere and float themselves as colonial masses in their
environments. Other bacteria produce slime materials to attach themselves to a surface or substrate.
Bacteria may attach to surface, produce slime, divide and produce microcolonies within the slime layer,
and construct a biofilm, which becomes an enriched and protected environment for themselves and
other bacteria.

A classic example of biofilm construction in nature is the formation of dental plaque mediated by the
oral bacterium, Streptococcus mutans. The bacteria adhere specifically to the pellicle of the tooth by
means of a protein on the cell surface. The bacteria grow and synthesize a dextran capsule which binds
them to the enamel and forms a biofilm some 300-500 cells in thickness. The bacteria are able to cleave
sucrose (provided by the animal diet) into glucose plus fructose. The fructose is fermented as an energy
source for bacterial growth. The glucose is polymerized into an extracellular dextran polymer that
cements the bacteria to tooth enamel and becomes the matrix of dental plaque. The dextran slime can
31
be depolymerized to glucose for use as a carbon source, resulting in production of lactic acid within the
biofilm (plaque) that decalcifies the enamel and leads to dental caries or bacterial infection of the tooth.

Another important characteristic of capsules may be their ability to block some step in the phagocytic
process and thereby prevent bacterial cells from being engulfed or destroyed by phagocytes. For
example, the primary determinant of virulence of the pathogen Streptococcus pneumoniae is its
polysaccharide capsule, which prevents ingestion of pneumococci by alveolar macrophages. Bacillus
anthracis survives phagocytic engulfment because the lysosomal enzymes of the phagocyte cannot
initiate an attack on the poly-D-glutamate capsule of the bacterium. Bacteria such as Pseudomonas
aeruginosa, that construct a biofilm made of extracellular slime when colonizing tissues, are also
resistant to phagocytes, which cannot penetrate the biofilm.

Cell Wall

Most procaryotes have a rigid cell wall. The cell wall is an essential structure that protects the cell
protoplast from mechanical damage and from osmotic rupture or lysis. Procaryotes usually live in
relatively dilute environments such that the accumulation of solutes inside the procaryotic cell
cytoplasm greatly exceeds the total solute concentration in the outside environment. Thus, the osmotic
pressure against the inside of the plasma membrane may be the equivalent of 10-25 atm. Since the
membrane is a delicate, plastic structure, it must be restrained by an outside wall made of porous, rigid
material that has high tensile strength. Such a material is murein, the ubiquitous component of
bacterial cell walls.

The cell walls of bacteria deserve special attention for several reasons:
1. They are an essential structure for viability, as described above.
2. They are composed of unique components found nowhere else in nature.
3. They are one of the most important sites for attack by antibiotics.
4. They provide ligands for adherence and receptor sites for drugs or viruses.
5. They cause symptoms of disease in animals.
6. They provide for immunological distinction and immunological variation among strains of bacteria.

The cell walls of all Bacteria contain a unique type of peptidoglycan called murein. Peptidoglycan is
a polymer of disaccharides (a glycan) cross-linked by short chains of amino acids (peptides), and many
types of peptidoglycan exist. All Bacterial peptidoglycans contain N-acetylmuramic acid, which is
the definitive component of murein. The cell walls of Archaea may be composed of protein,
polysaccharides, or peptidoglycan-like molecules, but never do they contain murein. This feature
distinguishes the Bacteria from the Archaea.

The profiles of the cell walls of Bacteria, as seen with the electron microscope, are redrawn in Figure
5. In the Gram-positive Bacteria (those that retain the purple crystal violet dye when subjected to the
Gram-staining procedure) the cell wall is thick (15-80 nanometers), consisting of several layers of
peptidoglycan. In the Gram-negative Bacteria (which do not retain the crystal violet) the cell wall is
relatively thin (10 nanometers) and is composed of a single layer of peptidoglycan surrounded by a
membranous structure called the outer membrane. The outer membrane of Gram-negative bacteria
invariably contains a unique component, lipopolysaccharide (LPS or endotoxin), which is toxic to
animals. In Gram-negative bacteria the outer membrane is usually thought of as part of the cell wall.

Peptidoglycan structure and arrangement in E. coli is representative of all Enterobacteriaceae, and

many other Gram-negative bacteria, as well. The glycan backbone is made up of alternating molecules
of N-acetylglucosamine (G) and N-acetylmuramic acid (M) connected by a beta1,4-glycoside bond.
32
The 3-carbon of N-acetylmuramic acid (M) is substituted with a lactyl ether group derived from
pyruvate. The lactyl ether connects the glycan backbone to a peptide side chain that contains L-alanine,
(L-ala), D-glutamate (D-glu), Diaminopimelic acid (DAP), and D-alanine (D-ala). MurNAc is unique
to bacterial cell walls, as is D-glu, DAP and D-ala. The muramic acid subunit of E. coli is shown in
Figure 13 below.

Figure 13. The structure of the muramic acid subunit of the peptidoglycan of Escherichia coli. This is the type of
murein found in most Gram-negative bacteria. The glycan backbone is a repeat polymer of two amino sugars, N-
acetylglucosamine (G) and N-acetylmuramic acid (M). Attached to the N-acetylmuramic acid is a tetrapeptide
consisting of L-ala-D-glu-DAP-D-ala.b. Abbreviated structure of the muramic acid subunit. c. Nearby tetrapeptide
side chains may be linked to one another by an interpeptide bond between DAP on one chain and D-ala on the other.
d. The polymeric form of the molecule.

Strands of murein are assembled in the periplasm from about 10 muramic acid subunits. Then the
strands are connected to form a continuous glycan molecule that encompasses the cell. Wherever their
proximity allows it, the tetrapeptide chains that project from the glycan backbone can be cross-linked
by an interpeptide bond between a free amino group on DAP and a free carboxy group on a nearby D-
ala. The assembly of peptidoglycan on the outside of the plasma membrane is mediated by a group of
periplasmic enzymes which are transglycosylases, transpeptidases and carboxypeptidases. The
mechanism of action of penicillin and related beta-lactam antibiotics is to block transpeptidase and
carboxypeptidase enzymes during their assembly of the murein cell wall. Hence, the beta lactam
antibiotic are said to "block cell wall synthesis" in the bacteria.

The glycan backbone of the peptidoglycan molecule can be cleaved by an enzyme called lysozyme that
is present in animal serum, tissues and secretions, and in the phagocytic lysosome. The function of
lysozyme is to lyse bacterial cells as a constitutive defense against bacterial pathogens. Some Gram-
positive bacteria are very sensitive to lysozyme and the enzyme is quite active at low concentrations.
Lachrymal secretions (tears) can be diluted 1:40,000 and retain the ability to lyse certain bacterial cells.
Gram-negative bacteria are less vulnerable to attack by lysozyme because their peptidoglycan is
shielded by the outer membrane. The exact site of lysozymal cleavage is the beta 1,4 bond between N-
acetylmuramic acid (M) and N-acetylglucosamine (G) , such that the muramic acid subunit shown in
Figure 13(a) is the result of the action of lysozyme on bacterial peptidoglycan.

33
In Gram-positive bacteria there are numerous different peptide arrangements among peptidoglycans.
The best studied is the murein of Staphylococcus aureus shown in Figure 14 below. In place of DAP
(in E. coli) is the diamino acid, L-lysine (L-lys), and in place of the interpeptide bond (in Gram-
negatives) is an interpeptide bridge of amino acids that connects a free amino group on lysine to a
free carboxy group on D-ala of a nearby tetrapeptide side chain. This arrangement apparently allows
for more frequent cross-bonding between nearby tetrapeptide side chains. In S. aureus, the interpeptide
bridge is a peptide consisting of 5 glycine molecules (called a pentaglycine bridge). Assembly of the
interpeptide bridge in Gram-positive murein is inhibited by the beta lactam antibiotics in the same
manner as the interpeptide bond in Gram-negative murein. Gram-positive bacteria are more sensitive to
penicillin than Gram-negative bacteria because the peptidoglycan is not protected by an outer
membrane and it is a more abundant molecule. In Gram-positive bacteria, peptidoglycans may vary in
the amino acid in place of DAP or L-lys in position 3 of the tetrapeptide, and in the exact composition
of the interpeptide bridge. At least eight different types of peptidoglycan exist in Gram-positive
bacteria.

Figure 14. Schematic diagram of the peptidoglycan sheet of Staphylococcus aureus. G = N-acetyl-glucosamine; M =
N-acetyl-muramic acid; L-ala = L-alanine; D-ala = D-alanine; D-glu = D-glutamic acid; L-lys = L-lysine. This is one
type of murein found in Gram-positive bacteria. Compared to the E. coli peptidoglycan (Figure 7) there is L-lys in
place of DAP (diaminopimelic acid) in the tetrapeptide. The free amino group of L-lys is substituted with a glycine
pentapeptide (gly-gly-gly-gly-gly-) which then becomes an interpeptide bridge forming a link with a carboxy group
from D-ala in an adjacent tetrapeptide side chain. Gram-positive peptidoglycans differ from species to species,
mainly in regards to the amino acids in the third position of the tetrapeptide side chain and in the amino acid
composition of the interpeptide bridge.

Gram-negative bacteria may contain a single monomolecular layer of murein in their cell walls while
Gram-positive bacteria are thought to have several layers or "wraps" of peptidoglycan. Closely
associated with the layers of peptidoglycan in Gram-positive bacteria are a group of molecules called
teichoic acids. Teichoic acids are linear polymers of polyglycerol or polyribitol substituted with
phosphates and a few amino acids and sugars. The teichoic acid polymers are occasionally anchored to
the plasma membrane (called lipoteichoic acids) apparently directed outward at right angles to the
layers of peptidoglycan. The functions of teichoic acid are not known. They are essential to viability of
Gram-positive bacteria in the wild. One idea is that they provide a channel of regularly-oriented
negative charges for threading positively charged substances through the complicated peptidoglycan
network. Another theory is that teichoic acids are in some way involved in the regulation and assembly
of muramic acid subunits on the outside of the plasma membrane. There are instances, particularly in

34
the streptococci, wherein teichoic acids have been implicated in the adherence of the bacteria to tissue
surfaces.

The Outer Membrane of Gram-negative Bacteria

Of special interest as a component of the Gram-negative cell wall is the outer membrane, a discrete
bilayered structure on the outside of the peptidoglycan sheet (see Figure 15 below). For the bacterium,
the outer membrane is first and foremost a permeability barrier, but primarily due to its
lipopolysaccharide content, it possesses many interesting and important characteristics of Gram-
negative bacteria. The outer membrane is a lipid bilayer intercalated with proteins, superficially
resembling the plasma membrane. The inner face of the outer membrane is composed of phospholipids
similar to the phosphoglycerides that compose the plasma membrane. The outer face of the outer
membrane may contain some phospholipid, but mainly it is formed by a different type of amphiphilic
molecule which is composed of lipopolysaccharide (LPS). Outer membrane proteins usually traverse
the membrane and in one case, anchor the outer membrane to the underlying peptidoglycan sheet.

Figure 15. Schematic illustration of the outer membrane, cell wall and plasma membrane of a Gram-negative
bacterium. Note the structure and arrangement of molecules that constitute the outer membrane.

The LPS molecule that constitutes the outer face of the outer membrane is composed of a hydrophobic
region, called Lipid A, that is attached to a hydrophilic linear polysaccharide region, consisting of the
core polysaccharide and the O-specific polysaccharide.

Figure 16. Structure of LPS

The Lipid A head of the molecule inserts into the interior of the membrane, and the polysaccharide tail
of the molecule faces the aqueous environment. Where the tail of the molecule inserts into the head
there is an accumulation of negative charges such that a magnesium cation is chelated between adjacent
LPS molecules. This provides the lateral stability for the outer membrane, and explains why treatment
of Gram-negative bacteria with a powerful chelating agent, such as EDTA, causes dispersion of LPS
molecules.

35
Bacterial lipopolysaccharides are toxic to animals. When injected in small amounts LPS or endotoxin
activates macrophages to produce pyrogens, activates the complement cascade causing inflammation,
and activates blood factors resulting in intravascular coagulation and hemorrhage. Endotoxins may play
a role in infection by any Gram-negative bacterium. The toxic component of endotoxin (LPS) is Lipid
A. The O-specific polysaccharide may provide ligands for bacterial attachment and confer some
resistance to phagocytosis. Variation in the exact sugar content of the O polysaccharide (also referred
to as the O antigen) accounts for multiple antigenic types (serotypes) among Gram-negative bacterial
pathogens. Therefore. even though Lipid A is the toxic component in LPS, the polysaccharides
nonetheless contribute to virulence of Gram-negative bacteria.

The proteins in the outer membrane of Escherichia coli are well characterized (see Table 4). About
400,00 copies of the Braun lipoprotein are covalently attached to the peptidoglycan sheet at one end
and inserted into the hydrophobic interior of the membrane at the opposite end. A group of trimeric
proteins called porins form pores of a fixed diameter through the lipid bilayer of the membrane. The
omp C and omp F porins of E. coli are designed to allow passage of hydrophilic molecules up to mw
of about 750 daltons. Larger molecules or harmful hydrophobic compounds (such as bile salts in the
intestinal tract) are excluded from entry. Porins are designed in Gram-negative bacteria to allow
passage of useful molecules (nutrients) through the barrier of the outer membrane, but to exclude
passage harmful substances from the environment. The ubiquitous omp A protein in the outer
membrane of E. coli has a porin like structure, and may function in uptake of specific ions, but it is also
a receptor for the F pilus and an attachment site for bacterial viruses.

Table 4. Functions of the outer membrane components of Escherichia coli.

Component Function
Lipopolysaccharide
Permeability barrier
(LPS)
Mg++ bridges Stabilizes LPS and is essential for its permeability characteristics
Braun lipoprotein Anchors the outer membrane to peptidoglycan (murein) sheet
proteins that form pores or channels through outer membrane for passage of hydrophilic
Omp C and Omp F porins
molecules
Omp A protein provides receptor for some viruses and bacteriocins; stabilizes mating cells during conjugation

A correlation between Gram stain reaction and cell wall properties of bacteria is summarized in Table
5. The Gram stain procedure contains a "destaining" step wherein the cells are washed with an acetone-
alcohol mixture. The lipid content of the Gram-negative wall probably affects the outcome of this step
so that Gram-positive cells retain a primary stain while Gram-negative cells are destained.

Table 5. Correlation of Grams stain with other properties of Bacteria.

Property Gram-positive Gram-negative

Thickness of wall thick (20-80 nm) thin (10 nm)
Number of layers 1 2
Peptidoglycan (murein) content >50% 10-20%
Teichoic acids in wall present absent
Lipid and lipoprotein content 0-3% 58%
Protein content 0 9%
Lipopolysaccharide content 0 13%

36
Sensitivity to Penicillin G yes no (1)
Sensitivity to lysozyme yes no (2)

(1) A few Gram-negative bacteria are sensitive to natural penicillins. Many Gram-negative bacteria are sensitive to some
type of penicillin, especially semisynthetic penicillins. Gram-negative bacteria, including E. coli, can be made sensitive to
natural penicillin by procedures that disrupt the permeability characteristics of the outer membrane.
(2) Gram-negative bacteria are sensitive to lysozyme if pretreated by some procedure that removes the outer membrane and
exposes the peptidoglycan directly to the enzyme.

Cell Wall-less Forms

A few bacteria are able to live or exist without a cell wall. The mycoplasmas are a group of bacteria
that lack a cell wall. Mycoplasmas have sterol-like molecules incorporated into their membranes and
they are usually inhabitants of osmotically-protected environments. Mycoplasma pneumoniae is the
cause of primary atypical bacterial pneumonia, known in the vernacular as "walking pneumonia". For
obvious reasons, penicillin is ineffective in treatment of this type of pneumonia. Sometimes, under the
pressure of antibiotic therapy, pathogenic streptococci can revert to cell wall-less forms (called
spheroplasts) and persist or survive in osmotically-protected tissues. When the antibiotic is withdrawn
from therapy the organisms may regrow their cell walls and reinfect unprotected tissues.

The Plasma Membrane

The plasma membrane, also called the cytoplasmic membrane, is the most dynamic structure of a
procaryotic cell. Its main function is a s a selective permeability barrier that regulates the passage of
substances into and out of the cell. The plasma membrane is the definitive structure of a cell since it
sequesters the molecules of life in a unit, separating it from the environment. The bacterial membrane
allows passage of water and uncharged molecules up to mw of about 100 daltons, but does not allow
passage of larger molecules or any charged substances except by means special membrane transport
processes and transport systems.

Since procaryotes lack any intracellular organelles for processes such as respiration or photosynthesis
or secretion, the plasma membrane subsumes these processes for the cell and consequently has a
variety of functions in energy generation, and biosynthesis. For example, the electron transport
system that couples aerobic respiration and ATP synthesis is found in the procaryotic membrane.
The photosynthetic chromophores that harvest light energy for conversion into chemical energy are
located in the membrane. Hence, the plasma membrane is the site of oxidative phosphorylation and
photophosphorylation in procaryotes, analogous to the functions of mitochondria and chloroplasts in
eukaryotic cells. Besides transport proteins that selectively mediate the passage of substances into
and out of the cell, procaryotic membranes may contain sensing proteins that measure concentrations
of molecules in the environment or binding proteins that translocate signals to genetic and metabolic
machinery in the cytoplasm. Membranes also contain enzymes involved in many metabolic processes
such as cell wall synthesis, septum formation, membrane synthesis, DNA replication, CO2 fixation and
ammonia oxidation. The predominant functions of bacterial membranes are listed in the table below.

Table 6. Functions of the procaryotic plasma membrane.

1. Osmotic or permeability barrier

2. Location of transport systems for specific solutes (nutrients and ions)

37
 3. Energy generating functions, involving respiratory and photosynthetic electron transport systems, establishment
of proton motive force, and transmembranous, ATP-synthesizing ATPase

4. Synthesis of membrane lipids (including lipopolysaccharide in Gram-negative cells)

5. Synthesis of murein (cell wall peptidoglycan)

6. Assembly and secretion of extracytoplasmic proteins

7. Coordination of DNA replication and segregation with septum formation and cell division

8. Chemotaxis (both motility per se and sensing functions)

9. Location of specialized enzyme system

Bacterial membranes are composed of 40 percent phospholipid and 60 percent protein. The
phospholipids are amphoteric molecules with a polar hydrophilic glycerol "head" attached via an ester
bond to two nonpolar hydrophobic fatty acid tails, which naturally form a bilayer in aqueous
environments. Dispersed within the bilayer are various structural and enzymatic proteins which carry
out most membrane functions. At one time, it was thought that the proteins were neatly organized along
the inner and outer faces of the membrane and that this accounted for the double track appearance of
the membrane in electron micrographs. However, it is now known that while some membrane proteins
are located and function on one side or another of the membrane, most proteins are partly inserted into
the membrane, or possibly even traverse the membrane as channels from the outside to the inside. It is
possible that proteins can move laterally along a surface of the membrane, but it is thermodynamically
unlikely that proteins can be rotated within a membrane, which discounts early theories of how
transport systems might work. The arrangement of proteins and lipids to form a membrane is called the
fluid mosaic model, and is illustrated in Figure 17.

The membranes of Bacteria are structurally similar to the cell membranes of eukaryotes, except that
bacterial membranes consist of saturated or monounsaturated fatty acids (rarely, polyunsaturated fatty
acids) and do not normally contain sterols (Figure 11a). The membranes of Archaea form bilayers
functionally equivalent to bacterial membranes, but archaeal lipids are saturated, branched, repeating
isoprenoid subunits that attach to glycerol via an ether linkage as opposed to the ester linkage found in
glycerides of eukaryotic and bacterial membrane lipids (Figure 18). The structure of archaeal
membranes is thought to be an adaptation to their existence and survival in extreme environments.

Figure 17. Fluid mosaic model of a biological membrane. In aqueous environments membrane phospholipids
arrange themselves in such a way that they spontaneously form a fluid bilayer. Membrane proteins, which may be
structural or functional, may be permanently or transiently associated with one side or the other of the membrane,
38
or even be permanently built into the bilayer, while other proteins span the bilayer and may form transport channels
through the membrane.

Figure 18. Generalized structure of a membrane lipids. (top). A phospholipid in the membrane of the bacterium
Escherichia coli. The R1 and R2 positions on glycerol are substituted with saturated or monounsaturated fatty acids,
with ester linkages to the glyceride. The R3 position is substituted with phosphatidylethanolamine, the most common
substituent in this position in Bacteria. (bottom). An Archaeal membrane lipid. In contrast to bacterial
phospholipids, which are glycerol esters of fatty acids, the lipids in membranes of Archaea are diethers of glycerol
and long-chain, branched, saturated hydrocarbons called isoprenoids or which are made up of repeating C5
subunits. One of the major isoprenoids is the C20 molecule phytanol. The R3 position of glycerol may or may not be
substituted. The structure of archaeal membrane lipids is thought to be an adaptation to extreme environments such
as hot and acidic conditions where Archaea prevail in nature.

Transport Processes

The proteins that mediate the passage of solutes through membranes are referred to variously as
transport systems, carrier proteins, porters, and permeases. Transport systems operate by one of
three transport processes as described below in Figure 19. In a uniport process, a solute passes
through the membrane unidirectionally. In symport processes (also called cotransport) two solutes
must be transported in the same direction at the same time; in antiport processes ( also called
exchange diffusion), one solute is transported in one direction simultaneously as a second solute is
transported in the opposite direction.

39
Figure 19. Transport processes in bacterial cells. Solutes enter or exit from bacterial cells by means of one of three
processes: uniport, symport (also called cotransport) and antiport (also called exchange diffusion). Transport
systems (Figure 13 below) operate by one or another of these processes.

Types of Transport Systems

Bacteria have a variety of types of transport systems which can be used alternatively in various
environmental situations. The elaborate development of transport processes and transport systems in
procaryotes probably reflects their need to concentrate substances inside the cytoplasm against the
concentration (gradient) of the environment. Concentration of solutes in the cytoplasm requires the
operation of an active transport system, of which there are two types in bacteria: ion driven
transport systems (IDT) and binding-protein dependent transport systems (BPDT). The definitive
feature of an active transport system is the accumulation of the solute in the cytoplasm at
concentrations far in excess of the environment. According to the laws of physical chemistry, this type
of process requires energy.

Figure 20. Operation of bacterial transport systems. Bacterial transport systems are operated by transport proteins
(sometimes called carriers, porters or permeases) in the plasma membrane. Facilitated diffusion is a carrier-
mediated system that does not require energy and does not concentrate solutes against a gradient. Active transport
systems such as Ion-driven transport and Binding protein-dependent transport, use energy and concentrate
molecules against a concentration gradient. Group translocation systems, such as the phosphotransferase (pts)
system in Escherichia coli, use energy during transport and modify the solute during its passage across the
membrane.

There are four types of carrier-mediated transport systems in procaryotes. The carrier is a protein (or
group of proteins) that functions in the passage of a small molecule from one side of a membrane to the
other side. A transport system may be a single transmembranous protein that forms a channel that
admits passage of a specific solute, or it may be a coordinated system of proteins that binds and
sequentially passes a small molecule through the membrane. Transport systems have the property of
specificity for the solute transported. Some transport systems transport a single solute with the same
specificity and kinetics as an enzyme. Some transport systems will transport (structurally) related
molecules, although at reduced efficiency compared to their primary substrate. Most transport systems
transport specific sugars, amino acids, anions or cations that are of nutritional value to the bacterium.

40
Facilitated diffusion systems (FD) arethe least common type of transport system in bacteria. Actually,
the glycerol uniporter in E. coli is the only well known facilitated diffusion system. FD involves the
passage of a specific solute through a carrier that forms a channel in the membrane. The solute can
move in either direction through the membrane to the point of of equilibrium on both sides of the
membrane. Although the system is carrier-mediated and specific, no energy is expended in the
transport process. For this reason the glycerol molecule cannot be accumulated against the
concentration gradient.

Ion driven transport systems (IDT) and Binding-protein dependent transport systems (BPDT) are
active transport systems that are used for transport of most solutes by bacterial cells. IDT is used for
accumulation of many ions and amino acids; BPDT is frequently used for sugars and amino acids. IDT
is a symport or antiport process that uses a hydrogen ion (H+) i.e., proton motive force (pmf), or some
other cation, i.e.,chemiosmotic potential, to drive the transport process. IDT systems such as the lactose
permease of E. coli utilize the consumption of a hydrogen ion during the transport of lactose. Thus the
energy expended during active transport of lactose is in the form of pmf. The lactose permease is a
single transmembranous polypeptide that spans the membrane seven times forming a channel that
specifically admits lactose.

Binding-protein dependent transport systems (BPDT), such as the histadine transport system in E.
coli, are composed of four proteins. Two proteins form a membrane channel that allows passage of the
histadine. A third protein resides in the periplasmic space where it is able to bind the amino acid and
pass it to a forth protein which admits the amino acid into the membrane channel. Driving the solute
through the channel involves the expenditure of energy, which is provided by the hydrolysis of ATP.

Group translocation systems (GT), more commonly known as the phosphotransferase system (PTS)
in E. coli, are used primarily for the transport of sugars. Like binding protein-dependent transport
systems, they are composed of several distinct components. However, GT systems specific for one
sugar may share some of their components with other group transport systems. In E. coli, glucose may
be transported by a group translocation process that involves the phosphotransferase system. The actual
carrier in the membrane is a protein channel fairly specific for glucose. Glucose specifically enters the
channel from the outside, but in order to exit into the cytoplasm, it must first be phosphorylated by the
phosphotransferase system. The PTS derives energy from the metabolic intermediate phosphoenol
pyruvate (PEP). PEP is hydrolyzed to pyruvate and glucose is phosphorylated to form glucose-
phosphate during the process. Thus, by the expenditure of a single molecule of high energy phosphate,
glucose is transported and changed to glucose-phosphate.

Table 7. Distinguishing characteristics of bacterial transport systems.

PD = passive diffusion
FD = facilitated diffusion
IDT = ion-driven transport
BPDT = binding protein dependent transport
GT = group translocation

Property PD FD IDT BPDT GT

carrier mediated - + + + +
conc. against gradient - - + + NA
specificity - + + + +
energy expended - - pmf ATP PEP
solute modified during transport - - - - +
41
The plasma membrane of procaryotes may invaginate into the cytoplasm or form stacks or vesicles
attached to the inner membrane surface. These structures are sometimes referred to as mesosomes Such
internal membrane systems may be analogous to the cristae of mitochondria or the thylakoids of
chloroplasts which increase the surface area of membranes to which enzymes are bound for specific
enzymatic functions. The photosynthetic apparatus (light harvesting pigments and ATPase) of
photosynthetic procaryotes is contained in these types of membranous structures. Mesosomes may also
represent specialized membrane regions involved in DNA replication and segregation, cell wall
synthesis, or increased enzymatic activity. Membrane foldings and vesicles sometimes appear in
electron micrographs of procaryotic cells as artifacts of preparative techniques. These membranous
structures, of course, are not mesosomes, but their existence does not prove that mesosomes are not
present in procaryotes, and there are several examples of procaryotic membrane topology and
appearance that are suggestive of mesosomes.

There are a few antibiotics (e.g. polymyxin), hydrophobic agents (e.g. bile salts), and proteins (e.g.
complement) that can damage bacterial membranes.

Table 8. Representative periplasmic proteins in E. coli.

Binding proteins
For amino acids (e.g. histadine, arginine)
For sugars (e.g. glucose, maltose)
For vitamins (e.g. thiamine, vitamin B12)
For ions (e.g. phosphate, sulfate)

Biosynthetic enzymes
For murein assembly (e.g. transglycosylases, carboxypeptidases, transpeptidases)
For fimbrial subunit secretion and assembly (e.g. chaperonins)

Degradative enzymes
phosphatases
proteases

Detoxifying enzymes
Beta-lactamases (e.g. penicillinase)
Aminoglycoside-phosphorylating enzymes

42
Figure 21. Schematic view of the plasma membrane of Escherichia coli. The S and M rings which constitute the
flagellar motor are shown. The motor ring is imbedded in the phospholipid bilayer. It is powered by pmf to rotate
the flagellar filament. The electron transport system is shown oxidizing NAD by removal of a pair of electrons,
passing them through its sequence of carriers eventually to O2. ATPase is the transmembranous protein enzyme that
utilizes protons from the outside to synthesize ATP on the inside of the membrane. Several other transmembranous
proteins are transport systems which are operating by either symport or antiport processes.

The Cytoplasm

The cytoplasmic constituents of procaryotic cells invariably include the procaryotic chromosome and
ribosomes. The chromosome is typically one large circular molecule of DNA, more or less free in the
cytoplasm. Procaryotes sometimes possess smaller extrachromosomal pieces of DNA called plasmids.
The total DNA content of a procaryote is referred to as the cell genome. During cell growth and
division, the procaryotic chromosome is replicated in the usual semi-conservative fashion before for
distribution to progeny cells. However, the eukaryotic processes of meiosis and mitosis are absent in
procaryotes. Replication and segregation of procaryotic DNA is coordinated by the membrane, possibly
by mesosomes.

43
The distinct granular appearance of procaryotic cytoplasm is due to the presence and distribution of
ribosomes The ribosomes of procaryotes are smaller than cytoplasmic ribosomes of eukaryotes.
procaryotic ribosomes are 70S in size, being composed of 30S and 50S subunits. The 80S ribosomes of
eukaryotes are made up of 40S and 60S subunits. Ribosomes are involved in the process of translation
(protein synthesis), but some details of their activities differ in eukaryotes, Bacteria and Archaea.
Protein synthesis using 70S ribosomes occurs in eukaryotic mitochondria and chloroplasts, and this is
taken as a major line of evidence that these organelles are descended from procaryotes.

Table 9. Molecular composition of E. coli under conditions of balanced growth.

Molecule Percentage of dry weight

Protein 55

Total RNA 20.5

DNA 3.1

Phospholipid 9.1

Lipopolysaccharide 3.4

Murein 2.5

Glycogen 2.5

Small molecules: precursors, metabolites, vitamins, etc. 2.9

Inorganic ions 1.0

Total dry weight 100.0

Table 10. Small molecules present in a growing bacterial cell.

Molecule Approximate number of kinds

Amino acids, their precursors and derivatives 120

Nucleotides, their precursors and derivatives 100

Fatty acids and their precursors 50

Sugars, carbohydrates and their precursors or derivatives 250

quinones, porphyrins, vitamins, coenzymes and prosthetic groups and their precursors 300

Table 11. Inorganic ions present in a growing bacterial cell.

44
Ion Function
+
K Maintenance of ionic strength; cofactor for certain enzymes
+
NH4 Principal form of inorganic N for assimilation
++
Ca Cofactor for certain enzymes
++
Fe Present in cytochromes and other metalloenzymes
++
Mg Cofactor for many enzymes; stabilization of outer membrane of Gram-negative bacteria
Mn++ Present in certain metalloenzymes
Co++ Trace element constituent of vitamin B12 and its coenzyme derivatives and found in certain metalloenzymes
Cu++ Trace element present in certain metalloenzymes
Mo++ Trace element present in certain metalloenzymes
Ni++ Trace element present in certain metalloenzymes
++
Zn Trace element present in certain metalloenzymes
--
SO4 Principal form of inorganic S for assimilation
---
PO4 Principal form of P for assimilation and a participant in many metabolic reactions

Inclusions

Often contained in the cytoplasm of procaryotic cells is one or another of some type of inclusion
granule. Inclusions are distinct granules that may occupy a substantial part of the cytoplasm. Inclusion
granules are usually reserve materials of some sort. For example, carbon and energy reserves may be
stored as glycogen (a polymer of glucose) or as polybetahydroxybutyric acid (a type of fat) granules.
Polyphosphate inclusions are reserves of PO4 and possibly energy; elemental sulfur (sulfur globules)
are stored by some phototrophic and some lithotrophic procaryotes as reserves of energy or electrons.
Some inclusion bodies are actually membranous vesicles or intrusions into the cytoplasm which
contain photosynthetic pigments or enzymes.

Table 12. Some inclusions in bacterial cells.

Cytoplasmic inclusions Where found Composition Function

glycogen many bacteria e.g. E. coli polyglucose reserve carbon and energy source
polybetahydroxyutyric polymerized hydroxy
many bacteria e.g. Pseudomonas reserve carbon and energy source
acid (PHB) butyrate
polyphosphate (volutin many bacteria e.g. linear or cyclical reserve phosphate; possibly a
granules) Corynebacterium polymers of PO4 reserve of high energy phosphate
phototrophic purple and green reserve of electrons (reducing
sulfur globules sulfur bacteria and lithotrophic elemental sulfur source) in phototrophs; reserve
colorless sulfur bacteria energy source in lithotrophs
aquatic bacteria especially protein hulls or shells buoyancy (floatation) in the
gas vesicles
cyanobacteria inflated with gases vertical water column
endospore-forming bacilli (genus unknown but toxic to certain
parasporal crystals protein
Bacillus) insects
magnetite (iron oxide) orienting and migrating along
magnetosomes certain aquatic bacteria
Fe3O4 geo- magnetic field lines
enzymes for autotrophic
carboxysomes many autotrophic bacteria site of CO2 fixation
CO2 fixation
phycobilisomes cyanobacteria phycobiliproteins light-harvesting pigments
chlorosomes Green bacteria lipid and protein and light-harvesting pigments and

45
 bacteriochlorophyll antennae

Endospores

A bacterial structure sometimes observed as an inclusion is actually a type of dormant cell called an
endospore. Endospores are formed by a few groups of Bacteria as intracellular structures, but
ultimately they are released as free endospores. Biologically, endospores are a fascinating type of cell.
Endospores exhibit no signs of life, being described as cryptobiotic. They are highly resistant to
environmental stresses such as high temperature (some endospores can be boiled for hours and retain
their viability), irradiation, strong acids, disinfectants, etc. They are probably the most durable cell
produced in nature. Although cryptobiotic, they retain viability indefinitely such that under appropriate
environmental conditions, they germinate back into vegetative cells. Endospores are formed by
vegetative cells in response to environmental signals that indicate a limiting factor for vegetative
growth, such as exhaustion of an essential nutrient. They germinate and become vegetative cells when
the environmental stress is relieved. Hence, endospore-formation is a mechanism of survival rather
than a mechanism of reproduction.

Figure 22. Early and late stages of endospore formation. Drawing by Vaike Haas, University of Wisconsin Madison.
During endospore formation, a vegetative cell is converted to a heat-resistant spore. There are eight stages, O,I-VII,
in the sporulation cycle of a Bacillus species, and the process takes about eight hours. During the early stages (Stage
II,) one bacterial chromosome and a few ribosomes are partitioned off by the bacterial membrane to form a
protoplast within the mother cell. By the late stages (Stage VI) the protoplast (now called a forespore) has developed
a second membrane and several wall-like layers of material are deposited between the two membranes.

Table 13. Differences between endospores and vegetative cells.

Property Vegetative cells Endospores

Typical Gram-positive murein cell wall Thick spore coat, cortex, and peptidoglycan
Surface coats
polymer core wall

46
Microscopic appearance Nonrefractile Refractile
Calcium dipicolinic acid Absent Present in core
Cytoplasmic water activity High Very low
Enzymatic activity Present Absent
Macromolecular synthesis Present Absent
Heat resistance Low High
Resistance to chemicals and
Low High
acids
Radiation resistance Low High
Sensitivity to lysozyme Sensitive Resistant
Sensitivity to dyes and staining Sensitive Resistant

Figure 23. Bacterial endospores. Phase microscopy of sporulating bacteria demonstrates the refractility of
endospores, as well as characteristic spore shapes and locations within the mother cell.

Figure 24. Electron micrograph of a bacterial endospore. The spore has a core wall of unique peptidoglycan
surrounded by several layers, including the cortex, the spore coat and the exosporium. The dehydrated core contains
the bacterial chromosome and a few ribosomes and enzymes to jump-start protein synthesis and metabolism during
germination.

47
 Todar's Online Textbook of Bacteriology

NUTRITION AND GROWTH OF BACTERIA

© 2004 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

Nutritional Requirements of Cells

Every organism must find in its environment all of the substances required for energy generation and
cellular biosynthesis. The chemicals and elements of this environment that are utilized for bacterial
growth are referred to as nutrients or nutritional requirements. In the laboratory, bacteria are grown
in culture media which are designed to provide all the essential nutrients in solution for bacterial
growth.

The Major Elements

At an elementary level, the nutritional requirements of a bacterium such as E. coli are revealed by the
cell's elemental composition, which consists of C, H, O, N, S. P, K, Mg, Fe, Ca, Mn, and traces of Zn,
Co, Cu, and Mo. These elements are found in the form of water, inorganic ions, small molecules, and
macromolecules which serve either a structural or functional role in the cells. The general physiological
functions of the elements are outlined in Table 1 below.

Table 1. Major elements, their sources and functions in bacterial cells.

% of dry
Element Source Function
weight
organic compounds or
Carbon 50 Main constituent of cellular material
CO2
H2O, organic
Constituent of cell material and cell water; O2 is
Oxygen 20 compounds, CO2, and
electron acceptor in aerobic respiration
O2
NH3, NO3, organic Constituent of amino acids, nucleic acids nucleotides,
Nitrogen 14
compounds, N2 and coenzymes
H2O, organic
Hydrogen 8 Main constituent of organic compounds and cell water
compounds, H2
inorganic phosphates Constituent of nucleic acids, nucleotides,
Phosphorus 3
(PO4) phospholipids, LPS, teichoic acids
SO4, H2S, So, organic Constituent of cysteine, methionine, glutathione,
Sulfur 1
sulfur compounds several coenzymes
Main cellular inorganic cation and cofactor for certain
Potassium 1 Potassium salts
enzymes
Magnesium 0.5 Magnesium salts Inorganic cellular cation, cofactor for certain

48
 enzymatic reactions
Inorganic cellular cation, cofactor for certain enzymes
Calcium 0.5 Calcium salts
and a component of endospores
Component of cytochromes and certain nonheme
Iron 0.2 Iron salts iron-proteins and a cofactor for some enzymatic
reactions

Trace Elements

Table 1 ignores the occurrence of trace elements in bacterial nutrition. Trace elements are metal ions
required by certain cells in such small amounts that it is difficult to detect (measure) them, and it is not
necessary to add them to culture media as nutrients. Trace elements are required in such small amounts
that they are present as "contaminants" of the water or other media components. As metal ions, the
trace elements usually act as cofactors for essential enzymatic reactions in the cell. One organism's
trace element may be another's required element and vice-versa, but the usual cations that qualify as
trace elements in bacterial nutrition are Mn, Co, Zn, Cu, and Mo.

Carbon and Energy Sources for Bacterial Growth

In order to grow in nature or in the laboratory, a bacterium must have an energy source, a source of
carbon and other required nutrients, and a permissive range of physical conditions such as O2
concentration, temperature, and pH. Sometimes bacteria are referred to as individuals or groups based
on their patterns of growth under various chemical (nutritional) or physical conditions. For example,
phototrophs are organisms that use light as an energy source; anaerobes are organisms that grow
without oxygen; thermophiles are organisms that grow at high temperatures.

All living organisms require a source of energy. Organisms that use radiant energy (light) are called
phototrophs. Organisms that use (oxidize) an organic form of carbon are called heterotrophs or
chemo(hetero)trophs. Organisms that oxidize inorganic compounds are called lithotrophs.

The carbon requirements of organisms must be met by organic carbon (a chemical compound with a
carbon-hydrogen bond) or by CO2. Organisms that use organic carbon are heterotrophs and organisms
that use CO2 as a sole source of carbon for growth are called autotrophs.

Thus, on the basis of carbon and energy sources for growth four major nutritional types of procaryotes
may be defined (Table 2).

Table 2. Major nutritional types of procaryotes

Carbon
Nutritional Type Energy Source Examples
Source
Cyanobacteria, some Purple
Photoautotrophs Light CO2
and Green Bacteria
Organic Some Purple and Green
Photoheterotrophs Light
compounds Bacteria
Chemoautotrophs or Inorganic compounds, A few Bacteria and many
CO2
Lithotrophs (Lithoautotrophs) e.g. H2, NH3, NO2, H2S Archaea
49
Chemoheterotrophs or Organic Most Bacteria, some
Organic compounds
Heterotrophs compounds Archaea

Almost all eukaryotes are either photoautotrophic (e.g. plants and algae) or heterotrophic (e.g. animals,
protozoa, fungi). Lithotrophy is unique to procaryotes and photoheterotrophy, common in the Purple
and Green Bacteria, occurs only in a very few eukaryotic algae. Phototrophy has not been found in the
Archaea, except for nonphotosynthetic light-driven ATP synthesis in the extreme halophiles.

Growth Factors

This simplified scheme for use of carbon, either organic carbon or CO2, ignores the possibility that an
organism, whether it is an autotroph or a heterotroph, may require small amounts of certain organic
compounds for growth because they are essential substances that the organism is unable to synthesize
from available nutrients. Such compounds are called growth factors.

Growth factors are required in small amounts by cells because they fulfill specific roles in
biosynthesis. The need for a growth factor results from either a blocked or missing metabolic pathway
in the cells. Growth factors are organized into three categories.

1. purines and pyrimidines: required for synthesis of nucleic acids (DNA and RNA)

2. amino acids: required for the synthesis of proteins

3. vitamins: needed as coenzymes and functional groups of certain enzymes

Some bacteria (e.g E. coli) do not require any growth factors: they can synthesize all essential purines,
pyrimidines, amino acids and vitamins, starting with their carbon source, as part of their own
intermediary metabolism. Certain other bacteria (e.g. Lactobacillus) require purines, pyrimidines,
vitamins and several amino acids in order to grow. These compounds must be added in advance to
culture media that are used to grow these bacteria. The growth factors are not metabolized directly as
sources of carbon or energy, rather they are assimilated by cells to fulfill their specific role in
metabolism. Mutant strains of bacteria that require some growth factor not needed by the wild type
(parent) strain are referred to as auxotrophs. Thus, a strain of E. coli that requires the amino acid
tryptophan in order to grow would be called a tryptophan auxotroph and would be designated E.
colitrp-.

50
 Figure 1. Cross-feeding between Staphylococcus aureus and Haemophilus influenzae growing on blood agar. ©
Gloria J. Delisle and Lewis Tomalty, Queens University, Kingston, Ontario, Canada. Licensed for use by ASM
Microbe Library http://www.microbelibrary.org. Haemophilus influenzae was first streaked on to the blood agar
plate followed by a cross streak with Staphylococcus aureus. H. influenzae is a fastidious bacterium which requires
both hemin and NAD for growth. There is sufficient hemin in blood for growth of Haemophilus, but the medium is
insufficient in NAD. S. aureus produces NAD in excess of its own needs and secretes it into the medium, which
supports the growth of Haemophilus as satellite colonies.

Some vitamins that are frequently required by certain bacteria as growth factors are listed in Table 3.
The function(s) of these vitamins in essential enzymatic reactions gives a clue why, if the cell cannot
make the vitamin, it must be provided exogenously in order for growth to occur.

Table 3. Common vitamins required in the nutrition of certain bacteria.

Vitamin Coenzyme form Function

p-Aminobenzoic
- Precursor for the biosynthesis of folic acid
acid (PABA)
Transfer of one-carbon units and required for
Folic acid Tetrahydrofolate synthesis of thymine, purine bases, serine,
methionine and pantothenate
Biotin Biotin Biosynthetic reactions that require CO2 fixation
Transfer of acyl groups in oxidation of keto
Lipoic acid Lipoamide
acids
Mercaptoethane-
Coenzyme M CH4 production by methanogens
sulfonic acid
NAD (nicotinamide adenine
Nicotinic acid Electron carrier in dehydrogenation reactions
dinucleotide) and NADP
Pantothenic acid Coenzyme A and the Acyl Oxidation of keto acids and acyl group carriers
51
 Carrier Protein (ACP) in metabolism
Transamination, deamination, decarboxylation
Pyridoxine (B6) Pyridoxal phosphate
and racemation of amino acids
FMN (flavin mononucleotide)
Riboflavin (B2) and FAD (flavin adenine Oxidoreduction reactions
dinucleotide)
Decarboxylation of keto acids and transaminase
Thiamine (B1) Thiamine pyrophosphate (TPP)
reactions
Cobalamine coupled to adenine
Vitamin B12 Transfer of methyl groups
nucleoside
Vitamin K Quinones and napthoquinones Electron transport processes

Culture Media for the Growth of Bacteria

For any bacterium to be propagated for any purpose it is necessary to provide the appropriate
biochemical and biophysical environment. The biochemical (nutritional) environment is made available
as a culture medium, and depending upon the special needs of particular bacteria (as well as particular
investigators) a large variety and types of culture media have been developed with different purposes
and uses. Culture media are employed in the isolation and maintenance of pure cultures of bacteria and
are also used for identification of bacteria according to their biochemical and physiological properties.

The manner in which bacteria are cultivated, and the purpose of culture media, varies widely. Liquid
media are used for growth of pure batch cultures, while solidified media are used widely for the
isolation of pure cultures, for estimating viable bacterial populations, and a variety of other purposes.
The usual gelling agent for solid or semisolid medium is agar, a hydrocolloid derived from red algae.
Agar is used because of its unique physical properties (it melts at 100 degrees and remains liquid until
cooled to 40 degrees, the temperature at which it gels) and because it cannot be metabolized by most
bacteria. Hence as a medium component it is relatively inert; it simply holds (gels) nutrients that are in
aquaeous solution.

Types of Culture Media

Culture media may be classified into several categories depending on their composition or use. A
chemically-defined (synthetic) medium (Table 4a and 4b) is one in which the exact chemical
composition is known. A complex (undefined) medium (Table 5a and 5b) is one in which the exact
chemical constitution of the medium is not known. Defined media are usually composed of pure
biochemicals off the shelf; complex media usually contain complex materials of biological origin such
as blood or milk or yeast extract or beef extract, the exact chemical composition of which is obviously
undetermined. A defined medium is a minimal medium (Table4a) if it provides only the exact
nutrients (including any growth factors) needed by the organism for growth. The use of defined
minimal media requires the investigator to know the exact nutritional requirements of the organisms in
question. Chemically-defined media are of value in studying the minimal nutritional requirements of
microorganisms, for enrichment cultures, and for a wide variety of physiological studies. Complex
media usually provide the full range of growth factors that may be required by an organism so they
may be more handily used to cultivate unknown bacteria or bacteria whose nutritional requirement are
complex (i.e., organisms that require a lot of growth factors, known or unknown).

52
Figure 2. Legionella pneumophila. Direct fluorescent antibody (DFA) stain of a patient respiratory tract specimen. ©
Gloria J. Delisle and Lewis Tomalty. Queens University, Kingston, Ontario, Canada. Licensed for use by ASM
Microbe Library http://www.microbelibrary.org. In spite of its natural ocurrence in water cooling towers and air
conditioners, Legionella is a fastidious bacterium grown in the laboratory, which led to the long lag in identification
of the first outbreak of Legionaire's disease in Philadelphia in 1977. Had fluoresent antibody to the bacterium been
available at that time, diagnosis could have been made as quickly as the time to prepare and view this slide.

Most pathogenic bacteria of animals, which have adapted themselves to growth in animal tissues,
require complex media for their growth. Blood, serum and tissue extracts are frequently added to
culture media for the cultivation of pathogens. Even so, for a few fastidious pathogens such as
Treponema pallidum, the agent of syphilis, and Mycobacterium leprae, the cause of leprosy, artificial
culture media and conditions have not been established. This fact thwarts the the ability to do basic
research on these pathogens and the diseases that they cause.

Other concepts employed in the construction of culture media are the principles of selection and
enrichment. A selective medium is one which has a component(s) added to it which will inhibit or
prevent the growth of certain types or species of bacteria and/or promote the growth of desired species.
One can also adjust the physical conditions of a culture medium, such as pH and temperature, to render
it selective for organisms that are able to grow under these certain conditions.

A culture medium may also be a differential medium if allows the investigator to distinguish between
different types of bacteria based on some observable trait in their pattern of growth on the medium.
Thus a selective, differential medium for the isolation of Staphylococcus aureus, the most common
bacterial pathogen of humans, contains a very high concentration of salt (which the staph will tolerate)
that inhibits most other bacteria, mannitol as a source of fermentable sugar, and a pH indicator dye.
From clinical specimens, only staph will grow. S. aureus is differentiated from S. epidermidis (a
nonpathogenic component of the normal flora) on the basis of its ability to ferment mannitol. Mannitol-
fermenting colonies (S. aureus)produce acid which reacts with the indicator dye forming a colored halo
around the colonies; mannitol non-fermenters (S. epidermidis) use other non-fermentative substrates in
the medium for growth and do not form a halo around their colonies.

An enrichment medium employs a slightly different twist. An enrichment medium (Table 5a and 5b)
contains some component that permits the growth of specific types or species of bacteria, usually

53
because they alone can utilize the component from their environment. However, an enrichment
medium may have selective features. An enrichment medium for nonsymbiotic nitrogen-fixing bacteria
omits a source of added nitrogen to the medium. The medium is inoculated with a potential source of
these bacteria (e.g. a soil sample) and incubated in the atmosphere wherein the only source of nitrogen
available is N2. A selective enrichment medium (Table 5b) for growth of the extreme halophile
(Halococcus) contains nearly 25 percent salt [NaCl], which is required by the extreme halophile and
which inhibits the growth of all other procaryotes.

Table 4a. Minimal medium for the growth of Bacillus megaterium. An example of a chemically-defined medium for
growth of a heterotrophic bacterium.

Component Amount Function of component

sucrose 10.0 g C and energy source
K2HPO4 2.5 g pH buffer; P and K source
KH2PO4 2.5 g pH buffer; P and K source
(NH4)2HPO4 1.0 g pH buffer; N and P source
MgSO4 7H2O 0.20 g S and Mg++ source
FeSO4 7H2O 0.01 g Fe++ source
MnSO4 7H2O 0.007 g Mn++ Source
water 985 ml
pH 7.0

Table 4b. Defined medium (also an enrichment medium) for the growth of Thiobacillus thiooxidans, a
lithoautotrophic bacterium.

Component Amount Function of component

NH4Cl 0.52 g N source
KH2PO4 0.28 g P and K source
MgSO4 7H2O 0.25 g S and Mg++ source
CaCl2 2H2O 0.07 g Ca++ source
Elemental Sulfur 1.56 g Energy source
CO2 5%* C source
water 1000 ml
pH 3.0
* Aerate medium intermittently with air containing 5% CO2.

Table 5a. Complex medium for the growth of fastidious bacteria.

Component Amount Function of component

Beef extract 1.5 g Source of vitamins and other growth factors
Yeast extract 3.0 g Source of vitamins and other growth factors
54
Peptone 6.0 g Source of amino acids, N, S, and P
Glucose 1.0 g C and energy source
Agar 15.0 g Inert solidifying agent
water 1000 ml
pH 6.6

Table 5b. Selective enrichment medium for growth of extreme halophiles.

Component Amount Function of component

Casamino acids 7.5 g Source of amino acids, N, S and P
Yeast extract 10.0 g Source of growth factors
Trisodium citrate 3.0 g C and energy source
KCl 2.0 g K+ source
MgSO4 7 H2O 20.0 g S and Mg++ source
FeCl2 0.023 g Fe++ source
NaCl 250 g Na+ source for halophiles and inhibitory to nonhalophiles
water 1000 ml
pH 7.4

Physical and Environmental Requirements for Microbial Growth

The procaryotes exist in nature under an enormous range of physical conditions such as O2
concentration, Hydrogen ion concentration (pH) and temperature. The exclusion limits of life on the
planet, with regard to environmental parameters, are always set by some microorganism, most often a
procaryote, and frequently an Archaeon. Applied to all microorganisms is a vocabulary of terms used
to describe their growth (ability to grow) within a range of physical conditions. A thermophile grows at
high temperatures, an acidophile grows at low pH, an osmophile grows at high solute concentration,
and so on. This nomenclature will be employed in this section to describe the response of the
procaryotes to a variety of physical conditions.

The Effect of Oxygen

Oxygen is a universal component of cells and is always provided in large amounts by H2O. However,
procaryotes display a wide range of responses to molecular oxygen O2 (Table 6).

Obligate aerobes require O2 for growth; they use O2 as a final electron acceptor in aerobic respiration.

Obligate anaerobes (occasionally called aerophobes) do not need or use O2 as a nutrient. In fact, O2 is
a toxic substance, which either kills or inhibits their growth. Obligate anaerobic procaryotes may live
by fermentation, anaerobic respiration, bacterial photosynthesis, or the novel process of
methanogenesis.

Facultative anaerobes (or facultative aerobes) are organisms that can switch between aerobic and
anaerobic types of metabolism. Under anaerobic conditions (no O2) they grow by fermentation or
anaerobic respiration, but in the presence of O2 they switch to aerobic respiration.
55
Aerotolerant anaerobes are bacteria with an exclusively anaerobic (fermentative) type of metabolism
but they are insensitive to the presence of O2. They live by fermentation alone whether or not O2 is
present in their environment.

Table 6. Terms used to describe O2 Relations of Microorganisms.

Environmen
t
Group Aerobic Anaerobic O2 Effect
Required (utilized for aerobic
Obligate Aerobe Growth No growth
respiration)
Growth if level not Required but at levels below 0.2
Microaerophile No growth
too high atm
Obligate Anaerobe No growth Growth Toxic
Facultative Anaerobe Not required for growth but
Growth Growth
(Facultative Aerobe) utilized when available
Aerotolerant Anaerobe Growth Growth Not required and not utilized

The response of an organism to O2 in its environment depends upon the occurrence and distribution of
various enzymes which react with O2 and various oxygen radicals that are invariably generated by cells
in the presence of O2. All cells contain enzymes capable of reacting with O2. For example, oxidations
of flavoproteins by O2 invariably result in the formation of H2O2 (peroxide) as one major product and
small quantities of an even more toxic free radical, superoxide or O2.-. Also, chlorophyll and other
pigments in cells can react with O2 in the presence of light and generate singlet oxygen, another radical
form of oxygen which is a potent oxidizing agent in biological systems.

In aerobes and aerotolerant anaerobes the potential for lethal accumulation of superoxide is prevented
by the enzyme superoxide dismutase (Figure 1). All organisms which can live in the presence of O2
(whether or not they utilize it in their metabolism) contain superoxide dismutase. Nearly all organisms
contain the enzyme catalase, which decomposes H2O2. Even though certain aerotolerant bacteria such
as the lactic acid bacteria lack catalase, they decompose H2O2 by means of peroxidase enzymes which
derive electrons from NADH2 to reduce peroxide to H2O. Obligate anaerobes lack superoxide
dismutase and catalase and/or peroxidase, and therefore undergo lethal oxidations by various oxygen
radicals when they are exposed to O2. See Figure 3 below.

All photosynthetic (and some nonphotosynthetic) organisms are protected from lethal oxidations of
singlet oxygen by their possession of carotenoid pigments which physically react with the singlet
oxygen radical and lower it to its nontoxic "ground" (triplet) state. Carotenoids are said to "quench"
singlet oxygen radicals.

56
 Figure 3. The action of superoxide dismutase, catalase and peroxidase. These enzymes detoxify oxygen radicals that
are inevitably generated by living systems in the presence of O2. The distribution of these enzymes in cells determines
their ability to exist in the presence of O 2

Table 7. Distribution of superoxide dismutase, catalase and peroxidase in procaryotes with different O2 tolerances.

Superoxide
Group Catalase Peroxidase
dismutase
Obligate aerobes and most facultative anaerobes (e.g.
+ + -
Enterics)
Most aerotolerant anaerobes (e.g. Streptococci) + - +
Obligate anaerobes (e.g. Clostridia, Methanogens,
- - -
Bacteroides)

The Effect of pH on Growth

The pH, or hydrogen ion concentration, [H+], of natural environments varies from about 0.5 in the most
acidic soils to about 10.5 in the most alkaline lakes. Appreciating that pH is measured on a logarithmic
scale, the [H+] of natural environments varies over a billion-fold and some microorganisms are living at
the extremes, as well as every point between the extremes! Most free-living procaryotes can grow over
a range of 3 pH units, about a thousand fold change in [H+]. The range of pH over which an organism
grows is defined by three cardinal points: the minimum pH, below which the organism cannot grow,
the maximum pH, above which the organism cannot grow, and the optimum pH, at which the
organism grows best. For most bacteria there is an orderly increase in growth rate between the
minimum and the optimum and a corresponding orderly decrease in growth rate between the optimum
and the maximum pH, reflecting the general effect of changing [H+] on the rates of enzymatic reaction
(Figure 4).

Microorganisms which grow at an optimum pH well below neutrality (7.0) are called acidophiles.
Those which grow best at neutral pH are called neutrophiles and those that grow best under alkaline
conditions are called alkaliphiles. Obligate acidophiles, such as some Thiobacillus species, actually
require a low pH for growth since their membranes dissolve and the cells lyse at neutrality. Several
genera of Archaea, including Sulfolobus and Thermoplasma, are obligate acidophiles. Among
eukaryotes, many fungi are acidophiles, but the champion of growth at low pH is the eukaryotic alga
Cyanidium which can grow at a pH of 0.

In the construction and use of culture media, one must always consider the optimum pH for growth of a
desired organism and incorporate buffers in order to maintain the pH of the medium in the changing
milieu of bacterial waste products that accumulate during growth. Many pathogenic bacteria exhibit a

57
relatively narrow range of pH over which they will grow. Most diagnostic media for the growth and
identification of human pathogens have a pH near 7.

Figure 4. Growth rate vs pH for three environmental classes of procaryotes. Most free-living bacteria grow over a
pH range of about three units. Note the symmetry of the curves below and above the optimum pH for growth.

Table 8. Minimum, maximum and optimum pH for growth of certain procaryotes.

Organism Minimum pH Optimum pH Maximum pH

Thiobacillus thiooxidans 0.5 2.0-2.8 4.0-6.0
Sulfolobus acidocaldarius 1.0 2.0-3.0 5.0
Bacillus acidocaldarius 2.0 4.0 6.0
Zymomonas lindneri 3.5 5.5-6.0 7.5
Lactobacillus acidophilus 4.0-4.6 5.8-6.6 6.8
Staphylococcus aureus 4.2 7.0-7.5 9.3
Escherichia coli 4.4 6.0-7.0 9.0
Clostridium sporogenes 5.0-5.8 6.0-7.6 8.5-9.0
Erwinia caratovora 5.6 7.1 9.3
Pseudomonas aeruginosa 5.6 6.6-7.0 8.0
Thiobacillus novellus 5.7 7.0 9.0
Streptococcus pneumoniae 6.5 7.8 8.3
Nitrobacter sp 6.6 7.6-8.6 10.0

The Effect of Temperature on Growth

Microorganisms have been found growing in virtually all environments where there is liquid water,
regardless of its temperature. In 1966, Professor Thomas D. Brock, then at Indiana University, made
the amazing discovery in boiling hot springs of Yellowstone National Park that bacteria were not just
surviving there, they were growing and flourishing. Brock's discovery of thermophilic bacteria, archaea
and other "extremophiles" in Yellowstone is summarized for the general public in an article at this web
site. See Life at High Temperatures.

58
Subsequently, procaryotes have been detected growing around black smokers and hydrothermal vents
in the deep sea at temperatures at least as high as 120 degrees. Microorganisms have been found
growing at very low temperatures as well. In supercooled solutions of H2O as low as -20 degrees,
certain organisms can extract water for growth, and many forms of life flourish in the icy waters of the
Antarctic, as well as household refrigerators, near 0 degrees.

A particular microorganism will exhibit a range of temperature over which it can grow, defined by
three cardinal points in the same manner as pH (Figure 6, cf. Figure 4). Considering the total span of
temperature where liquid water exists, the procaryotes may be subdivided into several subclasses on the
basis of one or another of their cardinal points for growth. For example, organisms with an optimum
temperature near 37 degrees (the body temperature of warm-blooded animals) are called mesophiles.
Organisms with an optimum T between about 45 degrees and 70 degrees are thermophiles. Some
Archaea with an optimum T of 80 degrees or higher and a maximum T as high as 115 degrees, are now
referred to as extreme thermophiles or hyperthermophiles. The cold-loving organisms are
psychrophiles defined by their ability to grow at 0 degrees. A variant of a psychrophile (which usually
has an optimum T of 10-15 degrees) is a psychrotroph, which grows at 0 degrees but displays an
optimum T in the mesophile range, nearer room temperature. Psychrotrophs are the scourge of food
storage in refrigerators since they are invariably brought in from their mesophilic habitats and continue
to grow in the refrigerated environment where they spoil the food. Of course, they grow slower at 2
degrees than at 25 degrees. Think how fast milk spoils on the counter top versus in the refrigerator.

Psychrophilic bacteria are adapted to their cool environment by having largely unsaturated fatty acids
in their plasma membranes. Some psychrophiles, particularly those from the Antarctic have been found
to contain polyunsaturated fatty acids, which generally do not occur in procaryotes. The degree of
unsaturation of a fatty acid correlates with its solidification T or thermal transition stage (i.e., the
temperature at which the lipid melts or solidifies); unsaturated fatty acids remain liquid at low T but are
also denatured at moderate T; saturated fatty acids, as in the membranes of thermophilic bacteria, are
stable at high temperatures, but they also solidify at relatively high T. Thus, saturated fatty acids (like
butter) are solid at room temperature while unsaturated fatty acids (like safflower oil) remain liquid in
the refrigerator. Whether fatty acids in a membrane are in a liquid or a solid phase affects the fluidity of
the membrane, which directly affects its ability to function. Psychrophiles also have enzymes that
continue to function, albeit at a reduced rate, at temperatures at or near 0 degrees. Usually,
psychrophile proteins and/or membranes, which adapt them to low temperatures, do not function at the
body temperatures of warm-blooded animals (37 degrees) so that they are unable to grow at even
moderate temperatures.

Thermophiles are adapted to temperatures above 60 degrees in a variety of ways. Often thermophiles
have a high G + C content in their DNA such that the melting point of the DNA (the temperature at
which the strands of the double helix separate) is at least as high as the organism's maximum T for
growth. But this is not always the case, and the correlation is far from perfect, so thermophile DNA
must be stabilized in these cells by other means. The membrane fatty acids of thermophilic bacteria are
highly saturated allowing their membranes to remain stable and functional at high temperatures. The
membranes of hyperthermophiles, virtually all of which are Archaea, are not composed of fatty acids
but of repeating subunits of the C5 compound, phytane, a branched, saturated, "isoprenoid" substance,
which contributes heavily to the ability of these bacteria to live in superheated environments. The
structural proteins (e.g. ribosomal proteins, transport proteins (permeases) and enzymes of
thermophiles and hyperthermophiles are very heat stable compared with their mesophilic counterparts.
The proteins are modified in a number of ways including dehydration and through slight changes in
their primary structure, which accounts for their thermal stability.

59
 Figure 5 (above).SEM of a thermophilic Bacillus species isolated from a compost pile at 55o C. © Frederick C.
Michel. The Ohio State University -OARDC, Wooster, Ohio. Licensed for use by ASM Microbe Library
http://www.microbelibrary.org . The rods are 3-5 microns in length and 0.5 to 1 micron in width with terminal
endospores in a slightly-swollen sporangium.

Figure 6 (below). Growth rate vs temperature for five environmental classes of procaryotes. Most procaryotes will
grow over a temperature range of about 30 degrees. The curves exhibit three cardinal points: minimum, optimum
and maximum temperatures for growth. There is a steady increase in growth rate between the minimum and
optimum temperatures, but slightly past the optimum a critical thermolabile cellular event occurs, and the growth
rates plunge rapidly as the maximum T is approached. As expected and as predicted by T.D. Brock, life on earth,
with regard to temperature, exists wherever water remains in a liquid state. Thus, psychrophiles grow in solution
wherever water is supercooled below 0 degrees; and extreme thermophilic archaea (hyperthermophiles) have been
identified growing near deep-sea thermal vents at temperatures up to 120 degrees. Theoretically, the bar can be
60
pushed to even higher temperatures.

Table 9. Terms used to describe microorganisms in relation to temperature requirements for growth.

Temperature for growth (degrees C)

Group Minimum Optimum Maximum Comments
Psychrophile Below 0 10-15 Below 20 Grow best at relatively low T
Psychrotroph 0 15-30 Above 25 Able to grow at low T but prefer moderate T
Most bacteria esp. those living in association
Mesophile 10-15 30-40 Below 45
with warm-blooded animals
Above 100 Among all thermophiles is wide variation in
Thermophile* 45 50-85
(boiling) optimum and maximum T
*For "degrees" of thermophily see text and graphs above

Figure 7. Thermus aquaticus,the thermophilic bacterium that is the source of taq polymerase.
L wet mount; R electron micrograph. T.D. Brock. Life at High Temperatures.

Table 10a. Minimum, maximum and optimum temperature for growth of certain bacteria and archaea.

Temperature for growth (degrees C)

Bacterium Minimum Optimum Maximum
Listeria monocytogenes 1 30-37 45
Vibrio marinus 4 15 30
Pseudomonas maltophilia 4 35 41
Thiobacillus novellus 5 25-30 42
Staphylococcus aureus 10 30-37 45
Escherichia coli 10 37 45
Clostridium kluyveri 19 35 37
Streptococcus pyogenes 20 37 40
Streptococcus pneumoniae 25 37 42
Bacillus flavothermus 30 60 72
Thermus aquaticus 40 70-72 79
Methanococcus jannaschii 60 85 90
Sulfolobus acidocaldarius 70 75-85 90

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Pyrobacterium brockii 80 102-105 115

Table 10b. Optimum growth temperature of some procaryotes.

Genus and species Optimal growth temp (degrees C)

Vibrio cholerae 18-37
Photobacterium phosphoreum 20
Rhizobium leguminosarum 20
Streptomyces griseus 25
Rhodobacter sphaeroides 25-30
Pseudomonas fluorescens 25-30
Erwinia amylovora 27-30
Staphylococcus aureus 30-37
Escherichia coli 37
Mycobacterium tuberculosis 37
Pseudomonas aeruginosa 37
Streptococcus pyogenes 37
Treponema pallidum 37
Thermoplasma acidophilum 59
Thermus aquaticus 70
Bacillus caldolyticus 72
Pyrococcus furiosus 100

Table 10c. Hyperthermophilic Archaea.

Temperature for growth(degrees C)

Genus Minimum Optimum Maximum Optimum pH

Sulfolobus 55 75-85 87 2-3
Desulfurococcus 60 85 93 6
Methanothermus 60 83 88 6-7
Pyrodictium 82 105 113 6
Methanopyrus 85 100 110 7

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Figure 8. Sulfolobus acidocaldarius is an extreme thermophile and an acidophile found in geothermally-heated acid
springs, mud pots and surface soils with temperatures from 60 to 95 degrees C, and a pH of 1 to 5. Left: Electron
micrograph of a thin section (85,000X). Under the electron microscope the organism appears as irregular spheres
which are often lobed. Right: Fluorescent photomicrograph of cells attached to a sulfur crystal. Fimbrial-like
appendages have been observed on the cells attached to solid surfaces such as sulfur crystals.T.D. Brock. Life at
High Temperatures.

Water Availability

Water is the solvent in which the molecules of life are dissolved, and the availability of water is
therefore a critical factor that affects the growth of all cells. The availability of water for a cell depends
upon its presence in the atmosphere (relative humidity) or its presence in solution or a substance (water
activity). The water activity (Aw) of pure H2O is 1.0 (100% water). Water activity is affected by the
presence of solutes such as salts or sugars, that are dissolved in the water. The higher the solute
concentration of a substance, the lower is the water activity and vice-versa. Microorganisms live over a
range of Aw from 1.0 to 0.7. The Aw of human blood is 0.99; seawater = 0.98; maple syrup = 0.90;
Great Salt Lake = 0.75. Water activities in agricultural soils range between 0.9 and 1.0.

The only common solute in nature that occurs over a wide concentration range is salt [NaCl], and some
microorganisms are named based on their growth response to salt. Microorganisms that require some
NaCl for growth are halophiles. Mild halophiles require 1-6% salt, moderate halophiles require 6-
15% salt; extreme halophiles that require 15-30% NaCl for growth are found among the
archaea. Bacteria that are able to grow at moderate salt concentrations, even though they grow best in
the absence of NaCl, are called halotolerant. Although halophiles are "osmophiles" (and halotolerant
organisms are "osmotolerant") the term osmophiles is usually reserved for organisms that are able to
live in environments high in sugar. Organisms which live in dry environments (made dry by lack of
water) are called xerophiles.

The concept of lowering water activity in order to prevent bacterial growth is the basis for preservation
of foods by drying (in sunlight or by evaporation) or by addition of high concentrations of salt or sugar.

63
Figure 9. Growth rate vs osmolarity for different classes of procaryotes. Osmolarity is determined by solute
concentration in the environment. Osmolarity is inversely related to water activity (Aw), which is more like a
measure of the concentration of water (H 2O) in a solution. Increased solute concentration means increased
osmolarity and decreased A w. TFrom left to right the graph shows the growth rate of a normal (nonhalophile) such
as E. coli or Pseudomonas, the growth rate of a halotolerant bacterium such as Staphylococcus aureus,and the growth
rate of an extreme halophile such as the archaean Halococcus.Note that a true halophile grows best at salt
concentrations where most bacteria are inhibited.

Table 11. Limiting water activities (Aw) for growth of certain procaryotes.

Organism Minimum Aw for growth

Caulobacter 1.00
Spirillum 1.00
Pseudomonas .91
Salmonella/E. coli .91
Lactobacillus .90
Bacillus .90
Staphylococcus .85
Halococcus .75

64
 Todar's Online Textbook of Bacteriology

GROWTH OF BACTERIAL POPULATIONS

© 2002 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

Measurement of Bacterial Growth

Growth is an orderly increase in the quantity of cellular constituents. It depends upon the ability of the
cell to form new protoplasm from nutrients available in the environment. In most bacteria, growth
involves increase in cell mass and number of ribosomes, duplication of the bacterial chromosome,
synthesis of new cell wall and plasma membrane, partitioning of the two chromosomes, septum
formation, and cell division. This asexual process of reproduction is called binary fission.

Figure 1. Bacterial growth by binary fission. Most bacteria reproduce by a relatively simple asexual process called
binary fission: each cell increases in size and divides into two cells. During this process there is an orderly increase
in cellular structures and components, replication and segregation of the bacterial DNA, and formation of a septum
or cross wall which divides the cell into two progeny cells. The process is coordinated by the bacterial membrane
perhaps by means of mesosomes. The DNA molecule is believed to be attached to a point on the membrane where it
is replicated. The two DNA molecules remain attached at points side-by-side on the membrane while new membrane
material is synthesized between the two points. This draws the DNA molecules in opposite directions while new cell
65
wall and membrane are laid down as a septum between the two chromosomal compartments. When septum
formation is complete the cell splits into two progeny cells. The time interval required for a bacterial cell to divide or
for a population of bacterial cells to double is called the generation time. Generation times for bacterial species
growing in nature may be as short as 15 minutes or as long as several days.
Electron micrograph of Streptococcus pyogenes by Maria Fazio and Vincent A. Fischetti, Ph.D. with permission. The
Laboratory of Bacterial Pathogenesis and Immunology, Rockefeller University.

For unicellular organisms such as the bacteria, growth can be measured in terms of two different
parameters: changes in cell mass and changes in cell numbers.

Methods for Measurement of Cell Mass

Methods for measurement of the cell mass involve both direct and indirect techniques.

1. Direct physical measurement of dry weight, wet weight, or volume of cells after centrifugation.

2. Direct chemical measurement of some chemical component of the cells such as total N, total
protein, or total DNA content.

3. Indirect measurement of chemical activity such as rate of O2 production or consumption, CO2

production or consumption, etc.

4. Turbidity measurements employ a variety of instruments to determine the amount of light scattered
by a suspension of cells. Particulate objects such as bacteria scatter light in proportion to their
numbers. The turbidity or optical density of a suspension of cells is directly related to cell mass or cell
number, after construction and calibration of a standard curve. The method is simple and
nondestructive, but the sensitivity is limited to about 107 cells per ml for most bacteria.

Methods for Measurement of Cell Numbers

Measuring techniques involve direct counts, visually or instrumentally, and indirect viable cell counts.

1. Direct microscopic counts are possible using special slides known as counting chambers. Dead
cells cannot be distinguished from living ones. Only dense suspensions can be counted (>107 cells per
ml), but samples can be concentrated by centrifugation or filtration to increase sensitivity.

A variation of the direct microscopic count has been used to observe and measure growth of bacteria in
natural environments. In order to detect and prove that thermophilic bacteria were growing in boiling
hot springs, T.D. Brock immersed microscope slides in the springs and withdrew them periodically for
microscopic observation. The bacteria in the boiling water attached to the glass slides naturally and
grew as microcolonies on the surface.

2. Electronic counting chambers count numbers and measure size distribution of cells. For cells the
size of bacteria the suspening medium must be very clean. Such elecronic devices are more often used
to count eukaryotic cells such as blood cells.

3. Indirect viable cell counts, also called plate counts, involve plating out (spreading) a sample of a
culture on a nutrient agar surface. The sample or cell suspension can be diluted in a nontoxic diluent
(e.g. water or saline) before plating. If plated on a suitable medium, each viable unit grows and forms a

66
colony. Each colony that can be counted is called a colony forming unit (cfu) and the number of cfu's
is related to the viable number of bacteria in the sample.

Advantages of the technique are its sensitivity (theoretically, a single cell can be detected), and it
allows for inspection and positive identification of the organism counted. Disadvantages are (1) only
living cells develop colonies that are counted; (2) clumps or chains of cells develop into a single
colony; (3) colonies develop only from those organisms for which the cultural conditions are suitable
for growth. The latter makes the technique virtually useless to characterize or count the total number
of bacteria in complex microbial ecosystems such as soil or the animal rumen or gastrointestinal
tract. Genetic probes can be used to demonstrate the diversity and relative abundance of procaryotes in
such an environment, but many species identified by genetic techniques have so far proven
unculturable.

Table 1. Some Methods used to measure bacterial growth

Method Application Comments

Enumeration of bacteria in milk Cannot distinguish living from
Direct microscopic count
or cellular vaccines nonliving cells
Enumeration of bacteria in
Very sensitive if plating
Viable cell count (colony counts) milk, foods, soil, water,
conditions are optimal
laboratory cultures, etc.
Estimations of large numbers of Fast and nondestructive, but
Turbidity measurement bacteria in clear liquid media cannot detect cell densities less
and broths than 107 cells per ml
Measurement of total cell yield only practical application is in the
Measurement of total N or protein
from very dense cultures research laboratory
Measurement of Biochemical Requires a fixed standard to relate
activity e.g. O2 uptake CO2 Microbiological assays chemical activity to cell mass
production, ATP production, etc. and/or cell numbers
Measurement of dry weight or wet
Measurement of total cell yield probably more sensitive than total
weight of cells or volume of cells
in cultures N or total protein measurements
after centrifugation

67
Figure 2. Bacterial colonies growing on a plate of nutrient agar.
Hans Knoll Institute. Jena, Germany.

The Bacterial Growth Curve

In the laboratory, under favorable conditions, a growing bacterial population doubles at regular
intervals. Growth is by geometric progression: 1, 2, 4, 8, etc. or 20, 21, 22, 23.........2n (where n = the
number of generations). This is called exponential growth. In reality, exponential growth is only part
of the bacterial life cycle, and not representative of the normal pattern of growth of bacteria in Nature.

When a fresh medium is inoculated with a given number of cells, and the population growth is
monitored over a period of time, plotting the data will yield a typical bacterial growth curve (Figure 3
below).

Figure 3. The typical bacterial growth curve. When bacteria are grown in a closed system (also called a batch
culture), like a test tube, the population of cells almost always exhibits these growth dynamics: cells initially adjust
to the new medium (lag phase) until they can start dividing regularly by the process of binary fission (exponential
phase). When their growth becomes limited, the cells stop dividing (stationary phase), until eventually they show
loss of viability (death phase). Note the parameters of the x and y axes. Growth is expressed as change in the
number viable cells vs time. Generation times are calculated during the exponential phase of growth. Time
measurements are in hours for bacteria with short generation times.

Four characteristic phases of the growth cycle are recognized.

68
1. Lag Phase. Immediately after inoculation of the cells into fresh medium, the population remains
temporarily unchanged. Although there is no apparent cell division occurring, the cells may be growing
in volume or mass, synthesizing enzymes, proteins, RNA, etc., and increasing in metabolic activity.

The length of the lag phase is apparently dependent on a wide variety of factors including the size of
the inoculum; time necessary to recover from physiacal damage or shock in the transfer; time required
for synthesis of essential coenzymes or division factors; and time required for synthesis of new
(inducible) enzymes that are necessary to metabolize the substrates present in the medium.

2. Exponential (log) Phase. The exponential phase of growth is a pattern of balanced growth wherein
all the cells are dividing regularly by binary fission, and are growing by geometric progression. The
cells divide at a constant rate depending upon the composition of the growth medium and the
conditions of incubation. The rate of exponential growth of a bacterial culture is expressed as
generation time, also the doubling time of the bacterial population. Generation time (G) is defined as
the time (t) per generation (n = number of generations). Hence, G=t/n is the equation from which
calculations of generation time (below) derive.

3. Stationary Phase. Exponential growth cannot be continued forever in a batch culture (e.g. a closed
system such as a test tube or flask). Population growth is limited by one of three factors: 1. exhaustion
of available nutrients; 2. accumulation of inhibitory metabolites or end products; 3. exhaustion of
space, in this case called a lack of "biological space".

During the stationary phase, if viable cells are being counted, it cannot be determined whether some
cells are dying and an equal number of cells are dividing, or the population of cells has simply stopped
growing and dividing. The stationary phase, like the lag phase, is not necessarily a period of
quiescence. Bacteria that produce secondary metabolites, such as antibiotics, do so during the
stationary phase of the growth cycle (Secondary metabolites are defined as metabolites produced after
the active stage of growth). It si during the stationary phase that spore-forming bacteria have to induce
or unmask the activity of dozens of genes that may be involved in sporulation process.

4. Death Phase. If incubation continues after the population reaches stationary phase, a death phase
follows, in which the viable cell population declines. (Note, if counting by turbidimetric measurements
or microoscopic counts, the death phase cannot be observed.). During the death phase, the number of
viable cells decreases geometrically (exponentially), essentially the reverse of growth during the log
phase.

Growth Rate and Generation Time

As mentioned above, bacterial growth rates during the phase of exponential growth, under standard
nutritional conditions (culture medium, temperature, pH, etc.), define the bacterium's generation time.
Generation times for bacteria vary from about 12 minutes to 24 hours or more. The generation time for
E. coli in the laboratory is 15-20 minutes, but in the intestinal tract, the coliform's generation time is
estimated to be 12-24 hours. For most known bacteria that can be cultured, generation times range
from about 15 minutes to 1 hour. Symbionts such as Rhizobium tend to have longer generation times.
Many lithotrophs, such as the nitrifying bacteria, also have long generation times. Some bacteria that
are pathogens, such as Mycobacterium tuberculosis and Treponema pallidum, have especially long
generation times, and this is thought to be an advantage in their virulence. Generation times for a few
bacteria are are shown in Table 2.

Table 2. Generation times for some common bacteria under optimal conditions of growth.

69
Bacterium Medium Generation Time (minutes)
Escherichia coli Glucose-salts 17
Bacillus megaterium Sucrose-salts 25
Streptococcus lactis Milk 26
Streptococcus lactis Lactose broth 48
Staphylococcus aureus Heart infusion broth 27-30
Lactobacillus acidophilus Milk 66-87
Rhizobium japonicum Mannitol-salts-yeast extract 344-461
Mycobacterium tuberculosis Synthetic 792-932
Treponema pallidum Rabbit testes 1980

Calculation of Generation Time

When growing exponentially by binary fission, the increase in a bacterial population is by geometric
progression. If we start with one cell, when it divides, there are 2 cells in the first generation, 4 cells in
the second generation, 8 cells in the third generation, and so on. The generation time is the time
interval required for the cells (or population) to divide.

G (generation time) = t(time, in minutes or hours)/n(number of generations)

G = t/n

G = generation time (time for the cells to divide)

t = time interval in hours or minutes

B = number of bacteria at the beginning of a time interval

b = number of bacteria at the end of the time interval

n = number of generations (number of times the cell population doubles during the time interval)

b = B x 2n (This equation is an expression of growth by binary fission)

Solve for n:

logb = logB + nlog2

n = logb - logB
log2

n = logb - logB
.301

n = 3.3 logb/B

70
G = t/n

Solve for G

G= t
3.3 log b/B

Example: What is the generation time of a bacterial population that increases from 10,000 cells to 10,000,000 cells in
four hours of growth?

G= t
3.3 log b/B

G = 240 minutes
3.3 log 107/104

G = 240 minutes
3.3 x 3

G = 24 minutes

Continuous Culture of Bacteria

The cultures so far discussed for growth of bacterial populations are called batch cultures. Since the
nutrients are not renewed, exponential growth is limited to a few generations. Bacterial cultures can be
maintained in a state of exponential growth over long periods of time using a system of continuous
culture (Figure 4), designed to relieve the conditions that stop exponential growth in batch cultures.
Continuous culture, in a device called a chemostat, can be used to maintain a bacterial population at a
constant density, a situation that is, in many ways, more similar to bacterial growth in natural
environments.

In a chemostat, the growth chamber is connected to a reservoir of sterile medium. Once growth is
initiated, fresh medium is continuously supplied from the reservoir. The volume of fluid in the growth
71
chamber is maintained at a constant level by some sort of overflow drain. Fresh medium is allowed to
enter into the growth chamber at a rate that limits the growth of the bacteria. The bacteria grow (cells
are formed) at the same rate that bacterial cells (and spent medium) are removed by the overflow. The
rate of addition of the fresh medium determines the rate of growth because the fresh medium always
contains a limiting amount of an essential nutrient. Thus, the chemostat relieves the insufficiency of
nutrients, the accumulation of toxic substances, and the accumulation of excess cells in the culture,
which are the parameters that initiate the stationary phase of the growth cycle. The bacterial culture can
be grown and maintained at relatively constant conditions, depending on the flow rate of the nutrients.

Figure 4. Schematic diagram of a chemostat,

a device for the continuous culture of bacteria.
The chemostat relieves the environmental conditions
that restrict growth by continuously supplying
nutrients to cells and removing waste substances
and spent cells from the culture medium.

Synchronous Growth of Bacteria

Studying the growth of bacterial populations in batch or continuous cultures does not permit any
conclusions about the growth behavior of individual cells, because the distribution of cell size (and
hence cell age) among the members of the population is completely random. Information about the
growth behavior of individual bacteria can, however, be obtained by the study of synchronous
cultures. Synchronized cultures must be composed of cells which are all at the same stage of the
bacterial cell cycle. Measurements made on synchronized cultures are equivalent to measurements
made on individual cells.

A number of clever techniques have been devised to obtain bacterial populations at the same stage in
the cell cycle. Some techniques involve manipulation of environmental parameters which induces the
population to start or stop growth at the same point in the cell cycle, while others are physical methods
for selection of cells that have just completed the process of binary fission. Theoretically, the smallest
cells in a bacterial population are those that have just completed the process of cell
division. Synchronous growth of a population of bacterial cells is illustrated in Figure 5. Synchronous
cultures rapidly lose synchrony because not all cells in the population divide at exactly the same size,
age or time.

72
Figure 5. The synchronous growth of a bacterial
population. By careful selection of cells that have
just divided, a bacterial population can be
synchronized in the bacterial cell division cycle.
Synchrony can be maintained for only a few generations.

73
 Todar's Online Textbook of Bacteriology

THE CONTROL OF MICROBIAL GROWTH

© 2002 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

Introduction

The control of microbial growth is necessary in many practical situations, and significant
advances in agriculture, medicine, and food science have been made through study of this
area of microbiology.

"Control of growth", as used here, means to prevent growth of microorganisms. This control is
effected in two basic ways: (1) by killing microorganisms or (2) by inhibiting the growth of
microorganisms. Control of growth usually involves the use of physical or chemical agents
which either kill or prevent the growth of microorganisms. Agents which kill cells are called
cidal agents; agents which inhibit the growth of cells (without killing them) are referred to as
static agents. Thus the term bactericidal refers to killing bacteria and bacteriostatic refers
to inhibiting the growth of bacterial cells. A bactericide kills bacteria, a fungicide kills fungi,
and so on.

Sterilization is the complete destruction or elimination of all viable organisms (in or on an

object being sterilized). There are no degrees of sterilization: an object is either sterile or not.
Sterilization procedures involve the use of heat, radiation or chemicals, or physical removal of
cells.

Methods of Sterilization

Heat: most important and widely used. For sterilization always consider type of heat, time of
application and temperature to ensure destruction of all microorganisms. Endospores of
bacteria are considered the most thermoduric of all cells so their destruction guarantees
sterility.

Incineration: burns organisms and physically destroys them. Used for needles , inoculating
wires, glassware, etc. and objects not destroyed in the incineration process.

Boiling: 100o for 30 minutes. Kills everything except some endospores (Actually, for the
purposes of purifying drinking water 100o for five minutes is probably adequate though there
have been some reports that Giardia cysts can survive this process). To kill endospores, and
therefore sterilize the solution, very long or intermittent boiling is required.

74
Autoclaving (steam under pressure or pressure cooker): 121o for 15 minutes (15#/in2
pressure). Good for sterilizing almost anything, but heat-labile substances will be denatured
or destroyed.

Dry heat (hot air oven): 160o/2hours or 170o/1hour. Used for glassware, metal, and objects
that won't melt.
The protocol and recommendations for the use of heat to control microbial growth are given in
Table 1.

Table 1. Recommended use of heat to control bacterial growth

Treatment Temperature Effectiveness

Vaporizes organic material on nonflammable
Incineration >500o surfaces but may destroy many substances in the
process
30 minutes of boiling kills microbial pathogens
Boiling 100o and vegetative forms of bacteria but may not kill
bacterial endospores
Three 30-minute intervals of boiling, followed by
Intermittent boiling 100o
periods of cooling kills bacterial endospores
Autoclave and pressure kills all forms of life including bacterial
121o/15 minutes
cooker (steam under endospores. The substance being sterilized must
at 15# pressure
pressure) be maintained at the effective T for the full time
For materials that must remain dry and which are
Dry heat (hot air oven) 160o/2 hours not destroyed at T between 121o and 170o Good
for glassware, metal, not plastic or rubber items
Same as above. Note increasing T by 10 degrees
Dry heat (hot air oven) 170o/1 hour
shortens the sterilizing time by 50 percent
kills most vegetative bacterial cells including
Pasteurization (batch
63o/30 minutes pathogens such as streptococci, staphylococci
method)
and Mycobacterium tuberculosis
Effect on bacterial cells similar to batch method;
Pasteurization (flash for milk, this method is more conducive to
72o/15 seconds
method) industry and has fewer undesirable effects on
quality or taste

Irradiation: usually destroys or distorts nucleic acids. Ultraviolet light is usually used
(commonly used to sterilize the surfaces of objects), although x-rays and microwaves are
possibly useful.

Filtration: involvres the physical removal (exclusion) of all cells in a liquid or gas, especially
important to sterilize solutions which would be denatured by heat (e.g. antibiotics, injectable
drugs, amino acids, vitamins, etc.)

75
Chemical and gas: (formaldehyde, glutaraldehyde, ethylene oxide) toxic chemicals kill all
forms of life in a specialized gas chamber.

Control of Microbial Growth by Physical Agents

Applications of Heat The lethal temperature varies in microorganisms. The time required to
kill depends on the number of organisms, species, nature of the product being heated, pH,
and temperature. Whenever heat is used to control microbial growth inevitably both time and
temperature are considered.

Sterilization (boiling, autoclaving, hot air oven) kills all microorganisms with heat; commonly
employed in canning, bottling, and other sterile packaging procedures.

Pasteurization is the use of mild heat to reduce the number of microorganisms in a product
or food. In the case of pasteurization of milk the time and temperature depend on killing
potential pathogens that are transmitted in milk, i.e., staphylococci, streptococci, Brucella
abortus and Mycobacterium tuberculosis. For pasteurzation of milk: batch nethod:
63o/30minutes; flash method: 71o/15 seconds.

Low temperature (refrigeration and freezing): Most organisms grow very little or not at all
at 0o. Store perishable foods at low temperatues to slow rate of growth and consequent
spoilage (e.g. milk). Low temperatures are not bactericidal. Psychrotrophs, rather than true
psychrophiles, are the usual cause of food spoilage in refrigerated foods.

Drying (removal of H2O): Most microorganisms cannot grow at reduced water activity (Aw <
0.90). Often used to preserve foods (e.g. fruits, grains, etc.). Methods involve removal of
water from product by heat, evaporation, freeze-drying, addition of salt or sugar.

Irradiation (microwave, UV, x-ray): destroys microorganisms as described under

"sterilization". Many spoilage organisms are easily killed by irradiation. In some parts of
Europe, fruits and vegetables are irradiated to increase their shelf life up to 500 percent. The
practice has not been accepted in the U.S.

Control of microbial growth by chemical agents

Antimicrobial agents are chemicals that kill or inhibit the growth microorganisms.
Antimicrobial agents include chemical preservatives and antiseptics, as well as drugs used in
the treatment of infectious diseases of plants and animals. Antimicrobial agents may be of
natural or synthetic origin, and they may have a static or cidal effect on microorganisms.

Types of antimicrobial agents

Antiseptics: microbicidal agents harmless enough to be applied to the skin and mucous
membrane; should not be taken internaslly. Examples: mercurials, silver nitrate, iodine
solution, alcohols, detergents.

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Disinfectants: Agents that kill microorganisms, but not necessarily their spores,not safe for
application to living tissues; they are used on inanimate objects such as tables, floors,
utensils, etc. Examples: chlorine, hypochlorites, chlorine compounds, lye, copper sulfate,
quaternary ammonium compounds.

Note: disinfectants and antiseptics are distinguished on the basis of whether they are safe for
application to mucous membranes. Often, safety depends on the concentration of the
compound. For example, sodium hypochlorite (chlorine), as added to water is safe for
drinking, but "chlorox" (5% hypochlorite), an excellent disinfectant, is hardly safe to drink.

Common antiseptics and disinfectants and their uses are summarized in Table 2.

Table 2. Common antiseptics and disinfectants

Chemical Action Uses

Denatures proteins and
Ethanol (50-70%) Antiseptic used on skin
solubilizes lipids
Denatures proteins and
Isopropanol (50-70%) Antiseptic used on skin
solubilizes lipids
Reacts with NH2, SH and
Formaldehyde (8%) Disinfectant, kills endospores
COOH groups
Tincture of Iodine (2% I2 in 70%
Inactivates proteins Antiseptic used on skin
alcohol)
Forms hypochlorous acid
Disinfect drinking water; general
Chlorine (Cl2) gas (HClO), a strong
disinfectant
oxidizing agent
General antiseptic and used in
Silver nitrate (AgNO3) Precipitates proteins
the eyes of newborns
Inactivates proteins by Disinfectant, although
Mercuric chloride reacting with sulfide occasionally used as an
groups antiseptic on skin
Detergents (e.g. quaternary Skin antiseptics and
Disrupts cell membranes
ammonium compounds) disinfectants
Phenolic compounds (e.g. Antiseptics at low
Denature proteins and
carboloic acid, lysol, concentrations; disinfectants at
disrupt cell membranes
hexylresorcinol, hexachlorophene) high concentrations
Disinfectant used to sterilize
Ethylene oxide gas Alkylating agent heat-sensitive objects such as
rubber and plastics

Preservatives: static agents used to inhibit the growth of microorganisms, most often in
foods. If eaten they should be nontoxic. Examples; calcium propionate, sodium benzoate,
formaldehyde, nitrate, sulfur dioxide. Table 3 is a list of common preservative and their uses.

Table 3. Common food preservatives and their uses

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 Effective
Preservative Uses
Concentration
Propionic acid and Antifungal agent in breads, cake, Swiss
0.32%
propionates cheeses
Sorbic acid and Antifungal agent in cheeses, jellies, syrups,
0.2%
sorbates cakes
Benzoic acid and Antifungal agent in margarine, cider, relishes,
0.1%
benzoates soft drinks
Sodium diacetate 0.32% Antifungal agent in breads
Antimicrobial agent in cheeses, buttermilk,
Lactic acid unknown
yogurt and pickled foods
Antimicrobial agent in dried fruits, grapes,
Sulfur dioxide, sulfites 200-300 ppm
molasses
Sodium nitrite 200 ppm Antibacterial agent in cured meats, fish
Sodium chloride unknown Prevents microbial spoilage of meats, fish, etc.
Prevents microbial spoilage of preserves,
Sugar unknown
jams, syrups, jellies, etc.
Wood smoke unknown Prevents microbial spoilage of meats, fish, etc.

Chemotherapeutic agents: antimicrobial agents of synthetic origin useful in the treatment of

microbial or viral disease. Examples: sulfonilamides, isoniazid, ethambutol, AZT,
chloramphenicol. Note that the microbiologist's definition of a chemotherapeutic agent
requires that the agent be used for antimicrobial purposes and so excludes synthetic agents
used for therapy against diseases that are not of microbial origin.

Antibiotics: antimicrobial agents produced by microorganisms that kill or inhibit other

microorganisms. This is the microbiologist's definition. A more broadened definition of an
antibiotic includes any chemical of natural origin (from any type of cell) which has the effect to
kill or inhibit the growth of other types cells. Since most clinically-useful antibiotics are
produced by microorganisms and are used to kill or inhibit infectious Bacteria, we will follow
the classic definition.

Antibiotics are low molecular-weight (non-protein) molecules produced as secondary

metabolites, mainly by microorganisms that live in the soil. Most of these microorganisms
form some type of a spore or other dormant cell, and there is thought to be some relationship
(besides temporal) between antibiotic production and the processes of sporulation. Among
the molds, the notable antibiotic producers are Penicillium and Cephalosporium , which are
the main source of the beta-lactam antibiotics (penicillin and its relatives). In the Bacteria, the
Actinomycetes, notably Streptomyces species, produce a variety of types of antibiotics
including the aminoglycosides (e.g. streptomycin), macrolides (e.g. erythromycin), and the
tetracyclines. Endospore-forming Bacillus species produce polypeptide antibiotics such as
polymyxin and bacitracin. The table below (Table 4) is a summary of the classes of antibiotics
and their properties including their biological sources.

Table 4. Classes of antibiotics and their properties

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 Spectrum
Biological
Chemical class Examples (effective Mode of action
source
against)
Inhibits steps in
Penicillium
Beta-lactams cell wall
Penicillin G, notatum and Gram-positive
(penicillins and (peptidoglycan)
Cephalothin Cephalosporium bacteria
cephalosporins) synthesis and
species
murein assembly
Inhibits steps in
Gram-positive and cell wall
Semisynthetic Ampicillin,
Gram-negative (peptidoglycan)
penicillin Amoxycillin
bacteria synthesis and
murein assembly
Clavamox is Gram-positive and Suicide inhibitor
Streptomyces
Clavulanic Acid clavulanic acid Gram-negative of beta-
clavuligerus
plus amoxycillin bacteria lactamases
Inhibits steps in
Gram-positive and cell wall
Chromobacter
Monobactams Aztreonam Gram-negative (peptidoglycan)
violaceum
bacteria synthesis and
murein assembly
Inhibits steps in
Gram-positive and cell wall
Streptomyces
Carboxypenems Imipenem Gram-negative (peptidoglycan)
cattleya
bacteria synthesis and
murein assembly
Gram-positive and Inhibit translation
Streptomyces
Aminoglycosides Streptomycin Gram-negative (protein
griseus
bacteria synthesis)
Gram-positive and
Inhibit translation
Micromonospora Gram-negative
Gentamicin (protein
species bacteria esp.
synthesis)
Pseudomonas
Inhibits steps in
Gram-positive
murein
Streptomyces bacteria, esp.
Glycopeptides Vancomycin (peptidoglycan)
orientales Staphylococcus
biosynthesis and
aureus
assembly
Gram-positive and
Inhibits
Gram-negative
Streptomyces translation
Lincomycins Clindamycin bacteria esp.
lincolnensis (protein
anaerobic
synthesis)
Bacteroides
Gram-positive Inhibits
Streptomyces
Macrolides Erythromycin bacteria, Gram- translation
erythreus
negative bacteria (protein

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 not enterics, synthesis)
Neisseria,
Legionella,
Mycoplasma
Damages
Bacillus Gram-negative
Polypeptides Polymyxin cytoplasmic
polymyxa bacteria
membranes
Inhibits steps in
murein
Gram-positive
Bacitracin Bacillus subtilis (peptidoglycan)
bacteria
biosynthesis and
assembly
Inactivate
Streptomyces membranes
Polyenes Amphotericin Fungi
nodosus containing
sterols
Inactivate
Streptomyces membranes
Nystatin Fungi (Candida)
noursei containing
sterols
Gram-positive and
Inhibits
Gram-negative
Streptomyces transcription
Rifamycins Rifampicin bacteria,
mediterranei (eubacterial RNA
Mycobacterium
polymerase)
tuberculosis
Gram-positive and
Inhibit translation
Streptomyces Gram-negative
Tetracyclines Tetracycline (protein
species bacteria,
synthesis)
Rickettsias
Gram-positive and
Gram-negative Inhibit translation
Semisynthetic
Doxycycline bacteria, (protein
tetracycline
Rickettsias synthesis)
Ehrlichia, Borellia
Inhibits
Gram-positive and
Streptomyces translation
Chloramphenicol Chloramphenicol Gram-negative
venezuelae (protein
bacteria
synthesis)

Antimicrobial Agents Used in the Treatment of Infectious Disease

The modern era of antimicrobial chemotherapy began in 1929 with Fleming's discovery of the
powerful bactericidal substance penicillin, and Domagk's discovery in 1935 of synthetic
chemicals (sulfonamides) with broad antimicrobial activity. In the early 1940's, spurred
partially by the need for antibacterial agents in WW II, penicillin was isolated, purified and
injected into experimental animals, where it was found to not only cure infections but also to
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possess incredibly low toxicity for the animals. This fact ushered into being the age of
antibiotic chemotherapy and an intense search for similar antimicrobial agents of low toxicity
to animals that might prove useful in the treatment of infectious disease. The rapid isolation of
streptomycin, chloramphenicol and tetracycline soon followed, and by the 1950's, these and
several other antibiotics were in clinical usage.

The most important property of a clinically-useful antimicrobial agent, especially from the
patient's point of view, is its selective toxicity, i.e., that the agent acts in some way that
inhibits or kills bacterial pathogens but has little or no toxic effect on the animal taking the
drug This implies that the biochemical processes in the bacteria are in some way different
from those in the animal cells, and that the advantage of this difference can be taken in
chemotherapy. Antibiotics may have a cidal (killing) effect or a static (inhibitory) effect on a
range of microbes. The range of bacteria or other microorganisms that are affected by a
certain antibiotic are is expressed as its spectrum of action. Antibiotics effective against
procaryotes which kill or inhibit a wide range of Gram-positive and Gram-negative bacteria
are said to be broad spectrum . If effective mainly against Gram-positive or Gram-negative
bacteria, they are narrow spectrum . If effective against a single organism or disease, they
are referred to as limited spectrum.

Kinds of Antimicrobial Agents and their Primary Modes of Action

1. Cell wall synthesis inhibitors Cell wall synthesis inhibitors generally inhibit some step in
the synthesis of bacterial peptidoglycan. Generally they exert their selective toxicity against
eubacteria because human cells lack cell walls.

Beta lactam antibiotics Chemically, these antibiotics contain a 4-membered beta lactam
ring. They are the products of two groups of fungi, Penicillium and Cephalosporium molds,
and are correspondingly represented by the penicillins and cephalosporins. The beta lactam
antibiotics inhibit the last step in peptidoglycan synthesis, the final cross-linking between
between peptide side chains, mediated by bacterial carboxypeptidase and transpeptidase
enzymes . Beta lactam antibiotics are normally bactericidal and require that cells be actively
growing in order to exert their toxicity.

Natural penicillins, such as Penicillin G or Penicillin V, are produced by fermentation of

Penicillium chrysogenum. They are effective against streptococcus, gonococcus and
staphylococcus, except where resistance has developed. They are considered narrow
spectrum since they are not effective against Gram-negative rods.

Semisynthetic penicillins first appeared in 1959. A mold produces the main part oif the
molecule (6-aminopenicillanic acid) which can be modified chemically by the addition of side
shains. Many of these compounds have been developed to have distinct benefits or
advantages over penicillin G, such as increased spectrum of activity (effectiveness against
Gram-negative rods), resistance to penicillinase, effectiveness when administered orally, etc.
Amoxycillin and Ampicillin have broadened spectra against Gram-negatives and are
effective orally; Methicillin is penicillinase-resistant.

Clavulanic acid is a chemical sometimes added to a semisynthetic penicillin preparation.

Thus, amoxycillin plus clavulanate is clavamox or augmentin. The clavulanate is not an

81
antimicrobial agent. It inhibits beta lactamase enzymes and has given extended life to
penicillinase-sensitive beta lactams.

Although nontoxic, penicillins occasionally cause death when administered to persons who
are allergic to them. In the U.S. there are 300 - 500 deaths annually due to penicillin allergy.
In allergic individuals the beta lactam molecule attaches to a serum protein which initiates an
IgE-mediated inflammatory response.

Cephalolsporins are beta lactam antibiotics with a similar mode of action to penicillins that
are produced by species of Cephalosporium. The have a low toxicity and a somewhat
broader spectrum than natural penicillins. They are often used as penicillin substitutes,
against Gram-negative bacteria, and in surgical prophylaxis. They are subject to degradation
by some bacterial beta-lactamases, but they tend to be resistant to beta-lactamases from S.
aureus .

Bacitracin is a polypeptide antibiotic produced by Bacillus species. It prevents cell wall

growth by inhibiting the release of the muropeptide subunits of peptidoglycan from the lipid
carrier molecule that carries the subunit to the outside of the membrane Teichoic acid
synthesis, which requires the same carrier, is also inhibited. Bacitracin has a high toxicity
which precludes its systemic use. It is present in many topical antibiotic preparations, and
since it is not absorbed by the gut, it is given to "sterilize" the bowel prior to surgery.

2. Cell membrane inhibitors disorganize the structure or inhibit the function of bacterial
membranes. The integrity of the cytoplasmic and outer membranes is vital to bacteria, and
compounds that disorganize the membranes rapidly kill the cells. However, due to the
similarities in phospholipids in eubacterial and eukaryotic membranes, this action is rarely
specific enough to permit these compounds to be used systemically. The only antibacterial
antibiotic of clinical importance that acts by this mechanism is Polymyxin, produced by
Bacillus polymyxis. Polymyxin is effective mainly against Gram-negative bacteria and is
usually limited to topical usage. Polymyxins bind to membrane phospholipids and thereby
interfere with membrane function. Polymyxin is occasionally given for urinary tract infections
caused by Pseudomonas that are gentamicin, carbenicillin and tobramycin resistant. The
balance between effectiveness and damage to the kidney and other organs is dangerously
close, and the drug should only be given under close supervision in the hospital.

3. Protein synthesis inhibitors Many therapeutically useful antibiotics owe their action to
inhibition of some step in the complex process of translation. Their attack is always at one of
the events occurring on the ribosome and rather than the stage of amino acid activation or
attachment to a particular tRNA. Most have an affinity or specificity for 70S (as opposed to
80S) ribosomes, and they achieve their selective toxicity in this manner. The most important
antibiotics with this mode of action are the tetracyclines, chloramphenicol, the macrolides
(e.g. erythromycin) and the aminoglycosides (e.g. streptomycin).

The aminoglycosides are products of Streptomyces species and are represented by

streptomycin, kanamycin, tobramycin and gentamicin. These antibiotics exert their activity by
binding to bacterial ribosomes and preventing the initiation of protein synthesis.
Aminoglycosides have been used against a wide variety of bacterial infections caused by
Gram-positive and Gram-negative bacteria. Streptomycin has been used extensively as a
primary drug in the treatment of tuberculosis. Gentamicin is active against many strains of
Gram-positive and Gram-negative bacteria, including some strains of Pseudomonas
82
aeruginosa. Kanamycin (a complex of three antibiotics, A, B and C) is active at low
concentrations against many Gram-positive bacteria, including penicillin-resistant
staphylococci. Gentamicin and Tobramycin are mainstays for treatment of Pseudomonas
infections. An unfortunate side effect of aminoglycosides has tended to restrict their usage:
prolonged use is known to impair kidney function and cause damage to the auditory nerves
leading to deafness.

The tetracyclines consist of eight related antibiotics which are all natural products of
Streptomyces, although some can now be produced semisynthetically. Tetracycline,
chlortetracycline and doxycycline are the best known. The tetracyclines are broad-
spectrum antibiotics with a wide range of activity against both Gram-positive and Gram-
negative bacteria. The tetracyclines act by blocking the binding of aminoacyl tRNA to the A
site on the ribosome. Tetracyclines inhibit protein synthesis on isolated 70S or 80S
(eukaryotic) ribosomes, and in both cases, their effect is on the small ribosomal subunit.
However, most bacteria possess an active transport system for tetracycline that will allow
intracellular accumulation of the antibiotic at concentrations 50 times as great as that in the
medium. This greatly enhances its antibacterial effectiveness and accounts for its specificity
of action, since an effective concentration cannot be accumulated in animal cells. Thus a
blood level of tetracycline which is harmless to animal tissues can halt protein synthesis in
invading bacteria.

The tetracyclines have a remarkably low toxicity and minimal side effects when taken by
animals. The combination of their broad spectrum and low toxicity has led to their overuse
and misuse by the medical community and the wide-spread development of resistance has
reduced their effectiveness. Nonetheless, tetracyclines still have some important uses, such
as in the treatment of Lyme disease.

Chloramphenicol has a broad spectrum of activity but it exerts a bacteriostatic effect. It is

effective against intracellular parasites such as the rickettsiae. Unfortunately, aplastic anemia,
which is dose related develops in a small proportion (1/50,000) of patients. Chloramphenicol
was originally discovered and purified from the fermentation of a Streptomyces, but currently
it is produced entirely by chemical synthesis. Chloramphenicol inhibits the bacterial enzyme
peptidyl transferase thereby preventing the growth of the polypeptide chain during protein
synthesis.

Chloramphenicol is entirely selective for 70S ribosomes and does not affect 80S ribosomes.
Its unfortunate toxicity towards the small proportion of patients who receive it is in no way
related to its effect on bacterial protein synthesis. However, since mitochondria probably
originated from procaryotic cells and have 70S ribosomes, they are subject to inhibition by
some of the protein synthesis inhibitors including chloroamphenicol. This likely explains the
toxicity of chloramphenicol. The eukaryotic cells most likely to be inhibited by chloramphenicol
are those undergoing rapid multiplication, thereby rapidly synthesizing mitochondria. Such
cells include the blood forming cells of the bone marrow, the inhibition of which could present
as aplastic anemia. Chloramphenicol was once a highly prescribed antibiotic and a number of
deaths from anemia occurred before its use was curtailed. Now it is seldom used in human
medicine except in life-threatening situations (e.g. typhoid fever).

The Macrolides are a family of antibiotics whose structures contain large lactone rings linked
through glycoside bonds with amino sugars. The most important members of the group are
erythromycin and oleandomycin. Erythromycin is active against most Gram-positive
83
bacteria, Neisseria, Legionella and Haemophilus, but not against the Enterobacteriaceae.
Macrolides inhibit bacterial protein synthesis by binding to the 50S ribosomal subunit. Binding
inhibits elongation of the protein by peptidyl transferase or prevents translocation of the
ribosome or both. Macrolides are bacteriostatic for most bacteria but are cidal for a few Gram-
positive bacteria.

4. Effects on Nucleic Acids Some chemotherapeutic agents affect the synthesis of DNA or
RNA, or can bind to DNA or RNA so that their messages cannot be read. Either case, of
course, can block the growth of cells. The majority of these drugs are unselective, however,
and affect animal cells and bacterial cells alike and therefore have no therapeutic application.
Two nucleic acid synthesis inhibitors which have selective activity against procaryotes and
some medical utility are nalidixic acid and rifamycins.

Nalidixic acid is a synthetic chemotherapeutic agent which has activity mainly against Gram-
negative bacteria. Nalidixic acid belongs to a group of compounds called quinolones.
Nalidixic acid is a bactericidal agent that binds to the DNA gyrase enzyme (topoisomerase)
which is essential for DNA replication and allows supercoils to be relaxed and reformed.
Binding of the drug inhibits DNA gyrase activity.

Some quinolones penetrate macrophages and neutrophils better than most antibiotics and
are thus useful in treatment of infections caused by intracellular parasites. However, the main
use of nalidixic acid is in treatment of lower urinary tract infections (UTI). The compound is
unusual in that it is effective against several types of Gram-negative bacteria such as E. coli,
Enterobacter aerogenes, K. pneumoniae and species which are common causes of UTI. It is
not usually effective against Pseudomonas aeruginosa, and Gram-positive bacteria are
resistant. However, a fluoroquinolone, Ciprofloxacin (Cipro) was recently recommended as
the drug of choice for prophylaxis and treatment of anthrax.

The rifamycins are also the products of Streptomyces. Rifampicin is a semisynthetic

derivative of rifamycin that is active against Gram-positive bacteria (including Mycobacterium
tuberculosis) and some Gram-negative bacteria. Rifampicin acts quite specifically on
eubacterial RNA polymerase and is inactive towards RNA polymerase from animal cells or
towards DNA polymerase. The antibiotic binds to the beta subunit of the polymerase and
apparently blocks the entry of the first nucleotide which is necessary to activate the
polymerase, thereby blocking mRNA synthesis. It has been found to have greater bactericidal
effect against M .tuberculosis than other anti-tuberculosis drugs, and it has largely replaced
isoniazid as one of the front-line drugs used to treat the disease, especially when isoniazid
resistance is indicated. It is effective orally and penetrates well into the cerebrospinal fluid and
is therefore useful for treatment of tuberculosis meningitis and meningitis caused by Neisseria
meningitidis.

5. Competitive Inhibitors The competitive inhibitors are mostly all synthetic

chemotherapeutic agents. Most are "growth factor analogs" which are structurally similar to a
bacterial growth factor but which do not fulfill its metabolic function in the cell. Some are
bacteriostatic and some are bactericidal.

Sulfonamides were introduced as chemotherapeutic agents by Domagk in 1935, who

showed that one of these compounds (prontosil) had the effect of curing mice with infections
caused by beta-hemolytic streptococci. Chemical modifications of the compound
sulfanilamide gave compounds with even higher and broader antibacterial activity. The
84
resulting sulfonamides have broadly similar antibacterial activity, but differ widely in their
pharmacological actions. Bacteria which are almost always sensitive to the sulfonamides
include Streptococcus pneumoniae, beta-hemolytic streptococci and E. coli. The
sulfonamides have been extremely useful in the treatment of uncomplicated UTI caused by E.
coli, and in the treatment of meningococcal meningitis (because they cross the blood-brain
barrier).

The sulfonamides (e.g. Gantrisin) and Trimethoprim are inhibitors of the bacterial enzymes
required for the synthesis of tetrahydofolic acid (THF), the vitamin form of folic acid essential
for 1-carbon transfer reactions. Sulfonamides are structurally similar to para aminobenzoic
acid (PABA), the substrate for the first enzyme in the THF pathway, and they competitively
inhibit that step . Trimethoprim is structurally similar to dihydrofolate (DHF) and competitively
inhibits the second step in THF synthesis mediated by the DHF reductase. Animal cells do not
synthesize their own folic acid but obtain it in a preformed fashion as a vitamin. Since animals
do not make folic acid, they are not affected by these drugs, which achieve their selective
toxicity for bacteria on this basis.

Three additional synthetic chemotherapeutic agents have been used in the treatment of
tuberculosis: isoniazid (INH), paraaminosalicylic acid (PAS), and ethambutol. The usual
strategy in the treatment of tuberculosis has been to administer a single antibiotic (historically
streptomycin, but now, most commonly, rifampicin is given) in conjunction with INH and
ethambutol. Since the tubercle bacillus rapidly develops resistance to the antibiotic,
ethambutol and INH are given to prevent outgrowth of a resistant strain. It must also be
pointed out that the tubercle bacillus rapidly develops resistance to ethambutol and INH if
either drug is used alone. Ethambutol inhibits incorporation of mycolic acids into the
mycobacterial cell wall. Isoniazid has been reported to inhibit mycolic acid synthesis in
mycobacteria and since it is an analog of pyridoxine (Vitamin B6) it may inhibit pyridoxine
catalyzed reactions as well. Isoniazid is activated by a mycobacterial peroxidase enzyme and
destroys several targets in the cell. PAS is an anti-folate. PAS was once a primary anti-
tuberculosis drug, but now it is a secondary agent, having been largely replaced by
ethambutol.

Bacterial resistance to antibiotics

Penicillin became generally available for treatment of bacterial infections, especially those
caused by staphylococci and streptococci, about 1946. Initially, the antibiotic was effective
against all sorts of infections caused by these two Gram-positive bacteria. Resistance to
penicillin in some strains of staphylococci was recognized almost immediately. (Resistance to
penicillin today occurs in as many as 80% of all strains of Staphylococcus aureus).
Surprisingly, Streptococcus pyogenes (Group A strep) have never fully developed resistance
to penicillin and it remains a reasonable choice antibiotic for many types of streptococcal
infections. Natural penicillins have never been effective against most Gram-negative
pathogens (e.g. Salmonella, Shigella, Bordetella pertussis, Yersinia pestis, Pseudomonas)
with the notable exception of Neisseria gonorrhoeae. Gram-negative bacteria are inherently
resistant because their vulnerable cell wall is protected by an outer membrane that prevents
permeation of the penicillin molecule.

The period of the late 1940s and early 1950s saw the discovery and introduction of
streptomycin, chloramphenicol, and tetracycline, and the age of antibiotic chemotherapy
85
came into full being. These antibiotics were effective against the full array of bacterial
pathogens including Gram-positive and Gram-negative bacteria, intracellular parasites, and
the tuberculosis bacillus. However, by 1953, during a Shigella outbreak in Japan, a strain of
the dysentery bacillus was isolated which was multiple drug resistant, exhibiting resistance to
chloramphenicol, tetracycline, streptomycin, and the sulfanilamides. There was also evidence
mounting that bacteria could pass genes for multiple drug resistance between strains and
even between species. It was also apparent that Mycobacterium tuberculosis was capable of
rapid development of resistance to streptomycin which had become a mainstay in
tuberculosis therapy.

By the 1960's it became apparent that some bacterial pathogens were developing resistance
to antibiotic-after-antibiotic, at a rate faster than new antibiotics could be brought to market. A
more conservative approach to the use of antibiotics has not been fully accepted by the
medical and agricultural communities, and the problems of emerging multiple-drug resistant
pathogens still loom. The most important pathogens to emerge in multiple drug resistant
forms so far have been Mycobacterium tuberculosis and Staphylococcus aureus.

The basis of bacterial resistance to antibiotics

Inherent (Natural) Resistance Bacteria may be inherently resistant to an antibiotic. For

example, a streptomycete has some gene that is responsible for resistance to its own
antibiotic; or a Gram-negative bacterium has an outer membrane that establishes a
permeability barrier against the antibiotic; or an organism lacks a transport system for the
antibiotic; or it lacks the target or reaction that is hit by the antibiotic.

Acquired Resistance Bacteria can develop resistance to antibiotics, e.g. bacterial

populations previously-sensitive to antibiotics become resistant. This type of resistance
results from changes in the bacterial genome. Acquired resistance is driven by two genetic
processes in bacteria: (1) mutation and selection (sometimes referred to as vertical evolution);
(2) exchange of genes between strains and species (sometimes called horizontal evolution).

Vertical evolution is strictly a matter of Darwinian evolution driven by principles of natural

selection: a spontaneous mutation in the bacterial chromosome imparts resistance to a
member of the bacterial population. In the selective environment of the antibiotic, the wild type
(non mutants) are killed and the resistant mutant is allowed to grow and flourish. The mutation
rate formost bacterial genes is approximately 10-8. This means that if a bacterial population
doubles from 108 cells to 2 x 108 cells, there is likely to be a mutant present for any given
gene. Since bacteria grow to reach population densities far in excess of 109 cells, such a
mutant could develop from a single generation during 15 minutes of growth.

Horizontal evolution is the acquisition of genes for resistance from another organism. For
example, a streptomycete has a gene for resistance to streptomycin (its own antibiotic), but
somehow that gene escapes and gets into E. coli or Shigella. Or, more likely, Some
bacterium develops genetic resistance through the process of mutation and selection and
then donates these genesto some other bacterium through one of several processes for
genetic exchange that exist in bacteria.

Bacteria are able to exchange genes in nature by three processes: conjugation, transduction
and transformation. Conjugation involves cell-to-cell contact as DNA crosses a sex pilus
86
from donor to recipient. During transduction, a virus transfers the genes between mating
bacteria. In transformation, DNA is acquired directly from the environment, having been
released from another cell. Genetic recombination can follow the transfer of DNA from one
cell to another leading to the emergence of a new genotype (recombinant). It is common for
DNA to be transferred as plasmids between mating bacteria. Since bacteria usually develop
their genes for drug resistance on plasmids (called resistance transfer factors, or RTFs), they
are able to spread drug resistance to other strains and species during genetic exchange
processes.

The combined effects of fast growth rates, high concentrations of cells, genetic processes of
mutation and selection, and the ability to exchange genes, account for the extraordinary rates
of adaptation and evolution that can be observed in the bacteria. For these reasons bacterial
adaptation (resistance) to the antibiotic environment seems to take place very rapidly in
evolutionary time: bacteria evolve fast!

The medical problem of bacterial drug resistance

Obviously, if a bacterial pathogen is able to develop or acquire resistance to an antibiotic,

then that substance becomes useless in the treatment of infectious disease caused by that
pathogen (unless the resistance can somehow be overcome with secondary measures). So
as pathogens develop resistance, we must find new (different) antibiotics to fill the place of
the old ones in treatment regimes. Hence, natural penicillins have become useless against
staphylococci and must be replaced by other antibiotics; tetracycline, having been so widely
used and misused for decades, has become worthless for many of the infections that once
designated it as a "wonder drug".

Not only is there a problem in finding new antibiotics to fight old diseases (because resistant strains of
bacteria have emerged), there is a parallel problem to find new antibiotics to fight new diseases. In the
past two decades, many "new" bacterial diseases have been discovered (Legionnaire's disease, gastric
ulcers, Lyme disease, toxic shock syndrome, "skin-eating" streptococci). We are only now able to
examine patterns of susceptibility and resistance to antibiotics among new pathogens that cause these
diseases. Broad patterns of resistance exist in these pathogens, and it seems likely that we will soon
need new antibiotics to replace the handful that are effective now against these bacteria, especially as
resistance begins to emerge among them in the selective environment antibiotic chemotherapy.

87
 Todar's Online Textbook of Bacteriology

THE DIVERSITY OF METABOLISM IN PROCARYOTES

© 2004 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

Introduction

A lot of hoopla is made about microbial diversity. Based on superficial inspection, the bacteria and
archea hardly seem diversified. There are but a few basic morphologies, the possibilities of motility and
resting cells (spores), and a major differential stain (the Gram stain) to distinguish the procaryotes
microscopically. In the eukaryotes, there may be more structural diversity within a single genus of
organisms. So what is all the hoopla about? It is about biochemical or metabolic diversity, especially
as it relates to energy-generating metabolism and biosynthesis of secondary metabolites. The
procaryotes, as a group, conduct all the same types of basic metabolism as eukaryotes, but, in addition,
there are several types of energy-generating metabolism among the procaryotes that are non existent in
eukaryotic cells or organisms. The diversity of procaryotes is expressed by their great variation in
modes of energy production and metabolism.

Even within a procaryotic species, there may be great versatility in metabolism. Consider Escherichia
coli. The bacterium can produce energy for growth by fermentation or respiration. It can respire
aerobically using O2 as a final electron acceptor, or it can respire under anaerobic conditions, using
NO3 or fumarate as a terminal electron acceptor. E. coli can use glucose or lactose as a sole carbon
source for growth, with the metabolic ability to transform the sugar into all the necessary amino acids,
vitamins and nucleotides that make up cells. A relative of E. coli, Rhodospirillum rubrum, has all the
heterotrophic capabilities as E. coli,plus the ability to grow by photoautotrophic, photoheterotrophic or
lithotrophic means. It does require one growth factor, however; biotin must be added to its growth
media.

Fundamentally, most eukaryotes produce energy (ATP) through alcohol fermentation (e.g. yeast), lactic
acid fermentation (e.g. muscle cells, neutrophils), aerobic respiration (e.g. molds, protozoa, animals) or
oxygenic photosynthesis (e.g. algae, plants). These modes of energy-generating metabolism exist
among procaryotes, in addition to all following types of energy production which are virtually non
existent in eukaryotes.

Unique fermentations proceeding through the Embden-Meyerhof pathway

Other fermentation pathways such as the phosphoketolase (heterolactic) and Entner-Doudoroff

pathways

Anaerobic respiration: respiration that uses substances other than 02 as a final electron acceptor

Lithotrophy: use of inorganic substances as sources of energy

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Photoheterotrophy: use of organic compounds as a carbon source during bacterial photosynthesis

Anoxygenic photosynthesis: photophosphorylation in the absence of O2

Methanogenesis: an ancient type of archaeon metabolism that uses H2 as an energy source and
produces methane

Light-driven nonphotosynthetic photophosphorylation: unique archaeon metabolism that converts

light energy into chemical energy

In addition, among autotrophic procaryotes, there are three ways to fix CO2, two of which are unknown
among eukaryotes, the CODH (acetyl CoA pathway) and the reverse TCA cycle.

Energy-Generating Metabolism

The term metabolism refers to the sum of the biochemical reactions required for energy generation
and the use of energy to synthesize cell material from small molecules in the environment. Hence,
metabolism has an energy-generating component, called catabolism, and an energy-consuming,
biosynthetic component, called anabolism. Catabolic reactions or sequences produce energy as ATP,
which can be utilized in anabolic reactions to build cell material from nutrients in the environment. The
relationship between catabolism and anabolism is illustrated in Figure 1 below.

Figure 1. The relationship between catabolism and anabolism in a cell. During catabolism, energy is changed from
one form to another, and keeping with the laws of thermodynamics, such energy transformations are never
completely efficient, i.e., some energy is lost in the form of heat. The efficiency of a catabolic sequence of reactions is
the amount of energy made available to the cell (for anabolism) divided by the total amount of energy released
during the reactions.

ATP

During catabolism, useful energy is temporarily conserved in the "high energy bond" of ATP -
adenosine triphosphate. No matter what form of energy a cell uses as its primary source, the energy is

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ultimately transformed and conserved as ATP - the universal currency of energy exchange in biological
systems. When energy is required during anabolism, it may be spent as the high energy bond of ATP
which has a value of about 8 kcal per mole. Hence, the conversion of ADP to ATP requires 8 kcal of
energy, and the hydrolysis of ATP to ADP releases 8 kcal.

Figure 2. The structure of ATP. ATP is derived from the nucleotide adenosine monophosphate (AMP) or adenylic
acid, to which two additional phosphate groups are attached through pyrophosphate bonds (~P). These two bonds
are energy rich in the sense that their hydrolysis yields a great deal more energy than a corresponding covalent
bond.ATP acts as a coenzyme in energetic coupling reactions wherein one or both of the terminal phosphate groups
is removed from the ATP molecule with the bond energy being used to transfer part of the ATP molecule to another
molecule to activate its role in metabolism. For example, Glucose + ATP-----> Glucose-P + ADP or Amino Acid +
ATP ----->AMP-Amino Acid + PPi.

Because of the central role of ATP in energy-generating metabolism, expect to see its involvement as a
coenzyme in most energy-producing processes in cells.

NAD

Another coenzyme commonly involved in energy-producing metabolism, derived from the vitamin
niacin, is the pyridine nucleotide, NAD (Nicotinamide Adenine Dinucleotide). The basis for
chemical transformations of energy usually involves oxidation/reduction reactions. For a biochemical
to become oxidized, electrons must be removed by an oxidizing agent. The oxidizing agent is an
electron acceptor that becomes reduced in the reaction. During the reaction, the oxidizing agent is
converted to a reducing agent that can add its electrons to another chemical, thereby reducing it, and
reoxidizing itself. The molecule that usually functions as the electron carrier in these types of coupled
oxidation-reduction reactions in biological systems is NAD and its phosphorylated derivative,
NADP. NAD or NADP can become alternately oxidized or reduced by the loss or gain of two
electrons. The oxidized form of NAD is symbolized NAD; the reduced form is symbolized as
NADH, NADH2 or NADH + H+. The structure of NAD is drawn below.

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Figure 3. The Structure of NAD. (a) Nicotinamide Adenine Dinucleotide is composed of two nucleotide molecules:
Adenosine monophosphate (adenine plus ribose-phosphate) and nicotinamide ribotide (nicotinamide plus ribose-
phosphate). NADP has an identical structure except that it contains an additional phosphate group attached to one
of the ribose residues. (b) The oxidized and reduced forms of of the nicotinamide moiety of NAD. Nicotinamide is the
active part of the molecule where the reversible oxidation and reduction takes place.The oxidized form of NAD has
one hydrogen atom less than the reduced form and, in addition, has a positive charge on the nitrogen atom which
+
allows it to accept a second electron upon reduction. Thus the correct way to symbolize the reaction is NAD + 2H---
+
-->NADH + H . However, for convenience we will hereafter use the symbols NAD and NADH2.

OFF THE WALL. Many bacterial protein toxins including the cholera toxin, pertussis toxin and diphtheria toxin,
exert their enzymatic activity using NAD as a co-substrate. The toxins are referred to as ADP-ribosylation toxins,
because they cleave NAD into nicotinamide plus ADP-ribose (ADPR) and then transfer the ADPR to some host
molecule. For example, the diphtheria toxin transfers ADPR to elongation factor 2, irreversibly inactivating its role
in chain elongation during protein synthesis. Thus, the biological activity of the diphtheria toxin is to inhibit protein
synthesis in eukaryotic cells.

Coenzyme A

Coenzyme A is another coenzyme frequently involved in energy-generating metabolism of

procaryotes. Coenzyme A is involved in a type of ATP-generating reaction seen in some fermentative
bacteria and in all respiratory organisms. The reaction occurs in association with the oxidation of keto
acids such as pyruvic acid and alpha ketoglutaric acid. These substrates are central to glycolysis and the
TCA cycle, respectively, and they are direct or indirect precursors of several essential macromolecules
in a cell. The oxidations of pyruvate and alpha ketoglutatate, involving Coenzyme A, NAD, a
dehydrogenation reaction and a decarboxylation reaction, are two of the most important, and complex,
reactions in metabolism.

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Figure 4. (a) The Structure of Coenzyme A. CoA-SH is a derivative of ADP. The molecule shown here attached to
ADP is pantothenic acid, which carries a terminal thiol (-S) group. (b) the oxidation of the keto acid, pyruvic acid, to
acetyl~SCoA. This is the reaction that enters two carbons from pyruvate into the TCA cycle.

In the oxidation of keto acids, coenzyme A (CoA or CoASH) becomes attached through a thioester
linkage (~S) to the carboxyl group of the oxidized product. Part of the energy released in the oxidation
is conserved in the thioester bond. This bond energy can be subseqently used to synthesize ATP, as in
the case of the clostridia that convert acetyl~SCoA +ADP + Pi--------> acetic acid + CoASH +
ATP. Or in the case of respiratory organisms, the thioester bond energy is expended when
acetyl~SCoA condenses with oxalacetate in order to drive the TCA cycle into its oxidative branch.

ATP Synthesis in Procaryotes

The objective of a catabolic pathway is to make ATP: to transform either chemical energy or
electromagnetic (light) energy into the chemical energy contained within the high-energy bonds of
ATP. Cells fundamentally can produce ATP in two ways: substrate level phosphorylation and
electron transport phosphorylation.

Substrate level phosphorylation (SLP) is The simplest, oldest and least-evolved way to make ATP.
In a substrate level phosphorylation, ATP is made during the conversion of an organic molecule from
one form to another. Energy released during the conversion is partially conserved during the synthesis
of the high energy bond of ATP. SLP occurs during fermentations and respiration (the TCA cycle), and
even during some lithotrophic transformations of inorganic substrates.

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Figure 5. Three examples of substrate level phosphorylation. (a) and (b) are the two substrate level phosphorylations
that occur during the Embden Meyerhof pathway, but they occur in all other fermentation pathways which have an
Embden-Meyerhof component. (c) is a substrate level phosphorylation found in Clostridium and Bifidobacterium.
These are two anaerobic (fermentative) bacteria who learned how to make one more ATP from glycolysis beyond the
formation of pyruvate.

Electron Transport Phosphorylation (ETP) is a much more complicated affair that evolved long
after SLP. Electron Transport Phosphorylation takes place during respiration, photosynthesis,
lithotrophy and possibly other types of bacterial metabolism. ETP requires that electrons removed from
substrates be dumped into an electron transport system (ETS) contained within a membrane. The
electrons are transferred through the ETS to some final electron acceptor in the membrane (like O2 in
aerobic respiration) , while their traverse through the ETS results in the extrusion of protons and the
establishment of a proton motive force (pmf) across the membrane. An essential component of the
membrane for synthesis of ATP is a membrane-bound ATPase (ATP synthetase) enzyme. The
ATPase enzyme transports protons, thereby utilizing the pmf (protons) during the synthesis of ATP.
The idea in electron transport phosphorylation is to drive electrons through an ETS in the membrane,
establish a pmf, and use the pmf to synthesize ATP. Obviously, ETP take a lot more "gear" than SLP,
in the form of membranes, electron transport systems, ATPase enzymes, etc.

A familiar example of energy-producing and energy-consuming functions of the bacterial membrane,

related to the establishment and use of pmf and the production of ATP, is given in the following
drawing of the plasma membrane of Escherichia coli.

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Figure 6. The plasma membrane of Escherichia coli. The membrane in cross-section reveals various transport
systems, the flagellar motor apparatus (S and M rings), the respiratory electron transport system, and the
membrane-bound ATPase enzyme. Reduced NADH + H+ feeds pairs of electrons into the ETS. The ETS is the
sequence of electron carriers in the membrane [FAD --> FeS --> QH2 (Quinone) --> (cytochromes) b --> b --> o] that
ultimately reduces O2 to H2O during respiration. At certain points in the electron transport process, the electrons
pass "coupling sites" and this results in the translocation of protons from the inside to the outside of the membrane,
thus establishing the proton motive force (pmf) on the membrane. The pmf is used in three ways by the bacterium to
do work or conserve energy: active transport (e.g. lactose and proline symport; calcium and sodium antiport);
motility (rotation of the bacterial flagellum), and ATP synthesis (via the ATPase enzyme during the process of
oxidative phosphorylation or electron transport phosphorylation).

Heterotrophic Types of Metabolism

Heterotrophy (i.e. chemoheterotrophy) is the use of an organic compound as a source of carbon and
energy. It is the complete metabolism package. The cell oxidizes organic molecules in order to produce
energy (catabolism) and then uses the energy to synthesize cellular material from these the organic
molecules (anabolism). We animals are familiar with heterotrophic metabolism. Many Bacteria (but
just a few Archaea) are heterotrophs, particularly those that live in associations with animals.

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Heterotrophic bacteria are the masters of decomposition and biodegradation in the environment.
Heterotrophic metabolism is driven mainly by two metabolic processes: fermentations and respirations.

Fermentation

Fermentation is an ancient mode of metabolism, and it must have evolved with the appearance of
organic material on the planet. Fermentation is metabolism in which energy is derived from the partial
oxidation of an organic compound using organic intermediates as electron donors and electron
acceptors. No outside electron acceptors are involved; no membrane or electron transport system is
required; all ATP is produced by substrate level phosphorylation.

By definition, fermentation may be as simple as two steps illustrated in the following model. Indeed,
some amino acid fermentations by the clostridia are this simple. But the pathways of fermentation are
a bit more complex, usually involving several preliminary steps to prime the energy source for
oxidation and substrate level phosphorylations.

Figure 7. Model fermentation. L. The substrate is oxidized to an organic intermediate; the usual oxidizing agent is
NAD. Some of the energy released by the oxidation is conserved during the synthesis of ATP by the process of
substrate level phosphorylation. Finally, the oxidized intermediate is reduced to end products. Note that NADH2 is
the reducing agent, thereby balancing its redox ability to drive the energy-producing reactions. R. In lactic
fermentation by Lactobacillus, the substrate (glucose) is oxidized to pyruvate, and pyruvate becomes reduced to
lactic acid. Redox balance is maintained by coupling oxidations to reductions within the pathway. For example, in
lactic acid fermentation via the Embden-mererhof pathway, the oxidation of glyceraldehyde phosphate to
phosphoglyceric acid is coupled to the reduction of pyruvic acid to lactic acid.

In biochemistry, for the sake of convenience, fermentation pathways start with glucose. This is because
it is the simplest molecule, requiring the fewest catalytic steps, to enter into a pathway of glycolysis
and central metabolism. In procaryotes there exist three major pathways of glycolysis (the dissimilation
of sugars): the classic Embden-Meyerhof pathway, which is also used by most eukaryotes, including
yeast (Saccharomyces): the phosphoketolase or heterolactic pathway related to the hexose-pentose
shunt; and the Entner-Doudoroff pathway. Whether or not a bacterium is a fermenter, it will likely
dissimilate sugars through one or more of these pathways (See Table 1 below).

The Embden-Meyerhof Pathway

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This is the pathway of glycolysis most familiar to biochemists and eukaryotic biologists, as well as to
brewers, breadmakers and cheeseheads. The pathway is operated by Saccharomyces to produce ethanol
and CO2. The pathway is used by the (homo)lactic acid bacteria to produce lactic acid, and it is used by
many other bacteria to produce a variety of fatty acids, alcohols and gases. Some end products of
Embden-Meyerhof fermentations are essential components of foods and beverages, and some are
useful fuels and industrial solvents. Diagnostic microbiologists use bacterial fermentation profiles (e.g.
testing an organism's ability to ferment certain sugars, or examining an organisms's array of end
products) in order to identify them, down to the genus level.

Figure 8. The Embden Meyerhof pathway for glucose dissimilation. The overall reaction is the oxidation of glucose
to 2 pyruvic acid. The two branches of the pathway after the cleavage are identical, drawn in this manner for
comparison with other bacterial pathways of glycolysis.

The first three steps of the pathway prime (phosphorylate) and rearrange the hexose for cleavage into 2
trioses (glyceraldehyde-phosphate). Fructose 1,6-diphosphate aldolase is the key (cleavage) enzyme
in the E-M pathway. Each triose molecule is oxidized and phosphorylated followed by two substrate
level phosphorylations that yield 4 ATP during the drive to pyruvate.

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Lactic acid bacteria reduce the pyruvate to lactic acid; yeast reduce the pyruvate to alcohol (ethanol)
and CO2 as shown in Figure 9 below.

The oxidation of glucose to lactate yields a total of 56 kcal per mole of glucose. Since the cells harvest
2 ATP (16 kcal) as useful energy, the efficiency of the lactate fermentation is about 29 percent (16/56).
Ethanol fermentations have a similar efficiency.

Figure 9. (a) The Embden Meyerhof pathway of lactic acid fermentation in lactic acid bacteria (Lactobacillus) and
(b) the Embden Meyerhof pathway of alcohol fermentation in yeast (Saccharomyces). The pathways yield two moles
of end products and two moles of ATP per mole of glucose fermented. The steps in the breakdown of glucose to
pyruvate are identical. The difference between the pathways is the manner of reducing pyruvic acid, thereby giving
rise to different end products.

Besides lactic acid, Embden-Meyerhof fermentations in bacteria can lead to a wide array of end
products depending on the pathways taken in the reductive steps after the formation of pyruvic acid.
Figure 10 below shows some of the pathways proceeding from pyruvic acid in certain bacteria.
Usually, these bacterial fermentations are distinguished by their end products into the following groups.

1. Homolactic Fermentation. Lactic acid is the sole end product. Pathway of the homolactic acid
bacteria (Lactobacillus and most streptococci). The bacteria are used to ferment milk and milk products
in the manufacture of yogurt, buttermilk, sour cream, cottage cheese, cheddar cheese, and most
fermented dairy products.

2. Mixed Acid Fermentations. Mainly the pathway of the Enterobacteriaceae. End products are a
mixture of lactic acid, acetic acid, formic acid, succinate and ethanol, with the possibility of gas
formation (CO2 and H2) if the bacterium possesses the enzyme formate dehydrogenase, which cleaves
formate to the gases.

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2a. Butanediol Fermentation. Forms mixed acids and gases as above, but, in addition, 2,3 butanediol
from the condensation of 2 pyruvate. The use of the pathway decreases acid formation (butanediol is
neutral) and causes the formation of a distinctive intermediate, acetoin. Water microbiologists have
specific tests to detect low acid and acetoin in order to distinguish non fecal enteric bacteria (butanediol
formers, such as Klebsiella and Enterobacter) from fecal enterics (mixed acid fermenters, such as E.
coli, Salmonella and Shigella).

3. Butyric acid fermentations, as well as the butanol-acetone fermentation (below), are run by the
clostridia, the masters of fermentation. In addition to butyric acid, the clostridia form acetic acid, CO2
and H2 from the fermentation of sugars. Small amounts of ethanol and isopropanol may also be formed.

3a. Butanol-acetone fermentation. Butanol and acetone were discovered as the main end products of
fermentation by Clostridium acetobutylicum during the World War I. This discovery solved a critical
problem of explosives manufacture (acetone is required in the manufacture gunpowder) and is said to
have affected the outcome of the War. Acetone was distilled from the fermentation liquor of
Clostridium acetobutylicum,,which worked out pretty good if you were on our side, because organic
chemists hadn't figured out how to synthesize it chemically. You can't run a war without gunpowder, at
least you couldn't in those days.

4. Propionic acid fermentation. This is an unusual fermentation carried out by the propionic acid
bacteria which include corynebacteria, Propionibacterium and Bifidobacterium. Although sugars can
be fermented straight through to propionate, propionic acid bacteria will ferment lactate (the end
product of lactic acid fermentation) to acetic acid, CO2 and propionic acid. The formation of propionate
is a complex and indirect process involving 5 or 6 reactions. Overall, 3 moles of lactate are converted
to 2 moles of propionate + 1 mole of acetate + 1mole of CO2, and 1 mole of ATP is squeezed out in the
process. The propionic acid bacteria are used in the manufacture of Swiss cheese, which is
distinguished by the distinct flavor of propionate and acetate, and holes caused by entrapment of CO2.

Figure 10. Fermentations in bacteria that proceed through the Embden-Meyerhof pathway.

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The Embden-Meyerhof pathway for glucose dissimilation (Figure 8), as well as the TCA cycle
discussed below (Figure 14), are two pathways that are at the center of metabolism in nearly all
organisms. Not only do these pathways dissimilate organic compounds and provide energy,they also
provide the precursors for biosynthesis of macromolecules that make up living systems (see Figure 25
below). These are rightfully-called amphibolic pathways since the have both an anabolic and a
catabolic function.

The Heterolactic (Phosphoketolase) Pathway

The phosphoketolase pathway (Figure 11) is distinguished by the key cleavage enzyme,
phosphoketolase, which cleaves pentose phosphate into glyceraldehyde-3-phosphate and acetyl
phosphate. As a fermentation pathway, it is employed mainly by the heterolactic acid bacteria, which
include some species of Lactobacillus and Leuconostoc.In this pathway, glucose-phosphate is oxidized
to 6-phosphogluconic acid, which becomes oxidized and decarboxylated to form pentose phosphate.
Unlike the Embden-Meyerhof pathway, NAD-mediated oxidations take place before the cleavage of
the substrate being utilized. Pentose phosphate is subsequently cleaved to glyceraldehyde-3-phosphate
(GAP) and acetyl phosphate. GAP is converted to lactic acid by the same enzymes as the E-M
pathway. This branch of the pathway contains an oxidation coupled to a reduction while 2 ATP are
produced by substrate level phosphorylation. Acetyl phosphate is reduced in two steps to ethanol,
which balances the two oxidations before the cleavage but does not yield ATP. The overall reaction is
Glucose ---------->1 lactic acid + 1 ethanol +1 CO2 with a net gain of 1 ATP. The efficiency is about
half that of the E-M pathway.

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Heterolactic species of bacteria are occasionally used in the fermentation industry. For example, one
type of fermented milk called kefir, analogous to yogurt which is produced by homolactic acid bacteria,
is produced using a heterolactic Lactobacillus species. Likewise, sauerkraut fermentations use
Leuconostoc species of bacteria to complete the fermentation.

Figure 11. The heterolactic (phosphoketolase) pathway of fermentation. Compare with the Embden-Meyerhof
pathway in Figure 9. This pathway differs in the early steps before the cleavage of the molecule. The overall reaction
in the fermentation of glucose is Glucose -------> Lactic acid + ethanol + CO2 + 1 ATP (net).

The Entner-Doudoroff Pathway

Only a few bacteria, most notably Zymomonas, employ the Entner-Doudoroff pathway as a
fermentation path. However, many bacteria, especially those grouped around the pseudomonads, use
the pathway as a way to degrade carbohydrates for respiratory metabolism (see Table 1 below). The E-
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D pathway yields 2 pyruvic acid from glucose (same as the E-M pathway) but like the phosphoketolase
pathway, oxidation occurs before the cleavage, and the net energy yield per mole of glucose utilized is
one mole of ATP.

In the E-D pathway, glucose phosphate is oxidized to 2-keto-3-deoxy-6-phosphogluconic acid (KDPG)

which is cleaved by KDPG aldolase to pyruvate and GAP. The latter is oxidized to pyruvate by E-M
enzymes wherein 2 ATP are produced by substrate level phosphorylations. Pyruvic acid from either
branch of the pathway is reduced to ethanol and CO2, in the same manner as yeast, by the "yeast-like
bacterium", Zymomonas (Figure 12 below). Thus, the overall reaction is Glucose ---------->2 ethanol +2
CO2, and a net gain of 1 ATP.

Zymomonas is a bacterium that lives on the surfaces of plants, including the succulent Maguey cactus
which is indigenous to Mexico. Just as grapes are crushed and fermented by resident yeast to wine, so
may the Maguey flesh be crushed and allowed to ferment with Zymomonas, which gives rise to "cactus
beer" or "pulque", as it is known in Mexico. Distilled pulque yields tequila in the state of Jalisco or
mescal in the state of Oaxaca. Many cultures around the world prepare their native fermented brews
with Zymomonas in deference to the yeast, Saccharomyces, although they may not have a choice in the
matter. Zymomonas has potential advantageous over yeast for the industrial production of alcohol, but
the industry is geared to do what it can do, and no change in organisms is forthcoming.

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Figure 12. The Entner-Doudoroff Pathway of Fermentation. The overall reaction is Glucose -------> 2 ethanol + 2
CO2 + 1 ATP (net).

Table 1. Oxidative pathways of glycolysis employed by various bacteria.

Embden-Meyerhof Phosphoketolase Entner-Doudoroff

Bacterium
pathway (heterolactic) pathway pathway
Acetobacter aceti - + -
Agrobacterium
- - +
tumefaciens
Azotobacter vinelandii - - +
Bacillus subtilis major minor -
Escherichia coli + - -
Lactobacillus
+ - -
acidophilus
Leuconostoc
- + -
mesenteroides
Pseudomonas
- - +
aeruginosa
Vibrio cholerae minor - major
Zymomonas mobilis - - +

Table 2. End product yields in microbial fermentations.

Pathway Key enzyme Ethanol Lactic Acid CO2 ATP

Embden-Meyerhof
fructose 1,6-diP aldolase 2 0 2 2
Saccharomyces
Embden-Meyerhof
fructose 1,6-diP aldolase 0 2 0 2
Lactobacillus
Heterolactic
phosphoketolase 1 1 1 1
Streptococcus
Entner-Doudoroff
KDPG aldolase 2 0 2 1
Zymomonas

Respiration

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Compared to fermentation as a means of oxidizing organic compounds, respiration is a lot more
complicated. Respirations result in the complete oxidation of the substrate by an outside electron
acceptor. In addition to a pathway of glycolysis, four essential structural or metabolic components are
needed:

1. The tricarboxylic acid (TCA) cycle (also known as the citric acid cycle or the Kreb's cycle): when
an organic compound is utilized as a substrate, the TCA cycle is used for the complete oxidation of the
substrate. The end product that always results from the complete oxidation of an organic compound is
CO2.

2. A membrane and an associated electron transport system (ETS). The ETS is a sequence of
electron carriers in the plasma membrane that transports electrons taken from the substrate through
the chain of carriers to a final electron acceptor. The electrons enter the ETS at a very low redox
potential (E'o) and exit at a relatively high redox potential. This drop in potential releases energy that
can be harvested by the cells in the process of ATP synthesis by the mechanisms of electron transport
phosphorylation. The operation of the ETS establishes a proton motive force (pmf) due to the
formation of a proton gradient across the membrane.

3. An outside electron acceptor ("outside", meaning it is not internal to the pathway, as is pyruvate in
a fermentation). For aerobic respiration the electron acceptor is O2, of course. Molecular oxygen is
reduced to H20 in the last step of the electron transport system. But in the bacterial processes of
anaerobic respiration, the final electron acceptors may be SO4 or S or NO3 or NO2 or certain other
inorganic compounds, or even an organic compound, such as fumarate.

4. A transmembranous ATPase enzyme (ATP synthetase). This enzyme utilizes the proton motive
force established on the membrane (by the operation of the ETS) to synthesize ATP in the process of
electron transport phosphorylation. It is believed that the transmembranous Fo subunit is a proton
transport system that transports 2H+ to the F1 subunit (the actual ATPase) on the inside of the
membrane. The 2 protons are required and consumed during the synthesis of ATP from ADP plus Pi.
See Figure 6 -the membrane of E. coli. The reaction catalyzed by the ATPase enzyme is ADP + Pi + 2
H+ <----------> ATP. (It is important to appreciate the reversibility of this reaction in order to account
for how a fermentative bacterium, without an ETS, could establish a necessary pmf on the membrane
for transport or flagellar rotation. If such an organism has a transmembranous ATPase, it could produce
ATP by SLP, and subsequently the ATPase could hydrolyze the ATP, thereby releasing protons to the
outside of the membrane.)

The diagram below of aerobic respiration (Figure 13) integrates these metabolic processes into a
scheme that represents the overall process of respiratory metabolism. A substrate such as glucose is
completely oxidized to to CO2 by the combined pathways of glycolysis and the TCA cycle. Electrons
removed from the glucose by NAD are fed into the ETS in the membrane. As the electrons traverse the
ETS, a pmf becomes established across the membrane. The electrons eventually reduce an outside
electron acceptor, O2, and reduce it to H20. The pmf on the membrane is used by the ATPase enzyme to
synthesize ATP by a process referred to as "oxidative phosphorylation".

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 Figure 13. Model of Aerobic respiration.

Paramount to appreciation of respiration, is an understanding of the role of the TCA cycle. The TCA
cycle (including the steps leading into it) accounts for the complete oxidation of the substrate and
provides 10 pairs of electrons (from glucose) for transit through the ETS. For every pair of electrons
put into the ETS, 2 or 3 ATP may be produced, so a huge amount of ATP is produced in a respiration,
compared to a fermentation.

Glucose is dissimilated in a pathway of glycolysis to the intermediate, pyruvate, and it is the pyruvate
that is moved into the TCA cycle, eventually becoming oxidized to 3 CO2. Since 2 pyruvate are formed
from one glucose, the cycle must turn twice for every molecule of glucose oxidized to 6 CO2.

Initially, pyruvate is oxidized and decarboxylated in a complex reaction involving NAD, Coenzyme A,
and pyruvate dehydrogenase (pyruvate decarboxylase), forming the most central molecule in
metabolism, Acetyl CoA. (See Figure 4). Acetyl CoA condenses with the 4C-compound, oxaloacetic
acid, to form the first stable intermediate of the TCA cycle, 6C-citric acid (citrate), a tricarboxylic acid.
Citrate is isomerized to isocitrate, which is oxidized and decarboxylated forming alpha-ketoglutarate
(akg). Alpha ketoglutarate dehydrogenase uses CoA and NAD to oxidize akg to succinyl CoA in a
reaction analogous to the pyruvate dehydrogenase reaction above. Succinyl CoA is converted to
succinate during a substrate level phosphorylation yielding high energy GTP (equivalent to ATP). This
completes the decarboxylation of pyruvate forming 3 CO2. The remaining three steps in the cycle
complete the oxidation of succinate and regenerate the oxalacetate necessary to drive the cycle. During
the oxidation of pyruvic acid to 3 CO2 by one turn of the TCA cycle, 4 NADH2, 1 FADH2 and one
ATP (actually GTP) are produced. Since the TCA cycle is an important amphibolic pathway, several
intermediates of the cycle may be withdrawn for anabolic (biosynthetic) pathways (See Figure 25).

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Figure 14. The tricarboxylic acid (TCA) or Kreb's cycle

The overall reaction for the aerobic respiration of glucose is

Glucose + 6 O2 ----------> 6 CO2 + 6 H20 + 688 kcal (total)

which can be written

Glucose ----------> 6 CO2 + 10 NADH2 + 2 FADH2 + 4 ATP

(2NADH2 from glycolysis, 8NADH2 from two turns of TCA, 2 FADH2 from two turns of TCA; 2ATP
(net) from glycolysis, 2 ATP (GTP) from two turns of TCA)

In E. coli, 2 ATP are produced for each pair of electrons that are introduced into the ETS by NADH2.
One ATP is produced from a pair of electrons introduced by FADH2. Hence, the equation can be
rewritten

Glucose + 6 O2 ----------> 6 CO2 + 6 H20 + 20 ATP (ETP) + 2 ATP (ETP) + 4 ATP (SLP) + 688 kcal
(total)

Since a total of 26 ATP is formed during the release of 688 kcal of energy, the efficiency of this
respiration is 26x8/688 or about 30 percent. In Pseudomonas (or mitochondria), due to the exact nature
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of the ETS, 3 ATP are produced for each pair of electrons that are introduced into the ETS by NADH2
and 2 ATP are produced from a pair of electrons introduced by FADH2. Hence, the overall reaction in
Pseudomonas, using the same dissimilatory pathways as E. coli, is

Glucose + 6 O2 ----------> 6 CO2 + 6 H20 + 38 ATP + 688 kcal (total)

and the corresponding efficiency is about 45 percent.

Respiration in some procaryotes is possible using electron acceptors other than oxygen (O2). This type
of respiration in the absence of oxygen is referred to as anaerobic respiration. Although anaerobic
respiration is more complicated than the foregoing statement, in its simplest form it represents the
substitution or use of some compound other than O2 as a final electron acceptor in the electron
transport chain. Electron acceptors used by procaryotes for respiration or methanogenesis (an
analogous type of energy generation in archaea) are described in the table below.

Table 3. Electron acceptors for respiration and methanogenesis in procaryotes

electron reduced end
name of process organism
acceptor product
Escherichia,
O2 H 2O aerobic respiration
Streptomyces
NO3 NO2, NH3 or N2 anaerobic respiration: denitrification Bacillus, Pseudomonas
anaerobic respiration: sulfate
SO4 S or H2S Desulfovibrio
reduction
anaerobic respiration:
fumarate succinate Escherichia
using an organic e- acceptor
CO2 CH4 methanogenesis Methanococcus

Biological methanogenesis is the source of methane (natural gas) on the planet. Methane is preserved
as a fossil fuel (until we use it all up) because it is produced and stored under anaerobic conditions, and
oxygen is needed to oxidize the CH4 molecule. Methanogenesis is not really a form of anaerobic
respiration, but it is a type of energy-generating metabolism that requires an outside electron acceptor
in the form of CO2.

Denitrification is an important process in agriculture because it removes NO3 from the soil. NO3 is a
major source of nitrogen fertilizer in agriculture. Almost one-third the cost of some types of agriculture
is in nitrate fertilizers The use of nitrate as a respiratory electron acceptor is usually an alternative to the
use of oxygen. Therefore, soil bacteria such as Pseudomonas and Bacilluswill use O2 as an electron
acceptor if it is available, and disregard NO3. This is the rationale in maintaining well-aerated soils by
the agricultural practices of plowing and tilling. E. coli will utilize NO3 (as well as fumarate) as a
respiratory electron acceptor and so it may be able to continue to respire in the anaerobic intestinal
habitat.

Sulfate reduction is not an alternative to the use of O2 as an electron acceptor. It is an obligatory

process that occurs only under anaerobic conditions. Methanogens and sulfate reducers may share

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habitat, especially in the anaerobic sediments of eutrophic lakes such as Lake Mendota, where they
crank out methane and hydrogen sulfide at a surprising rate.

Anaerobic respiring bacteria and methanogens play an essential role in the biological cycles of carbon,
nitrogen and sulfur. In general, they convert oxidized forms of the elements to a more reduced state.
The lithotrophic procaryotes metabolize the reduced forms of nitrogen and sulfur to a more oxidized
state in order to produce energy. The methanotrophic bacteria, which uniquely posses the enzyme
methane monooxygenase, can oxidize methane as a source of energy. Among all these groups of
procaryotes there is a minicycle of the elements in a model ecosystem.

Lithotrophic Types of Metabolism

Lithotrophy is the use of an inorganic compound as a source of energy. Most lithotrophic bacteria are
aerobic respirers that produce energy in the same manner as all aerobic respiring organisms: they
remove electrons from a substrate and put them through an electron transport system that will produce
ATP by electron transport phosphorylation. Lithotrophs just happen to get those electrons from an
inorganic, rather than an organic compound.

Some lithotrophs are facultative lithotrophs, meaning they are able to use organic compounds, as
well, as sources of energy. Other lithotrophs do not use organic compounds as sources of energy; in
fact, they won't transport organic compounds. CO2 is the sole source of carbon for the methanogens
and the nitrifying bacteria and a few other species scattered about in other groups. These
lithoautotrophs are often referred to as "chemoautotrophs", but the term lithoautotroph is a more
accurate description of their metabolism. The lithotrophs are a very diverse group of procaryotes,
united only by their ability to oxidize an inorganic compound as an energy source.

Lithotrophy runs through the Bacteria and the Archaea. If one considers methanogen oxidation of H2
a form of lithotrophy, then probably most of the Archaea are lithotrophs. Lithotrophs are usually
organized into "physiological groups" based on their inorganic substrate for energy production and
growth (see Table 5 below).

Table 5. Physiological groups of lithotrophs

physiological group energy source oxidized end product organism
hydrogen bacteria H2 H 2O Alcaligenes, Pseudomonas
methanogens H2 H 2O Methanobacterium
carboxydobacteria CO CO2 Rhodospirillum, Azotobacter
nitrifying bacteria* NH3 NO2 Nitrosomonas
nitrifying bacteria* NO2 NO3 Nitrobacter
sulfur oxidizers H2S or S SO4 Thiobacillus, Sulfolobus
++ +++
iron bacteria Fe Fe Gallionella, Thiobacillus
* The overall process of nitrification, conversion of NH3 to NO3, requires a consortium of
microorganisms.

The hydrogen bacteria oxidize H2 (hydrogen gas) as an energy source. The hydrogen bacteria are
facultative lithotrophs as evidenced by the pseudomonads that fortuitously possess a hydrogenase

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enzyme that will oxidize H2 and put the electrons into their respiratory ETS. They will use H2 if they
find it in their environment even though they are typically heterotrophic. Indeed, most hydrogen
bacteria are nutritionall-versatile in their ability to use a wide range of carbon and energy sources.
Some hydrogen bacteria possess an NAD-linked hydrogenase that transfers electrons from H2 to NAD
in a one-step process. NAD then delivers the electrons to the ETS. Others have hydrogenase enzymes
that pass electrons to different carriers in the bacterial electron transport system.

The methanogens used to be considered a major group of hydrogen bacteria - until it was discovered
that they are Archaea. The methanogens are able to oxidize H2 as a sole source of energy while
transferring the electrons from H2 to CO2 in its reduction to methane. Apparently, H2 has more energy
available than CH4, for all you physical chemists out there. Metabolism of the methanogens is
absolutely unique, yet methanogens represent the most prevalent and diverse group of Archaea.
Methanogens use H2 and CO2 to produce cell material and methane. They have unique coenzymes and
electron transport processes. Their type of energy generating metabolism is never seen in the Bacteria,
and their mechanism of autotrophic CO2 fixation is very rare, except in methanogens.

The carboxydobacteria are able to oxidize CO (carbon monoxide) to CO2, using an enzyme CODH
(carbon monoxide dehydrogenase). The carboxydobacteria are not obligate CO users, i.e., some are
also hydrogen bacteria, and some are phototrophic bacteria. Interestingly, the enzyme CODH used by
the carboxydobacteria to oxidize CO to CO2, is used by the methanogens for the reverse reaction - the
reduction of CO2 to CO - during CO2 fixation by the CODH pathway (Figure 23).

The nitrifying bacteria are represented by two genera, Nitrosomonas and Nitrobacter. Together these
bacteria can accomplish the oxidation of NH3 to NO3, known as the process of nitrification. No single
organism can carry out the whole oxidative process. Nitrosomonas oxidizes ammonia to NO2 and
Nitrobacter oxidizes NO2 to NO3. Most of the nitrifying bacteria are obligate lithoautotrophs, the
exception being a few strains of Nitrobacter that will utilize acetate. CO2 fixation utilizes RUBP
carboxylase and the Calvin Cycle. Nitrifying bacteria grow in environments rich in ammonia, where
extensive protein decomposition is taking place. Nitrification in soil and aquatic habitats is an essential
part of the nitrogen cycle.

Lithotrophic sulfur oxidizers include both Bacteria (e.g. Thiobacillus) and Archaea (e.g. Sulfolobus).
Sulfur oxidizers oxidize H2S (sulfide) or S (elemental sulfur) as a source of energy. Similarly, the
purple and green sulfur bacteria oxidize H2S or S as an electron donor for photosynthesis, and use the
electrons for CO2 fixation (the dark reaction of photosynthesis). Obligate autotrophy, which is nearly
universal among the nitrifiers, is variable among the sulfur oxidizers. Lithoautotrophic sulfur oxidizers
are found in environments rich in H2S, such as volcanic hot springs and fumaroles, and deep-sea
thermal vents. Some are found as symbionts and endosymbionts of higher organisms. Since they can
generate energy from an inorganic compound and fix CO2 as autotrophs, they may play a fundamental
role in primary production in environments that lack sunlight. As a result of their lithotrophic
oxidations, these organisms produce sulfuric acid (SO4), and therefore tend to acidify their own
environments. Some of the sulfur oxidizers are acidophiles that will grow at a pH of 1 or less. Some
are hyperthermophiles that grow at temperatures of 115 degrees C.

Iron bacteria oxidize Fe++ (ferrous iron) to Fe+++ (ferric iron). At least two bacteria probably oxidize
Fe++ as a source of energy and/or electrons and are capable of lithoautotrophic growth: the stalked
bacterium Gallionella, which forms flocculant rust-colored colonies attached to objects in nature, and
Thiobacillus ferrooxidans, which is also a sulfur-oxidizing lithotroph.

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 Figure 15. Lithotrophic oxidations

Phototrophic Metabolism

Phototrophy is the use of light as a source of energy for growth, more specifically the conversion of
light energy into chemical energy in the form of ATP. Procaryotes that can convert light energy into
chemical energy include the photosynthetic cyanobacteria, the purple and green bacteria and the
"halobacteria" (actually archaea). The cyanobacteria conduct plant photosynthesis, called oxygenic
photosynthesis; the purple and green bacteria conduct bacterial photosynthesis or anoxygenic
photosynthesis; the extreme halophilic archaea use a type of nonphotosynthetic
photophosphorylation mediated by bacteriorhodopsin to transform light energy into ATP.

Photosynthesis is the conversion of light energy into chemical energy that can be used in the formation
of cellular material from CO2. Photosynthesis is a type of metabolism separable into a catabolic and
anabolic component. The catabolic component of photosynthesis is the light reaction, wherein light
energy is transformed into electrical energy, then chemical energy. The anabolic component involves
the fixation of CO2 and its use as a carbon source for growth, usually called the dark reaction. In
photosynthetic procaryotes there are two types of photosynthesis and two types of CO2 fixation.

The Light Reactions depend upon the presence of chlorophyll, the primary light-harvesting pigment
in the membrane of photosynthetic organisms. Absorption of a quantum of light by a chlorophyll
molecule causes the displacement of an electron at the reaction center. The displaced electron is an
energy source that is moved through a membrane photosynthetic electron transport system, being
successively passed from an iron-sulfur protein (X ) to a quinone to a cytochrome and back to
chlorophyll (Figure 16 below). As the electron is transported, a proton motive force is established on
the membrane, and ATP is synthesized by an ATPase enzyme. This manner of converting light energy
into chemical energy is called cyclic photophosphorylation.

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 Figure 16. Photosystem I: cyclical electron flow coupled to photophosphorylation

The functional components of the photochemical system are light harvesting pigments, a membrane
electron transport system, and an ATPase enzyme. The photosynthetic electron transport system of is
fundamentally similar to a respiratory ETS, except that there is a low redox electron acceptor (e.g.
ferredoxin) at the top (low redox end) of the electron transport chain, that is first reduced by the
electron displaced from chlorophyll.

There are several types of pigments distributed among various phototrophic organisms. Chlorophyll is
the primary light-harvesting pigment in all photosynthetic organisms. Chlorophyll is a tetrapyrrole
which contains magnesium at the center of the porphyrin ring. It contains a long hydrophobic side
chain that associates with the photosynthetic membrane. Cyanobacteria have chlorophyll a, the same
as plants and algae. The chlorophylls of the purple and green bacteria, called bacteriochlorophylls are
chemically different than chlorophyll a in their substituent side chains. This is reflected in their light
absorption spectra. Chlorophyll a absorbs light in two regions of the spectrum, one around 450nm and
the other between 650 -750nm; bacterial chlorophylls absorb from 800-1000nm in the far red region of
the spectrum.

The chlorophylls are partially responsible for light harvesting at the photochemical reaction center. The
energy of a photon of light is absorbed by a special chlorophyll molecule at the reaction center, which
becomes instantaneously oxidized by a nearby electron acceptor of low redox potential. The energy
present in a photon of light is conserved as a separation of electrical charge which can be used to
generate a proton gradient for ATP synthesis.

Carotenoids are always associated with the photosynthetic apparatus. They function as secondary
light-harvesting pigments, absorbing light in the blue-green spectral region between 400-550 nm.
Carotenoids transfer energy to chlorophyll, at near 100 percent efficiency, from wave lengths of light
that are missed by chlorophyll. In addition, carotenoids have an indispensable function to protect the
photosynthetic apparatus from photooxidative damage. Carotenoids have long hydrocarbon side chains
in a conjugated double bond system. Carotenoids "quench" the powerful oxygen radical, singlet
oxygen, which is invariably produced in reactions between chlorophyll and O2 (molecular oxygen).
Some nonphotosynthetic bacterial pathogens, i.e., Staphylococcus aureus, produce carotenoids that
protect the cells from lethal oxidations by singlet oxygen in phagocytes.

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Phycobiliproteins are the major light harvesting pigments of the cyanobacteria. They also occur in
some groups of algae. They may be red or blue, absorbing light in the middle of the spectrum between
550 and 650nm. Phycobiliproteins consist of proteins that contain covalently-bound linear tetrapyrroles
(phycobilins). They are contained in granules called phycobilisomes that are closely associated with
the photosynthetic apparatus. Being closely linked to chlorophyll they can efficiently transfer light
energy to chlorophyll at the reaction center.

Figure 17. The distribution of photosynthetic pigments among photosynthetic microorganisms.

All phototrophic bacteria are capable of performing cyclic photophosphorylation as described above
and in Figure 16 and below in Figure 18. This universal mechanism of cyclic photophosphorylation is
referred to as Photosystem I. Bacterial photosynthesis uses only Photosystem I (PSI), but the more
evolved cyanobacteria, as well as algae and plants, have an additional light-harvesting system called
Photosystem II (PSII). Photosystem II is used to reduce Photosystem I when electrons are withdrawn
from PSI for CO2 fixation. PSII transfers electrons from H2O and produces O2, as shown in Figure 20.

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Figure 18. The cyclical flow of electrons during bacterial (anoxygenic) photosynthesis. A cluster of carotenoid and
chlorophyll molecules at the Reaction Center harvests a quantum of light. A bacterial chlorophyll molecule becomes
instantaneously oxidized by the loss of an electron. The light energy is used to boost the electron to a low redox
intermediate, ferredoxin, (or some other iron sulfur protein) which can enter electrons into the photosynthetic
electron transport system in the membrane. As the electrons traverse the ETS a proton motive force is established
that is used to make ATP in the process of photophosphorylation. The last cytochrome in the ETS returns the
electron to chlorophyll. Since light energy causes the electrons to turn in a cycle while ATP is synthesized, the
process is called cyclic photophosphorylation. Compare bacterial photosynthesis with the scheme that operates in
Photosystem I in Figure 16 above. Bacterial photosynthesis uses only Photosystem I for the conversion of light
energy into chemical energy.

Figure 19. The normally cyclical flow of electrons during bacterial photosynthesis must be opened up in order to
obtain electrons for CO2 ficxation. In the case of the purple sulfur bacteria, they use H2S as a source of electrons.
The oxidation of H 2S is coupled to PSI. Light energy boosts an electron, derived from H2S, to the level of ferredoxin,
which reduces NADP to provide electrons for autotrophic CO 2 fixation.

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 Figure 20. Electron flow in plant (oxygenic) photosynthesis. Photosystem I and the mechanisms of cyclic
photophosphorylation operate in plants, algae and cyanobacteria, as they do in bacterial photosynthesis. In plant
photosynthesis, chlorophyll a is the major chlorophyll species at the reaction center and the exact nature of the
primary electron acceptors (X or ferredoxin) and the components of the ETS are different than bacterial
photosynthesis. But the fundamental mechanism of cyclic photophosphorylation is the same. However, when
electrons must be withdrawn from photosystem I (ferredoxin--e--->NADP in upper left), those electrons are
replenished by the operation of Photosystem II. In the Reaction Center of PSII, a reaction between light, chlorophyll
and H 2O removes electrons from H2O (leading to the formation of O2) and transfers them to a component of the
photosynthetic ETS (primary electron acceptor). The electrons are then transferred through a chain of electron
carriers consisting of cytochromes and quinones until they reach shlorophyll in PSI. The resulting drop in redox
potential allows for the synthesis of ATP in a process called noncyclic photophosphorylation. The operation of
photosystem II is what fundamentally differentiates plant photosynthesis from bacterial photosynthesis. Photosystem
II accounts for the source of reductant for CO 2 fixation (provided by H2O), the production of O2, and ATP synthesis
by noncyclic photophosphorylation

Most of the phototrophic procaryotes are obligate or facultative autotrophs, which means that they are
able to fix CO2 as a sole source of carbon for growth. Just as the oxidation of organic material yields
energy, electrons and CO2, in order to build up CO2 to the level of cell material (CH2O), energy (ATP)
and electrons (reducing power) are required. The overall reaction for the fixation of CO2 in the Calvin
cycle is CO2 + 3ATP + 2NADPH2 ----------> CH2O + 2ADP + 2Pi + 2NADP. The light reactions
operate to produce ATP to provide energy for the dark reactions of CO2 fixation. The dark reactions
also need reductant (electrons). Usually the provision of electrons is in some way connected to the light
reactions. A model for coupling the light and dark reactions of photosynthesis is illustrated in Figure 21
below.

The general scheme for finding electrons for CO2 fixation is to open up Photosystem I and remove the
electrons, eventually getting them to NADP which can donate them to the dark reaction. In bacterial
photosynthesis the process may be quite complex. The electrons are removed from Photosystem I at the
level of a cytochrome, then moved through an energy-consuming reverse electron transport system
to an iron-sulfur protein, ferredoxin, which reduces NADP to NADPH2. The electrons that replenish
Photosystem I come from the oxidation of an external photosynthetic electron donor, which may be
H2S, other sulfur compounds, H2, or certain organic compounds.
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In plant photosynthesis, the photosynthetic electron donor is H2O, which is lysed by photosystem II,
resulting in the production of O2. Electrons removed from H2O travel through Photosystem II to
Photosystem I as described in Figure 20 above. Electrons removed from Photosystem I reduce
ferredoxin directly. Ferredoxin, in turn, passes the electrons to NADP.

Figure 21. Model for coupling the light and dark reactions of photosynthesis.

The differences between plant and bacterial photosynthesis are summarized in Table 6 below. Bacterial
photosynthesis is an anoxygenic process. The external electron donor for bacterial photosynthesis is
never H2O, and therefore, purple and green bacteria never produce O2 during photosynthesis.
Furthermore, bacterial photosynthesis is usually inhibited by O2 and takes place in microaerophilic and
anaerobic environments. Bacterial chlorophylls use light at longer wave lengths not utilized in plant
photosynthesis, and therefore they do not have to compete with oxygenic phototrophs for light.
Bacteria use only cyclic photophosphorylation (Photosystem I) for ATP synthesis and lack a second
photosystem.

Table 6. Differences between plant and bacterial photosynthesis

plant photosynthesis bacterial photosynthesis

organisms plants, algae, cyanobacteria purple and green bacteria
chlorophyll a bacteriochlorophyll
type of chlorophyll
absorbs 650-750nm absorbs 800-1000nm
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Photosystem I
present present
(cyclic photophosphorylation)
Photosystem I
present absent
(noncyclic photophosphorylation)
Produces O2 yes no
H2S, other sulfur compounds or
Photosynthetic electron donor H2O
certain organic compounds

While photosynthesis is highly-evolved in the procaryotes, it apparently originated in the Bacteria and
did not spread or evolve in Archaea. But the Archaea, in keeping with their unique ways, are not
without representatives which can conduct a type of light-driven photophosphorylation. The extreme
halophiles, archaea that live in natural environments such as the Dead Sea and the Great Salt Lake at
very high salt concentration (as high as 25 percent NaCl) adapt to the high-salt environment by the
development of "purple membrane", actually patches of light-harvesting pigment in the plasma
membrane. The pigment is a type of rhodopsin called bacteriorhodopsin which reacts with light in a
way that forms a proton gradient on the membrane allowing the synthesis of ATP. This is the only
example in nature of non photosynthetic photophosphorylation. These organisms are heterotrophs
that normally respire by aerobic means. The high concentration of NaCl in their environment limits the
availability of O2 for respiration so they are able to supplement their ATP-producing capacity by
converting light energy into ATP using bacteriorhodopsin.

Autotrophic CO2 fixation

The use of RUBP carboxylase and the Calvin cycle is the most common mechanism for CO2 fixation
among autotrophs. Indeed, RUBP carboxylase is said to be the most abundant enzyme on the planet
(nitrogenase, which fixes N2 is second most abundant). This is the only mechanism of autotrophic CO2
fixation among eukaryotes, and it is used, as well, by all cyanobacteria and purple bacteria.
Lithoautotrophic bacteria also use this pathway. But the green bacteria and the methanogens, as well as
a few isolated groups of procaryotes, have alternative mechanisms of autotrophic CO2 fixation and do
not possess RUBP carboxylase.

RUBP carboxylase (ribulose bisphosphate carboxylase) uses ribulose bisphosphate (RUBP) and CO2
as co-substrates. In a complicated reaction the CO2 is "fixed" by addition to the RUBP, which is
immediately cleaved into two molecules of 3-phosphoglyceric acid (PGA). The fixed CO2 winds up in
the -COO group of one of the PGA molecules. Actually, this is the reaction which initiates the Calvin
cycle (Figure 22 below).

The Calvin cycle is concerned with the conversion of PGA to intermediates in glycolysis that can be
used for biosynthesis, and with the regeneration of RUBP, the substrate that drives the cycle. After the
initial fixation of CO2, 2 PGA are reduced and combined to form hexose-phosphate by reactions which
are essentially the reverse of the oxidative Embden-Meyerhof pathway. (Now is a good time to go back
to Figure 8 and look at the E-M pathway for the location of PGA and glucose-phosphate). The hexose
phosphate is converted to pentose-phosphate, which is phosphorylated to regenerate RUBP. An
important function of the Calvin cycle is to provide the organic precursors for the biosynthesis of cell
material. Intermediates must be constantly withdrawn from the Calvin cycle in order to make cell

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material. In this regard, the Calvin cycle is an anabolic pathway. The fixation of CO2 to the level of
glucose (C6H12O6) requires 18 ATP and 12 NADPH2.

Figure 22. The Calvin cycle and its relationship to the synthesis of cell materials.

The methanogens, a very abundant group of procaryotes, use CO2 as a source of carbon for growth, and
as a final electron acceptor in an energy-producing process that produces methane. If a methanogen is
fed labeled CO2 as a sole form of carbon, 95 percent of the label winds up in methane and 5 percent
winds up in cell material. The methanogens fix CO2 by means of the enzyme CODH (carbon
monoxide dehydrogenase) and the Acetyl CoA pathway (Figure 23 below).

The pathway of methanogenesis steadily reduces CO2 to the methyl (CH3) level, mediated by the
coenzyme methanopterin (MP), related to folic acid. MP-CH3 may be reduced to methane (not shown)
or the MP may be replaced by a vitamin B12-like molecule to enter the pathway of CO2 fixation. The
"B12"-CH3 is substrate for CO fixation mediated by the CODH. CODH reduces CO2 to CO and adds
the CO to "BB12"-CH3 to form acetyl-[CODH]. Coenzyme A (CoA) then replaces the CODH, resulting
in the formation of Acetyl CoA, which is in the heart of biosynthetic metabolism. The net effect is the
reduction of 2 CO2 to Acetyl CoA.

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Figure 23. The CODH or acetyl CoA pathway of CO2 fixation in the methanogens

Finally, in the photosynthetic Green Bacteria, the pathway of autotrophic CO2 fixation involves the
reversal of familiar decarboxylation reactions in and around the TCA cycle. The two primary reactions
utilized by the Green Bacteria are two Ferredoxin (FD)-mediated reactions, the reduction of Acetyl
CoA to pyruvate, and the reduction of succinyl CoA to alpha-ketoglutarate This is referred to as the
reverse TCA cycle for CO2 uptake.

Figure 24. The two ferredoxin (FD)-mediated reactions used for CO2 uptake in the green bacteria are a reversal of
the oxidation of keto acids mediated by NAD and CoA (Figure 4).

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Biosynthesis

The pathways of central metabolism (i.e., glycolysis and the TCA cycle), with a few modifications,
always run in one direction or another in all organisms. The reason - these pathways provide the
precursors for the biosynthesis of cell material. When a pathway, such as the Embden-Meyerhof
pathway or the TCA cycle, functions to provide energy in addition to chemical intermediates for the
synthesis of cell material, the pathway is referred to as an amphibolic pathway. Pathways of
glycolysis and the TCA cycle are amphibolic pathways because they provide ATP and chemical
intermediates to build new cell material. The main metabolic pathways, and their relationship to
biosynthesis of cell material, are shown in Figure 25 below.

Biosynthesis or intermediary metabolism is a topic of biochemistry, more so than microbiology. It

will not be dealt with in detail here. The fundamental metabolic pathways of biosynthesis are similar in
all organisms, in the same way that protein synthesis or DNA structure are similar in all organisms.
When biosynthesis proceeds from central metabolism as drawn below, some of the main precursors for
synthesis of procaryotic cell structures and components are as follows.

Polysaccharide capsules or inclusions are polymers of glucose and other sugars.

Cell wall peptidoglycan (NAG and NAM) is derived from glucose phosphate.

Amino acids for the manufacture of proteins have various sources, the most important of which are
pyruvic acid, alpha ketoglutaric acid and oxalacetic acid.

Nucleotides (DNA and RNA) are synthesized from ribose phosphate. ATP and NAD are part of
purine (nucleotide) metabolism.

Triose-phosphates are precursors of glycerol, and acetyl CoA is a main precursor of lipids for
membranes

Vitamins and coenzymes are synthesized in various pathways that leave central metabolism. In the
example given in Figure 25, heme synthesis proceeds from the serine pathway, as well as from
succinate in the TCA cycle.

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Figure 25. The main pathways of biosynthesis in procaryotic cells

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 Todar's Online Textbook of Bacteriology

REGULATION AND CONTROL OF METABOLIC ACTIVITY

© 2004 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

Adaptation to the Nutritional and Physical Environment

Unlike plant and animal cells, most bacteria are exposed to a constantly changing physical and
chemical environment. Within limits, bacteria can react to changes in their environment through
changes in patterns of structural proteins, transport proteins, toxins, enzymes, etc., which adapt them to
a particular ecological situation. For example, E. coli does not produce fimbriae for colonization
purposes when living in a planktonic (free-floating or swimming) environment. Vibrio cholerae does
not produce the cholera toxin that causes diarrhea unless it is in the human intestinal tract. Bacillus
subtilis does not make the enzymes for tryptophan biosynthesis if it can find preexisting tryptophan in
its environment. If E. coli is fed glucose and lactose together, it will use the glucose first because it
takes two less enzymes to use glucose than it does to use lactose. In Neisseria gonorrhoeae, the
bacterium will develop a sophisticated iron gathering and transport system if it senses that iron is in
short supply in its environment.

Bacteria have developed sophisticated mechanisms for the regulation of both catabolic and anabolic
pathways. Generally, bacteria do not synthesize degradative (catabolic) enzymes unless the substrates
for these enzymes are present in their environment. For example, synthesis of enzymes that degrade
lactose would be wasteful unless the substrate for these enzymes (lactose) was available in the
environment. Similarly, bacteria have developed diverse mechanisms for the control of biosynthetic
(anabolic) pathways. Bacterial cells shut down biosynthetic pathways when the end products of the
pathway are not needed or are readily obtained by transport from the environment. For example, if a
bacterium could find a preformed amino acid like tryptophan in its environment, it would make sense
to shut down its own pathway of tryptophan biosynthesis, and thereby conserve energy. However, in
real bacterial life, the control mechanisms for all these metabolic pathways must be reversible, since
the environment can change quickly and drastically.

Some of the common mechanisms by which bacterial cells can regulate and control their metabolic
activities are discussed in this chapter It is important for the reader to realize that most of these
mechanisms have been observed or described in the bacterium, Escherichia coli, and they are mostly
untested and unproved to exist in many other bacteria or procaryotes (although, whenever they are
looked for, they are often found). The perceptive reader will appreciate that the origins of the modern
science of molecular biology are found in the experiments that explained these regulatory processes in
E. coli.

Conditions Affecting Enzyme Formation in Bacteria

As stated above, bacterial cells can change patterns of enzymes, in order to adapt them to their specific
environment. Often the concentration of an enzyme in a bacterial cell depends on the presence of the
substrate for the enzyme. Constitutive enzymes are always produced by cells independently of the
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composition of the medium in which the cells are grown. The enzymes that operate during glycolysis
and the TCA cycle are generally constitutive: they are present at more or less the same concentration in
cells at all times. Inducible enzymes are produced ("turned on") in cells in response to a particular
substrate; they are produced only when needed. In the process of induction the substrate, or a
compound structurally similar to the substrate, evokes formation of the enzyme and is sometimes called
an inducer. A repressible enzyme is one whose synthesis is downregulated or "turned off" by the
presence of (for example) the end product of a pathway that the enzyme normally participates in. In this
case, the end product is called a corepressor of the enzyme.

Regulation of Enzyme Reactions

Not all enzymatic reactions occur in a cell to the same extent. Some compounds are needed in large
amounts and the reactions involved in their synthesis must therefore occur in large amounts. Other
compounds are needed in small amounts and the corresponding reactions involved in their synthesis
need only occur in small amounts.

In bacterial cells, enzymatic reactions may be regulated by two unrelated modes: (1) control or
regulation of enzyme activity (feedback inhibition or end product inhibition), which mainly operates
to regulate biosynthetic pathways; and (2) control or regulation of enzyme synthesis including, end-
product repression, which functions in the regulation of biosynthetic pathways, and enzyme
induction and catabolite repression, which regulate mainly degradative pathways. The process of
feedback inhibition regulates the activity of preexisting enzymes in the cells. The processes of end-
product repression, enzyme induction and catabolite repression are involved in the control of synthesis
of enzymes. These latter processes which regulate the synthesis of enzymes may be either a form of
positive control or negative control. End-product repression and enzyme induction are mechanisms of
negative control which lead to a decrease in the transcription of proteins. Catabolite repression is
considered a form of positive control because it affects an increase in transcription of proteins.

Table 1.Points for regulation of various metabolic processes. Bacteria exert control over their metabolism at every
possible stage starting at the level of the gene that encodes for a protein and ending with alteration or modifications
in the protein after it is produced. For example, variation in gene structure can vary the activity or production of a
protein, just as modifications of a protein after it is produced can alter or change its activity. One of the most
important sites for control of metabolism at the genetic level is regulation of transcription. At this level, in positive
control mechanisms (e.g. catabolite repression), a regulatory protein has an effect to increase the rate of
transcription of a gene, while in negative control mechanisms (e.g. enzyme induction or end product repression) a
regulatory protein has the effect to decrease the rate of transcription of a gene. Sometimes this nomeneclature may
seem counter-intuitive, but molecular biologists have stuck us with it.

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Allosteric Proteins

Although there are examples of regulatory processes that occur at all stages in molecular biology of
bacterial cells (see Table 1 above), the most common points of regulation are at the level of
transcription (e.g. enzyme induction and enzyme repression) and changing the activity of preexisting
proteins. In turn, these levels of control are usually modulated by proteins with the property of
allostery.

An allosteric protein is one which has an active (catalytic) site and an allosteric (effector) site. In an
allosteric enzyme, the active site binds to the substrate of the enzyme and converts it to a product. The
allosteric site is occupied by some small molecule which is not a substrate. However, when the
allosteric site is occupied by the effector molecule, the configuration of the active site is changed so
that it is now unable to recognize and bind to its substrate (Figure 1). If the protein is an enzyme, when
the allosteric site is occupied, the enzyme is inactive, i.e., the effector molecule decreases the activity
of the enzyme. There is an alternative situation, however. The effector molecule of certain allosteric
enzymes binds to its allosteric site and consequently transforms the enzyme from an inactive to an
active state (Figure 2). Some multicomponent allosteric enzymes have several sites occupied by various
effector molecules that modulate enzyme activity over a range of conditions.

Figure 1. Example of an allosteric enzyme with a negative effector site. When the effector molecule binds to the
allosteric site, substrate binding and catalytic activity of the enzyme are inactivated. When the effector is detached
from the allosteric site the enzyme is active.

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Figure 2. Example of an allosteric enzyme with a positive effector site. The effector molecule binds to the allosteric
site resulting in alteration of the active site that stimulates substrate binding and catalytic activity.

Some allosteric proteins are not enzymes, but nonetheless have an active site and an allosteric site.
The regulatory proteins that control metabolic pathways involving end product repression, enzyme
induction and catabolite repression are allosteric proteins. In their case, the active site is a DNA
binding site, which, when active, binds to a specific sequence of DNA, and which, when inactive, does
not bind to DNA. The allosteric or effector molecule is a small molecule which can occupy the
allosteric site and affect the active site. In the case of enzyme repression, a positive effector molecule
(called a corepressor) binds to the allosteric regulatory protein and activates its ability to bind to DNA.
In the case of enzyme induction a negative effector molecule (called an inducer) binds to the allosteric
site, causing the active site to change conformation thereby detaching the protein from its DNA binding
site.

Feedback Inhibition

Feedback inhibition (or end product inhibition) is a mechanism for the inhibition of preformed
enzymes that is seen primarily in the regulation of whole biosynthetic pathways, e.g. pathways
involved in the synthesis of the amino acids. Such pathways usually involve many enzymatic steps, and
the final (end) product is many steps removed from the starting substrate. By this mechanism, the final
product is able to feed back to the first step in the pathway and to regulate its own biosynthesis.

In feedback inhibition, the end product of a biosynthetic pathway inhibits the activity of the first
enzyme that is unique to the pathway, thus controlling production of the end product. The first enzyme
in the pathway is an allosteric enzyme. Its allosteric site will bind to the end product (e.g. amino acid)
of the pathway which alters its active site so that it cannot mediate the enzymatic reaction which
initiates the pathway. Other enzymes in the pathway remain active, but they do not see their substrates.
The pathway is shut down as long as adequate amounts of the end product are present. If the end
product is used up or disappears, the inhibition is relieved, the enzyme regains its activity, and the
organism can resume synthesis of the end product. Thus, if a E. coli bacterium swims out of a glucose
minimal medium into milk or some other medium rich in growth factors, the bacterium can stop
synthesizing any of the essential metabolites that are made available directly from the new
environment.

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One of the most intensely studied bacterial pathways is the pathway of tryptophan biosynthesis (Figure
3). The pathway of tryptophan biosynthesis is regulated by feed back inhibition. Tryptophan is the
effector molecule for allosteric enzyme a. When the end product of the pathway (tryptophan) attaches
to enzyme a, the enzyme is inactive and can no longer join glutamine and chorismic acid into
anthranilate. If tryptophan is disjoined from the enzyme the pathway is resumed, and tryptophan
synthesis will continue. Tryptophan biosynthesis is also regulated at a genetic level by the processes of
enzyme repression (below) and attenuation.

Note: In the case of feedback inhibition (above), the signal molecule, tryptophan, is a negative effector
of Enzyme a in the pathway of tryptophan biosynthesis, because when it binds to Enzyme a, it
inactivates the enzyme. In enzyme repression (below) tryptophan is a signal molecule that acts as a
positive effector of the trp repressor protein because when it binds to the repressor it activates the
protein, so that it binds to the trp DNA.

Figure 3. The pathway of tryptophan biosynthesis in E. coli. The pathway is regulated by the process of feedback
inhibition. Tryptophan (trp), the end product of the pathway, is the effector molecule that binds to the allosteric site
of Enzyme a, the first enzyme in the pathway. When trp is bound to the enzyme the catalytic (active) site of Enzyme
a is altered so that it is unable to react with its subtrates and the synthesis of anthranilate is inhibited.

If a metabolic pathway branches, leading to the synthesis of two amino acids, each end product (amino
acid) can control its own synthesis without affecting the other (Figure 4). For example, the amino acids
proline and arginine are both synthesized from glutamic acid. Each amino acid can regulate the first
enzyme unique to its own synthesis without affecting the other, so that a surplus of arginine, for
example, will not shut off the synthesis of proline.

Figure 4. Generalized scheme for regulation of a branched metabolic pathway by the process of feedback inhibition.

Enzyme Repression

Enzyme repression is a form of negative control (down-regulation) of bacterial transcription. This

process, along with that of enzyme induction, is called negative control because a regulatory protein
brings about inhibition of mRNA synthesis which leads to decreased synthesis of enzymes.

Although feedback inhibition shuts off synthesis of the end product of a pathway, it still allows some
waste of energy and carbon if the cell continued to manufacture enzymes for which it has no use. It is
the process of enzyme repression that prevents the synthesis of the enzymes concerned with the
synthesis of that particular end product. In the case of the pathway of tryptophan biosynthesis
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(Figure 3), the end product of the pathway, tryptophan, serves as an effector molecule that can
shutdown the synthesis of the Enzymes a, b, c, d, and e that are concerned with tryptophan
biosynthesis. This results in saving of many molecules of ATP which must be expended during protein
synthesis, and it conserves amino acid precursors for synthesis of other proteins. The process is slower
to act than is feedback inhibition (which acts immediately) because pre-existing enzymes have to be
diluted out as a result of cell division before its effects are seen.

The genes for tryptophan biosynthesis in Escherichia coli are organized on the bacterial chromosome
in the tryptophan operon (trp operon). An operon is a cluster of genes that are controlled by the same
elements and which are coordinately transcribed and translated. The trp operon consists of a Promoter
(P) region, an Operator (O) region, an Attenuator (A) region, and the five structural genes for the
enzymes involved in tryptophan biosynthesis (Trp A-E) The components of the trp operon and its
control elements are described in Figure 5 and Table 2 below.

Figure 5. Genetic organization of the Trp operon and its control elements

Table 2. The Trp operon and its control elements

R = Regulatory gene that encodes for the trp Repressor protein that is concerned with regulating the synthesis of the
5 gene products. An active repressor binds to a specific nucleotide sequence in the operator region and thereby
blocks binding of RNAp to the promoter to initiate transcription.

O = Operator specific nucleotide sequence on DNA to which an active Repressor binds.

P = Promoter specific nucleotide sequence on DNA to which RNA polymerase binds to initiate transcription. If the
repressor protein binds to the operator, RNAp is prevented from binding with the promoter and initiating
transcription. Therefore, none of the enzymes concerned with tryptophan biosynthesis are synthesized.

A = Attenuator DNA sequence which lies between the operator and the structural genes for trp biosynthesis. The
attenuator is a barrier that RNA polymerase must traverse if it is to transcribe the genes for tryptophan
biosynthesis. In the presence of trp, most RNAp molecules fall off the DNA before transcribing the trp genes. In the
absence of trp, RNAp is able to traverse the attenuator region to successfully transcribe the trp genes.

Trp A, B, C, D, E = Trp Genes structural genes for enzymes involved in tryptophan biosynthesis.

Trp = tryptophan end product of the tryptophan biosynthetic pathway. When combined with the repressor protein
the Repressor is active. Trp is called a corepressor.

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The trp operon is regulated by a regulatory gene (Trp L) ustream of the trp promoter. The product of
the R (L) gene, the trp Repressor, is an allosteric protein which is regulated by tryptophan. The
Repressor is produced constitutively in small amounts in an inactive form. When the Repressor
combines with tryptophan it becomes activated and binds to the DNA of the trp operon in such a way
that it blocks the transcription of the structural genes for tryptophan. Thus, in the presence of
tryptophan, transcription of the genes for tryptophan biosynthesis is repressed (tryptophan is not
produced), while in the absence of tryptophan, the genes for tryptophan biosynthesis can be transcribed
(tryptophan is produced); See Figure 6 below.

Figure 6a. Derepression of the trp operon. In the absence of trp the inactive repressor cannot bind to the operator to
block transcription.The cell must synthesize the amino acid.

Figure 6b. Repression of the trp operon. In the presence of tryptophan the trp operon is repressed because trp
activates the repressor. Transcription of is blocked because the active repressor binds to the DNA and prevents
binding of RNA polymerase.

Enzyme Induction

In some cases, metabolites or substrates can turn on inactive genes so that they are transcribed. In the
process of enzyme induction, the substrate or a compound structurally similar to the substrate, evokes
the formation of enzyme(s) which are usually involved in the degradation of the substrate. Enzymes
that are synthesized as a result of genes being turned on are called inducible enzymes and the
substance that activates gene transcription is called the inducer. Inducible enzymes are produced only
in response to the presence of a their substrate and, in a sense, are produced only when needed. In this
way the cell does not waste energy synthesizing unneeded enzymes.

The best known and best studied case of enzyme induction involves the enzymes of lactose degradation
in E. coli. Only in the presence of lactose does the bacterium synthesize the enzymes that are necessary
to utilize lactose as a carbon and energy source for growth. Two enzymes are required for the initial
breakdown of lactose: lactose permease, which actively transports the sugar into the cell, and beta
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galactosidase, which splits lactose into glucose plus galactose. The genes for these enzymes are
contained within the lactose operon (lac operon) in the bacterial chromosome (Figure 7).

Figure 7. The Lac operon and its control elements

The mechanism of enzyme induction is similar to end product repression in that a regulatory gene, a
promoter, and an operator are involved, but a major difference is that the lac Repressor is active only
in the absence of the inducer molecule (lactose). In the presence of lactose, the Repressor cannot
bind to the operator region, so that the genes for lactose transport and cleavage are transcribed. In the
absence of lactose, the Repressor is active and will bind to the operator with the result that the genes for
lactose metabolism are not transcribed. The induction (presence of lactose) and the repression (absence
of lactose) of the lactose operon is represented in Figure 8 . The function of the components and control
elements are shown in Table 3.

Figure 8. Enzyme Induction. Induction (or derepression) of the lac operon.

Table 3. Functional and regulatory components of the lac operon

Lac R = Regulatory gene (also known as Lac I) gene that encodes for the lac Repressor protein that is concerned
with regulating the synthesis of the structural genes in the operon. Lac I is adjacent to the Promoter site of the
operon. An active repressor binds to a specific nucleotide sequence in the operator region and thereby blocks
binding of RNAp to the promoter to initiate transcription. The lac repressor is inactivated by lactose, and is active in
the absence of lactose.

O = Operator specific nucleotide sequence on DNA to which an active Repressor binds.

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P = Promoter specific nucleotide sequence on DNA to which RNA polymerase binds to initiate transcription. (The
promoter site of the lac operon is further divided into two regions, an upstream region called the CAP site, and a
downstream region consisting of the RNAp interaction site. The CAP site is involved in catabolite repression of the
lac operon.). If the Repressor protein binds to the operator, RNAp is prevented from binding with the promoter and
initiating transcription. Under these conditions the enzymes concerned with lactose utilization are not synthesized.

Lac Z, Y and A = Structural Genes in the lac operon. Lac Z encodes for Beta-galactosidase; Lac Y encodes the
lactose permease; Lac A encodes a transacetylase whose function is not known.

lac = lactose the inducer molecule. When lactose binds to the Repressor protein, the Repressor is inactivated; the
operon is derepressed; the transcription of the genes for lactose utilization occurs.

Catabolite Repression

Enzyme Induction is still considered a form of negative control because the effect of the regulatory
molecule (the active repressor) is to decrease or downregulate transcription. Catabolite repression is
a type of positive control of transcription, since a regulatory protein affects an increase
(upregulation) in the rate of transcription of an operon. The process was discovered in E. coli and was
originally referred to as the glucose effect because it was found that glucose repressed the synthesis
of certain inducible enzymes, even though the inducer of the pathway was present in the environment.
The discovery was made during study of the regulation of lac operon in E. coli. Since glucose is
degraded by constitutive enzymes and lactose is initially degraded by inducible enzymes, what would
happen if the bacterium was grown in limiting amounts of glucose and lactose? A plot of the bacterial
growth rate resulted in a diauxic growth curve which showed two distinct phases of active growth
(Figure 9). During the first phase of exponential growth, the bacteria utilize glucose as a source of
energy until all the glucose is exhausted. Then, after a secondary lag phase, the lactose is utilized
during a second stage of exponential growth.

Figure 9. The Diauxic Growth Curve of E. coli grown in limiting concentrations of a mixture of glucose and lactose

During the period of glucose utilization, lactose is not utilized because the cells are unable to transport
and cleave the disaccharide lactose. Glucose is always metabolized first in preference to other sugars.
Only after glucose is completely utilized is lactose degraded. The lactose operon is repressed even
though lactose (the inducer) is present. The ecological rationale is that glucose is a better source of
energy than lactose since its utilization requires two less enzymes.

Only after glucose is exhausted are the enzymes for lactose utilization synthesized. The secondary lag
during diauxic growth represents the time required for the complete induction of the lac operon and
synthesis of the enzymes necessary for lactose utilization (lactose permease and beta-galactosidase).
Only then does bacterial growth occur at the expense of lactose. Since the availability of glucose

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represses the enzymes for lactose utilization, this type of repression became known as catabolite
repression or the glucose effect.

Glucose is known to repress a large number of inducible enzymes in many different bacteria. Glucose
represses the induction of inducible operons by inhibiting the synthesis of cyclic AMP (cAMP), a
nucleotide that is required for the initiation of transcription of a large number of inducible enzyme
systems including the lac operon.

The role of cyclic a cAMP is complicated. cAMP is required to activate an allosteric protein called
CAP (catabolite activator protein) which binds to the promoter CAP site and stimulates the binding
of RNAp polymerase to the promoter for the initiation of transcription. Thus to efficiently promote
gene transcription of the lac operon, not only must lactose be present to inactivate the lac repressor, but
cAMP must be available to bind to CAP which binds to DNA to facilitate transcription. In the
presence of glucose, adenylate cyclase (AC) activity is blocked. AC is required to synthesize cAMP
from ATP. Therefore, if cAMP levels are low, CAP is inactive and transcription does not occur. In
the absence of glucose, cAMP levels are high, CAP is activated by cAMP, and transcription occurs
(in the presence of lactose).

Many positively controlled promoters, such as the lac promoter, are not fully functional in the presence
of RNAp alone and require activation by CAP. CAP is encoded by a separate Regulatory gene, and is
present in constitutive levels. CAP is active only in the presence of cAMP. The binding of cAMP to
CAP causes a conformational change in the protein allowing it to bind to the promoter near the RNAp
binding site. CAP can apparently interact with RNAp to increase operon transcription about 50-fold.
Positive control of the lac operon is illustrated in Figure10.

Figure 10. Catabolite repression is positive control of the lac operon. The effect is an increase in the rate of
transcription.In this case, the CAP protein is activated by cAMP to bind to the lac operon and facilitate the binding
of RNA polymerase to the promoter to transcribe the genes for lactose utilization.

As a form of catabolite repression, the glucose effect serves a useful function in bacteria: it requires the
cells to use the best available source of energy. For many bacteria, glucose is the most common and
readily utilizable substrate for growth. Thus, it inhibits indirectly the synthesis of enzymes that
metabolize poorer sources of energy.

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 Todar's Online Textbook of Bacteriology

PROCARYOTES IN THE ENVIRONMENT

© 2005 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

The most significant effect that procaryotes have on their environment is their underlying ability to
recycle the essential elements that make up cells. The earth is a closed system with limited amounts of
carbon, oxygen and nitrogen available to all forms of life. These essential elements must be converted
from one form to another and shared among all living organisms. The total biomass of microbial cells
in the biosphere, their metabolic diversity and their persistence in all habitats that support life,
guarantee that microbes will play crucial roles in the transformations and recycling of these elements.

The table below lists the major elements that make up a typical procaryotic cell (in this case, E. coli).
As expected, over 90 percent of the elemental analaysis consists of carbon, hydrogen, oxygen, nitrogen,
phosphorus and sulfur. These are the elements that become combined to form all the biochemicals that
comprise living systems. C, H, O, N, P and S are the constituents of organic material (An organic
compound is a chemical that contains a carbon to hydrogen bond. Organic compounds on earth are
evidence of life. Organic compounds may be symolized as CH2O, which is the emperical formula for a
sugar such as glucose.) H and O are the constituents of water (H2O), that makes up over 95 percent of
the cell composition. Calcium (Ca++), iron (Fe++), magnesium (Mg++) and potassium (K+) are present as
inorganic salts in the cytoplasm of cells.

Table 1. Major elements, their sources and functions in cells.

% of dry
Element Source Function
weight
organic compounds or
Carbon 50 Main constituent of cellular material
CO2
H2O, organic
Constituent of cell material and cell water; O2 is
Oxygen 20 compounds, CO2, and
electron acceptor in aerobic respiration
O2
NH3, NO3, organic Constituent of amino acids, nucleic acids nucleotides,
Nitrogen 14
compounds, N2 and coenzymes
H2O, organic
Hydrogen 8 Main constituent of organic compounds and cell water
compounds, H2
inorganic phosphates Constituent of nucleic acids, nucleotides,
Phosphorus 3
(PO4) phospholipids, LPS, teichoic acids
SO4, H2S, S, organic Constituent of cysteine, methionine, glutathione,
Sulfur 1
sulfur compounds several coenzymes
Main cellular inorganic cation and cofactor for certain
Potassium 1 Potassium salts
enzymes

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 Inorganic cellular cation, cofactor for certain
Magnesium 0.5 Magnesium salts
enzymatic reactions
Inorganic cellular cation, cofactor for certain enzymes
Calcium 0.5 Calcium salts
and a component of endospores
Component of cytochromes and certain nonheme iron-
Iron 0.2 Iron salts
proteins and a cofactor for some enzymatic reactions

The table ignores the occurrence of "trace elements" in cells. Trace elements are metal ions required in
cellular nutrition in such small amounts that it is difficult to determine their presence in cells. The usual
metals that qualify as trace elements are Mn++, Co++, Zn++, Cu++ and Mo++. Trace elements are usually
built into vitamins and enzymes. For example, vitamin B12 contains cobalt (Co++) and the bacterial
nitrogenase enzyme contains molybdenum (Mo++).

The structure and metabolism of any organism adapts it to its environment. Thus the various groups of
microbes are adapted to certain environmental niches based on their predominant type of metabolism
relevant to the elemental nutrients available.

The fungi (molds and yeasts). The molds are aerobic organisms that utilize organic compounds for
growth. They play an important role in decomposition or biodegradation of organic matter, particularly
in soil. Yeasts can grow anaerobially (without oxygen) through the process of fermentation. They play
a role in fermentations in environments high in sugar. The prominant role of fungi in the environment
is in the carbon cycle, during the process of decomposition, especially in the soil.

The algae are also an important part of the carbon cycle. They are the predominant photosyntheic
organisms in many aquatic environments. The algae are autotrophs, which means they use carbon
dioxide (CO2) as a source of carbon for growth. Hence they convert atmospheric CO2 into organic
material (i.e., algal cells). Algae also play a role in the oxygen (O2) cycle since their style of
photosynthesis, similar to plants, produces O2 in the atmosphere. The cyanobacteria are a group of
procaryotic microbes, as prevalent as algae, that have this type of metabolism. Photosynthetic algae
and cyanobacteria can be found in most environments where there is moisture and light.They are a
major component of marine plankton which the basis of the food chain in the oceans.

Protozoans are heterotrophic organisms that have to catch or trap their own food. Therefore, they have
developed elaborate mechanisms for movement and acquiring organic food which they can digest.
Their food usually turns out to be bacterial cells, so one might argue that they are ecological predators
that keep bacterial populations under control.....in soil, aquatic environments, intestinal tracts of
animals, and many other environments.

The procaryotic bacteria and archaea, as a result of their diversity and unique types of metabolism,
are involved in the cycles of virtually all essential elements. In two cases, methanogenesis (conversion
of carbon dioxide into methane) and nitrogen fixation (conversion of nitrogen in the atmosphere into
biological nitrogen) are unique to procaryotes and earns them their "essential role" in the carbon and
nitrogen cycles.

There are other metabolic processes that are unique, or nearly so, in the procaryotes that bear
significantly on the cycles of elements. For example, procaryotes called lithotrophs use inorganic
compounds like ammonia and hydrogen sulfide as a source of energy, and others called anaerobic
respirers use nitrate (NO3) or sulfate (SO4) in the place of oxygen, so they can respire without air.

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Most of the archaea are lithotrophs that use hydrogen (H2) or hydrogen sulfide (H2S) as a source of
energy, while many soil bacteria are anaerobic respirers that can use their efficient respiratory
metabolism in the absence of O2.

The basic processes of heterotrophy are spread throughout the bacteria. Most of the bacteria in the soil
and water, and in associations with animals and plants, are heterotrophs. Heterotrophy means living
off of dead organic matter, usually by some means of respiration (same as animals) or fermentation
(same as yeast or lactic acid bacteria). Bacterial heterotrophs in the carbon chain are important in the
processes of biodegradation and decomposition under aerobic and anaerobic conditions.

In bacteria, there is a unique type of photosynthesis that does not use H2O or produce O2 which impacts
on the carbon and sulfur cycles.

Meanwhile, the cyanobacteria (mentioned above) fix CO2 and produce O2 during photosynthesis, and
they make a very large contribution to the carbon and oxygen cycles.

The list of examples of microbial involvement in the cycles of elements that make up living systems is
endless, and probably every microbe in the web is involved in an intimate and unique way.

The Oxygen Cycle

Basically, O2 is derived from the photolysis of H2O during plant (oxygenic) photosynthesis. Two
major groups of microorganisms are involved in this process, the eukaryotic algae, and the procaryotic
cyanobacteria (formerly known as "blue-green algae"). The cyanobacteria and algae are the source of
much of the O2 in the earth's atmosphere. Of course, plants account for some O2 production as well,
but the microbes predominate in marine habitats which cover the majority of the planet.

Since most aerobic organisms need the O2 that results from plant photosynthesis, this establishes
a relationship between plant photosyntheisis and aerobic respiration, two prominant types of
metabolism on earth. Photosynthesis produces O2 needed for aerobic respiration. Respiration produces
CO2 needed for autotrophic growth.

CO2 + H2O-----------------> CH2O (organic material) + O2 plant (oxygenic) photosynthesis

CH2O + O2-----------------> CO2 + H2O aerobic respiration

Since these photosynthetic microbes are also autotrophic (meaning they convert CO2 to organic
material during growth) they have a similar impact on the carbon cycle (below).

The Carbon Cycle

Carbon is the backbone of all organic molecules and is the most prevalent element in cellular (organic)
material. In its most oxidized form, CO2, it can be viewed as an "inorganic" molecule (no C - H bond).
Autotrophs, which include plants, algae, photosynthetic bacteria, lithotrophs, and methanogens, use
CO2 as a sole source of carbon for growth, which reduces the molecule to organic cell material (CH2O).
Heterotrophs require organic carbon for growth, and ultimately convert it back to CO2.

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Thus, a relationship between autotrophs and heterotrophs is established wherein autotrophs fix carbon
needed by heterotrophs, and heterotrophs produce CO2 used by the autotrophs.

CO2 + H2O-----------------> CH2O (organic material) autotrophy

CH2O + O2-----------------> CO2 + H2O heterotrophy

Since CO2 is the most prevalent greenhouse gas in the atmosphere, it isn't good if these two equations
to get out of balance (i.e. heterotrophy predominating over autotrophy, as when rain forests are
destroyed and replaced with cattle).

Autotrophs are referred to as primary producers at the "bottom of the food chain" because they
convert carbon to a form required by heterotrophs. Among procaryotes, the cyanobacteria, the
lithotrophs and the methanogens are a formidable biomass of autotrophs that account for a
corresponding amount of CO2 fixation in the global carbon cycle.

The lithotrophic bacteria and archaea that oxidize reduced N and S compounds and play important
roles in the natural cycles of N and S (discussed below), are virtually all autotrophs. The prevalence of
these organisms in sulfur-rich environments (marine sediments, thermal vents, hot springs,
endosymbionts, etc. may indicate an unappreciated role of these procaryotes as primary producers of
organic carbon on earth.

The methanogens play a dual role in the carbon cycle. These archaea are inhabitants of virtually all
anaerobic environments in nature where CO2 and H2 (hydrogen gas) occur. They use CO2 in their
metabolism in two distinct ways. About 5 percent of CO2 taken up is reduced to cell material during
autotrophic growth; the remaining 95 percent is reduced to CH4 (methane gas) during a unique process
of generating cellular energy. Hence, methane accumulates in rocks as fossil fuel ("natural gas"), in the
rumen of cows and guts of termites, in sediments, swamps, landfills and sewage digestors. Since CH4 is
the second-most prevalent of the greenhouse gases, it is best to discourage processes that lead to its
accumulation in the atmosphere.

CO2 + H2 -----------------> CH2O (cell material) + CH4 methanogenesis

Under aerobic conditions, methane and its derivatives (methanol, formaldehyde, etc.) can be oxidized
as energy sources by bacteria called methylotrophs. Metabolically this is a version of decomposition
or biodegradation during the carbon cycle which is discussed below.

Biodegradation is the process in the carbon cycle for which microbes get most credit (or
blame). Biodegradation is the decomposition of organic material (CH2O) back to CO2 + H2O and H2.
In soil habitats, the fungi play a significant role in biodegradation, but the procaryotes are equally
important. The typical decomposition scenario involves the initial degradation of biopolymers
(cellulose, lignin, proteins, polysaccharides) by extracellular enzymes, followed by oxidation
(fermentation or respiration) of the monomeric subunits. The ultimate end products are CO2, H2O and
H2, perhaps some NH3 (ammonia) and sulfide (H2S), depending on how one views the overall process.
These products are scarfed up by lithotrophs and autotrophs for recycling. Procaryotes which play an
important role in biodegradation in nature include the actinomycetes, clostridia, bacilli, arthrobacters
and pseudomonads.

Overall Process of Biodegradation (Decomposition)

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polymers (e.g. cellulose)-----------------> monomers (e.g. glucose) depolymerization

monomers-----------------> fatty acids (e.g. lactic acid, acetic acid, propionic acid) + CO2 + H2
fermentation

monomers + O2 -----------------> CO2 + H2O aerobic respiration

The importance of microbes in biodegradation is embodied in the adage that "there is no known natural
compound that cannot be degraded by some microorganism." The proof of the adage is that we aren't
up to our ears in whatever it is that couldn't be degraded in the last 3.5 billion years. Actually, we are
up to our ears in cellulose and lignin, which is better than concrete, and some places are getting up to
their ears in teflon, plastic, styrofoam, insecticides, pesticides and poisons that are degraded slowly by
microbes, or not at all.

Figure 1. The Carbon Cycle. Organic matter (CH2O) derived from photosynthesis (plants, algae and cyanobacteria)
provides nutrition for heterotrophs (e.g.animals and associated bacteria), which convert it back to CO2. Organic
wastes, as well as dead organic matter in the soil and water, are ultimately broken down to CO 2 by microbial
processes of biodegradation.

OFF THE WALL

The figure above mostly ignores the role of methanogenesis in the carbon cycle. Since
methanogens have the potential to remove CO2 from the atmosphere, converting it to cell
material and CH4, these procaryotes not only influence the carbon cycle, but their metabolism
also affects the concentration of major greenhouse gases in earth's atmosphere.

Recently, I asked a colleague, Professor Paul Weimer of the University of Wisconsin Department
of Bacteriology, whether mathanogenesis which utilizes CO2 while producing CH4 was better or
worse on the greenhouse effect. This is his response.

"Worse. For methanogenesis by CO2 reduction, the stoichiometry is 4H2 + CO2 --> CH4 + 2 H2O,
so one mole of a greenhouse gas is exhanged for another. But methane is about 15 times more
potent than is CO2 in terms of heat absorption capability on a per-molecule basis, so the net
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effect is a functional increase in heat absorption by the atmosphere. Remember also that in most
natural environments, around two-thirds of the methane is produced by aceticlastic
methanogenesis (CH3COOH --> CH4 + CO2) - an even less welcome situation, as BOTH products
are greenhouse gases.

Even though methane concentrations in the atmosphere are two orders of magnitude below those
of CO2, methane is thought to account for about 15% of the anthropogenic climate forcing,
compared to about 60% from CO2. Most of the rest of the contribution is from nitrous oxide
(N2O, a respiratory denitrification product that has something like 300 times the heat absorbing
capacity as CO2) and the old chlorofluorocarbons (CFCs), even stonger heat absorbers yet, but
more famous and dangerous as stratospheric ozone-depleters."

The Nitrogen Cycle

The nitrogen cycle is the most complex of the cycles of elements that make up biological systems. This
is due to the importance and prevalence of N in cellular metabolism, the diversity of types of nitrogen
metabolism, and the existence of the element in so many forms. Procaryotes are essentially involved in
the biological nitrogen cycle in three unique processes.

Nitrogen Fixation: this process converts N2 in the atmosphere into NH3 (ammonia), which is
assimilated into amino acids and proteins. Nitrogen fixation occurs in many free-living bacteria such as
clostridia, azotobacters and cyanobacteria, and in symbiotic bacteria such as Rhizobium and Frankia,
which associate with plant roots to form characteristic nodules. Biological nitrogen fixation is the most
important way that N2 from the air enters into biological systems.

N2 ----------------> 2 NH3 nitrogen fixation

Anaerobic Respiration: this relates to the use of oxidized forms of nitrogen (NO3 and NO2) as final
electron acceptors for respiration. Anaerobic respirers such as Bacillus and Pseudomonas are common
soil inhabitants that will use nitrate (NO3) as an electron acceptor. NO3 is reduced to NO2 (nitrite) and
then to a gaseous form of nitrogen such as N2 or N2O (nitrous oxide) or ammonia (NH3). The process is
called denitrification. Denitrifying bacteria are typical aerobes that respire whenever oxygen is
available by aerobic respiration. If O2 is unavailable for respiration, they will turn to the alternative
anaerobic respiration which uses NO3. Since NO3 is a common and expensive form of fertilizer in soils,
denitrification may not be so good for agriculture, and one rationale for tilling the soil is to keep it
aerobic, thereby preserving nitrate fertilizer in the soil.

NO3 ----------------> NO2 ----------------> N2 denitrification

OFF THE WALL

The overall reactions of denitrification shown above proceed through the formation of nitrous
oxide (N2O). A recent article by Wunsch an Zumft in Journal of Bacteriology, vol. 187 (2005),
sheds new light on the process of denitrification. N2O is a bacterial metabolite in the REVERSAL
of Nitrogen fixation. The anthropogenic atmospheric increase of N2O is a cause for concern, as
noted above (as a greenhouse gas, N2O has 300 times the heat absorbing capacity as CO2).
Denitrifying bacteria respire using N2O as an electron acceptor yielding N2 and the thereby
provide a sink for N2O. This article provides new insight into this process by identifying a
membrane-bound protein in denitrifying bacteria called NosR, that is necessary for the
expression of N2O reductase from the nosZ gene. The NosR protein has redox centers positioned
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on opposite sides of the cytoplasmic membrane, which allows it to sustain whole-cell N2O
respiration by acting on N2O reductase.

Nitrification is a form of lithotrophic metabolism that is chemically the opposite of denitrification.

Nitrifying bacteria such as Nitrosomonas utilize NH3 as an energy source, oxidizing it to NO2, while
Nitrobacter will oxidize NO2 to NO3. Nitrifying bacteria generally occur in aquatic environments and
their significance in soil fertility and the global nitrogen cycle is not well understood.

The Overall process of Nitrification

NH3 ----------------> NO2 (Nitrosomonas)

NO2 ----------------> NO3 (Nitrobacter)

A final important aspect of the nitrogen cycle that involves procaryotes, though not exclusively, is
decomposition of nitrogen-containing compounds. Most organic nitrogen (in protein, for example)
yields ammonia (NH3) during the process of deamination. Fungi are involved in decomposition, as
well.

Plants, animals and protista, as well as the procaryotes, complete the nitrogen cycle during the uptake
of the element for their own nutrition. Nitrogen assimilation is usually in the form of nitrate, an amino
group, or ammonia.

Figure 2. The Nitrogen Cycle

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The Sulfur Cycle

Sulfur is a component of a couple of vitamins and essential metabolites and it occurs in two amino
acids, cysteine and methionine. In spite of its paucity in cells, it is an absolutely essential element for
living systems. Like nitrogen and carbon, the microbes can transform sulfur from its most oxidized
form (sulfate or SO4) to its most reduced state (sulfide or H2S). The sulfur cycle, in particular, involves
some unique groups of procaryotes and procaryotic processes. Two unrelated groups of procaryotes
oxidize H2S to S and S to SO4. The first is the anoxygenic photosynthetic purple and green sulfur
bacteria that oxidize H2S as a source of electrons for cyclic photophosphorylation. The second is the
"colorless sulfur bacteria" (now a misnomer because the group contains many Archaea) which oxidize
H2S and S as sources of energy. In either case, the organisms can usually mediate the complete
oxidation of H2S to SO4.

H2S----------------> S ----------------> SO4 litho or phototrophic sulfur oxidation

Sulfur-oxidizing procaryotes are frequently thermophiles found in hot (volcanic) springs and near deep
sea thermal vents that are rich in H2S. They may be acidophiles, as well, since they acidify their own
environment by the production of sulfuric acid.

Since SO4 and S may be used as electron acceptors for respiration, sulfate reducing bacteria produce
H2S during a process of anaerobic respiration analogous to denitrification. The use of SO4 as an
electron acceptor is an obligatory process that takes place only in anaerobic environments. The process
results in the distinctive odor of H2S in anaerobic bogs, soils and sediments where it occurs.

Sulfur is assimilated by bacteria and plants as SO4 for use and reduction to sulfide. Animals and
bacteria can remove the sulfide group from proteins as a source of S during decomposition. These
processes complete the sulfur cycle.

Figure 3. The Sulfur Cycle

The Phosphorus cycle

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The phosphorus cycle is comparatively simple. Inorganic phosphate exists in only one form. It is
interconverted from an iorganic to an organic form and back again, and there is no gaseous
intermediate.

Phosphorus is an essential element in biological systems because it is a constituent of nucleic acids,

(DNA and RNA) and it occurs in the phospholipids of cell membranes. Phosphate is also a constituent
of ADP and ATP which are universally involved in energy exchange in biological systems.

Dissolved phosphate (PO4) inevitably ends up in the oceans. It is returned to land by shore animals and
birds that feed on phosphorus containing sea creatures and then deposit their feces on land. Dissolved
PO4 is also returned to land by a geological process, the uplift of ocean floors to form land masses, but
the process is very slow. However, the figure below considers how PO4 is recycled among land-based
groups of organisms.

Figure 4. The Phosphorus Cycle. Plants, algae and photosynthetic bacteria can absorb phosphate (PO4) dissolved in
water, or if it washes out of rocks and soils. They incorporate the PO 4 into various organic forms, including such
molecules as DNA, RNA, ATP, and phospholipid.The plants are consumed by animals wherein the organic
phosphate in the plant becomes organic phosphate in the animal and in the bacteria that live with the animal.
Animal waste returns inorganic PO 4 to the environment and also organic phosphate in the form of microbial cells.
Dead plants and animals, as well as animal waste, are decomposed by microbes in the soil. The phosphate eventually
is mineralized to the soluble PO4 form in water and soil, to be taken up again by photosynthetic organisms.

Ecology of a Stratified Lake

The role of microbes in the global cycle of elements (described above) can be visited on a smaller
scale, in a lake, for example, like Lake Mendota, which may become stratified as illustrated in Figure 5.
The surface of the lake is well-lighted by the sun and is aerobic. The bottom of the lake and its
sediments are dark and anaerobic. Generally there is less O2 and less light as the water column is
penetrated from the surface. Assuming that the nutrient supply is stable and there is no mixing between
layers of lake water, we should, for the time being, have a stable ecosystem with recycling of essential
elements among the living systems. Here is how it would work.
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At the surface, light and O2 are plentiful, CO2 is fixed and O2 is produced. Photosynthetic plants, algae
and cyanobacteria produce O2, cyanobacteria can even fix N2; aerobic bacteria, insects, animals and
plants live here.

At the bottom of the lake and in the sediments, conditions are dark and anaerobic. Fermentative
bacteria produce fatty acids, H2 and CO2, which are used by methanogens to produce CH4. Anaerobic
respiring bacteria use NO3 and SO4 as electron acceptors, producing NH3 and H2S. Several soluble
gases are in the water: H2, CO2, CH4, NH3 and H2S.

The biological activity at the surface of the lake and at the bottom of the lake may have a lot to do with
what will be going on in the middle of the water column, especially near the interface of the aerobic
and anaerobic zones. This area, called the thermocline, is biologically very active. Bacterial
photosynthesis, which is anaerobic, occurs here, using longer wave lenghts of light that will penetrate
the water column and are not absorbed by all the plant chlorophyll above. The methanotrophs will stay
just within the aerobic area taking up the CH4 from the sediments as a carbon source, and returning it as
CO2. Lithotrophic nitrogen- and sulfur-utilizing bacteria do something analogous: they are aerobes that
use NH3 and H2S from the sediments, returning them to NO3 and SO4.

Figure 5. Ecology of a Stratified lake

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 Todar's Online Textbook of Bacteriology

IMPORTANT GROUPS OF PROCARYOTES

© 2004 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

Figure 0. The Phylogenetic Tree of Life based on Comparative ssrRNA Sequencing.The Tree shows the procaryotes
in two Domains, Archaea and Bacteria. At a taxonomic level, most organisms at the tips of the Archaeal branches
represent a unique Order; most organisms a the tips of the bacterial branches are classified into a unique Phylum.
On the Archaeal limb, the three physiological groups are evident in the names: "thermo" and "pyro" for the
extreme thermophiles; "methano" for the methanogens; and "halophiles" for the extreme halophiles. The most
important, best known, and diverse groups (phyla) branching off of the Bacterial limb are the Cyanobacteria,
Proteobacteria and Gram positives.

The procaryotes (or prokaryotes) consist of millions of genetically-distinct unicellular organisms.

What they lack in structural diversity, so well-known among eucaryotes (including the protista), they
make up for in their physiological diversity. It is often a particular physiological trait that unifies and
distinguishes a particular group of procaryotes to microbiologists. In Bergey's Manualof Determinative
bacteriology (1994), the identifiable groups of procaryotes are assembled based on easily-observed
phenotypic characteristics such as Gram stain, morphology (rods, cocci, etc), motility, structural
features (e.g. spores, filaments, sheaths, appendages, etc.), and on distinguishing physiological features
(e.g. anoxygenic photosynthesis, anaerobiasis, methanogenesis, lithotrophy, etc.).

Nowadays, this type of artificial classification scheme has been abandoned in favor of hierarchal
taxonomic schemes based on comparative genetic analysis of the nucleotide sequences of the small
subunit ribosomal RNA that iscontained in all cellular organisms. In the Second edition of Bergey's
Manual of Systematic Bacteriology (2001) as well as the current edition of The Prokaryotes,
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phylogeny dominates the classification schemes. Such an approach generates the Phylogentic Tree of
Life (above) that lands the procaryotes in two Domains, Archaea and Bacteria. At a taxonomic level,
organisms at the tips of the archaeal branches represent Orders; The tips of the bacterial branches are
Phyla. More information on the taxonomy, phylogeny and classification of procaryotes is given in the
references at the bottom of this page. Also, an excellent article online that integrates phylogeny with
classification of procaryotes is Classification and Phylogeny by Gary Olsen.

In the ensuing description of procaryotes, groups of organisms are placed under artificial headings
based on common structural, biochemical or ecological properties. This does not imply close genetic
relatedness among different genera in a group. Sometimes all of the members of a group do share a
close genetic relatedness; in other cases, members of a group are genetically-unrelated, even to an
extent that is greater than exists among all members of the Eucaryotic domain. Also herein, some
procaryotes are placed in more than one group, and some groups consist of both Archaea and Bacteria.

ARCHAEA

On the basis of ssrRNA analysis, the Archaea consist of three phylogenetically-distinct groups:
Crenarchaeota, Euryarchaeota and Korarchaeota. However, for the Korarchaeota, only their
nucleic acids have been detected, and no organisms have been isolated or cultured. Based on their
physiology, the Archaea can be organized into three types: methanogens (procaryotes that produce
methane); extreme halophiles (procaryotes that live at very high concentrations of salt (NaCl); and
extreme (hyper) thermophiles (procaryotes that live at very high temperatures). In addition to the
unifying archaeal features that distinguish them from Bacteria (i.e., no murein in cell wall, ether-linked
membrane lipids, etc.), the Archaea exhibit other unique structural or biochemical attributes which
adapt them to their particular habitats. The Crenarchaeota consists mainly of hyperthermophilic
sulfur-dependent procaryotes and the Euryarchaeota contains the methanogens and extreme
halophiles. ssrRNAs of the Korarchaeota have been obtained from hyperthermophilic environments
similar to those inhabitated by Crenarchaeota. None of the Korarchaeota have been cultured in the
laboratory, although information about them can be inferred from their genome structure.

Figure 1. Phylogenetic tree of Archaea

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Methanogens are obligate anaerobes that will not tolerate even brief exposure to air (O2). Anaerobic
environments are plentiful, however, and include marine and fresh-water sediments, bogs and deep
soils, intestinal tracts of animals, and sewage treatment facilities. Methanogens have an incredible type
of metabolism that can use H2 as an energy source and CO2 as a carbon source for growth. In the
process of making cell material from H2 and CO2, the methanogens produce methane (CH4) in a unique
energy-generating process. The end product (methane gas) accumulates in their environment.
Methanogen metabolism created most the natural gas (fossil fuel) reserves that are tapped as energy
sources for domestic or industrial use. Methanogens are normal inhabitants of the rumen (fore-
stomach) of cows and other ruminant animals. A cow belches about 50 liters of methane a day during
the process of eructation (chewing the cud). Methane is a significant greenhouse gas and is
accumulating in the atmosphere at an alarming rate. When rain forests are destroyed and replaced by
cows, it is "double-hit" on the greenhouse: (1) less CO2 is taken up due to removal of the the
autotrophic green plants; (2) additional CO2 and CH4 are produced as gases by the combined
metabolism of the animal and symbiotic methanogens. Methanogens represent a microbial system that
can be exploited to produce energy from waste materials. Large amounts of methane are produced
during industrial sewage treatment processes, but the gas is usually wasted rather than trapped for
recycling.

Figure 2. Methanococcus jannischii (Holger Jannisch). The archaean was originally isolated from a sample taken
from a "white smoker" chimney at an oceanic depth of 2,600 meters on the East Pacific Rise. It can be grown in a
mineral medium containing only H2 and CO2 as sources of energy and carbon for growth within a temperature
range of 50 to 86 degrees. Cells are irregular cocci that are motile due to two bundles of polar flagella inserted near
the same cellular pole, making it a rare example of a motile coccus.

Extreme halophiles live in natural environments such as the Dead Sea, the Great Salt Lake, or
evaporating ponds of seawater where the salt concentration is very high (as high as 5 molar or 25
percent NaCl). The organisms require salt for growth and will not grow at low salt concentrations
(Actually, the cells lyse at low NaCl concentrations). Their cell walls, ribosomes, and enzymes are
stabilized by Na+. Halobacterium halobium, the prevalent species in the Great Salt Lake, adapts to the
high-salt environment by the development of "purple membrane", formed by patches of light-
harvesting pigment in the plasma membrane. The pigment is a type of rhodopsin called
bacteriorhodopsin which reacts with light in a way that forms a proton gradient on the membrane
allowing the synthesis of ATP. This is the only example in nature of non photosynthetic
photophosphorylation. The organisms are heterotrophs that normally respire by aerobic means. The
high concentration of NaCl in their environment limits the availability of O2 for respiration so they are
able to supplement their ATP-producing capacity by converting light energy into ATP using
bacteriorhodopsin.

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Figure 3. Halobacterium salinariumis an extreme halophile that grows at 4 to 5 M NaCl and does not grow below 3 M
NaCl. This freeze etched preparation shows the surface structure of the cell membrane and reveals smooth patches
of "purple membrane" (bacteriorhodopsin) imbedded in the plasma membrane.

Thermomphiles and extreme thermophiles or "hyperthermophiles" come from several distinct

phylogenetic lines of Archaea. These organisms require a very high temperature (80 degrees to 105
degrees) for growth. Their membranes and enzymes are unusually stable at high temperatures. Most of
these Archaea require elemental sulfur for growth. Some are anaerobes that use sulfur as an electron
acceptor for respiration in place of oxygen. Some are lithotrophs that oxidize sulfur as an energy
source. Sulfur-oxidizers grow at low pH (less than pH 2), partly because they acidify their own
environment by oxidizing So (sulfur) to SO4 (sulfuric acid). Hyperthermophiles are inhabitants of hot,
sulfur-rich environments usually associated with volcanism, such as hot springs, geysers and fumaroles
in Yellowstone National Park and elsewhere, and thermal vents ("smokers") and cracks in the ocean
floor. Sulfolobus was the first hyperthermophilic Archaean discovered by Thomas D. Brock of the
University of Wisconsin in 1970. His discovery, along with that of Thermus aquaticus (a thermophiloc
bacterium)in Yellowstone National Park, launched the field of hyperthermophile biology. (Thermus
aquaticusis the source of the enzyme taq polymerase used in the polymerase chain reaction, PCR.,
The bacterium has an optimum temperature for growth of 70 degrees.) Sulfolobus grows in sulfur-rich,
hot acid springs at temperatures as high as 90 degrees and pH values as low as 1. Thermoplasma,also
discovered by Brock, is a unique thermophile that is the sole representative of a distinct phylogenetic
line of Archaea. Thermoplasma resembles the bacterial mycoplasmas in that it lacks a cell wall.
Thermoplasma grows optimally at 55 degrees and pH 2. Interestingly, it has only been found in self-
heating coal refuse piles, which are a man-made waste.

Figure 4. Sulfolobus acidocaldarius (T.D. Brock). Sulfolobusis an extreme thermophile that has been found in
geothermally-heated acid springs, mud pots and surface soils with temperatures from 60 to 95 degrees C, and a pH
of 1 to 5. Left: Electron micrograph of a thin section (85,000X). Under the electron microscope the organism appears
as irregular spheres which are often lobed. Right: Fluorescent photomicrograph of cells attached to a sulfur crystal.
Fimbrial-like appendages have been observed on the cells attached to solid surfaces such as sulfur crystals.

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Although the Archaea are often inhabitants of unusual or extreme environments, there may be
corresponding species of Bacteria, and even eucaryotes, in these habitats as well. No bacterium can
produce methane, but in many anaerobic environments Bacteria are found in association with
methanogens. With regard to acid tolerance, a bacterium, Thiobacillus, has been observed growing at
pH near 0. A eucaryotic alga, Cyanidium, has also been found growing near pH 0. In superheated
environments (greater than 100 degrees), Archaea may have an exclusive hold, but Bacteria have been
isolated from boiling hot springs in Yellowstone National Park and other parts of the world. No
bacterium grows at the highest salt concentration which supports the growth of the halobacteria, but
osmophilic yeasts and fungi can grow at correspondingly low water actvities where sugar is the solute
in high concentration.

BACTERIA

Phylogenetic analysis of the Bacteria has demonstrated the existence of at least 13 distinct groups
(Figure 5), but many groups consist of members that are phenotypically and physiologically unrelated,
and sometimes phylogenetically unrelated. The current edition of Bergey's Manual of Systematic
Bacteriology (2001) recognizes 23 distinct phyla of Bacteria (Phylum is the highest taxon in a
Domain), but there may still be great variation in phenotype among members. Below we discuss the
major groups of Bacteria based on morphology, physiology, or ecology, and often use informal, but
familiar, terms to identify them.

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 Figure 5. Phylogenetic tree of Bacteria

Photosynthetic purple and green bacteria. These bacteria conduct anoxygenic photosynthesis, also
called bacterial photosynthesis. Bacterial photosynthesis differs from plant-type (oxygenic)
photosynthesis in several ways. Bacterial photosynthesis does not produce O2; in fact, it only occurs
under anaerobic conditions. Bacterial photosynthesis utilizes a type of chlorophyll other than
chlorophyll a, and only one photosystem, photosystem I. The electron donor for bacterial
photosynthesis is never H2O but may be H2, H2S or So, or certain organic compounds. The light-
absorbing pigments of the purple and green bacteria consist of bacterial chlorophylls and carotenoids.
Phycobilins, characteristic of the cyanobacteria, are not found. Many purple and green sulfur bacteria
store elemental sulfur as a reserve material that can be further oxidized to SO4 as a photosynthetic
electron donor.

The purple and green bacteria may use H2S during photosynthesis in the same manner that
cyanobacteria or algae or plants use H2O as an electron donor for autotrophic CO2 reduction (the "dark
reaction" of photosynthesis). Or they may utilize organic compounds as electron donors for
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photosynthesis. For example, Rhodobacter can use light as an energy source while oxidizing succinate
or butyrate in order to obtain electrons for CO2 fixation.

The bacterium that became an endosymbiont of eucaryotes and evolved into mitochondria is thought to
be a relative of the purple nonsulfur bacteria. This conclusion is based on similar metabolic features of
mitochondria and purple nonsulfur bacteria and on comparisons of the base sequences in their 16S
rRNAs.

Figure 6. Photomicrographs (phase contrast and and ordinary illumination) of various photosynthetic bacteria
(Norbert Pfennig). Magnifications are about 1400X. The purple and green bacteria exhibit a full range of
procaryotic morphologies, as these photomicrographs illustrate. Diversity among their phylogenetic relationships is
also noted.

A. Purple sulfur bacteria (L to R): Chromatium vinosum, Thiospirillum jenense, Thiopedia rosea. The purple sulfur
bacteria are classified among the Gammaproteobacteria, a class that also includes Pseudomonas and E. coli.

B. Purple nonsulfur bacteria (L to R): Rhodospirillum rubrum, Rhodobacter sphaeroides, Rhodomicrobium vannielii.
The purple nonsulfur bacteria are in the Alphaproteobacteria, which also includes Rhizobium, Agrobacterium and
the Rickettsias. The latter bacteria represent a direct lineage to mitochondria.

C. Green sulfur bacteria (L to R): Chlorobium limicola, Prosthecochloris aestuarii, Pelodictyon clathratiforme. The
Green sulfur bacteria represent a distinct phylogenetic lineage and cluster in their own phylum represented by
Chlorobium in Figure 5.

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Figure 7. Green nonsulfur bacterium, Chloroflexus (T.D. Brock). Chloroflexus also represents a phylogenetically
distinct group of green bacteria. Chloroflexus is a thermophilic, filamentous gliding bacterium.

Figure 8. Photosynthetic procaryotes growing in a hot spring run-off channel (T.D. Brock). The white area of the
channel is too hot for photosynthetic life, but as the water cools along a gradient, the colored phototrophic bacteria
colonize and ultimately construct the colored microbial mats composed of a consortium of photosynthetic
microorganisms.

Cyanobacteria. The cyanobacteria deserve special emphasis because of their great ecological
importance in the global carbon, oxygen and nitrogen cycles, as well as their evolutionary significance
in relationship to plants. Photosynthetic cyanobacteria have chlorophyll a and carotenoids in addition
to some unusual accessory pigments named phycobilins. The blue pigment, phycocyanin and the red
one, phycoerythrin, absorb wavelengths of light for photosynthesis that are missed by chlorophyll and
the carotenoids. Within the cytoplasm of cyanobacteria are numerous layers of membranes, often
parallel to one another. These membranes are photosynthetic thylakoids that resemble those found in
chloroplasts, which, in fact, correspond in size to the entire cyanobacterial cell. The main storage
product of the cyanobacteria is glycogen, and glycogen inclusions may be seen in the cytoplasm of the
cells. Cyanobacteria are thought to have given rise to eucaryotic chloroplasts during the evolutionary
events of endosymbiosis. In biochemical detail, cyanobacteria are especially similar to the chloroplasts
of red algae (Rhodophyta).

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Most cyanobacteria have a mucilaginous sheath, or coating, which is often deeply pigmented,
particularly in species that occur in terrestrial habitats. The colors of the sheaths in different species
include light gold, yellow, brown, red, green, blue, violet, and blue-black. It is these pigments that
impart color to individual cells and colonies as well as to "blooms" of cyanobacteria in aquatic
environments

Figure 9. Some common cyanobacteria L to R: Oscillatoria, a filamentous species common in fresh water and hot
springs; Nostoc, a sheathed communal species; Anabaena, a nitrogen-fixing species. The small cell with an opaque
surface (third from right) in the anabaena filament is a heterocyst, a specialized cell for nitrogen fixation. The large
bright cell in the filament is a type of spore called an akinete; Synechococcus, a unicelluar species in marine habitats
and hot springs. Synechococcus is among the most important photosynthetic bacteria in the marine environment,
estimated to account for about 25 percent of the primary production that occurs in typical marine habitats.

Although thousands of cyanobacteria have been observed, only about 200 species have been identified
as distinct, free-living, nonsymbiotic procaryotes. Relative to other oxygenic phototrophs,
cyanobacteria often grow under fairly extreme environmental conditions such as high temperature and
salinity . They are the only oxygenic phototrophs present in many hot springs of the Yellowstone
ecosystem; and in frigid lakes and oceans of Antarctica, they form luxuriant mats 2 to 4 centimeters
thick in water beneath more than five meters of permanent ice. However, cyanobacteria are absent in
acidic waters where their eucaryotic counterparts, the algae, may be abundant.

Layered chalk deposits called stromatolites, which exhibit a continuous geologic record covering 2.7
billion years, are produced when colonies of cyanobacteria bind calcium-rich sediments. Today,
stromatolites are formed in only a few places, such as shallow pools in hot dry climates. The abundance
of cyanobacteria in the fossil record is evidence of the early development of the cyanobacteria and their
important role in elevating the level of free oxygen in the atmosphere of the early Earth.

Cyanobacteria often form filaments and may grow in large masses or "tufts" one meter or more in
length. Some are unicellular, a few form branched filaments, and a few form irregular plates or
irregular colonies. Cyanobacterial cells usually divide by binary fission, and the resulting progeny cells
may separate to form new colonies. In addition, filaments may break into fragments, called
hormogonia, which separate and develop into new colonies. As in other filamentous or colonial
bacteria, the cells of cyanobacteria may joined by their walls or by mucilaginous sheaths, but each cell
is an independent unit of life.

As true Bacteria, cyanobacteria contain peptidoglycan or murein in their cell walls. Most cyanobacteria
have a Gram-negative type cell wall that consists of an outer membrane component, even though they
may show a distant phylogenetic relationship with certain Gram-positive bacteria. Some of the
filamentous cyanobacteria are motile by means gliding or rotating around a longitudinal axis. Short
segments (hormogonia) may break off from a cyanobacterial colony and glide away from their parent
colony at rates as rapid as 10 micrometers per second. The mechanism for this movement is
unexplained but may be connected to the extrusion of slime (mucilage) through small pores in their cell
wall, together with contractile waves in one of the surface layers of the wall.
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Cyanobacteria are found in most aerobic environments where water and light are available for growth.
Mainly they live in fresh water and marine habitats. Those inhabiting the surface layers of water are
part of a complex microbial community called plankton. Planktonic cyanobacteria usually contain
cytoplasmic inclusions called gas vesicles which are hollow protein structures filled with various gases.
The vesicles can be inflated or deflated with gases allowing the organisms to maintain buoyancy and to
float at certain levels in the water. Thus, the cyanobacteria can regulate their position in the water
column to meet their optimal needs for photosynthesis, oxygen, and light-shielding. When numerous
cyanobacteria become unable to regulate their gas vesicles properly (for example, because of extreme
fluctuations of temperature or oxygen supply), they may float to the surface of a body of water and
form visible "blooms". A planktonic species related to Oscillatoria gives rise to the redness (and the
name) of the Red Sea.

The cyanobacteria have very few harmful effects on plants or animals. They may be a nuisance if they
bloom in large numbers and then die and decay in bodies of fresh water that are used for drinking or
recreational purposes. Many cyanobacteria are responsible for the earthy odors and flavors of fresh
waters, including drinking waters, due to the production of compounds called geosmins. Some
cyanobacteria that form blooms secrete poisonous substances that are toxic for animals that ingest large
amounts of the contaminated water.

Many marine cyanobacteria occur in limestone (calcium carbonate) or lime-rich substrates, such as
coral algae and the shells of mullosks. Some fresh water species, particularly those that grow in hot
springs, often deposit thick layers of lime in their colonies.

Some cyanobacteria can fix nitrogen. In filamentous cyanobacteria, nitrogen fixation often occurs in
heterocysts, which are specialized, enlarged cells, usually distributed along the length of a filament or
at the end of a filament. Heterocysts have intercellular connections to adjacent vegetative cells, and
there is continuous movement of the products of nitrogen fixation moving from heterocysts to
vegetative cells, and the products of photosynthesis moving from vegetative cells to heterocysts.
Heterocysts are low in phycobilin pigments and have only photosystem I. They lack the oxygen-
evolving photosystem II. Furthermore, they are surrounded in a thickened, specialized glycolipid cell
wall that slows the rate of diffusion of O2 into the cell. Any O2 that diffuses into the heterocyst is
rapidly reduced by hydrogen, a byproduct of N2 fixation, or is expelled through the wall of the
heterocyst. The process of nitrogen fixation, specifically the enzyme nitrogenase, only functions in
anaerobic conditions so the organism must maintain these oxygen-free compartments in order for
N2fixation to occur.

In addition to the heterocysts, some cyanobacteria form resistant spores called akinetes enlarged cells
around which thickened outer walls develop. Akinetes are resistant to heat, freezing and drought
(desiccation) and thus allow the cyanobacteria to survive unfavorable environmental conditions. The
are functionally analogous to bacterial endospores, but they bear little resemblance and lack the
extraordinary resistance properties of endospores.

A few cyanobacteria are symbionts of liverworts, ferns, cycads, flagellated protozoa, and algae,
sometimes occurring as endosymbionts of the eucaryotic cells. In the case of the water fern, Azolla, the
cyanobacterial endophyte (a species of Anabaena) fixes nitrogen that becomes available to the plant. In
addition, it is often the case that the photosynthetic partners of lichens are cyanobacteria.

The planktonic cyanobacteria fix an enormous amount of CO2 during photosynthesis, and as "primary
producers" they are the basis of the food chain in marine environments. Their type of photosynthesis,
which utilizes photosystem II, generates a substantial amount of oxygen present in the earth's
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atmosphere. Since many cyanobacteria can fix N2 under certain conditions, they are one of the most
significant free-living nitrogen-fixing procaryotes. Cyanobacteria carried out plant-type (oxygenic)
photosynthesis for at least a billion and a half years before the emergence of plants, and cyanobacteria
are believed to be the evolutionary forerunners of modern-day plant and algal chloroplasts. A group of
phototrophic procaryotes, called prochlorophytes contain chlorophyll a and b but do not contain
phycobilins. Prochlorophytes, therefore, resemble both cyanobacteria (because they are procaryotic and
contain chlorophyll a) and the plant chloroplast (because they contain chlorophyll b instead of
phycobilins). Prochloron,the first prochlorophyte discovered, is phenotypically very similar to certain
plant chloroplasts and is the leading candidate for the type of bacterium that might have undergone
endosymbiotic events that led to the development of the plant chloroplast.

Spirochetes are a phylogenetically distinct group of Bacteria which have a unique cell morphology and
mode of motility. Spirochetes are very thin, flexible, spiral-shaped procaryotes that move by means of
structures called axial filaments or endoflagella. The flagellar filaments are contained within a sheath
between the cell wall peptidoglycan and an outer membrane. The filaments flex or rotate within their
sheath which causes the cells to bend, flex and rotate during movement. Most spirochetes are free
living (in muds and sediments), or live in associations with animals (e.g. in the oral cavity or GI tract).
A few are pathogens of animals (e.g. leptospirosis in dogs, Syphilis in humans and Lyme Disease in
dogs and humans).

Figure 10. Spirochetes: A. Cross section of a spirochete showing the location of endoflagella between the inner
membrane and outer sheath; B. Borrelia burgdorferi, the agent of Lyme disease; C. Treponema pallidum, the
spirochete that causes syphilis.

Other Spiral-Shape and and Curved Bacteria. The main thing that unifies this group of bacteria is
their spiral or vibrioid (curved) shape, although they are all classified among the Proteobacteria.
Nontheless, in certain environments, their characteristic shape can instantly inform an observer of their
identity. Bacteria referred to as "spirilla" are Gram-negative aerobic heterotrophic bacteria with a
helical or spiral shape. Their metabolism is usually respiratory and never fermentative. Unlike
spirochetes, they have a rigid cell wall and are motile by means of ordinary polar flagella. Spirilla are
inhabitants of microaerophilic aquatic environments. Most spirilla require or prefer that oxygen in their
environment be present in an amount that is well below atmospheric concentration. The
Rhodospirillaceaeare found in the Alpha group of Proteobacteria; Spirillaceae and Oceanospirillaceae
are Gammaproteobacteria.

As inhabitants of marine and fresh waters many spirilla are endowed with some interesting
properties. Magnetospirillumcontains magnetosomes and exhibits the property of magnetotaxis
(movement in relationship to the magnetic field of the earth). Oceanospirillum lives in marine habitats
and is able to grow at NaCl concentrations as high as 9 percent. Azospirillum is a nitrogen-fixing
bacterium that enters into a mutualistic symbiosis with certain tropical grasses and grain crops. Spirilla
are thought to play a significant role in recycling of organic matter, particularly in aquatic
environments.

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Two pathogens of humans are found among the spiril forms in the Epsilon group of Proteobacteria.
Campylobacter jejuni is an important cause of bacterial diarrhea, especially in children. The bacterium
is transmitted via contaminated food, usually undercooked poultry or shellfish, or untreated drinking
water. Helicobacter pylori is able to colonize the gastric mucosal cells of humans, i.e., the lining of the
stomach, and it has been well established as the cause of peptic ulcers.

Bacteria with a curved rod or comma shape are referred to as "vibrios". Like the spiral forms, vibrios
are very common bacteria in aquatic environments. They are found among the Gammaproteobacteria
and have structural and metabolic properties that overlap with both the enterics and the pseudomonads.
In Bergey's Manual (2001) Vibrionaceae is a family on the level with Enterobacteriaceae. Vibrios are
facultative like enterics, but they have polar flagella, are oxidase-positive, and dissimilate sugars in the
same manner as the pseudomonads. In aquatic habitats they overlap with the Pseudomonadaceae in
their ecology, although Pseudomonas species favor fresh water and vibrios prefer salt water. The genus
Vibrio contains an important pathogen of humans, Vibrio cholerae, the cause of Asiatic cholera.
Cholera is an intestinal disease with a pathology related to diarrheal diseases caused by the enteric
bacteria.

Five species of marine vibrios exhibit the property of bioluminescence, the ability to emit light of a
blue-green color. These bacteria may be found as saprophytes of dead fish or as symbionts of living
fish and invertebrates in marine environments. Some grow in special organs of the fish and emit light
for the benefit of the fish (to attract prey, or as a mating signal) in return for a protected habitat and
supply of nutrients. The reaction leading to light emission, catalyzed by the enzyme luciferase, has
been found to be the same in all procaryotes, and differs from light emission by eucaryotes such as the
fire fly. Luciferase diverts electrons from the normal respiratory electron transport chain and causes
formation of an excited peroxide that leads to emission of light.

The small vibrioid bacterium, Bdellovibrio,is a tiny curved rod that is a parasite of other Gram-negative
bacteria, including E. coli. It preys on other bacteria by entering into the periplasmic space and
obtaining nutrients from the cytoplasm of its host cell while undergoing an odd type of reproductive
cycle. Bdellovibriois a member of the Deltaproteobacteria.

The Myxobacteria are a group of fruiting gliding bacteria that comprise a unique order of
Deltaproteobacteria. They exhibit a unique type of gliding motility. The vegetative cells move (glide)
about together as a swarm, and then they aggregate together to form a multicellular fruiting body in
which development and spore formation takes place. They exhibit the most complex behavioral
patterns and life cycles of all known procaryotes. Myxobacteria are inhabitants of the soil. They have a
eucaryotic counterpart in nature in the Myxomycetes, or slime molds, and the two types of organisms
are an example of parallel or convergent evolution, having adopted similar life styles in the soil
environment.

The vegetative cells of myxobacteria are typical Gram-negative rods that glide across a substrate such
as a decaying leaf or piece of animal dung, or colonies of other bacteria. They obtain nutrients from the
substrate as they glide across it and they secrete a slime track which other myxobacterial cells
preferentially follow. If their nutrients become exhausted, the cells signal to one another to aggregate
and form a swarm of myxobacteria which eventually differentiate into a multicellular fruiting body
that contains myxospores, a type of dormant cell descended from a differentiated vegetative cell. In the
case of Stigmatella, the myxospores are packed into secondary structures called cysts, which develop at
the tips of the fruiting body (Figure 11). The bright-colored fruiting bodies of myxobacteria, containing

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millions of cells and spores, can often be seen with the unaided eye on dung pellets and decaying
vegetation in the soil.

Figure 11. Stigmatella aurantiaca, a fruiting myxobacterium: L. Life Cycle R. Fruiting Body.

Lithotrophs. Lithotrophy, a type of metabolism that requires inorganic compounds as sources of

energy. This metabolism is firmly established in both the Archaea and the Bacteria. The methanogens
utilize H2 as an energy source, and many extreme thermophiles use H2S or elemental sulfur as a source
of energy for growth. Lithotrophic Bacteria are typically Gram-negative species that utilize inorganic
substrates including H2, NH3, NO2, H2S, S, Fe++, and CO. Ecologically, the most important lithotrophic
Bacteria are the nitrifying bacteria, Nitrosomonas and Nitrobacter that together convert NH3 to NO2,
and NO2 to NO3, and the colorless sulfur bacteria, such as Thiobacillus, that oxidize H2S to S and S to
SO4. Most lithotrophic bacteria are autotrophs, and in some cases, they may play an important role in
primary production of organic material in nature. Lithotrophic metabolism does not extend to
eucaryotes (unless a nucleated cell harbors lithotrophic endosymbiotic bacteria), and these bacteria are
important in the biogeochemical cycles of the elements.

Figure 12. Lithotroph Habitats. A. Stream in Northern Wisconsin near Hayward is a good source of iron bacteria
(John Lindquist). B. Bacteriologist J.C. Ensign of the University of Wisconsin observing growth of iron bacteria in a
run-off channel from the Chocolate Pots along the Gibbon River, in Yellowstone National Park (K.Todar). C. An
acid hot spring at the Norris Geyser Basin in Yellowstone is rich in iron and sulfur (T.D. Brock). D. A black smoker
chimney in the deep sea emits iron sulfides at very high temperatures (270 to 380 degrees C).
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Pseudomonads. "Pseudomonad" is an informal term for bacteria which morphologically and
physiologically resemble members of the genus Pseudomonas, a very diverse group of Gram-negative
rods with a strictly-respiratory mode of metabolism. The term is usually applied to bacteria in the
genera Pseudomonas, and Xanthomonas, which are Alphaproteobacteria, and to plant and animal
pathogens such as Burkholderia, Ralstonia and Acidovorax, which are Betaproteobacteria. But many
other related bacteria share their definitive characterictics, i.e., Gram-negative aerobic rods. The
morphology and habitat of many pseudomonads sufficiently overlaps with the enterics (below) that
microbiologists must quickly learn how to differentiate these two types of Gram-negative motile rods.
Pseudomonads move by polar flagella; enterics such as E. coli swim by means of peritrichous flagella.
Enterics ferment sugars such as glucose; pseudomonads generally do not ferment sugars. And most
pseudomonads have an unusual cytochrome in their respiratory electron transport chain that can be
detected in colonies by a colorimetric test called the oxidase test. Pseudomonads are typically oxidase-
positive.

Figure 13. Profile of a pseudomonad: Gram-negative rods motile by polar flagella. A. Electron micrograph, negative
stain. B. Scanning electron micrograph. C. Gram stain.

Most pseudomonads are free-living organisms in soil and water; they play an important role in
decomposition, biodegradation, and the C and N cycles. The phrase "no naturally-occurring organic
compound cannot be degraded by some microorganism" must have been coined to apply to members of
the genus Pseudomonas, known for their ability to degrade hundreds of different organic compounds
including insecticides, pesticides, herbicides, plastics, petroleum substances, hydrocarbons and other of
the most refractory molecules in nature. However, they are usually unable to degrade biopolymers in
their environment, such as cellulose and lignen, and their role in anaerobic decomposition is minimal.

There are about 150 species of Pseudomonas, but, especially among the plant pathogens, there are
many strains and biovars among the species. These bacteria are frequently found as part of the normal
flora of plants, but they are one of the most important bacterial pathogens of plants, as well.
Pseudomonas syringae and Xanthomonas species cause a wide variety of plant diseases as discussed
below. One strain of Pseudomonas that lives on the surfaces of plants can act as an "ice nucleus" which
causes ice formation and inflicts frost damage on plants at one or two degrees above the conventional
freezing temperature of water (0 degrees C). One Pseudomonas species is an important pathogen of
humans, Pseudomonas aeruginosa, the quintessential opportunistic pathogen, which is a leading cause
of hospital-acquired infections. Pseudomonas species are discussed elsewhere in the text
at Opportunistic Infections caused by Pseudomonas aeruginosa and The Genus Pseudomonas.

Among some interesting or important ecologic relatives of the pseudomonads are Rhizobiumand
Bradyrhizobium, species that fix nitrogen in association with leguminous plants, and related
Agrobacterium species that cause tumors ("galls") in plants. These bacteria are discussed later in this
article because of their special relationships with plants. Relatives of the pseudomonads also include

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the methanotrophs that can oxidize methane and other one-carbon compounds, the azotobacters,
which are very prevalent free-living (nonsymbiotic) nitrogen-fixing bacteria.

Enterics. Enteric bacteria are Gram-negative rods with facultative anaerobic metabolism that live in
the intestinal tracts of animals. This group consists of Escherichia coli and its relatives, the members of
the family Enterobacteriaceae. Enteric bacteria are related phenotypically to several other genera of
bacteria such as Pseudomonas and Alcaligenes, but are physiologically quite unrelated. Generally, a
distinction can be made on the ability to ferment glucose: enteric bacteria all ferment glucose to acid
end products while similar Gram-negative bacteria cannot ferment glucose. Because they are consistent
members of the normal flora of humans, and because of their medical importance, an extremely large
number of enteric bacteria have been isolated and characterized.

Escherichia coli is, of course, the type species of the enterics. E. coli is such a regular inhabitant of the
intestine of humans that it is used by public health authorities as an indicator of fecal pollution of
drinking water supplies, swimming beaches, foods, etc. E. coli is the most studied of all organisms in
biology because of its occurrence, and the ease and speed of growing the bacteria in the laboratory. It
has been used in hundreds of thousands of experiments in cell biology, physiology, and genetics, and
was among the first cells for which the entire chromosomal DNA base sequence was determined. In
spite of the knowledge gained about the molecular biology and physiology of E. coli, surprisingly little
is known about its ecology, for example why it consistently associates with humans, how it helps its
host, how it harms its host, etc. A few strains of E. coli are pathogenic (one is notorious, strain
0157:H7, that keeps turning up in raw hamburger headed for a fast-food restaurants). Pathogenic
strains of E. coli cause intestinal tract infections (usually acute and uncomplicated, except in the very
young ), uncomplicated urinary tract infections and neonatal meningitis. See E. coli and
Gastroenteritis, Urinary tract Infections and Neonatal Meningitis.

Figure 14. Left: Escherichia coli cells. Right: E. coli colonies on EMB Agar.

The enteric group also includes some other intestinal pathogens of humans such as Shigella
dysenteriae, cause of bacillary dysentery, and Salmonella typhimurium, cause of gastroenteritis.
Salmonella typhi, which infects via the intestinal route, causes typhoid fever. Some bacteria that don't
have an intestinal habitat resemble E. coli in enough ways to warrant inclusion in the enteric group.
This includes Proteus, a common saprophyte of decaying organic matter, Yersinia pestis, which causes
bubonic plague, and Erwinia, an important pathogen of plants.

Gram-negative pathogens. The Gram negative bacteria that are important pathogens of humans are
found sattered throughout the Proteobacteria. In the Alphaproteobacteria, one finds the Rickettsias, a
group of obligate intracellular parasites which are the cause of typhus and Rocky Mountain Spotted
fever. In the Beta group, the agents of whooping cough (pertussis) (Bordetella pertussis),gonorrhea
(Neisseria gonorrhoeae), and meningococcal meningitis (Neisseria meningitidis) are found.
See Gonorrhea and Meningitis . Among the Gamma group, Pseudomonas aeruginosa, the enterics,
and Vibrio cholerae have already been mentioned. Likewise, the agents of Legionaires' pneumonia
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(Legionella pneumophilia), and childhood meningitis (Haemophilus influenzae) are
Gammaproteobacteria. Campylobacter and Helicobacter are Epsilonproteobacteria. Most of these
bacteria are discussed elsewhere in this article and/or in separate chapters which deal with their
pathogenicity for humans.

Nitrogen-fixing organisms. This is a diverse group of procaryotes, reaching into phylogenetically

distinct groups of Archaea and Bacteria. Members are unified only on the basis of their metabolic
ability to "fix" nitrogen. Nitrogen fixation is the reduction of N2 (atmospheric nitrogen) to NH3
(ammonia). It is a complicated enzymatic process mediated by the enzyme nitrogenase. Nitrogenase is
found only in procaryotes and is second only to RUBP carboxylase (the enzyme responsible for CO2
fixation) as the most abundant enzyme on Earth.

The conversion of nitrogen gas (which constitutes about 80 percent of the atmosphere) to ammonia
introduces nitrogen into the biological nitrogen cycle. Living cells obtain their nitrogen in many forms,
but usually from ammonia (NH3) or nitrates (NO3), and never from N2. Nitrogenase extracts N2 from
the atmosphere and reduces it to NH3 in a reaction that requires substantial reducing power (electrons)
and energy (ATP). The NH3 is immediately assimilated into amino acids and proteins by subsequent
cellular reactions. Thus, nitrogen from the atmosphere is fixed into living (organic) material.

Although a widespread trait in procaryotes, nitrogen fixation occurs in only a few select genera.
Outstanding among them are the symbiotic bacteria Rhizobium and Bradyrhizobium which form
nodules on the roots of legumes. In this symbiosis the bacterium invades the root of the plant and fixes
nitrogen which it shares with the plant. The plant provides a favorable habitat for the bacterium and
supplies it with nutrients and energy for efficient nitrogen fixation. Rhizobium and Bradyrhizobium are
Gram-negative aerobes related to the pseudomonads (above). An unrelated bacterium, an actinomycete
(below), enters into a similar type of symbiosis with plants. The actinomycete, Frankia, forms nodules
on the roots of several types of trees and shrubs, including alders (Alnus), wax myrtles (Myrica) and
mountain lilacs (Ceanothus). They, too, fix nitrogen which is provided to their host in a useful form.
This fact allows alder species to be "pioneer plants" (among the first to colonize) in newly-forming
nitrogen-deficient soils. Still other bacteria live in regular symbiotic associations with plants on roots or
leaves and fix nitrogen for their hosts, but they do not cause tissue hyperplasia or the formation of
nodules.

Cyanobacteria are likewise very important in nitrogen fixation. Cyanobacteria provide fixed nitrogen,
in addition to fixed carbon, for their symbiotic partners which make up lichens. This enhances the
capacity for lichens to colonize bare areas where fixed nitrogen is in short supply. In some parts of
Asia, rice can be grown in the same paddies continuously without the addition of fertilizers because of
the presence of nitrogen fixing cyanobacteria. The cyanobacteria, especially Anabaena, occur in
association with the small floating water fern Azolla, which forms masses on the paddies. Because of
the nearly obligate association of Azolla with Anabaena, paddies covered with Azolla remain rich in
fixed nitrogen.

In addition to symbiotic nitrogen-fixing bacteria, there are various free-living nitrogen-fixing

procaryotes in both soil and aquatic habitats. Cyanobacteria may be able to fix nitrogen in virtually all
habitats that they occupy. Clostridia and some methanogens fix nitrogen in anaerobic soils and
sediments, including thermophilic environments. A common soil bacterium, Azotobacter is a vigorous
nitrogen fixer, as is Rhodospirillum, a purple sulfur bacterium. Even Klebsiella, an enteric bacterium
closely related to E. coli, fixes nitrogen. There is great scientific interest, of course, in knowing how
one might move the genes for nitrogen fixation from a procaryote into a eucaryote such as corn or some

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other crop plant. The genetically engineered plant might lose its growth requirement for costly
ammonium or nitrate fertilizers and grow in nitrogen deficient soils.

Besides nitrogen fixation, bacteria play other essential roles in the processes of the nitrogen cycle. For
example, saprophytic bacteria, decompose proteins releasing NH3 in the process of ammoniafication.
NH3 is oxidized by lithotrophic Nitrosomonas species to NO2 which is subsequently oxidized by
Nitrobacter to NO3. The overall conversion of NH3 to NO3 is called nitrification. NO3 can be
assimilated by cells as a source of nitrogen (assimilatory nitrate reduction), or certain bacteria can
reduce NO3 during a process called anaerobic respiration, wherein nitrate is used in place of oxygen
as a terminal electron acceptor for a process analogous to aerobic respiration. In the case of anaerobic
respiration, NO3 is first reduced to NO2, which is subsequently reduced to N2O or N2 or NH3 (all
gases). This process is called denitrification and it occurs in anaerobic environments where nitrates are
present. If denitrification occurs in crop soils it may not be beneficial to agriculture if it converts
utilizable forms of nitrogen (as in nitrate fertilizers) to nitrogen gases that will be lost into the
atmosphere. One rationale for tilling the soil is to keep it aerobic in order to discourage denitrification
processes in Pseudomonas and Bacillus which are ubiquitous inhabitants.

The pyogenic cocci are spherical bacteria which cause various suppurative (pus-producing) infections
in animals. Included are the Gram-positive cocci Staphylococcus aureus, Streptococcus pyogenes and
Streptococcus pneumoniae, and the Gram-negative cocci, Neisseria gonorrhoeae and N. meningitidis.
These bacteria are leading pathogens of humans. It is estimated that they produce at least a third of all
the bacterial infections of humans, including strep throat, pneumonia, food poisoning, various skin
diseases and severe types of septic shock, gonorrhea and meningitis. Staphylococcus aureus is arguably
the most successful of all bacterial pathogens because it has a very wide range of virulence
determinants (so it can produce a wide range of infections) and it often occurs as normal flora of
humans (on skin, nasal membranes and the GI tract), which ensures that it is readily transmitted from
one individual to another. In terms of their phylogeny, physiology and genetics, these genera of
bacteria are quite unrelated to one another. They share a common ecology, however, as parasites of
humans.

Figure 15. Gallery of pyogenic cocci, Gram stains of clinical specimens (pus), L to R: Staphylococcus aureus,
Streptococcus pyogenes, Streptococcus pneumoniae, Neisseria gonorrhoeae, Neisseria meningitidis. The large cells with
lobed nuclei are neutrophils. Pus is the outcome of the battle between phagocytes (neutrophils) and the invading
cocci. As the bacteria are ingested and killed by the neutrophils, the neutrophils eventually lyse (rupture) and release
their own components, plus the digested products of bacterial cells, which are the make-up of pus. As a defense
against phagocytes the staphylococci and streptococci produce toxins that kill the neutrophils before they are able to
ingest the bacteria. This contributes to the pus, and therefore these bacteria are "pyogenic" during their pathogenic
invasions.

Two species of Staphylococcus live in association with humans: Staphylococcus epidermidis which
lives normally on the skin and mucous membranes, and Staphylococcus aureus which may occur
normally at various locales, but in particular on the nasal membranes (nares). S. epidermidis is rarely a
pathogen and probably benefits its host by producing acids on the skin that retard the growth of
dermatophytic fungi. Staphylococcus aureus always has the potential to cause disease and so is
considered a pathogen. Different strains of S. aureus differ in the range of diseases they can cause,
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including boils and pimples, wound infections, pneumonia, osteomyelitis, septicemia, food
intoxication, and toxic shock syndrome. S. aureus is the leading cause of nosocomial (hospital-
acquired) infections by Gram-positive bacteria. Also, it is notoriously resistant to penicillin and many
other antibiotics. Recently, a strain of S. aureus has been reported that is resistant to EVERY known
antibiotic in clinical usage, which is a grim reminder that the clock is ticking on the lifetime of the
usefulness of current antibiotics in treatment of infectious disease.

Streptococcus pypgenes,more specifically the Beta-hemolytic Group A Streptococci, like S. aureus,

causes an array of suppurative diseases and toxinoses (diseases due to the production of a bacterial
toxin), in addition to some autoimmune or allergic diseases. S. pyogenes is rarely found as normal flora
(<1%), but it is the main streptococcal pathogen for man, most often causing tonsillitis or strep throat.
Streptococci also invade the skin to cause localized infections and lesions, and produce toxins that
cause scarlet fever and toxic shock. Sometimes, as a result of an acute streptococcal infection,
anomalous immune responses are started that lead to diseases like rheumatic fever and
glomerulonephritis, which are called post-streptococcal sequelae. Unlike the staphylococci, the
streptococci have not developed widespread resistance to penicillin and the other beta lactam
antibiotics, so that the beta lactams remain drugs of choice for the treatment of acute streptococcal
infections.

Streptococcus pneumoniae is the most frequent cause of bacterial lobar pneumonia in humans. It is
also a frequent cause of otitis media (infection of the middle ear) and meningitis. The bacterium
colonizes the nasopharynx and from there gains access to the lung or to the eustachian tube. If the
bacteria descend into the lung they can impede engulfment by alveolar macrophages if they possess a
capsule which somehow prevents the engulfment process. Thus, encapsulated strains are able to invade
the lung and are virulent (cause disease) and noncapsulated strains, which are readily removed by
phagocytes, are nonvirulent.

The Neisseriaceae comprise a family of Gram-negative BetaProteobacteria with metabolic

characteristics similar to pseudomonads. The neisseriae are small, Gram-negative cocci usually seen in
pairs with flattened adjacent sides. Most neisseriae are normal flora or harmless commensals of
mammals living on mucous membranes. In humans they are common residents of the throat and upper
respiratory tract. Two species are primary pathogens of humans, Neisseria gonorrhoeae and Neisseria
meningitidis, the bacterial causes of gonorrhea and meningicoccal meningitis.

Neisseria gonorrhoeae is the second leading cause of sexually-transmitted disease in the U.S., causing
over three million cases of gonorrhea annually. Sometimes, in females, the disease may be
unrecognized or asymptomatic such that an infected mother can give birth and unknowingly transmit
the bacterium to the infant during its passage through the birth canal. The bacterium is able to colonize
and infect the newborn eye resulting neonatal ophthalmia, which may produce blindness. For this
reason (as well as to control Chlamydia which may also be present), an antimicrobial agent is usually
added to the neonate eye at the time of birth.

Neisseria meningitidis is one bacterial cause of meningitis, an inflammation of the meninges of the
brain and spinal cord. Other bacteria that cause meningitis include Haemophilus influenzae,
Staphylococcus aureus and Escherichia coli. Meningococcal meningitis differs from other causes in
that it is often responsible for epidemics of meningitis. It occurs most often in children aged 6 to 11
months, but it also occurs in older children and in adults. Meningococcal meningitis can be a rapidly
fatal disease, and untreated meningitis has a mortality rate near 50 percent. However, early intervention
with antibiotics is highly effective, and with treatment most individuals recover without permanent
damage to the nervous system.
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Lactic acid bacteria are Gram-positive, nonsporeforming rods and cocci which produce lactic acid as
a sole or major end product of fermentation. They are important in the food industry as fermentation
organisms in the production of cheese, yogurt, buttermilk, sour cream, pickles, sauerkraut, sausage and
other foods. Important genera are Streptococcus and Lactobacillus. Some species are normal flora of
the human body (found in the oral cavity, GI tract and vagina); some streptococci are pathogens of
humans (see pyogenic cocci above). Certain oral lactic acid bacteria are responsible for the formation
of dental plaque and the initiation of dental caries (cavities).

Endospore-forming bacteria produce a unique resting cell called an endospore. They are Gram-
positive and usually rod-shaped, but there are exceptions. The two important genera are Bacillus, the
members of which are aerobic sporeformers in the soils, and Clostridium, whose species are anaerobic
sporeformers of soils, sediments and the intestinal tracts of animals.

Figure 16. Endospore-forming bacilli (phase contrast illumination). Endospores are dehydrated, refractile cells
appearing as points of bright light under phase microcsopy. Endospore-forming bacteria are characterized by the
location (position) of the endospore in the mother cell (sporangium) before its release. The spore may be central,
terminal or subterminal, and the sporangium may or may not be swollen to accomodate the spore.

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Figure 17. Anatomy of an endospore, cross section drawing by Viake Haas. Endospores differ from the vegetative
cells that form them in a variety of ways. Several new surface layers develop outside the core (cell) wall, including
the cortex and spore coat. The cytoplasm is dehydrated and contains only the cell genome and a few ribosomes and
enzymes. The endospore is cryptobiotic (exhibits no signs of life) and is remarkably resistant to environmental stress
such as heat (boiling), acid, irradiation, chemicals and disinfectants. Some endospores have remained dormant for 25
million years preserved in amber, only to be shaken back into life when extricated and introduced into a favorable
environment.

Figure 18. The sequential steps in the process of endospore formation in Bacillus subtilis.

Some sporeformers are pathogens of animals, usually due to the production of powerful toxins.
Bacillus anthracis causes anthrax, a disease of domestic animals (cattle, sheep, etc.) which may be
transmitted to humans. Bacillus cereus is becoming inceasingly recognized as an agent of food
poisoning. Clostridium botulinum causes botulism a form of food-poisoning, and Clostridium tetani
causes tetanus.

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Figure 19. Robert Koch's original photomicrographs of Bacillus anthracis. In 1876, Koch established by careful
microscopy that the bacterium was always present in the blood of animals that died of anthrax. He took a small
amount of blood from such an animal and injected it into a healthy mouse, which subsequently became diseased and
died. He took blood from that mouse and injected it into a another healthy mouse. After repeating this several times
he was able to recover the original anthrax organism from the dead mouse, demonstrating for the first time that a
specific bacterium is the cause of a specific disease. In so doing, he established Koch's Postulates, which still today
supply the microbiological standard to demonstrate that a specific microbe is the cause of a specific disease.

In association with the process of sporulation, some Bacillus species form a crystalline protein
inclusion called parasporal crystals. The protein crystal and the spore (actually the spore coat) are
toxic to lepidopteran insects (certain moths and caterpillars) if ingested. The crystals and spores of
Bacillus thuringiensis are marketed as "Bt" a natural insecticide for use on garden or crop plants.
Another species of Bacillus, B. cereus, produces an antibiotic that inhibits growth of Phytophthera,, a
fungus that attacks alfalfa seedling roots causing a "damping off" disease. The bacteria, growing in
association with the roots of the seedlings, can protect the plant from disease.

Also, apparently in association with the sporulation process, some Bacillus species produce clinically-
useful antibiotics. Bacillus antibiotics such as polymyxin and bacitracin are usually polypeptide
molecules that contain unusual amino acids.

Actinomycetes and related bacteria are a large group of Gram-positive bacteria that usually grow by
filament formation, or at least show a tendency towards branching and filament formation. Many of the
organisms can form resting structures called spores, but they are not the same as endospores. Branched
forms superficially resemble molds and are a striking example of convergent evolution of a procaryote
and a eucaryote together in the soil habitat. Actinomycetes such as Streptomyces have a world-wide
distribution in soils. They are important in aerobic decomposition of organic compounds and have an
important role in biodegradation and the carbon cycle. Products of their metabolism, called geosmins,
impart a characteristic earthy odor to soils. Actinomycetes are the main producers of antibiotics in
industrial settings, being the source of most tetracyclines, macrolides (e.g. erythromycin), and
aminoglycosides (e.g. streptomycin, gentamicin, etc.). Two bacteria in this diverse group are important
pathogens of humans: Mycobacterium tuberculosis is the cause of tuberculosis; Corynebacterium
diphtheriae is the cause of diphtheria. Also, many nonpathogenic mycobacteria and corynebacteria
live in associations with animals.

Figure 20. Schematic diagrams illustrating mycelial growth and spore formation in several genera of actinomycetes.

Rickettsias and chlamydiae are two unrelated groups of Bacteria that are obligate intracellular
parasites of eucaryotic cells. Rickettsias cannot grow outside of a host cell because they have leaky
160
membranes and are unable to obtain nutrients in an extracellular habitat. Chlamydiae are unable to
produce ATP in amounts required to sustain metabolism outside of a host cell and are, in a sense,
energy-parasites.

Rickettsias occur in nature in the gut lining of arthropods (ticks, fleas, lice, etc.). They are transmitted
to vertebrates by an arthropod bite and produce such diseases as typhus fever, Rocky Mountain
Spotted Fever, Q fever and canine ehrlichiosis. Chlamydiae are tiny bacteria that infect birds and
mammals. They may colonize and infect tissues of the eye and urogenital tract in humans. Chlamydia
trachomatis causes several important diseases in humans: chlamydia, the most prevalent sexually
transmitted disease in the U.S., trachoma, a leading cause of blindness worldwide, and
lymphogranuloma venereum.

Figure 21. Mammalian cells infected with rickettsial organisms. L. Bartonella bacilliformis infection of human
erythrocytes and blood monoyctyes. R. Ehrlichia canis infection of canine erythrocytes and blood monocytes. The
distinct stained intracytoplasmic inclusion body in the monocyte is characteristic of the infection.

Mycoplasmas are a group of bacteria that lack a cell wall. The cells are bounded by a single triple-
layered membrane. They may be free-living in soil and sewage, parasitic inhabitants of the mouth and
urinary tract of humans, or pathogens in animals and plants. In humans, Mycoplasma pneumoniae
causes primary atypical pneumonia ("walking pneumonia").

Mycoplasmas include the smallest known cells, usually about 0.2 - 0.3 micrometers in diameter.
Mycoplasmas correspondingly have the smallest known genome of any cell. Their DNA is thought to
contain about 650 genes, which is about one-fifth the number found in E. coli and other common
bacteria. Mycoplasmas can survive without a cell wall because their cytoplasmic membrane is more
stable than that of other procaryotes. In one group of mycoplasmas, the membrane contains sterols
which seem to be responsible for the stability. Also, mycoplasmas tend to inhabit environments of high
osmolarity wherein the risk of osmotic shock and lysis of the cells is minimized.

Plant-pathogenic bacteria. Many economically-important diseases of plants are caused by members

of the Bacteria. It is estimated that one-eighth of the crops worldwide are lost to diseases caused by
bacteria, fungi or insects. Almost all kinds of plants can be affected by bacterial diseases, and many of
these diseases can be extremely destructive.

Almost all plant-pathogenic bacteria are Gram-negative bacilli, usually affiliated with the
pseudomonads or enterics (above). The symptoms of bacterial disease in plants are described by a
number of terms such as spots, blights, soft rots, wilts, and galls. Bacterial spots of various sizes on
stems, leaves, flowers and fruits are usually caused by Pseudomonas or Xanthomonas species. Bacteria
may cause spots by producing toxins that kill cells at the site of infection. Blights are caused by rapidly
developing necrosis (dead, discolored areas) on stems, leaves and flowers. Fire blight in apples and
pears, caused by Erwinia amylovora, can kill young trees within a single season. Bacterial soft rots
occur most commonly in fleshy vegetables such as potatoes or onions or fleshy fruits such as tomatoes

161
and eggplants. The most destructive soft rots are caused by Erwinia species that attack fruits and
vegetables at the post-harvest stage.

Bacterial vascular wilts mainly affect herbaceous plants. The bacteria invade the vessels of the xylem,
where they multiply, interfering with the movement of water and inorganic nutrients and resulting in
the wilting and the death of the plants. The bacteria commonly degrade portions of the vessel walls and
can even cause the vessels to rupture. Once the walls have ruptured, the bacteria then spread to the
adjacent parenchyma tissues, where they continue to multiply. In some bacterial wilts, the bacteria ooze
to the surface of the stems or leaves through cracks formed over cavities filled with cellular debris,
gums, and bacteria. More commonly, however, the bacteria do not reach the surface of the plant until
the plant has been killed by the disease. Wilts of alfalfa and bean plants are cause by species of
Clavibacter; bacterial wilt of cucurbits, such as squashes and watermelons, are cause by Erwinia
tracheiphila; the black rot of crucifers such as cabbage is caused by Xanthomonas campestris. The
most economically-important wilt of plants is caused by Pseudomonas solanacearum which affects 44
genera of plants, including such major crops as bananas, peanuts, tomatoes, potatoes, eggplants and
tobacco. This disease occurs worldwide in tropical, subtropical, and warm temperate areas.

Mycoplasmas (discussed above) have been identified in more than 200 plant species and associated
with more than 50 plant diseases, many with symptoms of yellowing. Among these plant-pathogens are
the spiroplasmas (genus Spiroplasma), which are pleomorphic, ovoid or spiral-shaped cells which are
motile by means of a rotary or screw-like motion. Intracellular fibrils are thought to be responsible for
their movement. The organisms have been isolated from the fluids of vascular plants and from the gut
of insects that feed on these fluids. Some have been cultured on artificial media, including Spiroplasma
citri, which is isolated from the leaves of citrus plants, where it causes citrus stubborn disease, and
from corn plants suffering from corn stunt disease. A number of other mycoplasma-like organisms
(sometimes called MLOs) have been detected in diseased plants by electron microscopy, which has
been taken as evidence that these organisms may be more involved in plant disease than previously
realized.

The causative agent of a common plant disease, termed crown gall, is Agrobacterium tumefaciens. The
disease is characterized by large galls or swellings that form on the plant at the site of infection, usually
near the soil line. Crown gall is a problem in nurseries, affecting ornamental plants and fruit stock, and
it may be a serious disease in grapes. Because of their role in the genetic engineering of plants, the
molecular biology of these bacteria is intensively studied.

References:
1. Balows, A., H.G. Truper, M. Dworkin, W. Harder, and K.-H. Schleifer (eds.). The Prokaryotes, 2nd
ed. Springer-Verlag, New York. 1992. Published in four volumes. The most complete reference on the
characteristics of procaryotes. Includes procedures for the selective isolation and identification of virtually all known
procaryotes. The online edition at The Prokaryotes provides access to the full text which is a work in continuous
progress.

2. Holt, J.G. (editor-in-chief). Bergey's Manual of Systematic Bacteriology. 1st edition.

published in four volumes:
Volume 1 (1984)
Gram-negative Bacteria of general, medical, or industrial importance
Volume 2 (1986)
Gram-positive Bacteria other than Actinomycetes
Volume 3 (1989)
Archaeobacteria, Cyanobacteria, and remaining Gram-negative Bacteria
162
Volume 4 (1989)
Actinomycetes
This has been the standard authoritative guide to bacterial taxonomy and identification throughout the nineties and
continuing into the new millenium. It was the usual place to begin a literature survey or an identification process of a
specific bacterial group. The newer (second) edition, 2001 (below), takes a hierarchical approach to classification
based primarly on genetic similarities as reflected in 16S and 23S ribosomal RNA sequences. As the second edition
becomes progressively more available, it is sure to replace this classic, although it will remain useful to aid in the
identification of bacteria.

3. Holt, J.G. (ed). Bergey's Manual of Determinative Bacteriology. 9th Edition. 1994.
The book was compiled by abstracting the phenotypic information contained in the four volumes of Bergey's Manual
of Systematic Bacteriology.The arrangement of the book is strictly phenotypic,,with no attempt to offer a natural
higher classification. The arrangement chosen is utilitarian and is intended to aid in the identification of bacteria.
The bacteria are divided into 35 groups, which are comparable to the "Parts" in the eighth edition and the
"Sections" in the Systematic volumes. These groups are not meant to be formal taxonomic ranks, but are a
continuation of the tradition of dividing the bacteria into easily recognized phenotypic groups. This arrangement is
most useful for diagnostic purposes.

4. Garrity G.M. (ed). Bergey's Manual of Systematic Bacteriology. 2nd Edition. 2001
Volume 1 (2001)
The Archaea and the deeply branching and phototrophic Bacteria
Volume 2 (2001)
The Proteobacteria
Volume 3 (2002)
The low G + C Gram-positive Bacteria
Volume 4 (2002)
The high G + C Gram-positive Bacteria
Volume 5 (2003)
The Planctomycetes, Spriochaetes, Fibrobacteres, Bacteriodetes and Fusobacteria
The current "Bergey's Manual" in 5 volumes. The classification and taxonomy results from comparative sequencing
of ribosomal RNA. Two Domains of Procaryotes are identified, Archaea and Bacteria. The Domains are
subclassified into Phylum, Class, Order, Family, Genus and Species. The Bacterial Domain contains 23 Phyla. A
genus outline that includes an index of organisms is available online at Bergey's Manual Genus Outline 2001.

163
 Todar's Online Textbook of Bacteriology

THE NATURE OF HOST-PARASITE INTERACTIONS

© 2002 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

The Nature of Host-parasite Interactions in Humans

Bacteria are consistently associated with the body surfaces of animals. There are many more bacterial
cells on the surface of a human (including the gastrointestinal tract) than there are human cells that
make up the animal. The bacteria that are consistently associated with an animal are called the normal
flora. These bacteria have a full range of symbiotic interactions with their animal hosts.

In biology, symbiosis is defined as "life together", i.e. that two organisms live in an association with
one -another. Thus, there are at least three types of relationships based on the quality of the association
for the members of the symbiotic association.

Types of Symbiotic Associations

1. Mutualism. Both members of the association benefit.

2. Commensalism. There is no apparent benefit or harm to either member of the association.

3. Parasitism. One member of the association lives at the expense of the other member.
It is this type of a symbiotic association that draws our attention in this course. For many parasites are
or can become pathogens, microorganisms the cause disease.

Bacterial Pathogenesis

A pathogen is a microorganism (or virus) that is able to produce disease. Pathogenicity is the ability
of a microorganism to cause disease in another organism, namely the host for the pathogen. As implied
above, pathogenicity is a manifestation of a host- parasite interaction.

In humans, some of the normal bacterial flora (e.g. Staphylococcus aureus, Streptococcus pneumoniae,
Haemophilus influenzae) are potential pathogens that live in a commensal or parasitic relationship
without producing disease. They do not cause disease in their host unless they have an opportunity
brought on by some compromise or weakness in the host's anatomical barriers, tissue resistance or
immunity. Furthermore, the bacteria are in a position to be transmitted from one host to another, giving
them additional opportunities to colonize or infect.

There are some pathogens that do not associate with their host EXCEPT in the case of disease. These
bacteria are obligate pathogens, even though some may rarely occur as normal flora, in asymptomatic
or recovered carriers, or in some form where they cannot be eliminated by the host.

164
Opportunistic Pathogens

Bacteria which cause a disease in a compromised host which typically would not occur in a healthy
(noncompromised) host are acting as opportunistic pathogens. A member of the normal flora can
such as Staphylococcus aureus or E. coli can cause an opportunistic infection, but so can an
environmental organism such as Pseudomonas aeruginosa. When a member of the normal flora causes
an infectious disease, it might be referred to as an endogenous bacterial disease, referring to a disease
brought on by bacteria 'from within'.

Infection

The normal flora, as well as any "contaminating" bacteria from the environment, are all found on the
body surfaces of the animal; the blood and internal tissues are sterile. If a bacterium, whether or not a
component of the normal flora, breaches one of these surfaces, an infection is said to have occurred.
Infection does not necessarily lead to infectious disease. In fact, infection probably rarely leads to
infectious disease. Some bacteria rarely cause disease if they do infect; some bacteria will usually cause
disease if they infect. But other factors, such as the route of entry , the number of infectious bacteria,
and status of the host defenses, play a role in determining the outcome of infection.

Determinants of Virulence

Pathogenic bacteria are able to produce disease because they possess certain structural or biochemical
or genetic traits that render them pathogenic or virulent. (The term virulence is best interpreted as
referring to the degree of pathogenicity.) The sum of the characteristics that allow a bacterium to
produce disease are the pathogen's determinants of virulence.

Some pathogens may rely on a single determinant of virulence, such as toxin production, to cause
damage to their host. Thus, bacteria such as Clostridium tetani and Corynebacterium diphtheriae,
which have hardly any invasive characteristics, are able to produce disease, the symptoms of which
depend on a single genetic trait in the bacteria: the ability to produce a toxin. Other pathogens, such as
Staphylococcus aureus, Streptococcus pyogenes and Pseudomonas aeruginosa, maintain a large
repertoire of virulence determinants and consequently are able to produce a more complete range of
diseases that affect different tissues in their host.

Properties of the Host

The host in a host-parasite interaction is the animal that maintains the parasite. The host and parasite
are in a dynamic interaction, the outcome of which depends upon the properties of the parasite and of
the host. The bacterial parasite has its determinants of virulence that allow it to invade and damage
the host and to resist the defenses of the host. The host has various degrees of resistance to the
parasite in the form of the host defenses.

Host Defenses

A healthy animal can defend itself against pathogens at different stages in the infectious disease
process. The host defenses may be of such a degree that infection can be prevented entirely. Or, if
infection does occur, the defenses may stop the process before disease is apparent. At other times, the
defenses that are necessary to defeat a pathogen may not be effective until infectious disease is well
into progress.

165
Typically the host defense mechanisms are divided into two groups:

1. Constitutive Defenses. Defenses common to all healthy animals. These defenses provide general
protection against invasion by normal flora, or colonization, infection, and infectious disease caused by
pathogens. The constitutive defenses have also been referred to as "natural" or "innate" resistance,
since they are inherent to the host.

2. Inducible Defenses. Defense mechanisms that must be induced or turned on by host exposure to
a pathogen (as during an infection). Unlike the constitutive defenses, they are not immediately ready
to come into play until after the host is appropriately exposed to the parasite. The inducible defenses
involve the immune responses to a pathogen causing an infection.

The inducible defenses are generally quite specifically directed against an invading pathogen. The
constitutive defenses are not so specific, and are directed toward general strategic defense. The
constitutive defenses, by themselves, may not be sufficient to protect the host against pathogens. Such
pathogens that evade or overcome the relatively nonspecific constitutive defenses are usually
susceptible to the more specific inducible defenses, once they have developed.

The Immune System

The inducible defenses are so-called because they are induced upon primary exposure to pathogen or
one of its products. The inducible defenses are a function of the immunological system and the
immune responses. The constitutive defenses are innate and immediately available for host defense.
The inducible defenses must be triggered in a host and initially take time to develop. The type of
resistance thus developed in the host is called acquired immunity. The term immune usually means
the ability to resist infectious disease. Immunity refers to the relative state of resistance of the host to a
specific pathogen.

Acquired immunity, itself, is sometimes divided into two types based on how it is acquired by the
host.

In active immunity, the host undergoes an immunological response and produces the cells and
factors responsible for the immunity, i.e., the host produces its own antibodies and/or immuno-reactive
lymphocytes. Active immunity can persist a long time in the host, up to many years in humans.

In passive immunity there is acquisition by a host of immune factors which were produced in
another animal, i.e., the host receives antibodies and/or immuno-reactive lymphocytes originally
produced in another animal. Passive immunity is typically short-lived and usually persists only a few
weeks or months.

Antigens

Antigens are chemical substances of relatively high molecular weight, that stimulate the immune
response in animals. Bacteria are composed of various macromolecular components that are antigens or
" antigenic" in their host and bacterial antigens interact with the host immunological system in a
variety of ways.

Natural Antibodies

166
Studies on germ-free animals have confirmed that a normal bacterial flora in the gastrointestinal tract
are necessary for full development of immunological (lymphatic) tissues in the intestine. Furthermore,
the interaction between these immune tissues and intestinal bacteria results in the production of serum
and secretory antibodies that are directed against bacterial antigens. These antibodies probably help
protect the host from invasion by its own normal flora, and they can cross react with antgenically-
related pathogens. For example, antibodies against normal E. coli could react with closely-related
pathogenic Shigella dysenteriae. These type of antibodies are sometimes called natural or cross-
reactive antibodies.

Bacterial Antigens made into Vaccines

In another way, bacterial antigens that are the components or products of pathogens are the
substances that induce the immune defenses of the host to defend against, and to eliminate, the
pathogen or disease. In the laboratory, these bacterial antigens can be manipulated or changed so that
they will stimulate the immune response in the absence of infection or pathology. These isolated or
modified antigens are the basis for active immunization (vaccination) against bacterial disease. Thus,
a modified form of the tetanus toxin (tetanus toxoid), which has lost its toxicity but retains its
antigenicity, is used to immunize against tetanus. Or, antigenic parts of the whooping cough bacterium,
Bordetella pertussis can be used to induce active formation of antibodies that will react with the living
organism and thereby prevent infection.

Antimicrobial Agents

One line of defense against bacterial infection is chemotherapy with antimicrobial agents such as
antibiotics. The ecological relationships between animals and bacteria in the modern world are
mediated by the omnipresence of antibiotics. Antibiotics are defined as substances produced by a
microorganism that kill or inhibit other microorganisms. Originally, a group of soil bacteria, the
Streptomyces, were the most innovative producers of antibiotics for clinical usage. They were the
source of streptomycin, tetracycline, erythromycin and chloramphenicol, to name just a few antibiotics.
Because bacteria evolve rapidly toward resistance, because bacteria can exchange genes for
antibiotic resistance, perhaps because we have overused and misused antibiotics, many pathogens
are emerging as resistant to antibiotics. There have already been reported infections by Enterococcus,
Staphylococcus aureus and Pseudomonas aeruginosa that are refractory to all known antibiotics.
Bacterial resistance to antimicrobial agents has become part of a pathogen's determinants of virulence.
These are examples of genetic means by which bacteria exert their virulence.

The usage of antibiotics to control the growth of parasites is an artificial way to intervene in the natural
process of the host-parasite interaction. But, of course, it is done for the obvious purpose of curing the
disease. The body heals itself: most antibiotics just stop bacterial growth, and the host must rely
entirely on its native defenses to accomplish the neutralization of bacterial toxins or the elimination of
bacterial cells. The judicious use of antibiotics in the past five decades has saved millions of lives from
infections caused by bacteria.

167
 Todar's Online Textbook of Bacteriology

THE NATURE OF HOST-PARASITE INTERACTIONS

© 2002 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

The Nature of Host-parasite Interactions in Humans

Bacteria are consistently associated with the body surfaces of animals. There are many more bacterial
cells on the surface of a human (including the gastrointestinal tract) than there are human cells that
make up the animal. The bacteria that are consistently associated with an animal are called the normal
flora. These bacteria have a full range of symbiotic interactions with their animal hosts.

In biology, symbiosis is defined as "life together", i.e. that two organisms live in an association with
one -another. Thus, there are at least three types of relationships based on the quality of the association
for the members of the symbiotic association.

Types of Symbiotic Associations

1. Mutualism. Both members of the association benefit.

2. Commensalism. There is no apparent benefit or harm to either member of the association.

3. Parasitism. One member of the association lives at the expense of the other member.
It is this type of a symbiotic association that draws our attention in this course. For many parasites are
or can become pathogens, microorganisms the cause disease.

Bacterial Pathogenesis

A pathogen is a microorganism (or virus) that is able to produce disease. Pathogenicity is the ability
of a microorganism to cause disease in another organism, namely the host for the pathogen. As implied
above, pathogenicity is a manifestation of a host- parasite interaction.

In humans, some of the normal bacterial flora (e.g. Staphylococcus aureus, Streptococcus pneumoniae,
Haemophilus influenzae) are potential pathogens that live in a commensal or parasitic relationship
without producing disease. They do not cause disease in their host unless they have an opportunity
brought on by some compromise or weakness in the host's anatomical barriers, tissue resistance or
immunity. Furthermore, the bacteria are in a position to be transmitted from one host to another, giving
them additional opportunities to colonize or infect.

There are some pathogens that do not associate with their host EXCEPT in the case of disease. These
bacteria are obligate pathogens, even though some may rarely occur as normal flora, in asymptomatic
or recovered carriers, or in some form where they cannot be eliminated by the host.

168
Opportunistic Pathogens

Bacteria which cause a disease in a compromised host which typically would not occur in a healthy
(noncompromised) host are acting as opportunistic pathogens. A member of the normal flora can
such as Staphylococcus aureus or E. coli can cause an opportunistic infection, but so can an
environmental organism such as Pseudomonas aeruginosa. When a member of the normal flora causes
an infectious disease, it might be referred to as an endogenous bacterial disease, referring to a disease
brought on by bacteria 'from within'.

Infection

The normal flora, as well as any "contaminating" bacteria from the environment, are all found on the
body surfaces of the animal; the blood and internal tissues are sterile. If a bacterium, whether or not a
component of the normal flora, breaches one of these surfaces, an infection is said to have occurred.
Infection does not necessarily lead to infectious disease. In fact, infection probably rarely leads to
infectious disease. Some bacteria rarely cause disease if they do infect; some bacteria will usually cause
disease if they infect. But other factors, such as the route of entry , the number of infectious bacteria,
and status of the host defenses, play a role in determining the outcome of infection.

Determinants of Virulence

Pathogenic bacteria are able to produce disease because they possess certain structural or biochemical
or genetic traits that render them pathogenic or virulent. (The term virulence is best interpreted as
referring to the degree of pathogenicity.) The sum of the characteristics that allow a bacterium to
produce disease are the pathogen's determinants of virulence.

Some pathogens may rely on a single determinant of virulence, such as toxin production, to cause
damage to their host. Thus, bacteria such as Clostridium tetani and Corynebacterium diphtheriae,
which have hardly any invasive characteristics, are able to produce disease, the symptoms of which
depend on a single genetic trait in the bacteria: the ability to produce a toxin. Other pathogens, such as
Staphylococcus aureus, Streptococcus pyogenes and Pseudomonas aeruginosa, maintain a large
repertoire of virulence determinants and consequently are able to produce a more complete range of
diseases that affect different tissues in their host.

Properties of the Host

The host in a host-parasite interaction is the animal that maintains the parasite. The host and parasite
are in a dynamic interaction, the outcome of which depends upon the properties of the parasite and of
the host. The bacterial parasite has its determinants of virulence that allow it to invade and damage
the host and to resist the defenses of the host. The host has various degrees of resistance to the
parasite in the form of the host defenses.

Host Defenses

A healthy animal can defend itself against pathogens at different stages in the infectious disease
process. The host defenses may be of such a degree that infection can be prevented entirely. Or, if
infection does occur, the defenses may stop the process before disease is apparent. At other times, the
defenses that are necessary to defeat a pathogen may not be effective until infectious disease is well
into progress.

169
Typically the host defense mechanisms are divided into two groups:

1. Constitutive Defenses. Defenses common to all healthy animals. These defenses provide general
protection against invasion by normal flora, or colonization, infection, and infectious disease caused by
pathogens. The constitutive defenses have also been referred to as "natural" or "innate" resistance,
since they are inherent to the host.

2. Inducible Defenses. Defense mechanisms that must be induced or turned on by host exposure to
a pathogen (as during an infection). Unlike the constitutive defenses, they are not immediately ready
to come into play until after the host is appropriately exposed to the parasite. The inducible defenses
involve the immune responses to a pathogen causing an infection.

The inducible defenses are generally quite specifically directed against an invading pathogen. The
constitutive defenses are not so specific, and are directed toward general strategic defense. The
constitutive defenses, by themselves, may not be sufficient to protect the host against pathogens. Such
pathogens that evade or overcome the relatively nonspecific constitutive defenses are usually
susceptible to the more specific inducible defenses, once they have developed.

The Immune System

The inducible defenses are so-called because they are induced upon primary exposure to pathogen or
one of its products. The inducible defenses are a function of the immunological system and the
immune responses. The constitutive defenses are innate and immediately available for host defense.
The inducible defenses must be triggered in a host and initially take time to develop. The type of
resistance thus developed in the host is called acquired immunity. The term immune usually means
the ability to resist infectious disease. Immunity refers to the relative state of resistance of the host to a
specific pathogen.

Acquired immunity, itself, is sometimes divided into two types based on how it is acquired by the
host.

In active immunity, the host undergoes an immunological response and produces the cells and
factors responsible for the immunity, i.e., the host produces its own antibodies and/or immuno-reactive
lymphocytes. Active immunity can persist a long time in the host, up to many years in humans.

In passive immunity there is acquisition by a host of immune factors which were produced in
another animal, i.e., the host receives antibodies and/or immuno-reactive lymphocytes originally
produced in another animal. Passive immunity is typically short-lived and usually persists only a few
weeks or months.

Antigens

Antigens are chemical substances of relatively high molecular weight, that stimulate the immune
response in animals. Bacteria are composed of various macromolecular components that are antigens or
" antigenic" in their host and bacterial antigens interact with the host immunological system in a
variety of ways.

Natural Antibodies

170
Studies on germ-free animals have confirmed that a normal bacterial flora in the gastrointestinal tract
are necessary for full development of immunological (lymphatic) tissues in the intestine. Furthermore,
the interaction between these immune tissues and intestinal bacteria results in the production of serum
and secretory antibodies that are directed against bacterial antigens. These antibodies probably help
protect the host from invasion by its own normal flora, and they can cross react with antgenically-
related pathogens. For example, antibodies against normal E. coli could react with closely-related
pathogenic Shigella dysenteriae. These type of antibodies are sometimes called natural or cross-
reactive antibodies.

Bacterial Antigens made into Vaccines

In another way, bacterial antigens that are the components or products of pathogens are the
substances that induce the immune defenses of the host to defend against, and to eliminate, the
pathogen or disease. In the laboratory, these bacterial antigens can be manipulated or changed so that
they will stimulate the immune response in the absence of infection or pathology. These isolated or
modified antigens are the basis for active immunization (vaccination) against bacterial disease. Thus,
a modified form of the tetanus toxin (tetanus toxoid), which has lost its toxicity but retains its
antigenicity, is used to immunize against tetanus. Or, antigenic parts of the whooping cough bacterium,
Bordetella pertussis can be used to induce active formation of antibodies that will react with the living
organism and thereby prevent infection.

Antimicrobial Agents

One line of defense against bacterial infection is chemotherapy with antimicrobial agents such as
antibiotics. The ecological relationships between animals and bacteria in the modern world are
mediated by the omnipresence of antibiotics. Antibiotics are defined as substances produced by a
microorganism that kill or inhibit other microorganisms. Originally, a group of soil bacteria, the
Streptomyces, were the most innovative producers of antibiotics for clinical usage. They were the
source of streptomycin, tetracycline, erythromycin and chloramphenicol, to name just a few antibiotics.
Because bacteria evolve rapidly toward resistance, because bacteria can exchange genes for
antibiotic resistance, perhaps because we have overused and misused antibiotics, many pathogens
are emerging as resistant to antibiotics. There have already been reported infections by Enterococcus,
Staphylococcus aureus and Pseudomonas aeruginosa that are refractory to all known antibiotics.
Bacterial resistance to antimicrobial agents has become part of a pathogen's determinants of virulence.
These are examples of genetic means by which bacteria exert their virulence.

The usage of antibiotics to control the growth of parasites is an artificial way to intervene in the natural
process of the host-parasite interaction. But, of course, it is done for the obvious purpose of curing the
disease. The body heals itself: most antibiotics just stop bacterial growth, and the host must rely
entirely on its native defenses to accomplish the neutralization of bacterial toxins or the elimination of
bacterial cells. The judicious use of antibiotics in the past five decades has saved millions of lives from
infections caused by bacteria.

171
 Todar's Online Textbook of Bacteriology

The Bacterial Flora of Humans

© 2002 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

The Normal Flora

In a healthy animal, the internal tissues, e.g. blood, brain, muscle, etc., are normally free of
microorganisms. On the other hand, the surface tissues, e.g. skin and mucous membranes, are
constantly in contact with environmental organisms and become readily colonized by certain microbial
species. The mixture of organisms regularly found at any anatomical site is referred to as the normal
flora.

The normal flora of humans is exceedingly complex and consists of more than 200 species of
bacteria. The makeup of the normal flora depends upon various factors, including genetics, age, sex,
stress, nutrition and diet of the individual. The normal flora of humans consists of a few eukaryotic
fungi and protists, and some methanogenic Archaea that colonize the lower intestinal tract, but the
Bacteria are the most numerous and obvious microbial components of the normal flora. The
distribution of the bacterial flora of humans is shown in Table 1. This table lists only a fraction of the
total bacterial species that occur as normal flora of humans, and it does not express the total number or
concentration of bacteria at any site.

TABLE 1. BACTERIA COMMONLY FOUND ON THE SURFACES OF THE HUMAN BODY

Lower Anterior
BACTERIUM Skin Conjunctiva Nose Pharynx Mouth Vagina
Intestine urethra
Staphylococcus epidermidis
++ + ++ ++ ++ + ++ ++
(1)
Staphylococcus aureus* (2) + +/- + + + ++ +/- +
Streptococcus mitis + ++ +/- + +
Streptococcus salivarius ++ ++
Streptococcus mutans* (3) + ++
Enterococcus faecalis* (4) +/- + ++ + +
Streptococcus pneumoniae*
+/- +/- + + +/-
(5)
Streptococcus pyogenes* (6) +/- +/- + + +/- +/-
Neisseria sp. (7) + + ++ + + +
Neisseria meningitidis* (8) + ++ + +
Veillonellae sp. + +/-
Enterobacteriaceae* +/- +/- +/- + ++ + +

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(Escherichia coli) (9)
Proteus sp. +/- + + + + + +
Pseudomonas aeruginosa*
+/- +/- + +/-
(10)
Haemophilus influenzae*
+/- + + +
(11)
Bacteroides sp.* ++ + +/-
Bifidobacterium bifidum
++
(12)
Lactobacillus sp. (13) + ++ ++ ++
Clostridium sp.* (14) +/- ++
Clostridium tetani (15) +/-
Corynebacteria (16) ++ + ++ + + + + +
Mycobacteria + +/- +/- + +
Actinomycetes + +
Spirochetes + ++ ++
Mycoplasmas + + + +/- +

++ = nearly 100 percent + = common +/- = rare * = potential pathogen

Table 1 Notes
(1) The staphylococci and corynebacteria occur at every site listed. Staphylococcus epidermidis
is highly adapted to the diverse environments of its human host. S. aureus is a potential
pathogen. It is a leading cause of bacterial disease in humans. It can be transmitted from the
nasal membranes of an asymptomatic carrier to a susceptible host.

S. epidermidis. Scanning EM. CDC.

(2) Many of the normal flora are either pathogens or opportunistic pathogens, The asterisks
indicate members of the normal flora a that may be considered major pathogens of humans.

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S. aureus. Gram stain.

(3) Streptococcus mutans is the primary bacterium involved in plaque formation and initiation
of dental caries. Viewed as an opportunistic infection, dental disease is one of the most
prevalent and costly infectious diseases in the United States.

Streptococcus mutans. Gram stain. CDC

(4) Enterococcus faecalis was formerly classified as Streptococcus faecalis. The bacterium is
such a regular a component of the intestinal flora, that many European countries use it as the
standard indicator of fecal pollution, in the same way we use E. coli in the U.S. In recent years,
Enterococcus faecalis has emerged as a significant, antibiotic-resistant, nosocomial pathogen.

Vancomycin Resistant Enterococcus faecalis. Scanning E.M. CDC

(5) Streptococcus pneumoniae is present in the upper respiratory tract of about half the
population. If it invades the lower respiratory tract it can cause pneumonia. Streptococcus
pneumoniae causes 95 percent of all bacterial pneumonia.

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Streptococcus pneumoniae. Direct fluorescent antibody stain. CDC.

(6) Streptococcus pyogenes refers to the Group A, Beta-hemolytic streptococci.

Streptococcus pyogenes. Gram stain.

(7) Gram-negative cocci, represented by various Neisseria, are frequent inhabitants of the upper
respiratory tract, mainly the pharynx. Neisseria meningitidis, an important cause of bacterial
meningitis, can colonize as well, until the host can develop active immunity against the
pathogen.

Neisseria meningitidis.Gram stain.

(8) While E. coli is a consistent resident of the small intestine, many other enteric bacteria may
reside here as well, including Klebsiella, Enterobacter and Citrobacter. Some strains of E. coli
are pathogens that cause intestinal infections, urinary tract infections and neonatal meningitis.

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E. coli. Scanning E.M. Shirley Owens. Center for Electron Optics. Michigan State University.

(9) Pseudomonas aeruginosa is the quintessential opportunistic pathogen of humans that can
invade virtually any tissue. It is a leading cause of hospital-acquired (nosocomial) Gram-
negative infections, but its source is often exogenous (from outside the host).

Colonies of Pseudomonas aeruginosa growing on an agar plate.

(10) Haemophilus influenzae is a frequent secondary invader to viral influenza, and was named
accordingly. The bacterium was the leading cause of meningitis in infants and children until the
recent development of the Hflu type B vaccine.

Haemophilus influenzae. Gram stain.

(11) The greatest number of bacteria are found in the lower intestinal tract, specifically the
colon and the most prevalent bacteria are the Bacteroides, a group of Gram-negative, anaerobic,
non-sporeforming bacteria. They have been implicated in the initiation colitis and colon cancer.

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Bacteroides fragilis. Gram stain.

(12) Bifidobacteria are Gram-positive, non-sporeforming, lactic acid bacteria. They have been
described as "friendly" bacteria in the intestine of humans. Bifidobacterium bifidum is the
predominant bacterial species in the intestine of breast-fed infants, where it presumably
prevents colonization by potential pathogens. These bacteria are sometimes used in the
manufacture of yogurts and are frequently incorporated into probiotics.

Bifidobacterium bifidum. Gram stain

(13) Lactobacilli in the oral cavity probably contribute to acid formation that leads to dental
caries. Lactobacillus acidophilus colonizes the vaginal epithelium during child-bearing years
and establishes the low pH that inhibits the growth of pathogens.

Lactobacillus species and a vaginal squaemous epithelial cell. CDC

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(14) There are numerous species of Clostridium that colonize the bowel. Clostridium
perfringens is commonly isolated from feces. Clostridium difficile may colonize the bowel and
cause "antibiotic-induced diarrhea" or pseudomembranous colitis.

Clostridium perfringens. Gram stain.

(15) Clostridium tetani is included in the table as an example of a bacterium that is "transiently
associated" with humans as a component of the normal flora. The bacterium can be isolated
from feces of (up to) 25 percent of the population. The endospores are probably ingested with
food and water, and the bacterium does not colonize the intestine.

Clostridium tetani. Gram stain.

(16) The corynebacteria, and certain related propionic acid bacteria, are consistent skin
flora. Some have been implicated as a cause of acne. Corynebacterium diphtheriae, the agent
of diphtheria, was considered a member of the normal flora before the widespread use of the
diphtheria toxoid, which is used to immunize against the disease.

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 Corynebacterium diphtheriae. Methylene blue stain.

Very little is known about the nature of the associations between humans and their normal flora, but
they are thought to be dynamic interactions rather than associations of mutual indifference. Both host
and bacteria are thought to derive benefit from each other, and the associations are, for the most part,
mutualistic. The normal flora derives from the host a supply of nutrients, a stable environment and
constant temperature, protection, and transport. The host obtains from the normal flora certain
nutritional benefits, stimulation of the immune system, and colonization strategies that exclude
potential pathogens at the site.

The normal flora are obviously adapted to their host (tissues), most probably by biochemical
interactions between bacterial surface components (ligands or adhesins) and host cell molecular
receptors. A great deal of information is available on the nature of adhesion of bacterial pathogens to
animal cells and tissues, and reasonably similar mechanisms should apply to the normal flora.

In general, there are three explanations for why the normal bacterial flora are located at particular
anatomical sites.

1. The normal flora exhibit a tissue preference or predilection for colonization. Certain species
of bacteria are invariably in one locale and never in another (See Table 1 above). This is
sometimes referred to as tissue tropism (See Table 2 below). One explanation for tissue
tropism is that the host provides an essential growth factor needed by the bacterium. Of course,
to explain why bacteria are not at an alternative site, the host inherently provides an
inhospitable environment for the bacterium by the production of such substances as stomach
acids, bile salts and lysozyme.

2. Many, perhaps most, of the normal flora are able to specifically colonize a particular tissue
or surface using their own surface components (e.g. capsules, fimbriae, cell wall components,
etc.) as specific ligands for attachment to specific receptors located at the colonization site (See
Table 3)

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 3. Some of the indigenous bacteria are able to construct bacterial biofilms on a tissue surface,
or they are able to colonize a biofilm built by another bacterial species. Many biofilms are a
mixture of microbes, although one member is responsible for maintaining the biofilm and may
predominate.

TABLE 2. EXAMPLES OF TISSUE TROPISM OF SOME BACTERIA ASSOCIATED WITH

HUMANS

BACTERIUM TISSUE
Corynebacterium diphtheriae Throat
Neisseria gonorrhoeae Urogenital epithelium
Streptococcus mutans Tooth surfaces
Streptococcus salivarius Tongue surfaces
Vibrio cholerae Small intestine epithelium
Escherichia coli Small intestine epithelium
Staphylococcus aureus Nasal membranes
Staphylococcus epidermidis Skin

TABLE 3. EXAMPLES OF SPECIFIC ATTACHMENTS OF BACTERIA TO HOST CELL OR

TISSUE SURFACES

Bacterial ligand for

Bacterium Host cell or tissue receptor Attachment site
attachment
Streptococcus Amino terminus of
Protein F Pharyngeal epithelium
pyogenes fibronectin
Streptococcus
Glycosyl transferase Salivary glycoprotein Pellicle of tooth
mutans
Streptococcus Buccal epithelium of
Lipoteichoic acid Unknown
salivarius tongue
Streptococcus N-acetylhexosamine-
Cell-bound protein Mucosal epithelium
pneumoniae galactose disaccharide
Staphylococcus Amino terminus of
Cell-bound protein Mucosal epithelium
aureus fibronectin
Neisseria N-methylphenyl- alanine Glucosamine-galactose Urethral/cervical
gonorrhoeae pili carbohydrate epithelium
Species-specific
Enterotoxigenic E.
Type-1 fimbriae carbohydrate(s) (e.g. Intestinal epithelium
coli
mannose)
Uropathogenic E.
Type 1 fimbriae Complex carbohydrate Urethral epithelium
coli
Uropathogenic E. Globobiose linked to
P-pili (pap) Upper urinary tract
coli ceramide lipid
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 Fimbriae ("filamentous Galactose on sulfated
Bordetella pertussis Respiratory epithelium
hemagglutinin") glycolipids
Fucose and mannose
Vibrio cholerae N-methylphenylalanine pili Intestinal epithelium
carbohydrate
Treponema
Peptide in outer membrane Surface protein (fibronectin) Mucosal epithelium
pallidum
Respiratory
Mycoplasma Membrane protein Sialic acid
epithelium
Conjunctival or
Chlamydia Unknown Sialic acid
urethral epithelium

THE COMPOSITION OF THE NORMAL FLORA

The normal flora of corresponding anatomical sites in different animal species varies widely. Within a
single species (e.g. humans) there is additional variation in the normal flora that is related to factors
such as age, sex, diet and nutrition. Some bacteria are found regularly at particular anatomical locales;
others are present only occasionally, or at certain times during life. Developmental changes in humans
such as weaning, the eruption of the teeth, and the onset and cessation of ovarian functions, invariably
affect the composition of the normal flora in the intestinal tract, the oral cavity, and the vagina,
respectively. However, within the limits of these fluctuations, the bacterial flora of humans is
sufficiently constant to a give general description of the situation.

It has been calculated that the normal human houses about 1012 bacteria on the skin, 1010 in the mouth,
and 1014 in the gastrointestinal tract. The latter number is far in excess of the number of eukaryotic
cells in all organs which comprise the human host.

Normal Flora of the Skin.The adult human is covered with approximately 2 square meters of skin.
The density and composition of the normal flora of the skin vary with anatomical locale. The high
moisture content of the axilla, groin, and areas between the toes supports the activity and growth of
relatively high densities of bacterial cells, but the density of bacterial populations at most other sites is
fairly low, generally in 100s or 1000s per square cm. Qualitatively, the bacteria on the skin near any
body orifice may be similar to those in the orifice.

The majority of skin microorganisms are found in the most superficial layers of the epidermis and the
upper parts of the hair follicles. They consist largely of micrococci (Staphylococcus epidermidis and
Micrococcus sp.) and corynebacteria. These are generally nonpathogenic and considered to be
commensal, although mutualistic and parasitic roles have been assigned to them. Sometimes potentially
pathogenic Staphylococcus aureus is found on the face and hands, particularly in individuals who are
nasal carriers.

Normal Flora of the Cunjunctiva. A variety of bacteria may be cultivated from the normal
conjunctiva but the number of organisms is usually small. Staphylococcus epidermidis and certain
coryneforms (Propoinibacterium acnes) are dominant. Staphylococcus aureus, some streptococci,
Haemophilus sp. and Neisseria sp. are occasionally found. The conjunctiva is kept moist and healthy
by the continuous secretions from the lachrymal glands. Blinking wipes the conjunctiva every few
seconds mechanically washing away foreign objects including bacteria. Lachrymal secretions (tears)
also contain bactericidal substances including lysozyme. There is little or no opportunity for
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microorganisms to colonize the conjunctiva without special mechanisms to attach to the epithelial
surfaces and some ability to withstand attack by lysozyme. Pathogens which do infect the conjunctiva
(e.g. Neisseria gonorrhoeae and Chlamydia trachomatis) are thought to be able to specifically attach to
the conjunctival epithelium by means of sialic acid receptors on epithelial cells, but this is not certain.

Propionibacterium acnes

Normal Flora of the Respiratory Tract. The nares (nostrils) are always heavily colonized,
predominantly with Staphylococcus epidermidis and corynebacteria, and often (about 20% of the
general population) with Staphylococcus aureus, this being the main carrier site of this important
pathogen. The healthy sinuses, in contrast are sterile. A large number of bacterial species colonize the
upper respiratory tract (nasopharynx). The predominant species are non-hemolytic and alpha-hemolytic
streptococci and Neisseria, but sometimes pathogens such as Streptococcus pneumoniae, Streptococcus
pyogenes, Haemophilus influenzae and Neisseria meningitidis colonize the pharynx.

Moraxella catarrhalis. Gram stain.

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Veilonella. Gram stain.

The lower respiratory tract (trachea, bronchi, and pulmonary tissues) are virtually free of
microorganisms, mainly because of the efficient cleansing action of the ciliated epithelium which lines
the tract. Any bacteria reaching the lower respiratory tract are swept upward by the action of the
mucociliary blanket that lines the bronchi, to be removed subsequently by coughing, sneezing,
swallowing, etc. If the respiratory tract epithelium becomes damaged, as in bronchitis or viral
pneumonia, the individual may become susceptible to infection by pathogens descending from the
nasopharynx (e.g. H. influenzae or S. pneumoniae). The pathogen Bordetella pertussis is specifically
able to colonize the tracheal epithelium of humans, allowing it to produce the disease, pertussis
(whooping cough).

Normal flora of the Urogenital Tract. Urine is normally sterile, and since the urinary tract is flushed
with urine every few hours, microorganisms have problems gaining access and becoming established.
The flora of the anterior urethra, as indicated principally by urine cultures, suggests that the area my be
inhabited by a relatively consistent normal flora consisting of Staphylococcus epidermidis,
Enterococcus faecalis and some alpha-hemolytic streptococci. Their numbers are not plentiful,
however. In addition, some enteric bacteria (e.g. E. coli,Proteus) and corynebacteria, which are
probably contaminants from the skin, vulva or rectum, may occasionally be found at the anterior
urethra.

The vagina becomes colonized soon after birth with corynebacteria, staphylococci, nonpyogenic
streptococci, E. coli, and a lactic acid bacterium historically named "Doderlein's bacillus"
(Lactobacillus acidophilus). During reproductive life, from puberty to menopause, the vaginal
epithelium contains glycogen due to the actions of circulating estrogens. Doderlein's bacillus
predominates, being able to metabolize the glycogen to lactic acid. The lactic acid and other products
of metabolism inhibit colonization by all except Doderlein's bacillus and a select number of lactic acid
bacteria. The resulting low pH of the vaginal epithelium prevents establishment of most bacteria as
well as the potentially-pathogenic yeast, Candida albicans. This is a striking example of the protective
effect of the normal bacterial flora for their humam host.

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Lactic acid bacteria, possibly Doderlein's bacillus, in ascociation with a vaginal epithelial cell.

Normal Flora of the Human Oral Cavity. The presence of nutrients, epithelial debris, and secretions
makes the mouth a favorable habitat for a great variety of bacteria. Oral bacteria include streptococci,
lactobacilli, staphylococci and corynebacteria, with a great number of anaerobes, especially
bacteroides.

The mouth presents a succession of different ecological situations with age, and this corresponds with
changes in the composition of the normal flora. At birth the oral cavity is composed solely of the soft
tissues of the lips, cheeks, tongue and palate, which are kept moist by the secretions of the salivary
glands. At birth the oral cavity is sterile but rapidly becomes colonized from the environment,
particularly from the mother in the first feeding. Streptococcus salivarius is dominant and may make up
98% of the total oral flora until the appearance of the teeth (6 - 9 months in humans). The eruption of
the teeth during the first year leads to colonization by S. mutans and S. sanguis. These bacteria require
a nondesquamating (nonepithelial) surface in order to colonize. They will persist as long as teeth
remain. Other strains of streptococci adhere strongly to the gums and cheeks but not to the teeth. The
creation of the gingival crevice area (supporting structures of the teeth) increases the habitat for the
variety of anaerobic species found. The complexity of the oral flora continues to increase with time,
and Bacteroides and spirochetes colonize around puberty.

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Lactobacillus acidophilus. Gram Stain.

Clearly, the normal bacterial flora of the oral cavity benefit from their associations with their host. Are
there benefits as well to the host? Perhaps. The normal flora occupy available colonization sites which
makes it more difficult for other microorganisms (nonindigenous species) to become established. Also,
the oral flora contribute to host nutrition through the synthesis of vitamins, and they contribute to
immunity by inducing low levels of circulating and secretory antibodies that may cross react with
pathogens. Finally, the oral bacteria exert microbial antagonism against nonindigenous species by
production of inhibitory fatty acids, peroxides, bacteriocins, etc.

The oral flora of humans may harm their host since some of these bacteria are parasites or opportunistic
pathogens. If certain oral bacteria are able to invade tissues not normally accessible to them,
characteristic diseases result. For example, oral organisms gaining entrance into tissues (e.g. via
surgical wounds) may cause abscesses of alveolar bone, lung, brain or the extremities. Such infections
usually contain mixtures of bacteria with Bacteroides melaninogenicus often playing a dominant role.
Also, oral streptococci may be introduced into wounds created by dental manipulation or treatment. If
this occurs in an individual with damaged heart valves due to rheumatic fever (previously induced by
streptococci), the oral streptococci may adhere to the damaged heart valves and initiate subacute
bacterial endocarditis.

DENTAL PLAQUE, DENTAL CARIES AND PERIODONTAL DISEASE

Dental plaque, dental caries and periodontal disease in humans also result from actions initiated by the
normal bacterial flora. This is arguably the most significant and costly negative effect resulting from
human symbioses with bacteria.

Dental Plaque, which is material adhering to the teeth, consists of bacterial cells (60-70% the volume
of the plaque), salivary polymers, and bacterial extracellular products. Plaque is a naturally-constructed
biofilm, in which the consortia of bacteria may reach a thickness of 300-500 cells on the surfaces of the
teeth. These accumulations subject the teeth and gingival tissues to high concentrations of bacterial
metabolites, which result in dental disease.

By far the dominant bacterial species in dental plaque are Streptococcus sanguis and Streptococcus
mutans, both of which are considered responsible for plaque.

185
Streptococcus mutans. Gram stain. CDC.

Plaque formation is initiated by a weak attachment of the streptococcal cells to salivary glycoproteins
forming a pellicle on the surface of the teeth. This is followed by a stronger attachment by means of
extracellular sticky polymers of glucose (glucans) which are synthesized by the bacteria from dietary
sugars (principally sucrose). An enzyme on the cell surface of Streptococcus mutans, glycosyl
transferase, is apparently involved in initial attachment of the bacterial cells to the tooth surface and in
the conversion of sucrose to dextran and levan polymers (glucans) which form the extracellular matrix
of plaque. Attachment of S. mutans and the formation of glucans is mediated by glycosyl transferase.
The specificity of the adhesion has been proven by the fact that the attachment can be prevented by
specific antibody to the enzyme.

Dental Caries is the destruction of the enamel, dentin or cementum of teeth due to bacterial activities.
Caries are initiated by direct demineralization of the enamel of teeth due to lactic acid and other
organic acids which accumulate in dental plaque. Lactic acid bacteria in the plaque produce lactic acid
from the fermentation of sugars and other carbohydrates in the diet of the host. Streptococcus mutans
has most consistently been associated with the initiation of dental caries, but other lactic acid bacteria
are probably involved as well. These organisms normally colonize the occlusal fissures and contact
points between the teeth, and this correlates with the incidence of decay on these surfaces.

Streptococcus mutans has a number of physiological and biochemical properties which implicate it in
the initiation of dental caries.

1. It is a regular component of the normal oral flora of humans which occurs in relatively large
numbers. It readily colonizes tooth surfaces: salivary components (mucins, which are
glycoproteins) form a thin film on the tooth called the enamel pellicle. The adsorbed mucins are
thought to serve as molecular receptors for ligands on the bacterial cell surface.

2. It contains the enzyme glycosyl transferase that probably serves as the bacterial ligand for
attachment, and that polymerizes glucose obtained from dietary sucrose to glucans which leads
directly to the formation of plaque.

3. It produces lactic acid from the utilization of dietary carbohydrate which demineralizes tooth
enamel. S. mutans produces more lactic acid and is more acid-tolerant than most other
streptococci.

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 4. It stores polysaccharides made from dietary sugars which can be utilized as reserve carbon
and energy sources for production of lactic acid. The extracellular glucans formed by S. mutans
are, in fact, bacterial capsular polysaccharides that function as carbohydrate reserves. The
organisms can also form intracellular polysaccharides from sugars which are stored in cells and
then metabolized to lactic acid.

Streptococcus mutans appears to be important in the initiation of dental caries because its activities lead
to colonization of the tooth surfaces, plaque formation, and localized demineralization of tooth enamel.
It is not however, the only cause of dental decay. After initial weakening of the enamel, various oral
bacteria gain access to interior regions of the tooth. Lactobacilli, Actinomyces, and various proteolytic
bacteria are commonly found in human carious dentin and cementum, which suggests that they are
secondary invaders that contribute to the progression of the lesions.

Actinomyces israelii

Periodontal Diseases are bacterial infections that affect the supporting structures of the teeth (gingiva,
cementum, periodontal membrane and alveolar bone). The most common form, gingivitis, is an
inflammatory condition of the gums. It is associated with accumulations of bacterial plaque in the area.
Increased populations of Actinomyces have been found, and they have been suggested as the cause.

Diseases that are confined to the gum usually do not lead to loss of teeth, but there are other more
serious forms of periodontal disease that affect periodontal membrane and alveolar bone resulting in
tooth loss. Bacteria in these lesions are very complex populations consisting of Gram-positive
organisms (including Actinomyces and streptococci) and Gram-negative organisms (including
spirochetes and Bacteroides). The mechanisms of tissue destruction in periodontal disease are not
clearly defined but hydrolytic enzymes, endotoxins, and other toxic bacterial metabolites seem to be
involved.

TABLE 4. FREQUENTLY ENCOUNTERED BACTERIA IN PLAQUE, DENTAL CARIES,

GINGIVITIS AND PERIODONTITIS

BACTERIUM Plaque Dental caries Gingivitis Periodontitis

Streptococcus sanguis ++ ++ ++ +
S. mutans ++ ++ 0 0

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S. salivarius 0 0 0 0
Actinomyces viscosis + + ++ +
A. israelii + + ++ ++
Lactobacillus sp. + + 0 0
Propionibacterium acnes 0 + + ++
Bacteroides sp. 0 0 + ++
Selenomonas sputagena 0 0 + ++
Large spirochetes 0 0 0 ++

++ = Frequently encountered in high proportions; + = Frequently encountered in low to moderate

proportions; 0 = Sometimes encountered in low proportions or not detectable.
Modified from Davis, et al.: Microbiology. 4th ed. J. B. Lippincott. Philadelphia, 1990.

Normal Flora of the Gastrointestinal Tract.

Colonies of E. coli growing on EMB agar.

The bacterial flora of the GI tract of animals has been studied more extensively than that of any other
site. The composition differs between various animal species, and within an animal species. In humans,
there are differences in the composition of the flora which are influenced by age, diet, cultural
conditions, and the use of antibiotics. The latter greatly perturbs the composition of the intestinal
flora. The following table shows the distribution of some common intestinal bacteria in various animal
species including humans.

TABLE 5. NUMBERS OF VIABLE BACTERIA FOUND IN THE FECES OF ADULT

ANIMALS (Log # viable cells per gram feces) *

Animal E. coli C. perfringens Enterococci Bacteroides Lactobacilli

Cattle 4.3 2.3 5.3 0 2.4
Sheep 6.5 4.3 6.1 0 3.9
Horses 4.1 0 6.8 0 7.0
Pigs 6.5 3.6 6.4 5.7 8.4
Chickens 6.6 2.4 7.5 0 8.5

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Rabbits 2.7 0 4.3 8.6 0
Dogs 7.5 8.4 7.6 8.7 4.6
Cats 7.6 7.4 8.3 8.9 8.8
Mice 6.8 0 7.9 8.9 9.1
Humans 6.7 3.2 5.2 9.7 8.8

* Median values from 10 animals

Modified from Rosebury, T. : Microorganisms Indigenous to Man. McGraw-Hill. New York. 1962.

In the upper GI tract of adult humans, the esophagus contains only the bacteria swallowed with saliva
and food. Because of the high acidity of the gastric juice very few bacteria (mainly acid-tolerant
lactobacilli) can be cultured from the normal stomach. However, at least half the population in the
United States is colonized by a pathogenic bacterium, Helicobacter pylori. Since the 1980s, this
bacterium has been known to be the cause of gastric ulcers, and it is probably a cause of gastric and
duodenal cancer as well.

Helicobacter pylori. ASM

The proximal small intestine has a relatively sparse Gram-positive flora, consisting mainly of
lactobacilli and Enterococcus faecalis. This region has about 105 - 107 bacteria per ml of fluid. The
distal part of the small intestine contains greater numbers of bacteria (108/ml) and additional species
including coliforms and Bacteroides, in addition to lactobacilli and enterococci. The flora of the large
intestine (colon) is qualitatively similar to that found in feces. Populations of bacteria in the colon reach
levels of 1011/ml feces. Coliforms become more prominent, and enterococci, clostridia and lactobacilli
can be regularly found, but the predominant species are anaerobic Bacteroides and anaerobic lactic acid
bacteria in the genus Bifidobacterium (Bifidobacterium bifidum). These organisms may outnumber E.
coli by 1,000:1 to 10,000:1. It is now known that significant numbers of anaerobic methanogenic
bacteria (up to 1010/gm) also reside in the colon of humans. The range of incidence of certain bacteria
in the large intestine of humans is shown below.

TABLE 6. BACTERIA FOUND IN THE LARGE INTESTINE OF HUMANS

BACTERIUM Range of Incidence

Bacteroides fragilis 100
Bacteroides melaninogenicus 100
Bacteroides oralis 100

189
Lactobacillus 20-60
Clostridium perfringens 25-35
Clostridium septicum 5-25
Clostridium tetani 1-35
Bifidobacterium bifidum 30-70
Staphylococcus aureus 30-50
Enterococcus faecalis 100
Escherichia coli 100
Salmonella enteritidis 3-7
Salmonella typhi 0.00001
Klebsiella sp. 40-80
Enterobacter sp. 40-80
Proteus mirabilis 5-55
Pseudomonas aeruginosa 3-11
Peptostreptococcus sp. common
Peptococcus sp. moderate
Methanogens (Archaea) common

Modified from Youmans, et al.: The Biologic and Clinical Basis of Infectious Disease. W. B. Saunders
Co. Philadelphia. 1985.

At birth the entire intestinal tract is sterile, but bacteria enter with the first feed. The initial colonizing
bacteria vary with the food source of the infant. In breast-fed infants bifidobacteria account for more
than 90% of the total intestinal bacteria. Enterobacteriaceae and enterococci are regularly present, but
in low proportions, while bacteroides, staphylococci, lactobacilli and clostridia are practically absent.
In bottle-fed infants, bifidobacteria are not predominant. When breast-fed infants are switched to a diet
of cow's milk or solid food, bifidobacteria are progressively joined by enterics, bacteroides, enterococci
lactobacilli and clostridia. Apparently, human milk contains a growth factor that enriches for growth of
bifidobacteria, and these bacteria play an important role in preventing colonization of the infant
intestinal tract by non indigenous or pathogenic species.

Clostridium difficile. Gram stain.

190
The composition of the flora of the gastrointestinal tract varies along the tract (at longitudinal levels)
and across the tract (at horizontal levels) where certain bacteria attach to the gastrointestinal epithelium
and others occur in the lumen. There is frequently a very close association between specific bacteria in
the intestinal ecosystem and specific gut tissues or cells (evidence of tissue tropism). Many bacteria
adhere specifically to the gastrointestinal epithelial surfaces, and this has been shown in many animal
species including humans, cows, dogs, pigs, mice and chickens. Gram-positive bacteria, such as the
streptococci and lactobacilli, are thought to adhere to the gastrointestinal epithelium using
polysaccharide capsules or wall lipoteichoic acids to attach to specific receptors on the epithelial cells.
Likewise, Gram-negative bacteria such as the enterics may attach by means of specific fimbriae on the
bacterial cell which bind to glycoproteins on the epithelial cell surface.

THE BENEFITS OF THE NORMAL FLORA

The indigenous bacteria of the gastrointestinal tract of an animal, perhaps mainly as a consequence of
their great numbers, seem to have the greatest overall impact on their host. The nature of the
interactions between an animal host and its normal flora has been inferred from the study of germ-free
animals (animals which lack any bacterial flora) compared to conventional animals (animals which
have a typical normal flora). Following are the primary beneficial effects of the normal flora that are
derived from these studies.
1. The normal flora synthesize and excrete vitamins in excess of their own needs, which can
be absorbed as nutrients by the host. For example, enteric bacteria secrete Vitamin K and
Vitamin B12, and lactic acid bacteria produce certain B-vitamins. Germ-free animals may be
deficient in Vitamin K to the extent that it is necessary to supplement their diets.

2. The normal flora prevent colonization by pathogens by competing for attachment sites or
for essential nutrients. This is thought to be their most important beneficial effect, which has
been demonstrated in the oral cavity, the intestine, the skin, and the vaginal epithelium. In
some experiments, germ-free animals can be infected by 10 Salmonella bacteria, while the
infectious dose for conventional animals is near 106 cells.

3. The normal flora may antagonize other bacteria through the production of substances
which inhibit or kill nonindigenous species. The intestinal bacteria produce a variety of
substances ranging from relatively nonspecific fatty acids and peroxides to highly specific
bacteriocins, which inhibit or kill other bacteria.

4. The normal flora stimulate the development of certain tissues, i.e., the caecum and
certain lymphatic tissues (Peyer's patches) in the GI tract. The caecum of germ-free animals is
enlarged, thin-walled, and fluid-filled, compared to that organ in conventional animals. Also,
based on the ability to undergo immunological stimulation, the intestinal lymphatic tissues of
germ-free animals are poorly-developed compared to conventional animals.

5. The normal flora stimulate the production of cross-reactive antibodies. Since the normal
flora behave as antigens in an animal, they induce an immunological response, in particular, an
antibody-mediated immune (AMI) response. Low levels of antibodies produced against
components of the normal flora are known to cross react with certain related pathogens, and
thereby prevent infection or invasion. Antibodies produced against antigenic components of the
normal flora are sometimes referred to as "natural" antibodies, and such antibodies are lacking
in germ-free animals.

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 Todar's Online Textbook of Bacteriology

The Mechanisms of Bacterial Pathogenicity

© 2002 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

Introduction

A pathogen is a microorganism that is able to cause disease in a plant, animal or insect. Pathogenicity
is the ability to produce disease in a host organism. Microbes express their pathogenicity by means of
their virulence, a term which refers to the degree of pathogenicity of the microbe. Hence the
determinants of virulence of a pathogen are any of its genetic or biochemical or structural features
that enable it to produce disease. in a host.

The relationship between a host and a pathogen is dynamic, since each modifies the activities and
functions of the other. The outcome of an infection depends on the virulence of the pathogen and the
relative degree of resistance or susceptibility of the host, due mainly to the effectiveness of the host
defense mechanisms.

The Underlying Mechanisms of Bacterial Pathogenicity

Two broad qualities of pathogenic bacteria underlie the means by which they cause disease:

1. The ability to invade tissues: Invasiveness, which encompasses mechanisms for colonization
(adherence and initial multiplication), ability to bypass or overcome host defense mechanisms, and
the production of extracellular substances which facilitate invasion.

2. The ability to produce toxins: Toxigenesis. Bacteria produce two types of toxins called exotoxins
and endotoxins. Exotoxins are released from bacterial cells and may act at tissue sites removed from
the site of bacterial growth. Endotoxins are cell-associated substances that are structural components
of the cell walls of Gram-negative bacteria. However, endotoxins may be released from growing
bacterial cells or from cells which are lysed as a result of effective host defense (e.g. lysozyme) or the
activities of certain antibiotics (e.g. penicillins and cephalosporins). Hence, bacterial toxins, both
soluble and cell-associated, may be transported by blood and lymph and cause cytotoxic effects at
tissue sites remote from the original point of invasion or growth. Some bacterial toxins may also act at
the site of colonization and play a role in invasion.

COLONIZATION

The first stage of microbial infection is colonization: the establishment of the pathogen at the
appropriate portal of entry. Pathogens usually colonize host tissues that are in contact with the external
environment. Sites of entry in human hosts include the urogenital tract, the digestive tract, the
respiratory tract and the conjunctiva. Organisms that infect these regions have usually developed tissue

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adherence mechanisms and some ability to overcome or withstand the constant pressure of the host
defenses on the surface.

Bacterial Adherence to Mucosal Surfaces. In its simplest form, bacterial adherence or attachment to
a eukaryotic cell or tissue surface requires the participation of two factors: a receptor and an adhesin.
The receptors so far defined are usually specific carbohydrate or peptide residues on the eukaryotic cell
surface. The bacterial adhesin is typically a macromolecular component of the bacterial cell surface
which interacts with the host cell receptor. Adhesins and receptors usually interact in a complementary
and specific fashion. Table 1 is a list of terms that are used in medical microbiology to refer
tomicrobial adherence to surfaces or tissues.

TABLE 1. TERMS USED TO DESCRIBE ADHERENCE FACTORS IN HOST-PARASITE

INTERACTIONS
ADHERENCE FACTOR DESCRIPTION
A surface structure or macromolecule that binds a bacterium to a specific
Adhesin
surface
A complementary macromolecular binding site on a (eukaryotic) surface
Receptor
that binds specific adhesins or ligands
Lectin Any protein that binds to a carbohydrate
A surface molecule that exhibits specific binding to a receptor molecule
Ligand
on another surface
The mucopolysaccharide layer of glucosaminoglycans covering animal
Mucous
cell mucosal surfaces
Filamentous proteins on the surface of bacterial cells that may behave as
Fimbriae
adhesins for specific adherence
Common pili Same as fimbriae
A specialized pilus that binds mating procaryotes together for the purpose
Sex pilus
of DNA transfer
Fimbriae in Enterobacteriaceae which bind specifically to mannose
Type 1 fimbriae
terminated glycoproteins on eukaryotic cell surfaces
A layer of exopolysaccharide fibers on the surface of bacterial cells which
Glycocalyx
may be involved in adherence to a surface
A detectable layer of polysaccharide (rarely polypeptide) on the surface of
Capsule
a bacterial cell which may mediate specific or nonspecific attachment
A distinct cell wall component of the outer membrane of Gram-negative
Lipopolysaccharide (LPS) bacteria with the potential structural diversity to mediate specific
adherence. Probably functions as an adhesin
Teichoic acids and Cell wall components of Gram-positive bacteria that may be involved in
lipoteichoic acids (LTA) nonspecific or specific adherence

Specific Adherence of Bacteria to Cell and Tissue Surfaces

Several types of observations provide indirect evidence for specificity of adherence of bacteria to host
cells or tissues:
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1. Tissue tropism: particular bacteria are known to have an apparent preference for certain tissues over
others, e.g. S. mutans is abundant in dental plaque but does not occur on epithelial surfaces of the
tongue; the reverse is true for S. salivarius which is attached in high numbers to epithelial cells of the
tongue but is absent in dental plaque.

2. Species specificity: certain pathogenic bacteria infect only certain species of animals, e.g. N.
gonorrhoeae infections are limited to humans; Enteropathogenic E. coli K-88 infections are limited to
pigs; E. coli CFA I and CFA II infect humans; E.coli K-99 strain infects calves.; Group A streptococcal
infections occur only in humans.

3. Genetic specificity within a species: certain strains or races within a species are genetically immune
to a pathogen , e.g. Certain pigs are not susceptible to E. coli K-88 infections; Susceptibility to
Plasmodium vivax infection (malaria) is dependent on the presence of the Duffy antigens on the host's
redblood cells.

Although other explanations are possible, the above observations might be explained by the existence
of specific interactions between microorganisms and eukaryotic tissue surfaces which allow
microorganisms to become established on the surface.

Mechanisms of Adherence to Cell or Tissue Surfaces

The mechanisms for adherence may involve two steps:

1. nonspecific adherence: reversible attachment of the bacterium to the eukaryotic surface

(sometimes called "docking")

2. specific adherence: reversible permanent attachment of the microorganism to the surface

(sometimes called "anchoring").

The usual situation is that reversible attachment precedes irreversible attachment but in some cases, the
opposite situation occurs or specific adherence may never occur

Nonspecific adherence involves nonspecific attractive forces which allow approach of the bacterium
to the eukaryotic cell surface. Possible interactions and forces involved are:

1. hydrophobic interactions

2. electrostatic attractions

3. atomic and molecular vibrations resulting from fluctuating dipoles of similar frequencies

4. Brownian movement

5. recruitment and trapping by biofilm polymers interacting with the bacterial glycocalyx (capsule)

Specific adherence involves permanent formation of many specific lock-and-key bonds between
complementary molecules on each cell surface. Complementary receptor and adhesin molecules must
be accessible and arranged in such a way that many bonds form over the area of contact between the
two cells. Once the bonds are formed, attachment under physiological conditions becomes virtually
irreversible.
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Several types of experiments provide direct evidence that receptor and/or adhesin molecules
mediate specificity of adherence of bacteria to host cells or tissues. These include:

1. The bacteria will bind isolated receptors or receptor analogs.

2. The isolated adhesins or adhesin analogs will bind to the eukaryotic cell surface.

3. Adhesion (of the bacterium to the eukaryotic cell surface) is inhibited by:

a. isolated adhesin or receptor molecules

b. adhesin or receptor analogs

c. enzymes and chemicals that specifically destroy adhesins or receptors

d. antibodies specific to surface components (i.e., adhesins or receptors)

Some Specific Bacterial Adhesins and their Receptors

The adhesins of E. coli are their common pili or fimbriae. A single strain of E. coli is known to be able
to express several distinct types of fimbriae encoded by distinct regions of the chromosome or
plasmids. This genetic diversity permits an organism to adapt to its changing environment and exploit
new opportunities presented by different host surfaces. Many of the adhesive fimbriae of E. coli have
probably evolved from fimbrial ancestors resembling Type-1 and type 4 fimbriae.

Type-1 fimbriae enable E. coli to bind to D-mannose residues on eukaryotic cell surfaces. Type-1
fimbriae are said to be "mannose-sensitive" since exogenous mannose blocks binding to receptors on
red blood cells. Although the primary 17kDa fimbrial subunit is the major protein component of Type-
1 fimbriae, the mannose-binding site is not located here, but resides in a minor protein (28-31kDa)
located at the tips or inserted along the length of the fimbriae. By genetically varying the minor "tip
protein" adhesin, the organisms can gain ability to adhere to different receptors. For example, tip
proteins on pyelonephritis-associated (pap) pili recognize a galactose-galactose disaccharide, while tip
proteins on S-fimbriae recognize sialic acid.

Pseudomonas, Vibrio and Neisseria possess a fimbrial protein subunit which contains methylated
phenylalanine at its amino terminus. These "N-methylphenylalanine pili" have been established as
virulence determinants in pathogenesis of Pseudomonas aeruginosa lung infection in cystic fibrosis
patients. These type of fimbriae occur in Neisseria gonorrhoeae and their receptor is thought to be an
oligosaccharide.

The adhesins of Streptococcus pyogenesare controversial. In 1972, Gibbons and his colleagues
demonstrated that attachment of streptococci to the oral mucosa of mice is dependent on M protein.
Olfek and Beachey argued that lipoteichoic acid (LTA), rather than M protein, was responsible for
streptococcal adherence to buccal epithelial cells. In 1996, Hasty and Courtney proposed a two-step
model of attachment that involved both M protein and teichoic acids. They suggested that LTA loosely
tethers streptococci to epithelial cells, and then M protein secures a firmer, irreversible association. In
1992, protein F was
discovered and found to be a fibronectin binding protein. More recently, in 1998, M proteins M1 and
M3 were also found to bind to fibronectin. Apparently, S. pyogenes produces multiple adhesins with
varied specificities.
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Staphylococcus aureus also binds to the amino terminus of fibronectin by means of a fibronectin-
binding protein which occurs on the bacterial surface. Apparently S. aureus and Group A streptococci
use different mechanisms but adhere to the same receptor on epithelial surfaces.

Treponema pallidum has three related surface adhesins (P1, P2 and P3) which bind to a four-amino
acid sequence (Arg-Gly-Asp-Ser) of the cell-binding domain of fibronectin. It is not clear if T.
pallidum uses fibronectin to attach to host surfaces or coats itself with fibronectin to avoid host
defenses (phagocytes and immune responses).

TABLE 2. EXAMPLES OF SPECIFIC ATTACHMENTS OF BACTERIA TO HOST

CELL OR TISSUE SURFACES
Bacterium Adhesin Receptor Attachment site Disease
Streptococcus Amino terminus of Pharyngeal
Protein F Sore throat
pyogenes fibronectin epithelium
Streptococcus Salivary
Glycosyl transferase Pellicle of tooth Dental caries
mutans glycoprotein
Buccal
Streptococcus
Lipoteichoic acid Unknown epithelium of None
salivarius
tongue
N-
Streptococcus acetylhexosamine- Mucosal
Cell-bound protein pneumonia
pneumoniae galactose epithelium
disaccharide
Staphylococcus Amino terminus of Mucosal
Cell-bound protein Various
aureus fibronectin epithelium
Glucosamine-
Neisseria N-methylphenyl- Urethral/cervical
galactose Gonorrhea
gonorrhoeae alanine pili epithelium
carbohydrate
Enterotoxigenic Species-specific Intestinal
Type-1 fimbriae Diarrhea
E. coli carbohydrate(s) epithelium
Uropathogenic Complex Urethral
Type 1 fimbriae Urethritis
E. coli carbohydrate epithelium
Uropathogenic Globobiose linked Upper urinary
P-pili (pap) Pyelonephritis
E. coli to ceramide lipid tract
Fimbriae
Bordetella Galactose on Respiratory Whooping
("filamentous
pertussis sulfated glycolipids epithelium cough
hemagglutinin")
N- Fucose and
Intestinal
Vibrio cholerae methylphenylalanine mannose Cholera
epithelium
pili carbohydrate
Treponema Peptide in outer Surface Mucosal
Syphilis
pallidum membrane protein(fibronectin) epithelium
Respiratory
Mycoplasma Membrane protein Sialic acid Pneumonia
epithelium

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 Conjunctival or
Conjunctivitis
Chlamydia Unknown Sialic acid urethral
or urethritis
epithelium

INVASION

The invasion of a host by a pathogen may be aided by the production of bacterial extracellular
substances which act against the host by breaking down primary or secondary defenses of the body.
Medical microbiologists have long referred to these substances as invasins. Invasins are proteins
(enzymes) that act locally to damage host cells and/or have the immediate effect of facilitating the
growth and spread of the pathogen. The damage to the host as a result of this invasive activity may
become part of the pathology of an infectious disease.

The extracellular proteins produced by bacteria which promote their invasion are not clearly
distinguished from some extracellular protein toxins ("exotoxins") which also damage the host.
Invasins usually act at a short range (in the immediate vicinity of bacterial growth) and may not
actually kill cells in their range of activity; exotoxins are often cytotoxic and may act at remote sites
(removed from the site of bacterial growth). Also, exotoxins typically are more specific and more
potent in their activity than invasins. Even so, some classic exotoxins (e.g. diphtheria toxin, anthrax
toxin) may play some role in invasion in the early stages of an infection, and some invasins (e.g.
staphylococcal leukocidin) have a relatively specific cytopathic effect.

A Survey of Bacterial Invasins

Spreading Factors

"Spreading Factors" is a descriptive term for a family of bacterial enzymes that affect the physical
properties of tissue matrices and intercellular spaces, thereby promoting the spread of the pathogen.

Hyaluronidase. is the original spreading factor It is produced by streptococci. staphylococci, and

clostridia. The enzyme attacks the interstitial cement ("ground substance") of connective tissue by
depolymerizing hyaluronic acid.

Collagenase is produced by Clostridium histolyticum and Clostridium perfringens. It breaks down

collagen, the framework of muscles, which facilitates gas gangrene due to these organisms.

Neuraminidase is produced by intestinal pathogens such as Vibrio cholerae and Shigella dysenteriae.
It degrades neuraminic acid (also called sialic acid), an intercellular cement of the epithelial cells of the
intestinal mucosa.

Streptokinase and Staphylokinase are produced by streptococci and staphylococci, respectively.

Kinase enzymes convert inactive plasminogen to plasmin which digests fibrin and prevents clotting of
the blood. The relative absence of fibrin in spreading bacterial lesions allows more rapid diffusion of
the infectious bacteria.

Enzymes that Cause Hemolysis and/or Leucolysis

These enzymes usually act on the animal cell membrane by insertion into the membrane (forming a
pore that results in cell lysis), or by enzymatic attack on phospholipids, which destabilizes the
membrane. They may be referred to as lecithinases or phospholipases, and if they lyse red blood cells
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they are sometimes called hemolysins. Leukocidins, produced by staphylococci and streptolysin
produced by streptococci specifically lyse phagocytes and their granules. These latter two enzymes are
also considered to be bacterial exotoxins.

Phospholipases, produced by Clostridium perfringens (i.e., alpha toxin), hydrolyze phospholipids in

cell membranes by removal of polar head groups.

Lecithinases, also produced by Clostridium perfringens, destroy lecithin (phosphatidylcholine) in cell

membranes.

Hemolysins, notably produced by staphylococci (i.e., alpha toxin), streptococci (i.e.,streptolysin) and
various clostridia, may be channel-forming proteins or phospholipases or lecithinases that destroy red
blood cells and other cells (i.e., phagocytes) by lysis.

Staphylococcal coagulase

Coagulase, formed by Staphylococcus aureus, is a cell-associated and diffusible enzyme that converts
fibrinogen to fibrin which causes clotting. Coagulase activity is almost alway associated with
pathogenic S. aureus and almost never associated with nonpathogenic S. epidermidis, which has led to
much speculation as to its role as a determinant of virulence. Possibly, cell bound coagulase could
provide an antigenic disguise if it clotted fibrin on the cell surface. Or a staphylococcal lesion encased
in fibrin (e.g. a boil or pimple) could make the bacterial cells resistant to phagocytes or tissue
bactericides or even drugs which might be unable to diffuse to their bacterial target.

Extracellular Digestive Enzymes

Heterotrophic bacteria, in general, produce a wide variety of extracellular enzymes including

proteases, lipases, glycohydrolases, nucleases, etc., which are not clearly shown to have a direct role
in invasion or pathogenesis. These enzymes presumably have other functions related to bacterial
nutrition or metabolism, but may aid in invasion either directly or indirectly.

Toxins With Short-Range Effects Related to Invasion

Bacterial protein toxins which have adenylate cyclase activity, are thought to have immediate effects
on host cells that promote bacterial invasion. One component of the anthrax toxin (EF or Edema
Factor) is an adenylate cyclase that acts on nearby cells to cause increased levels of cyclic AMP and
disruption of cell permeability. One of the toxins of Bordetella pertussis, the agent of whooping
cough, has a similar effect. These toxins may contribute to invasion through their effetcts on
macrophages or lymphocytes in the vicinity which are playing an essential role to contain the infection.

The following table summarizes the activities of many bacterial proteins that are noted for their
contribution to bacterial invasion of tissues.

TABLE 3. SOME EXTRACELLULAR BACTERIAL PROTEINS THAT ARE CONSIDERED

INVASINS
Invasin Bacteria Involved Activity
Streptococci,
Hyaluronidase Degrades hyaluronic of connective tissue
staphylococci and
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 clostridia
Collagenase Clostridium species Dissolves collagen framework of muscles
Vibrio cholerae and
Neuraminidase Degrades neuraminic acid of intestinal mucosa
Shigella dysenteriae
Coagulase Staphylococcus aureus Converts fibrinogen to fibrin which causes clotting
Staphylococci and
Kinases Converts plasminogen to plasmin which digests fibrin
streptococci
Disrupts neutrophil membranes and causes discharge of
Leukocidin Staphylococcus aureus
lysosomal granules
Repels phagocytes and disrupts phagocyte membrane and
Streptolysin Streptococcus pyogenes
causes discharge of lysosomal granules
Streptococci,
Phospholipases or lecithinases that destroy red blood cells
Hemolysins staphylococci and
(and other cells) by lysis
clostridia
Lecithinases Clostridium perfringens Destroy lecithin in cell membranes
Phospholipases Clostridium perfringens Destroy phospholipids in cell membrane
One component (EF) is an adenylate cyclase which
Anthrax EF Bacillus anthracis
causes increased levels of intracellular cyclic AMP
One toxin component is an adenylate cyclase that acts
Pertussis AC Bordetella pertussis
locally producing an increase in intracellular cyclic AMP

EVASION OF HOST DEFENSES

Some pathogenic bacteria are inherently able to resist the bactericidal components of host tissues. For
example, the poly-D-glutamate capsule of Bacillus anthracis protects the organisms against cell lysis
by cationic proteins in sera or in phagocytes. The outer membrane of Gram-negative bacteria is a
formidable permeability barrier that is not easily penetrated by hydrophobic compounds such as bile
salts which are harmful to the bacteria. Pathogenic mycobacteria have a waxy cell wall that resists
attack or digestion by most tissue bactericides. And intact lipopolysaccharides (LPS) of Gram-negative
pathogens may protect the cells from complement-mediated lysis or the action of lysozyme.

Most successful pathogens, however, possess additional structural or biochemical features which allow
them to resist the main lines of host internal defense against them, i.e., the phagocytic and immune
responses of the host.

Overcoming Host Phagocytic Defenses

Microorganisms invading tissues are first and foremost exposed to phagocytes. Bacteria that readily
attract phagocytes, and that are easily ingested and killed, are generally unsuccessful as parasites. In
contrast, most bacteria that are successful as parasites interfere to some extent with the activities of
phagocytes or in some way avoid their attention.

Microbial strategies to avoid phagocytic killing are numerous and diverse, but are usually aimed at
blocking one or of more steps in the phagocytic process. Recall the steps in phagocytosis:

1. Contact between phagocyte and microbial cell

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2. Engulfment

3. Phagosome formation

4. Phagosome-lysosome fusion

5. Killing and digestion

Avoiding Contact with Phagocytes

Bacteria can avoid the attention of phagocytes in a number of ways.

1. Invade or remain confined in regions inaccessible to phagocytes. Certain internal tissues (e.g. the
lumen of glands) and surface tissues (e.g. the skin) are not patrolled by phagocytes.

2. Avoid provoking an overwhelming inflammatory response. Some pathogens induce minimal or no

inflammation required to focus the phagocytic defenses.

3. Inhibit phagocyte chemotaxis. e.g. Streptococcal streptolysin (which also kills phagocytes)
suppresses neutrophil chemotaxis, even in very low concentrations. Fractions of Mycobacterium
tuberculosis are known to inhibit leukocyte migration. Clostridium toxin inhibits neutrophil
chemotaxis.

4. Hide the antigenic surface of the bacterial cell. Some pathogens can cover the surface of the bacterial
cell with a component which is seen as "self" by the host phagocytes and immune system. Phagocytes
cannot recognize bacteria upon contact and the possibility of opsonization by antibodies to enhance
phagocytosis is minimized. For example, pathogenic Staphylococcus aureus produces cell-bound
coagulase which clots fibrin on the bacterial surface. Treponema pallidum binds fibronectin to its
surface. Group A streptococci are able to synthesize a capsule composed of hyaluronic acid.

Inhibition of Phagocytic Engulfment

Some bacteria employ strategies to avoid engulfment (ingestion) if phagocytes do make contact with
them. Many important pathogenic bacteria bear on their surfaces substances that inhibit phagocytic
adsorption or engulfment. Clearly it is the bacterial surface that matters. Resistance to phagocytic
ingestion is usually due to a component of the bacterial cell wall, or fimbriae, or a capsule enclosing the
bacterial wall. Classical examples of antiphagocytic substances on the bacterial surface include:

Polysaccharide capsules of S. pneumoniae, Haemophilus influenzae, Treponema pallidum and

Klebsiella pneumoniae

M protein and fimbriae of Group A streptococci

Surface slime (polysaccharide) produced by Pseudomonas aeruginosa

O antigen associated with LPS of E. coli

K antigen of E. coli or the analogous Vi antigen of Salmonella typhi

Cell-bound or soluble Protein A produced by Staphylococcus aureus

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Survival Inside of Phagocytes

Some bacteria survive inside of phagocytic cells, in either neutrophils or macrophages. Bacteria that
can resist killing and survive or multiply inside of phagocytes are considered intracellular parasites.
The environment of the phagocyte may be a protective one, protecting the bacteria during the early
stages of infection or until they develop a full complement of virulence factors. The intracellular
environment guards the bacteria against the activities of extracellular bactericides, antibodies, drugs,
etc.

Most intracellular parasites have special (genetically-encoded) mechanisms to get themselves into their
host cell as well as special mechanisms to survive once they are inside. Intracellular parasites usually
survive by virtue of mechanisms which interfere with the bactericidal activities of the host cell. Some
of these bacterial mechanisms include:

1. Inhibition of phagosome-lysosome fusion. The bacteria survive inside of phagosomes because they
prevent the discharge of lysosomal contents into the phagosome environment. Specifically
phagolysosome formation is inhibited in the phagocyte. This is the strategy employed by Salmonella,
M. tuberculosis, Legionella and the Chlamydiae.

2. Survival inside the phagolysosome. With some intracellular parasites, phagosome-lysosome fusion
occurs but the bacteria are resistant to inhibition and killing by the lysosomal constituents. Also, some
extracellular pathogens can resist killing in phagocytes utilizing similar resistance mechanisms. Little is
known of how bacteria can resist phagocytic killing within the phagocytic vacuole, but it may be due to
the surface components of the bacteria or due to extracellular substances that they produce which
interfere with the mechanisms of phagocytic killing. Bacillus anthracis, Mycobacterium tuberculosis
and Staphylococcus aureus all possess mechanisms to survive intracellular killing in macrophages.

3. Escape from the phagosome. Early escape from the phagosome vacuole is essential for growth and
virulence of some intracellular pathogens. This is a very clever strategy employed by the Rickettsias
which produce a phospholipase enzyme that lyses the phagosome membrane within thirty secondes of
after ingestion.

Products of Bacteria that Kill or Damage Phagocytes

One obvious strategy in defense against phagocytosis is direct attack by the bacteria upon the
professional phagocytes. Any of the substances that pathogens produce that cause damage to
phagocytes have been referred to as "aggressins". Most of these are actually extracellular enzymes or
toxins that kill phagocytes. Phagocytes may be killed by a pathogen before or after ingestion.

Killing phagocytes before ingestion. Many Gram-positive pathogens, particularly the pyogenic cocci,
secrete extracellular enzymes which kill phagocytes. Many of these enzymes are called "hemolysins"
because their activity in the presence of red blood cells results in the lysis of the rbcs.

Pathogenic streptococci produce streptolysin. Streptolysin O binds to cholesterol in membranes. The

effect on neutrophils is to cause lysosomal granules to explode, releasing their contents into the cell
cytoplasm.

Pathogenic staphylococci produce leukocidin, which also acts on the neutrophil membrane and causes
discharge of lysosomal granules.

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Other examples of bacterial extracellular proteins that inhibit phagocytosis include the Exotoxin A of
Pseudomonas aeruginosa which kills macrophages, and the bacterial exotoxins that are adenylate
cyclases (e.g. anthrax toxin EF and pertussis AC) which decrease phagocytic activity.

Killing phagocytes after ingestion. Some bacteria exert their toxic action on the phagocyte after
ingestion has taken place. They may grow in the phagosome and release substances which can pass
through the phagosome membrane and cause discharge of lysosomal granules, or they may grow in the
phagolysosome and release toxic substances which pass through the phagolysosome membrane to other
target sites in the cell. Many bacteria which are the intracellular parasites of macrophages (e.g
Mycobacteria, Brucella, Listeria) usually destroy macrophages in the end, but the mechanisms are not
understood.

Overcoming Host Phagocytic Defenses

On epithelial surfaces the main antibacterial immune defense of the host is the protection afforded by
secretory antibody (IgA). Once the epithelial surfaces have been penetrated, however, the major host
defenses of inflammation, complement, phagocytosis, Antibody-mediated Immunity (AMI), and Cell-
mediated Immunity (CMI) are encountered. If there is a way for a pathogen to successfully bypass or
overcome these host defenses, then some bacterial pathogen has probably discovered it. Bacteria
evolve very rapidly in relation to their host, so that most of the feasible anti-host strategies are likely to
have been tried out and exploited. Ability to defeat the immune defenses may play a major role in the
virulence of a bacterium and in the pathology of disease. Several strategic bacterial defenses are
described below.

Immunological Tolerance to a Bacterial Antigen

Tolerance is a property of the host in which there is an immunologically-specific reduction in the

immune response to a given Ag. Tolerance to a bacterial Ag does not involve a general failure in the
immune response but a particular deficiency in relation to the specific antigen(s) of a given bacterium.
If there is a depressed immune response to relevant antigens of a parasite, the process of infection is
facilitated. Tolerance can involve either AMI or CMI or both arms of the immunological response.

Tolerance to an Ag can arise in a number of ways, but three are possibly relevant to bacterial
infections.

1. Fetal exposure to Ag

2. High persistent doses of circulating Ag

3. Molecular mimicry. If a bacterial Ag is very similar to normal host "antigens", the immune
responses to this Ag may be weak giving a degree of tolerance. Resemblance between bacterial Ag and
host Ag is referred to as molecular mimicry. In this case the antigenic determinants of the bacterium are
so closely related chemically to host "self" components that the immunological cells cannot distinguish
between the two and an immune response cannot be raised. Some bacterial capsules are composed of
polysaccharides (hyaluronic acid, sialic acid) so similar to host tissue polysaccharides that they are not
immunogenic.

Antigenic Disguise

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Bacteria may be able to coat themselves with host proteins (fibrin, fibronectin, antibody molecules) or
with host polysaccharides (sialic acid, hyaluronic acid) so that they are able to hide their own antigenic
surface components from the immunological system.

Immunosuppression

Some pathogens (mainly viruses and protozoa, rarely bacteria) cause immunosuppression in the
infected host. This means that the host shows depressed immune responses to antigens in general,
including those of the infecting pathogen. Suppressed immune responses are occasionally observed
during chronic bacterial infections such as leprosy and tuberculosis.

Persistence of a Pathogen at Bodily Sites Inaccessible to the Immune Response

Some pathogens can avoid exposing themselves to immune forces.

Intracellular pathogens can evade host immune responses as long as they stay inside of infected cells
and they do not allow microbial Ag to form on the cell surface. Macrophages support the growth of the
bacteria and at the same time give them protection from immune responses.

Some pathogens persist on the luminal surfaces of the GI tract, oral cavity and the urinary tract, or the
lumen of the salivary gland, mammary gland or the kidney tubule.

Induction of Ineffective Antibody

Many types of antibody are formed against a given Ag, and some bacterial components may display
various antigenic determinants. Antibodies tend to range in their capacity to react with Ag (the ability
of specific Ab to bind to an Ag is called avidity). If Abs formed against a bacterial Ag are of low
avidity, or if they are directed against unimportant antigenic determinants, they may have only weak
antibacterial action. Such "ineffective" (non-neutralizing) Abs might even aid a pathogen by combining
with a surface Ag and blocking the attachment of any functional Abs that might be present.

Antibodies Absorbed by Soluble Bacterial Antigens

Some bacteria can liberate antigenic surface components in a soluble form into the tissue fluids. These
soluble antigens are able to combine with and "neutralize" antibodies before they reach the bacterial
cells. For example, small amounts of endotoxin (LPS) may be released into surrounding fluids by
Gram-negative bacteria.

Antigenic Variation

One way bacteria can avoid forces of the immune response is by periodically changing antigens, i.e.,
undergoing antigenic variation. Some bacteria avoid the host antibody response by changing from one
type of fimbriae to another, by switching fimbrial tips. This makes the original AMI response obsolete
by using new fimbriae that do not bind the previous antibodies. Pathogenic bacteria can vary (change)
other surface proteins that are the targets of antibodies. Antigenic variation is prevalent among
pathogenic viruses as well.

Changing antigens during the course of an infection

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Antigens may vary or change within the host during the course of an infection, or alternatively antigens
may vary among multiple strains (antigenic types) of a parasite in the population. Antigenic variation is
an important mechanism used by pathogenic microorganisms for escaping the neutralizing activities of
antibodies. Antigenic variation usually results from site-specific inversions or gene conversions or gene
rearrangements in the DNA of the microorganisms.

Changing antigens between infections

Many pathogenic bacteria exist in nature as multiple antigenic types or serotypes, meaning that they are
variant strains of the same pathogenic species. For example, there are multiple serotypes of Salmonella
typhimurium based on differences in cell wall (O) antigens or flagellar (H) antigens. There are 80
different antigenic types of Streptococcus pyogenes based on M-proteins on the cell surface. There are
over one hundred strains of Streptococcus pneumoniae depending on their capsular polysaccharide
antigens. Based on minor differences in surface structure chemistry there are multiple serotypes of
Vibrio cholerae, Staphylococcus aureus, Escherichia coli, Neisseria gonorrhoeae and an assortment of
other bacterial pathogens.

TOXIGENESIS

Two types of bacterial toxins

At a chemical level there are two types of bacterial toxins:

lipopolysaccharides, which are associated with the cell walls of Gram-negative bacteria.

proteins, which may be released into the extracellular environment of pathogenic bacteria.

The lipopolysaccharide (LPS) component of the Gram-negative bacterial outer membrane bears the
name endotoxin because of its association with the cell wall of bacteria.

Most of the protein toxins are thought of as exotoxins, since they are "released" from the bacteria and
act on host cells at a distance.

BACTERIAL PROTEIN TOXINS

The protein toxins are typically soluble proteins secreted by living bacteria during exponential growth.
The production of protein toxins is generally specific to a particular bacterial species (e.g. only
Clostridium tetani produces tetanus toxin; only Corynebacterium diphtheriae produces the diphtheria
toxin). Usually, virulent strains of the bacterium produce the toxin (or range of toxins) while
nonvirulent strains do not, such that the toxin is the major determinant of virulence. Both Gram-
positive and Gram-negative bacteria produce soluble protein toxins. Bacterial protein toxins are the
most potent poisons known and may show activity at very high dilutions.

The protein toxins resemble enzymes in a number of ways. Like enzymes, bacterial exotoxins:

are proteins

are denatured by heat, acid, proteolytic enzymes

have a high biological activity (most act catalytically)

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exhibit specificity of action

As enzymes attack specific substrates, so bacterial protein toxins are highly specific in the substrate
utilized and in their mode of action. The substrate (in the host) may be a component of tissue cells,
organs, or body fluid. Usually the site of damage caused by the toxin indicates the location of the
substrate for that toxin. Terms such as "enterotoxin", "neurotoxin", "leukocidin" or "hemolysin" are
sometimes used to indicate the target site of some well-defined protein toxins.

Certain protein toxins have very specific cytotoxic activity (i.e., they attack specific cells, for example,
tetanus or botulinum toxins), but some (as produced by staphylococci, streptococci, clostridia, etc.)
have fairly broad cytotoxic activity and cause nonspecific death of tissues (necrosis). Toxins that are
phospholipases may be relatively nonspecific in their cytotoxicity because they cleave phospholipids
which are components of host cell membranes resulting in the death of the cell by leakage of cellular
contents. This is also true of pore-forming "hemolysins" and "leukocidins".

A few protein toxins obviously bring about the death of the host and are known as "lethal toxins", and
even though the tissues affected and the target sites may be known, the precise mechanism by which
death occurs is not understood (e.g. anthrax toxin).

As "foreign" substances to the host, most of the protein toxins are strongly antigenic. In vivo, specific
antibody (antitoxin) neutralizes the toxicity of these bacterial proteins. However, in vitro, specific
antitoxin may not fully inhibit their enzymatic activity. This suggests that the antigenic determinant of
the toxin is distinct from the active (enzymatic) portion of the protein molecule. The degree of
neutralization of the enzymatic site may depend on the distance from the antigenic site on the molecule.
However, since the toxin is fully neutralized in vivo, this suggests that other (host) factors must play a
role.

Protein toxins are inherently unstable: in time they lose their toxic properties but retain their antigenic
ones. This was first discovered by Ehrlich and he coined the term toxoid for this product. Toxoids are
detoxified toxins which retain their antigenicity and their immunizing capacity. The formation of
toxoids can be accelerated by treating toxins with a variety of reagents including formalin, iodine,
pepsin, ascorbic acid, ketones, etc. The mixture is maintained at 37o at pH range 6 to 9 for several
weeks. The resulting toxoids can be use for artificial immunization against diseases caused by
pathogens where the primary determinant of bacterial virulence is toxin production. Toxoids are the
immunizing agents against diphtheria and tetanus that are part of the DPT vaccine.

A + B Subunit Arrangement of Protein Toxins

Many protein toxins, notably those that act intracellularly (with regard to host cells), consist of two
components: one component (subunit A) is responsible for the enzymatic activity of the toxin; the other
component (subunit B) is concerned with binding to a specific receptor on the host cell membrane and
transferring the enzyme across the membrane. The enzymatic component is not active until it is
released from the native toxin. Isolated A subunits are enzymatically active and but lack binding and
cell entry capability. Isolated B subunits may bind to target cells (and even block the binding of the
native A+B toxin), but they are nontoxic. There are a variety of ways that toxin subunits may be
synthesized and arranged: A-B or A-5B indicates that subunits synthesized separately and associated
by noncovalent bonds; A/B denotes subunit domains of a single protein that may be separated by
proteolytic cleavage; A + B indicates separate protein subunits that interact at the target cell surface;
5B indicates that the binding domain is composed of 5 identical subunits.

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Attachment and Entry of Toxins

There are at least two mechanisms of toxin entry into target cells. In one mechanism called direct
entry, the B subunit of the native toxin (A+B) binds to a specific receptor on the target cell and induces
the formation of a pore in the membrane through which the A subunit is transferred into the cell
cytoplasm. In an alternative mechanism, the native toxin binds to the target cell and the A+B structure
is taken into the cell by the process of receptor-mediated endocytosis (RME). The toxin is
internalized in the cell in a membrane-enclosed vesicle called an endosome. H+ ions enter the
endosome lowering the internal pH which causes the A+B subunits to separate. Somehow, the B
subunit affects the release of the A subunit from the endosome so that it will reach its target in the cell
cytoplasm. The B subunit remains in the endosome and is recycled to the cell surface. In both cases, a
large protein molecule must insert into and cross a membrane lipid bilayer. This activity is reflected in
the ability of most A/B native toxins, or their B components, to insert into artificial lipid bilayers,
creating ion permeable pathways.

Other Considerations

In keeping with the observation that genetic information for functions not involved in viability of
bacteria is frequently located extrachromosomally, the genes encoding toxin production are generally
located on plasmids or in lysogenic bacteriophages. Thus the processes of genetic exchange in bacteria,
notably conjugation and transduction, can mobilize these genetic elements between strains of bacteria,
and therefore may play a role in determining the pathogenic potential of a bacterium.

Why certain bacteria produce such potent toxins is mysterious and is analogous to asking why an
organism should produce an antibiotic. The production of a toxin may play a role in adapting a
bacterium to a particular niche, but it is not essential to the viability of the organism. Many toxigenic
bacteria are free-living in Nature and in associations with humans in a form which is phenotypically
identical to the toxigenic strain but lacking the ability to produce the toxin.

There is conclusive evidence for the pathogenic role of diphtheria, tetanus and botulinum toxins,
various enterotoxins, staphylococcal toxic shock syndrome toxin, and streptococcal erythrogenic toxin.
And there is clear evidence for the pathological involvement of pertussis toxin, anthrax toxin, shiga
toxin and the necrotizing toxins of clostridia in host-parasite relationships.

Table 4. SOURCES AND ACTIVITIES OF BACTERIAL TOXINS

BACTERIUM
NAME OF TOXIN ACTIVITY
INVOLVED
Edema Factor (EF) is an adenylate cyclase that causes
increased levels in intracellular cyclic AMP in phagocytes
Anthrax toxin (EF) Bacillus anthracis
and formation of ion-permeable pores in membranes
(hemolysis)
Acts locally to increase levels of cyclic AMP in phagocytes
Adenylate cyclase
Bordetella pertussis and formation of ion-permeable pores in membranes
toxin
(hemolysis)
ADP ribosylation of G proteins stimulates adenlyate
Cholera enterotoxin Vibrio cholerae cyclase and increases cAMP in cells of the GI tract,
causing secretion of water and electrolytes
E. coli LT toxin Escherichia coli Similar to cholera toxin
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 Enzymatically cleaves rRNA resulting in inhibition of
Shiga toxin Shigella dysenteriae
protein synthesis in susceptible cells
Clostridium Zn++ dependent protease that inhibits neurotransmission at
Botulinum toxin
botulinum neuromuscular synapses resulting in flaccid paralysis
Zn++ dependent protease that inhibits neurotransmission at
Tetanus toxin Clostridium tetani
inhibitory synapses resulting in spastic paralysis
Corynebacterium ADP ribosylation of elongation factor 2 leads to inhibition
Diphtheria toxin
diphtheriae of protein synthesis in target cells
ADP ribosylation of G proteins blocks inhibition of
Pertussis toxin Bordetella pertussis
adenylate cyclase in susceptible cells
Staphylococcus Staphylococcus Massive activation of the immune system, including
enterotoxins* aureus lymphocytes and macrophages, leads to emesis (vomiting)
Toxic shock
Staphylococcus Acts on the vascular system causing inflammation, fever
syndrome toxin
aureus and shock
(TSST-1)*
Erythrogenic toxin Streptococcus
Causes localized erythematous reactions
(scarlet fever toxin)* pyogenes

* The "pyrogenic exotoxins" produced by Staphylococcus aureus and Streptococcus pyogenes have been designated
as superantigens. They represent a family of molecules with the ability to elicit massive activation of the immune
system. These proteins share the ability to stimulate T cell proliferation by interaction with Class II MHC molecules
on APCs and specific V beta chains of the T cell receptor. The important feature of this interaction is the resultant
production of IL-1, TNF, and other lymphokines which appear to be the principal mediators of disease processes
associated with these toxins.

ENDOTOXINS

Endotoxins are part of the outer cell wall of bacteria. Endotoxins are invariably associated with Gram-
negative bacteria as constituents of the outer membrane of the cell wall. Although the term endotoxin
is occasionally used to refer to any "cell-associated" bacterial toxin, it should be reserved for the
lipopolysaccharide complex associated with the outer envelope of Gram-negative bacteria such as E.
coli, Salmonella, Shigella, Pseudomonas, Neisseria, Haemophilus, and other leading pathogens.
Lipopolysaccharide (LPS) participates in a number of outer membrane functions that are essential for
bacterial growth and survival, especially within the context of a host-parasite interaction.

The biological activity of endotoxin is associated with the lipopolysaccharide (LPS). Toxicity is
associated with the lipid component (Lipid A) and immunogenicity (antigenicity) is associated with the
polysaccharide components. The cell wall antigens (O antigens) of Gram-negative bacteria are
components of LPS. LPS activates complement by the alternative (properdin) pathway and may be a
part of the pathology of most Gram-negative bacterial infections.

For the most part, endotoxins remain associated with the cell wall until disintegration of the bacteria. In
vivo, this results from autolysis, external lysis, and phagocytic digestion of bacterial cells. It is known,
however, that small amounts of endotoxin may be released in a soluble form, especially by young
cultures.

Compared to the classic exotoxins of bacteria, endotoxins are less potent and less specific in their
action, since they do not act enzymatically. Endotoxins are heat stable (boiling for 30 minutes does not
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destabilize endotoxin), but certain powerful oxidizing agents such as , superoxide, peroxide and
hypochlorite degrade them. Endotoxins, although strongly antigenic, cannot be converted to toxoids. A
comparison of the properties of bacterial endotoxins compared to classic exotoxins is shown in Table 5.

Table 5. CHARACTERISTICS OF BACTERIAL ENDOTOXINS AND EXOTOXINS

PROPERTY ENDOTOXIN EXOTOXIN
CHEMICAL NATURE Lipopolysaccharide(mw = 10kDa) Protein (mw = 50-1000kDa)
RELATIONSHIP TO CELL Part of outer membrane Extracellular, diffusible
DENATURED BY BOILING No Usually
ANTIGENIC Yes Yes
FORM TOXOID No Yes
POTENCY Relatively low (>100ug) Relatively high (1 ug)
SPECIFICITY Low degree High degree
ENZYMATIC ACTIVITY No Usually
PYROGENICITY Yes Occasionally

Lipopolysaccharides are complex amphiphilic molecules with a mw of about 10kDa, that vary widely
in chemical composition both between and among bacterial species. In a basic groundplan common to
all endotoxins, LPS consists of three components or regions:

(1) Lipid A---- (2) Core polysaccharide---- (3) O polysaccharide

Lipid A is the lipid component of LPS. It contains the hydrophobic, membrane-anchoring region of
LPS. Lipid A consists of a phosphorylated N-acetylglucosamine (NAG) dimer with 6 or 7 fatty acids
(FA) attached. Usually 6 FA are found. All FA in Lipid A are saturated. Some FA are attached directly
to the NAG dimer and others are esterified to the 3-hydroxy fatty acids that are characteristically
present. The structure of Lipid A is highly conserved among Gram-negative bacteria. Among
Enterobacteriaceae Lipid A is virtually constant.

The Core (R) polysaccharide is attached to the 6 position of one NAG. The R antigen consists of a
short chain of sugars. For example: KDO - Hep - Hep - Glu - Gal - Glu - GluNAc.
Two unusual sugars are usually present, heptose and 2-keto-3-deoxyoctonoic acid (KDO), in the core
polysaccharide. KDO is unique and invariably present in LPS and so has been an indicator in assays for
LPS (endotoxin).

With minor variations, the core polysaccharide is common to all members of a bacterial genus (e.g.
Salmonella), but it is structurally distinct in other genera of Gram-negative bacteria. Salmonella,
Shigella and Escherichia have similar but not identical cores.

The O polysaccharide (also referred to as the O antigen or O side chain) is attached to the core
polysaccharide. It consists of repeating oligosaccharide subunits made up of 3-5 sugars. The individual
chains vary in length ranging up to 40 repeat units. The O polysaccharide is much longer than the core
polysaccharide and it maintains the hydrophilic domain of the LPS molecule. Often, a unique group of
sugars, called dideoxyhexoses, occurs in the O polysaccharide.

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A major antigenic determinant (antibody-combining site) of the Gram-negative cell wall resides in the
O polysaccharide. Great variation occurs in the composition of the sugars in the O side chain between
species and even strains of Gram-negative bacteria.

LPS and virulence of Gram-negative bacteria

Endotoxins are toxic to most mammals. They are strong antigens but they seldom elicit immune
responses which give full protection to the animal against secondary challenge with the endotoxin.
They cannot be toxoided. Endotoxins released from multiplying or disintegrating bacteria significantly
contribute to the symptoms of Gram-negative bacteremia and septicemia, and therefore represent
important pathogenic factors in Gram-negative infections. Regardless of the bacterial source, all
endotoxins produce the same range of biological effects in the animal host. The injection of living or
killed Gram-negative cells, or purified LPS, into experimental animals causes a wide spectrum of
nonspecific pathophysiological reactions related to inflammation such as:

fever

changes in white blood cell counts

disseminated intravascular coagulation

tumor necrosis

hypotension

shock

lethality

The sequence of events follows a regular pattern: 1. latent period; 2. physiological distress (fever,
diarrhea, prostration, shock); 3. death. How soon death occurs varies on the dose of the endotoxin,
route of administration, and species of animal. Animals vary in their susceptibility to endotoxin.

The role of Lipid A

The physiological activities of endotoxins are mediated mainly by the Lipid A component of LPS.
Lipid A is the toxic component of LPS, as evidence by the fact that injection of purified Lipid A into an
experimental animal will elicit the same response as intact LPS. The primary structure of Lipid A has
been elucidated, and Lipid A has been chemically synthesized. Its biological activity appears to depend
on a peculiar conformation that is determined by the glucosamine disaccharide, the PO4 groups, the
acyl chains, and also the KDO-containing inner core. Lipid A is known to react at the surfaces of
macrophages causing them to release cytokines that mediate the pathophysiological response to
endotoxin.

The role of the O polysaccharide

Although nontoxic, the polysaccharide side chain (O antigen) of LPS may act as a determinant of
virulence in Gram-negative bacteria. The O polysaccharide is responsible for the property of
"smoothness" of bacterial cells, which may contribute to their resistance to phagocytic engulfment. The
O polysaccharide is hydrophilic and may allow diffusion or delivery of the toxic lipid in the
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hydrophilic (in vivo) environment. The long side chains of LPS afforded by the O polysaccharide may
prevent host complement from depositing on the bacterial cell surface which would bring about
bacterial cell lysis. The O polysaccharide may supply a bacterium with its specific ligands (adhesins)
for colonization which is essential for expression of virulence. Lastly, the O-polysaccharide is
antigenic, and the usual basis for antigenic variation in Gram-negative bacteria rests in differences in
their O polysaccharides.

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 Todar's Online Textbook of Bacteriology

Bacteria of Medical Importance

© 2005 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

Introduction

Historically, bacteria have been the cause of some of the most deadly diseases and widespread
epidemics of human civilization. Although smallpox and malaria, diseases caused by other microbes,
may have killed more humans than bacterial diseases, bacterial diseases such as tuberculosis, typhus,
plague, diphtheria, typhoid fever, cholera, dysentery, and pneumonia have taken a mighty toll on
humanity. Water purification, immunization (vaccination) and modern antibiotic treatment continueto
reduce the morbidity and the mortality of bacterial disease in the Twenty-first Century, at least in the
developed world where these are acceptable cultural practices. However, many new bacterial pathogens
have been recognized in the past 25 years (see Table 1) and many "old" bacterial pathogens, such as
Staphylococcus aureus and Mycobacterium tuberculosis, have emerged with new forms of virulence
and new patterns of resistance to antimicrobial agents.

Table 1. Bacterial pathogens and diseases recognized or reemerged since 1977

Bacterium Disease
Legionella pneumophila Legionnaires' pneumonia
Listeria monocytogenes listeriosis
Campylobacter jejuni gastroenteritis distributed world-wide
Staphylococcus aureus toxic shock syndrome
E. coli O157:H7 hemorrhagic colitis; hemolytic uremic syndrome
Borrelia burgdorferi Lyme Disease and complications
Helicobacter pylori gastric and duodenal ulcers
Ehrlichia chaffeensis human ehrlichiosis
Clostridium difficile antibiotic induced diarrhea; pseudomembranous colitis
Vibrio cholerae O139 epidemic cholera
Salmonella enterica Serotype Typhimurium
salmonellosis
DT 104
Bartonella henselae cat scratch fever
necrotizing fasciitis (GAS); streptococcal toxic shock
Streptococcus pyogenes
syndrome
Chlamydia pneumoniae atherosclerosis
Clostridium botulinum sudden infant death syndrome (SIDS)

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Vibrio vulnificus woumd infection, septicemia, gastrointestinal disease
Parachlamydia pneumonia
Corynebacterium amycolatum hospital-acquired endocarditis

Most of the bacterial pathogens of humans are classified as Gram-positive or Gram-negative, some
notable exceptions being the mycoplasmas, chlamydiae, spirochetes and the mycobacteria. In this
article the major pathogens of humans are organized into natural groups based on bacteriological
criteria, rather than on the basis of affected organ, mode of transmission, or type of disease. This goes
with being written by a bacteriologist.

Spirochetes

The spirochetes are a phylogenetically distinct group of bacteria which have a unique cell morphology
and mode of motility. Spirochetes are very thin, flexible, spiral-shaped procaryotes that move by means
of structures called axial filaments or endoflagella. The flagellar filaments are contained within a
sheath between the cell wall peptidoglycan and an outer membrane. The filaments flex or rotate within
their sheath which causes the cells to bend, flex and rotate during movement. Most spirochetes are free
living (in muds and sediments), or live in associations with animals (e.g. in the oral cavity or GI tract).
A few are pathogens of animals Treponema pallidum is the agent of syphilis, a sexually transmitted
disease, and Borrelia burgdorferi causes Lyme Disease. which is transmitted by the bite of the deer
tick.

Figure 1. Spirochetes: A. Cross section of a spirochete showing the location of endoflagella between the inner
membrane and outer sheath; B. Borrelia burgdorferi, the agent of Lyme disease; C. Treponema pallidum, the
spirochete that causes syphilis. (CDC)

Spirilla and other curved bacteria

Spirilla are Gram-negative bacteria with a helical or spiral shape. Their metabolism is respiratory and
never fermentative. Unlike spirochetes, they have a rigid cell wall and are motile by means of ordinary
polar flagella. Two important pathogens of humans are found among the spiral forms. Campylobacter
jejuni is the cause of bacterial diarrhea, especially in children. The bacterium is transmitted via
contaminated food, usually undercooked poultry or shellfish, or untreated drinking water. Helicobacter
pylori is able to colonize the gastric mucosal cells of humans, i.e., the lining of the stomach, and it has
been well established as the cause of peptic ulcers and there is strong evidence for its involvement in
adenocarcinoma.

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Figure 2. Helicobacter pylori from
Helicobacter pylori Causing Adenocarcinoma, by Jon Cutlan

Vibrios

The term vibrio refers to a Gram-negative bacterium which has the cell shape of a curved rod or a
comma. Members of the genus Vibrio are common bacteria in aquatic environments, especially marine
environments. They have structural and metabolic properties that overlap with both the enterics and
the pseudomonads. Vibrios are facultative (grow in the presence or absence of O2), like enterics, but
they have polar flagella, are oxidase-positive, and degrade sugars in the same manner as the
pseudomonads. In aquatic habitats they overlap with the pseudomonads in their ecology, although
pseudomonads favor fresh water and vibrios prefer salt water. Some marine vibrios are bioluminescent
(they emit light) and some are symbionts of fish, squid and other marine life. Vibrio
choleraecauses epidemic or Asiatic cholera which, untreated, is one of the most rapidly fatal
infectious diseases known. The pathology is related to diarrheal diseases caused by the enteric bacteria,
except it is relentless, and a patient can die rapidly from dehydration. The cholera toxin, which is the
classic model of a bacterial enterotoxin, is also produced by some strains of E. coli.

Figure 3. Vibrio cholerae, the agent of Asiatic or epidemic cholera.

The Gram-negative aerobic rods and cocci

The name refers to Gram-negative bacteria phenotypically related to members of the genus
Pseudomonas. Their metabolism is respiratory and never fermentative. Important human pathogens
include Pseudomonas aeruginosa,Neisseria gonorrhoeae,Neisseria meningitidis, Bordetella
pertussis, Haemophilus influenzae, Legionella, Brucella and Francisella, and a few others. Many
bacteria in this physiological group are free-living in soil and water, and they play an important role in
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decomposition, biodegradation, and the C and N cycles. Also, many bacteria which are pathogens of
plants are found in this group, including Pseudomonas, Xanthomonas and Agrobacterium.

Figure 4. Three looks at Pseudomonas,the head of the Gram-negative aerobic rods. A. Electron micrograph, negative
stain. B. Scanning electron micrograph. C. Gram stain.

Pseudomonas aeruginosa is the quintessential opportunistic pathogen of humans. It is a leading

cause of hospital-acquired infections (nosocomial infections), and it is difficult to erradicate due to its
resistance to most antimicrobial agents. There is probably no tissue that cannot become infected by
Pseudomonas if the host defenses are weakened, and it is difficult to erradicate due to it's resistance to
antimicrobial agents. It is usually involved in soft tissue infections, urinary tract infections and
pneumonia

Whooping cough (or pertussis) is caused by Bordetella pertussis. The disease is particularly serious
in infants and young children and has a high mortality rate. Whooping cough is controlled by
vaccination with the acellular pertussis vaccine, which is usually given in association with
diphtheria, tetanus and sometimes H. influenzae type b (Hib), as part of the childhood immunization
program in the U.S.

Legionaires' pneumonia is caused by Legionella pneumophila. This pneumonia, and the bacterium,
were not discovered until 1976, when there was an outbreak of disease at a Legionaire's meeting in
Philadelphia. It took several months to find, culture and grow the bacterium. The incident was a wake-
up call to public health officials that there were probably a lot of disease-producing bacteria outthere
that they know nothing about.

Neisseria gonorrhoeae causes the sexually-transmitted disease gonorrhea, and Neisseria

meningitidisis the agent of meningicoccal meningitis. The Neisseriae are discussed below with the
Pyogenic Cocci.

Haemophilus influenzae is also a cause of meningitis, but the icidence of the disease has declined
rapidly with the use of the Hib vaccine which began in 1994. Haemophilus is sometimes involved in
infections of the upper respiratory tract, particularly the sinuses.

Brucellosis is a chronic debilitating infection in humans associated with reproductive failure in

domestic animals. Person-to-person transmission of brucellae is extremely rare. Brucella abortus is the
species usually involved in human disease. The primary reservoir of the organism is in cattle, although
bison are sometimes wrongfully accused.

Enterics

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Enteric bacteria are Gram-negative rods with facultative anaerobic metabolism that live in the
intestinal tracts of animals in health and disease. This group consists of Escherichia coli and its
relatives, the members of the family Enterobacteriaceae. Enteric bacteria are related phenotypically to
several other genera of bacteria such as Pseudomonas and Vibrios. Generally, a distinction can be
made on the ability to ferment glucose; enteric bacteria all ferment glucose to acid end products while
similar Gram-negative bacteria (e.g. pseudomonads) cannot ferment glucose. Because they are
consistent members of the normal flora humans, and because of their medical importance, an
extremely large number of enteric bacteria have been isolated and characterized.

Escherichia coli is, of course, the type species of the enterics. E. coli is such a regular inhabitant of the
intestine of humans that it is used by public health authorities as an indicator of fecal pollution of
drinking water supplies, swimming beaches, foods, etc. E. coli is the most studied of all organisms in
biology because of its occurrence, and the ease and speed of growing the bacteriium in the laboratory.
It has been used in hundreds of thousands of experiments in cell biology, physiology, and genetics, and
was among the first cells for which the entire chromosomal DNA base sequence (genome) was
determined. In spite of the knowledge gained about the molecular biology and physiology of E. coli,
surprisingly little is known about its ecology, for example, why it consistently associates with humans,
how it helps its host, how it harms its host, etc. A few strains of E. coli are pathogenic (one is now
notorious, strain 0157:H7, that keeps turning up in raw hamburger headed for a fast-food restaurants).
Escherichia coli causes intestinal tract infections (usually acute and uncomplicated, except in the
very young ) or uncomplicated urinary tract infections and neonatal meningitis.

Figure 5. E. coli O157.H7. © David E. Graham. Virginia Polytechnic Institute and State University, Blacksburg,
Virginia. Image by William Ghiorse, Department of Microbiology, Cornell University, Ithaca, New York. Licensed
for use by ASM Microbe Library http://www.microbelibrary.org.This is a phase contrast image of cells immobilized
on an agar-coated slide.

The enteric group also includes some other intestinal pathogens of humans such as Shigella
dysenteriae, cause of bacillary dysentery, and Salmonella enteritidis, cause of food poisoning and
gastroenteritis. Salmonella typhi, which infects via the intestinal route, causes typhoid fever. Some
bacteria that don't have an intestinal habitat resemble E. coli in enough ways to warrant inclusion in the
enteric group. This includes Proteus, a common saprophyte of decaying organic matter and Yersinia
pestis, which causes bubonic plague. Also classified as an enteric is Erwinia, a pathogen of plants
that causes fireblight in pear and apple trees and soft rot of carrots and potatoes.

Pyogenic Cocci

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The pyogenic cocci are spherical bacteria that cause various suppurative (pus-producing) infections in
animals. Included are the Gram-positive cocci Staphylococcus aureus, Streptococcus pyogenes and
Streptococcus pneumoniae,and the Gram-negative cocci, Neisseria gonorrhoeae and N. meningitidis.
In terms of their phylogeny, physiology and genetics, these genera of bacteria are unrelated to one
another. They share a common ecology, however, as parasites of humans.

The Gram-positive cocci are the leading pathogens of humans. It is estimated that they produce at least
a third of all the bacterial infections of humans, including strep throat, pneumonia, food poisoning,
various skin diseases and severe types of septic shock. The Gram-negative cocci, notably the
neisseriae, cause gonorrhea and meningicoccal meningitis.

Figure 6. Gallery of pyogenic cocci, Gram stains of clinical specimens (pus), L to R: Staphylococcus aureus,
Streptococcus pyogenes, Streptococcus pneumoniae, Neisseria gonorrhoeae, Neisseria meningitidis.The large cells with
lobed nuclei are neutrophils. Pus is the outcome of the battle between phagocytes (neutrophils) and the invading
cocci. As the bacteria are ingested and killed by the neutrophils, the neutrophils eventually lyse (rupture) and release
their own components, plus the digested products of bacterial cells, which are the make-up of pus. As a defense
against phagocytes the staphylococci and streptococci produce toxins that kill the neutrophils before they are able to
ingest the bacteria. This contributes to the pus, and therefore these bacteria are "pyogenic" during their pathogenic
invasions.

Two species of Staphylococcus live in association with humans: Staphylococcus epidermidis which
lives normally on the skin and mucous membranes, and Staphylococcus aureus which may occur
normally at various locales, but in particular on the nasal membranes (nares). S. epidermidis is rarely a
pathogen and probably benefits its host by producing acids on the skin that retard the growth of
dermatophytic fungi.

S. aureus always has the potential to cause disease and so is considered a pathogen. Different strains of
S. aureus differ in the range of diseases they can cause, including boils and pimples, wound
infections, pneumonia, osteomyelitis, septicemia, food intoxication, and toxic shock syndrome. S.
aureus is the leading cause of nosocomial (hospital-acquired) infections by Gram-positive bacteria.
Also, it is notoriously resistant to penicillin and many other antibiotics. Recently, a strain of S. aureus
has been reported that is resistant to all known antibiotics in clinical usage, which is a grim reminder
that the clock is ticking on the lifetime of the usefulness of current antibiotics in treatment of infectious
disease.

Staphylococcus aureus is a successful bacterial pathogen because it has a very wide range of virulence
determinants (structural, biochemical or genetic features that allow the bacterium to cause disease),
and it occurs as normal flora of humans (on skin, nasal membranes and the GI tract), which ensures
that it is readily transmitted from one individual to another.

Streptococcus pyogenes, more specifically the beta-hemolytic group A streptococci, like S. aureus,
causes an array of suppurative diseases and toxinoses (diseases due to the production of a bacterial
toxin), in addition to some autoimmune or allergic diseases. S. pyogenes is occasionally found as
normal flora in the upper respiratory tract(<15% of individuals), but it is the main streptococcal
pathogen for man, most often causing tonsillitis or strep throat. Streptococci also invade the skin to
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cause localized infections and lesions, and produce toxins that cause scarlet fever and toxic shock.
Sometimes, as a result of an acute streptococcal infection, anomalous immune responses are started that
lead to diseases like rheumatic fever and glomerulonephritis, which are called post-streptococcal
sequelae. Unlike the staphylococci, the streptococci have not developed widespread resistance to
penicillin and the other beta lactam antibiotics, so that the beta lactams remain drugs of choice for the
treatment of acute streptococcal infections.

Streptococcus pneumoniae is the most frequent cause of bacterial pneumonia in humans. It is also a
frequent cause of otitis media (infection of the middle ear) and meningitis. The bacterium colonizes
the nasopharynx and from there gains access to the lung or to the eustachian tube. If the bacteria
descend into the lung they can impede engulfment by alveolar macrophages if they possess a capsule
which somehow prevents the engulfment process. Thus, encapsulated strains are able to invade the lung
and are virulent (cause disease) and noncapsulated strains, which are readily removed by phagocytes,
are nonvirulent.

The Neisseriae cause gonorrhea and meningitis. Neisseriaceae is a family of Gram-negative bacteria
with characteristics of enterics and pseudomonads. The neisseriae are small, Gram-negative cocci
usually seen in pairs with flattened adjacent sides. Most neisseriae are normal flora or harmless
commensals of mammals living on mucous membranes. In humans they are common residents of the
throat and upper respiratory tract. Two species are primary pathogens of man, Neisseria
gonorrhoeaeand Neisseria meningitidis.

Neisseria gonorrhoeae is the second leading cause of sexually-transmitted disease in the U.S., causing
over 300,000 cases of gonorrhea annually. Sometimes, in females, the disease may be unrecognized or
asymptomatic such that an infected mother can give birth and unknowingly transmit the bacterium to
the infant during its passage through the birth canal. The bacterium is able to colonize and infect the
newborn eye resulting neonatal ophthalmia, which may produce blindness. For this reason (as well as
to control Chlamydia which may also be present), an antimicrobial agent is usually added to the
newborn eye at the time of birth.

Neisseria meningitidis is an important cause of bacterial meningitis, an inflammation of the meninges

of the brain and spinal cord. Other bacteria that cause meningitis include Haemophilus
influenzae,Staphylococcus aureus and Escherichia coli. Meningococcal meningitis differs from other
causes in that it is often responsible for epidemics of meningitis. It occurs most often in children aged 6
to 11 months, but it also occurs in older children and in adults. Meningococcal meningitis can be a
rapidly fatal disease, and untreated meningitis has a mortality rate near 50 percent. However, early
intervention with antibiotics is highly effective, and with treatment most individuals recover without
permanent damage to the nervous system.

Endospore-forming bacteria

Endospore-forming bacteria produce a unique resting cell called an endospore. They are Gram-
positive and usually rod-shaped, but there are exceptions. The two medically-important genera
are Bacillus, the members of which are aerobic sporeformers in the soils, and Clostridium,whose
species are anaerobic sporeformers of soils, sediments and the intestinal tracts of animals.

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Figure 7. Endospore-forming bacilli (phase contrast illumination). Endospores are dehydrated, refractile cells
appearing as points of bright light under phase microcsopy. Endospore-forming bacteria are characterized by the
location (position) of the endospore in the mother cell (sporangium) before its release. The spore may be central,
terminal or subterminal, and the sporangium may or may not be swollen to accomodate the spore.

Some sporeformers are pathogens of animals, usually due to the production of powerful toxins.
Bacillus anthracis causes anthrax, a disease of domestic animals (cattle, sheep, etc.), which may be
transmitted to humans. Bacillus cereus causes food poisoning. Clostridium botulimum causes
botulism, a form of food poisoning, and Clostridium tetani is the agent of tetanus. Clostridium
perfringens causes food poisoning, anaerobic wound infections and gas gangrene, and Clostridium
difficile causes asevere form of colitis called pseudomembranous colitis. Whenever the spore-formers
act as pathogens, it is not uncommon or surprising that their spores are somehow involved in
transmission or survival of the organism between hosts.

Figure 8. Robert Koch's original photomicrographs of Bacillus anthracis. In 1876, Koch established by careful
microscopy that the bacterium was always present in the blood of animals that died of anthrax. He took a small
amount of blood from such an animal and injected it into a healthy mouse, which subsequently became diseased and
died. He took blood from that mouse and injected it into a another healthy mouse. After repeating this several times
he was able to recover the original anthrax organism from the dead mouse, demonstrating for the first time that a
specific bacterium is the cause of a specific disease. In so doing, he established Koch's Postulates, which still today
supply the microbiological standard to demonstrate that a specific microbe is the cause of a specific disease.

Listeria monocytogenes is a Gram-positive rod-shaped bacterium related to bacillus and Clostridium

but it does not form endospores. Listeria monocytogenes is the agentof listeriosis, a serious infection
caused by eating food contaminated with the bacteria. Listeriosis has recently been recognized as an
important public health problem in the United States. The disease affects primarily pregnant women,
newborns, and adults with weakened immune systems.

Figure 9. Listeria monocytogenes. Transmission EM.

Actinomycetes and related bacteria

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The actinomycetes are not thought of as pathogenic bacteria, but two of their relatives are among the
most important pathogens of humans, these being the agents of tuberculosis and
diphtheria. Actinomycetes are a large group of Gram-positive bacteria that usually grow by filament
formation, or at least show a tendency towards branching and filament formation. Many of the
organisms can form resting structures called spores, but they are not the same as endospores. Branched
forms superficially resemble molds and are a striking example of convergent evolution of a procaryote
and a eukaryote together in the soil habitat. Actinomycetes such as Streptomyces have a world-wide
distribution in soils. They are important in aerobic decomposition of organic compounds and have an
important role in biodegradation and the carbon cycle. Actinomycetes are the main producers of
antibiotics in industrial settings, being the source of most tetracyclines, macrolides (e.g. erythromycin),
and aminoglycosides (e.g. streptomycin, gentamicin, etc.).

Two genera of bacteria that are related to the actinomycetes, Corynebacterium and Mycobacterium,
contain portant pathogens of humans: Otherwise, many nonpathogenic mycobacteria and
corynebacteria live in normal associations with animals.

Mycobacterium tuberculosis is the etiologic agent of tuberculosis (TB) in humans. Tuberculosis is

the leading cause of death in the world from a single infectious disease. Mycobacterium tuberculosis
infects 1.7 billion people/year which is equal to 33% of the entire world population. The bacterium is
responsible for over 3 million deaths/year. After a century of decline in the United States, tuberculosis
is increasing, and multiple drug-resistant strains have emerged. This increase in cases is attributable to
changes in the social structure in cities, the HIV epidemic, and patient failure to comply with treatment
programs. A related organism, Mycobacterium leprae, causes leprosy.

Figure 10. Mycobacterium tuberculosis Acid-fast stain. 1000X magnification. © Gloria J. Delisle and Lewis Tomalty,
Queens University, Kingston, Ontario, Canada. Licensed for use by ASM Microbe Library
http://www.microbelibrary.org.These bacteria were observed in a sputum sample from a patient with active
tuberculosis.

The genus Corynebacterium consists of a diverse group of bacteria including animal and plant
pathogens, as well as saprophytes. Some corynebacteria are part of the normal flora of humans, finding
a suitable niche in virtually every anatomic site. The best known and most widely studied species
is Corynbacterium diphtheriae, the causal agent of diphtheria. The study of Corynebacterium
diphtheriae traces closely the development of medical microbiology, immunology and molecular
biology. Many contributions to these fields, as well as to our understanding of host-bacterial
interactions, have been made studying diphtheria and the diphtheria toxin.

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Rickettsias and chlamydiae are two unrelated groups of bacteria that are obligate intracellular
parasites of eukaryotic cells. Rickettsias cannot grow outside of a host cell because they have leaky
membranes and are unable to obtain nutrients in an extracellular habitat. Chlamydiae are unable to
produce ATP in amounts required to sustain metabolism outside of a host cell and are, in a sense,
energy-parasites.

Rickettsias occur in nature in the gut lining of arthropods (ticks, fleas, lice, etc.). They are transmitted
to vertebrates by an arthropod bite and produce diseases such as typhus fever, Rocky Mountain
Spotted Fever, Q fever and ehrlichiosis.

Chlamydiae are tiny bacteria that infect birds and mammals. They may colonize and infect tissues of
the eye and urogenital tract in humans. Chlamydia trachomatis causes several important diseases in
humans: chlamydia, the most prevalent sexually transmitted disease in the U.S., trachoma, a leading
cause of blindness worldwide, and lymphogranuloma venereum.
Chlamydia pneumoniae is a cause of pneumonia and has been recently linked to atherosclerosis.

Figure 11. Ehrlichia chaffeensis © Vsevolod Popov, J. Steven Dumler, and David H. Walker. University of Texas
Medical Branch at Galveston. Licensed for use by ASM Microbe Library http://www.microbelibrary.org.
Ehrlichiaeare obligate intracellular parasites related to the rickettsiae that are tick-borne pathogens of dogs and
humans. In humans, they cause human granulocytic ehrlichiosis (HGE) and human monocytic ehrlichiosis
(HME). In this electron micrograph, dense-core cells of E. chaffeensis are seen exiting the host cell following rupture
of the cytoplasmic membrane. The ehrlichiae will now go on to infect additional host cells or they may be ingested by
a feeding tick, and spread to another animal.

Mycoplasmas are a group of bacteria that lack a cell wall. The cells are bounded by a single triple-
layered membrane. They may be free-living in soil and sewage, parasitic inhabitants of the mouth and
urinary tract of humans, or pathogens in animals and plants. In humans, Mycoplasma pneumoniae
causes primary atypical pneumonia, also called walking pneumonia.

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 Todar's Online Textbook of Bacteriology

The Constitutive Defenses of the Host against Microbial Pathogens

© 2002 Kenneth Todar University of Wisconsin Department of Bacteriology

Introduction: Host Defense Mechanisms

Although humans are in continuous associations with microorganisms, and some readily colonize the
body surfaces (see The Bacterial Flora of Humans ), it is relatively rare that these microorganisms
cause damage to their host. In part, this is due to the effectiveness of the host defense mechanisms,
which restrict invasion by normal flora (some of which may be potential pathogens), and which defend
against non-indigenous microorganisms that are overt pathogens.

Just as the outcome of an interaction between the host and a member of the normal flora always
depends on specific properties inherent to both the host and the microbe, so does the outcome of an
interaction between the host and a parasite. Sometimes the host tolerates colonization by a parasite but
restricts it to regions of the body where it can do no harm (e.g. Staphylococcus aureus on the nasal
membranes or Streptococcus pneumoniae in the upper respiratory tract). If the parasite invades (i.e.,
breaches an anatomical barrier or progress beyond the point of colonization), an infection is said to
have occurred. If, as a result of infection, pathological harm to the host becomes evident, this is called
an infectious disease. An infectious disease is a consequence of a microbial parasite causing such a
degree of harm to its host that it results in a pathological process.

The healthy animal defends itself against pathogens different stages. The host defenses may be of such
a degree that infection can be prevented entirely. Or, if infection does occur, the defenses may stop the
process before disease is apparent. At other times, the defenses that are necessary to defeat a parasite
may not be effective until infectious disease is well into progress.

Typically the host defense mechanisms are divided into two groups:

1. Constitutive Defenses: Defenses common to all healthy animals. These defenses provide general
protection against invasion by normal flora, or colonization, infection, and infectious disease caused by
pathogens. The constitutive defenses have also been referred to as"natural" or "innate" resistance, since
they are inherent to a specific host, but these terms are better reserved for certain types of constitutive
defense (see below).

2. Inducible Defenses: Defense mechanisms that must be induced or turned on by host exposure to a
pathogen (as during an infection). Unlike the constitutive defenses, they are not immediately ready to
come into play until after the host is appropriately exposed to the parasite. The inducible defenses
involve the immune responses to a pathogen causing an infection.

The inducible defenses are generally quite specifically directed against an invading pathogen. The
constitutive defenses are not so specific, and are directed toward general strategic defense.
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Constitutive Defenses of the Host

The constitutive defenses of the host can be arranged in the following categories:

Differences in susceptibility to certain pathogens

Anatomical defenses

Microbial antagonism

Tissue bactericides, including complement

Inflammation (ability to undergo an inflammatory response)

Phagocytosis

Each of these topics is discussed in the sections below.

Differences in Susceptibility of Animal Hosts to Microbial Pathogens

This type of resistance is also called innate and natural resistance. There are two aspects innate
resistance: (1) natural (genetic) resistance among all members of a species, called species resistance
and (2) individual resistance within the same animal species

Species resistance

Certain animals are naturally resistant or nonsusceptible to certain pathogens. Certain pathogens infect
only humans, not lower animals, e.g. syphilis, gonorrhea, measles, poliomyelitis. On the other hand,
certain pathogens (e.g. canine distemper virus) do not infect humans. Shigella infects humans and
baboons but not chimpanzees. Little information is available to explain these absolute differences in
susceptibility to a pathogen but it could be due to:

Absence of specific tissue or cellular receptors for attachment (colonization) by the pathogen. For
example, different strains of enterotoxigenic E. coli , defined by different fimbrial antigens, colonize
human infants, calves and piglets, by recognizing species-specific carbohydrate receptors on
enterocytes in the gastrointestinal tract.

Temperature of the host and ability of pathogen to grow. For example, birds do not normally
become infected with mammalian strains of Mycobacterium tuberculosis because these strains cannot
grow at the high body temperature of birds. The anthrax bacillus (Bacillus anthracis) will not grow in
the cold-blooded frog (unless the frog is maintained at 37o).

Lack of the exact nutritional requirements to support the growth of the pathogen. Naturally-
requiring purine-dependent strains of Salmonella typhi grow only in hosts supplying purines. Mice and
rats lack this growth factor and pur- strains are avirulent. By injecting purines into these animals, such
that the growth factor requirement for the bacterium is satisfied, the organisms prove virulent.

Lack of a target site for a microbial toxin. Most toxins produced by microbial cells exert their toxic
activity only after binding to susceptible cells or tissues in an animal. Certain animals may lack an
appropriate target cell or specific type of cell receptor for the toxin to bind to, and may therefore be
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nonsusceptible to the activity of the toxin. For example, injection of diphtheria toxin fails to kill the rat.
The unchanged toxin is excreted in the urine. Inject a sample of the urine (or pure diphtheria toxin) into
the guinea pig, and it dies of typical lesions caused by diphtheria toxin.

Individual resistance

There are many reasons why individuals of the same animal species may exhibit greater or lesser
susceptibility to the same infective agent.

Age: usually this relates to the development and status of the immune system which varies with age.
May also be associated with changes in normal flora coincidental to developmental changes in the
animal.

Sex: usually linked to the presence and/or development of the sex organs. For example, mastitis and
infectious diseases leading to abortion will obviously occur only in the female; orchitis would occur
only in males). Could also be due to anatomical structure related to sex (bladder infections are 14-times
more common in females than males), and possibly the effects of sex hormones on infections.

Stress. Stress is a complex of different factors and apparently has a real influence on health. Undue
exertion, shock, change in environment, climatic change, nervous or muscular fatigue, etc. are factors
known to contribute to increases in susceptibility to infection. The best explanation is that in time of
stress the output of cortisone from the adrenal cortex is increased. This suppresses the inflammatory
processes of the host and the overall effect may be harmful. There are also a number of relationships
between stress-related hormones and the functioning of the immune defenses.

Diet, malnutrition. Infections may be linked with vitamin and protein deficiencies and this might
explain partly why many infectious diseases are more prevalent and infant mortality rates are highest in
parts of the world where malnourishment is a problem. Also, overfed and obese animals are more
susceptible to infection. Diets high in sucrose predispose individuals to dental caries.

Intercurrent disease or trauma. The normal defenses of an animal are impaired by organic diseases
such as leukemia, Hodgkin's disease, diabetes, AIDS, etc. Frequently, inflammatory or immune
responses are delayed or suppressed. Colds or influenza may predispose an individual to pneumonia.
Smoking tobacco predisposes to infections of the respiratory tract. Burned tissue is readily infected by
Pseudomonas aeruginosas.

Therapy against other diseases. Modern therapeutic procedures used in some diseases can render an
individual more susceptible to infection. Under these conditions, not only pathogens but organisms of
the normal flora and nonpathogens in the host's environment may be able to initiate infection.
Examples of therapeutic procedures that reduce the efficiency of the host's defenses are treatment with
corticosteroids, cytotoxic drugs, antibiotics, or irradiation.

Anatomical Defenses

The structural integrity of the body surfaces, i.e., the skin and mucous membranes, forms an effective
barrier to initial lodgement or penetration by microorganisms. The skin is a very effective barrier to
bacteria so that no bacterium by itself is known to be able to penetrate unbroken skin. Of course, a
puncture, cut or scrape in the skin could introduce infectious bacteria. The mucous membranes are
more vulnerable to penetration by infectious bacteria but still pose a formidable barrier of mucus and
antimicrobial substances. Nonetheless, most infectious agents impinge on the skin or mucous
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membranes of the oral cavity, respiratory tract, GI tract or urogenital tract, and from these sites most
infections occur.

Figure 1. Anatomical defenses associated with tissue surfaces

Skin. The intact surface of the healthy epidermis seems to be rarely if ever penetrated by bacteria. If
the integrity of the epidermis is broken (by the bite of an insect, needle stick, abrasion, cut, etc.)
invasive microbes may enter. The normal flora of the skin, which metabolize substances secreted onto
the skin, produce end products (e.g. fatty acids) that discourage the colonization of skin by potential
pathogens. Perspiration contains lysozyme and other antimicrobial substances.

Mucous membranes. Many are heavily colonized with bacteria in whose moist secretions they
survive. These normal flora are restricted from entry and usually occupy any attachment sites that
might otherwise be used by pathogens. The normal flora established on mucous membranes may
antagonize non-indigenous species by other means, as well. Typically, mucus contains a number of
types of anti-microbial compounds, including lysozyme and secretory antibodies (IgA). Sometimes
phagocytes patrol mucosal surfaces (e.g. in the lower respiratory tract). Nonetheless, some pathogens
are able to penetrate the mucous membranes, and this is probably the major site from which pathogens
invade. Probably, damage to the epithelial cells caused by toxic products of these bacteria plays a role.

Respiratory tract. Fine hairs and baffles of the nares (nasal membranes) entrap bacteria which are
inhaled. Those which pass may stick to mucosal surfaces of the trachea or be swept upward by the
ciliated epithelium of the lower respiratory tract. Coughing and sneezing also eliminate bacteria. The
lower respiratory tract (lung) is well protected by mucus, lysozyme, secretory antibody, and
phagocytosis.

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Mouth, stomach and intestinal tract. Microorganisms entering by the oral route, more than any other,
have to compete with the well-adapted normal flora of the mouth and intestine. Most organisms that are
swallowed are destroyed by acid and various secretions of the stomach. Alkaline pH of the lower
intestine can discourage other organisms. The peristaltic action of the intestine ultimately flushes out
organisms which have not succeeded in colonization. Bile salts and lysozyme are present, which kill or
inhibit many types of bacteria.

Urogenital Tract. The flushing mechanisms of sterile urine, and the acidity of urine, maintain the
bladder and most of the urethra free of microorganisms. The vaginal epithelium of the female maintains
a high population of Doderlein's bacillus (Lactobacillus acidophilus) whose acidic end products of
metabolism (lactic acid) prevent colonization by most other types of microorganisms including
potentially-pathogenic yeast (Candida albicans).

Eyes (Conjunctiva). The conjunctiva of the eye is remarkably free of most microorganisms. Blinking
mechanically removes microbes, the lavaging action of tears washes the surface of the eye, and
lachrymal secretions (tears) contain relatively large amounts of lysozyme.

Microbial Antagonism

This refers to the protection of the surfaces afforded by an intact normal flora in a healthy animal, and
it has already been discussed in several contexts. There are three main ways that the normal flora
protect the surfaces where they are colonized:

Competition with non-indigenous species for binding (colonization) sites. The normal flora are
highly-adapted to the tissues of their host. That is why they are there!

Specific antagonism against non-indigenous species. Members of the normal flora may produce
highly specific proteins called bacteriocins which kill or inhibit other (usually closely-related) species
of bacteria.

Nonspecific antagonism against non-indigenous species. The normal flora produce a variety of
metabolites and end products that inhibit other microorganisms. These include fatty acids (lactate,
propionate, etc.) and peroxides.

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Figure 2. Enterococcus faecalis, also classified as Streptococcus faecalis. Occassionally there is invasion of the host by
the normal flora, as evidenced by this blood culture. Enterococcus faecalis, blood culture. © Gloria J. Delisle and
Lewis Tomalty, Queens University Kingston, Ontario, Canada. Licensed for use by ASM Microbe Library
http://www.microbelibrary.org.

Antimicrobial Substances in Host Tissues

The body fluids and organized tissues of animals naturally contain a variety of antimicrobial agent that
kill or inhibit the growth of microbes. The sources and activities of a variety of host antimicrobial
substances are summarized in Table 1.

TABLE 1. ANTIMICROBIAL SUBSTANCES OF HOST ORIGIN PRESENT IN BODY FLUIDS AND

ORGANIZED TISSUES
Chemical
Substance Common Sources Activity
Composition
Serum, saliva, sweat,
Lysozyme Protein Bacterial cell lysis
tears
Protein-
Cell death or lysis of
carbohydrate
Complement Serum bacteria; participates in
lipoprotein
inflammation
complex
Basic proteins and polypeptides
(histones, -lysins and other Serum or organized Proteins or basic Disruption of bacterial
cationic proteins, tissue tissues peptides plasma membrane
polypeptides)
Body secretions, Inhibit microbial growth
Lactoferrin and transferrin Glycoprotein
serum, organized by binding (withholding
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 tissue spaces ) iron
Act with peroxide to
Saliva, tissues, cells
Peroxidase Protein cause lethal oxidations
(neutrophils)
of cells
Serum and mucosal Clearance of bacteria
Fibronectin Glycoprotein
surfaces (opsonization)
Virus-infected cells, Resistance to virus
Interferons Protein
lymphocytes infections
Cause fever; promote
Macrophages,
Interleukins Protein activation of immune
lymphocytes
system

Complement

Complement can be considered as part of the constitutive host defense mechanisms (it is present at
constitutive levels) because of its role in inflammation and phagocytosis. However, the antimicrobial
activities of complement can be activated completely by reactions between antigens and antibodies and,
therefore, it may play a role in the inducible (immune) defenses, as well.

Complement is an enzymatic system of serum proteins made up of 9 major components (C1 - C9) that
are sequentially activated in many Ag - Ab reactions resulting in disruption of membranes. Therefore,
complement (C') may be involved in the lysis of certain bacteria, some viruses, and other
microorganisms. In addition, some C' components play a part in phagocytic chemotaxis, opsonization
and the inflammatory response.

Complement is activated in the classical pathway by reactions between antibodies and antigens on the
surface of a microbe. Some Immunoglobulins (i.e., IgG and IgM) can "fix complement" because they
have a cmoplement binding site on the Fc portion of the molecule. The reaction between IgG and Ag
activates the complement and initiates a "cascade reaction" on the surface of the microbe that results in
the principal effects of complement which are:

1. Generation of inflammatory factors, C3a and C5a, which focus antimicrobial serum factors and
leukocytes into the site of infection.

2. Attraction of phagocytes. Chemotactic factors C3a and C5a attract phagocytes to the site.

3. Enhancement of phagocytic engulfment. C3b component on Ag - Ab complex attaches to C3b

receptors on phagocytes and promotes opsonization of Ab-coated cells. C3b-opsonization is important
when Ab is IgM because phagocytes have receptors for Fc of IgM only when it is associated with C3b.

4. Lysis of bacterial cells (lysozyme-mediated) or virus-infected cells. When C8 and C9 are bound
to the complex, a phospholipase is formed that destroys the membrane of Ag-bearing host cells (e.g.
virus-infected cells) or the outer membrane of Gram-negative bacteria. Lysozyme gains access to
peptidoglycan and completes destruction of the bacterial cell.

In addition to the classical pathway"of complement activation an alternative pathway ( sometimes

called the "properdin pathway") of complement activation exists which is independent of
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immunoglobulins. Insoluble polysaccharides (including bacterial LPS, peptidoglycan and teichoic
acids) can activate complement. This allows antibody-independent activation of the complement
cascade that may be important in initial (pre-antibody) defense against various types of infections
caused by bacteria.

Inflammation

Of all the defense mechanisms in the animal host, the inflammatory response may be the most
important for dealing with microbial infection. Inflammation is necessary for the proper functioning of
all the host defenses, including the immune defenses, because it focuses all circulating antimicrobial
factors on the site of infection. These include phagocytes, lymphocytes, antibodies, complement and
other antimicrobial components of plasma. However, inflammation is also an important aspect of
bacterial pathogenesis since the inflammatory response induced by a microbe can result in considerable
damage to the host and, therefore, be part of the pathology of microbial disease.

Inflammation is a tissue reaction to infection or injury, the characteristic symptoms of which are
redness, swelling, heat and pain. These are sometimes called the cardinal signs of inflammation. The
redness is due to increased blood flow to the area of injury. The swelling (edema) is due to increased
extravascular fluid and phagocyte infiltration to the damaged area. The heat is due to the increased
blood flow and the action of pyrogens (fever-inducing agents). The pain is caused by local tissue
destruction and irritation of sensory nerve receptors.

Inflammation can be induced by certain immunological reactions, tissue damage, or the entry of an
injurious agent (microbial or nonmicrobial). Certain bacterial cells and/or their products (e.g.
structural components or toxins) can induce an inflammatory response. Inflammation increases the
blood supply and temperature in the inflamed tissues, which favors maximal metabolic activity of the
leukocytes, and lowers the pH slightly, which tends to inhibit the multiplication of many
microorganisms.

The events involved in the induction and maintenance of the inflammatory response are summarized
below.

(1) The inflammatory response is triggered by pathogen invasion or tissue injury. Injured and dying
cells release cytoplasmic constituents which lower the pH in the surrounding extracellular environment.

(2) The increased acidity activates an extracellular enzyme kallikrein which in turn activates
bradykinin.

(3a) Bradykinin binds to receptors on the capillary walls opening junctions between cells to allow
leakage of plasma components collectively referred to as the inflammatory exudate.
Increased capillary permeability allows leukocytes to pass from the vessels into tissues (this process is
called diapedisis). The first to appear, and the most dominant, are neutrophils, which are actively
phagocytic. The other components of the inflammatory exudate and their functions are described in
Table 2 below).

(3b)Bradykinin also binds to mast cells of the connective tissue that are associated with the small
vessels of most tissues. This initiates other events that are associated with the process of inflammation.

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Initially there is a rapid influx of Ca++, intracellular cAMP levels drop, and mediator-rich lysosomal
granules migrate to the cell surface, fuse with the cell membrane, and discharge their contents
(preformed mediators of inflammation such as histamine, heparin, etc.) to the exterior by exocytosis

The change in mast cell permeability activates an enzyme, phospholipase A2 to synthesize a substance
called arachidonic acid. This compound can be acted upon subsequently by the cyclooxygenase
pathways or lipooxygenase pathways of the mast cell leading to new synthesis of prostaglandins,
leukotrienes, and other mediators of inflammation. These substances contribute to the inflammatory
exudate.

TABLE 2. FUNCTION OF COMPONENTS AND CELLS IN THE INFLAMMATORY EXUDATE

Component Function
Bradykinin, histamine,
Inflammatory Agents (IA) which act on the vascular system to
leukotrienes, serotonin,
produce increased blood flow and permeability
prostaglandins
Fibrin: (formed from fibrinogen
coagulates and may localize an invading pathogen
in plasma)
Lysozyme causes lysis of bacterial cell walls
various activities increase the inflammatory response and lead to
Complement
increased phagocytosis and complement-mediated lysis of cells
block colonization by pathogens; neutralize microbial toxins or
Antibodies (in immune
viruses; opsonize pathogens making them more susceptible to
individuals)
phagocytosis; activate complement
Pyrogens, including cause fever acting on the thermo-regulatory control centers in the
endogenous pyrogen hypothalamus. (Interleukin-1, which is produced by macrophages,
(Interleukin 1) also promotes activation and mitosis of B-cells and T-cells)
migrate to focus of infection and ingest and destroy foreign agents by
Neutrophils
phagocytosis
engulf and destroy infective agents, process antigenic components
Macrophages
and convey them to lymphocytes
Immunocompetent lymphocytes
for direct participation in immunological responses (AMI and CMI)
(B-cells and T-cells)

The overall effect of an inflammatory reaction is to recruit various cells and components to the actual
site of microbial invasion. Many of these cells and plasma components have a direct role in defense
against the intruding microorganism. These include neutrophils (phagocytes which engulf and destroy
the microbes); macrophages and lymphocytes which are the cells necessary to initiate immunological
responses against the pathogen; pre-existing antibodies which can neutralize microbial pathogens or
their toxins; and plasma components such as lysozyme, complement and fibrin, which have a variety
of antimicrobial activities.

Phagocytic Defenses

When invading parasites penetrate the tissues the inflammatory response, previously described, is
immediately brought into play. Part of this response leads to the recruitment of phagocytes to the site of

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inflammation. Phagocytes are a class of cells which are capable of ingestion (engulfment) and
destruction of microorganisms that are responsible for inciting the inflammatory response. First to
accumulate around the invaders and initiate the phagocytic process are neutrophils. Later, local and
blood-borne macrophages also migrate to the tissue site and initiate phagocytosis. Neutrophils (also
known as polymorphonuclear leucocytes or PMNs) and macrophages are sometimes referred to as
professional phagocytes for their roles in this process.

Properties of Neutrophils

Neutrophils have their origin in multi-potential stem cells in the bone marrow. They differentiate in the
marrow and are released in a mature form, containing a full complement of bactericidal agents. They
are short-lived cells which constitute 30-70% of the circulating white blood cells (leukocytes).

During differentiation in the marrow (2-3 days) the nucleus of the cell becomes multilobed (hence the
name polymorphonuclear leukocyte), cell division ceases, and mitochondria and endoplasmic
reticulum disappear from the cytoplasm. At the same time the cell becomes motile and actively
phagocytic. Cytoplasmic granules are formed from the Golgi apparatus. These granules are called
lysosomes and contain the various bactericidal and digestive enzymes which can destroy bacterial cells
after engulfment. The contents of lysosomal granules include lysozyme, cationic proteins, acid
hydrolases, proteases, peroxidase and lactoferrin. Neutrophils also contain large store of glycogen;
since they derive most of their metabolic energy from glycolysis, they can function efficiently in
anaerobic environments.

Some additional properties of neutrophils are:

-Only half the neutrophils in human circulation are detectable in the blood; the rest adhere to vessel
walls.

-For every circulating neutrophil, approximately 100 near mature cells are held in reserve in the bone
marrow pool.

-Once a neutrophil enters the tissues, intestinal tract or respiratory tract, it never returns to the
circulation.

Properties of Macrophages

Macrophages (also called mononuclear phagocytes) also arise from bone marrow stem cells which
give rise to promonocytes which develop into monocytes that are released into the blood stream.
Monocytes make up 3-7% of the circulating white blood cells. The monocyte is actively phagocytic
and and bactericidal. Within 2 days or so, the blood stream monocytes (sometimes called wondering
macrophages) emigrate into the tissues where they settle down, enlarge and become fixed macrophages
(tissue histiocytes), which also have phagocytic potential. Macrophages are more active in
phagocytosis than monocytes and develop many more granules containing hydrolytic enzymes. New
macrophages can develop by cell division under inflammatory stimuli, but most macrophages are
matured blood monocytes.

The total pool of macrophages is referred to as the system of mononuclear phagocytes. The system is
scattered throughout connective tissue, basement membranes of small blood vessels, liver sinusoids,
the spleen, lung , bone marrow and lymph nodes. Monocytes from the blood migrate into virtually
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every organ in the body where they mature into fixed macrophages. In the lymph nodes, they function
as scavengers to remove foreign material from the circulation.

Compared to neutrophils, macrophages are long-lived cells. As phagocytes, neutrophils play a more
important role in the acute stages of an infection, while macrophages are principally involved in
chronic types of infections. Neutrophils circulate in the blood stream, and during an acute inflammatory
response they migrate through the endothelial cell junctions as part of the inflammatory exudate. They
migrate to the focus of the infection and ingest or phagocytose the foreign agents, Neutrophils which
have become engorged with bacteria usually die and largely make up the material of pus. Macrophages,
which are also attracted to the area during an inflammatory response, are slower to arrive and become
increasingly involved in chronic infections. They, too, are actively phagocytic and will engulf and
destroy foreign particles such as bacteria. However, macrophages have another indispensable function
in host defense: they "process" the antigenic components of infective agents and present them to
lymphocytes, a process that is usually required for the initiation of the immune responses of the host.
Macrophages are among an elite corps of antigen-presenting cells or APC's.

The Phagocytic Process

Phagocytosis and destruction of engulfed bacteria involves the following sequence of events:

1. Delivery of phagocytic cells to the site of infection

2. Phagocytic adherence to the target

3. Ingestion or engulfment of the target particle

4. Phagolysosome formation

5. Intracellular killing

6. Intracellular digestion (and egestion, in the case of macrophages)

These steps involved in the phagocytic process in macrophages are illustrated below.

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Figure 3. Phagocytosis by a Macrophage. A bacterium, which may or may not be opsonized, is engulfed by the
process of endocytosis. The bacterium is ingested in a membranous vesicle called the phagosome. Digestive granules
(lysosomes) merge with phagosome, release their contents, and form a structure called the phagolysosome. The
killing and digestion of the bacterial cell takes place in the phagolysosome. The macrophage egests debris while
processing the antigenic components of the bacterium, which it returns to its surface in association with MHC II for
antigen presentation to TH cells.

Delivery of phagocytic cells to the site of infection

The delivery of phagocytic cells, monocytes or neutrophils, to the site of microbial infection involves
two processes:

Diapedisis: the migration of cells across vascular walls which is initiated by the mediators of
inflammation (kinins, histamine, prostaglandins, etc.)

Chemotaxis. Phagocytes are motile by ameboid action. Chemotaxis is movement of the cells in
response to a chemical stimulus. The eventual concentration of phagocytes at a site of injury results
from chemotactic response by the phagocytes which is analogous to bacterial chemotaxis. A number of
chemotactic factors (attractants) have been identified, both for neutrophils and monocytes. These
include bacterial products, cell and tissue debris, and components of the inflammatory exudate such as
peptides derived from complement.

Phagocytic adherence

Phagocytosis is initiated by adherence of a particle to the surface of the plasma membrane of a

phagocyte. This step usually involves several types of surface receptors on the phagocyte membrane.
Three major receptors on phagocytes recognize the Fc portion of IgG: one is for monomeric IgG and
the others are for antigen-crosslinked IgGs. Another receptor binds a complement factor C3b. Other
phagocyte receptors bind fibronectin and mannose-terminated oligsaccharides. Under certain
circumstances of infection, bacteria or viruses may become coated or otherwise display on their
surfaces one or another of these substances (i.e., IgG, C3b, fibronectin or mannose). Such microbes are
said to be opsonized and such substances as IgG or complement C3b bound to the surface of microbes
are called opsonins. (Opsonin comes from a Greek word meaning "sauce" or "seasoning": they make

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the bacterium or virus more palatable and more easily ingested by the phagocyte.) Opsonins provide
extrinsic ligands for specific receptors on the phagocyte membrane, which dramatically increases the
rate of adherence and ingestion of the pathogen . Opsonized bacteria can be cleared from the blood by
phagocytes; many types of non opsonized bacteria cannot be cleared.

Less firm attachments of a phagocyte to a particle can take place in the absence of opsonization. This
can be thought of as nonspecific attachment which might be due to net surface charge on the
phagocyte or particle and/or hydrophobicity of the particle.

Also, a phenomenon called surface phagocytosis exists: a phagocyte can simply trap an organism
against a surface and initiate ingestion. Surface phagocytosis may be an important pre-antibody defense
mechanism which may determine whether an infection will become a disease and how severe the
disease will become.

Ingestion

After attachment of the phagocyte to its target, some sort of signal generation, which is poorly
understood, results in physical or chemical changes in the cell that triggers ingestion. Ingestion is an
engulfment process that involves infolding or invagination of the cell membrane enclosing the particle
and ultimately releasing it into the cytoplasm of the cell within a membrane vesicle. The end result of
ingestion is entry of the particle enclosed in a vesicle derived from the plasma membrane of the cell.
This structure is called the phagosome.

Formation of the phagolysosome

The phagosome migrates into the cytoplasm and collides with lysosomal granules which explosively
discharge their contents into the membrane-enclosed vesicle (phagosome). Membranes of the
phagosome and lysosome actually fuse resulting in a digestive vacuole called the phagolysosome.
Other lysosomes will fuse with the phagolysosome. It is within the phagolysosome that killing and
digestion of the engulfed microbe takes place. Some of the microbicidal constituents of the lysosomes
of neutrophils and macrophages include lysozyme, cationic proteins, various proteases
and hydrolyases and peroxidases. The killing processes are confined to the membranous organelles of
the phagocytes (the phagolysosome) such that none of the toxic substances and lethal activities of the
phagocytes are turned against themselves.

Intracellular killing of organisms

After phagolysosome formation the first detectable effect on bacterial physiology, occurring within a
few minutes after engulfment, is loss of viability (ability to reproduce). The exact mechanism is
unknown. Inhibition of macromolecular synthesis occurs later. By 10 to 30 minutes after ingestion
many pathogenic and nonpathogenic bacteria are killed followed by lysis and digestion of the bacteria
by lysosomal enzymes. The microbicidal activities of phagocytes are complex and multifarious.
Metabolic products, as well as lysosomal constituents, are responsible. These activities differ to some
extent in neutrophils, monocytes and macrophages.

The microbicidal activities of phagocytes are usually divided into oxygen-dependent and oxygen-
independent events

Oxygen-independent activity

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Lysosomal granules contain a variety of extremely basic proteins that strongly inhibit bacteria, yeasts
and even some viruses. A few molecules of any one of these cationic proteins appear able to inactivate
a bacterial cell by damage to their permeability barriers, but their exact modes of action are not known.
The lysosomal granules of neutrophils contain lactoferrin, an extremely powerful iron-chelating agent,
which withholds potential iron needed for bacterial growth. The pH of the phagolysosome may be as
low as 4.0 due to accumulation of lactic acid, which is sufficiently acidic to prevent the growth of most
pathogens. This acidic environment apparently optimizes the activity of many degradative lysosomal
enzymes including lysozyme, glycosylases, phospholipases, and nucleases.

Oxygen-dependent activity

Liganding of Fc receptors (on neutrophils, monocytes or macrophages) and mannose receptors (on
macrophages) increases their O2 uptake, called the respiratory burst. These receptors activate a
membrane-bound NADPH oxidase that reduces O2 to O2- (superoxide). Superoxide can be reduced to
OH. (hydroxyl radical) or dismutated to H2O2 (hydrogen peroxide) by superoxide dismutase. O2-, OH.,
and H2O2 are activated oxygen species that are potent oxidizing agents in biological systems which
adversely affect a number of cellular structures including membranes and nucleic acids. Furthermore,
at least in the case of neutrophils, these reactive oxygen intermediates can act in concert with a
lysosomal enzyme called myeloperoxidase to function as the myeloperoxidase system, or MPO.

Myeloperoxidase is one of the lysosomal enzymes of neutrophils which is released into the phagocytic
vacuole during fusion to form the phagolysosome. Myeloperoxidase uses H2O2 generated during the
respiratory burst to catalyze halogenation (mainly chlorination) of phagocytosed microbes. Such
halogenations are a potent mechanism for killing cells.

When the NADPH oxidase and myeloperoxidase systems are operating in concert, a series of reactions
leading to lethal oxygenation and halogenation of engulfed microbes occurs.

Intracellular digestion

Dead microbes are rapidly degraded in phagolysosomes to low molecular-weight components. Various
hydrolytic enzymes are involved including lysozyme, proteases, lipases, nucleases, and glycosylases.
Neutrophils die and lyse after extended phagocytosis, killing, and digestion of bacterial cells. This
makes up the characteristic properties of pus.

Macrophages egest digested debris and allow insertion of microbial antigenic components into the
plasma membrane for presentation to lymphocytes in the immunological response.

Figure 4. Phagocytosis ofStreptococcus pyogenes by a macrophage. CELLS alive!

Bacterial Defense Against Phagocytosis

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Pathogenic bacteria have a variety of defenses against phagocytes. In fact, most successful pathogens
have some mechanism(s) to contend with the phagocytic defenses of the host. These mechanisms will
be discussed in detail later as part of the determinants of virulence of pathogens. However, in general,
pathogens may resist phagocytosis by:

Evading phagocytes by growing in regions of the body which are not accessible to them

Avoiding engulfment by phagocytes after contact

Being able to kill phagocytes either before or after engulfment

Being able to survive inside of phagocytes (or other types of cells) and to persist as intracellular
parasites

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 Todar's Online Textbook of Bacteriology

Immune Defense against Microbial Pathogens

© 2002 Kenneth Todar University of Wisconsin Department of Bacteriology

Inducible defenses

The constitutive defenses, by themselves, may not be sufficient to protect the host against pathogens.
However, even if pathogens evade or overcome the relatively nonspecific constitutive defenses, they
may yet be detected and attacked by the more specific inducible defenses, once they have developed.
The inducible defenses are so-called because they are induced upon primary exposure to a pathogen or
one of its products. The inducible defenses are a function of the immunological system and the
immune responses. They must be triggered in a host and initially take time to develop. The type of
resistance thus developed in the host is called acquired immunity.

Acquired immunity

Acquired immunity may be divided into two types based on how it is acquired by the host.

In the case of active immunity, the host undergoes an immunological response and produces the cells
and factors responsible for the immunity, i.e., the host produces its own antibodies and/or immuno-
reactive lymphocytes. Active immunity can persist a long time in the host, up to many years in humans.

Passive immunity is acquisition by a host of immune factors which were produced in another animal,
i.e., the host receives antibodies and/or immuno-reactive lymphocytes originally produced during an
active response in another animal. Passive immunity is typically short-lived and usually persists only a
few weeks or months.

In either case of active or passive immunity, resistance may be acquired by natural means or by
artificial means (i.e., vaccination and immunization procedures). Some familiar examples of active and
passive immunity are given in the table below.

Table 1. Examples of Active and Passive Immunity

Type of
How Acquired by Host Examples
Immunity
Antibodies are produced by the host in response to the
As a result of exposure to an
Active infectious agent itself (e.g. recovery from the disease),
infectious agent or one of its
Immunity or in response to artificial immunization (vaccination)
products (antigens)
with some product derived from the infectious agent
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 (e.g. toxoid, killed cells, structural components of
cells, inactivated virus, etc.).
As a result of the acquisition of Injection of immune serum from an individual
antibodies which have been previously immunized or recovered from disease, e.g.
Passive produced in another animal (by hepatitis; Injection of serum from an animal
Immunity active means) or derived from hyperimmunized with tetanus toxoid; Placental
cells grown in tissue culture transfer of antibodies from mother to fetus; Transfer of
(monoclonal antibodies) antibodies from mother to infant in milk by nursing.

The immune system

The immunological system is comprised of the lymphoid tissues and organs of the body. Lymphoid
tissues are widely distributed : they are concentrated in bone marrow, lymph nodes, spleen, liver,
thymus, and Peyer's patches scattered in linings of the GI tract. The lymphoid system is encompassed
by the system of mononuclear phagocytes. Lymphocytes are the predominant cells, but macrophages
and plasma cells are present also. Lymphocytes are cells which circulate, alternating between the
circulatory blood stream and the lymphatic channels. The distribution of lymphatic tissues that make up
the immune system in humans is illustrated in the figure below.

Figure 1. Anatomy of the Immune System. (A): The major components of the immune system are lymph nodes
connected by lymph ducts, Peyer's patches (masses of lymphocytes in the lower gastrointestinal tract), thymus,
spleen, and bone marrow. (B): A lymph node. Afferent lymph ducts bring lymph-containing antigens into the lymph
node. Macrophages, B cells or dendridic cells in the cortical region make contact with the antigen and process it for
presentation to immunocompetent B cells and T cells, thereby initiating an immune response. As a result, B cells are
stimulated to develop into antibody-secreting plasma cells, and T-cells are stimulated to develop into effector T cells
of various classes. Antibodies leave the lymph node by the efferent ducts that empty into the blood stream.
Lymphocytes can also leave the node by the efferent duct and travel to other sites in the lymphatic system or enter
into the blood circulation. A single lymphocyte completes a circuit through the circulating blood and lymphatic
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systems once every 24 hours.

The immunological system is able to recognize foreign substances (antigens) which stimulate the
system to produce antibody-mediated immunity (AMI), cell-mediated immunity (CMI), or
both. AMI and CMI are the two great arms of the immune system that are discussed in more detail
below.

An antigen (Ag) is a substance, usually macromolecular, that induces an immunological response.

Because of its complex macromolecular structure, a single microorganism consists of multiple antigens
(e.g. surface structures such as cell wall components, fimbriae, flagella, etc., or extracellular proteins,
such as toxins or enzymes produced by the microorganism). The coat proteins and some of the
envelope proteins of animal viruses are also usually antigenic. The host is able to respond specifically
to each and every antigen to come into contact with the components of the immunological system.

The immune response

Immunological responses are associated with macrophages and two subpopulations of lymphocytes
which are derived from primitive bone marrow cells. All of the cells involved in the immunological
responses are derived from bone marrow stem cells which have differentiated under the influence of
various tissues and stimuli. Macrophages develop from monocytes previously released from the bone
marrow into the blood circulation. Lymphocytes responsible for AMI are processed by lymphoid tissue
in the bone marrow and develop there into B lymphocytes or B cells. Lymphocytes responsible for
CMI are processed by the thymus gland and mature into T lymphocytes or T cells.

Under antigenic stimulus, B-lymphocytes become transformed into antibody-secreting plasma cells.
The plasma cells synthesize large amounts of immunoglobulins (antibodies) which will react
stereochemically with the stimulating antigen.

Under antigenic stimulus, pre T-lymphocytes differentiate into several classes of effector T cells which
are committed to various activities upon recognition of the specific antigen that induced their
formation. T cells have many activities relevant to immunity including (1) mediation of the B-cell
response to antigen; (2) ability to recognize and destroy cells bearing foreign Ag on their surface; and
(3) production of a variety of diffusible compounds called cytokines and/or lymphokines, which
include substances that are activators of macrophages, mediators of inflammation, chemotactic
attractants, lymphocyte mitogens, and interferon. Cytokines and lymphokines are molecules (peptides,
proteins) produced by cells as a means of intercellular communication. Generally, they are secreted by
a cell to stimulate the activity of another cell.

The overall aspects of the induction of the immune responses (AMI and CMI) are shown in the
following schematic diagram.

Figure 2. Schematic Diagram of the Development of the Immune Responses

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Three important features of the immunological system relevant to host defense and/or "immunity"
to pathogenic microorganisms are:

1. Specificity. An antibody or reactive T cell will react specifically with the antigen that induced its
formation; it will not react with other antigens. Generally, this specificity is of the same order as that of
enzyme-substrate specificity or receptor-ligand specificity. However, cross-reactivity is possible. The
specificity of the immune response is explained on the basis of the clonal selection hypothesis: during
the primary immune response, a specific antigen selects a pre-existing clone of specific lymphocytes
and stimulates exclusively its activation, proliferation and differentiation.

2. Memory. The immunological system has a "memory". Once the immunological response has
reacted to produce a specific type of antibody or reactive T cell, it is capable of producing more of the
antibody or activated T cell more rapidly and in larger amounts. This is sometimes referred to as a
secondary, or memory response.

3. Tolerance. An animal generally does not undergo an immunological response to its own
(potentially-antigenic) components. The animal is said to be tolerant, or unable to react to its own
potentially-antigenic components. This ensures that under normal conditions, an immune response to
"self" antigens (called an autoimmune response) does not occur. Autoimmune responses are
potentially harmful to the host. Tolerance is brought about in a number of ways, but basically the
immunological system is able to distinguish "self" components from "non-self" (foreign) antigens; it
will respond to "non-self" but not to "self". Sometimes in an animal, tolerance can be "broken", which
may result in an autoimmune disease.

The two types immunity: AMI and CMI

Antibody-mediated immunity (AMI) is the type of immunity that is mediated by soluble host
proteins called antibodies or immunoglobulins. Because it is largely due to the presence of circulating
antibody molecules in the serum, is also called circulating immunity or humoral immunity.
Antibodies (Ab) are proteins (globulins) produced in response to an encounter with an antigen. There
are several classes or types of antibodies (and subclasses of the types), but all of the classes of
antibodies that are produced in response to a specific antigen react stereochemically with that antigen
and not with other (different) antigens. The host has the genetic capacity to produce specific antibodies
to thousands of different antigens, but does not do so until there is an appropriate (specific) antigenic
239
stimulus. Due to clonal selection, the host produces only the homologous antibodies that will react with
that antigen. These antibodies are found in the blood (plasma) and lymph and in many extravascular
tissues. They have a various roles in host defense against microbial and viral pathogens as discussed
below.

Cell-mediated immunity (CMI) is the type of immunity that is mediated by specific subpopulations
of T-lymphocytes called effector T cells. In non immune animals precursor T cells (pT cells) exist as
"resting T cells". They bear receptors for specific antigens. Stimulation with Ag results in their
activation. The cells enlarge, enter into a mitotic cycle, reproduce and develop into effector T cells
whose activities are responsible for this type of immunity. They also develop into clones of identical
reactive T cells called memory T cells.

The biological activities of the antibody-mediated and cell-mediated immune responses are different
and vary from one type of infection to another. The AMI response involves interaction of B
lymphocytes with antigen and their differentiation into antibody-secreting plasma cells. The secreted
antibody binds to the antigen and in some way leads to its neutralization or elimination from the body.
The CMI response involves several subpopulations of T lymphocytes that recognize antigens on the
surfaces of cells. TH cells respond to antigen with the production of lymphokines. The distinction
between TH1 and TH2 is based on their lymphokine profiles. TH2 cells have previously been referred
to as T helper cells because they provide lymphokines (e.g. IL-2 and IL-4) which activate T cells and
B cells at the start of the immune response. TH1 cells were formerly known as delayed type
hypersensitivity cells (TDTH) because of their role in this allergic process. TC cells or cytotoxic T
lymphocytes (CTLs) are able to kill cells that are showing a new or foreign antigen on their surface (as
virus-infected cells, or tumor cells, or transplanted tissue cells).

Membrane receptors on B cells and T cells

The nature of the membrane receptors for antigen on B cells and T cells is fairly well understood. Each
B cell has approximately 105 membrane-bound antibody molecules (IgD or IgM) which correspond in
specificity to the antibody that the cell is programmed to produce. Each T cell has about 105 molecules
of a specific antigen-binding T cell receptor (TCR) exposed on its surface. The TCR is similar, but
not identical, to antibody. In addition, T cell subsets bear some distinguishing surface markers, notably
CD4 or CD8. T cells bearing CD4 always recognize antigens in association with class II major
histocompatability complex (class II MHC) proteins on the surfaces of other cells. CD4+ T
lymphocytes generally function as T helper cells. T cells bearing CD8 ( CD8+ )always recognize
antigen in association with class I MHC proteins and typically function as cytotoxic T cells. The
important markers, actions and interactions of T cells, B cells and Antigen Presenting Cells (APC)
are illustrated below.

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Figure 3. Receptor interactions between B cells, T cells and Antigen Presenting Cells (APC)

241
Induction of primary immune responses

Induction of a primary immune response begins when an antigen penetrates epithelial surfaces. It
will eventually come into contact with macrophages or certain other classes of Antigen Presenting
cells (APCs), which include B cells, monocytes, dendritic cells, Langerhans cells and endothelial cells.
Antigens, such as bacterial cells, are internalized by endocytosis and "processed" by the APC, then
"presented" to immunocompetent lymphocytes to initiate the early steps of the immunological
response. Processing by a macrophage (for example) results in attaching antigenic materials to the
surface of the membrane in association with MHC II molecules on the surface of the cell . The
antigen-class II MHC complex is presented to a T-helper (TH2) cell which is able to recognize
processed antigen associated with a class II MHC molecule on the membrane of the macrophage. This
interaction, together with stimulation by Interleukin 1 (IL-1), produced by the macrophage, will
activate the TH2 cell. Activation of the TH2 cell causes that cell to begin to produce Interleukin 2 (IL-
2), and to express a membrane receptor for IL-2. The secreted IL-2 autostimulates proliferation of the
TH2 cells. Stimulated TH2 cells produce a variety of lymphokines including IL-2, IL-4, IL-6, and
gamma Interferon which mediate various aspects of the immune response. For example, IL-2 binds to
IL-2 receptors on other T cells (which have bound the Ag) and stimulates their proliferation, while IL-4
causes B cells to proliferate and differentiate into antibody-secreting plasma cells and memory B cells.
IL-4 activates only B cells in the vicinity which themselves have bound the antigen, and not others, so
as to sustain the specificity of the immune response.

As previously mentioned, B cells themselves behave as APCs. Cross-linked antigens bound to

antibody receptors on the surface of a B cell cause internalization of some of the antigen and
expression on the B cell membrane together with MHC II molecules. The TH2 cell recognizes the
antigen together with the Class II MHC molecules, and secretes the various lymphokines that activate
the B cells to become antibody-secreting plasma cells and memory B cells. Even if the antigen cannot
cross-link the receptor, it may be endocytosed by the B cell, processed, and returned to the surface in
association with MHC II where it can be recognized by specific TH2 cells which will become activated
to initiate B cell differentiation and proliferation. In any case, the overall B-cell response leads to
antibody-mediated immunity (AMI).

The antigen receptors on B cell surfaces are thought to be the specific types of antibodies that they
are genetically-programmed to produce. Hence, there are thousands of sub-populations of B cells
distinguished only by their ability to produce a unique (reactive) type of antibody molecule. A B cell
can also react with a homologous antigen on the surface of the macrophage, or with soluble antigens.
When a B-cell is bound to Ag, and simultaneously is stimulated by IL-4 produced by a nearby TH2
cell, the B cell is stimulated to grow and divide to form a clone of identical B cells, each capable of
producing identical antibody molecules. The activated B cells further differentiate into plasma cells
which synthesize and secrete large amounts of antibody, and into a special form of B cells called
memory B cells. The antibodies produced and secreted by the plasma cells will react specifically with
the homologous antigen that induced their formation. Many of these reactions lead to host defense and
to prevention of reinfection by pathogens. Memory cells play a role in secondary immune responses.

Plasma cells are relatively short-lived (about one week) but produce large amounts of antibody during
this period. Memory cells, on the other hand, are relatively long-lived and upon subsequent exposure to
Ag they become quickly transformed into Ab-producing plasma cells.

Generation of cell mediated immunity (CMI) begins when (for example) a TC cell recognizes a
processed antigen associated with MHC I on the membrane of a cell (usually an altered self cell, but
possibly a transplanted tissue cell or a eukaryotic parasite). Under stimulation by IL-2 produced by
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TH2 cells the TC cell becomes activated to become a cytotoxic T lymphocyte (CTL) capable of
lysing the cell which is showing the new (foreign) antigen on its surface, a primary manifestation of
CMI.

The interaction between an antigen-presenting macrophage and a TH cell stimulates the macrophage to
produce and secrete a cytokine called Interleukin-1 (IL-1) that acts locally on the TH cell. The IL-1
stimulates the TH-cell to differentiate and produce its own cytokines (which in this case might be
called lymphokines because they arise from a lymphocyte). These lymphokines have various
functions. Interleukin-4 has an immediate effect on nearby B-cells. Interleukin-2 has an immediate
effect on T cells as described above.

Time is required before a primary immune response is effective as a host defense. Antigens have to be
recognized, taken up, digested, processed, and presented by APCs; a few select TH cells must react
with Ag and respond; preexisting B or T lymphocytes must encounter the Ag and proliferate and
differentiate into effector cells (plasma cells or CTLs). In the case of AMI, antibody level has to build
up to an effective physiological concentration to render its host resistant. It may take several days or
weeks to reach a level of effective immunity, even though this immunity may persist for many months,
or years, or even a lifetime, due to the presence of the antibodies. In natural infections, the inoculum is
small, and even though the antigenic stimulus increases during microbial replication, only small
amounts of antibody are formed within the first few days, and circulating antibody is not detectable
until about a week after infection.

Induction of a secondary immune response

On re-exposure to microbial antigens (secondary exposure to antigen), there is an accelerated

immunological response, the secondary or memory response. Larger amounts of antibodies are formed
in only 1-2 days. This is due to the activities of specific memory B cells or memory T cells which were
formed during the primary immune response. These memory cells, when stimulated by homologous
Ag, "remember" having previously seen the Ag, and are able to rapidly divide and differentiate into
effector cells. Stimulating memory cells to rapidly produce very high (effective) levels of persistent
circulating antibodies is the basis for giving "booster"-type vaccinations to humans and pets.

Figure 4. Primary and Secondary Immune Responses. Following the first exposure to an antigen the immune
response (as evidenced by following the concentration of specific antibody in the serum) develops gradually over a

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period of days, reaches a low plateau within 2-3 weeks, and usually begins to decline in a relatively short period of
time. When the antigen is encountered a second time, a secondory (memory) response causes a rapid rise in the
concentration of antibody, reaching a much higher level in the serum, which may persist for a relatively long period
of time. This is not to say that a protective level of antibody may not be reached by primary exposure alone, but
usually to ensure a high level of protective antibody that persists over a long period of time, it is necessary to have
repeated antigenic stimulation of the immune system.

Antibody-mediated Immunity
Antibodies are proteins produced by lymphocytes that can specifically bind a wide variety of protein
and polysaccharide antigens and elicit a response that is significant in antimicrobial defense. In
conjunction with the complement system, antibodies are the mediators of humoral (circulating)
immunity, and their presence on mucosal surfaces provides resistance to many infectious agents.
Antibodies are essential for the prevention and/or cure of many types of bacterial and viral infections.

As mediators of immunity, it was discovered at the turn of the century that antibodies were contained
within the serum fraction of blood. It was demonstrated in 1939 that antibodies were specifically
located in the gamma fraction of electrophoresed serum, thus the term gammaglobulin was coined for
serum containing antibodies. Antibodies themselves, were called immunoglobulins.

The Classes of Antibodies

There are a number of types of antibodies or immunoglobulins that react stereochemically and
specifically with an antigen that induced their formation. Each of these classes of immunoglobulins
(abbreviated Ig) is produced by a specific clone of plasma cells. Five immunoglobulin classes are
defined on the basis of their heavy chain composition, named IgG, IgM, IgA, IgE, and IgD. IgG and
IgA are further divided into subclasses.

Figure 5. Schematic representation of the various Classes of Immunoglobulins

The classes of immunoglobulins have different physical and chemical characteristics and they exhibit
unique biological properties. Their synthesis occurs at different stages and rates during an immune
response and/or during the course of an infection. Their importance and functions in host resistance
(immunity) are different.

IgG. Immunoglobulin G is the predominant Ig in the serum; it makes up about 80% of the total
antibody found in an animal at any given time, being 75% of the total serum antibody. It can diffuse
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out of the blood stream into the extravascular spaces and it is the most common Ig found there. Its
concentration in tissue fluids is increased during inflammation. It is particularly effective at the
neutralization of bacterial extracellular toxins and viruses. It also has opsonizing ability and
complement-fixing ability. It is IgG that crosses the placental barrier, and thereby provides passive
immunity to the fetus and infant for the first six months of life.

IgG is the model for understanding the structure and function of antibody molecules, and it is fitting to
examine its biochemical properties before discussion of the properties of all of the other types of
immunoglobulins.

Figure 6. Model of an Immunoglobulin: the Structure of IgG

IgG is a protein with a molecular weight of about 150,000 daltons. The protein consists of two
identical heavy (H) chains (each with a mw of about 50kd) and two identical light (L) chains (mw
about 25kd). Each L chain is connected to a H chain and the two H-chains are connected to one another
by disulfide bridges. The molecule is drawn to look like a Y. The stem of the Y is called the Fc region
and it consists mainly of two halves of the identical H chains. Each of the "arms" of the Y contains one
complete L-chain and half of one of the H-chains. The Y stem stands on the carboxy termini of the H
chains; the tips of the arms contain the amino termini of the H and L-chains. Each arm is sometimes
referred to as the Fab region of the molecule. The Fab region is the antigen binding fragment of the
antibody molecule. A specific region of the antigen (called the antigenic determinant) will react
stereochemically with the antigen-binding region at the amino terminus of each Fab. Hence, the IgG
molecule, which has two antigen binding fragments [(Fab)2] is said to be divalent: it can bind to two
Ag molecules. The polypeptide composition of the Fc region of all IgG1 antibody molecules is
relatively constant regardless of antibody specificity; however, the Fab regions always differ in their
exact amino acid sequences depending upon their antigenic specificity. Even though the antigen does
not react with the Fc region of the IgG1 molecule, this should not be taken to mean that the Fc region
has no importance or biological activity. On the contrary, specific amino acid regions of the Fc portion
of the molecule are recognized by receptors on phagocytes and certain other cells, and the Fc domain
contains a peptide region that will bind to and activate complement, which is often required for the
manifestation of AMI.

Understanding the structure and properties of IgG is useful to discussion of its function in host defense.
Since the IgG molecule is divalent, it can cross-link Ag molecules, which may lead to precipitation or
agglutination of antigens; if IgG is bound to Ag on a microbial cell or surface, its Fc region may
provide an extrinsic ligand which will be recognized by specific receptors on phagocytes, Such

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microbial cells or viruses coated with IgG molecules are said to be opsonized for phagocytosis.
Opsonized pathogens are taken up and destroyed much more readily by phagocytes than their non-
opsonized counterparts. IgG, as well as IgM and IgA, will neutralize the activity of toxins, including
bacterial exotoxins. Furthermore, cross-linked IgG molecules on the surface of a cell can bind and
activate complement from the serum and set off a cascade of reactions that can lead to destruction of
the cell (antigen). It is probably due to its relatively small size and its persistence in the serum of a
mother, that IgG is shared with the fetus in utero, and the infant is born with the full complement of
mother's IgG antibodies.

IgM is the first immunoglobulin to be synthesized by infants and the first to appear in the blood stream
during the course of an infection. Mainly, it is confined to the bloodstream giving the host protection
against blood-borne pathogens. IgM makes up about 10% serum immunoglobulins. IgM is arranged to
resemble a pentamer of five immunoglobulin molecules (mw = 900kd) tethered together at by their Fc
domains. In addition to covalent linkages between the monomeric subunits, the pentamer is stabilized
by a 15kd polypeptide called the J chain. IgM, therefore, has a theoretical "valence" of 10 (i.e., it has
exposed 10 Fab domains). Probably, the most important role of IgM is its ability to function early in
the immune responses against blood-borne pathogens. As might be expected, IgM is very efficient at
agglutinating particulate antigens. Also, IgM binds complement strongly and such IgM antibodies
bound to a microbial surface act as opsonins, rendering the microbe more susceptible to phagocytosis.
In the presence of complement and IgM whole microbial cells may be killed and lysed. IgM also
appears on the surfaces of mature B cells as a transmembranous monomer where it functions as an
antigen receptor, capable of activating B cells when bound to antigen.

IgA exists as a 160kd monomer in serum and as a 400kd dimer in secretions. As in the case of IgM,
polymerization (dimerization) is via a J-chain. There are two subclasses based on different heavy
chains, IgA1 and IgA2. IgA1 is produced in bone marrow and makes up most of the serum IgA. Both
IgA1 and IgA2 are synthesized in GALT (gut associated lymphoid tissues) to be secreted onto the
mucosal surfaces. Since IgA may be synthesized locally and secreted in the seromucous secretions of
the body, it is sometimes referred to as secretory antibody or sIgA. Quantitatively, IgA is synthesized
in amounts greater than IgG, but it has a short half life in serum (6 days), and it is lost in secretory
products. The concentration of IgA in serum is about 15% of the total antibody. Secretion of dimeric
IgA is mediated by a 100kd glycoprotein called the secretory component. It is the addition of the
secretory piece to the IgA molecules that accounts for their ability to exit the body to mucosal surfaces
via the exocrine glands. IgM can be transported similarly and makes up a small proportion of secretory
antibodies.

Secretory IgA is the predominant immunoglobulin present in gastrointestinal fluids, nasal secretions,
saliva, tears and other mucous secretions of the body. IgA antibodies are important in resistance to
infection of the mucosal surfaces of the body, particularly the respiratory, intestinal and urogenital
tracts. IgA acts as a protective coating for the mucous surfaces against microbial adherence or initial
colonization. IgA can also neutralize toxin activity on mucosal surfaces. Fc receptors for IgA-coated
microorganisms found on monocytes and neutrophils derived from the respiratory mucosa, suggest that
IgA may have a role in the lung, at least, in opsonization of pathogens.

Secretory IgA is also transferred via the milk, i.e., the colostrum, from a nursing mother to a newborn,
which provides passive immunity to many pathogens, especially those that enter by way of the GI tract.
The transfer of IgA via the milk lasts about six months in a woman and the infant encounters many
infectious agents while thus partially protected. Under these circumstances the infectious agent might
multiply, but only to a limited extent, stimulating the infant's own immune response without causing

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significant disease (e.g. poliovirus). The infant thus acquires active immunity while partially protected
by maternal immunity.

IgE is a 190kd immunoglobulin which accounts for 0.002% of the total serum immunoglobulins. It is
produced especially by plasma cells below the respiratory and intestinal epithelia. The majority of IgE
is bound to tissue cells, especially mast cells. If an infectious agent succeeds in penetrating the IgA
barrier, it comes up against the next line of defense, the MALT (mucosa-associated lymphoid tissues)
system which is manned by IgE. IgE is bound very firmly to the Fc receptors (specifically for IgE) on
mast cells. Contact with Ag leads to release of mediators of inflammation from the mast cells, which
effectively recruits various agents of the immune response including complement, chemotactic factors
for phagocytes, T-cells, etc. Although a well-known manifestation of this reaction is a type of
immediate hypersensitivity reaction called atopic allergy (e.g. hives, asthma, hay fever, etc.), the
MALT responses act as a defense mechanism because they amplify the inflammatory response and
may facilitate rejection of a pathogen.

IgD is a 175kd molecule that resembles IgG in its monomeric form. IgD antibodies are found for the
most part on the surfaces of B lymphocytes. The same cells may also carry IgM antibody. It is thought
that IgD and IgM function as mutually-interacting antigen receptors for control of B-cell activation and
suppression. Hence, IgD may have an immunoregulatory function. Recall that only specific subclones
of B-cells respond to a specific Ag upon stimulation. The specific subclone of B-cells must display an
antibody receptor that recognizes specifically the Ag. It would stand to reason that the basis of this
specificity involved a B-cell receptor that had the sort of specificity characteristic of antibody
molecules.

Functions of Antibodies in Host Defense

The functions of antibodies, and hence the AMI response, in host defense against pathogenic microbes
is summarized below.

Opsonization: Antibodies enhance phagocytic engulfment of microbial antigens. IgG and IgM Abs
have a combining site for the Ag and a site for cytophilic association with phagocytes. Bacteria and
viral particles are ingested with increased efficiency.

Steric hindrance: Antibodies combine with the surfaces of microorganisms and may block or prevent
their attachment to susceptible cells or mucosal surfaces. Ab against a viral component can block
attachment of the virus to susceptible host cells and thereby reduce infectivity. Secretory IgA can block
attachment of pathogens to mucosal surfaces.

Toxin Neutralization: Toxin-neutralizing antibodies (antitoxins) react with a soluble bacterial toxin
and block the interaction of the toxin with its specific target cell or substrate.

Agglutinatio and Precipitation: Antibodies combine with the surfaces of microorganisms or soluble
antigens and cause them to agglutinate or precipitate. This reduces the number of separate infectious
units and makes them more readily phagocytosed because the clump of particles is larger in size. Also,
floccules or aggregates of neutralized toxin may be removed by phagocytes.

Activation of Complement: antibodies combined with the surface of microorganisms or surfaces of

Ag activate the complement cascade which has four principal effects related to host defense

1. induction of the inflammatory responsechemotactic

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2. attraction of phagocytes to the site of immunological encounter

3. opsonization of cells showing foreign Ag

4. complement-mediated lysis of certain bacteria or viruses

Antibody-dependent cell cytotoxicity (ADCC): IgG can enable certain cells (Natural Killer cells) to
recognize and kill opsonized target cells. NK cells are lymphocytes or monocytes, but certain other
types of cells including neutrophils also act this way. NK cells attach to opsonized target cells by
means of an IgG Fc receptor and kill by an extracellular mechanism after attachment. ADCC will be
discussed as part of cell-mediated immunity.

Cell-mediated Immunity
CMI is a type of resistance in which cells of the immune system are directly involved, but antibody
production or activity is of minor importance. CMI differs from AMI in that immunity cannot be
transferred (passively) from animal to animal by antibodies or serum, but can be transferred by
lymphocytes removed from the blood.

The CMI response

During the cell-mediated immune response, various subsets of T lymphocytes are activated and
develop into effector T cells. These include cytotoxic T lymphocytes (CTL's or TC cells) and T
helper cells of the TH1 and TH2 subsets. TH1 cells secrete lymphokines that activate macrophages and
mediate delayed type hypersensitivity responses. TH2 cells secrete lymphokines that stimulate B cell
development and may help activate TC cells to their full cyotoxic capacity.

T cells that generate CMI are present in the lymphoid tissues, blood and lymph. Due to constant
recirculation between blood and lymph nodes via lymphatics and back to the blood, one T cell
circulates once in about 24 hours. Each carries receptors for the specific Ag with which it can react. T
cell recognition of Ag only occurs when the Ag is associated with proteins of the MHC complex. The T
cells have receptors (TCR) complementary to the complexed MHC determinant and the antigenic
determinant. TH1 cells and TH2 cells recognize Ag in association with MHC II (as displayed by
macrophages and other APCs); TC-cells recognize Ag on cells complexed with MHC I (as displayed
by altered self cells).

Stepwise Activation of TC cells

During a primary CMI response, antigen is presented to the precursor TC lymphocytes (CD8+) in
association with MHC Class I proteins. All nucleated cells express MHC I on their surfaces so virtually
any cell in the animal expressing a new ("nonself") Ag on its surface will activate the cytotoxic T
lymphocytes. TH2 cells can augment activation of the TC cells, but they probably are not required.

Activation of TH cells

TH-cells (CD4+) reacting with Ag may produce a variety of lymphokines. Notably, Interleukin-2 (IL-2)
stimulates T cell activation and IL-4 stimulates B cells. It is now clear that the T-helper cells are
composed of distinct subsets that can be distinguished on the basis of their patterns of lymphokine
production.
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TH1 cells "see" foreign Ag on the surface of APC's in the context of MHC II. Mainly, TH1 cells
produce IL-2, gamma IFN and lymphotoxin. This results in macrophage activation and the delayed-
type hypersensitivity (DTH) reaction, and in help for TC cell activation.

TH2 cells also see foreign Ag on the surface of APC's in the context of MHC II. Their response is to
secrete IL-4, IL-5, IL-6, IL-10 and IL-13 that help activate B cells, provide help for the production of
IgE that attaches to mast cells, and promote mast cell and eosinophil activation.

Both types of TH cells develop under most conditions but their ratios and the predominance of certain
lymphokines can vary, and this may mediate the pathology and outcome of certain bacterial infections.

The lymphokines produced by TH cells stimulate B cells and pTC cells, inducing them to proliferate
and mature into effector cells. Gamma Interferon activates macrophages and Natural Killer (NK) cells
to their full cytolytic potential. Lymphotoxins (i.e., tumor necrosis factor or TNF) kill cells at a
distance.

Function of cytotoxic T-lymphocytes

TC (cytotoxic) cells can destroy cells bearing new antigens on their surfaces (as might result in a viral
infection, a tumor cell, or an infection by a bacterial intracellular parasite). TC cells exert their
cytotoxic activity when they are in physical contact with cells bearing new Ag and MHC I protein.
Contact between the TC cell and the target cell is required for lysis, although the exact mechanism of
lysis is not known. The target cell membrane is damaged at the site of contact (the "kiss of death")
leaving a gaping hole about 40 nm in diameter that cannot be repaired. When the TC cell moves away
30-60 seconds later, there is leakage of the cell components, an influx of H2O, and the target cell swells
up and dies. Apparently the TC cell releases some of its cytolytic contents directly into the target cell
so that within a few minutes the target cell literally disintegrates. The TC cell can move away and kill
again.

TC cells generally respond to Ag in association with MHC I proteins on the surface of a target cell. If
they responded to Ag by itself, they could react with it when it was free in extracellular fluids, and their
cytotoxic activity would be triggered off with no purpose. As stated above, almost all host cells,
including macrophages, display MHC I. Hence, an effector TC cell can destroy a macrophage which is
otherwise carrying out a useful function by presenting Ag to TH lymphocytes as part of the AMI or
CMI responses. Usually, the time course of the response is such that TH cells have already developed
and have carried out their (helping) function when TC cells begin to become active.

Delayed Type Hypersensitivity

TH1-cells (CD4+) are a subset of T-lymphocytes that recognize Ag in association with Class II (and
possibly Class I) MHC proteins. When TH1-cells are presented Ag in association with MHC II by a
macrophage, their development is stimulated by macrophage Interleukin-1 (IL-1), and autostimulated
by IL-2, which the TH cell produces. They respond by differentiating and producing a variety
lymphokines that induce a local inflammatory response, and attract, trap, and activate phagocytes. One
aspect of this response is a state of delayed-type hypersensitivity (DTH) in the host. This is usually
evident in chronic infections wherein CMI is largely involved (e.g. tuberculosis).

Delayed-type hypersensitivity reactions usually present themselves as allergic reactions. Such allergic
reactions generally require about 24 hours to develop following a secondary exposure to Ag. This time
is required for the circulating TH cells (actually memory cells) to encounter the Ag and to begin
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producing lymphokines, and to attract macrophages and TC cells to the site, for these cells are the real
mediators of the allergic reaction. The phagocytic and cytolytic activities of these cells are responsible
for the localized tissue destruction which occurs. Poison oak (ivy) rash is a familiar example of delayed
hypersensitivity, but the reaction is also evident in several types of chronic or persistent bacterial
infections including tuberculosis, leprosy and brucellosis, and in some fungal and protozoal infections.

One of the best known examples of the delayed-type hypersensitivity reaction is the Mantoux
(tuberculin) test which is utilized to determine current or previous infection by the tubercle bacillus
(Mycobacterium tuberculosis). A small amount of Ag called the purified protein derivative (PPD),
derived from the cell wall of the bacterium, is injected subcutaneously usually just under the skin of the
forearm. The test is evaluated after 24-48 hours. A positive test is an allergic response (an "urticarial
weal") at the site of the injection, which might look like a swollen reddened area about the size of a
quarter. A negative test is no reaction. A positive test does not mean that the individual has an active
case of tuberculosis, but that the individual has at least been exposed to the tubercle bacillus or one of
its products sufficiently to have undergone a primary immune response. Hence, an individual
exhibiting a positive test may have active tuberculosis, may have an unapparent (subclinical) form of
the disease, may have previously had the disease, or possibly may have been artificially immunized
against the disease.

Two types of cells other than dermal macrophages have been proposed as antigen presenting cells
(APCs) to initiate DTH reactions on the skin, epidermal Langerhans cells and venular endothelial cells.
In humans, antigen presentation by Langerhans cells (which bear class II MHC), probably initiates
sensitization, whereas antigen presentation by endothelial cells probably initiates DTH reactions upon
secondary challenge.

Involvement of macrophages in mediation of CMI

During induction of the cell-mediated immune response, macrophages play their usual role in the
presentation of Ag to T helper cells and in producing cytokines that are involved in the initiation of
immune reactions. In addition, macrophages play a role in the expression of CMI. Many of the
lymphokines produced by TH cells are aimed at attraction, entrapment and activation of macrophages
at the site of the reaction. One of these lymphokines, Gamma Interferon, causes the local macrophage
population to develop an increased number of lysosomes and also increased secretion of microbicidal
products. Oxygen-dependent killing mechanisms of the macrophage are stimulated, and the
macrophage develops increased power to ingest and kill microorganisms. Such lymphokine-stimulated
macrophages are referred to as "angry" or activated macrophages.

Compared to normal macrophages, activated macrophages exhibit much greater ability to destroy
intracellular pathogens. Activated macrophages may play an important role in the recovery from
chronic bacterial infections and in resistance to certain tumors. Activated macrophages may be able to
overcome bacterial intracellular parasites which are able to thwart the macrophage killing mechanisms
before activation. Macrophage involvement in CMI may be part of the pathology of certain diseases.
Where there is difficulty in elimination an intracellular parasite (e.g. the tuberculosis bacillus) the
chronic CMI response to local antigens leads to the accumulations of densely-packed macrophages
which release fibrinogenic factors and stimulate the formation of granulation and fibrosis. The resulting
structure, called a granuloma, actually represents an attempt by the host to isolate a persistent
infection.

Other Aspects of cell-mediated immunity

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Another class of cytotoxic lymphocytes distinct from TC cells may be stimulated during the cell-
mediated immune response. These are referred to as Natural Killer or NK cells. NK cells are found in
blood and lymphoid tissues, especially the spleen. They do not bear T cell (or B cell) markers. Like TC
cells, they are able to recognize and kill cells that are displaying a new Ag on their surfaces, but unlike
TC cells, they do not display TCR and they are not MHC-restricted.

The existence of NK specificity is demonstrated by the phenomenon of "cold target inhibition"; one
NK target cell type can inhibit lysis of a different NK target type by competing for effector cells,
whereas cells that are not NK targets do not compete. NK cells are present in an animal in the absence
of antigenic stimulation, and it is for this reason that they are referred to as "natural" killers. They
might also be considered part of the constitutive defenses; however, NK cells become activated in a
CMI response by T cell lymphokines, including Interleukin-2 and Gamma Interferon.

Some NK cells are thought to be an immature form of a T-lymphocyte, but various other types of cells
including macrophages, neutrophils and eosinophils, display NK activity. Some NK cells have surface
receptors (CD16) for the Fc portion of IgG. They bind to target cells by receptors for the Fc portion of
antibody that has reacted with antigen on the target cell. This type of CMI is called antibody-
dependent cell-mediated cytotoxicity or ADCC. NK cells may also have receptors for the C3
component of complement, and therefore recognize cells that are coated with C3 as targets. ADCC is
thought to be an important defense against a variety of parasitic infections caused by protozoa and
helminths.

Summary: cells involved in expression of CMI

Cell mediated immunity (CMI) is carried out by several types of cells including macrophages, TH
lymphocytes TC lymphocytes, and NK (natural killer) cells. After an immunological encounter, these
cells are activated to produce and/or respond to various classes of lymphokines that are the mediators
of CMI. A summary of the types of cells involved in the xpression of CMI is provided below.

TC (cytotoxic) Lymphocytes (CTLs): kill cells bearing foreign Ag on surface in association with
MHC I. TC cells can kill cells that are harboring intracellular parasites (either bacteria or viruses) as
long as the infected cell is displaying a microbial antigen on its surface. TC cells kill tumor cells and
account for rejection of transplanted cells. TC cells recognize Ag-MHC I complexes on target cells,
contact them, and release the contents of granules directly into the target cell membrane which lyses
the cell.

TH Lymphocytes: produce lymphokines that are "helper" factors for development of B-cells into
antibody-secreting plasma cells; also produce certain lymphokines which stimulate the differentiation
of effector T lymphocytes and the activity of macrophages. TH1 cells recognize Ag on macrophages in
association with MHC II and become activated (by IL-1) to produce lymphokines including gamma
Interferon that activates macrophages and NK cells. These cells mediate various aspects of the CMI
response including delayed type hypersensitivity reactions. TH2 cells recognize Ag in association with
MHC II on an APC and then produce interleukins and other substances that stimulate specific B-cell
and T-cell proliferation and activity.

Macrophages: are important as Ag-presenting cells that initiate T-cell interactions, development and
proliferation. Macrophages are also involved in expression of CMI since they become activated by
gamma IFN produced in a CMI response. Activated macrophages have increased phagocytic potential
and release soluble substances that cause inflammation and destroy many bacteria and other cells.

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Natural Killer (NK) cells: Cytotoxic cells that lyse cells bearing new antigen regardless of their MHC
type and even lyse some cells that bear no MHC proteins. Natural Killer cells are defined by their
ability to kill cells displaying a foreign Ag (e.g. tumor cells) regardless of MHC type and regardless of
previous sensitization (exposure) to the Ag. Some NK cells are probably derived from TC cells (CTLs),
but they do not display T cell markers. NK cells can be activated by IL-2 and gamma IFN. Natural
Killers lyse cells in the same manner as CTLs. Some NK cells have receptors for the Fc domain of IgG
and so are able to bind to the Fc portion of IgG antibody on the surface of a target cell and release
cytolytic components that kill the target cell. This mechanism of killing is referred to as antibody-
dependent cell-mediated cytotoxicity (ADCC).

Summary: Lymphokines involved in expression of CMI

Extracellular factors that affect cell proliferation and differentiation have been defined as cytokines.
These include the lymphokines, which are proteins produced by T-lymphocytes that have effects on the
differentiation, proliferation and activity of various cells involved in the expression of CMI. In general,
lymphokines function by (1) focusing circulating leukocytes and lymphocytes into the site of
immunological encounter; (2) stimulating the development and proliferation of B-cells and T-cells; (3)
stimulating and preparing macrophages for their phagocytic tasks; (4) stimulating natural killer (NK)
cells; (5) providing antiviral cover and activity. The names and functions of some of the important
lymphokines are described below.

IL-1 (Interleukin-1): Initially called lymphocyte activation factor. Mainly a product of macrophages,
IL-1 has a variety of effects on various types of cells. It acts as a growth regulator of T-cells and B-
cells, and it induces other cells such as hepatocytes to produce proteins relevant to host defense. IL-1
forms a chemotactic gradient for neutrophils and serves as an endogenous pyrogen which produces
fever. Thus, IL-1 plays an important role in both the immune responses and in the inflammatory
response.

IL-2 (Interleukin-2): stimulates the proliferation of T-cells and activates NK (natural killer) cells.

IL-3 (Interleukin-3): regulates the proliferation of stem cells and the differentiation of mast cells.

IL-4 (Interleukin-4): causes B cell proliferation and enhanced antibody synthesis.

IL-6 (Interleukin-6): (same as beta Interferon) has effects on B cell differentiation and on antibody
production and on T cell activation, growth, and differentiation. Probably has a major role in the
mediation of the inflammatory and immune responses initiated by infection or injury.

IL-8 (Interleukin-8): chemotactic attractant for neutrophils.

IL-13 (Interleukin-13): shares many of the properties of IL-4, and is a potent regulator of
inflammatory and immune responses.

Interferons: Gamma-Interferon (gamma IFN) is produced by T cells and may be considered a

lymphokine. It is sometimes called "immune interferon" (alpha-Interferon is "leukocyte interferon";
beta-Interferon is "fibroblast interferon"). Gamma-interferon has several antiviral effects including
inhibition of viral protein synthesis in infected cells. It also activates macrophages and NK cells, and
stimulates IL-1, IL-2, and antibody production.

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Lymphotoxins: (Tumor Necrosis Factor-Beta): (TNF-beta is produced by T cells; TNF-alpha is
produced by T cells, as well as other types of cells.) TNF kills cells, including tumor cells (at a
distance).

Colony Stimulating Factor (CSF): several, including GMCSF, cause phagocytic white cells of all
types to differentiate and divide.

Contrasting Roles of the AMI and CMI Responses in Host Defense

AMI and CMI responses are generated during almost all infections, but the relative magnitude and
importance of each type of response shows great variation in different hosts and with different
infectious agents.

In some types of infections antibody plays a major role in immunity or recovery. For example, viruses
producing systemic disease with a viremia stage (viruses free in the blood as they spread from infected
to uninfected cells), such as poliomyelitis or yellow fever, can be controlled ("neutralized") by
circulating antibody. Pathogenic bacteria that multiply outside of cells (nearly all bacteria) at sights
accessible to antibody, phagocytes and complement, can be stopped by the forces of AMI. Diseases
caused by circulating bacterial toxins (e.g. diphtheria and tetanus) are controlled by circulating
antibodies that neutralize toxins. Circulating antibodies (and perhaps secretory IgA, as well) present in
immune animals can prevent reinfection by pathogens.

In other types of infections CMI is of supreme importance in recovery. These tend to be infections
where the microbe grows or multiplies intracellularly. Bacterial infections of this nature include
tuberculosis, brucellosis and syphilis. Recovery is associated with development of a pronounced CMI
response, even though it is CMI that contributes to the pathology of the disease.

The clearest picture of the importance of CMI in recovery from disease is seen in certain viral
infections (e.g. herpes, pox viruses and measles virus infections) Viruses are always intracellular
parasites and may only rarely expose themselves to the extracellular forces of AMI. Antibodies could
neutralize free virus particles liberated from cells but often have little influence on infected cells. The
best strategic defense against virus-infected cells seems to be to kill the infected cell when the virus
may be in a replicative (noninfectious) form. Many viruses, as they mature, cause foreign (viral)
antigens to appear on the infected cell surface. These cells are recognized by the host's CMI defenses
and they become target cells for cytolysis. The infected cell can be destroyed before virus is liberated.

The CMI response also plays a role in destruction of tumor cells and in rejection of tissue transplants in
animals. A major problem in transplantation of tissues from one individual to another is rejection
which is often based on CMI response to "foreign" cells (not a perfect match antigenically). Since
tumor cells contain specific antigens not seen on normal cells they also may be recognized as foreign
and destroyed by the forces of CMI. If tumor cells develop on a regular basis in animals, it may be the
forces o CMI that eliminate them or hold them in check The increase in the incidence of many types of
cancer (tumors) in humans with advancement of age may be correlated with a decline in the peak
efficiency of the immune system that occurs about 25 years of age.

In summary, antibody-mediated immunity (AMI) is probably most useful as an immune defense

because of its ability to neutralize or destroy extracellular pathogens and to prevent occurrence of
reinfection. Cell-mediated immunity (CMI) plays the major role in immune defense against infections
caused by intracellular parasites, infections caused by viruses (either virulent or oncogenic), rejection
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of transplanted tissues or cells, and in the destruction of tumor cells. The contrasting roles of AMI and
CMI as inducible host defenses are presented in the following table.

Table 2. Relative Importance of Immune Defenses in Various Types of Infections

Type of Infectious Agent Immune Defense Mechanisms Examples
AMI: IgG, IgA,
Prevent entry IgM
MULTIPLIES INSIDE TISSUE CELLS viruses, Rickettsia
Kill infected cell CMI: TC, NK,
ADCC
viruses,
Activate CMI:
MULTIPLIES INSIDE PHAGOCYTES Mycobacterium
phagocytes lymphokines
tuberculosis
Kill infected CMI: TC, NK,
phagocytes ADCC
AMI:
Kill microbe
MULTIPLIES OUTSIDE CELLS Complement most bacteria
extracellularly
mediated lysis
Opsonized
phagocytosis and AMI: IgG, IgM
lysis
Neutralize toxins AMI: IgG, IgM
MULTIPLIES OUTSIDE CELLS BUT
streptococci E. coli
ATTACHMENT TO BODY SURFACES Prevent attachment AMI: IgA
Neisseria
REQUIRED FOR INVASION

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 Todar's Online Textbook of Bacteriology

BACTERIAL STRUCTURE IN RELATIONSHIP TO PATHOGENICITY

© 2002 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

The Importance of the Bacterial Surface

All of the various surface components of a bacterial cell are important in its ecology since they mediate
the contact of the bacterium with its environment. The only "senses" that a bacterium has result from its
immediate contact with its environment. It must use its surface components to assess the environment
and respond in a way that supports its own existence and survival in that environment. The surface
properties of a bacterium are determined by the exact molecular composition of its membrane and cell
wall, including LPS, and the other surface structures such as flagella, fimbriae and capsules.

The surface of Streptococcus pyogenes. High magnification electron micrograph of an ultra-thin section by Maria
Fazio and Vincent A.Fischetti, Ph.D. with permission. The Laboratory of Bacterial Pathogenesis and Immunology,
Rockefeller University. At this magnification, especially in the cell on the left, the cell wall and cell surface fibrils,
consisting mainly of M protein, are well defined. The interdigitaion of these fibrils between neighboring cells of
different chains can also be seen.

Bacterial surface components may have a primary biological function that has nothing to do with
pathogenicity. Thus, the function of the LPS in the outer membrane of Gram-negative bacteria has to
do with its permeability characteristics, rather than its toxicity for animals. However, there are endless
examples wherein a bacterial surface component plays an indispensable role in the pathogenesis of
infectious disease. Bacterial surface structures may act as (1) permeability barriers that allow
selective passage of nutrients and exclusion of harmful substances (e.g. antimicrobial agents); (2)
adhesins used to attach or adhere to specific surfaces or tissues; (3) enzymes to mediate specific
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reactions on the cell surface important in the survival of the organism; (4) protective structures
against phagocytic engulfment or killing; (5) antigenic disguises; (6) "sensing proteins" that can
respond to temperature, osmolarity, salinity, light, oxygen, nutrients, etc., resulting in a molecular
signal to the genome of the cell that will cause expression of some determinant of virulence (e.g. an
exotoxin).

In medical situations, the surface components of bacterial cells are major determinants of virulence for
many pathogens. Pathogens can colonize tissues, resist phagocytosis and the immune response, and
induce inflammation, complement activation and immune responses in animals by means of various
structural components.

The surface of Bacillus anthracis. From Mesnage, et al. Journal of Bacteriology (1998) 180, 52-58.
http://www.pasteur.fr/recherche/unites/scme/Biblio/capsulea.htm. The bacterial membrane is evident as the
innermost layer surrounding the cytoplasm. P denotes the peptidoglycan cell wall. S refers to the S-layer which
consists of two proteins including the major antigen. C denotes the poly-D-glutamic acid capsule that is exterior to
and completely covers the S-layer proteins.

The Structure of the Bacterial Surface

Structurally, a bacterial cell has three architectural regions: appendages (proteins attached to the cell
surface) in the form of flagella and fimbriae; a cell envelope consisting of a capsule, cell wall and
plasma membrane; and a cytoplasmic region that contains the cell genome (DNA) and ribosomes and
various sorts of inclusions. The surface components of a bacterium are the constituents of its cell
envelope and appendages.

Flagella are filamentous protein structures attached to the cell surface that provide swimming
movement for most motile bacterial cells. The diameter of a bacterial flagellum is about 20 nanometers,
well-below the resolving power of the light microscope. The flagellar filament is rotated by a motor
apparatus in the plasma membrane allowing the cell to swim in fluid environments. Bacterial flagella
are powered by proton motive force (chemiosmotic potential) established on the bacterial membrane.

Bacteria are known to exhibit a variety of types of tactic behavior, i.e., the ability to move (swim) in
response to environmental stimuli. For example, during chemotaxis a bacterium can sense the quality
and quantity of certain chemicals in its environment and swim towards them (if they are useful
nutrients) or away from them (if they are harmful substances). During aerotaxis, bacteria swim toward
or away from O2.

For a few pathogens motility is known to be a determinant of virulence. In the case of Vibrio cholerae,
the vibrios apparently swim (laterally) into the intestinal mucosa to avoid being flushed out by the
peristaltic action of the gut. Flagella are antigenic, and therefore, vulnerable to attack by host antibody
molecules. Antibody molecules directed against flagellar antigens can agglutinate and/or immobilize

256
bacterial cells, or possibly opsonize them from phagocytosis, which presumably would aid in host
defense.

Vibrio cholerae. Liefson's flagellar stain (CDC). Bacterial flagella are below the resolving power of the light
microscope. In order to be visualized, the bacteria must be reacted with a stain that precipitates along the flagellar
filaments, which increases their effective diameter to the point of resolution. Vibrio cholerae is motile by means of a
single polar flagellum inserted into one pole of the cell.

Fimbriae and Pili are interchangeable terms used to designate short, hair-like structures on the surfaces
of bacterial cells. Fimbriae are shorter and stiffer than flagella, and slightly smaller in diameter. Like
flagella, they are composed of protein. A specialized type of pilus (always called a pilus), the F or sex
pilus, mediates the transfer of DNA between mating bacteria, but the function of the smaller, more
numerous common pili is quite different. Inasmuch as many bacteria are able to exchange genes for
virulence by means of conjugation, the sex pilus which confers the ability to conjugate, may well play a
role in the their assembly of virulence determinants.

Common pili (almost always called fimbriae) are usually involved in adherence (attachment) of
bacterial cells to surfaces in nature. In medical situations, they are major determinants of bacterial
virulence because they allow pathogens to attach to (colonize) tissues and to resist attack by phagocytic
white blood cells. As surface structures on the bacterial cell, the functions of fimbriae overlap with
those of capsules discussed below. Fimbriae are also antigenic and secretory antibodies (IgA) will often
block bacterial colonization, while circulating antibodies (IgG or IgM) will opsonize bacterial cells for
phagocytosis.

Neisseria gonorrhoeae. Electron micrograph by David M. Phillips, Visuals Unlimited, with permission. This
pathogen utilizes its fimbriae in order to initially colonize the urethral or cervical epithelium.

Most bacteria contain some sort of a polysaccharide layer outside of the cell wall or outer membrane.
In a general sense, this layer is called a capsule. A true capsule is a discrete detectable layer of
polysaccharides deposited outside the cell wall. A less discrete structure or matrix which embeds the
cells is a called a slime layer. A type of capsule found in bacteria called a glycocalyx is a thin layer of
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tangled polysaccharide fibers which is almost always observed on the surface of cells growing in nature
(as opposed to the laboratory). Capsules, slime layers, and glycocalyx are known to mediate specific or
non specific adherence of bacteria to particular surfaces. Capsules are known to protect bacteria from
engulfment by predatory phagocytes and from attack by antimicrobial agents.

In nature, and in many medical situations, colonies of bacteria construct and live in a biofilm, made up
principally of capsule material. A biofilm usually consists of a consortium (mixture) of bacteria living
in a matrix of slime which is secreted by one of the bacterial members. Dental plaque is an example of
a natural biofilm, as is a slimy mass of bacteria attached to a rock in a mountain stream. In medical
situations, bacteria in a biofilm may have certain advantages over planktonic counterparts. For
example, biofilm bacteria may be less susceptible to phagocytes, drugs, or neutralizing antibodies.

Many polysaccharide capsules possess an antigenic epitope so they will induce and react with host
antibodies. Where the capsule is a main determinant of virulence of a pathogen (e.g. Streptococcus
pneumoniae) antibodies against the bacterium neutralize its virulence.

Bacterial capsules visualized by various techniques. Left. Streptococcus pneumoniae -India ink capsule outline
(K.Todar); Middle. Bacillus anthracis -fluorescent-tagged antibody (CDC); Right. Streptococcus pyogenes -
transmission electron micrograph by Maria Fazio and Vincent A. Fischetti, Ph.D. with permission. The Laboratory
of Bacterial Pathogenesis and Immunology , Rockefeller University. S. pneumoniae capsular material is composed of
polysaccharide. The capsule is the pathogen's most important determinant of virulence because it allows the
bacterial cells to escape phagocytes in the lung. The B.anthracis capsule is composed of poly-D-glutamic acid. Its
capsule is antiphagocytic, and it protects the bacteria from complement- mediated lysis in serum or blood. The
capsule of S. pyogenes is composed of hyaluronic acid, the same polymer as found in human connective tissue. The
capsule is an antigenic disguise that prevents recognition of the streptococci by phagocytes or the immune system.

The cell wall of a bacterium is an essential structure that protects the delicate cell protoplast from
osmotic lysis. The cell wall of Bacteria consists of a polymer of disaccharides cross-linked by short
chains of amino acids (peptides). This molecule is a type of peptidoglycan called murein. Murein is
unique to Bacteria. In the Gram-positive bacteria, the cell wall is thick (15-80 nanometers), consisting
of several layers of peptidoglycan complexed with molecules called teichoic acids . In the Gram-
negative bacteria, the cell wall is relatively thin (10 nanometers) and is composed of a single layer of
peptidoglycan surrounded by a membranous structure called the outer membrane. Murein is a
substance unique in nature to bacterial cell walls. Also, the outer membrane of Gram-negative bacteria
invariably contains a unique component, lipopolysaccharide (LPS or endotoxin), which is toxic to
animals.

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The structure of the muramic acid subunit in the peptidoglycan Escherichia. col1. The molecule consists of N-acetyl
glucoasamine (NAG) attached (via a beta 1,4 link) to N-acetyl-muramic acid (NAM).Attached to the NAM is a
peptide chain, which (in the case of E. coli, as illustrated) consists of L-alanine, D-glutamate, diaminopimelic acid
and D-alanine. Some antibiotics, including bacitracin, act by blocking the synthesis of the muramic acid subunit.
Penicillin and related antibiotics (beta lactams), as well as vancomycin, block the assembly of the muropeptide
subunits into the peptidoglycan polymer.

The cell wall is a complicated structure, fundamentally different in Gram-positive and Gram-negative
bacteria. Cell wall components are major determinants of virulence in both groups of bacteria.
Endotoxin, inherent to all Gram-negative bacteria, is toxic to animals in a variety of ways.
Peptidoglycan and LPS, as well as some teichoic acids, induce the alternate complement pathway
leading to inflammation. Teichoic acids and O-specific polysaccharides may be used as adhesins by
Gram-positive and Gram-negative bacteria, respectively. Some cell wall components protect against
phagocytic engulfment or digestion. Variations in the macromolecular structure of cell wall
components may be at the basis of antigenic variation as well as specific host resistance to pathogens.

259
E. coli 0157. Transmission electron micrograph (CDC). O157 refers to the antigenic type of E. coli which, in this
case, is based on the precise molecular structure of the O-specific polysaccharide in the cell wall LPS.

The essential outer membrane of Gram-negative bacteria is the target for attack by complement,
hydrophobic agents and certain antibiotics. Murein (peptidoglycan) is dismantled by a host enzyme,
lysozyme, found in most body fluids. Several antibiotics, mainly the beta lactams, exert their
antimicrobial effect by blocking the synthesis and assembly of peptidoglycan.

Schematic drawing the outer membrane of a Gram-negative bacterium

260
The membranes of Bacteria are structurally similar to the cell membranes of eukaryotes, except that
bacterial membranes consist of saturated or monounsaturated fatty acids (never polyunsaturated fatty
acids) and do not normally contain sterols. The plasma membrane is an exceptionally dynamic
structure in bacteria which mediates permeability, transport, secretion and energy generation. In terms
of pathogenesis of a bacterium, it is absolutely dependent upon the integrity and function of its plasma
membrane. The membrane might be responsible for secretion of toxins, resistance to antimicrobial
agents, tactic responses or sensing other environmental signals to turn on or off genes for virulence.

Endospores are bacterial structures (resting cells) formed by a few groups of bacteria as intracellular
structures, but ultimately they are released as free endospores. Biologically, endospores are a
fascinating type of cell. Endospores exhibit no signs of life, being described as cryptobiotic. They are
highly resistant to environmental stresses such as high temperature (some endospores can be boiled for
hours and retain their viability), irradiation, strong acids, disinfectants, etc. They are probably the most
durable cell produced in nature. Although cryptobiotic, they retain viability indefinitely such that under
appropriate environmental conditions, they germinate back into vegetative cells.

Endospores are formed by two genera of Gram-positive bacteria: Bacillus, the aerobic sporeformers,
and Clostridium, the anaerobic sporeformers. Both genera contain pathogens, and the endospores
produced by these bacteria invariably play some role in the toxicity, transmission or survival of the
pathogen.

Spore stain of a Bacillus species. (CDC). Mature spores stain green whether free or still inside the
vegetative sporangium. Vegetative cells and sporangia stain red. The Schaeffer-Fulton stain technique
was applied. The primary stain, malachite green, is forced into the spores by heating the prepared slide
to boiling for 4-5 minutes. After washing, the vegetative cells are counterstained with safranine.

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MECHANISMS OF BACTERIAL PATHOGENICITY: COLONIZATION AND

INVASION
© 2002 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

Introduction

Microbial pathogenicity has been defined as the structural and biochemical mechanisms whereby
microorganisms cause disease. Pathogenicity in bacteria may be associated with unique structural
components of the cells (e.g. capsules, fimbriae, LPS or other cell wall components) or active secretion
of substances that either damage host tissues or protect the bacteria against host defenses.

Infection may imply colonization, multiplication, invasion or persistence of a pathogen on or within a

host, but disease (infectious disease) is used to describe an infection that causes significant overt
damage to the host. There are two broad qualities of pathogenic bacteria underlie the means by which
they cause disease: invasiveness and toxigenesis.

Invasiveness is the ability to invade tissues. This encompasses mechanisms for colonization
(adherence and initial multiplication), ability to bypass or overcome host defense mechanisms, and the
production of extracellular substances ("invasins") which facilitate the actual invasive process. This
chapter deals with the first two aspects of of invasiveness: colonization and invasion.

Toxigenesis is the ability to produce toxins.Toxic substances, both soluble and cell-associated, may
be transported by blood and lymph and cause cytotoxic effects at tissue sites remote from the original
point of invasion or growth.

COLONIZATION

The first stage of microbial infection is colonization: the establishment of the pathogen at the
appropriate portal of entry. Pathogens usually colonize host tissues that are in contact with the external
environment. Sites of entry in human hosts include the urogenital tract, the digestive tract, the
respiratory tract and the conjunctiva. Organisms that infect these regions have usually developed tissue
adherence mechanisms and some ability to overcome or withstand the constant pressure of the host
defenses on the surface.

Bacterial Adherence to Mucosal Surfaces. In its simplest form, bacterial adherence or attachment to
a eukaryotic cell or tissue surface requires the participation of two factors: a receptor and an adhesin.
The receptors so far defined are usually specific carbohydrate or peptide residues on the eukaryotic cell
surface. The bacterial adhesin is typically a macromolecular component of the bacterial cell surface
which interacts with the host cell receptor. Adhesins and receptors usually interact in a complementary
and specific fashion. Table 1 is a list of terms that are used in medical microbiology to refer

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tomicrobial adherence to surfaces or tissues.

TABLE 1. TERMS USED TO DESCRIBE ADHERENCE FACTORS IN HOST-PARASITE

INTERACTIONS
ADHERENCE FACTOR DESCRIPTION
A surface structure or macromolecule that binds a bacterium to a specific
Adhesin
surface
A complementary macromolecular binding site on a (eukaryotic) surface
Receptor
that binds specific adhesins or ligands
Lectin Any protein that binds to a carbohydrate
A surface molecule that exhibits specific binding to a receptor molecule
Ligand
on another surface
The mucopolysaccharide layer of glucosaminoglycans covering animal
Mucous
cell mucosal surfaces
Filamentous proteins on the surface of bacterial cells that may behave as
Fimbriae
adhesins for specific adherence
Common pili Same as fimbriae
A specialized pilus that binds mating procaryotes together for the purpose
Sex pilus
of DNA transfer
Fimbriae in Enterobacteriaceae which bind specifically to mannose
Type 1 fimbriae
terminated glycoproteins on eukaryotic cell surfaces
A layer of exopolysaccharide fibers on the surface of bacterial cells which
Glycocalyx
may be involved in adherence to a surface
A detectable layer of polysaccharide (rarely polypeptide) on the surface of
Capsule
a bacterial cell which may mediate specific or nonspecific attachment
A distinct cell wall component of the outer membrane of Gram-negative
Lipopolysaccharide (LPS) bacteria with the potential structural diversity to mediate specific
adherence. Probably functions as an adhesin
Teichoic acids and Cell wall components of Gram-positive bacteria that may be involved in
lipoteichoic acids (LTA) nonspecific or specific adherence

Specific Adherence of Bacteria to Cell and Tissue Surfaces

Several types of observations provide indirect evidence for specificity of adherence of bacteria to host
cells or tissues:

1. Tissue tropism: particular bacteria are known to have an apparent preference for certain tissues over
others, e.g. S. mutans is abundant in dental plaque but does not occur on epithelial surfaces of the
tongue; the reverse is true for S. salivarius which is attached in high numbers to epithelial cells of the
tongue but is absent in dental plaque.

2. Species specificity: certain pathogenic bacteria infect only certain species of animals, e.g. N.
gonorrhoeae infections are limited to humans; Enteropathogenic E. coli K-88 infections are limited to

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pigs; E. coli CFA I and CFA II infect humans; E.coli K-99 strain infects calves.; Group A streptococcal
infections occur only in humans.

3. Genetic specificity within a species: certain strains or races within a species are genetically immune
to a pathogen , e.g. Certain pigs are not susceptible to E. coli K-88 infections; Susceptibility to
Plasmodium vivax infection (malaria) is dependent on the presence of the Duffy antigens on the host's
redblood cells.

Although other explanations are possible, the above observations might be explained by the existence
of specific interactions between microorganisms and eukaryotic tissue surfaces which allow
microorganisms to become established on the surface.

Mechanisms of Adherence to Cell or Tissue Surfaces

The mechanisms for adherence may involve two steps:

1. nonspecific adherence: reversible attachment of the bacterium to the eukaryotic surface

(sometimes called "docking")

2. specific adherence: reversible permanent attachment of the microorganism to the surface

(sometimes called "anchoring").

The usual situation is that reversible attachment precedes irreversible attachment but in some cases, the
opposite situation occurs or specific adherence may never occur

Nonspecific adherence involves nonspecific attractive forces which allow approach of the bacterium
to the eukaryotic cell surface. Possible interactions and forces involved are:

1. hydrophobic interactions

2. electrostatic attractions

3. atomic and molecular vibrations resulting from fluctuating dipoles of similar frequencies

4. Brownian movement

5. recruitment and trapping by biofilm polymers interacting with the bacterial glycocalyx (capsule)

Specific adherence involves permanent formation of many specific lock-and-key bonds between
complementary molecules on each cell surface. Complementary receptor and adhesin molecules must
be accessible and arranged in such a way that many bonds form over the area of contact between the
two cells. Once the bonds are formed, attachment under physiological conditions becomes virtually
irreversible.

Several types of experiments provide direct evidence that receptor and/or adhesin molecules
mediate specificity of adherence of bacteria to host cells or tissues. These include:

1. The bacteria will bind isolated receptors or receptor analogs.

2. The isolated adhesins or adhesin analogs will bind to the eukaryotic cell surface.
264
3. Adhesion (of the bacterium to the eukaryotic cell surface) is inhibited by:

a. isolated adhesin or receptor molecules

b. adhesin or receptor analogs

c. enzymes and chemicals that specifically destroy adhesins or receptors

d. antibodies specific to surface components (i.e., adhesins or receptors)

Some Specific Bacterial Adhesins and their Receptors

The adhesins of E. coli are their common pili or fimbriae. A single strain of E. coli is known to be able
to express several distinct types of fimbriae encoded by distinct regions of the chromosome or
plasmids. This genetic diversity permits an organism to adapt to its changing environment and exploit
new opportunities presented by different host surfaces. Many of the adhesive fimbriae of E. coli have
probably evolved from fimbrial ancestors resembling Type-1 and type 4 fimbriae.

Type-1 fimbriae enable E. coli to bind to D-mannose residues on eukaryotic cell surfaces. Type-1
fimbriae are said to be "mannose-sensitive" since exogenous mannose blocks binding to receptors on
red blood cells. Although the primary 17kDa fimbrial subunit is the major protein component of Type-
1 fimbriae, the mannose-binding site is not located here, but resides in a minor protein (28-31kDa)
located at the tips or inserted along the length of the fimbriae. By genetically varying the minor "tip
protein" adhesin, the organisms can gain ability to adhere to different receptors. For example, tip
proteins on pyelonephritis-associated (pap) pili recognize a galactose-galactose disaccharide, while tip
proteins on S-fimbriae recognize sialic acid.

Pseudomonas, Vibrio and Neisseria possess a fimbrial protein subunit which contains methylated
phenylalanine at its amino terminus. These "N-methylphenylalanine pili" have been established as
virulence determinants in pathogenesis of Pseudomonas aeruginosa lung infection in cystic fibrosis
patients. These type of fimbriae occur in Neisseria gonorrhoeae and their receptor is thought to be an
oligosaccharide.

The adhesins of Streptococcus pyogenesare controversial. In 1972, Gibbons and his colleagues
demonstrated that attachment of streptococci to the oral mucosa of mice is dependent on M protein.
Olfek and Beachey argued that lipoteichoic acid (LTA), rather than M protein, was responsible for
streptococcal adherence to buccal epithelial cells. In 1996, Hasty and Courtney proposed a two-step
model of attachment that involved both M protein and teichoic acids. They suggested that LTA loosely
tethers streptococci to epithelial cells, and then M protein secures a firmer, irreversible association. In
1992, protein F was
discovered and found to be a fibronectin binding protein. More recently, in 1998, M proteins M1 and
M3 were also found to bind to fibronectin. Apparently, S. pyogenes produces multiple adhesins with
varied specificities.

Staphylococcus aureus also binds to the amino terminus of fibronectin by means of a fibronectin-
binding protein which occurs on the bacterial surface. Apparently S. aureus and Group A streptococci
use different mechanisms but adhere to the same receptor on epithelial surfaces.

Treponema pallidum has three related surface adhesins (P1, P2 and P3) which bind to a four-amino
acid sequence (Arg-Gly-Asp-Ser) of the cell-binding domain of fibronectin. It is not clear if T.
265
pallidum uses fibronectin to attach to host surfaces or coats itself with fibronectin to avoid host
defenses (phagocytes and immune responses).

TABLE 2. EXAMPLES OF SPECIFIC ATTACHMENTS OF BACTERIA TO HOST

CELL OR TISSUE SURFACES
Bacterium Adhesin Receptor Attachment site Disease
Streptococcus Amino terminus of Pharyngeal
Protein F Sore throat
pyogenes fibronectin epithelium
Streptococcus Salivary
Glycosyl transferase Pellicle of tooth Dental caries
mutans glycoprotein
Buccal
Streptococcus
Lipoteichoic acid Unknown epithelium of None
salivarius
tongue
N-
Streptococcus acetylhexosamine- Mucosal
Cell-bound protein pneumonia
pneumoniae galactose epithelium
disaccharide
Staphylococcus Amino terminus of Mucosal
Cell-bound protein Various
aureus fibronectin epithelium
Glucosamine-
Neisseria N-methylphenyl- Urethral/cervical
galactose Gonorrhea
gonorrhoeae alanine pili epithelium
carbohydrate
Enterotoxigenic Species-specific Intestinal
Type-1 fimbriae Diarrhea
E. coli carbohydrate(s) epithelium
Uropathogenic Complex Urethral
Type 1 fimbriae Urethritis
E. coli carbohydrate epithelium
Uropathogenic Globobiose linked Upper urinary
P-pili (pap) Pyelonephritis
E. coli to ceramide lipid tract
Fimbriae
Bordetella Galactose on Respiratory Whooping
("filamentous
pertussis sulfated glycolipids epithelium cough
hemagglutinin")
N- Fucose and
Intestinal
Vibrio cholerae methylphenylalanine mannose Cholera
epithelium
pili carbohydrate
Treponema Peptide in outer Surface Mucosal
Syphilis
pallidum membrane protein(fibronectin) epithelium
Respiratory
Mycoplasma Membrane protein Sialic acid Pneumonia
epithelium
Conjunctival or
Conjunctivitis
Chlamydia Unknown Sialic acid urethral
or urethritis
epithelium

INVASION

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The invasion of a host by a pathogen may be aided by the production of bacterial extracellular
substances which act against the host by breaking down primary or secondary defenses of the body.
Medical microbiologists have long referred to these substances as invasins.* Invasins are proteins
(enzymes) that act locally to damage host cells and/or have the immediate effect of facilitating the
growth and spread of the pathogen. The damage to the host as a result of this invasive activity may
become part of the pathology of an infectious disease.

*Some modern texts and research articles have used the term invasin in a very specific manner to refer to certain
bacterial proteins that aid the bacteria in their penetration of nonphagocytic host cells as an intracellular residence.
These invasins are surface and/or diffusible proteins that promote actin rearrangement in the cytoskeleton of the
host cells that stimulates engulfment of the bacteria. These types of invasins are utilized by intracellular pathogens
such as Listeria, Yersinia and Shigella.

The extracellular proteins produced by bacteria which promote their invasion are not clearly
distinguished from some extracellular protein toxins ("exotoxins") which also damage the host.
Invasins usually act at a short range (in the immediate vicinity of bacterial growth) and may not
actually kill cells in their range of activity; exotoxins are often cytotoxic and may act at remote sites
(removed from the site of bacterial growth). Also, exotoxins typically are more specific and more
potent in their activity than invasins. Even so, some classic exotoxins (e.g. diphtheria toxin, anthrax
toxin) may play some role in invasion in the early stages of an infection, and some invasins (e.g.
staphylococcal leukocidin) have a relatively specific cytopathic effect.

A Survey of Bacterial Invasins

Spreading Factors

"Spreading Factors" is a descriptive term for a family of bacterial enzymes that affect the physical
properties of tissue matrices and intercellular spaces, thereby promoting the spread of the pathogen.

Hyaluronidase. is the original spreading factor It is produced by streptococci. staphylococci, and

clostridia. The enzyme attacks the interstitial cement ("ground substance") of connective tissue by
depolymerizing hyaluronic acid.

Collagenase is produced by Clostridium histolyticum and Clostridium perfringens. It breaks down

collagen, the framework of muscles, which facilitates gas gangrene due to these organisms.

Neuraminidase is produced by intestinal pathogens such as Vibrio cholerae and Shigella dysenteriae.
It degrades neuraminic acid (also called sialic acid), an intercellular cement of the epithelial cells of the
intestinal mucosa.

Streptokinase and Staphylokinase are produced by streptococci and staphylococci, respectively.

Kinase enzymes convert inactive plasminogen to plasmin which digests fibrin and prevents clotting of
the blood. The relative absence of fibrin in spreading bacterial lesions allows more rapid diffusion of
the infectious bacteria.

Enzymes that Cause Hemolysis and/or Leucolysis

These enzymes usually act on the animal cell membrane by insertion into the membrane (forming a
pore that results in cell lysis), or by enzymatic attack on phospholipids, which destabilizes the
membrane. They may be referred to as lecithinases or phospholipases, and if they lyse red blood cells
they are sometimes called hemolysins. Leukocidins, produced by staphylococci and streptolysin
267
produced by streptococci specifically lyse phagocytes and their granules. These latter two enzymes are
also considered to be bacterial exotoxins.

Phospholipases, produced by Clostridium perfringens (i.e., alpha toxin), hydrolyze phospholipids in

cell membranes by removal of polar head groups.

Lecithinases, also produced by Clostridium perfringens, destroy lecithin (phosphatidylcholine) in cell

membranes.

Hemolysins, notably produced by staphylococci (i.e., alpha toxin), streptococci (i.e.,streptolysin) and
various clostridia, may be channel-forming proteins or phospholipases or lecithinases that destroy red
blood cells and other cells (i.e., phagocytes) by lysis.

Staphylococcal coagulase

Coagulase, formed by Staphylococcus aureus, is a cell-associated and diffusible enzyme that converts
fibrinogen to fibrin which causes clotting. Coagulase activity is almost alway associated with
pathogenic S. aureus and almost never associated with nonpathogenic S. epidermidis, which has led to
much speculation as to its role as a determinant of virulence. Possibly, cell bound coagulase could
provide an antigenic disguise if it clotted fibrin on the cell surface. Or a staphylococcal lesion encased
in fibrin (e.g. a boil or pimple) could make the bacterial cells resistant to phagocytes or tissue
bactericides or even drugs which might be unable to diffuse to their bacterial target.

Extracellular Digestive Enzymes

Heterotrophic bacteria, in general, produce a wide variety of extracellular enzymes including

proteases, lipases, glycohydrolases, nucleases, etc., which are not clearly shown to have a direct role
in invasion or pathogenesis. These enzymes presumably have other functions related to bacterial
nutrition or metabolism, but may aid in invasion either directly or indirectly.

Toxins With Short-Range Effects Related to Invasion

Bacterial protein toxins which have adenylate cyclase activity, are thought to have immediate effects
on host cells that promote bacterial invasion. One component of the anthrax toxin (EF = Edema
Factor) is an adenylate cyclase that acts on nearby cells to cause increased levels of cyclic AMP and
disruption of cell permeability. One of the toxins of Bordetella pertussis, the agent of whooping
cough, has a similar effect. These toxins may contribute to invasion through their effetcts on
macrophages or lymphocytes in the vicinity which are playing an essential role to contain the infection.

The following table summarizes the activities of many bacterial proteins that are noted for their
contribution to bacterial invasion of tissues.

TABLE 3. SOME EXTRACELLULAR BACTERIAL PROTEINS THAT ARE CONSIDERED

INVASINS
Invasin Bacteria Involved Activity
Streptococci,
Hyaluronidase staphylococci and Degrades hyaluronic of connective tissue
clostridia
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Collagenase Clostridium species Dissolves collagen framework of muscles
Vibrio cholerae and
Neuraminidase Degrades neuraminic acid of intestinal mucosa
Shigella dysenteriae
Coagulase Staphylococcus aureus Converts fibrinogen to fibrin which causes clotting
Staphylococci and
Kinases Converts plasminogen to plasmin which digests fibrin
streptococci
Disrupts neutrophil membranes and causes discharge of
Leukocidin Staphylococcus aureus
lysosomal granules
Repels phagocytes and disrupts phagocyte membrane and
Streptolysin Streptococcus pyogenes
causes discharge of lysosomal granules
Streptococci,
Phospholipases or lecithinases that destroy red blood cells
Hemolysins staphylococci and
(and other cells) by lysis
clostridia
Lecithinases Clostridium perfringens Destroy lecithin in cell membranes
Phospholipases Clostridium perfringens Destroy phospholipids in cell membrane
One component (EF) is an adenylate cyclase which
Anthrax toxin Bacillus anthracis
causes increased levels of intracellular cyclic AMP
One toxin component is an adenylate cyclase that acts
Pertussis toxin Bordetella pertussis
locally producing an increase in intracellular cyclic AMP

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 Todar's Online Textbook of Bacteriology

MECHANISMS OF BACTERIAL PATHOGENICITY: COLONIZATION AND

INVASION
© 2002 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

Introduction

Microbial pathogenicity has been defined as the structural and biochemical mechanisms whereby
microorganisms cause disease. Pathogenicity in bacteria may be associated with unique structural
components of the cells (e.g. capsules, fimbriae, LPS or other cell wall components) or active secretion
of substances that either damage host tissues or protect the bacteria against host defenses.

Infection may imply colonization, multiplication, invasion or persistence of a pathogen on or within a

host, but disease (infectious disease) is used to describe an infection that causes significant overt
damage to the host. There are two broad qualities of pathogenic bacteria underlie the means by which
they cause disease: invasiveness and toxigenesis.

Invasiveness is the ability to invade tissues. This encompasses mechanisms for colonization
(adherence and initial multiplication), ability to bypass or overcome host defense mechanisms, and the
production of extracellular substances ("invasins") which facilitate the actual invasive process. This
chapter deals with the first two aspects of of invasiveness: colonization and invasion.

Toxigenesis is the ability to produce toxins.Toxic substances, both soluble and cell-associated, may
be transported by blood and lymph and cause cytotoxic effects at tissue sites remote from the original
point of invasion or growth.

COLONIZATION

The first stage of microbial infection is colonization: the establishment of the pathogen at the
appropriate portal of entry. Pathogens usually colonize host tissues that are in contact with the external
environment. Sites of entry in human hosts include the urogenital tract, the digestive tract, the
respiratory tract and the conjunctiva. Organisms that infect these regions have usually developed tissue
adherence mechanisms and some ability to overcome or withstand the constant pressure of the host
defenses on the surface.

Bacterial Adherence to Mucosal Surfaces. In its simplest form, bacterial adherence or attachment to
a eukaryotic cell or tissue surface requires the participation of two factors: a receptor and an adhesin.
The receptors so far defined are usually specific carbohydrate or peptide residues on the eukaryotic cell
surface. The bacterial adhesin is typically a macromolecular component of the bacterial cell surface
which interacts with the host cell receptor. Adhesins and receptors usually interact in a complementary
and specific fashion. Table 1 is a list of terms that are used in medical microbiology to refer

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tomicrobial adherence to surfaces or tissues.

TABLE 1. TERMS USED TO DESCRIBE ADHERENCE FACTORS IN HOST-PARASITE

INTERACTIONS
ADHERENCE FACTOR DESCRIPTION
A surface structure or macromolecule that binds a bacterium to a specific
Adhesin
surface
A complementary macromolecular binding site on a (eukaryotic) surface
Receptor
that binds specific adhesins or ligands
Lectin Any protein that binds to a carbohydrate
A surface molecule that exhibits specific binding to a receptor molecule
Ligand
on another surface
The mucopolysaccharide layer of glucosaminoglycans covering animal
Mucous
cell mucosal surfaces
Filamentous proteins on the surface of bacterial cells that may behave as
Fimbriae
adhesins for specific adherence
Common pili Same as fimbriae
A specialized pilus that binds mating procaryotes together for the purpose
Sex pilus
of DNA transfer
Fimbriae in Enterobacteriaceae which bind specifically to mannose
Type 1 fimbriae
terminated glycoproteins on eukaryotic cell surfaces
A layer of exopolysaccharide fibers on the surface of bacterial cells which
Glycocalyx
may be involved in adherence to a surface
A detectable layer of polysaccharide (rarely polypeptide) on the surface of
Capsule
a bacterial cell which may mediate specific or nonspecific attachment
A distinct cell wall component of the outer membrane of Gram-negative
Lipopolysaccharide (LPS) bacteria with the potential structural diversity to mediate specific
adherence. Probably functions as an adhesin
Teichoic acids and Cell wall components of Gram-positive bacteria that may be involved in
lipoteichoic acids (LTA) nonspecific or specific adherence

Specific Adherence of Bacteria to Cell and Tissue Surfaces

Several types of observations provide indirect evidence for specificity of adherence of bacteria to host
cells or tissues:

1. Tissue tropism: particular bacteria are known to have an apparent preference for certain tissues over
others, e.g. S. mutans is abundant in dental plaque but does not occur on epithelial surfaces of the
tongue; the reverse is true for S. salivarius which is attached in high numbers to epithelial cells of the
tongue but is absent in dental plaque.

2. Species specificity: certain pathogenic bacteria infect only certain species of animals, e.g. N.
gonorrhoeae infections are limited to humans; Enteropathogenic E. coli K-88 infections are limited to

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pigs; E. coli CFA I and CFA II infect humans; E.coli K-99 strain infects calves.; Group A streptococcal
infections occur only in humans.

3. Genetic specificity within a species: certain strains or races within a species are genetically immune
to a pathogen , e.g. Certain pigs are not susceptible to E. coli K-88 infections; Susceptibility to
Plasmodium vivax infection (malaria) is dependent on the presence of the Duffy antigens on the host's
redblood cells.

Although other explanations are possible, the above observations might be explained by the existence
of specific interactions between microorganisms and eukaryotic tissue surfaces which allow
microorganisms to become established on the surface.

Mechanisms of Adherence to Cell or Tissue Surfaces

The mechanisms for adherence may involve two steps:

1. nonspecific adherence: reversible attachment of the bacterium to the eukaryotic surface

(sometimes called "docking")

2. specific adherence: reversible permanent attachment of the microorganism to the surface

(sometimes called "anchoring").

The usual situation is that reversible attachment precedes irreversible attachment but in some cases, the
opposite situation occurs or specific adherence may never occur

Nonspecific adherence involves nonspecific attractive forces which allow approach of the bacterium
to the eukaryotic cell surface. Possible interactions and forces involved are:

1. hydrophobic interactions

2. electrostatic attractions

3. atomic and molecular vibrations resulting from fluctuating dipoles of similar frequencies

4. Brownian movement

5. recruitment and trapping by biofilm polymers interacting with the bacterial glycocalyx (capsule)

Specific adherence involves permanent formation of many specific lock-and-key bonds between
complementary molecules on each cell surface. Complementary receptor and adhesin molecules must
be accessible and arranged in such a way that many bonds form over the area of contact between the
two cells. Once the bonds are formed, attachment under physiological conditions becomes virtually
irreversible.

Several types of experiments provide direct evidence that receptor and/or adhesin molecules
mediate specificity of adherence of bacteria to host cells or tissues. These include:

1. The bacteria will bind isolated receptors or receptor analogs.

2. The isolated adhesins or adhesin analogs will bind to the eukaryotic cell surface.
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3. Adhesion (of the bacterium to the eukaryotic cell surface) is inhibited by:

a. isolated adhesin or receptor molecules

b. adhesin or receptor analogs

c. enzymes and chemicals that specifically destroy adhesins or receptors

d. antibodies specific to surface components (i.e., adhesins or receptors)

Some Specific Bacterial Adhesins and their Receptors

The adhesins of E. coli are their common pili or fimbriae. A single strain of E. coli is known to be able
to express several distinct types of fimbriae encoded by distinct regions of the chromosome or
plasmids. This genetic diversity permits an organism to adapt to its changing environment and exploit
new opportunities presented by different host surfaces. Many of the adhesive fimbriae of E. coli have
probably evolved from fimbrial ancestors resembling Type-1 and type 4 fimbriae.

Type-1 fimbriae enable E. coli to bind to D-mannose residues on eukaryotic cell surfaces. Type-1
fimbriae are said to be "mannose-sensitive" since exogenous mannose blocks binding to receptors on
red blood cells. Although the primary 17kDa fimbrial subunit is the major protein component of Type-
1 fimbriae, the mannose-binding site is not located here, but resides in a minor protein (28-31kDa)
located at the tips or inserted along the length of the fimbriae. By genetically varying the minor "tip
protein" adhesin, the organisms can gain ability to adhere to different receptors. For example, tip
proteins on pyelonephritis-associated (pap) pili recognize a galactose-galactose disaccharide, while tip
proteins on S-fimbriae recognize sialic acid.

Pseudomonas, Vibrio and Neisseria possess a fimbrial protein subunit which contains methylated
phenylalanine at its amino terminus. These "N-methylphenylalanine pili" have been established as
virulence determinants in pathogenesis of Pseudomonas aeruginosa lung infection in cystic fibrosis
patients. These type of fimbriae occur in Neisseria gonorrhoeae and their receptor is thought to be an
oligosaccharide.

The adhesins of Streptococcus pyogenesare controversial. In 1972, Gibbons and his colleagues
demonstrated that attachment of streptococci to the oral mucosa of mice is dependent on M protein.
Olfek and Beachey argued that lipoteichoic acid (LTA), rather than M protein, was responsible for
streptococcal adherence to buccal epithelial cells. In 1996, Hasty and Courtney proposed a two-step
model of attachment that involved both M protein and teichoic acids. They suggested that LTA loosely
tethers streptococci to epithelial cells, and then M protein secures a firmer, irreversible association. In
1992, protein F was
discovered and found to be a fibronectin binding protein. More recently, in 1998, M proteins M1 and
M3 were also found to bind to fibronectin. Apparently, S. pyogenes produces multiple adhesins with
varied specificities.

Staphylococcus aureus also binds to the amino terminus of fibronectin by means of a fibronectin-
binding protein which occurs on the bacterial surface. Apparently S. aureus and Group A streptococci
use different mechanisms but adhere to the same receptor on epithelial surfaces.

Treponema pallidum has three related surface adhesins (P1, P2 and P3) which bind to a four-amino
acid sequence (Arg-Gly-Asp-Ser) of the cell-binding domain of fibronectin. It is not clear if T.
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pallidum uses fibronectin to attach to host surfaces or coats itself with fibronectin to avoid host
defenses (phagocytes and immune responses).

TABLE 2. EXAMPLES OF SPECIFIC ATTACHMENTS OF BACTERIA TO HOST

CELL OR TISSUE SURFACES
Bacterium Adhesin Receptor Attachment site Disease
Streptococcus Amino terminus of Pharyngeal
Protein F Sore throat
pyogenes fibronectin epithelium
Streptococcus Salivary
Glycosyl transferase Pellicle of tooth Dental caries
mutans glycoprotein
Buccal
Streptococcus
Lipoteichoic acid Unknown epithelium of None
salivarius
tongue
N-
Streptococcus acetylhexosamine- Mucosal
Cell-bound protein pneumonia
pneumoniae galactose epithelium
disaccharide
Staphylococcus Amino terminus of Mucosal
Cell-bound protein Various
aureus fibronectin epithelium
Glucosamine-
Neisseria N-methylphenyl- Urethral/cervical
galactose Gonorrhea
gonorrhoeae alanine pili epithelium
carbohydrate
Enterotoxigenic Species-specific Intestinal
Type-1 fimbriae Diarrhea
E. coli carbohydrate(s) epithelium
Uropathogenic Complex Urethral
Type 1 fimbriae Urethritis
E. coli carbohydrate epithelium
Uropathogenic Globobiose linked Upper urinary
P-pili (pap) Pyelonephritis
E. coli to ceramide lipid tract
Fimbriae
Bordetella Galactose on Respiratory Whooping
("filamentous
pertussis sulfated glycolipids epithelium cough
hemagglutinin")
N- Fucose and
Intestinal
Vibrio cholerae methylphenylalanine mannose Cholera
epithelium
pili carbohydrate
Treponema Peptide in outer Surface Mucosal
Syphilis
pallidum membrane protein(fibronectin) epithelium
Respiratory
Mycoplasma Membrane protein Sialic acid Pneumonia
epithelium
Conjunctival or
Conjunctivitis
Chlamydia Unknown Sialic acid urethral
or urethritis
epithelium

INVASION

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The invasion of a host by a pathogen may be aided by the production of bacterial extracellular
substances which act against the host by breaking down primary or secondary defenses of the body.
Medical microbiologists have long referred to these substances as invasins.* Invasins are proteins
(enzymes) that act locally to damage host cells and/or have the immediate effect of facilitating the
growth and spread of the pathogen. The damage to the host as a result of this invasive activity may
become part of the pathology of an infectious disease.

*Some modern texts and research articles have used the term invasin in a very specific manner to refer to certain
bacterial proteins that aid the bacteria in their penetration of nonphagocytic host cells as an intracellular residence.
These invasins are surface and/or diffusible proteins that promote actin rearrangement in the cytoskeleton of the
host cells that stimulates engulfment of the bacteria. These types of invasins are utilized by intracellular pathogens
such as Listeria, Yersinia and Shigella.

The extracellular proteins produced by bacteria which promote their invasion are not clearly
distinguished from some extracellular protein toxins ("exotoxins") which also damage the host.
Invasins usually act at a short range (in the immediate vicinity of bacterial growth) and may not
actually kill cells in their range of activity; exotoxins are often cytotoxic and may act at remote sites
(removed from the site of bacterial growth). Also, exotoxins typically are more specific and more
potent in their activity than invasins. Even so, some classic exotoxins (e.g. diphtheria toxin, anthrax
toxin) may play some role in invasion in the early stages of an infection, and some invasins (e.g.
staphylococcal leukocidin) have a relatively specific cytopathic effect.

A Survey of Bacterial Invasins

Spreading Factors

"Spreading Factors" is a descriptive term for a family of bacterial enzymes that affect the physical
properties of tissue matrices and intercellular spaces, thereby promoting the spread of the pathogen.

Hyaluronidase. is the original spreading factor It is produced by streptococci. staphylococci, and

clostridia. The enzyme attacks the interstitial cement ("ground substance") of connective tissue by
depolymerizing hyaluronic acid.

Collagenase is produced by Clostridium histolyticum and Clostridium perfringens. It breaks down

collagen, the framework of muscles, which facilitates gas gangrene due to these organisms.

Neuraminidase is produced by intestinal pathogens such as Vibrio cholerae and Shigella dysenteriae.
It degrades neuraminic acid (also called sialic acid), an intercellular cement of the epithelial cells of the
intestinal mucosa.

Streptokinase and Staphylokinase are produced by streptococci and staphylococci, respectively.

Kinase enzymes convert inactive plasminogen to plasmin which digests fibrin and prevents clotting of
the blood. The relative absence of fibrin in spreading bacterial lesions allows more rapid diffusion of
the infectious bacteria.

Enzymes that Cause Hemolysis and/or Leucolysis

These enzymes usually act on the animal cell membrane by insertion into the membrane (forming a
pore that results in cell lysis), or by enzymatic attack on phospholipids, which destabilizes the
membrane. They may be referred to as lecithinases or phospholipases, and if they lyse red blood cells
they are sometimes called hemolysins. Leukocidins, produced by staphylococci and streptolysin
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produced by streptococci specifically lyse phagocytes and their granules. These latter two enzymes are
also considered to be bacterial exotoxins.

Phospholipases, produced by Clostridium perfringens (i.e., alpha toxin), hydrolyze phospholipids in

cell membranes by removal of polar head groups.

Lecithinases, also produced by Clostridium perfringens, destroy lecithin (phosphatidylcholine) in cell

membranes.

Hemolysins, notably produced by staphylococci (i.e., alpha toxin), streptococci (i.e.,streptolysin) and
various clostridia, may be channel-forming proteins or phospholipases or lecithinases that destroy red
blood cells and other cells (i.e., phagocytes) by lysis.

Staphylococcal coagulase

Coagulase, formed by Staphylococcus aureus, is a cell-associated and diffusible enzyme that converts
fibrinogen to fibrin which causes clotting. Coagulase activity is almost alway associated with
pathogenic S. aureus and almost never associated with nonpathogenic S. epidermidis, which has led to
much speculation as to its role as a determinant of virulence. Possibly, cell bound coagulase could
provide an antigenic disguise if it clotted fibrin on the cell surface. Or a staphylococcal lesion encased
in fibrin (e.g. a boil or pimple) could make the bacterial cells resistant to phagocytes or tissue
bactericides or even drugs which might be unable to diffuse to their bacterial target.

Extracellular Digestive Enzymes

Heterotrophic bacteria, in general, produce a wide variety of extracellular enzymes including

proteases, lipases, glycohydrolases, nucleases, etc., which are not clearly shown to have a direct role
in invasion or pathogenesis. These enzymes presumably have other functions related to bacterial
nutrition or metabolism, but may aid in invasion either directly or indirectly.

Toxins With Short-Range Effects Related to Invasion

Bacterial protein toxins which have adenylate cyclase activity, are thought to have immediate effects
on host cells that promote bacterial invasion. One component of the anthrax toxin (EF = Edema
Factor) is an adenylate cyclase that acts on nearby cells to cause increased levels of cyclic AMP and
disruption of cell permeability. One of the toxins of Bordetella pertussis, the agent of whooping
cough, has a similar effect. These toxins may contribute to invasion through their effetcts on
macrophages or lymphocytes in the vicinity which are playing an essential role to contain the infection.

The following table summarizes the activities of many bacterial proteins that are noted for their
contribution to bacterial invasion of tissues.

TABLE 3. SOME EXTRACELLULAR BACTERIAL PROTEINS THAT ARE CONSIDERED

INVASINS
Invasin Bacteria Involved Activity
Streptococci,
Hyaluronidase staphylococci and Degrades hyaluronic of connective tissue
clostridia
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Collagenase Clostridium species Dissolves collagen framework of muscles
Vibrio cholerae and
Neuraminidase Degrades neuraminic acid of intestinal mucosa
Shigella dysenteriae
Coagulase Staphylococcus aureus Converts fibrinogen to fibrin which causes clotting
Staphylococci and
Kinases Converts plasminogen to plasmin which digests fibrin
streptococci
Disrupts neutrophil membranes and causes discharge of
Leukocidin Staphylococcus aureus
lysosomal granules
Repels phagocytes and disrupts phagocyte membrane and
Streptolysin Streptococcus pyogenes
causes discharge of lysosomal granules
Streptococci,
Phospholipases or lecithinases that destroy red blood cells
Hemolysins staphylococci and
(and other cells) by lysis
clostridia
Lecithinases Clostridium perfringens Destroy lecithin in cell membranes
Phospholipases Clostridium perfringens Destroy phospholipids in cell membrane
One component (EF) is an adenylate cyclase which
Anthrax toxin Bacillus anthracis
causes increased levels of intracellular cyclic AMP
One toxin component is an adenylate cyclase that acts
Pertussis toxin Bordetella pertussis
locally producing an increase in intracellular cyclic AMP

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 Todar's Online Textbook of Bacteriology

MECHANISMS OF BACTERIAL PATHOGENICITY: Bacterial Defense

Against Phagocytes
© 2002 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

Introduction

Some pathogenic bacteria are inherently able to resist the bactericidal components of host tissues,
usually as a function of some structural property. For example, the poly-D-glutamate capsule of
Bacillus anthracis protects the organisms against action of cationic proteins (defensins) in sera or in
phagocytes. The outer membrane of Gram-negative bacteria is a permeability barrier that is not easily
penetrated by hydrophobic compounds such as bile salts in the GI tract that are harmful to the bacteria.
Pathogenic mycobacteria have a waxy cell wall that resists attack or digestion by most tissue
bactericides. And intact lipopolysaccharides (LPS) of Gram-negative pathogens may protect the cells
from complement-mediated lysis or the action of lysozyme.

Most successful pathogens, however, possess additional structural or biochemical features that allow
them to resist the host cellular defense against them, i.e., the phagocytic and immune responses. If a
pathogen breaches the host's surface defenses, it must then overcome the host's phagocytic response to
succed in an infection.

Ability of Pathogens to Avoid or Overcome Phagocytes

Microorganisms invading tissues are first and foremost exposed to phagocytes. Bacteria that readily
attract phagocytes, and that are easily ingested and killed, are generally unsuccessful as pathogens. In
contrast, most bacteria that are successful as pathogens interfere to some extent with the activities of
phagocytes or in some way avoid their attention.

Bacterial pathogens have devised numerous and diverse strategies to avoid phagocytic engulfment and
killing. Most are aimed at blocking one or more of the steps in phagocytosis, thereby halting the
process. The process of phagocytosis is discussed in Constitutive Host Defense against Bacterial
Pathogens.

Avoiding Contact with Phagocytes

Bacteria can avoid the attention of phagocytes in a number of ways.

1. Pathogens may invade or remain confined in regions inaccessible to phagocytes. Certain internal
tissues (e.g. the lumens of glands, the urinary bladder) and surface tissues (e.g. the skin) are not
patrolled by phagocytes.

2. Some pathogens are able to avoid provoking an overwhelming inflammatory response. Without
inflammation the host is unable to focus the phagocytic defenses.
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3. Some bacteria or their products inhibit phagocyte chemotaxis. For example, Streptococcal
streptolysin (which also kills phagocytes) suppresses neutrophil chemotaxis, even in very low
concentrations. Fractions of Mycobacterium tuberculosis are known to inhibit leukocyte migration. The
Clostridium toxin also inhibits neutrophil chemotaxis.

4. Some pathogens can cover the surface of the bacterial cell with a component which is seen as "self"
by the host phagocytes and immune system. Such a strategy hides the antigenic surface of the
bacterial cell. Phagocytes cannot recognize bacteria upon contact and the possibility of opsonization by
antibodies to enhance phagocytosis is minimized. For example, pathogenic Staphylococcus aureus
produces cell-bound coagulase which clots fibrin on the bacterial surface. Treponema pallidum, the
agent of syphilis, binds fibronectin to its surface. Group A streptococci are able to synthesize a capsule
composed of hyaluronic acid. Hyaluronic acid is the ground substance (tissue cement) in connective
tissue.

Inhibition of Phagocytic Engulfment

Some bacteria employ strategies to avoid engulfment (ingestion) if phagocytes do make contact with
them. Many important pathogenic bacteria bear on their surfaces substances that inhibit phagocytic
adsorption or engulfment. Clearly it is the bacterial surface that matters. Resistance to phagocytic
ingestion is usually due to a component of the bacterial cell surface (cell wall, or fimbriae, or a
capsule). Classical examples of antiphagocytic substances on the bacterial surface include:

1. Polysaccharide capsules of S. pneumoniae, Haemophilus influenzae, Treponema pallidum and

Klebsiella pneumoniae.

2. M protein and fimbriae of Group A streptococci

3. Surface slime (polysaccharide) produced as a biofilm by Pseudomonas aeruginosa

4. O polysaccharide associated with LPS of E. coli

5. K antigen (acidic polysaccharides) of E. coli or the analogous Vi antigen of Salmonella typhi

6. Cell-bound or soluble Protein A produced by Staphylococcus aureus. Protein A attaches to the Fc

region of IgG and blocks the cytophilic (cell-binding) domain of the Ab. Thus, the ability of IgG to act
as an opsonic factor is inhibited, and opsonin-mediated ingestion of the bacteria is blocked.

Survival Inside of Phagocytes

Some bacteria survive inside of phagocytic cells, in either neutrophils or macrophages. Bacteria that
can resist killing and survive or multiply inside of phagocytes are considered intracellular parasites. In
this case, the environment of the phagocyte may be a protective one, protecting the bacteria during the
early stages of infection or until they develop a full complement of virulence factors. The intracellular
environment guards the bacteria against the activities of extracellular bactericides, antibodies, drugs,
etc. Some bacteria that are intracellular parasites are listed in Table 1.

Table 1. BACTERIAL INTRACELLULAR PATHOGENS

Organism Disease

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Mycobacterium tuberculosis Tuberculosis
Mycobacterium leprae Leprosy
Listeria monocytogenes Listeriosis
Salmonella typhi Typhoid Fever
Shigella dysenteriae Bacillary dysentery
Yersinia pestis Plague
Brucella species Brucellosis
Legionella pneumophila Pneumonia
Rickettsiae Typhus; Rocky Mountain Spotted Fever
Chlamydia Chlamydia; Trachoma

Many intracellular parasites have special (genetically-encoded) mechanisms to get themselves into host
cells that are nonphagocytic. Intracellular pathogens such as Yersinia, Listeria, Salmonella, Shigella
and Legionella possess complex machinery for cellular invasion and intracellular survival. These
systems involve various types of non-toxin virulence factors. Sometimes these factors are referred to as
bacterial invasins. Still other bacteria such as Bordetella pertussis and Streptococcus pyogenes, have
recently been discovered in the intracellular habitat of epithelial cells.

Legionella pneumophilia enters mononuclear phagocytes by depositing complement C3b on their

surfaces and using that host protein to serve as the ligand for binding to macrophage cell surfaces. After
ingestion, they remain in vacuoles that do not fuse with lysosomes apparently due to the influence of
soluble substances produced by the bacteria.

Salmonella possesses an invasin operon (inv A - H) that encodes for factors that regulate their entry
into host cells. Mutations in the operon yield organisms that can adhere to target cells without being
internalized. This suggests that one or more of the inv proteins stimulates signal transduction in the host
cell that results engulfment of the salmonellae. A similar invasin gene in Yersinia is known to encode a
protein that both promotes adherence and activates the cytochalasin-dependent engulfment process.
This invasin can confer invasive capacity on noninvasive E. coli, and even latex particles.

Intracellular parasites survive inside of phagocytes by virtue of mechanisms which interfere with the
bactericidal activities of the host cell. Some of these bacterial mechanisms include:

1. Inhibition of fusion of the phagocytic lysosomes (granules) with the phagosome. The bacteria
survive inside of phagosomes because they prevent the discharge of lysosomal contents into the
phagosome environment. Specifically phagolysosome formation is inhibited in the phagocyte. This is
the strategy employed by Salmonella, M. tuberculosis, Legionella and the chlamydiae.

-With M. tuberculosis, bacterial cell wall components (sulfatides) are thought to be released from the
phagosome and modify lysosomal membranes to inhibit fusion.

-In Chlamydia, some element of the bacterial (elementary body) wall appears to modify the membrane
of the phagosome in which it is contained.

-In L. pneumophilia, as with the chlamydia, some structural feature of the bacterial cell surface, already
present at the time of entry (ingestion), appears to modify the membranes of the phagosomes, thus

280
preventing their merger with lysosomal granules. In Legionella, it is known that a single gene is
responsible for the inhibition of phagolysosomal fusion.

-In Salmonella typhimurium, the pH that develops in the phagosome after engulfment actually induces
bacterial gene products that are essential for their survival in macrophages.

2. Survival inside the phagolysosome. With some intracellular parasites, phagosome-lysosome fusion
occurs, but the bacteria are resistant to inhibition and killing by the lysosomal constituents. Also, some
extracellular pathogens can resist killing in phagocytes utilizing similar resistance mechanisms. Little is
known of how bacteria can resist phagocytic killing within the phagocytic vacuole, but it may be due to
the surface components of the bacteria or due to extracellular substances that they produce which
interfere with the mechanisms of phagocytic killing. Some examples of how certain bacteria (both
intracellular and extracellular pathogens) resist phagocytic killing are given below.

-Mycobacterium leprae grows inside phagocytic vacuoles even after extensive fusion with lysosomes.

-Mycobacteria (including M. tuberculosis) have waxy, hydrophobic cell wall and capsule components
(mycolic acids), which are not easily attacked by lysosomal enzymes.

-Cell wall components (LPS?) of Brucella abortus apparently interfere with the intracellular
bactericidal mechanisms of phagocytes.

-B. abortus and Staphylococcus aureus are vigorous catalase and superoxide dismutase producers,
which might neutralize the toxic oxygen radicals that are generated by the NADPH oxidase and MPO
systems in phagocytes. S. aureus also produces cell-bound pigments (carotenoids) that "quench" singlet
oxygen produced in the phagocytic vacuole.

-The outer membrane and capsular components of Gram-negative bacteria (e.g. Salmonella, Yersinia,
Brucella, E. coli) can protect the peptidoglycan layer from the lytic activity of lysozyme.

-Some pathogens (e.g. Salmonella, E. coli) are known to produce extracellular iron-binding compounds
(siderophores) which can extract Fe+++ from lactoferrin (or transferrin) and supply iron to cells for
growth.

-Bacillus anthracis resists killing and digestion by means of its capsule which is made up of polyD-
glutamate. The "unnatural" configuration of this polypeptide affords resistance to attack or digestion by
cationic proteins or by conventional proteases.

Escape from the phagosome. Early escape from the phagosome vacuole is essential for growth and
virulence of some intracellular pathogens.

-This is a clever strategy employed by the Rickettsiae. Rickettsia enter host cells in membrane-bound
vacuoles (phagosomes) but are free in the cytoplasm a short time later, perhaps in as little as 30
seconds. A bacterial enzyme, phospholipase A, may be responsible for dissolution of the phagosome
membrane.

-Listeria monocytogenes relies on several molecules for early lysis of the phagosome to ensure their
release into the cytoplasm. These include a pore-forming hemolysin (listeriolysin O) and two forms of
phospholipase C. Once in the cytoplasm, Listeria induces its own movement through a remarkable
process of host cell actin polymerization and formation of microfilaments within a comet-like tail.
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-Shigella also lyses the phagosomal vacuole and induces cytoskeletal actin polymerization for the
purpose of intracellular movement and cell-cell spread.

Products of Bacteria that Kill or Damage Phagocytes

One obvious strategy in defense against phagocytosis is direct attack by the bacteria upon the
professional phagocytes. Any of the substances that pathogens produce that cause damage to
phagocytes have been referred to as aggressins. Most of these are actually extracellular enzymes or
toxins that kill phagocytes. Phagocytes may be killed by a pathogen before or after ingestion.

Killing Phagocytes Before Ingestion

Many Gram-positive pathogens, particularly the pyogenic cocci, secrete extracellular enzymes that kill
phagocytes. Many of these enzymes are called hemolysins because their activity in the presence of red
blood cells results in the lysis of the rbcs.

-Pathogenic streptococci produce streptolysin. Streptolysin O binds to cholesterol in membranes. The

effect on neutrophils is to cause lysosomal granules to explode, releasing their contents into the cell
cytoplasm.

-Pathogenic staphylococci produce leukocidin, which also acts on the neutrophil membrane and causes
discharge of lysosomal granules.

-Extracellular proteins that inhibit phagocytosis include the Exotoxin A of Pseudomonas aeruginosa
which kills macrophages, and the bacterial exotoxins that are adenylate cyclases (e.g. anthrax toxin EF
and pertussis toxin AC) which decrease phagocytic activity.

Killing Phagocytes After Ingestion. Some bacteria exert their toxic action on the phagocyte after
ingestion has taken place. They may grow in the phagosome and release substances which can pass
through the phagosome membrane and cause discharge of lysosomal granules, or they may grow in the
phagolysosome and release toxic substances which pass through the phagolysosome membrane to other
target sites in the cell. Many bacteria that are the intracellular parasites of macrophages (e.g
Mycobacterium, Brucella, Listeria) usually destroy macrophages in the end, but the mechanisms are
not understood.

Other Antiphagocytic Strategies Used by Bacteria

The foregoing has been a discussion of the most commonly-employed strategies of bacterial defense
against phagocytes. Although there are few clear examples, some other antiphagocytic strategies or
mechanisms probably exist. For example, a pathogen may have a mechanism to inhibit the production
of phagocytes or their release from the bone marrow.

A summary of bacterial mechanisms for interference with phagocytes is given in the table below.

Table 2. BACTERIAL INTERFERENCE WITH PHAGOCYTES

BACTERIUM TYPE OF INTERFERENCE MECHANISM
Streptococcus Streptolysin induces lysosomal discharge
Kill phagocyte
pyogenes into cell cytoplasm
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 Inhibit neutrophil chemotaxis Streptolysin is chemotactic repellent
Resist engulfment (unless Ab is
M Protein on fimbriae
present)
Avoid detection by phagocytes Hyaluronic acid capsule
Staphylococcus Leukocidin induces lysosomal discharge into
Kill phagocyte
aureus cytoplasm
Protein A blocks Fc portion of Ab;
Inhibit opsonized phagocytosis
Polysaccharide capsule in some strains
Carotenoids, catalase, superoxide dismutase
Resist killing
detoxify toxic oxygen radicals
Cell-bound coagulase hides ligands for
Inhibit engulfment
phagocytic contact
Bacillus anthracis Kill phagocyte Anthrax toxin EF
Resist killing Capsular polyglutamate
Streptococcus Resist engulfment (unless Ab is
Capsular polysaccharide
pneumoniae present)
Klebsiella
Resist engulfment Polysaccharide capsule
pneumoniae
Haemophilus
Resist engulfment Polysaccharide capsule
influenzae
Pseudomonas Exotoxin A kills macrophages; Cell-bound
Kill phagocyte
aeruginosa leukocidin
Resist engulfment Alginate slime and biofilm polymers
Salmonella typhi Resist engulfment and killing Vi (K) antigen (microcapsule)
Bacteria develop resistance to low pH,
Salmonella
Survival inside phagocytes reactive forms of oxygen, and
typhimurium
host"defensins" (cationic proteins)
Listeria Listeriolysin, phospholipase C lyse
Escape from phagosome
monocytogenes phagosome membrane
Clostridium
Inhibit phagocyte chemotaxis toxin
perfringens
Inhibit engulfment Capsule
Yersinia pestis Resist engulfment and/or killing Protein capsule on cell surface
Yersinia Yop proteins injected directly into
Kill phagocytes
enterocolitica neutrophils
Cell wall components detoxify toxic oxygen
Mycobacteria Resist killing and digestion radicals; prevent acidification of
phagolysosome
Mycobacterium
Inhibit lysosomal fusion Mycobacterial sulfatides modify lysosomes
tuberculosis
Legionella Inhibit phagosome-lysosomal
Unknown
pneumophilia fusion

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Neisseria Inhibit phagolysosome formation;
Involves outer membrane protein(porin) P.I
gonorrhoeae possibly reduce respiratory burst
Rickettsia Escape from phagosome Phospholipase A
Chlamydia Inhibit lysosomal fusion Bacterial substance modifies phagosome
Brucella abortus Resist killing Cell wall substance (LPS?)
Treponema
Resist engulfment Polysaccharide capsule material
pallidum
O antigen (smooth strains); K antigen (acid
Escherichia coli Resist engulfment
polysaccharide)
Resist engulfment and possibly
K antigen
killing

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MECHANISMS OF BACTERIAL PATHOGENICITY: Bacterial Defense

against the Host Immune Responses
© 2002 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

Bacterial Mechanisms to Overcome Host Immune Defenses

Antibody-mediated immunity (AMI) is the principal specific immune response effective against
extracellular bacteria. The major protective immune response against intracellular bacteria is cell-
mediated immunity (CMI).

On epithelial surfaces, the main antibacterial immune defense of the host is the protection afforded by
secretory IgA. Once the epithelial surfaces have been penetrated, however, the major immune defenses
of AMI and CMI are encountered.

If there is a way for an organism to successfully bypass or overcome the immune defenses, then some
bacterial pathogen has probably "discovered" it. Bacteria evolve very rapidly in relation to their host,
so that most of the feasible anti-host strategies are likely to have been tried out and exploited.
Consequently, pathogenic bacteria have developed numerous ways to bypass or overcome the immune
defenses of the host, which contribute to the virulence of the microbe and the pathology of the disease.

Immunological Tolerance to a Bacterial Antigen

Tolerance is a property of the host in which there is an immunologically-specific reduction in the

immune response to a given Ag. Tolerance to a bacterial Ag does not involve a general failure in the
immune response but a particular deficiency in relation to the specific antigen(s) of a given bacterium.
If there is a depressed immune response to relevant antigens of a parasite, the process of infection is
facilitated. Tolerance can involve either AMI or CMI or both arms of the immunological response.

Tolerance to an Ag can arise in a number of ways, but three are possibly relevant to bacterial
infections.

1. Fetal exposure to Ag. If a fetus is infected at certain stages of immunological development, the
microbial Ag may be seen as "self", thus inducing tolerance to the Ag which may persist even after
birth.

2. High persistent doses of circulating Ag. Tolerance to a bacterium or one of its products might arise
when large amounts of bacterial antigens are circulating in the blood.

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3. Molecular mimicry. If a bacterial Ag is very similar to normal host "antigens", the immune
responses to this Ag may be weak giving a degree of tolerance. Resemblance between bacterial Ag and
host Ag is referred to as molecular mimicry. In this case the antigenic determinants of the bacterium are
so closely related chemically to host "self" components that the immunological cells cannot distinguish
between the two and an immune response cannot be raised. Some bacterial capsules are composed of
polysaccharides (hyaluronic acid, sialic acid) so similar to host tissue polysaccharides that they are not
immunogenic.

Antigenic Disguise

As already mentioned, some pathogens can hide their unique antigens from opsonizing antibodies or
complement. Bacteria may be able to coat themselves with host proteins such as fibrin, fibronectin, or
even Ig molecules. In this way they are able to hide their own antigenic surface components from the
immunological system.

S. aureus produces cell-bound coagulase and clumping factor that cause fibrin to clot and to deposit
on the cell surface. It is possible that this disguises the bacteria immunologically so that they are not
readily identified as antigens and targets for an immune response.

Protein A produced by S. aureus, and the analogous Protein G produced by Streptococcus pyogenes,
bind the Fc portion of immunoglobulins, thus coating the bacteria with antibodies and canceling their
opsonizing ability.

The fibronectin coat of Treponema pallidumprovide an immunological disguise for the spirochetes.

In E. coli K1, that causes meningitis in newborns, a capsule composed predominantly of sialic acid
provides an antigenic disguise, as does the hyaluronic acid capsule of Streptococcus pyogenes.

Immunosuppression

Some pathogens (mainly viruses and protozoa, rarely bacteria) cause immunosuppression in the
infected host. This means that the host shows depressed immune responses to antigens in general,
including those of the infecting pathogen. Suppressed immune responses are occasionally observed
during chronic bacterial infections such as leprosy and tuberculosis.

In extreme forms of leprosy, caused by Mycobacterium leprae, there is poor response to leprosy
antigens, as well as unrelated antigens. After patients have been successfully treated, immunological
reactivity reappears, suggesting that general immunosuppression is in fact due to the disease.

In mild cases of leprosy there is frequently an associated immunological suppression that is specific for
M. leprae antigens. This is separate from tolerance, since unique antigens (proteins) of M. leprae have
been associated as the cause of this immunosuppression. The most likely explanations for this are due
to (1) lack of costimulatory signals (interference with cytokine secretion); (2) activation of suppressor
T cells; (3) disturbances in TH1/TH2 cell activities.

At present, little is known of the mechanisms by which pathogens inhibit immune responses. It seems
probable that it is due to interference with the immune functions of B cells, T cells or macrophages.
Since many intracellular bacteria infect macrophages, it might be expected that they compromise the
role of these cells in an immunological response.

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General immunosuppression induced in a host may be of immediate value to an invading pathogen, but
it is of no particular significance (to the invader) if it merely promotes infection by unrelated
microorganisms. Perhaps this is why it does not seem to be a commonly used strategy of the bacteria.

Persistence of a Pathogen at Bodily Sites Inaccessible to the Immune Response

Some pathogens can avoid exposing themselves to immune forces. Intracellular pathogens can evade
host immune responses as long as they stay inside of infected cells and they do not allow microbial Ag
to form on the cell surface. This is seen in macrophages infected with Brucella, Listeria or M. leprae.
The macrophages support the growth of the bacteria and at the same time give them protection from
immune responses. Some intracellular pathogens (Yersinia, Shigella) are residents of cells that are
neither phagocytes nor APC's and their antigens are not displayed on the infected cell's surface.

Some pathogens persist on the luminal surfaces of the GI tract, oral cavity and the urinary tract, or the
lumen of the salivary gland, mammary gland or the kidney tubule. If there is no host cell destruction,
the pathogen may avoid inducing an inflammatory response, and there is no way in which sensitized
lymphocytes or circulating antibodies can reach the site to eliminate the infection. Secretory IgA could
react with surface antigens on bacterial cells, but the complement sequence would be unlikely to be
activated and the cells would not be destroyed. Conceivably, IgA antibodies could immobilize bacteria
by agglutination of cells or block adherence of bacteria to tissue or cell surfaces, but it is unlikely that
IgA would kill bacteria directly or inhibit their growth.

Examples of some bacterial pathogens that grow at tissue sites generally inaccessible to the forces of
AMI and CMI are given below.

-Streptococcus mutans. The bacterium can initiate dental caries at any time after the eruption of the
teeth, regardless of the immune status of the host. Either the host does not undergo an effective immune
response or secretory IgA plays little role in preventing colonization and subsequent plaque
development.

-Vibrio choleraemultiplies in the GI tract where the bacteria elaborate a toxin which causes loss of
fluids and diarrhea in the host which is characteristic of the disease cholera. IgA antibodies against
cellular antigens of the cholera vibrios are not completely effective in preventing infection by these
bacteria as demonstrated by the relative ineffectiveness of the cholera vaccine prepared from phenol-
killed vibrios.

-The carrier state of typhoid fever results from a persistent infection by the typhoid bacillus, Salmonella
typhi. The organism is not eliminated during the initial infection and persists in the host for months,
years or a life time. In the carrier state S. typhi is able to colonize the biliary tract (gall bladder) away
from the immune forces, and be shed into urine and feces.

-Some bacteria cause persistent infections in the lumen of glands. Brucella abortus persistently infects
mammary glands of cows and is shed in the milk. Leptospira multiplies persistently in the lumen of the
kidney tubules of rats and is shed in the urine and remains infectious.

Induction of Ineffective Antibody

Many types of antibody are formed against a given Ag, and some bacterial components may display
various antigenic determinants. Antibodies tend to range in their capacity to react with Ag (the ability
of specific Ab to bind to an Ag is called avidity). If Abs formed against a bacterial Ag are of low
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avidity, or if they are directed against unimportant antigenic determinants, they may have only weak
antibacterial action. Such "ineffective" (non-neutralizing) Abs might even aid a pathogen by
combining with a surface Ag and blocking the attachment of any functional Abs that might be present.

In the case of Neisseria gonorrhoeae the presence of antibody to an outer membrane protein called rmp
interferes with the serum bactericidal reaction and in some way compromises the surface defenses of
the female urogenital tract. Increased susceptibility to reinfection is highly correlated with the presence
of circulating rmp antibodies.

Antibodies Absorbed by Soluble Bacterial Antigens

Some bacteria can liberate antigenic surface components in a soluble form into the tissue fluids. These
soluble antigens are able to combine with and "neutralize" antibodies before they reach the bacterial
cells. For example, small amounts of endotoxin (LPS) may be released into surrounding fluids by
Gram-negative bacteria.

Autolysis of Gram-negative or Gram-positive bacteria may release antigenic surface components in a

soluble form. Streptococcus pneumoniae and Neisseria meningitidis are known to release capsular
polysaccharides during growth in tissues. They are found in the serum of patients with pneumococcal
pneumonia and in the cerebrospinal fluid of patients with meningitis. Theoretically, these released
surface antigens could "mop up" antibody before it reached the bacterial surface which should be an
advantage to the pathogen. These soluble bacterial cell wall components are powerful antigens and
complement activators so they contribute in a major way to the pathology observed in meningitis and
pneumonia.

Protein A, produced by S. aureus may remain bound to the staphylococcal cell surface or it may be
released in a soluble form. Protein A will bind to the Fc region of IgG. On the cell surface, protein A
binds IgG in the wrong orientation to exert its antibacterial activity, and soluble protein A agglutinates
and partially inactivates IgG.

Local Interference with Antibody Activity

There are probably several ways that pathogens interfere with the antibacterial action of antibody
molecules. Some pathogens produce enzymes that destroy antibodies.

Neisseria gonorrhoeae, N. meningitidis, Haemophilus influenzae, Streptococcus pneumoniae and

Streptococcus mutans, which can grow on the surfaces of the body, produce IgA proteases that
inactivate secretory IgA by cleaving the molecule at the hinge region, detaching the Fc region of the
immunoglobulin. Soluble forms of Protein A produced S. aureus agglutinate immunoglobulin
molecules and partially inactivate IgG.

Antigenic Variation

One way bacteria can avoid forces of the immune response is to periodically changing antigens, i.e., to
undergo antigenic variation. Some bacteria avoid the host antibody response by changing from one
type of fimbriae to another, or by switching fimbrial tips. This makes the original AMI response
obsolete by using new fimbriae that do not bind the previous antibodies. Pathogenic bacteria can vary
(change) other surface proteins, especially outer membrane proteins, that are the targets of antibodies.

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Antigens may vary or change within the host during the course of an infection, or alternatively antigens
may vary among multiple strains (antigenic types) of a parasite in the population. Antigenic variation is
an important mechanism used by pathogenic microorganisms for escaping the neutralizing activities of
antibodies. Antigenic variation usually results from site-specific inversions or gene conversions or gene
rearrangements in the DNA of the microorganisms.

Borrelia recurrentis is a spirochete that causes the human disease relapsing fever. The disease is
characterized by episodes of fever which relapse (come and go) for a period of weeks or months. After
infection, the bacteria multiply in tissues and cause a febrile illness until the onset of an immune
response a week or so later. Bacteria then disappear from the blood because of antibody mediated
phagocytosis, lysis, agglutination, etc., and the fever falls. Then an antigenically distinct mutant arises
in the infected individual, multiplies, and in 4-10 days reappears in the blood and there is another
febrile attack. The immune system is stimulated and responds by conquering the new antigenic variant,
but the cycle continues such that there may be up to 10 febrile episodes before final recovery. With
each attack a new antigenic variant of the bacterium appears and a new set of antibodies is formed in
the host. Thus, this bacterium can change its antigens during the course of an infection in a single host,
and this variation in bacterial antigens contributes significantly to the course of the infection.

Neisseria gonorrhoeae can change fimbrial antigens during the course of an infection. During initial
stages of an infection, adherence to epithelial cells of the cervix or urethra is mediated by pili
(fimbriae). Equally efficient attachment to phagocytes would be undesirable. Rapid switching on and
off of the genes controlling pili are therefore necessary at different stages of the infection, and N.
gonorrhoeae is capable of undergoing this type of "pili switching" or phase variation. Genetically
controlled changes in outer membrane proteins also occur in the course of an infection. This finely
controlled expression of the genes for pili and surface proteins changes the adherence pattern to
different host cells, increases resistance to cervical proteases, increases resistance to phagocytosis and
immune lysis, and is presumably necessary for successful infection.

Many pathogenic bacteria exist in nature as multiple antigenic types or serotypes, meaning that they
are variant strains of the same pathogenic species. For example, there are multiple serotypes of
Salmonella typhimurium based on differences in cell wall (O) antigens or flagellar (H) antigens. There
are 80 different antigenic types of Streptococcus pyogenes based on M-proteins on the cell surface.
There are over one hundred strains of Streptococcus pneumoniae depending on their capsular
polysaccharide antigens. Based on minor differences in surface structure chemistry there are multiple
serotypes of Vibrio cholerae, Staphylococcus aureus, Escherichia coli, Neisseria gonorrhoeae and an
assortment of other bacterial pathogens. Antigenic variation is prevalent among pathogenic viruses as
well.

If the immune response is the main defense against a pathogen, then being able to shed old antigens
and present new ones to the immune system might allow infection or continued invasion by the
pathogen to occur. Furthermore, the infected host would seem to be the ideal selective environment for
the emergence of new antigenic variants of bacteria. Perhaps this explains why many bacteria exist in a
great variety of antigenic types.

Evading Complement

Antibodies that are bound to bacterial surfaces will activate complement by the classical pathway and
bacterial polysaccharides activate complement by the alternative pathway. Bacteria in serum and other
tissues, especially Gram-negative bacteria, need protection from the antimicrobial effects of
complement.
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One role of capsules in bacterial virulence is to protect the bacteria from complement activation and
the ensuing inflammatory response. Polysaccharide capsules can hide bacterial components such as
LPS or peptidoglycan which can induce the alternate complement pathway. Some bacterial capsules are
able to inhibit formation of the C3b complex on their surfaces, thus avoiding C3b opsonization and
subsequent formation of C5b and the membrane attack complex (MAC) on the bacterial cell surface.
Capsules that contain sialic acid (a common component of host cell glycoproteins), such as found in
Neisseria meningitidis, have this effect.

One of the principal targets of complement on Gram-negative bacteria is LPS. It serves as the
attachment site for C3b and triggers the alternative pathway of activation. It also binds C5b.

LPS can be modified by pathogens in two ways that affects its interaction with complement.
First, by attachment of sialic acid residues to the LPS O antigen, a bacterium can prevent the formation
of C3 convertase just as capsules that contain sialic acid can do so. Both Neisseria meningitidis and
Haemophilus influenzae, which cause bacterial meningitis, are able to covalently attach sialic acid
residues to their O antigens resulting in resistance to MAC. Second, LPS with long, intact O antigen
side-chains can prevent effective MAC killing. Apparently the MAC complex is held too far from the
vulnerable outer membrane to be effective.

Bacteria that are not killed and lysed in serum by the complement MAC are said to be serum resistant.
As might be expected many of the Gram-negative bacteria that cause systemic infections, (bacteremia
or septicemia) are serum resistant. Gram-positive bacteria are naturally serum-resistant since their cells
are not enclosed in an outer membrane.

Other ways that pathogens are able to inhibit the activity of complement is to destroy one or more of
the components of complement. Pseudomonas aeruginosa produces an extracellular elastase enzyme
that inactivates components of complement.

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MECHANISMS OF BACTERIAL PATHOGENICITY: PROTEIN TOXINS

© 2002 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

Bacterial Toxigenesis

Toxigenesis, or the ability to produce toxins, is an underlying mechanism by which many bacterial
pathogens produce disease. At a chemical level, there are two types of bacterial toxins,
lipopolysaccharides, which are associated with the cell walls of Gram-negative bacteria, and proteins,
which are released from bacterial cells and may act at tissue sites removed from the site of bacterial
growth. The cell-associated lipoplysaccharide (LPS) toxins are referred to as endotoxins and the
extracellular diffusible toxins are referred to as exotoxins.

Endotoxins are cell-associated substances that are structural components of the outer membrane of
Gram-negative bacteria. However, endotoxins may be released from growing bacterial cells or from
cells which are lysed as a result of effective host defense (e.g. lysozyme) or the activities of certain
antibiotics (e.g. penicillins and cephalosporins). Exotoxins are usually secreted by bacteria but in some
cases they are released by lysis of the bacterial cell. Hence, either type of bacterial toxin may ultimately
act in close association with the cells that produce the toxin, or at tissue sites remote from the original
point of bacterial invasion or growth. Some bacterial toxins may also act at the site of colonization and
play a role in invasion.

BACTERIAL PROTEIN TOXINS

Exotoxins are typically soluble proteins secreted by living bacteria during exponential growth. The
production of the toxin is generally specific to a particular bacterial species that produces the disease
associated with the toxin (e.g. only Clostridium tetani produces tetanus toxin; only Corynebacterium
diphtheriae produces the diphtheria toxin). Usually, virulent strains of the bacterium produce the toxin
while nonvirulent strains do not, and the toxin is the major determinant of virulence (e.g. tetanus and
diphtheria). At one time it was thought that exotoxin production was limited mainly to Gram-positive
bacteria, but both Gram-positive and Gram-negative bacteria produce soluble protein toxins.

Bacterial protein toxins are the most powerful human poisons known and retain high activity at very
high dilutions. The lethality of the most potent bacterial exotoxins is compared to the lethality of
strychnine, snake venom, and endotoxin in Table 1 below.

TABLE 1. LETHALITY OF BACTERIAL PROTEIN TOXINS

Lethal toxicity
compared
with:

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Toxin Toxic Dose (mg) Host Strychnine Endotoxin Snake Venom
Botulism Type D 0.8x10-8 Mouse 3x106 3x107 3x105
Tetanus 4x10-8 Mouse 1x106 1x107 1x105
Shigella Neurotoxin 2.3x10-6 Rabbit 1x106 1x107 1x105
Diphtheria 6x10-5 Guinea Pig 2x103 2x104 2x102

The protein toxins resemble enzymes in a number of ways. Like enzymes, bacterial exotoxins are
denatured by heat, acid and proteolytic enzymes; they have a high biological activity (most act
catalytically); and they exhibit specificity of action.
As enzymes attack specific substrates, so bacterial protein toxins are highly specific in the substrate
utilized and in their mode of action. The substrate (in the host) may be a component of tissue cells,
organs, or body fluid. Usually the site of damage caused by the toxin indicates the location of the
substrate for that toxin. Terms such as enterotoxin, neurotoxin, leukocidin or hemolysin are
sometimes used to indicate the target site of some well-defined protein toxins.

Certain protein toxins have very specific cytotoxic activity (i.e., they attack specific types of cells).
For example, tetanus or botulinum toxins attack only neurons. But some toxins (as produced by
staphylococci, streptococci, clostridia, etc.) have fairly broad cytotoxic activity and cause nonspecific
death of all sorts of cells and tissues, eventually resulting in necrosis. Toxins that are phospholipases
act in this way. They cleave phospholipids which are regular components of host cell membranes,
resulting in the death of the cell by leakage of cellular contents. This is also true of pore-forming
hemolysins and leukocidins.

A few bacterial toxins that obviously bring about the death of an animal are known simply as lethal
toxins, and even though the tissues affected and the target sites may be known, the precise mechanism
by which death occurs is not understood (e.g. anthrax toxin LF).

Bacterial protein toxins are strongly antigenic. In vivo, specific antibody (antitoxin) neutralizes the
toxicity of these bacterial proteins. However, in vitro, specific antitoxin may not fully inhibit their
enzymatic activity. This suggests that the antigenic determinant of the toxin may be distinct from the
active (enzymatic) portion of the protein molecule. The degree of neutralization of the enzymatic site
may depend on the distance from the antigenic site on the molecule. However, since the toxin is fully
neutralized in vivo, this suggests that other host factors must play a role in nature.

Protein toxins are inherently unstable: in time they lose their toxic properties but retain their antigenic
ones. This was first discovered by Ehrlich and he coined the term toxoid for this product. Toxoids are
detoxified toxins which retain their antigenicity and their immunizing capacity. The formation of
toxoids can be accelerated by treating toxins with a variety of reagents including formalin, iodine,
pepsin, ascorbic acid, ketones, etc. The mixture is maintained at 37 degrees at pH range 6 to 9 for
several weeks. The resulting toxoids can be use for artificial immunization against diseases caused by
pathogens where the primary determinant of bacterial virulence is toxin production. Toxoids are the
immunizing agents against diphtheria and tetanus that are part of the DPT vaccine.

A plus B subunit Arrangement of Protein Toxins

Many protein toxins, notably those that act intracellularly (with regard to host cells), consist of two
components: one component (subunit A) is responsible for the enzymatic activity of the toxin; the
other component (subunit B) is concerned with binding to a specific receptor on the host cell
membrane and transferring the enzyme across the membrane. The enzymatic component is not active
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until it is released from the native (A+B) toxin. Isolated A subunits are enzymatically active but lack
binding and cell entry capability. Isolated B subunits may bind to target cells (and even block the
binding of the native toxin), but they are nontoxic.

There are a variety of ways that toxin subunits may be synthesized and arranged: A + B indicates that
the toxin is synthesized and secreted as two separate protein subunits that interact at the target cell
surface; A-B or A-5B indicates that the A and B subunits are synthesized separately, but associated by
noncovalent bonds during secretion and binding to their target; 5B indicates that the binding domain of
the protein is composed of 5 identical subunits. A/B denotes a toxin synthesized as a single
polypeptide, divided into A and B domains, that may be separated by proteolytic cleavage.

Attachment and Entry of Toxins

There are at least two mechanisms of toxin entry into target cells.

In one mechanism called direct entry, the B subunit of the native (A+B) toxin binds to a specific
receptor on the target cell and induces the formation of a pore in the membrane through which the A
subunit is transferred into the cell cytoplasm.

In an alternative mechanism, the native toxin binds to the target cell and the A+B structure is taken into
the cell by the process of receptor-mediated endocytosis (RME). The toxin is internalized in the cell
in a membrane-enclosed vesicle called an endosome. H+ ions enter the endosome lowering the internal
pH which causes the A+B subunits to separate. Somehow, the B subunit affects the release of the A
subunit from the endosome so that it will reach its target in the cell cytoplasm. The B subunit remains
in the endosome and is recycled to the cell surface. In both cases (above) a large protein molecule must
insert into and cross a membrane lipid bilayer (either the cell membrane or the endosome membrane).
This activity is reflected in the ability of most A+B or A/B toxins, or their B components, to insert into
artificial lipid bilayers, creating ion permeable pathways.

A few bacterial toxins (e.g. diphtheria) are known to utilize both direct entry and RME to enter into
host cells, which is not surprising since both mechanisms are variations on a theme. Bacterial toxins
with similar enzymatic mechanisms may enter their target cells by different mechanisms. Thus, the
diphtheria toxin and Pseudomonas exotoxin A, which have identical mechanisms of enzymatic activity,
enter their host cells in slightly different ways. The adenylate cyclase toxin of Bordetella pertussis and
the anthrax toxin (Edema Factor) of Bacillus anthracis act similarly to catalyze the production of
cAMP from host cell intracellular ATP reserves. However, the anthrax toxin enters cells by receptor
mediated endocytosis, whereas the pertussis adenylate cyclase traverses the cell membrane directly.

The specific receptors for the B subunit of the toxin on target cells or tissues are usually
sialogangliosides (glycoproteins) called G-proteins on the cell membrane. For example, the cholera
toxin utilizes the ganglioside GM1, and tetanus toxin utilizes ganglioside GT1 and/or GD1b as
receptors on host cells.

Control of Synthesis and the Release of Protein Toxins

The regulation of synthesis and secretion of many bacterial toxins is tightly controlled by regulatory
elements that are sensitive to environmental signals. For example, the production of diphtheria toxin is
totally repressed by the availability of adequate amounts of iron in the medium for bacterial growth.
Only under conditions of limiting amounts of iron in the growth medium does toxin production become
derepressed. The expression of cholera toxin and related virulence factors (adhesins) is controlled by
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environmental osmolarity and temperature. In B. pertussis, induction of different virulence components
is staggered, such that attachment factors are produced initially to establish the infection, and toxins are
synthesized and released later to counter the host defenses and promote bacterial survival.

The processes by which protein toxins are assembled and secreted by bacterial cells are also variable.
Many of the classic exotoxins are synthesized with an NH terminal leader (signal) sequence consisting
of a few (1-3) charged amino acids and a stretch (14-20) of hydrophobic amino acids. The signal
sequence may bind and insert into the cytoplasmic membrane during translation such that the
polypeptide is secreted while being synthesized. The signal peptide is cleaved as the toxin (protein) is
released into the periplasm. Alternatively, the toxin may be synthesized intracytoplasmically, then
bound to a leader sequence for passage across the membrane. Frequently, chaperone proteins are
required to guide this process. Some multicomponent toxins, such as the cholera toxin, have their
subunits synthesized and secreted separately into the periplasm where they are assembled. In Gram-
negative bacteria, the outer membrane poses an additional permeability barrier that a protein toxin
usually has to mediate if it is to be released in a soluble form. It has been proposed that some Gram-
negative exotoxins (e.g. E. coli ST enterotoxin) might be released in membrane vesicles composed of
outer membrane components. Since these vesicles presumably would possess the outer membrane
associated attachment factors, they could act as smart bombs capable of specifically interacting with
and possibly entering target cells to release their contents of toxin.

Diphtheria toxin

The best known and studied bacterial toxin is the diphtheria toxin, produced by Corynebacterium
diphtheriae. Diphtheria toxin is a bacterial exotoxin of the A/B prototype. It is produced as single
polypeptide chain with a molecular weight of 60,000 daltons. The function of the protein is
distinguishable into two parts: subunit A, with a m.w. of 21,000 daltons, contains the enzymatic
activity for inhibition of elongation factor-2 involved in host protein synthesis; subunit B, with a m.w.
of 39,000 daltons, is responsible for binding to the membrane of a susceptible host cell.

In vitro, the native toxin is produced in an inactive form which can be activated by the proteolytic
enzyme trypsin in the presence of thiol (reducing agent). The enzymatic activity of Fragment A is
masked in the intact toxin. Fragment B is required to enable to enable Fragment A to reach the
cytoplasm of susceptible cells. The C terminal end of Fragment B is hydrophilic and contains
determinants that interact with specific membrane receptors on sensitive cell membranes and the N-
terminal end of Fragment B is strongly hydrophobic. The specific membrane receptor for the B
fragment has recently been shown to be a transmembranous heparin-binding protein on the susceptible
cell's surface.

The diphtheria toxin enters its target cells by either direct entry or receptor mediated endocytosis. The
first step is the irreversible binding of the C-terminal hydrophilic portion of Fragment B (AA 432-535)
to the receptor. During RME the whole toxin is then taken up in an endocytic vesicle. In the endocytic
vesicle, the pH drops to about 5 which allows unfolding of the A and B chains. This exposes
hydrophobic regions of both the A and B chains that can insert into the vesicle membrane. The result is
exposure of the A chain to the cytoplasmic side of the membrane. There, reduction and proteolytic
cleavage releases the A chain in the cytoplasm. A is released as an extended chain but regains its active
(enzymatic) globular conformation in the cytoplasm. The A chain catalyzes the ADP ribosylation of
elongation factor-2 (EF-2).

Diphtheria toxin is very potent in its action; a single molecule of subunit A within a cell is lethal and a
single diphtheria bacillus is thought to be able to produce about 5,000 molecules per hour. The toxin
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(subunit A) utilizes NAD as a substrate: it catalyzes the attachment of the ADP- ribose portion of NAD
to the elongation factor which inactivates its function in protein synthesis.

Other considerations

In keeping with the observation that genetic information for functions not involved in viability of
bacteria is frequently located extrachromosomally, the genes encoding toxin production are generally
located on plasmids or in lysogenic bacteriophages. Thus, the processes of genetic exchange in
bacteria, notably conjugation and transduction, can mobilize these genetic elements between strains
of bacteria, and therefore may play a role in determining the pathogenic potential of a bacterium.
Horizontal transfer of genetic elements that encode virulence also occurs between species of bacteria,
which could explain how E. coli and Vibrio cholerae produce a nearly-identical diarrhea-inducing toxin

Why certain bacteria produce such potent toxins is mysterious and is analogous to asking why an
organism should produce an antibiotic. The production of a toxin may play a role in adapting a
bacterium to a particular niche, but it is not essential to the viability of the organism. Most toxigenic
bacteria are free-living in Nature and in associations with humans in a form which is phenotypically
identical to the toxigenic strain but lacking the ability to produce the toxin.

There is conclusive evidence for the pathogenic role of diphtheria, tetanus and botulinum toxins,
various enterotoxins, staphylococcal toxic shock syndrome toxin, and streptococcal erythrogenic toxin.
And there is good evidence for the pathological involvement of pertussis toxin, anthrax toxin, shiga
toxin and the necrotizing toxins of clostridia, in bacterial disease.

A summary of bacterial protein toxins and their activities is given in Tables 2 and 3.

Details of the mechanisms of action of these toxins and their involvement in the pathogenesis of
disease is discussed in chapters with the specific bacterial pathogens.

For more information on bacterial toxins go to this website: Bacterial Toxins: Friends or Foes?

TABLE 2. ACTIVITIES OF EXTRACELLULAR BACTERIAL PROTEIN TOXINS

BACTERIA
NAME OF TOXIN ACTIVITY
INVOLVED
Edema Factor (EF) is an adenylate cyclase that causes
increased levels in intracellular cyclic AMP in
Anthrax toxin (EF) Bacillus anthracis
phagocytes and formation of ion-permeable pores in
membranes (hemolysis)
Acts locally to increase levels of cyclic AMP in
Adenylate cyclase toxin Bordetella pertussis phagocytes and formation of ion-permeable pores in
membranes (hemolysis)
ADP ribosylation of G proteins stimulates adenlyate
Cholera enterotoxin (ctx) Vibrio cholerae cyclase and increases cAMP in cells of the GI tract,
causing secretion of water and electrolytes
E. coli LT toxin Escherichia coli Similar to cholera toxin
Stimulates guanylate cyclase and promotes secretion of
E. coli ST toxin Escherichia coli
water and electrolytes from intestinal epithelium

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 Enzymatically cleaves rRNA resulting in inhibition of
Shiga toxin Shigella dysenteriae
protein synthesis in susceptible cells
Clostridium Stimulates adenylate cyclase leading to increased
Perfringens enterotoxin
perfringens cAMP in epithelial cells
Clostridium Zn++ dependent protease that inhibits neurotransmission
Botulinum toxin
botulinum at neuromuscular synapses resulting in flaccid paralysis
Zn++ dependent protease that Inhibits
Tetanus toxin Clostridium tetani neurotransmission at inhibitory synapses resulting in
spastic paralysis
Corynebacterium ADP ribosylation of elongation factor 2 leads to
Diphtheria toxin (dtx)
diphtheriae inhibition of protein synthesis in target cells
Pseudomonas
Exotoxin A Inhibits protein synthesis; similar to diphtheria toxin
aeruginosa
Lethal Factor (LF) is a Zn++ dependent protease that
Anthrax toxin (LF) Bacillus anthracis induces cytokine release and is cytotoxic to cells by an
unknown mechanism
ADP ribosylation of G proteins blocks inhibition of
Pertussis toxin (ptx) Bordetella pertussis
adenylate cyclase in susceptible cells
Staphylococcus Staphylococcus Massive activation of the immune system, including
enterotoxins* aureus lymphocytes and macrophages, leads to emesis
Toxic shock syndrome Staphylococcus Acts on the vascular system causing inflammation,
toxin (TSST-1)* aureus fever and shock
Staphylococcus Cleavage within epidermal cells (intraepidermal
Exfoliatin toxin*
aureus separation)
Erythrogenic toxin
Streptococcus Same as TSST - inflammation, fever and shock; can
(streptococcal pyrogenic
pyogenes cause localized erythematous reactions
exotoxin SPE)*

* The pyrogenic exotoxins produced by Staphylococcus aureus and Streptococcus pyogenes have been designated as
superantigens. They represent a family of molecules with the ability to elicit massive activation of the immune
system. These proteins share the ability to stimulate T cell proliferation by interaction with Class II MHC molecules
on APCs and specific V beta chains of the T cell receptor. The important feature of this interaction is the resultant
production of IL-1, TNF, and other lymphokines which appear to be the principal mediators of disease processes
associated with these toxins.

TABLE 3. ENZYMATIC ACTIVITY AND BIOLOGICAL EFFECTS OF SOME BACTERIAL

EXOTOXINS

TOXIN (subunit arr)* ENZYMATIC ACTIVITY BIOLOGICAL EFFECTS

Activates adenylate cyclase; increased
ADP ribosylates adenylate cyclase Gs levels of intracellular cAMP promote
Cholera toxin(A-5B)
regulatory protein secretion of fluid and electrolytes in
intestinal epithelium leading to diarrhea
Inhibits protein synthesis in animal
Diphtheria toxin (A/B) ADP ribosylates elongation factor 2
cells resulting in death of the cells
Pertussis toxin (A-5B) ADP ribosylates adenylate cyclase Gi Blocks inhibition of adenylate cyclase;

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 regulatory protein increased levels of cAMP effect
hormone activity and reduce
phagocytic activity
E. coli heat-labile toxin ADP ribosylates adenylate cyclase Gs
Similar or identical to cholera toxin
LT (A-5B) regulatory protein
Stimulates guanylate cyclase in
ST toxins, of which there several
epithelial cells of the GI tract resulting
E. coli heat stable toxin types, are small polypeptides ranging
in intra- cellular accumulation of cyclic
ST in size from 18 to 72 AA, and
GMP which has a net secretory effect
probably lack enzymatic activity
on cells and leads to diarrhea
Inactivates the mammalian 60S
Glycosidase cleavage of ribosomal
ribosomal subunit and leads to
Shiga toxin (A/5B) RNA (cleaves a single Adenine base
inhibition of protein synthesis and
from the 28S rRNA)
death of the susceptible cell
Pseudomonas ADP ribosylates elongation factor 2 Inhibits protein synthesis in susceptible
Exotoxin A (A/B) analogous to diphtheria toxin cells, resulting in death of the cells
++
Zn dependent protease acts on Inhibits presynaptic acetylycholine
Botulinum toxin (A/B) synaptobrevin at motor neuron release from peripheral cholinergic
ganglioside neurons resulting in flaccid paralysis
++
Zn dependent protease acts on Inhibits neurotransmitter release from
Tetanus toxin(A/B) synaptobrevin in central nervous inhibitory neurons in the CNS resulting
system in spastic paralysis
++
A1 (Lethal Factor=LF) is a Zn B subunit, called the Protective Antigen
Anthrax toxin LF dependent protease with an unknown (PA), plus LF induces cytokine release
(A2+B) substrate; A2 (Edema Factor=EF) is and death of target cells or
an adenylate cyclase experimental animals
Calmodulin-regulated adenylate
Bordetella pertussis Increases cAMP in phagocytes leading
cyclases that catalyze the formation of
AC toxin (A/B) and to inhibition of phagocytosis by
cyclic AMP from ATP in susceptible
Bacillus anthracis EF neutrophils and macrophages;
cells, and the formation of ion-
(A1+B) hemolysis or leukolysis
permeable pores in cell membranes
Separation through the stratum
Staphylococcus aureus Cleaves desmoglein 1, a cadherin granulosum of the epidermis, between
Exfoliatin B (?) found in desmosomes in the epidermis the living layers and the superficial
dead layers.

* toxin subunit arrangements: A-B or A-5B indicates subunits synthesized separately and associated by
noncovalent bonds; A/B denotes subunit domains of a single protein that may be separated by
proteolytic cleavage; A+B indicates subunits synthesized and secreted as separate protein subunits that
interact at the target cell surface; 5B indicates that the binding domain is composed of 5 identical
subunits.

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MECHANISMS OF BACTERIAL PATHOGENICITY: ENDOTOXINS

© 2002 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

BACTERIAL ENDOTOXINS

Endotoxins are part of the outer membrane of the cell wall of Gram-negative bacteria. Endotoxins are
invariably associated with Gram-negative bacteria whether the organisms are pathogens or not.
Although the term "endotoxin" is occasionally used to refer to any cell-associated bacterial toxin, it is
properly reserved to refer to the lipopolysaccharide complex associated with the outer membrane of
Gram-negative bacteria such as E. coli, Salmonella, Shigella, Pseudomonas, Neisseria, Haemophilus,
and other leading pathogens.

The biological activity of endotoxin is associated with the lipopolysaccharide (LPS). Toxicity is
associated with the lipid component (Lipid A) and immunogenicity is associated with the
polysaccharide components. The cell wall antigens (O antigens) of Gram-negative bacteria are
components of LPS. LPS elicits a variety of inflammatory responses in an animal. Because it activates
complement by the alternative (properdin) pathway, it is often part of the pathology of Gram-negative
bacterial infections.

The relationship of endotoxins to the bacterial cell surface is illustrated in Figure 1 below.

Figure 1. Structure of the cell surface of a Gram-negative bacterium

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In vivo, Gram-negative bacteria probably release minute amounts of endotoxin while growing. It is
known, that small amounts of endotoxin may be released in a soluble form, especially by young
cultures. However, for the most part, endotoxins remain associated with the cell wall until
disintegration of the bacteria. In vivo , this results from autolysis of the bacteria, external lysis
mediated by complement and lysozyme, and phagocytic digestion of bacterial cells.

Compared to the classic exotoxins of bacteria, endotoxins are less potent and less specific in their
action, since they do not act enzymatically. Endotoxins are heat stable (boiling for 30 minutes does not
destabilize endotoxin), but certain powerful oxidizing agents such as superoxide, peroxide and
hypochlorite, have been reported to neutralize them. Endotoxins, although antigenic, cannot be
converted to toxoids. A comparison of the properties of bacterial endotoxins and classic exotoxins is
shown in Table 1.

Table 1. Characteristics of bacterial endotoxins and classic exotoxins

PROPERTY ENDOTOXIN EXOTOXIN
CHEMICAL NATURE Lipopolysaccharide(mw = 10kDa) Protein (mw = 50-1000kDa)
RELATIONSHIP TO CELL Part of outer membrane Extracellular, diffusible
DENATURED BY BOILING No Usually
ANTIGENIC Yes Yes
FORM TOXOID No Yes
POTENCY Relatively low (>100ug) Relatively high (1 ug)
SPECIFICITY Low degree High degree
ENZYMATIC ACTIVITY No Usually
PYROGENICITY Yes Occasionally

The Role of LPS in the Outer Membrane of Gram-negative Bacteria

The function of the outer membrane of Gram-negative bacteria is to act as permeability barrier. The
outer membrane is impermeable to large molecules and hydrophobic compounds from the
environment. Endotoxin (LPS) is located on the outer face of the membrane, where it mediates contact
with the environment. LPS is essential to the function of the outer membrane, and as a structural
component of the cell, it may play several roles in the pathogenesis of Gram-negative bacterial
infections. First, it is a permeability barrier that is permeable only to low molecular weight, hydrophilic
molecules. In the E. colithe ompF and ompC porins exclude passage of all hydrophobic molecules and
any hydrophilic molecules greater than a molecular weight of about 700 daltons. This prevents
penetration of the bacteria by bile salts and other toxic molecules from the GI tract. It also a barrier to
lysozyme and many antimicrobial agents. Second, it impedes destruction of the bacterial cells by serum
components and phagocytic cells. Third, LPS plays an important role as a surface structure in the
interaction of the pathogen with its host. For example, LPS may be involved in adherence
(colonization), or resistance to phagocytosis, or antigenic shifts that determine the course and outcome
of an infection.

Chemical Nature of Endotoxin

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Most of the work on the chemical structure of endotoxin has been done with species of Salmonella and
E. coli. LPS can be extracted from whole cells by treatment with 45% phenol at 90o. Mild hydrolysis of
LPS yields Lipid A plus polysaccharide.

Lipopolysaccharides are complex amphiphilic molecules with a mw of about 10kDa, that vary widely
in chemical composition both between and among bacterial species The general architecture of LPS is
shown in Figure 2. The general structure of Salmonella LPS is shown in Figure 3 and the complete
structure of Salmonella lipid A is illustrated in Figure 4.

Figure 2. General architecture of Lipopolysaccharide

Figure 3. General Structure of Salmonella LPS

Glc = glucose; GlcNac = N-acetyl- glucosamine; Gal = galactose; Hep = heptose; P = phosphate; Etn = ethanolamine;
R1 and R2 = phoshoethanolamine or aminoarabinose. Ra to Re indicate incomplete forms of LPS. The Rd2
phenotype (not shown) would have only a single heptose unit. The Rc, Rd2, and Rd1 mutants lack the phosphate
group attached to Hep.

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 Figure 4. Complete structure of the Lipid A Moiety of LPS of S. typhimurium, S. minnesota, and E. coli

LPS consists of three components or regions, Lipid A, an R polysaccharide and an O polysaccharide.

Region I. Lipid A is the lipid component of LPS. It contains the hydrophobic, membrane-anchoring
region of LPS. Lipid A consists of a phosphorylated N-acetylglucosamine (NAG) dimer with 6 or 7
fatty acids (FA) attached. Usually 6 FA are found. All FA in Lipid A are saturated. Some FA are
attached directly to the NAG dimer and others are esterified to the 3-hydroxy fatty acids that are
characteristically present. The structure of Lipid A is highly conserved among Gram-negative bacteria.
Among Enterobacteriaceae Lipid A is virtually constant.

Region II. Core (R) antigen or R polysaccharide is attached to the 6 position of one NAG. The R
antigen consists of a short chain of sugars. For example: KDO - Hep - Hep - Glu - Gal - Glu - GluNAc
-

Two unusual sugars are usually present, heptose and 2-keto-3-deoxyoctonoic acid (KDO), in the core
polysaccharide. KDO is unique and invariably present in LPS and so has been an indicator in assays for
LPS (endotoxin).

With minor variations, the core polysaccharide is common to all members of a bacterial genus (e.g.
Salmonella), but it is structurally distinct in other genera of Gram-negative bacteria. Salmonella,
Shigella and Escherichia have similar but not identical cores.

Region III. Somatic (O) antigen or O polysaccharide is attached to the core polysaccharide. It
consists of repeating oligosaccharide subunits made up of 3 - 5 sugars. The individual chains vary in
length ranging up to 40 repeat units. The O polysaccharide is much longer than the core
polysaccharide, and it maintains the hydrophilic domain of the LPS molecule. A major antigenic
determinant (antibody-combining site) of the Gram-negative cell wall resides in the O polysaccharide.

Great variation occurs in the composition of the sugars in the O side chain between species and even
strains of Gram-negative bacteria. At least 20 different sugars are known to occur and many of these
sugars are characteristically unique dideoxyhexoses, which occur in nature only in Gram-negative cell
walls. Variations in sugar content of the O polysaccharide contribute to the wide variety of antigenic
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types of Salmonella and E. coli and presumably other strains of Gram-negative species. Particular
sugars in the structure, especially the terminal ones, confer immunological specificity of the O antigen,
in addition to "smoothness" (colony morphology) of the strain. Loss of the O specific region by
mutation results in the strain becoming a "rough" (colony morphology) or R strain.

The elucidation of the structure of LPS (Figure 3) relied heavily on the availability of mutants each
blocked at a particular step in LPS synthesis. The biosynthesis of LPS is strictly sequential. The core
sugars are added sequentially to Lipid A by successive additions, and the O side chain is added last,
one preassembled subunit at a time. The properties of mutants producing incomplete LPS molecules
suggests the nature and biological functions performed by various parts of the LPS molecule.

Loss of the O antigen results in loss of virulence suggesting that this portion is important during a host-
parasite interaction. It is known that such "rough" mutants are more susceptible to phagocytosis and
serum bactericidal reactions.

Loss of the more proximal parts of the core, as in "deep rough" mutants (i.e. in Rd1, Rd2, and Re
mutants in Figure 3) makes the strains sensitive to a range of hydrophobic compounds, including
antibiotics, detergents, bile salts and mutagens. This area contains a large number of charged groups
and is thought to be important in maintaining the permeability properties of the outer membrane.

Mutants in the assembly of Lipid A cannot be isolated except as conditional lethal mutants and this
region must therefore be essential for cell viability. The innermost region of LPS, consisting of Lipid A
and three residues of KDO, appears to be essential for viability, presumably for assembling the outer
membrane.

LPS and virulence of Gram-negative bacteria

Both Lipid A (the toxic component of LPS) and the polysaccharide side chains (the nontoxic but
immunogenic portion of LPS) act as determinants of virulence in Gram-negative bacteria.

The O polysaccharide and virulence

Virulence and the property of "smoothness", associated with an intact O polysaccharide, are regularly
associated in many bacterial infections. The involvement of the polysaccharide chain in virulence is
shown by the fact that small changes in the sugar sequences in the side chains of LPS result in major
changes in virulence. How are the polysaccharide side chains involved in the expression of virulence?
There are a number of possibilities:

1. Smooth antigens could allow organisms to adhere specifically to certain tissues, especially epithelial
tissues.

2. Smooth antigens probably allow resistance to phagocytes, since rough mutants are more readily
engulfed and destroyed by phagocytes.

3. The hydrophilic O polysaccharides could act as water-solubilizing carriers for toxic Lipid A. It is
known that the exact structure of the polysaccharide can greatly influence water binding capacity at the
cell surface.

4. The O antigens could provide protection from damaging reactions with antibody and
complement. Rough strains of Gram-negative bacteria derived from virulent strains are generally non
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virulent. Smooth strains have polysaccharide "whiskers" which bear O antigens projecting from the cell
surface. The O antigens are the key targets for the action of host antibody and complement, but when
the reaction takes place at the tips of the polysaccharide chains, a significant distance external to the
general bacterial cell surface, complement fails to have its normal lytic effect. Such bacteria are
virulent because of this resistance to immune forces of the host. If the projecting polysaccharide chains
are shortened or removed, antibody reacts with antigens on the general bacterial surface, or very close
to it, and complement can lyse the bacteria. This contributes to the loss of virulence in "rough" colonial
strains.

5. The O-polysaccharide or O antigen is the basis of antigenic variation among many important
Gram-negative pathogens including E. coli, Salmonella and Vibrio cholerae. Antigenic variation
guarantees the existence of multiple serotypes of the bacterium, so that it is afforded multiple
opportunities to infect its host if it can bypass the immune response against a different serotype.
Furthermore, even though the O polysaccharides are strong antigens, they seldom elicit immune
responses which give full protection to the host against secondary challenge with specific endotoxin.

Lipid A and virulence

Endotoxins are toxic to most mammals, and regardless of the bacterial source, all endotoxins produce
the same range of biological effects in the animal host. Most of our knowledge of the biological
activities of endotoxins derives not from the study of natural disease but by challenge of experimental
animals.

The injection of living or killed Gram-negative cells, or purified LPS, into experimental animals causes
a wide spectrum of nonspecific pathophysiological reactions such as: fever, changes in white blood
cell counts, disseminated intravascular coagulation, hypotension, shock and death. Injection of
fairly small doses of endotoxin results in death in most mammals. The sequence of events follows a
regular pattern: (1) latent period; (2) physiological distress (diarrhea, prostration, shock); (3) death.
How soon death occurs varies on the dose of the endotoxin, route of administration, and species of
animal. Animals vary in their susceptibility to endotoxin.

The physiological effects of endotoxin are thought to be mediated by Lipid A. Since Lipid A is
embedded in the outer membrane of bacterial cells, it probably only exerts its toxic effects when
released from multiplying cells in a soluble form, or when the bacteria are lysed as a result of autolysis,
complement and the membrane attack complex (MAC), ingestion and killing by phagocytes, or killing
with certain types of antibiotics.

It is thought that LPS released into the bloodstream by lysing Gram-negative bacteria is first bound by
certain plasma proteins identified as LPS-binding proteins. The LPS-binding protein complex
interacts with CD14 receptors on monocytes and macrophages and other types of receptors on
endothelial cells. In monocytes and macrophages three types of events are triggered during their
interaction with LPS:

1. Production of cytokines, including IL-1, IL-6, IL-8, tumor necrosis factor (TNF) and platelet-
activating factor. These in turn stimulate production of prostaglandins and leukotrienes. These are
powerful mediators of inflammation and septic shock that accompanies endotoxin toxemia. LPS
activates macrophages to enhanced phagocytosis and cytotoxicity. Macrophages are stimulated to
produce and release lysosomal enzymes, IL-1 ("endogenous pyrogen"), and tumor necrosis factor
(TNFalpha), as well as other cytokines and mediators.

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2. Activation of the complement cascade. C3a and C5a cause histamine release (leading to
vasodilation) and effect neutrophil chemotaxis and accumulation. The result is inflammation.

3. Activation of the coagulation cascade. Initial activation of Hageman factor (blood-clotting Factor
XII) can activate several humoral systems resulting in
a. coagulation: a blood clotting cascade that leads to coagulation, thrombosis, acute disseminated
intravascular coagulation, which depletes platelets and various clotting factors resulting in internal
bleeding.
b. activation of the complement alternative pathway (as above, which leads to inflammation)
c. plasmin activation which leads to fibrinolysis and hemorrhaging.
d. kinin activation releases bradykinins and other vasoactive peptides which causes hypotension.
The net effect is to induce inflammation, intravascular coagulation, hemorrhage and shock.

LPS also acts as a B cell mitogen stimulating the polyclonal differentiation and multiplication of B-
cells and the secretion of immunoglobulins, especially IgG and IgM.

The physiological activities of LPS are mediated mainly by the Lipid A component of LPS. Lipid A is
a powerful biological response modifier that can stimulate the mammalian immune system. During
infectious disease caused by Gram-negative bacteria, endotoxins released from, or part of, multiplying
cells have similar effects on animals and significantly contribute to the symptoms and pathology of the
disease encountered.

The primary structure of Lipid A has been elucidated and Lipid A has been chemically synthesized. Its
biological activity appears to depend on a peculiar conformation that is determined by the glucosamine
disaccharide, the PO4 groups, the acyl chains, and also the KDO-containing inner core.

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Antimicrobial Agents Used in Treatment of Infectious Disease

© 2002 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

Introduction

Most microbiologist distinguish two groups of antimicrobial agents used in the treatment of infectious
disease: antibiotics, which are natural substances produced by certain groups of microorganisms, and
chemotherapeutic agents, which are chemically synthesized. A hybrid substance is a semisynthetic
antibiotic, wherein a molecular version produced by the microbe is subsequently modified by the
chemist to achieve desired properties. Furthermore, some antimicrobial compounds, originally
discovered as products of microorganisms, can be synthesized entirely by chemical means. They might
be referred to as synthetic antibiotics to distinguish them from the chemotherapeutic agents.

The modern era of antimicrobial chemotherapy began in 1929 with Fleming's discovery of the
powerful bactericidal substance penicillin, and Domagk's discovery in 1935 of synthetic chemicals
(sulfonamides) with broad antimicrobial activity.

In the early 1940's, spurred partially by the need for antibacterial agents in WW II, penicillin was
isolated, purified and injected into experimental animals, where it was found to not only cure infections
but also to possess incredibly low toxicity for the animals. This fact ushered into being the age of
antibiotic chemotherapy and an intense search for similar antimicrobial agents of low toxicity to
animals that might prove useful in the treatment of infectious disease. The rapid isolation of
streptomycin, chloramphenicol and tetracycline soon followed, and by the 1950's, these and several
other antibiotics were in clinical usage.

The most important property of an antimicrobial agent, from a host point of view, is its selective
toxicity, i.e., that the agent acts in some way that inhibits or kills bacterial pathogens but has little or no
toxic effect on the host. This implies that the biochemical processes in the bacteria are in some way
different from those in the animal cells, and that the advantage of this difference can be taken in
chemotherapy.

Characteristics of Antibiotics

Antibiotics are low-molecular weight substances that are produced as secondary metabolites by certain
groups of microorganisms, especially Streptomyces, Bacillus, and a few molds (Penicillium and
Cephalosporium) that are inhabitants of soils (Table 1). Antibiotics may have a cidal (killing) effect or
a static (inhibitory) effect on a range of microbes. The range of bacteria or other microorganisms that
is affected by a certain antibiotic is expressed as its spectrum of action. Antibiotics effective against
procaryotes which kill or inhibit a wide range of Gram-positive and Gram-negative bacteria are said to
be broad spectrum. If effective mainly against Gram-positive or Gram-negative bacteria, they are
narrow spectrum. If effective against a single organism or disease, they are referred to as limited
spectrum.
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A clinically-useful antibiotic should have as many of these characteristics as possible.
-It should have a wide spectrum of activity with the ability to destroy or inhibit many different species
of pathogenic organisms.
-It should be nontoxic to the host and without undesirable side effects.
-It should be nonallergenic to the host.
-It should not eliminate the normal flora of the host.
-It should be able to reach the part of the human body where the infection is occurring.
-It should be inexpensive and easy to produce.
-It should be chemically-stable (have a long shelf-life).
-Microbial resistance is uncommon and unlikely to develop.

Kinds of Antimicrobial Agents and their Primary Modes of Action

The table below is a summary of the classes of antibiotics and their properties including their
biological source and mode of action.

Table 1. Classes of antibiotics and their properties

Spectrum
Biological
Chemical class Examples (effective Mode of action
source
against)
Inhibits steps in
Penicillium
Beta-lactams cell wall
Penicillin G, notatum and Gram-positive
(penicillins and (peptidoglycan)
Cephalothin Cephalosporium bacteria
cephalosporins) synthesis and
species
murein assembly
Inhibits steps in
Gram-positive and cell wall
Semisynthetic Ampicillin,
Gram-negative (peptidoglycan)
penicillin Amoxycillin
bacteria synthesis and
murein assembly
Clavamox is Gram-positive and "Suicide"
Streptomyces
Clavulanic Acid clavulanic acid Gram-negative inhibitor of beta-
clavuligerus
plus amoxycillin bacteria lactamases
Inhibits steps in
Gram-positive and cell wall
Chromobacter
Monobactams Aztreonam Gram-negative (peptidoglycan)
violaceum
bacteria synthesis and
murein assembly
Inhibits steps in
Gram-positive and cell wall
Streptomyces
Carboxypenems Imipenem Gram-negative (peptidoglycan)
cattleya
bacteria synthesis and
murein assembly
Gram-positive and Inhibit translation
Streptomyces
Aminoglycosides Streptomycin Gram-negative (protein
griseus
bacteria synthesis)
Gentamicin Micromonospora Gram-positive and Inhibit translation
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 species Gram-negative (protein
bacteria esp. synthesis)
Pseudomonas
Inhibits steps in
Gram-positive
murein
Streptomyces bacteria, esp.
Glycopeptides Vancomycin (peptidoglycan)
orientales Staphylococcus
biosynthesis and
aureus
assembly
Gram-positive and
Inhibits
Gram-negative
Streptomyces translation
Lincomycins Clindamycin bacteria esp.
lincolnensis (protein
anaerobic
synthesis)
Bacteroides
Gram-positive
bacteria, Gram-
Inhibits
negative bacteria
Streptomyces translation
Macrolides Erythromycin not enterics,
erythreus (protein
Neisseria,
synthesis)
Legionella,
Mycoplasma
Damages
Bacillus Gram-negative
Polypeptides Polymyxin cytoplasmic
polymyxa bacteria
membranes
Inhibits steps in
murein
Gram-positive
Bacitracin Bacillus subtilis (peptidoglycan)
bacteria
biosynthesis and
assembly
Inactivate
Streptomyces membranes
Polyenes Amphotericin Fungi
nodosus containing
sterols
Inactivate
Streptomyces membranes
Nystatin Fungi (Candida)
noursei containing
sterols
Gram-positive and
Inhibits
Gram-negative
Streptomyces transcription
Rifamycins Rifampicin bacteria,
mediterranei (bacterial RNA
Mycobacterium
polymerase)
tuberculosis
Gram-positive and
Inhibit translation
Streptomyces Gram-negative
Tetracyclines Tetracycline (protein
species bacteria,
synthesis)
Rickettsias
Semisynthetic Gram-positive and Inhibit translation
Doxycycline
tetracycline Gram-negative (protein
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 bacteria, synthesis)
Rickettsias
Ehrlichia, Borrelia
Inhibits
Gram-positive and
Streptomyces translation
Chloramphenicol Chloramphenicol Gram-negative
venezuelae (protein
bacteria
synthesis)

Antimicrobial Agents Used in the Treatment of Infectious Disease

The following discussion of antibiotics and chemotherapeutic organizes the antimicrobial agents based
on their mode of action in bacterial cells.

Cell wall synthesis inhibitors

Cell wall synthesis inhibitors generally inhibit some step in the synthesis of bacterial peptidoglycan.
Generally they exert their selective toxicity against eubacteria because human cells lack cell walls.

Beta lactam antibiotics. Chemically, these antibiotics contain a 4-membered beta lactam ring.They are
the products of two groups of fungi, Penicillium and Cephalosporium molds, and are correspondingly
represented by the penicillins and cephalosporins.

The beta lactam antibiotics are stereochemically related to D-alanyl-D-alanine which is a substrate for
the last step in peptidoglycan synthesis, the final cross-linking between between peptide side chains.
Penicillins bind to and inhibit the carboxypeptidase and transpeptidase enzymes that are required for
this step in peptidoglycan biosynthesis. Beta lactam antibiotics are normally bactericidal and require
that cells be actively growing in order to exert their toxicity.

Different beta lactams differ in their spectrum of activity and their effect on Gram-negative rods, as
well as their toxicity, stability in the human body, rate of clearance from blood, whether they can be
taken orally, ability to cross the blood-brain barrier, and susceptibility to bacterial beta-lactamases.

Natural penicillins, such as Penicillin G or Penicillin V, are produced by fermentation of Penicillium

chrysogenum. They are effective against streptococcus, gonococcus and staphylococcus, except where
resistance has developed. They are considered narrow spectrum since they are not effective against
Gram-negative rods.

Semisynthetic penicillins first appeared in 1959. A mold produces the main part of the molecule (6-
aminopenicillanic acid) which can be modified chemically by the addition of side shains. Many of
these compounds have been developed to have distinct benefits or advantages over penicillin G, such as
increased spectrum of activity (effectiveness against Gram-negative rods), resistance to penicillinase,
effectiveness when administered orally, etc. Amoxycillin and Ampicillin have broadened spectra
against Gram-negatives and are effective orally; Methicillin is penicillinase-resistant.

Clavulanic acid is a chemical sometimes added to a semisynthetic penicillin preparation. Thus,

amoxycillin plus clavulanate is clavamox or augmentin. The clavulanate is not an antimicrobial agent.
It inhibits beta lactamase enzymes and has given extended life to penicillinase-sensitive beta lactams.

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Although nontoxic, penicillins occasionally cause death when administered to persons who are allergic
to them. In the U.S. there are 300 - 500 deaths annually due to penicillin allergy. In allergic individuals
the beta lactam molecule attaches to a serum protein which initiates an IgE-mediated inflammatory
response.

Cephalolsporins are beta lactam antibiotics with a similar mode of action to penicillins that are
produced by species of Cephalosporium. The have a low toxicity and a somewhat broader spectrum
than natural penicillins. They are often used as penicillin substitutes, against Gram-negative bacteria,
and in surgical prophylaxis. They are subject to degradation by some bacterial beta lactamases, but they
tend to be resistant to beta-lactamases from S. aureus.

Two other classes of beta lactams are the carbapenems and monobactams. The latter are particularly
useful for the treatment of allergic individuals. A person who becomes allergic to penicillin usually
becomes allergic to the cephalosporins and the carbapenems as well. Such individuals can still be
treated with the monobactams, which are structurally different so as not to induce allergy.

Bacitracin is a polypeptide antibiotic produced by Bacillus species. It prevents cell wall growth by
inhibiting the release of the muropeptide subunits of peptidoglycan from the lipid carrier molecule that
carries the subunit to the outside of the membrane.Teichoic acid synthesis, which requires the same
carrier, is also inhibited. Bacitracin has a high toxicity which precludes its systemic use. It is present in
many topical antibiotic preparations, and since it is not absorbed by the gut, it is given to "sterilize" the
bowel prior to surgery.

Cycloserine inhibits the early stages of murein synthesis where D-alanyl-D-alanine is added to the
growing peptide side chain. The antibiotic resembles D-alanine in spatial structure, and it competitively
inhibits the racemase reaction that converts L-alanine to D-alanine and the synthetase reaction that
joins two D-alanine molecules. The affinity of cycloserine for these enzymes is about a hundred times
greater than that of D-alanine. Cycloserine enters bacterial cells by means of an active transport system
for glycine and can reach a relatively high intracellular concentration. This concentrating effect, along
with its high affinity for susceptible enzymes, enables cycloserine to function as a very effective
antimicrobial agent. However, it is fairly toxic and has limited use as a secondary drug for tuberculosis.

Glycopeptides, such as the antibiotic vancomycin, appear to inhibit both transglycosylation and
transpeptidation reactions during peptidoglycan assembly. They bind to the muropeptide subunit as it is
transferred out of the cell cytoplasm and inhibit subsequent polymerization reactions. Vancomycin is
not effective against Gram-negative bacteria because it cannot penetrate their outer membrane.
However, it has become important in clinical usage for treatment of infections by strains of
Staphylococcus aureus that are resistant to virtually all other antibiotics.

Cell membrane inhibitors

These antibiotics disorganize the structure or inhibit the function of bacterial membranes. The integrity
of the cytoplasmic and outer membranes is vital to bacteria, and compounds that disorganize the
membranes rapidly kill the cells. However, due to the similarities in phospholipids in eubacterial and
eukaryotic membranes, this action is rarely specific enough to permit these compounds to be used
systemically. The only antibacterial antibiotic of clinical importance that acts by this mechanism is
polymyxin, produced by Bacillus polymyxis. Polymyxin is effective mainly against Gram-negative
bacteria and is usually limited to topical usage. Polymyxin binds to membrane phospholipids and
thereby interferes with membrane function. Polymyxin is occasionally given for urinary tract infections
caused by Pseudomonas strains that are gentamicin, carbenicillin and tobramycin resistant. The balance
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between effectiveness and damage to the kidney and other organs is dangerously close, and the drug
should only be given under close supervision in the hospital.

Protein synthesis inhibitors

Many therapeutically useful antibiotics owe their action to inhibition of some step in the complex
process of protein synthesis. Their attack is always at one of the events occurring on the ribosome and
never at the stage of amino acid activation or attachment to a particular tRNA. Most have an affinity or
specificity for 70S (as opposed to 80S) ribosomes, and they achieve their selective toxicity in this
manner. The most important antibiotics with this mode of action are the tetracyclines,
chloramphenicol, the macrolides (e.g. erythromycin) and the aminoglycosides (e.g. streptomycin).

The aminoglycosides are products of Streptomyces species and are represented by streptomycin,
kanamycin, tobramycin and gentamicin. These antibiotics exert their activity by binding to bacterial
ribosomes and preventing the initiation of protein synthesis.

Streptomycin binds to 30S subunit of the bacterial ribosome, specifically to the S12 protein which is
involved in the initiation of protein synthesis. Experimentally, streptomycin has been shown to prevent
the initiation of protein synthesis by blocking the binding of initiator N-formylmethionine tRNA to the
ribosome. It also prevents the normal dissociation of ribosomes into their subunits, leaving them
mainly in their 70S form and preventing the formation of polysomes. The overall effect of streptomycin
seems to be one of distorting the ribosome so that it no longer can carry out its normal functions. This
evidently accounts for its antibacterial activity but does not explain its bactericidal effects, which
distinguishes streptomycin and other aminoglycosides from most other protein synthesis inhibitors.

Kanamycin and tobramycin have been reported to bind to the ribosomal 30S subunit and to prevent it
from joining to the 50S subunit during protein synthesis. They may have a bactericidal effect because
this leads to cytoplasmic accumulation of dissociated 30S subunits, which is apparently lethal to the
cells.

Aminoglycosides have been used against a wide variety of bacterial infections caused by Gram-
positive and Gram-negative bacteria. Streptomycin has been used extensively as a primary drug in the
treatment of tuberculosis. Gentamicin (a mixture of 3 components) is active against many strains of
Gram-positive and Gram-negative bacteria, including some strains of Pseudomonas aeruginosa.
Kanamycin (a complex of three antibiotics, A, B and C) is active at low concentrations against many
Gram-positive bacteria, including penicillin-resistant staphylococci. Gentamicin and Tobramycin are
mainstays for treatment of Pseudomonas infections. An unfortunate side effect of aminoglycosides has
tended to restrict their usage: prolonged use is known to impair kidney function and cause damage to
the auditory nerves leading to deafness.

The tetracyclines consist of eight related antibiotics which are all natural products of Streptomyces,
although some can now be produced semisynthetically or synthetically. Tetracycline,
chlortetracycline and doxycycline are the best known. The tetracyclines are broad-spectrum
antibiotics with a wide range of activity against both Gram-positive and Gram-negative bacteria.
Pseudomonas aeruginosa is less sensitive but is generally susceptible to tetracycline concentrations
that are obtainable in the bladder. The tetracyclines act by blocking the binding of aminoacyl tRNA to
the A site on the ribosome. Tetracyclines inhibit protein synthesis on isolated 70S or 80S (eukaryotic)
ribosomes, and in both cases, their effect is on the small ribosomal subunit. However, most bacteria
possess an active transport system for tetracycline that will allow intracellular accumulation of the
antibiotic at concentrations 50 times as great as that in the medium. This greatly enhances its
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antibacterial effectiveness and accounts for its specificity of action, since an effective concentration
cannot be accumulated in animal cells. Thus a blood level of tetracycline which is harmless to animal
tissues can halt protein synthesis in invading bacteria.

The tetracyclines have a remarkably low toxicity and minimal side effects when taken by animals. The
combination of their broad spectrum and low toxicity has led to their overuse and misuse by the
medical community and the wide-spread development of resistance has reduced their effectiveness.
Nonetheless, tetracyclines still have some important uses, such as the use of doxycycline in the
treatment of Lyme disease.

Some newly discovered members of the tetracycline family (e.g. chelocardin) have been shown to act
by inserting into the bacterial membrane, not by inhibiting protein synthesis.

Chloramphenicol is a protein synthesis inhibitor has a broad spectrum of activity but it exerts a
bacteriostatic effect. It is effective against intracellular parasites such as the rickettsiae. Unfortunately,
aplastic anemia, which is dose-related develops in a small proportion (1/50,000) of patients.
Chloramphenicol was originally discovered and purified from the fermentation of a Streptomyces, but
currently it is produced entirely by chemical synthesis. Chloramphenicol inhibits the bacterial enzyme
peptidyl transferase, thereby preventing the growth of the polypeptide chain during protein synthesis.

Chloramphenicol is entirely selective for 70S ribosomes and does not affect 80S ribosomes. Its
unfortunate toxicity towards the small proportion of patients who receive it is in no way related to its
effect on bacterial protein synthesis. However, since mitochondria probably originated from
procaryotic cells and have 70S ribosomes, they are subject to inhibition by some of the protein
synthesis inhibitors including chloroamphenicol. This likely explains the toxicity of chloramphenicol.
The eukaryotic cells most likely to be inhibited by chloramphenicol are those undergoing rapid
multiplication, thereby rapidly synthesizing mitochondria. Such cells include the blood forming cells of
the bone marrow, the inhibition of which could present as aplastic anemia. Chloramphenicol was once
a highly prescribed antibiotic and a number of deaths from anemia occurred before its use was
curtailed. Now it is seldom used in human medicine except in life-threatening situations (e.g. typhoid
fever).

The maccrolide family of antibiotics is characterized by structures thatcontain large lactone rings
linked through glycoside bonds with amino sugars. The most important members of the group are
erythromycin and oleandomycin. Erythromycin is active against most Gram-positive bacteria,
Neisseria, Legionella and Haemophilus, but not against the Enterobacteriaceae. Macrolides inhibit
bacterial protein synthesis by binding to the 50S ribosomal subunit. Binding inhibits elongation of the
protein by peptidyl transferase or prevents translocation of the ribosome or both. Macrolides are
bacteriostatic for most bacteria but are cidal for a few Gram-positive bacteria.

Lincomycin and clindamycin are a miscellaneous group of protein synthesis inhibitors with activity
similar to the macrolides. Lincomycin has activity against Gram-positive bacteria and some Gram-
negative bacteria (Neisseria, H. influenzae). Clindamycin is a derivative of lincomycin, with the same
range of antimicrobial activity, but it is considered more effective. It is frequently used as a penicillin
substitute and is effective against Gram-negative anaerobes (e.g. Bacteroides).

Effects on Nucleic Acids

Some antibiotics and chemotherapeutic agents affect the synthesis of DNA or RNA, or can bind to
DNA or RNA so that their messages cannot be read. Either case, of course, can block the growth of
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cells. The majority of these drugs are unselective, however, and affect animal cells and bacterial cells
alike and therefore have no therapeutic application. Two nucleic acid synthesis inhibitors which have
selective activity against procaryotes and some medical utility are the quinolones and rifamycins.

Nalidixic acid is a synthetic chemotherapeutic agent which has activity mainly against Gram-negative
bacteria. Nalidixic acid belongs to a group of compounds called quinolones. Nalidixic acid is a
bactericidal agent that binds to the DNA gyrase enzyme (topoisomerase) which is essential for DNA
replication and allows supercoils to be relaxed and reformed. Binding of the drug inhibits DNA gyrase
activity.

Some quinolones penetrate macrophages and neutrophils better than most antibiotics and are thus
useful in treatment of infections caused by intracellular parasites. However, the main use of nalidixic
acid is in treatment of lower urinary tract infections (UTI). The compound is unusual in that it is
effective against several types of Gram-negative bacteria such as E. coli, Enterobacter aerogenes, K.
pneumoniae and Proteus species which are common causes of UTI. It is not usually effective against
Pseudomonas aeruginosa, and Gram-positive bacteria are resistant.

Some quinolones have a broadened spectrum against Gram-positive bacteria. The fluoroquinolone,
Cipro. (ciprofloxacin) was recently touted as the drug of choice for treatment and prophylaxis of
anthrax, which is caused by a Gram-positive bacillus.

The rifamycins are a comparatively new group of antibiotics, also the products of Streptomyces.
Rifampicin is a semisynthetic derivative of rifamycin that is active against Gram-positive bacteria
(including Mycobacterium tuberculosis) and some Gram-negative bacteria. Rifampicin acts quite
specifically on the bacterial RNA polymerase and is inactive towards DNA polymerase or RNA
polymerase from animal cells. The antibiotic binds to the beta subunit of the polymerase and apparently
blocks the entry of the first nucleotide which is necessary to activate the polymerase, thereby blocking
mRNA synthesis. It has been found to have greater bactericidal effect against M .tuberculosis than
other anti-tuberculosis drugs, and it has largely replaced isoniazid as one of the front-line drugs used to
treat the disease, especially when isoniazid resistance is indicated. It is effective orally and penetrates
the cerebrospinal fluid so it is useful for treatment of bacterial meningitis.

Competitive Inhibitors

Many of the synthetic chemotherapeutic agents are competitive inhibitors of essential metabolites or
growth factors that are needed in bacterial metabolism. Hence, these types of antimicrobial agents are
sometimes referred to as anti-metabolites or growth factor analogs, since they are designed to
specifically inhibit an essential metabolic pathway in the bacterial pathogen. At a chemical level,
competitive inhibitors are structurally similar to a bacterial growth factor or metabolite, but they do not
fulfill their metabolic function in the cell. Some are bacteriostatic and some are bactericidal. Their
selective toxicity is based on the premise that the bacterial pathway does not occur in the host.

Sulfonamides were introduced as chemotherapeutic agents by Domagk in 1935, who showed that one
of these compounds (prontosil) had the effect of curing mice with infections caused by beta-hemolytic
streptococci. Chemical modifications of the compound sulfanilamide gave compounds with even
higher and broader antibacterial activity. The resulting sulfonamides have broadly similar antibacterial
activity, but differ widely in their pharmacological actions. Bacteria which are almost always sensitive
to the sulfonamides include Streptococcus pneumoniae, beta-hemolytic streptococci and E. coli. The
sulfonamides have been extremely useful in the treatment of uncomplicated UTI caused by E. coli, and
in the treatment of meningococcal meningitis (because they cross the blood-brain barrier).
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The sulfonamides (e.g. Gantrisin) and Trimethoprim are inhibitors of the bacterial enzymes required
for the synthesis of tetrahydofolic acid (THF), the vitamin form of folic acid essential for 1-carbon
transfer reactions. Sulfonamides are structurally similar to para aminobenzoic acid (PABA), the
substrate for the first enzyme in the THF pathway, and they competitively inhibit that step.
Trimethoprim is structurally similar to dihydrofolate (DHF) and competitively inhibits the second step
in THF synthesis mediated by the DHF reductase. Animal cells do not synthesize their own folic acid
but obtain it in a preformed fashion as a vitamin. Since animals do not make folic acid, they are not
affected by these drugs, which achieve their selective toxicity for bacteria on this basis.

Three additional synthetic chemotherapeutic agents have been used in the treatment of
tuberculosis: (INH), paraaminosalicylic acid (PAS), and ethambutol. The usual strategy in the
treatment of tuberculosis has been to administer a single antibiotic (historically streptomycin, but now,
most commonly, rifampicin is given) in conjunction with INH and ethambutol. Since the tubercle
bacillus rapidly develops resistance to the antibiotic, ethambutol and INH are given to prevent
outgrowth of a resistant strain. It must also be pointed out that the tubercle bacillus rapidly develops
resistance to ethambutol and INH if either drug is used alone. Ethambutol inhibits incorporation of
mycolic acids into the mycobacterial cell wall. Isoniazid has been reported to inhibit mycolic acid
synthesis in mycobacteria and since it is an analog of pyridoxine (Vitamin B6) it may inhibit
pyridoxine-catalyzed reactions as well. Isoniazid is activated by a mycobacterial peroxidase enzyme
and destroys several targets in the cell. PAS is an anti-folate, similar in activity to the sulfonamides.
PAS was once a primary anti-tuberculosis drug, but now it is a secondary agent, having been largely
replaced by ethambutol.

Microorganisms that Produce Antibiotics

The molds, Penicillium and Cephalosporium, produce Beta-lactam antibiotics, i.e., penicillin,
cephalosporin, and their relatives.

Actinomycetes, mainly Streptomyces species: produce tetracyclines, aminoglycosides (streptomycin

and its relatives), macrolides (erythromycin and its relatives), chloramphenicol, ivermectin, rifamycins,
and most other clinically-useful antibiotics that are not beta-lactams.

Bacillus species, such as B. polymyxa and Bacillus subtilis produce polypeptide antibiotics (e.g.
polymyxin and bacitracin).

These organisms all have in common that they live in a soil habitat and they form some sort of a spore
or resting structure. It is not known why these microorganisms produce antibiotics. It may rest in the
obvious, i.e., the antibiotics afford the microbes some nutritional advantage in their habitat by
antagonism against the competition. However, it may rest on the subtle: i.e., the antibiotics act as some
sort of hormone or signal molecule associated with sporulation or dormancy or germination.

Antibiotics are secondary metabolites of microorganisms and they are produced at the same time that
the cells begin sporulation processes. Antibiotics tend to be rather large, complicated, organic
molecules and may require as many as 30 separate enzymatic steps to synthesize. The maintenance of a
substantial component of the bacterial genome devoted solely to the synthesis of an antibiotic leads one
to the conclusion that the process (or molecule) is important, if not essential, to the survival of these
organisms in their natural habitat.

Most of the microorganisms that produce antibiotics are resistant to the action of their own antibiotic,
although the organisms are affected by other antibiotics, and their antibiotic may be effective against
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closely-related strains. Generally speaking, how or why bacteria are resistant to their own antibiotics is
also unknown, but the mechanisms may be similar to resistance that develops in medically-important
bacteria.

Microbial Resistance to Antibiotics

The first antibiotic, penicillin, was discovered in 1929 by Sir Alexander Fleming who observed
inhibition of staphylococci on an agar plate contaminated by a Penicillium mold. World War II (and the
inevitable bacterial infections that occurred in war-related wounds) was an important impetus to study
the chemotherapeutic value of penicillin. Penicillin became generally available for treatment of
bacterial infections, especially those caused by staphylococci and streptococci, about 1946. Initially,
the antibiotic was effective against all sorts of infections caused by these two Gram-positive bacteria. It
is important to note that a significant fraction of all human infections are caused by these two bacteria
(i.e., strep throat, pneumonia, septicemia, skin infections, wound infections, scarlet fever, toxic shock
syndrome). Penicillin had unbelievable ability to kill these bacterial pathogens without harming the
host that harbored them.

Resistance to penicillin in some strains of staphylococci was recognized almost immediately after
introduction of the drug. Resistance to penicillin today occurs in as many as 80% of all strains of
Staphylococcus aureus and some strains of S. aureus have been isolated that are resistant to virtually all
clinically-available antibiotics. Surprisingly, Streptococcus pyogenes (Group A strep) has never fully
developed resistance to penicillin, and it remains a reasonable choice antibiotic for many types of
streptococcal infections. Interestingly, penicillin has never been effective against most Gram-negative
pathogens (e.g. Salmonella, Shigella, Bordetella pertussis, Yersinia pestis, Pseudomonas) with the
notable exception of Neisseria gonorrhoeae. Gram-negative bacteria are inherently resistant to
penicillin because their vulnerable cell wall is protected by an outer membrane that prevents
permeation of the penicillin molecule.

The period of the late 1940s and early 1950s saw the discovery and introduction of streptomycin,
chloramphenicol, and tetracycline, and the age of antibiotic chemotherapy came into full being. These
antibiotics were effective against the full array of bacterial pathogens including Gram-positive and
Gram-negative bacteria, intracellular parasites, and the tuberculosis bacillus. However, by 1953, during
a Shigella outbreak in Japan, a strain of the dysentery bacillus was isolated which was multiple drug
resistant, exhibiting resistance to chloramphenicol, tetracycline, streptomycin, and the sulfanilamides.
There was also evidence mounting that bacteria could pass genes for multiple drug resistance between
strains and even between species. It was also apparent that Mycobacterium tuberculosis was capable of
rapid development of resistance to streptomycin which had become a mainstay in tuberculosis therapy.
Today, drug-resistant strains of M. tuberculosis are threatening to break through in one of the world's
most prevalent infectious diseases.

The Genetic Basis of Bacterial Resistance to Antibiotics

Inherent (Natural) Resistance. Bacteria may be inherently resistant to an antibiotic. For example, a
streptomycete has some gene that is responsible for resistance to its own antibiotic; or a Gram-negative
bacterium has an outer membrane that establishes a permeability barrier against the antibiotic; or an
organism lacks a transport system for the antibiotic; or it lacks the target or reaction that is hit by the
antibiotic.

Acquired Resistance. Bacteria can develop resistance to antibiotics, e.g. bacterial populations
previously-sensitive to antibiotics become resistant. This type of resistance results from changes in the
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bacterial genome. Acquired resistance is driven by two genetic processes in bacteria: (1) mutation and
selection (sometimes referred to as vertical evolution); (2) exchange of genes between strains and
species (sometimes called horizontal evolution).

Vertical evolution is strictly a matter of Darwinian evolution driven by principles of natural selection:
a spontaneous mutation in the bacterial chromosome imparts resistance to a member of the bacterial
population. In the selective environment of the antibiotic, the wild type (non mutants) are killed and the
resistant mutant is allowed to grow and flourish. The mutation rate for most bacterial genes is
approximately 10-8. This means that if a bacterial population doubles from 108 cells to 2 x 108 cells,
there is likely to be a mutant present for any given gene. Since bacteria grow to reach population
densities far in excess of 109 cells, such a mutant could develop from a single generation during 15
minutes of growth.

Horizontal evolution is the acquisition of genes for resistance from another organism. For example, a
streptomycete has a gene for resistance to streptomycin (its own antibiotic), but somehow that gene
escapes and gets into E. coli or Shigella. Or, more likely, a bacterium like E. coli develops genetic
resistance through the process of mutation and selection and then donates these genes to some other
bacterium through one of several processes for genetic exchange that exist in bacteria (below).

Bacteria are able to exchange genes in nature by three processes: conjugation, transduction and
transformation. Conjugation involves cell-to-cell contact as DNA crosses a sex pilus from donor to
recipient. During transduction, a virus transfers the genes between mating bacteria. In
transformation, DNA is acquired directly from the environment, having been released from another
cell. Genetic recombination can follow the transfer of DNA from one cell to another leading to the
emergence of a new genotype (recombinant). It is common for DNA to be transferred as plasmids
between mating bacteria. Since bacteria usually develop their genes for drug resistance on plasmids
(called resistance transfer factors, or RTFs), they are able to spread drug resistance to other strains
and species during genetic exchange processes.

The combined effects of fast growth rates, high concentrations of cells, genetic processes of mutation
and selection, and the ability to exchange genes, account for the extraordinary rates of adaptation and
evolution that can be observed in the bacteria. For these reasons bacterial adaptation (resistance) to the
antibiotic environment seems to take place very rapidly in evolutionary time. Bacteria evolve fast!

The Mechanisms of Bacterial Resistance to Antibiotics

section in progress

The Medical Problem of Bacterial Resistance

Obviously, if a bacterial pathogen is able to develop or acquire resistance to an antibiotic, then that
substance becomes useless in the treatment of infectious disease caused by that pathogen (unless the
resistance can somehow be overcome with secondary measures). So as pathogens develop resistance,
humanity must find new (different) antibiotics to fill the place of the old ones in treatment regimes.
Hence, natural penicillins have become useless against staphylococci and must be replaced by other
antibiotics; tetracycline, having been so widely used and misused for decades, has become worthless
for many of the infections that once designated it as a "wonder drug".

Not only is there a problem in finding new antibiotics to fight old diseases (because resistant strains of
bacteria have emerged), there is a parallel problem to find new antibiotics to fight new diseases. In the
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past two decades, many "new" bacterial diseases have been discovered (Legionnaire's disease, gastric
ulcers, Lyme disease, toxic shock syndrome, "skin-eating" streptococci). Broad patterns of resistance
exist in these pathogens, and it seems likely that new antibiotics will soon be needed to replace the
handful that are effective now against these bacteria, especially as resistance begins to emerge among
them in the selective environment antibiotic chemotherapy.

It is said that the discovery and use of antibiotics and immunization procedures against infectious
disease are two developments in the field of microbiology that have contributed about twenty years to
the average life span of humans in developed countries where these practices are employed. While the
greater part of this span in time is probably due to vaccination, most of us are either still alive or have
family members who are still alive because an antibiotic conquered an infectious disease that otherwise
would have killed the individual. If we want to retain this medical luxury in our society, we must be
vigilant and proactive: we must fully understand how and why antimicrobial agents work, and why
they don't work, and realize that we must maintain a stride ahead of microbial pathogens that can only
be contained by antibiotic chemotherapy.

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 Todar's Online Textbook of Bacteriology

Antimicrobial Agents Used in Treatment of Infectious Disease

© 2002 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

Introduction

Most microbiologist distinguish two groups of antimicrobial agents used in the treatment of infectious
disease: antibiotics, which are natural substances produced by certain groups of microorganisms, and
chemotherapeutic agents, which are chemically synthesized. A hybrid substance is a semisynthetic
antibiotic, wherein a molecular version produced by the microbe is subsequently modified by the
chemist to achieve desired properties. Furthermore, some antimicrobial compounds, originally
discovered as products of microorganisms, can be synthesized entirely by chemical means. They might
be referred to as synthetic antibiotics to distinguish them from the chemotherapeutic agents.

The modern era of antimicrobial chemotherapy began in 1929 with Fleming's discovery of the
powerful bactericidal substance penicillin, and Domagk's discovery in 1935 of synthetic chemicals
(sulfonamides) with broad antimicrobial activity.

In the early 1940's, spurred partially by the need for antibacterial agents in WW II, penicillin was
isolated, purified and injected into experimental animals, where it was found to not only cure infections
but also to possess incredibly low toxicity for the animals. This fact ushered into being the age of
antibiotic chemotherapy and an intense search for similar antimicrobial agents of low toxicity to
animals that might prove useful in the treatment of infectious disease. The rapid isolation of
streptomycin, chloramphenicol and tetracycline soon followed, and by the 1950's, these and several
other antibiotics were in clinical usage.

The most important property of an antimicrobial agent, from a host point of view, is its selective
toxicity, i.e., that the agent acts in some way that inhibits or kills bacterial pathogens but has little or no
toxic effect on the host. This implies that the biochemical processes in the bacteria are in some way
different from those in the animal cells, and that the advantage of this difference can be taken in
chemotherapy.

Characteristics of Antibiotics

Antibiotics are low-molecular weight substances that are produced as secondary metabolites by certain
groups of microorganisms, especially Streptomyces, Bacillus, and a few molds (Penicillium and
Cephalosporium) that are inhabitants of soils (Table 1). Antibiotics may have a cidal (killing) effect or
a static (inhibitory) effect on a range of microbes. The range of bacteria or other microorganisms that
is affected by a certain antibiotic is expressed as its spectrum of action. Antibiotics effective against
procaryotes which kill or inhibit a wide range of Gram-positive and Gram-negative bacteria are said to
be broad spectrum. If effective mainly against Gram-positive or Gram-negative bacteria, they are
narrow spectrum. If effective against a single organism or disease, they are referred to as limited
spectrum.
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A clinically-useful antibiotic should have as many of these characteristics as possible.
-It should have a wide spectrum of activity with the ability to destroy or inhibit many different species
of pathogenic organisms.
-It should be nontoxic to the host and without undesirable side effects.
-It should be nonallergenic to the host.
-It should not eliminate the normal flora of the host.
-It should be able to reach the part of the human body where the infection is occurring.
-It should be inexpensive and easy to produce.
-It should be chemically-stable (have a long shelf-life).
-Microbial resistance is uncommon and unlikely to develop.

Kinds of Antimicrobial Agents and their Primary Modes of Action

The table below is a summary of the classes of antibiotics and their properties including their
biological source and mode of action.

Table 1. Classes of antibiotics and their properties

Spectrum
Biological
Chemical class Examples (effective Mode of action
source
against)
Inhibits steps in
Penicillium
Beta-lactams cell wall
Penicillin G, notatum and Gram-positive
(penicillins and (peptidoglycan)
Cephalothin Cephalosporium bacteria
cephalosporins) synthesis and
species
murein assembly
Inhibits steps in
Gram-positive and cell wall
Semisynthetic Ampicillin,
Gram-negative (peptidoglycan)
penicillin Amoxycillin
bacteria synthesis and
murein assembly
Clavamox is Gram-positive and "Suicide"
Streptomyces
Clavulanic Acid clavulanic acid Gram-negative inhibitor of beta-
clavuligerus
plus amoxycillin bacteria lactamases
Inhibits steps in
Gram-positive and cell wall
Chromobacter
Monobactams Aztreonam Gram-negative (peptidoglycan)
violaceum
bacteria synthesis and
murein assembly
Inhibits steps in
Gram-positive and cell wall
Streptomyces
Carboxypenems Imipenem Gram-negative (peptidoglycan)
cattleya
bacteria synthesis and
murein assembly
Gram-positive and Inhibit translation
Streptomyces
Aminoglycosides Streptomycin Gram-negative (protein
griseus
bacteria synthesis)
Gentamicin Micromonospora Gram-positive and Inhibit translation
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 species Gram-negative (protein
bacteria esp. synthesis)
Pseudomonas
Inhibits steps in
Gram-positive
murein
Streptomyces bacteria, esp.
Glycopeptides Vancomycin (peptidoglycan)
orientales Staphylococcus
biosynthesis and
aureus
assembly
Gram-positive and
Inhibits
Gram-negative
Streptomyces translation
Lincomycins Clindamycin bacteria esp.
lincolnensis (protein
anaerobic
synthesis)
Bacteroides
Gram-positive
bacteria, Gram-
Inhibits
negative bacteria
Streptomyces translation
Macrolides Erythromycin not enterics,
erythreus (protein
Neisseria,
synthesis)
Legionella,
Mycoplasma
Damages
Bacillus Gram-negative
Polypeptides Polymyxin cytoplasmic
polymyxa bacteria
membranes
Inhibits steps in
murein
Gram-positive
Bacitracin Bacillus subtilis (peptidoglycan)
bacteria
biosynthesis and
assembly
Inactivate
Streptomyces membranes
Polyenes Amphotericin Fungi
nodosus containing
sterols
Inactivate
Streptomyces membranes
Nystatin Fungi (Candida)
noursei containing
sterols
Gram-positive and
Inhibits
Gram-negative
Streptomyces transcription
Rifamycins Rifampicin bacteria,
mediterranei (bacterial RNA
Mycobacterium
polymerase)
tuberculosis
Gram-positive and
Inhibit translation
Streptomyces Gram-negative
Tetracyclines Tetracycline (protein
species bacteria,
synthesis)
Rickettsias
Semisynthetic Gram-positive and Inhibit translation
Doxycycline
tetracycline Gram-negative (protein
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 bacteria, synthesis)
Rickettsias
Ehrlichia, Borrelia
Inhibits
Gram-positive and
Streptomyces translation
Chloramphenicol Chloramphenicol Gram-negative
venezuelae (protein
bacteria
synthesis)

Antimicrobial Agents Used in the Treatment of Infectious Disease

The following discussion of antibiotics and chemotherapeutic organizes the antimicrobial agents based
on their mode of action in bacterial cells.

Cell wall synthesis inhibitors

Cell wall synthesis inhibitors generally inhibit some step in the synthesis of bacterial peptidoglycan.
Generally they exert their selective toxicity against eubacteria because human cells lack cell walls.

Beta lactam antibiotics. Chemically, these antibiotics contain a 4-membered beta lactam ring.They are
the products of two groups of fungi, Penicillium and Cephalosporium molds, and are correspondingly
represented by the penicillins and cephalosporins.

The beta lactam antibiotics are stereochemically related to D-alanyl-D-alanine which is a substrate for
the last step in peptidoglycan synthesis, the final cross-linking between between peptide side chains.
Penicillins bind to and inhibit the carboxypeptidase and transpeptidase enzymes that are required for
this step in peptidoglycan biosynthesis. Beta lactam antibiotics are normally bactericidal and require
that cells be actively growing in order to exert their toxicity.

Different beta lactams differ in their spectrum of activity and their effect on Gram-negative rods, as
well as their toxicity, stability in the human body, rate of clearance from blood, whether they can be
taken orally, ability to cross the blood-brain barrier, and susceptibility to bacterial beta-lactamases.

Natural penicillins, such as Penicillin G or Penicillin V, are produced by fermentation of Penicillium

chrysogenum. They are effective against streptococcus, gonococcus and staphylococcus, except where
resistance has developed. They are considered narrow spectrum since they are not effective against
Gram-negative rods.

Semisynthetic penicillins first appeared in 1959. A mold produces the main part of the molecule (6-
aminopenicillanic acid) which can be modified chemically by the addition of side shains. Many of
these compounds have been developed to have distinct benefits or advantages over penicillin G, such as
increased spectrum of activity (effectiveness against Gram-negative rods), resistance to penicillinase,
effectiveness when administered orally, etc. Amoxycillin and Ampicillin have broadened spectra
against Gram-negatives and are effective orally; Methicillin is penicillinase-resistant.

Clavulanic acid is a chemical sometimes added to a semisynthetic penicillin preparation. Thus,

amoxycillin plus clavulanate is clavamox or augmentin. The clavulanate is not an antimicrobial agent.
It inhibits beta lactamase enzymes and has given extended life to penicillinase-sensitive beta lactams.

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Although nontoxic, penicillins occasionally cause death when administered to persons who are allergic
to them. In the U.S. there are 300 - 500 deaths annually due to penicillin allergy. In allergic individuals
the beta lactam molecule attaches to a serum protein which initiates an IgE-mediated inflammatory
response.

Cephalolsporins are beta lactam antibiotics with a similar mode of action to penicillins that are
produced by species of Cephalosporium. The have a low toxicity and a somewhat broader spectrum
than natural penicillins. They are often used as penicillin substitutes, against Gram-negative bacteria,
and in surgical prophylaxis. They are subject to degradation by some bacterial beta lactamases, but they
tend to be resistant to beta-lactamases from S. aureus.

Two other classes of beta lactams are the carbapenems and monobactams. The latter are particularly
useful for the treatment of allergic individuals. A person who becomes allergic to penicillin usually
becomes allergic to the cephalosporins and the carbapenems as well. Such individuals can still be
treated with the monobactams, which are structurally different so as not to induce allergy.

Bacitracin is a polypeptide antibiotic produced by Bacillus species. It prevents cell wall growth by
inhibiting the release of the muropeptide subunits of peptidoglycan from the lipid carrier molecule that
carries the subunit to the outside of the membrane.Teichoic acid synthesis, which requires the same
carrier, is also inhibited. Bacitracin has a high toxicity which precludes its systemic use. It is present in
many topical antibiotic preparations, and since it is not absorbed by the gut, it is given to "sterilize" the
bowel prior to surgery.

Cycloserine inhibits the early stages of murein synthesis where D-alanyl-D-alanine is added to the
growing peptide side chain. The antibiotic resembles D-alanine in spatial structure, and it competitively
inhibits the racemase reaction that converts L-alanine to D-alanine and the synthetase reaction that
joins two D-alanine molecules. The affinity of cycloserine for these enzymes is about a hundred times
greater than that of D-alanine. Cycloserine enters bacterial cells by means of an active transport system
for glycine and can reach a relatively high intracellular concentration. This concentrating effect, along
with its high affinity for susceptible enzymes, enables cycloserine to function as a very effective
antimicrobial agent. However, it is fairly toxic and has limited use as a secondary drug for tuberculosis.

Glycopeptides, such as the antibiotic vancomycin, appear to inhibit both transglycosylation and
transpeptidation reactions during peptidoglycan assembly. They bind to the muropeptide subunit as it is
transferred out of the cell cytoplasm and inhibit subsequent polymerization reactions. Vancomycin is
not effective against Gram-negative bacteria because it cannot penetrate their outer membrane.
However, it has become important in clinical usage for treatment of infections by strains of
Staphylococcus aureus that are resistant to virtually all other antibiotics.

Cell membrane inhibitors

These antibiotics disorganize the structure or inhibit the function of bacterial membranes. The integrity
of the cytoplasmic and outer membranes is vital to bacteria, and compounds that disorganize the
membranes rapidly kill the cells. However, due to the similarities in phospholipids in eubacterial and
eukaryotic membranes, this action is rarely specific enough to permit these compounds to be used
systemically. The only antibacterial antibiotic of clinical importance that acts by this mechanism is
polymyxin, produced by Bacillus polymyxis. Polymyxin is effective mainly against Gram-negative
bacteria and is usually limited to topical usage. Polymyxin binds to membrane phospholipids and
thereby interferes with membrane function. Polymyxin is occasionally given for urinary tract infections
caused by Pseudomonas strains that are gentamicin, carbenicillin and tobramycin resistant. The balance
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between effectiveness and damage to the kidney and other organs is dangerously close, and the drug
should only be given under close supervision in the hospital.

Protein synthesis inhibitors

Many therapeutically useful antibiotics owe their action to inhibition of some step in the complex
process of protein synthesis. Their attack is always at one of the events occurring on the ribosome and
never at the stage of amino acid activation or attachment to a particular tRNA. Most have an affinity or
specificity for 70S (as opposed to 80S) ribosomes, and they achieve their selective toxicity in this
manner. The most important antibiotics with this mode of action are the tetracyclines,
chloramphenicol, the macrolides (e.g. erythromycin) and the aminoglycosides (e.g. streptomycin).

The aminoglycosides are products of Streptomyces species and are represented by streptomycin,
kanamycin, tobramycin and gentamicin. These antibiotics exert their activity by binding to bacterial
ribosomes and preventing the initiation of protein synthesis.

Streptomycin binds to 30S subunit of the bacterial ribosome, specifically to the S12 protein which is
involved in the initiation of protein synthesis. Experimentally, streptomycin has been shown to prevent
the initiation of protein synthesis by blocking the binding of initiator N-formylmethionine tRNA to the
ribosome. It also prevents the normal dissociation of ribosomes into their subunits, leaving them
mainly in their 70S form and preventing the formation of polysomes. The overall effect of streptomycin
seems to be one of distorting the ribosome so that it no longer can carry out its normal functions. This
evidently accounts for its antibacterial activity but does not explain its bactericidal effects, which
distinguishes streptomycin and other aminoglycosides from most other protein synthesis inhibitors.

Kanamycin and tobramycin have been reported to bind to the ribosomal 30S subunit and to prevent it
from joining to the 50S subunit during protein synthesis. They may have a bactericidal effect because
this leads to cytoplasmic accumulation of dissociated 30S subunits, which is apparently lethal to the
cells.

Aminoglycosides have been used against a wide variety of bacterial infections caused by Gram-
positive and Gram-negative bacteria. Streptomycin has been used extensively as a primary drug in the
treatment of tuberculosis. Gentamicin (a mixture of 3 components) is active against many strains of
Gram-positive and Gram-negative bacteria, including some strains of Pseudomonas aeruginosa.
Kanamycin (a complex of three antibiotics, A, B and C) is active at low concentrations against many
Gram-positive bacteria, including penicillin-resistant staphylococci. Gentamicin and Tobramycin are
mainstays for treatment of Pseudomonas infections. An unfortunate side effect of aminoglycosides has
tended to restrict their usage: prolonged use is known to impair kidney function and cause damage to
the auditory nerves leading to deafness.

The tetracyclines consist of eight related antibiotics which are all natural products of Streptomyces,
although some can now be produced semisynthetically or synthetically. Tetracycline,
chlortetracycline and doxycycline are the best known. The tetracyclines are broad-spectrum
antibiotics with a wide range of activity against both Gram-positive and Gram-negative bacteria.
Pseudomonas aeruginosa is less sensitive but is generally susceptible to tetracycline concentrations
that are obtainable in the bladder. The tetracyclines act by blocking the binding of aminoacyl tRNA to
the A site on the ribosome. Tetracyclines inhibit protein synthesis on isolated 70S or 80S (eukaryotic)
ribosomes, and in both cases, their effect is on the small ribosomal subunit. However, most bacteria
possess an active transport system for tetracycline that will allow intracellular accumulation of the
antibiotic at concentrations 50 times as great as that in the medium. This greatly enhances its
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antibacterial effectiveness and accounts for its specificity of action, since an effective concentration
cannot be accumulated in animal cells. Thus a blood level of tetracycline which is harmless to animal
tissues can halt protein synthesis in invading bacteria.

The tetracyclines have a remarkably low toxicity and minimal side effects when taken by animals. The
combination of their broad spectrum and low toxicity has led to their overuse and misuse by the
medical community and the wide-spread development of resistance has reduced their effectiveness.
Nonetheless, tetracyclines still have some important uses, such as the use of doxycycline in the
treatment of Lyme disease.

Some newly discovered members of the tetracycline family (e.g. chelocardin) have been shown to act
by inserting into the bacterial membrane, not by inhibiting protein synthesis.

Chloramphenicol is a protein synthesis inhibitor has a broad spectrum of activity but it exerts a
bacteriostatic effect. It is effective against intracellular parasites such as the rickettsiae. Unfortunately,
aplastic anemia, which is dose-related develops in a small proportion (1/50,000) of patients.
Chloramphenicol was originally discovered and purified from the fermentation of a Streptomyces, but
currently it is produced entirely by chemical synthesis. Chloramphenicol inhibits the bacterial enzyme
peptidyl transferase, thereby preventing the growth of the polypeptide chain during protein synthesis.

Chloramphenicol is entirely selective for 70S ribosomes and does not affect 80S ribosomes. Its
unfortunate toxicity towards the small proportion of patients who receive it is in no way related to its
effect on bacterial protein synthesis. However, since mitochondria probably originated from
procaryotic cells and have 70S ribosomes, they are subject to inhibition by some of the protein
synthesis inhibitors including chloroamphenicol. This likely explains the toxicity of chloramphenicol.
The eukaryotic cells most likely to be inhibited by chloramphenicol are those undergoing rapid
multiplication, thereby rapidly synthesizing mitochondria. Such cells include the blood forming cells of
the bone marrow, the inhibition of which could present as aplastic anemia. Chloramphenicol was once
a highly prescribed antibiotic and a number of deaths from anemia occurred before its use was
curtailed. Now it is seldom used in human medicine except in life-threatening situations (e.g. typhoid
fever).

The maccrolide family of antibiotics is characterized by structures thatcontain large lactone rings
linked through glycoside bonds with amino sugars. The most important members of the group are
erythromycin and oleandomycin. Erythromycin is active against most Gram-positive bacteria,
Neisseria, Legionella and Haemophilus, but not against the Enterobacteriaceae. Macrolides inhibit
bacterial protein synthesis by binding to the 50S ribosomal subunit. Binding inhibits elongation of the
protein by peptidyl transferase or prevents translocation of the ribosome or both. Macrolides are
bacteriostatic for most bacteria but are cidal for a few Gram-positive bacteria.

Lincomycin and clindamycin are a miscellaneous group of protein synthesis inhibitors with activity
similar to the macrolides. Lincomycin has activity against Gram-positive bacteria and some Gram-
negative bacteria (Neisseria, H. influenzae). Clindamycin is a derivative of lincomycin, with the same
range of antimicrobial activity, but it is considered more effective. It is frequently used as a penicillin
substitute and is effective against Gram-negative anaerobes (e.g. Bacteroides).

Effects on Nucleic Acids

Some antibiotics and chemotherapeutic agents affect the synthesis of DNA or RNA, or can bind to
DNA or RNA so that their messages cannot be read. Either case, of course, can block the growth of
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cells. The majority of these drugs are unselective, however, and affect animal cells and bacterial cells
alike and therefore have no therapeutic application. Two nucleic acid synthesis inhibitors which have
selective activity against procaryotes and some medical utility are the quinolones and rifamycins.

Nalidixic acid is a synthetic chemotherapeutic agent which has activity mainly against Gram-negative
bacteria. Nalidixic acid belongs to a group of compounds called quinolones. Nalidixic acid is a
bactericidal agent that binds to the DNA gyrase enzyme (topoisomerase) which is essential for DNA
replication and allows supercoils to be relaxed and reformed. Binding of the drug inhibits DNA gyrase
activity.

Some quinolones penetrate macrophages and neutrophils better than most antibiotics and are thus
useful in treatment of infections caused by intracellular parasites. However, the main use of nalidixic
acid is in treatment of lower urinary tract infections (UTI). The compound is unusual in that it is
effective against several types of Gram-negative bacteria such as E. coli, Enterobacter aerogenes, K.
pneumoniae and Proteus species which are common causes of UTI. It is not usually effective against
Pseudomonas aeruginosa, and Gram-positive bacteria are resistant.

Some quinolones have a broadened spectrum against Gram-positive bacteria. The fluoroquinolone,
Cipro. (ciprofloxacin) was recently touted as the drug of choice for treatment and prophylaxis of
anthrax, which is caused by a Gram-positive bacillus.

The rifamycins are a comparatively new group of antibiotics, also the products of Streptomyces.
Rifampicin is a semisynthetic derivative of rifamycin that is active against Gram-positive bacteria
(including Mycobacterium tuberculosis) and some Gram-negative bacteria. Rifampicin acts quite
specifically on the bacterial RNA polymerase and is inactive towards DNA polymerase or RNA
polymerase from animal cells. The antibiotic binds to the beta subunit of the polymerase and apparently
blocks the entry of the first nucleotide which is necessary to activate the polymerase, thereby blocking
mRNA synthesis. It has been found to have greater bactericidal effect against M .tuberculosis than
other anti-tuberculosis drugs, and it has largely replaced isoniazid as one of the front-line drugs used to
treat the disease, especially when isoniazid resistance is indicated. It is effective orally and penetrates
the cerebrospinal fluid so it is useful for treatment of bacterial meningitis.

Competitive Inhibitors

Many of the synthetic chemotherapeutic agents are competitive inhibitors of essential metabolites or
growth factors that are needed in bacterial metabolism. Hence, these types of antimicrobial agents are
sometimes referred to as anti-metabolites or growth factor analogs, since they are designed to
specifically inhibit an essential metabolic pathway in the bacterial pathogen. At a chemical level,
competitive inhibitors are structurally similar to a bacterial growth factor or metabolite, but they do not
fulfill their metabolic function in the cell. Some are bacteriostatic and some are bactericidal. Their
selective toxicity is based on the premise that the bacterial pathway does not occur in the host.

Sulfonamides were introduced as chemotherapeutic agents by Domagk in 1935, who showed that one
of these compounds (prontosil) had the effect of curing mice with infections caused by beta-hemolytic
streptococci. Chemical modifications of the compound sulfanilamide gave compounds with even
higher and broader antibacterial activity. The resulting sulfonamides have broadly similar antibacterial
activity, but differ widely in their pharmacological actions. Bacteria which are almost always sensitive
to the sulfonamides include Streptococcus pneumoniae, beta-hemolytic streptococci and E. coli. The
sulfonamides have been extremely useful in the treatment of uncomplicated UTI caused by E. coli, and
in the treatment of meningococcal meningitis (because they cross the blood-brain barrier).
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The sulfonamides (e.g. Gantrisin) and Trimethoprim are inhibitors of the bacterial enzymes required
for the synthesis of tetrahydofolic acid (THF), the vitamin form of folic acid essential for 1-carbon
transfer reactions. Sulfonamides are structurally similar to para aminobenzoic acid (PABA), the
substrate for the first enzyme in the THF pathway, and they competitively inhibit that step.
Trimethoprim is structurally similar to dihydrofolate (DHF) and competitively inhibits the second step
in THF synthesis mediated by the DHF reductase. Animal cells do not synthesize their own folic acid
but obtain it in a preformed fashion as a vitamin. Since animals do not make folic acid, they are not
affected by these drugs, which achieve their selective toxicity for bacteria on this basis.

Three additional synthetic chemotherapeutic agents have been used in the treatment of
tuberculosis: (INH), paraaminosalicylic acid (PAS), and ethambutol. The usual strategy in the
treatment of tuberculosis has been to administer a single antibiotic (historically streptomycin, but now,
most commonly, rifampicin is given) in conjunction with INH and ethambutol. Since the tubercle
bacillus rapidly develops resistance to the antibiotic, ethambutol and INH are given to prevent
outgrowth of a resistant strain. It must also be pointed out that the tubercle bacillus rapidly develops
resistance to ethambutol and INH if either drug is used alone. Ethambutol inhibits incorporation of
mycolic acids into the mycobacterial cell wall. Isoniazid has been reported to inhibit mycolic acid
synthesis in mycobacteria and since it is an analog of pyridoxine (Vitamin B6) it may inhibit
pyridoxine-catalyzed reactions as well. Isoniazid is activated by a mycobacterial peroxidase enzyme
and destroys several targets in the cell. PAS is an anti-folate, similar in activity to the sulfonamides.
PAS was once a primary anti-tuberculosis drug, but now it is a secondary agent, having been largely
replaced by ethambutol.

Microorganisms that Produce Antibiotics

The molds, Penicillium and Cephalosporium, produce Beta-lactam antibiotics, i.e., penicillin,
cephalosporin, and their relatives.

Actinomycetes, mainly Streptomyces species: produce tetracyclines, aminoglycosides (streptomycin

and its relatives), macrolides (erythromycin and its relatives), chloramphenicol, ivermectin, rifamycins,
and most other clinically-useful antibiotics that are not beta-lactams.

Bacillus species, such as B. polymyxa and Bacillus subtilis produce polypeptide antibiotics (e.g.
polymyxin and bacitracin).

These organisms all have in common that they live in a soil habitat and they form some sort of a spore
or resting structure. It is not known why these microorganisms produce antibiotics. It may rest in the
obvious, i.e., the antibiotics afford the microbes some nutritional advantage in their habitat by
antagonism against the competition. However, it may rest on the subtle: i.e., the antibiotics act as some
sort of hormone or signal molecule associated with sporulation or dormancy or germination.

Antibiotics are secondary metabolites of microorganisms and they are produced at the same time that
the cells begin sporulation processes. Antibiotics tend to be rather large, complicated, organic
molecules and may require as many as 30 separate enzymatic steps to synthesize. The maintenance of a
substantial component of the bacterial genome devoted solely to the synthesis of an antibiotic leads one
to the conclusion that the process (or molecule) is important, if not essential, to the survival of these
organisms in their natural habitat.

Most of the microorganisms that produce antibiotics are resistant to the action of their own antibiotic,
although the organisms are affected by other antibiotics, and their antibiotic may be effective against
325
closely-related strains. Generally speaking, how or why bacteria are resistant to their own antibiotics is
also unknown, but the mechanisms may be similar to resistance that develops in medically-important
bacteria.

Microbial Resistance to Antibiotics

The first antibiotic, penicillin, was discovered in 1929 by Sir Alexander Fleming who observed
inhibition of staphylococci on an agar plate contaminated by a Penicillium mold. World War II (and the
inevitable bacterial infections that occurred in war-related wounds) was an important impetus to study
the chemotherapeutic value of penicillin. Penicillin became generally available for treatment of
bacterial infections, especially those caused by staphylococci and streptococci, about 1946. Initially,
the antibiotic was effective against all sorts of infections caused by these two Gram-positive bacteria. It
is important to note that a significant fraction of all human infections are caused by these two bacteria
(i.e., strep throat, pneumonia, septicemia, skin infections, wound infections, scarlet fever, toxic shock
syndrome). Penicillin had unbelievable ability to kill these bacterial pathogens without harming the
host that harbored them.

Resistance to penicillin in some strains of staphylococci was recognized almost immediately after
introduction of the drug. Resistance to penicillin today occurs in as many as 80% of all strains of
Staphylococcus aureus and some strains of S. aureus have been isolated that are resistant to virtually all
clinically-available antibiotics. Surprisingly, Streptococcus pyogenes (Group A strep) has never fully
developed resistance to penicillin, and it remains a reasonable choice antibiotic for many types of
streptococcal infections. Interestingly, penicillin has never been effective against most Gram-negative
pathogens (e.g. Salmonella, Shigella, Bordetella pertussis, Yersinia pestis, Pseudomonas) with the
notable exception of Neisseria gonorrhoeae. Gram-negative bacteria are inherently resistant to
penicillin because their vulnerable cell wall is protected by an outer membrane that prevents
permeation of the penicillin molecule.

The period of the late 1940s and early 1950s saw the discovery and introduction of streptomycin,
chloramphenicol, and tetracycline, and the age of antibiotic chemotherapy came into full being. These
antibiotics were effective against the full array of bacterial pathogens including Gram-positive and
Gram-negative bacteria, intracellular parasites, and the tuberculosis bacillus. However, by 1953, during
a Shigella outbreak in Japan, a strain of the dysentery bacillus was isolated which was multiple drug
resistant, exhibiting resistance to chloramphenicol, tetracycline, streptomycin, and the sulfanilamides.
There was also evidence mounting that bacteria could pass genes for multiple drug resistance between
strains and even between species. It was also apparent that Mycobacterium tuberculosis was capable of
rapid development of resistance to streptomycin which had become a mainstay in tuberculosis therapy.
Today, drug-resistant strains of M. tuberculosis are threatening to break through in one of the world's
most prevalent infectious diseases.

The Genetic Basis of Bacterial Resistance to Antibiotics

Inherent (Natural) Resistance. Bacteria may be inherently resistant to an antibiotic. For example, a
streptomycete has some gene that is responsible for resistance to its own antibiotic; or a Gram-negative
bacterium has an outer membrane that establishes a permeability barrier against the antibiotic; or an
organism lacks a transport system for the antibiotic; or it lacks the target or reaction that is hit by the
antibiotic.

Acquired Resistance. Bacteria can develop resistance to antibiotics, e.g. bacterial populations
previously-sensitive to antibiotics become resistant. This type of resistance results from changes in the
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bacterial genome. Acquired resistance is driven by two genetic processes in bacteria: (1) mutation and
selection (sometimes referred to as vertical evolution); (2) exchange of genes between strains and
species (sometimes called horizontal evolution).

Vertical evolution is strictly a matter of Darwinian evolution driven by principles of natural selection:
a spontaneous mutation in the bacterial chromosome imparts resistance to a member of the bacterial
population. In the selective environment of the antibiotic, the wild type (non mutants) are killed and the
resistant mutant is allowed to grow and flourish. The mutation rate for most bacterial genes is
approximately 10-8. This means that if a bacterial population doubles from 108 cells to 2 x 108 cells,
there is likely to be a mutant present for any given gene. Since bacteria grow to reach population
densities far in excess of 109 cells, such a mutant could develop from a single generation during 15
minutes of growth.

Horizontal evolution is the acquisition of genes for resistance from another organism. For example, a
streptomycete has a gene for resistance to streptomycin (its own antibiotic), but somehow that gene
escapes and gets into E. coli or Shigella. Or, more likely, a bacterium like E. coli develops genetic
resistance through the process of mutation and selection and then donates these genes to some other
bacterium through one of several processes for genetic exchange that exist in bacteria (below).

Bacteria are able to exchange genes in nature by three processes: conjugation, transduction and
transformation. Conjugation involves cell-to-cell contact as DNA crosses a sex pilus from donor to
recipient. During transduction, a virus transfers the genes between mating bacteria. In
transformation, DNA is acquired directly from the environment, having been released from another
cell. Genetic recombination can follow the transfer of DNA from one cell to another leading to the
emergence of a new genotype (recombinant). It is common for DNA to be transferred as plasmids
between mating bacteria. Since bacteria usually develop their genes for drug resistance on plasmids
(called resistance transfer factors, or RTFs), they are able to spread drug resistance to other strains
and species during genetic exchange processes.

The combined effects of fast growth rates, high concentrations of cells, genetic processes of mutation
and selection, and the ability to exchange genes, account for the extraordinary rates of adaptation and
evolution that can be observed in the bacteria. For these reasons bacterial adaptation (resistance) to the
antibiotic environment seems to take place very rapidly in evolutionary time. Bacteria evolve fast!

The Mechanisms of Bacterial Resistance to Antibiotics

section in progress

The Medical Problem of Bacterial Resistance

Obviously, if a bacterial pathogen is able to develop or acquire resistance to an antibiotic, then that
substance becomes useless in the treatment of infectious disease caused by that pathogen (unless the
resistance can somehow be overcome with secondary measures). So as pathogens develop resistance,
humanity must find new (different) antibiotics to fill the place of the old ones in treatment regimes.
Hence, natural penicillins have become useless against staphylococci and must be replaced by other
antibiotics; tetracycline, having been so widely used and misused for decades, has become worthless
for many of the infections that once designated it as a "wonder drug".

Not only is there a problem in finding new antibiotics to fight old diseases (because resistant strains of
bacteria have emerged), there is a parallel problem to find new antibiotics to fight new diseases. In the
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past two decades, many "new" bacterial diseases have been discovered (Legionnaire's disease, gastric
ulcers, Lyme disease, toxic shock syndrome, "skin-eating" streptococci). Broad patterns of resistance
exist in these pathogens, and it seems likely that new antibiotics will soon be needed to replace the
handful that are effective now against these bacteria, especially as resistance begins to emerge among
them in the selective environment antibiotic chemotherapy.

It is said that the discovery and use of antibiotics and immunization procedures against infectious
disease are two developments in the field of microbiology that have contributed about twenty years to
the average life span of humans in developed countries where these practices are employed. While the
greater part of this span in time is probably due to vaccination, most of us are either still alive or have
family members who are still alive because an antibiotic conquered an infectious disease that otherwise
would have killed the individual. If we want to retain this medical luxury in our society, we must be
vigilant and proactive: we must fully understand how and why antimicrobial agents work, and why
they don't work, and realize that we must maintain a stride ahead of microbial pathogens that can only
be contained by antibiotic chemotherapy.

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 Todar's Online Textbook of Bacteriology

Bacterial resistance to Antibiotics

© 2002 Kenneth Todar University of Wisconsin Department of Bacteriology

Definition of an antibiotic

Antibiotics are substances produced by microorganisms that kill or inhibit other microorganisms.
Antibiotics are products of the earth, more specifically of soil; they are byproducts of cellular
metabolism; antibiotics are "all natural".

History of antibiotics and antibiotic chemotherapy

The first antibiotic, penicillin, was discovered in 1929 by Sir Alexander Fleming who observed
inhibition of staphylococci on an agar plate contaminated by a Penicillium mold. World War II (and the
inevitable bacterial infections that occurred in war-related wounds) was an important impetus to study
the chemotherapeutic value of penicillin. Penicillin became generally available for treatment of
bacterial infections, especially those caused by staphylococci and streptococci, about 1946. Initially,
the antibiotic was effective against all sorts of infections caused by these two Gram-positive bacteria. It
is important to note that a significant fraction of all human infections are caused by these two bacteria
(i.e., strep throat, pneumonia, septicemia, skin infections, wound infections, scarlet fever, toxic shock
syndrome). Penicillin had unbelievable ability to kill these bacterial pathogens without harming the
host that harbored them. This brings to light the fundamental principle of antimicrobial chemotherapy
that may be relevant in this symposium, i.e., selective toxicity: Antibiotics used in the treatment of
disease must be effective against the pathogenic microorganism and not the host; the host (patient
taking the antibiotic) must essentially be resistant to the action of the drug.

Resistance to penicillin in some strains of staphylococci was recognized almost immediately after
introduction of the drug. (Resistance to penicillin today occurs in as many as 80% of all strains of
Staphylococcus aureus). Surprisingly, Streptococcus pyogenes (Group A strep) have never fully
developed resistance to penicillin and it remains a reasonable choice antibiotic for many types of
streptococcal infections. Interestingly, penicillin has never been effective against most Gram-negative
pathogens (e.g. Salmonella, Shigella, Bordetella pertussis, Yersinia pestis, Pseudomonas) with the
notable exception of Neisseria gonorrhoeae. Gram-negative bacteria are inherently resistant to
penicillin because their vulnerable cell wall is protected by an outer membrane that prevents
permeation of the penicillin molecule.

The period of the late 1940s and early 1950s saw the discovery and introduction of streptomycin,
chloramphenicol, and tetracycline, and the age of antibiotic chemotherapy came into full being. These
antibiotics were effective against the full array of bacterial pathogens including Gram-positive and
Gram-negative bacteria, intracellular parasites, and the tuberculosis bacillus. However, by 1953, during
a Shigella outbreak in Japan, a strain of the dysentery bacillus was isolated which was multiple drug
resistant, exhibiting resistance to chloramphenicol, tetracycline, streptomycin, and the sulfanilamides.
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There was also evidence mounting that bacteria could pass genes for multiple drug resistance between
strains and even between species. It was also apparent that Mycobacterium tuberculosis was capable of
rapid development of resistance to streptomycin which had become a mainstay in tuberculosis therapy.

Microorganisms that produce antibiotics

Penicillium and Cephalosporium: produce Beta-lactam antibiotics: penicillin, cephalosporin, and their
relatives.

Actinomycetes, mainly Streptomyces species: produce tetracyclines, aminoglycosides (streptomycin

and its relatives), macrolides (erythromycin and its relatives), chloramphenicol, ivermectin, rifamycins,
and most other clinically-useful antibiotics that are not beta-lactams.

Bacillus species, such as B. polymyxa and Bacillus subtilis produce polypeptide antibiotics (e.g.
polymyxin and bacitracin), and B. cereus produces zwittermicin.

These organisms all have in common that they live in a soil habitat and they form some sort of a spore
or resting structure. It is not known why these microorganisms produce antibiotics but it may rest in the
obvious : affording them some nutritional advantage in their habitat by antagonizing the competition;
or the subtle: acting as some sort of hormone or signal molecule associated with sporulation or
dormancy or germination. Antibiotics are secondary metabolites of microorganisms and they are
produced at the same time that the cells begin sporulation processes. Antibiotics tend to be rather large,
complicated, organic molecules and may require as many as 30 separate enzymatic steps to synthesize.
The maintenance of a substantial component of the bacterial genome devoted solely to the synthesis of
an antibiotic leads one to the conclusion that the process (or molecule) is important, if not essential, to
the survival of these organisms in their natural habitat.

Most of the microorganisms that produce antibiotics are resistant to the action of their own antibiotic,
although the organisms are affected by other antibiotics, and their antibiotic may be effective against
closely-related strains. Generally speaking, how or why bacteria are resistant to their own antibiotics is
also unknown, but it may be worth pondering or studying if we are to understand the cellular and
molecular basis of resistance.

The basis of microbial resistance to antibiotics

Inherent (Natural) Resistance. Bacteria may be inherently resistant to an antibiotic. For example, a
streptomycete has some gene that is responsible for resistance to its own antibiotic; or a Gram-negative
bacterium has an outer membrane that establishes a permeability barrier against the antibiotic; or an
organism lacks a transport system for the antibiotic; or it lacks the target or reaction that is hit by the
antibiotic.

Acquired Resistance. Bacteria can develop resistance to antibiotics, e.g. bacterial populations
previously-sensitive to antibiotics become resistant. This type of resistance results from changes in the
bacterial genome. Acquired resistance is driven by two genetic processes in bacteria: (1) mutation and
selection (sometimes referred to as vertical evolution); (2) exchange of genes between strains and
species (sometimes called horizontal evolution).

Vertical evolution is strictly a matter of Darwinian evolution driven by principles of natural selection:
a spontaneous mutation in the bacterial chromosome imparts resistance to a member of the bacterial
population. In the selective environment of the antibiotic, the wild type (non mutants) are killed and the
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resistant mutant is allowed to grow and flourish. The mutation rate for most bacterial genes is
approximately 10-8. This means that if a bacterial population doubles from 108 cells to 2 x 108 cells,
there is likely to be a mutant present for any given gene. Since bacteria grow to reach population
densities far in excess of 109 cells, such a mutant could develop from a single generation during 15
minutes of growth.

Horizontal evolution is the acquisition of genes for resistance from another organism. For example, a
streptomycete has a gene for resistance to streptomycin (its own antibiotic), but somehow that gene
escapes and gets into E. coli or Shigella. Or, more likely, Some bacterium develops genetic resistance
through the process of mutation and selection and then donates these genes to some other bacterium
through one of several processes for genetic exchange that exist in bacteria.

Bacteria are able to exchange genes in nature by three processes: conjugation, transduction and
transformation. Conjugation involves cell-to-cell contact as DNA crosses a sex pilus from donor to
recipient. During transduction, a virus transfers the genes between mating bacteria. In
transformation, DNA is acquired directly from the environment, having been released from another
cell. Genetic recombination can follow the transfer of DNA from one cell to another leading to the
emergence of a new genotype (recombinant). It is common for DNA to be transferred as plasmids
between mating bacteria. Since bacteria usually develop their genes for drug resistance on plasmids
(called resistance transfer factors, or RTFs), they are able to spread drug resistance to other strains
and species during genetic exchange processes.

The combined effects of fast growth rates, high concentrations of cells, genetic processes of mutation
and selection, and the ability to exchange genes, account for the extraordinary rates of adaptation and
evolution that can be observed in the bacteria. For these reasons bacterial adaptation (resistance) to the
antibiotic environment seems to take place very rapidly in evolutionary time: bacteria evolve fast!

The medical problem of bacterial drug resistance

Obviously, if a bacterial pathogen is able to develop or acquire resistance to an antibiotic, then that
substance becomes useless in the treatment of infectious disease caused by that pathogen (unless the
resistance can somehow be overcome with secondary measures). So as pathogens develop resistance,
we must find new (different) antibiotics to fill the place of the old ones in treatment regimes. Hence,
natural penicillins have become useless against staphylococci and must be replaced by other
antibiotics; tetracycline, having been so widely used and misused for decades, has become worthless
for many of the infections that once designated it as a "wonder drug".

Not only is there a problem in finding new antibiotics to fight old diseases (because resistant strains of
bacteria have emerged), there is a parallel problem to find new antibiotics to fight new diseases. In the
past two decades, many "new" bacterial diseases have been discovered (Legionnaire's disease, gastric
ulcers, Lyme disease, toxic shock syndrome, "skin-eating" streptococci). We are only now able to
examine patterns of susceptibility and resistance to antibiotics among new pathogens that cause these
diseases. Broad patterns of resistance exist in these pathogens, and it seems likely that we will soon
need new antibiotics to replace the handful that are effective now against these bacteria, especially as
resistance begins to emerge among them in the selective environment antibiotic chemotherapy.

Conclusions

It is said that the discovery and use of antibiotics and immunization procedures against infectious
disease are two developments in the field of microbiology that have contributed about twenty years to
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the average life span of humans in developed countries where these practices are employed. While the
greater part of this span in time is probably due to vaccination, most of us are either still alive or have
family members who are still alive because an antibiotic conquered an infectious disease that otherwise
would have killed the individual. If we want to retain this medical luxury in our society we must be
vigilant and proactive: we must fully understand how and why antimicrobial agents work, and why
they don't work, and realize that we must maintain a stride ahead of microbial pathogens that can only
be contained by antibiotic chemotherapy.

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 Todar's Online Textbook of Bacteriology

Staphylococcus
© 2005 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

Staphylococcus aureus. Electron micrograph from Visuals Unlimited, with permission.

The Staphylococci

Staphylococci are Gram-positive spherical bacteria that occur in microscopic clusters resembling
grapes. Bacteriological culture of the nose and skin of normal humans invariably yields staphylococci.
In 1884, Rosenbach described the two pigmented colony types of staphylococci and proposed the
appropriate nomenclature: Staphylococcus aureus (yellow) and Staphylococcus albus (white). The
latter species is now named Staphylococcus epidermidis. Although more than 20 species of
Staphylococcus are described in Bergey's Manual (2001), only Staphylococcus aureus and
Staphylococcus epidermidis are significant in their interactions with humans. S. aureus colonizes
mainly the nasal passages, but it may be found regularly in most other anatomical locales. S
epidermidis is an inhabitant of the skin.

Taxonomically, the genus Staphylococcus is in the Bacterial family Staphylococcaceae, which

includes three lesser known genera, Gamella, Macrococcus and Salinicoccus. The best-known of its
nearby phylogenetic relatives are the members of the genus Bacillus in the family Bacillaceae, which is
on the same level as the family Staphylococcaceae. The Listeriaceae are also a nearby family.

Staphylococcus aureus forms a fairly large yellow colony on rich medium, S. epidermidis has a
relatively small white colony. S. aureus is often hemolytic on blood agar; S. epidermidis is non
hemolytic. Staphylococci are facultative anaerobes that grow by aerobic respiration or by fermentation
that yields principally lactic acid. The bacteria are catalase-positive and oxidase-negative. S. aureus can

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grow at a temperature range of 15 to 45 degrees and at NaCl concentrations as high as 15 percent.
Nearly all strains of S. aureus produce the enzyme coagulase: nearly all strains of S. epidermidis lack
this enzyme. S. aureus should always be considered a potential pathogen; most strains of S. epidermidis
are nonpathogenic and may even play a protective role in their host as normal flora. Staphylococcus
epidermidis may be a pathogen in the hospital environment.

Staphylococci are perfectly spherical cells about 1 micrometer in diameter. They grow in clusters
because staphylococci divide in two planes. The configuration of the cocci helps to distinguish
staphylococci from streptococci, which are slightly oblong cells that usually grow in chains (because
they divide in one plane only). The catalase test is important in distinguishing streptococci (catalase-
negative) from staphylococci, which are vigorous catalase-producers. The test is performed by adding
3% hydrogen peroxide to a colony on an agar plate or slant. Catalase-positive cultures produce O2 and
bubble at once. The test should not be done on blood agar because blood itself contains catalase.

FIGURE 1. Gram stain of Staphylococcus aureus in pustular exudate

Table 1. Important phenotypic characteristics of Staphylococcus aureus

Gram-positive, cluster-forming coccus

nonmotile, nonsporeforming facultative anaerobe
fermentation of glucose produces mainly lactic acid
ferments mannitol (distinguishes from S. epidermidis)
catalase positive
coagulase positive
golden yellow colony on agar
normal flora of humans found on nasal passages, skin and mucous membranes
pathogen of humans, causes a wide range of suppurative infections, as well as food poisoning and
toxic shock syndrome

Pathogenesis of S. aureus infections

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Staphylococcus aureus causes a variety of suppurative (pus-forming) infections and toxinoses in
humans. It causes superficial skin lesions such as boils, styes and furunculosis; more serious
infections such as pneumonia, mastitis, phlebitis, meningitis, and urinary tract infections; and
deep-seated infections, such as osteomyelitis and endocarditis. S. aureus is a major cause of hospital
acquired (nosocomial) infection of surgical wounds and infections associated with indwelling medical
devices. S. aureus causes food poisoning by releasing enterotoxins into food, and toxic shock
syndrome by release of superantigens into the blood stream.

S. aureus expresses many potential virulence factors: (1) surface proteins that promote colonization
of host tissues; (2) invasins that promote bacterial spread in tissues (leukocidin, kinases,
hyaluronidase); (3) surface factors that inhibit phagocytic engulfment (capsule, Protein A); (4)
biochemical properties that enhance their survival in phagocytes (carotenoids, catalase production);
(5) immunological disguises (Protein A, coagulase, clotting factor); and (6) membrane-damaging
toxins that lyse eukaryotic cell membranes (hemolysins, leukotoxin, leukocidin; (7) exotoxins that
damage host tissues or otherwise provoke symptoms of disease (SEA-G, TSST, ET (8) inherent and
acquired resistance to antimicrobial agents.

FIGURE 2. Virulence determinants of Staphylococcus aureus

For the majority of diseases caused by S. aureus, pathogenesis is multifactorial, so it is difficult to

determine precisely the role of any given factor. However, there are correlations between strains
isolated from particular diseases and expression of particular virulence determinants, which suggests
their role in a particular diseases. The application of molecular biology has led to advances in
unraveling the pathogenesis of staphylococcal diseases. Genes encoding potential virulence factors
have been cloned and sequenced, and many protein toxins have been purified. With some
staphylococcal toxins, symptoms of a human disease can be reproduced in animals with the purified
protein toxins, lending an understanding of their mechanism of action.

Human staphylococcal infections are frequent, but usually remain localized at the portal of entry by the
normal host defenses. The portal may be a hair follicle, but usually it is a break in the skin which may
be a minute needle-stick or a surgical wound. Foreign bodies, including sutures, are readily colonized
by staphylococci, which may makes infections difficult to control. Another portal of entry is the
respiratory tract. Staphylococcal pneumonia is a frequent complication of influenza. The localized host

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response to staphylococcal infection is inflammation, characterized by an elevated temperature at the
site, swelling, the accumulation of pus, and necrosis of tissue. Around the inflamed area, a fibrin clot
may form, walling off the bacteria and leukocytes as a characteristic pus-filled boil or abscess. More
serious infections of the skin may occur, such as furuncles or impetigo. Localized infection of the bone
is called osteomyelitis. Serious consequences of staphylococcal infections occur when the bacteria
invade the blood stream. A resulting septicemia may be rapidly fatal; a bacteremia may result in
seeding other internal abscesses, other skin lesions, or infections in the lung, kidney, heart, skeletal
muscle or meninges.

FIGURE 3. Sites of infection and diseases caused by Staphylococcus aureus

Adherence to Host Cell Proteins

S. aureus cells express on their surface proteins that promote attachment to host proteins such as
laminin and fibronectin that form the extracellular matrix of epithelial and endothelial surfaces. In
addition, most strains express a fibrin/fibrinogen binding protein (clumping factor) which promotes
attachment to blood clots and traumatized tissue. Most strains of S. aureus express both fibronectin and
fibrinogen-binding proteins. In addition, an adhesin that promotes attachment to collagen has been
found in strains that cause osteomyelitis and septic arthritis. Interaction with collagen may also be
important in promoting bacterial attachment to damaged tissue where the underlying layers have been
exposed.

Evidence that staphylococcal matrix-binding proteins are virulence factors has come from studying
defective mutants in adherence assays. Mutants defective in binding to fibronectin and to fibrinogen
have reduced virulence in a rat model for endocarditis, and mutants lacking the collagen-binding
protein have reduced virulence in a mouse model for septic arthritis, suggesting that bacterial
colonization is ineffective. Furthermore, the isolated ligand-binding domain of the fibrinogen,
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fibronectin and collagen receptors strongly blocks attachment of bacterial cells to the corresponding
host proteins.

Invasion

The invasion of host tissues by staphylococci apparently involves the production of a huge array of
extracellular proteins, some of which may occur also as cell-associated proteins. These proteins are
described below with some possible explanations for their role in invasive process.

Membrane-damaging toxins

-toxin ( -hemolysin) The best characterized and most potent membrane-damaging toxin of S. aureus
is -toxin. It is expressed as a monomer that binds to the membrane of susceptible cells. Subunits then
oligomerize to form heptameric rings with a central pore through which cellular contents leak.

In humans, platelets and monocytes are particularly sensitive to -toxin. Susceptible cells have a
specific receptor for -toxin which allows the toxin to bind causing small pores through which
monovalent cations can pass. The mode of action of alpha hemolysin is likely by osmotic lysis.

-toxin is a sphingomyelinase which damages membranes rich in this lipid. The classical test for -
toxin is lysis of sheep erythrocytes. The majority of human isolates of S. aureus do not express -toxin.
A lysogenic bacteriophage is known to encode the toxin.

-toxin is a very small peptide toxin produced by most strains of S. aureus. It is also produced by S.
epidermidis. The role of -toxin in disease is unknown.

Leukocidin is a multicomponent protein toxin produced as separate components which act together to
damage membranes. Leukocidin forms a hetero-oliogmeric transmembrane pore composed of four
LukF and four LukS subunits, thereby forming an octameric pore in the affected mwembrane.
Leukocidin is hemolytic, but less so than alpha hemolysin.

Only 2% of all of S. aureus isolates express leukocidin, but nearly 90% of the strains isolated from
severe dermonecrotic lesions express this toxin, which suggests that it is an important factor in
necrotizing skin infections.

Coagulase and clumping factor

Coagulase is an extracellular protein which binds to prothrombin in the host to form a complex called
staphylothrombin. The protease activity characteristic of thrombin is activated in the complex, resulting
in the conversion of fibrinogen to fibrin. Coagulase is a traditional marker for identifying S aureus in
the clinical microbiology laboratory. However, there is no overwhelming evidence that it is a virulence
factor, although it is reasonable to speculate that the bacteria could protect themselves from phagocytic
and immune defenses by causing localized clotting.

There is some confusion in the literature concerning coagulase and clumping factor, the fibrinogen-
binding determinant on the S. aureus cell surface. Partly the confusion results from the fact that a small
amount of coagulase is tightly bound on the bacterial cell surface where it can react with prothrombin
leading to fibrin clotting. However, genetic studies have shown unequivocally that coagulase and
clumping factor are distinct entities. Specific mutants lacking coagulase retain clumping factor activity,
while clumping factor mutants express coagulase normally.
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Staphylokinase

Many strains of S aureus express a plasminogen activator called staphylokinase. This factor lyses
fibrin.The genetic determinant is associated with lysogenic bacteriophages. A complex formed between
staphylokinase and plasminogen activates plasmin-like proteolytic activity which causes dissolution of
fibrin clots. The mechanism is identical to streptokinase, which is used in medicine to treat patients
suffering from coronary thrombosis. As with coagulase, there is no strong evidence that staphylokinase
is a virulence factor, although it seems reasonable to imagine that localized fibrinolysis might aid in
bacterial spreading.

Other extracellular enzymes

S. aureus can express proteases, a lipase, a deoxyribonuclease (DNase) and a fatty acid modifying
enzyme (FAME). The first three probably provide nutrients for the bacteria, and it is unlikely that they
have anything but a minor role in pathogenesis. However, the FAME enzyme may be important in
abscesses, where it could modify anti-bacterial lipids and prolong bacterial survival.

Avoidance of Host Defenses

S. aureus expresses a number of factors that have the potential to interfere with host defense
mechanisms. This includes both structural and soluble elements of the bacterium.

Capsular Polysaccharide

The majority of clinical isolates of S aureus express a surface polysaccharide of either serotype 5 or 8.
This has been called a microcapsule because it can be visualized only by electron microscopy unlike
the true capsules of some bacteria which are readily visualized by light microscopy. S. aureus strains
isolated from infections express high levels of the polysaccharide but rapidly lose the ability when
cultured in the laboratory. The function of the capsule in virulence is not entirely clear. Although it
does impede phagocytosis in the absence of complement, it also impedes colonization of damaged
heart valves, perhaps by masking adhesins.

Protein A

Protein A is a surface protein of S. aureus which binds IgG molecules by their Fc region. In serum, the
bacteria will bind IgG molecules in the wrong orientation on their surface which disrupts opsonization
and phagocytosis. Mutants of S. aureus lacking protein A are more efficiently phagocytosed in vitro,
and mutants in infection models have diminished virulence.

Leukocidin

S. aureus can express a toxin that specifically acts on polymorphonuclear leukocytes. Phagocytosis is
an important defense against staphylococcal infection so leukocidin should be a virulence factor.

Exotoxins

S. aureus can express several different types of protein toxins which are probably responsible for
symptoms during infections. Those which damage the membranes of cells were discussed above under
Invasion. Some will lyse erythrocytes, causing hemolysis, but it is unlikely that hemolysis is a relevant

338
determinant of virulence in vivo. Leukocidin causes membrane damage to leukocytes, but is not
hemolytic.

Systemic release of -toxin causes septic shock, while enterotoxins and TSST-1 are superantigens that
may cause toxic shock. Staphylococcal enterotoxins cause emesis (vomiting) when ingested and the
bacterium is a leading cause of food poisoning.

The exfoliatin toxin causes the scalded skin syndrome in neonates, which results in widespread
blistering and loss of the epidermis. There are two antigenically distinct forms of the toxin, ETA and
ETB. The toxins have esterase and protease activity and apparently target a protein which is involved
in maintaining the integrity of the epidermis.

Superantigens: enterotoxins and toxic shock syndrome toxin

S. aureus secretes two types of toxin with superantigen activity, enterotoxins, of which there are six
antigenic types (named SE-A, B, C, D, E and G), and toxic shock syndrome toxin (TSST-1).
Enterotoxins cause diarrhea and vomiting when ingested and are responsible for staphylococcal food
poisoning. TSST-1 is expressed systemically and is the cause of toxic shock syndrome (TSS). When
expressed systemically, enterotoxins can also cause toxic shock syndrome. In fact, enterotoxins B and
C cause 50% of non-menstrual cases of TSS. TSST-1 is weakly related to enterotoxins, but it does not
have emetic activity. TSST-1 is responsible for 75% of TSS, including all menstrual cases. TSS can
occur as a sequel to any staphylococcal infection if an enterotoxin or TSST-1 is released systemically
and the host lacks appropriate neutralizing antibodies.

Superantigens stimulate T cells non-specifically without normal antigenic recognition (Figure 4). Up to
one in five T cells may be activated, whereas only 1 in 10,000 are stimulated during a usual antigen
presentation. Cytokines are released in large amounts, causing the symptoms of TSS. Superantigens
bind directly to class II major histocompatibility complexes of antigen-presenting cells outside the
conventional antigen-binding grove. This complex recognizes only the Vb element of the T cell
receptor. Thus any T cell with the appropriate Vb element can be stimulated, whereas normally, antigen
specificity is also required in binding.

FIGURE 4. Superantigens and the non-specific stimulation of T cells. Superantigens bind directly to class II major

339
histocompatibility complexes (MHC II) of antigen-presenting cells outside the normal antigen-binding groove. Up to
one in five T cells may be activated. Cytokines are released in large amounts, causing the symptoms of toxic shock.

Exfoliatin toxin (ET)

The exfoliatin toxin, associated with scalded skin syndrome, causes separation within the epidermis,
between the living layers and the superficial dead layers. The separation is through the stratum
granulosum of the epidermis. This is probably why healing occurs with little scarring although the risks
of fluid loss and secondary infections are increased. Staphylococcal exfoliative toxin B has been shown
to specifically cleave desmoglein 1, a
cadherin that is found in desmosomes in the epidermis.

Pathogenic Staphylococcus epidermidis

In contrast to S. aureus, little is known about mechanisms of pathogenesis of S. epidermidis infections.

Adherence is obviously a crucial step in the initiation of foreign body infections. Bacteria-plastic
interactions are probably important in colonization of catheters, and a polysaccharide adhesion (PS/A)
has been identified. In addition, when host proteins deposit on the implanted device S. epidermidis will
bind to fibronectin.

A characteristic of many pathogenic strains ofS. epidermidis is the production of a slime resulting in
biofilm formation. The slime is predominantly a secreted teichoic acid, normally found in the cell wall
of the staphylococci. This ability to form a biofilm on the surface of a prosthetic device is probably a
significant determinant of virulence for these bacteria.

Resistance of Staphylococci to Antimicrobial Drugs

Hospital strains of S. aureus are usually resistant to a variety of different antibiotics. A few strains are
resistant to all clinically useful antibiotics except vancomycin, and vancomycin-resistant strains are
increasingly-reported. The term MRSA refers to Methicillin resistant Staphylococcus aureus.
Methicillin resistance is widespread and most methicillin-resistant strains are also multiply resistant. A
plasmid associated with vancomycin resistance has been detected in Enterococcusfaecalis which can be
transferred to S. aureus in the laboratory, and it is speculated that this transfer may occur naturally (e.g.
in the gastrointestinal tract). In addition, S. aureus exhibits resistance to antiseptics and disinfectants,
such as quaternary ammonium compounds, which may aid its survival in the hospital environment.

Staphylococcal disease has been a perennial problem in the hospital environment since the beginning of
the antibiotic era. During the 1950's and early1960's, staphylococcal infection was synonymous with
nosocomial infection. Gram-negative bacilli (e.g. E. coli and Pseudomonas aeruginosa) have replaced
the staphylococci as the most frequent causes of nosocomial infections, although the staphylococci
have remained a problem, especially in surgical wounds.. S aureus responded to the introduction of
antibiotics by the usual bacterial means to develop drug resistance: (1) mutation in chromosomal genes
followed by selection of resistant strains and (2) acquisition of resistance genes as extrachromosomal
plasmids, transducing particles, transposons, or other types of DNA inserts. S. aureus expresses its
resistance to drugs and antibiotics through a variety of mechanisms.

Beginning with the use of the penicillin in the 1940's, drug resistance has developed in the
staphylococci within a very short time after introduction of an antibiotic into clinical use. Some strains
are now resistant to most conventional antibiotics, and there is concern that new antibiotics have not
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been forthcoming. New strategies in the pharmaceutical industry to find antimicrobial drugs involve
identifying potential molecular targets in cells (such the active sites of enzymes involved in cell
division), then developing inhibitors of the specific target molecule. Hopefully, this approach will turn
up new antimicrobial agents for the battle against staphylococcal infections. In fact, in the past two
years alternatives to vancomycin have been approved with the increase in VRSA (vancomycin resistant
S. aureus) isolates.

Host Defense against Staphylococcal Infections

Phagocytosis is the major mechanism for combatting staphylococcal infection. Antibodies are produced
which neutralize toxins and promote opsonization. However, the bacterial capsule and protein A may
interfere with phagocytosis. Biofilm growth on implants is also impervious to phagocytosis.
Staphylococci may be difficult to kill after phagocytic engulfment because they produce carotenoids
and catalase which neutralize singlet oxygen and superoxide which are primary phagocytic killing
mechanisms within the phagolysosome.

Treatment

Hospital acquired infection is often caused by antibiotic resistant strains (MRSA) and can only be
treated with vancomycin or an alternative. Until recently, infections acquired outside hospitals have
been treated with penicillinase-resistant -lactams. However, many of the community acquired (CA)
Staphylococcal infections are now methicillin resistant. Particularly in Georgia, Texas, and California,
the prevalence of CA-MRSA is widespread. Over 60% of abscess isolates from the emergency
department of an Austin, Texas hospital yielded MRSA. These organisms are uniformly resistant to
penicillins and cephalosporins. The infections have been treated with combination therapy using sulfa
drugs and minocycline or rifampin.

Vaccines

No vaccine is yet available that stimulates active immunity against staphylococcal infections in
humans. A vaccine based on fibronectin binding protein induces protective immunity against mastitis
in cattle and might also be used as a vaccine in humans.

Hyperimmune serum or monoclonal antibodies directed towards surface components (e.g., capsular
polysaccharide or surface protein adhesions) could theoretically prevent bacterial adherence and
promote phagocytosis by opsonization of bacterial cells. Also, human hyperimmune serum could be
given to hospital patients before surgery as a form of passive immunization.

When the precise molecular basis of the interactions between staphylococcal adhesins and host tissue
receptors is known it might be possible to design compounds that block the interactions and thus
prevent bacterial colonization. These could be administered systemically or topically.

In February, 2002, an experimental bivalent vaccine against Staphylococcus aureus was reported to be
safe and immunogenic for approximately 40 weeks in patients with end-stage renal disease undergoing
hemodialysis. The vaccine called StaphVAX is composed of S. aureus type 5 and 8 capsular
polysaccharides conjugated to nontoxic recombinant Pseudomonas aeruginosa exotoxin A. In
randomized trials, one injection of the vaccine was administered to 892 hemodialysis patients. Between
weeks 3 and 40, 11 cases of S. aureus bacteremia were diagnosed in the vaccinated group compared
with 26 cases in a control group. Nearly 90% of patients receiving the vaccine generated antibodies to
the two capsular polysaccharides. A decrease in vaccine efficacy after week 40 correlated with a
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decrease in S. aureus antibodies. The investigators did not believe that use of StaphVAX would be
limited to hemodialysis patients. For example, the vaccine might be used in cases where healthy
individuals come into the hospital for elective surgery, such as a joint replacement. Such patients do
not require protection for the rest of their lives; what they need is protection for a short period while
they are in the hospital. The vaccine manufacturer will experiment with booster shots to maintain
immunity for longer periods of time, and with passive immunization for such at-risk populations as
premature infants. They hope to gain FDA approval for the vaccine in 2006.

Table 2. Possible virulence determinants expressed in the pathogenesis of Staphylococcus aureus infections

boils and pimples (folliculitis)

Colonization: cell-bound (protein) adhesins
Invasion: Invasins: staphylokinase
Other extracellular enzymes (proteases, lipases, nucleases, collagenase, elastase. etc.)
Resistance to phagocytosis: coagulase, leukocidin
Resistance to immune responses: coagulase
Toxigenesis: cytotoxic toxins (hemolysins and leukocidin)

pneumonia
Colonization: cell-bound (protein) adhesins
Invasion:
Invasins: staphylokinase, hyaluronidase
Other extracellular enzymes (proteases, lipases, nucleases, collagenase, elastase. etc.)
Resistance to phagocytosis: coagulase, leukocidin, hemolysins, carotenoids, superoxide dismutase,
catalase, growth at low pH
Resistance to immune responses: coagulase, antigenic variation
Toxigenesis: Cytotoxic toxins (hemolysins and leukocidin)

food poisoning (emesis or vomiting)

Toxigenesis: Enterotoxins A-G

septicemia (invasion of the bloodstream)

Invasion:
Invasins: staphylokinase, hyaluronidase
Other extracellular enzymes (proteases, lipases, nucleases, collagenase, elastase. etc.)
Resistance to phagocytosis: coagulase, protein A, leukocidin, hemolysins, carotenoids, superoxide
dismutase, catalase, growth at low pH
Resistance to immune responses: coagulase, protein A, antigenic variation
Toxigenesis: cytotoxic toxins (hemolysins and leukocidin)

osteomyelitis (invasion of bone)

Colonization: cell-bound (protein) adhesins
Invasion:
Invasins: staphylokinase, hyaluronidase
Other extracellular enzymes (proteases, lipases, nucleases, collagenase, elastase. etc.)
Resistance to phagocytosis: coagulase, protein A, leukocidin, hemolysins, carotenoids, superoxide
dismutase, catalase, growth at low pH
Resistance to immune responses: coagulase, protein A, antigenic variation
Toxigenesis: cytotoxic toxins (hemolysins and leukocidin)

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toxic shock syndrome
Colonization: cell-bound (protein) adhesins
Resistance to immune responses: coagulase, antigenic variation
Toxigenesis: TSST toxin, Enterotoxins A-G

surgical wound infections

Colonization: cell-bound (protein) adhesins
Invasion:
Invasins: staphylokinase, hyaluronidase
Other extracellular enzymes (proteases, lipases, nucleases, collagenase, elastase. etc.)
Resistance to phagocytosis: coagulase, protein A, leukocidin, hemolysins, carotenoids, superoxide
dismutase, catalase, growth at low pH
Resistance to immune responses: coagulase, protein A, antigenic variation
Toxigenesis: cytotoxic toxins (hemolysins and leukocidin)

scalded skin syndrome (analogous to scarlet fever)

Colonization: cell-bound (protein) adhesins
Invasion:
Invasins: staphylokinase, hyaluronidase
Other extracellular enzymes (proteases, lipases, nucleases, collagenase, elastase. etc.)
Resistance to phagocytosis: coagulase, leukocidin, hemolysins
Resistance to immune responses: coagulase, antigenic variation
Toxigenesis: Exfoliatin toxin

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 Todar's Online Textbook of Bacteriology

Streptococcus pyogenes
© 2002 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

Introduction

Streptococcus pyogenes (Group A streptococcus) is a Gram-positive, nonmotile, nonsporeforming

coccus that occurs in chains or in pairs of cells. Individual cells are round-to-ovoid cocci, 0.6-1.0
micrometer in diameter (Figure 1). Streptococci divide in one plane and thus occur in pairs or
(especially in liquid media or clinical material) in chains of varying lengths. The metabolism of S.
pyogenes is fermentative; the organism is a catalase-negative aerotolerant anaerobe (facultative
anaerobe), and requires enriched medium containing blood in order to grow. Group A streptococci
typically have a capsule composed of hyaluronic acid and exhibit beta (clear) hemolysis on blood agar.

Figure 1. Streptococcus pyogenes. Left. Gram stain of Streptococcus pyogenes in a clinical specimen. Right. Colonies
of Streptococcus pyogenes on blood agar exhibiting beta (clear) hemolysis.

Streptococcus pyogenes is one of the most frequent pathogens of humans. It is estimated that between
5-15% of normal individuals harbor the bacterium, usually in the respiratory tract, without signs of
disease. As normal flora, S. pyogenes can infect when defenses are compromised or when the
organisms are able to penetrate the constitutive defenses. When the bacteria are introduced or
transmitted to vulnerable tissues, a variety of types of suppurative infections can occur.

In the last century, infections by S. pyogenes claimed many lives especially since the organism was the
most important cause of puerperal fever (sepsis after childbirth). Scarlet fever was formerly a severe
complication of streptococcal infection, but now, because of antibiotic therapy, it is little more than
streptococcal pharyngitis accompanied by rash. Similarly, erysipelas (a form of cellulitis
accompanied by fever and systemic toxicity) is less common today. However, there has been a recent
increase in variety, severity and sequelae of Streptococcus pyogenes infections, and a resurgence of
severe invasive infections, prompting descriptions of "flesh eating bacteria" in the news media. A
complete explanation for the decline and resurgence is not known. Today, the pathogen is of major
concern because of the occasional cases of rapidly progressive disease and because of the small risk of
serious sequelae in untreated infections. These diseases remain a major worldwide health concern, and

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effort is being directed toward clarifying the risk and mechanisms of these sequelae and identifying
rheumatogenic and nephritogenic strains of streptococci.

Acute Streptococcus pyogenes infections may present as pharyngitis (strep throat), scarlet fever
(rash), impetigo (infection of the superficial layers of the skin) or cellulitis (infection of the deep layers
of the skin). Invasive, toxigenic infections can result in necrotizing fasciitis, myositis and
streptococcal toxic shock syndrome. Patients may also develop immune-mediated post-streptococcal
sequelae, such as acute rheumatic fever and acute glomerulonephritis, following acute infections
caused by Streptococcus pyogenes.

Streptococcus pyogenes produces a wide array of virulence factors and a very large number of
diseases. Virulence factors of Group A streptococci include: (1) M protein, fibronectin-binding protein
(Protein F) and lipoteichoic acid for adherence; (2) hyaluronic acid capsule as an immunological
disguise and to inhibit phagocytosis; M-protein to inhibit phagocytosis (3) invasins such as
streptokinase, streptodornase (DNase B), hyaluronidase, and streptolysins; (4) exotoxins, such as
pyrogenic (erythrogenic) toxin which causes the rash of scarlet fever and systemic toxic shock
syndrome.

Classification of Streptococci

Hemolysis on blood agar

The type of hemolytic reaction displayed on blood agar has long been used to classify the streptococci.
Beta -hemolysis is associated with complete lysis of red cells surrounding the colony, whereas alpha-
hemolysis is a partial or "green" hemolysis associated with reduction of red cell hemoglobin.
Nonhemolytic colonies have been termed gamma-hemolytic. Hemolysis is affected by the species and
age of red cells, as well as by other properties of the base medium. Group A streptococci are nearly
always beta-hemolytic; related Group B can manifest alpha, beta or gamma hemolysis. Most strains of
S. pneumoniae are alpha-hemolytic but can cause -hemolysis during anaerobic incubation. Most of the
oral streptococci and enterococci are non hemolytic. The property of hemolysis is not very reliable for
the absolute identification of streptococci, but it is widely used in rapid screens for identification of S.
pyogenes and S. pneumoniae.

Antigenic types

The cell surface structure of Group A streptococci is among the most studied of any bacteria (Figure 2).
The cell wall is composed of repeating units of N-acetylglucosamine and N-acetylmuramic acid, the
standard peptidoglycan. Historically , the definitive identification of streptococci has rested on the
serologic reactivity of "cell wall" polysaccharide antigens as originally described by Rebecca
Lancefield. Eighteen group-specific antigens (Lancefield groups) were established. The Group A
polysaccharide is a polymer of N-acetylglucosamine and rhamnose. Some group antigens are shared by
more than one species. This polysaccharide is also called the C substance or group carbohydrate
antigen.

Pathogenesis

Streptococcus pyogenes owes its major success as a pathogen to its ability to colonize and rapidly
multiply and spread in its host while evading phagocytosis and confusing the immune system.
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Acute diseases associated with Streptococcus pyogenes occur chiefly in the respiratory tract,
bloodstream, or the skin. Streptococcal disease is most often a respiratory infection (pharyngitis or
tonsillitis) or a skin infection (pyoderma). Some strains of streptococci show a predilection for the
respiratory tract; others, for the skin. Generally, streptococcal isolates from the pharynx and respiratory
tract do not cause skin infections. Figure 3 describes the pathogenesis of S. pyogenes infections.

S. pyogenes is the leading cause of uncomplicated bacterial pharyngitis and tonsillitis commonly
referred to a strep throat. Other respiratory infections include sinusitis, otitis, and pneumonia .
Infections of the skin can be superficial (impetigo) or deep (cellulitis). Invasive streptococci cause
joint or bone infections, destructive wound infections (necrotizing fasciitis) and myositis,
meningitis and endocarditis. Two post streptococcal sequelae, rheumatic fever and
glomerulonephritis, may follow streptococcal disease, and occur in 1-3% of untreated infections.
These conditions and their pathology are not attributable to dissemination of bacteria, but to aberrent
immunological reactions to Group A streptococcal antigens. Scarlet fever and streptococcal toxic
shock syndrome are systemic responses to circulating bacterial toxins.

The cell surface of Streptococcus pyogenes accounts for many of the bacterium's determinants of
virulence, especially those concerned with colonization and evasion of phagocytosis and the host
immune responses. The surface of Streptococcus pyogenes is incredibly complex and chemically-
diverse. Antigenic components include capsular polysaccharide (C-substance), cell wall
peptidoglycan and lipoteichoic acid (LTA), and a variety of surface proteins, including M protein,
fimbrial proteins, fibronectin-binding proteins, (e.g. Protein F) and cell-bound streptokinase.

The cytoplasmic membrane of S. pyogenes contains some antigens similar to those of human cardiac,
skeletal, and smooth muscle, heart valve fibroblasts, and neuronal tissues, resulting in molecular
mimicry and a tolerant or suppressed immune response by the host.

The cell envelope of a Group A streptococcus is illustrated in Figure 2. The complexity of the surface
can be seen in several of the electron micrographs of the bacterium that accompany this article.

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Figure 2. Cell surface structure of Streptococcus pyogenes and secreted products involved in virulence.

In Group A streptococci, the R and T proteins are used as epidemiologic markers and have no known
role in virulence. The group carbohydrate antigen (composed of N-acetylglucosamine and rhamnose)
has been thought to have no role in virulence, but emerging strains with increased invasive capacity
produce a very mucoid colony, suggesting a role of the capsule in virulence.

The M proteins are clearly virulence factors associated with both colonization and resistance to
phagocytosis. More than 50 types of S. pyogenes M proteins have been identified on the basis of
antigenic specificity, and it is the M protein that is the major cause of antigenic shift and antigenic drift
in the Group A streptococci. The M protein (found in fimbriae) also binds fibrinogen from serum and
blocks the binding of complement to the underlying peptidoglycan. This allows survival of the
organism by inhibiting phagocytosis.

The streptococcal M protein, as well as peptidoglycan, N-acetylglucosamine, and group-specific

carbohydrate, contain antigenic epitopes that mimic those of mammalian muscle and connective tissue.
As mentioned above, the cell surface of recently emerging strains of streptococci is distinctly mucoid
(indicating that they are highly encapsulated). These strains are also rich in surface M protein. The M
proteins of certain M-types are considered rheumatogenic since they contain antigenic epitopes related
to heart muscle, and they therefore may lead to autoimmune rheumatic carditis (rheumatic fever)
following an acute infection.

The Hyaluronic Acid Capsule

The capsule of S. pyogenes is non antigenic since it is composed of hyaluronic acid, which is
chemically similar to that of host connective tissue. This allows the bacterium to hide its own antigens

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and to go unrecognized as antigenic by its host. The Hyaluronic acid capsule also prevents opsonized
phagocytosis by neutrophils or mancrophages.

Adhesins

Colonization of tissues by S. pyogenes is thought to result from a failure in the constitutive defenses
(normal flora and other nonspecific defense mechanisms) which allows establishment of the bacterium
at a portal of entry (often the upper respiratory tract or the skin) where the organism multiplies and
causes an inflammatory purulent lesion.

It is now realized that S. pyogenes (like many other bacterial pathogens) produces multiple adhesins
with varied specificities. There is evidence that Streptococcus pyogenes utilizes lipoteichoic acids
(LTA), M protein, and multiple fibronectin-binding proteins in its repertoire of adhesins. LTA is
anchored to proteins on the bacterial surface, including the M protein. Both the M proteins and
lipoteichoic acid are supported externally to the cell wall on fimbriae and appear to mediate bacterial
adherence to host epithelial cells. The fibronectin-binding protein, Protein F, has also been shown to
mediate streptococcal adherence to the amino terminus of fibronectin on mucosal surfaces.

Identification of Streptococcuspyogenes adhesins has long been a subject of conflict and debate. Most
of the debate was between proponents of the LTA model and those of the M protein model. In 1972,
Gibbons and his colleagues proposed that attachment of streptococci to the oral mucosa of mice is
dependent on M protein. However, Olfek and Beachey argued that lipoteichoic acid (LTA), rather than
M protein, was responsible for streptococcal adherence to buccal epithelial cells. In 1996, Hasty and
Courtney proposed a two-step model of attachment that involved both M protein and teichoic
acids. They suggested that LTA loosely tethers streptococci to epithelial cells, and then M protein
and/or other fibronectin (Fn)-binding proteins secure a firmer, irreversible association. The first
streptococcal fibronectin-binding protein (Sfb) was demonstrated in 1992. Shortly thereafter, protein F
was discovered. Most recently (1998), the M1 and M3 proteins were shown to bind fibronectin.

Extracellular products: invasins and exotoxins

Colonization of the upper respiratory tract and acute pharyngitis may spread to other portions of the
upper or lower respiratory tracts resulting in infections of the middle ear (otitis media), sinuses
(sinusitis), or lungs (pneumonia). In addition, meningitis can occur by direct extension of infection
from the middle ear or sinuses to the meninges or by way of bloodstream invasion from the pulmonary
focus. Bacteremia can also result in infection of bones (osteomyelitis) or joints (arthritis). During these
aspects of acute disease the streptococci bring into play a variety of secretory proteins that mediate
their invasion.

For the most part, streptococcal invasins and protein toxins interact with mammalian blood and tissue
components in ways that kill host cells and provoke a damaging inflammatory response. The soluble
extracellular growth products and toxins of Streptococcus pyogenes (see Figure 2, above), have been
studied intensely. Streptolysin S is an oxygen-stable leukocidin; Streptolysin O is an oxygen-labile
leukocidin. NADase is also leukotoxic. Hyaluronidase (the original "spreading factor") can digest
host connective tissue hyaluronic acid, as well as the organism's own capsule. Streptokinases
participate in fibrin lysis. Streptodornases A-D possess deoxyribonuclease activity; Streptodornases B
and D possess ribonuclease activity as well. Protease activity similar to that in Staphylococcus aureus
has been shown in strains causing soft tissue necrosis or toxic shock syndrome. This large repertoire of
products is important in the pathogenesis of S. pyogenes infections. Even so, antibodies to these
products are relatively insignificant in protection of the host.
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The streptococcal invasins act in a variety of ways summarized in Table 1 at the end of this article.
Streptococcal invasins lyse eukaryotic cells, including red blood cells and phagocytes; they lyse other
host macromolecules, including enzymes and informational molecules; they allow the bacteria to
spread among tissues by dissolving host fibrin and intercellular ground substances.

Pyrogenic Exotoxins

Three streptococcal pyrogenic exotoxins (SPE), formerly known as Erythrogenic toxin, are
recognized: types A, B, C. These toxins act as superantigens by a mechanism similar to those
described for staphylococci. As antigens, they do not requiring processing by antigen presenting cells.
Rather, they stimulate T cells by binding class II MHC molecules directly and nonspecifically. With
superantigens about 20% of T cells may be stimulated (vs 1/10,000 T cells stimulated by conventional
antigens) resulting in massive detrimental cytokine release. SPE A and SPE C are encoded by
lysogenic phages; the gene for SPE B is located on the bacterial chromosome.

The erythrogenic toxin is so-named for its association with scarlet fever which occurs when the toxin is
disseminated in the blood. Re-emergence in the late 1980's of exotoxin-producing strains of S.
pyogenes has been associated with a toxic shock-like syndrome similar in pathogenesis and
manifestation to staphylococcal toxic shock syndrome, and with other forms of invasive disease
associated with severe tissue destruction. The latter condition is termed necrotizing fasciitis.
Outbreaks of sepsis, toxic shock and necrotizing fasciitis have been reported at increasing frequency.
The destructive nature of wound infections prompted the popular press to refer to S. pyogenes as "flesh-
eating bacteria" and "ski-eating streptococci". The increase in invasive streptococcal disease was
associated with emergence of a highly virulent serotype M1 which is disseminated world-wide. The
M1 strain produces the erythrogenic toxin (Spe A), thought to be responsible for toxic shock, and the
enzyme cysteine protease which is involved in tissue destruction. Because clusters of toxic shock were
also associated with other serotypes, particularly M3 strains, it is believed that unidentified host factors
may also have played an important role in the resurgence of these dangerous infections.

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FIGURE 3. Pathogenesis of Streptococcus pyogenes infections. Adapted from Baron's Medical Microbiology
Chapter 13, Streptococcus by Maria Jevitz Patterson.

Post streptococcal sequelae

Infection with Streptococcus pyogenes can give rise to serious nonsuppurative sequelae: acute
rheumatic fever and acute glomerulonephritis. These pathological events begin 1-3 weeks after an
acute streptococcal illness, a latent period consistent with an immune-mediated etiology. Whether all S.
pyogenes strains are rheumatogenic is controversial; however, clearly not all strains are nephritogenic.

Acute rheumatic fever is a sequel only of pharyngeal infections, but acute glomerulonephritis can
follow infections of the pharynx or the skin. Although there is no adequate explanation for the precise
pathogenesis of acute rheumatic fever, an abnormal or enhanced immune response seems essential.
Also, persistence of the organism on pharyngeal tissues (i.e., the tonsils) is associated with an increased
likelihood of rheumatic fever. Acute rheumatic fever can result in permanent damage to the heart
valves. Less than 1% of sporadic streptococcal pharyngitis infections result in acute rheumatic fever;
however, recurrences are common, and life-long antibiotic prophylaxis is recommended following a
single case.

The occurrence of cross-reactive antigens in S. pyogenes and heart tissues possibly explains the
autoimmune responses that develop following some infections. The antibody mediated immune (AMI)
response (i.e., level of serum antibody) is higher in patients with rheumatic fever than in patients with
uncomplicated pharyngitis. In addition, cell-mediated immunity (CMI) seems to play a role in the
pathology of acute rheumatic fever.

Acute glomerulonephritis results from deposition of antigen-antibody-complement complexes on the

basement membrane of kidney glomeruli. The antigen may be streptococcal in origin or it may be a
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host tissue species with antigenic determinants similar to those of streptococcal antigen (cross-reactive
epitopes for endocardium, sarcolemma, vascular smooth muscle). The incidence of acute
glomerulonephritis in the United States is variable, perhaps due to cycling of nephritogenic strains, but
it appears to be decreasing. Recurrences are uncommon, and prophylaxis following an initial attack is
unnecessary.

Host defenses

S. pyogenes is usually an exogenous secondary invader, following viral disease or disturbances in the
normal bacterial flora. In the normal human the skin is an effective barrier against invasive
streptococci, and nonspecific defense mechanisms prevent the bacteria from penetrating beyond the
superficial epithelium of the upper respiratory tract. These mechanisms include mucociliary movement,
coughing, sneezing and epiglottal reflexes.

The host phagocytic system is a second line of defense against streptococcal invasion. Organisms can
be opsonized by activation of the classical or alternate complement pathway and by anti-streptococcal
antibodies in the serum. S. pyogenes is rapidly killed following phagocytosis enhanced by specific
antibody. The bacteria do not produce catalase or significant amounts of superoxide dismutase to
inactivate the oxygen metabolites (hydrogen peroxide, superoxide) produced by the oxygen-dependent
mechanisms of the phagocyte. Therefore, they are quickly killed after engulfment by phagocytes. The
streptococcal defense must be one to stay out of phagocytes.

In immune individuals, IgG antibodies reactive with M protein promote phagocytosis which results in
killing of the organism. This is the major mechanism by which AMI is able to terminate Group A
streptococcal infections. M protein vaccines are a major candidate for use against rheumatic fever, but
certain M protein types cross-react antigenically with the heart and themselves may be responsible for
rheumatic carditis. This risk of autoimmunity has prevented the use of Group A streptococcal vaccines.
However, since the cross-reactive epitopes of the M-protein are now known, it appears that limited
anti-streptococcal vaccines are on the horizon.

FIGURE 4. Phagocytosis ofStreptococcus pyogenes by a macrophage. CELLS alive!

The hyaluronic acid capsule allows the organism to evade opsonization. The capsule is also an
antigenic disguise that hides bacterial antigens and is non antigenic to the host. Actually, the hyaluronic
acid outer surface of S. pyogenes is weakly antigenic, but it does not result in stimulation of protective
immunity. The only protective immunity that results from infection by Group A streptococcus comes
from the development of type-specific antibody to the M protein of the fimbriae, which protrude from
the cell wall through the capsular structure. This antibody, which follows respiratory and skin
infections, is persistent. Presumably, protective levels of specific IgA is produced in the respiratory
secretions while protective levels of IgG are formed in the serum. Sometimes, intervention of an
infection with effective antibiotic treatment precludes the development of this persistent antibody. This

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accounts, in part, for recurring infections in an individual by the same streptococcal strain. Antibody to
the erythrogenic toxin involved in scarlet fever is also long lasting.

Treatment and prevention

Penicillin is still uniformly effective in treatment of Group A streptococcal disease. It is important to

identify and treat Group A streptococcal infections in order to prevent sequelae. No effective vaccine
has been produced, but specific M-protein vaccines are being tested.

Table 1. Summary of virulence determinants of Streptococcus pyogenes

Adherence (colonization) surface macromolecules

M protein

Lipoteichoic acid (LTA)

Protein F and Sfb (fibronectin-binding proteins)

Enhancement of spread in tissues

Hyaluronidase hydrolyses hyaluronic acid, part of the ground substance in host tissues.

Proteases

Streptokinase lyses fibrin

Evasion of phagocytosis
Capsule: hyaluronic acid is produced.

C5a peptidase: C5a enhances chemotaxis of phagocytes .

M protein is a fibrillar surface protein. Its distal end bears a negative charge that interferes with
phagocytosis. It also blocks complement deposition on the cell surface. Mutations during the course of
infection alter the structure of M proteins, rendering some antibodies ineffective. Strains that persist in
carriers frequently exhibit altered M proteins.

Leukocidins, including streptolysin S and streptolysin O, are proteins secreted by the streptococci to
kill phagocytes (and probably to release nutrients for their growth)

Defense against host immune responses

Antigenic disguise and tolerance provided by hyaluronic acid capsule

Antigenic variation. Antibody against M protein (antigen) is the only effective protective antibody, but
there are more than 50 different M types, and subsequent infections may occur with a different M
serotype.

Production of toxins and other systemic effects

Toxic shock: Exotoxin is superantigen that binds directly to MHC II (without being processed) and
binds abnormally to the T cell receptor of many (up to 20% of) T cells. Exaggerated production of
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cytokines causes the signs of shock: fever, rash, low blood pressure. aberrant interaction between toxin,
macrophage, and T cells.

Induction of circulating, cross-reactive antibodies

Some of the antibodies produced during infection by certain strains of streptococci cross-react with
certain host tissues. These antibodies can indirectly damage host tissues, even after the organisms have
been cleared, and cause autoimmune complications.

Table 2. Summary of diseases caused by Streptococcus pyogenes

Suppurative conditions (active infections associated with pus) occur in the throat, skin, and
systemically.

Throat
Streptococcal pharyngitis is acquired by inhaling aerosols emitted by infected individuals. The
symptoms reflect the inflammatory events at the site of infection. A few (1-3%) people develop
rheumatic fever weeks after the infection has cleared.

Skin
Impetigo involves the infection of epidermal layers of skin. Pre-pubertal children are the most
susceptible. Cellulitis occurs when the infection spreads subcutaneous tissues. Erysipelas is the
infection of the dermis. About 5% of patients will develop more disseminated disease. Necrotizing
fasciitis involves infection of the fascia and may proceed rapidly to underlying muscle.

Systemic
Scarlet fever is caused by production of erythrogenic toxin by a few strains of the organism.

Toxic shock is caused by a few strains that produce a toxic shock-like toxin.

Non-suppurative Sequelae
Some of the antibodies produced during the above infections cross-react with certain host tissues.
These can indirectly damage host tissues, even after the organisms have beencleared, and cause non
suppurative complications.

Rheumatic fever. M protein cross reacts with sarcolemma. Antibodies cross-react with heart tissue, fix
complement, and cause damage.

Glomerulonephritis. Antigen-antibody complexes may be deposited in kidney, fix complement, and

damage glomeruli. Only a few M-types are nephritogenic.

Gallery of electron micrographs of Streptococcus pyogenes from The Laboratory of Pathogenesis

and Immunology at Rockefeller University, the home of research on Streptococcus pyogenes

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Critical point dried whole group A streptococci (Streptococcus pyogenes) viewed directly by transmission electron
microscopy (TEM 6,500X). Chains of streptococci are clearly evident. To remove cell surface proteins, cells were
treated with trypsin prior to preparation and mounting. Strain: D471; M-type 6. Electron micrograph of
Streptococcus pyogenes by Maria Fazio and Vincent A. Fischetti, Ph.D. with permission. The Laboratory of Bacterial
Pathogenesis and Immunology, Rockefeller University.

Dividing streptococci (12,000X). Electron micrograph of Streptococcus pyogenes by Maria Fazio and Vincent A.
Fischetti, Ph.D. with permission. The Laboratory of Bacterial Pathogenesis and Immunology, Rockefeller University.

354
355
Electron micrograph of an ultra-thin section of a chain of group A streptococci (20,000X). The cell surface fibrils,
consisting primarily of M protein, are clearly evident. The bacterial cell wall, to which the fibrils are attached, is also
clearly seen as the light staining region between the fibrils and the dark staining cell interior. Incipient cell division is
also indicated by the nascent septum formation (seen as an indentation of the cell wall) near the cell equator. The
streptococcal cell diameter is equal to approximately one micron. Electron micrograph of Streptococcus pyogenes by
Maria Fazio and Vincent A. Fischetti, Ph.D. with permission. The Laboratory of Bacterial Pathogenesis and
Immunology, Rockefeller University.

Negative staining of group A streptococci viewed by TEM 28,000X. The "halo" around the chain of cells
(approximately equal in thickness to the cell diameter) is the remnants of the capsule that may be found surrounding
the exterior of certain strains of group A streptococci. The septa between pairs of dividing cells may also be seen.
Electron micrograph of Streptococcus pyogenes by Maria Fazio and Vincent A. Fischetti, Ph.D. with permission. The
Laboratory of Bacterial Pathogenesis and Immunology, Rockefeller University.

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High magnification electron micrograph of an ultra-thin section of a group A streptococcus sibling pair
(70,000 X). At this magnification, especially in the cell on the left, the cell wall and cell surface fibrils,
consisting primarily of M protein, are well defined. Interdigitaion of these fibrils between neighboring
cells of different chains is also in plain view. Strain: C126/21/1; M-type 43. Electron micrograph of
Streptococcus pyogenes by Maria Fazio and Vincent A. Fischetti, Ph.D. with permission. The
Laboratory of Bacterial Pathogenesis and Immunology, Rockefeller University.

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 Todar's Online Textbook of Bacteriology

Streptococcus pneumoniae: Pneumococcal pneumonia

© 2003 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

Introduction

Pneumonia is a disease of the lung that is caused by a variety of bacteria including Streptococcus,
Staphylococcus, Pseudomonas, Haemophilus, Chlamydia and Mycoplasma, several viruses, and certain
fungi and protozoans. The disease may be divided into two forms, bronchial pneumonia and lobar
pneumonia. Bronchial pneumonia is most prevalant in infants, young children and aged adults. It is
caused by various bacteria, including Streptococcus pneumoniae. Bronchial pneumonia involves the
alveoli contiguous to the larger bronchioles of the bronchial tree. Lobar pneumonia is more prone to
occur in younger adults. A majority (more than 80%) of the cases of lobar pneumonia are caused by
Streptococcus pneumoniae. Lobar pneumonia involves all of a single lobe of the lungs (although more
than one lobe may be involved), wherein the entire area of involvement tends to become a consolidated
mass, in contrast to the spongy texture of normal lung tissue. Streptococcus pneumoniae is known in
medical microbiology as the pneumococcus, referring to its morphology and its consistent
involvement in pneumonia This article deals with pneumonia caused by Streptococcus pneumoniae,or
pneumococcal pneumonia.

Streptococcus pneumoniae

Streptococcus pneumoniae are Gram-positive, lancet-shaped cocci (elongated cocci with a slightly
pointed outer curvature). Usually they are seen as pairs of cocci (diplococci), but they may also occur
singly and in short chains. When cultured on blood agar, they are alpha hemolytic. Individual cells are
between 0.5 and 1.25 micrometers in diameter. They do not form spores, and they are nonmotile. Like
other streptococci, they lack catalase and ferment glucose to lactic acid. Unlike other streptococci, they
do not display an M protein, they hydrolyze inulin, and their cell wall composition is characteristic
both in terms of their peptidoglycan and their teichoic acid).

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Gram Stain of a film of sputum from a case of lobar pneumonia

Cultivation

Streptococcus pneumoniae is fastidious bacterium, growing best in 5% carbon dioxide. Nearly 20% of
fresh clinical isolates require fully anaerobic conditions. In all cases, growth requires a source of
catalase (e.g. blood) to neutralize the large amount of hydrogen peroxide produced by the bacteria. In
complex media containing blood, at 37°C, the bacterium has a doubling time of 20-30 minutes.

On agar, pneumococci grow as glistening colonies, about 1 mm in diameter. Two serotypes, types 3
and 37, are mucoid. Pneumococci spontaneously undergo a genetically determined, phase variation
from opaque to transparent colonies at a rate of 1 in 105 . The transparent colony type is adapted to
colonization of the nasopharynx, whereas the opaque variant is suited for survival in blood. The
chemical basis for the difference in colony appearance is not known, but significant difference in
surface protein expression between the two types has been shown.

Streptococcus pneumoniae is a fermentative aerotolerant anaerobe. It is usually cultured in media that

contain blood. On blood agar, colonies characteristically produce a zone of alpha (green) hemolysis,
which differentiates S. pneumoniae from the group A (beta hemolytic) streptococcus, but not from
commensal alpha hemolytic (viridans) streptococci which are co-inhabitants of the upper respiratory
tract. Special tests such as inulin fermentation, bile solubility, and optochin (an antibiotic) sensitivity
must be routinely employed to differentiate the pneumococcus from Streptococcus viridans.

Streptococcus pneumoniaeGram-stain of blood broth culture

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Streptococcus pneumoniae is a very fragile bacterium and contains within itself the enzymatic ability to
disrupt and to disintegrate the cells. The enzyme is called an autolysin. The physiological role of this
autolysin is to cause the culture to undergo a characteristic autolysis that kills the entire culture when
grown to stationary phase. Virtually all clinical isolates of pneumococci harbor this autolysin and
undergo lysis usually beginning between 18-24 hours after initiation of growth under optimal
conditions. Autolysis is consistent with changes in colony morphology. Colonies initially appear with
a plateau-type morphology, then start to collapse in the centers when autolysis begins.

Identification

The minimum criteria for identification and distinction of pneumococci from other streptococci are bile
or optochin sensitivity, Gram-positive staining, and hemolytic activity. Pneumococci cause alpha
hemolysis on agar containing horse, human, rabbit and sheep erythrocytes. Under anaerobic conditions
they switch to beta hemolysis caused by an oxygen-labile hemolysin. Typically, pneumococci form a
16-mm zone of inhibition around a 5 mg optochin disc, and undergo lysis by bile salts (e.g.
deoxycholate). Addition of a few drops of 10% deoxycholate at 37°C lyses the entire culture in
minutes. The ability of deoxycholate to dissolve the cell wall, depends upon the presence of an
autolytic enzyme, LytA. Virtually all clinical isolates of pneumococci harbor the autolysin and undergo
deoxycholate lysis.

Streptococcus pneumoniae A mucoid strain on blood agar showing alpha hemolysis (green zone surrounding
colonies). Note the zone of inhibition around a filter paper disc impregnated with optochin. Viridans streptococci are
not inhibited by optochin.

Serotyping

The quellung reaction (swelling reaction) forms the basis of serotyping and relies on the swelling of
the capsule upon binding of homologous antibody The test consists of mixing a loopful of colony with
equal quantity of specific antiserum and then examining microscopically at 1000X for capsular
swelling. Although generally highly specific, cross-reactivity has been observed between capsular
types 2 and 5, 3 and 8, 7 and 18, 13 and 30, and with E. coli, Klebsiella, H. influenzaeType b, and
certain viridans streptococci.

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Streptococcus pneumoniae Quellung (capsular swelling) reaction can be used to demonstrate the presence of a
specific capsular type of the bacterium.

Cell Surface Structure

Streptococcus pneumoniaescanning electron micrograph of a pair of diplococci (CDC).

Capsule

A capsule composed of polysaccharide completely envelops the pneumococcal cells. During invasion
the capsule is an essential determinant of virulence. The capsule interferes with phagocytosis by
preventing C3b opsonization of the bacterial cells. 90 different capsule types of pneumococci have
been identified and form the basis of antigenic serotyping of the organism. Anti-pneumococcal
vaccines are based on formulations of various capsular (polysaccharide) antigens derived from the
highly-prevalent strains.

Streptococcus pneumoniae Fluorescent antibody stain of capsular material (CDC)

Cell Wall

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The cell wall of S. pneumoniae is roughly six layers thick and is composed of peptidoglycan with
teichoic acid attached to approximately every third N-acetylmuramic acid. Lipoteichoic acid is
chemically identical to the teichoic acid but is attached to the cell membrane by a lipid moiety. Both
the teichoic acid and the lipoteichoic acid contain phosphorylcholine; two choline residues may be
covalently added to each carbohydrate repeat. This is an essential element in the biology of S.
pneumoniae since the choline specifically adheres to choline-binding receptors that are located on
virtually all human cells.

Surface Proteins

On the basis of functional genomic analysis, it is estimated that the pneumococcus contains more than
500 surface proteins. Some are membrane-associated lipoproteins, and others are physically associated
with the cell wall. The latter includes five penicillin binding proteins (PBPs), two neuraminidases, and
an IgA protease. A unique group of proteins on the pneumococcal surface is the family of choline-
binding proteins (CBPs). Twelve CBPs are noncovalently bound to the choline moiety of the cell wall
and are used to "snap" various different functional elements onto the bacterial surface. The CBPs all
share a common C-terminal choline-binding domain while the N-termini of the CBPs are distinct,
indicating their functions are different. The CBP family includes such important determinants of
virulence such as PspA (protective antigen), LytA, B, and C (three autolysins), and CbpA (an
adhesin).
Genetics

S. pneumoniae has a natural transformation system as a mechanism for genetic exchange. This
process is of medical significance because it clearly underlies the explosion of antibiotic resistance in
the bacterium over the past 20 years. For example, penicillin resistance is due to altered penicillin-
binding proteins (PBPs) which exhibit a low affinity for beta lactam antibiotics. Comparison of the
nucleotide sequences encoding the PBPs in S. pneumoniae and S. mitis demonstrates that horizontal
gene transfer has occurred between these two bacteria. In the laborotory, S. pneumoniae can also be
transformed with genes from related and unrelated bacteria. As well, in the upper respiratory tract of
the host, horizontal exchanges of genetic information could take place between strains of pneumococci
that co-habitate or compete for dominance as normal flora.

Streptococcus pneumoniae can also develop antibiotic resistance by the timeless process of mutation
and selection. The bacterium has a relatively fast growth rate and achieves large cell densities in an
infectious setting, These conditions not only favor the occurrence natural transformation, but also the
emergence of spontaneous mutants resistant to the antibiotic.

During transformation the binding, uptake and incorporation of exogenous DNA occur as a sequence of
programmed events during a physiologically defined state known as competence. Competent bacteria
self-aggregate, easily form protoplasts, are prone to autolysis and have an increased H+ and Na+
content that leads to increased glycolysis and enhanced ATP reserves. A unique set of at least 11
proteins is preferentially expressed during competence. Early in the competent state, a 17 amino acid
peptide, known as competence-stimulating peptide (CSP) is released from the growing bacteria. CSP
induces competence when it reaches a critical concentration that depends on the cell density, consistent
with a quorum-sensing model.

Pneumococcal Pneumonia

Pathogenesis

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Streptococcus pneumoniae is a normal inhabitant of the human upper respiratory tract. The bacterium
can cause pneumonia, usually of the lobar type, paranasal sinusitis and otitis media, or meningitis
which is usually secondary to one of the former infections. Streptococcus pneumoniae is currently the
leading cause of invasive bacterial disease in children and the elderly.

Pneumococci spontaneously cause disease in humans, monkeys, rabbits, horses, mice and guinea pigs.
Nasopharyngeal colonization occurs in approximately 40% of the population. Pneumonia and otitis
media are the most common infections, meningitis being much more variable. The rabbit and the
mouse have been used extensively as animal models disease, leading to a reasonable understanding of
many of the pneumococcal determinants of virulence.

Colonization
Pneumococci adhere tightly to the nasopharyngeal epithelium by multiple mechanisms that, for most
individuals, appears to result in an immune response that generates type-specific immunity. For some
people, however, progression into the lungs or middle ear occurs. Passage of pneumococci up the
eustachian tube is accompanied by bacterial induced changes in the surface receptors of the epithelial
cell, particularly by neuraminidase. Inflammation in the middle ear is caused by pneumococcal cell
wall components, and pneumolysin inflicts major cytotoxicity on ciliated cells of the cochlea.

Upon reaching the lower respiratory tract by aerosol, pneumococci bypass the ciliated upper respiratory
epithelial cells unless there is damage to the epithelium. Instead, they progress to the alveolus and
associate with specific alveolar cells which produce a choline-containing surfactant.

Experimentally, in healthy tissues, it requires approximately 100,000 bacteria/ml to trigger an

inflammatory response. However, if a proinflammatory signal is supplied, inflammation ensues with as
few as 10 bacteria .This signal is a cytokine in experimental systems or an intercurrent viral infection in
clinical situations. The inflammatory response can cause considerable tissue damage.

Invasion
The bacteria invade and grow primarily due to their resistance to the host phagocytic response. The cell
wall components directly activate multiple inflammatory cascades including the alternative pathway of
complement activation, the coagulation cascade, and the cytokine cascade, inducing interleukin-1,
interleukin-6 and tumor necrosis factor from macrophages and other cells.

In addition, as pneumococci begin to lyse in response to host defensins and antimicrobial agents, they
release cell wall components, pneumolysin and other substances that lead to greater inflammation and
cytotoxic effects. Pneumolysin and hydrogen peroxide kill cells and induce production of nitric oxide
which may play a key role in septic shock.

During invasion, the interaction between the bacterial cell wall choline and the host PAF receptor G-
protein contributes to a state of altered vascular permeability. In the lung, this leads to arrival of an
inflammatory exudate. At first, a serous exudate forms. This is followed by the arrival of leukocytes,
thereby making the switch from a serous to a purulent exudate. Sites of pneumococcal infection are
particularly noted for the intensity of the purulent response.

Pneumococci occasionally are able to directly invade endothelial cells. The ligands by which
pneumococci bind to activated human cells include choline located on the cell wall teichoic acid that
can serve as a direct ligand to the PAF receptor, and the choline-binding protein, CbpA, which binds to
a specific carbohydrate on the alveolar cell surface. When bound to the PAF receptor, the
pneumococcus enters a vacuole in a receptor-mediated endocytic process and the vacuole moves across
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the cell expelling the bacteria on the ablumenal surface. In vitro, pneumococci will adhere to and
traverse an endothelial barrier over approximately 4 hours.

If bacteremia occurs, the risk of meningitis increases. Pneumococci can adhere specifically to cerebral
capillaries using the same pairings of choline to PAF receptor and CbpA to carbohydrate receptor.
Thus, the bacteria subvert the endocytosis/recycling pathway of the PAF receptor for cellular
transmigration. Once in the cerebrospinal fluid, a variety of pneumococcal components, particularly
cell wall components, incite the inflammatory response.

Bacterial Determinants of Virulence

Capsule
The bacterial capsule interferes with phagocytosis by leukocytes, a property dependent on its chemical
composition. Apparently, resistance to phagocytosis is brought about by interference with binding of
complement C3b to the cell surface.

During invasion of the mucosal surface, encapsulated strains are 100,000 times more virulent than
unencapsulated strains. The polysaccharide is nontoxic and noninflammatory, and the capsule does not
appear to engage any host defenses except for the induction of antibody-mediated immunity. The
pneumococcal capsule is not an antigenic disguise, and it does not impede the activities of underlying
components, such as the cell wall and surface proteins, to engage the host defense systems. However,
C-reactive protein or antibodies to teichoic acid, both of which bind to the cell wall under the capsule,
fail to opsonize encapsulated strains.

Cell Wall Components

The pneumococcal cell wall is a collection of potent inflammatory stimuli. Challenge with cell wall
components alone can recreate many of the symptoms of pneumonia, otitis media and meningitis in
experimental models. The phosphorylcholine decorating the teichoic acid and the lipoteichoic acid is a
key molecule enabling invasion, and acts both as an adhesin and as a docking site for the choline-
binding proteins (CBPs). Other respiratory pathogens such as Haemophilus, Pseudomonas, Neisseria
and Mycoplasma also have phosphorylcholine on lipopolysaccharide, proteins or fimbriae, suggesting a
shared mechanism for invasion of the respiratory tract. Two host-derived elements that recognize
choline are platelet activating factor (PAF) receptor and the C-reactive protein. Since respiratory
pathogens may be recognized and cleared by the C-reactive protein response as part of the constitutive
defenses, respiratory pathogens may share this invasive mechanism to subvert the signaling cascade of
endogenous PAF.

The peptidoglycan/teichoic acid complex of the pneumococcus is highly inflammatory. Smaller

components of peptidoglycan progressively lose specific inflammatory activity. The cell wall directly
activates the alternative pathway of the complement cascade, generating chemotaxins for leukocytes,
and the coagulation cascade, which promotes a "procoagulant state" favoring thrombosis. In addition,
peptidoglycan binds to CD14, a cell surface receptor known to initiate the inflammatory response for
endotoxin. This induces a cytokine cascade resulting in production of interleukin-1, interleukin 6 and
tumor necrosis factor from human cells.

Choline Binding Proteins

The CBP family includes such important determinants as PspA (protective antigen), LytA, B, and C
(three autolysins), and CbpA (an adhesin).
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The protective antigen (PspA) is a 65 kD protein with 10 choline-binding repeats. PspA appears to
inhibit complement-mediated opsonization of pneumococci, and mutants lacking PspA have reduced
virulence. Antibodies against PspA confer passive protection in mice.

Autolysin LytA is responsible for pneumococcal lysis in stationary phase as well as in the presence of
antibiotics. The protein has two functional domains: a C-terminal domain with six choline-binding
repeats that anchor the protein on the cell wall, and an N-terminal domain that provides amidase
activity. Autolysin LytB is a glucosaminidase involved in cell separation, and LytC exhibits
lysozyme-like activity.

CbpA is a major pneumococcal adhesin. It has eight choline-binding repeats. The adhesin interacts
with carbohydrates on the pulmonary epithelial surface carbohydrates. CbpA-deficient mutants are
defective in colonization of the nasopharynx and fail to bind to various human cells in vitro. CbpA
also has been reported to bind secretory IgA and complement component C3.

Hemolysins
In addition to surface-associated virulence determinants, pneumococci secrete exotoxins. Two
hemolysins have been described, the most potent of which is pneumolysin. Pneumolysin is stored
intracellularly and is released upon lysis of pneumococci by autolysin. Pneumolysin binds to
cholesterol and thus can indiscriminately bind to all cells without restriction to a receptor. This protein
assembles into oligomers to form transmembrane pores which ultimately lead to cell lysis.
Pneumolysin can also stimulate the production of inflammatory cytokines, inhibit beating of the
epithelial cell cilia, inhibit lymphocyte proliferation, decrease the bactericidal activity of neutrophils,
and activate complement. A second hemolysin activity has been described but has not been identified.
In addition, pneumococci also produce hydrogen peroxide in amounts greater than human leukocytes
produce. This small molecule is also a potent hemolysin.

Neuraminidase and IgA protease

Epidemiology

S. pneumoniae is a transient member of the normal flora, colonizing the nasopharynx of 40% of healthy
adults and children with no adverse effects. Children carry this pathogen in the nasopharynx
asymptomatically for about 4-6 weeks, often several serotypes at a time. New serotypes are acquired
approximately every 2 months. Serotypes 6, 14, 18, 19, and 23 are the most prevalent accounting for
60-80% of infections depending on the area of the world. Pneumococcal infection accounts for more
deaths than any other vaccine-preventable bacterial disease. Those most commonly at risk for
pneumococcal infection are children between 6 months and 4 years of age and adults over 60 years of
age. Virtually every child will experience pneumococcal otitis media before the age of 5 years. It is
estimated that 25% of all community-acquired pneumonia is due to pneumococcus (1,000 per 100,000
inhabitants). The Centers for Disease Control and Prevention ( CDC) reported 60,000 cases of invasive
pneumococcal disease in 1997 approximately 6,000 deaths. Recently, epidemics of disease have
reappeared in settings such as chronic care facilities, military camps and day care centers, a situation
not recognized since the pre-antibiotic era.

Also of concern, is the increased emergence of antibiotic resistance, especially in the past decade.
Multiple antibiotic resistant strains of S. pneumoniae that emerged in the early 1970s in Papua New
Guinea and South Africa were thought to be a fluke, but multiple antibiotic resistance now covers the
globe and has rapidly increased since 1995. Increases in penicillin resistance have been followed by
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resistance to cephalosporins and multidrug resistance. The incidence of resistance to penicillin
increased from <0.02 in 1987 to 3% in 1994 to 30% in some communities in the United States and 80%
in regions of some other countries in 1998. Resistance to other antibiotics has emerged simultaneously:
26% resistant to trimethoprim-sulfa, 9% resistant to cefotaxime, 30% resistant to macrolides, and 25%
resistant to multiple drugs. Resistant organisms remain fully virulent but seem to have arisen in less
than 10 serotypes. Serotypes 6A, 6B, 9V, 14, 19A and 23F are included in the vast majority of resistant
strains.

Vaccines

Given the 90 different capsular types of pneumococci, a comprehensive vaccine based on

polysaccharide alone is not feasible. Thus, vaccines based on a subgroup of highly prevalent types have
been formulated. The number of serotypes in the vaccine has increased from four in 1945, to 14 in the
1970s, and finally to the current 23-valent formulation (25 mg of each of serotypes 1, 2, 3, 4, 5, 6B, 7F,
8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19A, 19F, 20, 22F, 23F, and 33F). These serotypes
represent 85-90% of those that cause invasive disease and the vaccine efficacy is estimated at 60% .
However, underutilization of the vaccine is so extensive that the pneumococcus remains the most
common infectious agent leading to hospitalization in all age groups. This is further complicated by the
fact that polysaccharides are not immunogenic in children under the age of 2 years where a significant
amount of disease occurs.

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 Todar's Online Textbook of Bacteriology

Listeria monocytogenes and Listeriosis

© 2003 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

Listeria monocytogenes Transmission EM

Introduction

Listeria monocytogenes is a Gram-positive rod-shaped bacterium. It is the agent of listeriosis, a serious

infection caused by eating food contaminated with the bacteria. Listeriosis has recently been
recognized as an important public health problem in the United States. The disease affects primarily
pregnant women, newborns, and adults with weakened immune systems.

Listeriosis is a serious disease for humans; the overt form of the disease has a mortality greater than 25
percent. The two main clinical manifestations are sepsis and meningitis. Meningitis is often
complicated by encephalitis, a pathology that is unusual for bacterial infections.

Microscopically Listeria species appear as small, Gram-positive rods, which are sometimes arranged in
short chains. In direct smears they may be coccoid, so they can be mistaken for streptococci. Longer
cells may resemble corynebacteria. (Indeed, as Gram-positive, nonsporeforming, catalase-positive
rods, the genus Listeria was classified in the family Corynebacteriaceae through the seventh edition of
of Bergey's Manual). Flagella are produced at room temperature but not at 37° C. Hemolytic activity on
blood agar has been used as a marker to distinguish Listeria monocytogenes among other Listeria
species, but it is not an absolutely definitive criterion. Further biochemical characterization may be
necessary to distinguish between the different Listeria species.

16S rRNA cataloging studies of Stackebrandt et al. (1983) demonstrated that Listeria monocytogenes
was a distinct taxon within the Clostridium-Lactobacillus-Bacillus branch of the bacterial phylogeny
constructed by Woese (1981). Within this phylogeny, Listeria is most closely related to the genus
Brochothrix.

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Listeria monocytogenes Gram Stain

Natural Habitats

Until about 1960, Listeria monocytogenes was thought to be associated almost exclusively with
infections in animals, and less frequently in humans. However, in the last 30 years, listeriae, including
the pathogenic species L. monocytogenes and L. ivanovii have been isolated from a variety of sources,
and they are now recognized to be widely distributed in Nature. In addition to humans, at least 42
species of wild and domestic mammals and 17 avian species, including domestic and game fowl, can
harbor listeriae. Listeria monocytogenes is reportedly carried in the intestinal tract of 5-10% of the
human population without any apparent symptoms of disease. Listeriae have also been isolated from
crustaceans, fish, oysters, ticks, and flies.

The term listeriosis encompasses a wide variety of disease symptoms that are similar in animals and
humans. Listeria monocytogenes causes listeriosis in animals and humans; L. ivanovii causes the
disease in animals only, mainly sheep. Encephalitis is the most common form of the disease in
ruminant animals. In young animals, visceral or septicemic infections often occur. Intra-uterine
infection of the fetus via the placenta frequently results in abortion in sheep and cattle.

The true incidence of listeriosis in humans is not known, because in the average healthy adult,
infections are usually asymptomatic, or at most produce a mild influenza-like disease. Clinical features
range from mild influenza-like symptoms to meningitis and/or meningoencephalitis. Illness is most
likely to occur in pregnant women, neonates, the elderly and immunocompromised individuals, but
apparently healthy individuals may also be affected. In the serious (overt) form of the disease,
meningitis, frequently accompanied by septicemia, is the most commonly encountered disease
manifestation. In pregnant women, however, even though the most usual symptom is a mild influenza-
like illness without meningitis, infection of the fetus is extremely common and can lead to abortion,
stillbirth, or delivery of an acutely ill infant.

In humans, overt listeriosis following infection with L. monocytogenes is usually sporadic, but
outbreaks of epidemic proportions have occurred. In 1981, there was an outbreak that involved over
100 people in Canada. Thirty-four of the infections occurred in pregnant women, among whom there
were nine stillbirths, 23 infants born infected, and two live healthy births. Among 77 non pregnant
adults who developed overt disease, there was nearly 30% mortality. The source of the outbreak was
coleslaw produced by a local manufacturer.

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In 1985, in California, 142 people developed overt listeriosis. Of these, 93 cases were perinatal, and
among the 49 cases that were in non pregnant individuals, 48 were immunocompromised. Thirty
fetuses or newborn infants died and 18 adults died. The source of the bacteria was a certain brand of
"pasteurized" soft cheese that apparently had gotten contaminated with non pasteurized (raw) milk
during the manufacturing process.

Pathogenesis

Listeria monocytogenes is presumably ingested with raw, contaminated food. An invasin secreted by
the pathogenic bacteria enables the listeriae to penetrate host cells of the epithelial lining. The
bacterium is widely distributed so this event may occur frequently. Normally, the immune system
eliminates the infection before it spreads. Adults with no history of listeriosis have T lymphocytes
primed specifically by Listeria antigens. However, if the immune system is compromised, systemic
disease may develop. Listeria monocytogenes multiplies not only extracellularly but also
intracellularly, within macrophages after phagocytosis, or within parenchymal cells which are entered
by induced phagocytosis.

In mice infected with L. monocytogenes, the bacteria first appear in macrophages and then spread to
hepatocytes in the liver. The bacteria stimulate a CMI response that includes the production of TNF,
gamma interferon, macrophage activating factors and a cytotoxic T cell response. Possibly, in humans,
a failure to control L. monocytogenes by means of CMI allows the bacteria to spread systemically. As
well, unlike other bacterial pathogens, Listeria are able to penetrate the endothelial layer of the placenta
and thereby infect the fetus.

Virulence Factors

Growth at low temperatures

A peculiar property of L. monocytogenes that affects its food-borne transmission is the ability to
multiply at low temperatures. The bacteria may therefore grow and accumulate in contaminated food
stored in the refrigerator. So it is not surprising that listeriosis is usually associated with ingestion of
milk, meat or vegetable products that have been held at refrigeration temperatures for a long period of
time.

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Growth and viability of Listeria in certain foods at freezing temperatures (-20 degrees) and refrigeration
temperatures (4 degrees) over a 12 week period. Adapted from Baron's Medical Microbiology, Miscellaneous
Pathogenic Bacteria by H Hof.

Motility

As in the case of Vibrio cholerae, wherein movement, attachment and penetration of the intestinal
mucosa are determinants of infection (if not disease), this was thought to be the situation with Listeria,
which is also acquired by ingestion and must also find a way to attach to the intestinal mucosa. With
cholera, the actively-motile vibrios are thought to use their flagella to swim against the peristaltic
movement of the bowel content and to penetrate (by swimming laterally) the mucosal lining of the gut
where they adhere. Curiously, although Listeria are actively motile by means of peritrichous flagella at
room temperature (20-25 degrees), the organisms do not synthesize flagella at body temperatures (37
degrees). Instead, virulence is associated with another type of motility: the ability of the bacteria to
move themselves into, within and between host cells by polymerization of host cell actin at one end of
the bacterium ("growing actin tails") that can propel the bacteria through cytoplasm. However, one
should not totally dismiss the advantage of flagellar motility for existence and spread of the bacteria
outside of the immediate host environment.

Listeria monocytogenes Scanning EM showing Flagella

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Adherence and Invasion

Listeria can attach to and enter mammalian cells. The bacterium is thought to attach to epithelial cells
of the GI tract by means of D-galactose residues on the bacterial surface which adhere to D-galactose
receptors on the host cells. If this is correct, it is the opposite of the way that most other bacterial
pathogens are known to adhere, i.e., the bacterium displays the protein or carbohydrate ligand on its
surface and the host displays the amino acid or sugar residue to which the ligand binds. Having said
this, macrophages are well known to have "mannose binding receptors" on their surface whose function
presumably is to ligand to bacterial surface polysaccharides that terminate in mannose, as a prelude to
phagocytic uptake.

The bacteria are then taken up by induced phagocytosis, analogous to the situation in Shigella. An 80
kDa membrane protein called internalin probably mediates invasion. A complement receptor on
macrophages has been shown to be the internalin receptor, as well.

After engulfment, the bacterium may escape from the phagosome before phagolysosome fusion occurs
mediated by a toxin, which also acts as a hemolysin, listeriolysin O (LLO). This toxin is one of the so-
called SH-activated hemolysins, which are produced by a number of other Gram-positive bacteria, such
as group A streptococci (streptolysin O), pneumococci (pneumolysin), and Clostridium perfringens.
The hemolysin gene is located on the chromosome within a cluster of other virulence genes which are
all regulated by a common promoter. Survival of the bacterium within the phagolysosome may be
aided by its ability to produce catalase and superoxide dismutase which neutralize the effects of the
phagocytic oxidative burst.

Additional genetic determinants are necessary for further steps in the intracellular life cycle of L.
monocytogenes. One particular gene product, Act A (encoded by actA) promotes the polymerization of
actin, a component of the host cell cytoskeleton, on the bacterial surface. Within the host cell
environment, surrounded by a sheet of actin filaments, the bacteria reside and multiply. The growing
actin sheet functions as a propulsive force which drives the bacteria across the intracellular pathways
until they finally reach the surface. Then, the host cell is induced to form slim, long protrusions
containing living L. monocytogenes. Those cellular projections are engulfed by adjacent cells,
including non-professional phagocytes such as parenchymal cells. By such a mechanism, direct cell-to-
cell spread of Listeria in an infected tissue may occur without an extracellular stage.

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Steps in the invasion of cells and intracellular spread by L. monocytogenes. The bacterium apparently invades via the
intestinal mucosa. It is thought to attach to intestinal cells by means of D-galactose residues on the bacterial surface
which adhere to D-galactose receptors on susceptible intestinal cells The bacterium is taken up (including by non
phagocytic cells) by induced phagocytosis, which is thought to be mediated by a membrane associated protein called
internalin. Once ingested the bacterium produces listeriolysin (LLO) to escape from the phagosome. The bacterium
then multiplies rapidly in the cytoplasm and moves through the cytoplasm to invade adjacent cells by polymerizing
actin to form long tails.

Other Determinants of Virulence

L. monocytogenes produces two other hemolysins besides LLO: phosphatidylinositol-specific

phospholipase C (PI-PLC) and phosphatidylcholine-specific phospholipase C (PC-PLC). Unlike
LLO, which lyses host cells by forming a pore in the cell membrane, these phospholipases disrupt
membrane lipids such as phosphatidylinositol and phosphatidylcholine (lecithin).

The bacterium also produces a Zn++ dependent protease which may act as some sort of exotoxin.
Mutations in the encoding gene (mpl) reduce virulence in the mouse model.

Finally, an operon called lmaBA encodes a 20 kDa protein located on the bacterial surface. The protein
LMaA induces delayed type hypersensitivity and other CMI responses.

Host Defenses

Because L. monocytogenes multiplies intracellularly, it is largely protected against circulating immune

factors (AMI) such as antibodies and complement-mediated lysis. The effective host response is cell-
mediated immunity (CMI), involving both lymphokines (especially interferon) produced by CD4+
(TH1) cells and direct lysis of infected cells by CD8+ (TC) cells. Both of these defense mechanisms are
expressed in the microenvironment of the infected foci, which are organized as granulomas,
characterized by a central accumulation of macrophages with irregularly shaped nuclei, and by
peripheral lymphocytes recognizable by rounded nuclei and a narrow border of intensely staining
cytoplasm.

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Treatment and Prevention

If diagnosed early enough, antibiotic treatment of pregnant women or immunocompromised

individuals can prevent serious consequences of the disease. However, early diagnosis is the exception
rather than the rule, since the first signs of a case or an outbreak are reports of stillbirth or serious
infections resembling listeriosis. By then, any cohorts who have become infected from eating the same
food are likely recovered from an inapparent or flu-type infection, or they themselves may have
developed serious disease. However, processed foods known to be the source of Listeria that may still
be in the market place, restaurant or home should obviously not be used, and recalls should be
imperative. It must also be constantly recognized that L. monocytogenes is able to grow at low
temperatures.

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 Todar's Online Textbook of Bacteriology

The Pathogenic Neisseriae

© 2004 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

Neisseria meningitidis scanning EM

Introduction

The family Neisseriaceae consists of Gram-negative aerobic bacteria from fourteen genera (Bergey's
2001), including Neisseria, Chromobacterium, Kingella, and Aquaspirillum. The genus Neisseria
contains two important human pathogens, N. gonorrhoeae and N. meningitidis. N. gonorrhoeae causes
gonorrhea, and N. meningitidis is the cause of meningococcal meningitis. N. gonorrhoeae infections
have a high prevalence and low mortality, whereas N. meningitidis infections have a low prevalence
and high mortality.

Neisseria gonorrhoeae infections are acquired by sexual contact and usually affect the mucous
membranes of the urethra in males and the endocervix and urethra in females, although the infection
may disseminate to a variety of tissues. The pathogenic mechanism involves the attachment of the
bacterium to nonciliated epithelial cells via pili (fimbriae) and the production of lipopolysaccharide
endotoxin. Similarly, the lipopolysaccharide of Neisseria meningitidis is highly toxic, an it has an
additional virulence factor in the form of its antiphagocytic capsule. Both pathogens produce IgA
proteases which promote virulence. Many normal individuals may harbor Neisseria meningitidis in the
upper respiratory tract, but Neisseria gonorrhoeae is never part of the normal flora and is only found
after sexual contact with an infected person (or direct contact, in the case of infections in the newborn).
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In the vocabulary of the public health and medical microbiologist, N. gonorrhoeae is often referred to
as the "gonococcus", while N. meningitidis is known as the "meningococcus"and one form of the
disease it causes is called meningococcemia.

Figure 1. Left: Neisseria gonorrhoeae Gram stain of pure culture; Right: Neisseria gonorrhoeae Gram stain of a
pustular exudate.

Neisseria gonorrhoeae

Neisseria gonorrhoeae is a Gram-negative coccus, 0.6 to 1.0 µm in diameter, usually seen in pairs with
adjacent flattened sides (Figure 1 Left and Fig 2 below). The organism is frequently found
intracellularly in polymorphonuclear leukocytes (neutrophils) of the gonorrhea pustular exudate (Figure
1 Right). Fimbriae, which play a major role in adherence, extend several micrometers from the cell
surface (Figure 2 below).

Figure 2. Neisseria gonorrhoeae

Neisseria gonorrhoeae possesses a typical Gram-negative outer membrane composed of proteins,

phospholipids, and lipopolysaccharide (LPS). However, neisserial LPS is distinguished from enteric
LPS by its highly-branched basal oligosaccharide structure and the absence of repeating O-antigen
subunits. For these reasons, neisserial LPS is referred to as lipooligosaccharide (LOS). The bacterium
characteristically releases outer membrane fragments called "blebs" during growth. These blebs
contain LOS and probably have a role in pathogenesis if they are disseminated during the course of an
infection.

N. gonorrhoeae is a relatively fragile organism, susceptible to temperature changes, drying, uv light,

and other environmental conditions. Strains of N. gonorrhoeae are variable in their cultural
requirements so that media containing hemoglobin, NAD, yeast extract and other supplements are
needed for isolation and growth of the organism. Cultures are grown at 35-36 degrees in an atmosphere
of 3-10% added CO2.
375
Infections caused by N. gonorrhoeae

The disease gonorrhea is a specific type of urethritis that practically always involves mucous
membranes of the urethra, resulting in a copious discharge of pus, more apparent in the male than in the
female. The first usage of the term "gonorrhea", by Galen in the second century, implied a "flow of
seed". For centuries thereafter, gonorrhea and syphilis were confused, resulting from the fact that the
two diseases were often present together in infected individuals. Paracelsus (1530) thought that
gonorrhea was an early symptom of syphilis. The confusion was further heightened by the classic
blunder of English physician John Hunter, in 1767. Hunter intentionally inoculated himself with pus
from a patient with symptoms of gonorrhea and wound up giving himself syphilis! The causative agent
of gonorrhea, Neisseria gonorrhoeae, was first described by A. Neisser in 1879 in the pustular exudate
of a case of gonorrhea. The organism was grown in pure culture in 1885, and its etiological relationship
to human disease was later established using human volunteers in order to fulfill the experimental
requirements of Koch's postulates.

Gonorrheal infection is generally limited to superficial mucosal surfaces lined with columnar
epithelium. The areas most frequently involved are the urethra, cervix, rectum, pharynx, and
conjunctiva. Squamous epithelium, which lines the adult vagina, is not susceptible to infection by the
N. gonorrhoeae. However, the prepubescent vaginal epithelium, which has not been keratinized under
the influence of estrogen, may be infected. Hence, gonorrhea in young girls may present as
vulvovaginitis. Mucosal infections are usually characterized by a purulent discharge.

Uncomplicated gonorrhea in the adult male is an inflammatory and pyogenic infection of the mucous
membranes of the anterior urethra. The most common symptom is a discharge that may range from a
scanty, clear or cloudy fluid to one that is copious and purulent. Dysuria (difficulty in urination)is often
present. Inflammation of the urethral tissues results in the characteristic redness, swelling, heat, and
pain in the region. There is intense burning and pain upon urination.

Endocervical infection is the most common form of uncomplicated gonorrhea in women. Such
infections are usually characterized by vaginal discharge and sometimes by dysuria. About 50% of
women with cervical infections are asymptomatic. Asymptomatic infections occur in males, as well.
Males with asymptomatic urethritis are an important reservoir for transmission and are at increased risk
for developing complications. Asymptomatic males and females are a major problem as unrecognized
carriers of the disease, which occurs in the U.S. at an estimated rate of over one million cases per year.

In the male, the organism may invade the prostate resulting in prostatitis, or extend to the testicles
resulting in orchitis. In the female, cervical involvement may extend through the uterus to the fallopian
tubes resulting in salpingitis, or to the ovaries resulting in ovaritis. As many as 15% of women with
uncomplicated cervical infections may develop pelvic inflammatory disease (PID). The involvement
of testicles, fallopian tubes or ovaries may result in sterility. Occasionally, disseminated infections
occur. The most common forms of disseminated infection are a dermatitis-arthritis syndrome,
endocarditis and meningitis.

Rectal infections (proctitis) with N. gonorrhoeae occur in about one-third of women with cervical
infection. They most often result from autoinoculation with cervical discharge and are rarely
symptomatic. Rectal infections in homosexual men usually result from anal intercourse and are more
often symptomatic. Partners must be treated as well to avoid reinfection.

Ocular infections by N. gonorrhoeae can have serious consequences of corneal scarring or perforation.
Ocular infections (ophthalmia neonatorum) occur most commonly in newborns who are exposed to
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infected secretions in the birth canal. Part of the intent in adding silver nitrate or an antibiotic to the
eyes of the newborn is to prevent ocular infection by N. gonorrhoeae.

Pathogenesis

Gonorrhea in adults is almost invariably transmitted by sexual intercourse. The bacteria adhere to
columnar epithelial cells, penetrate them, and multiply on the basement membrane. Adherence is
mediated through fimbriae and opa (P.II) proteins. although nonspecific factors such as surface charge
and hydrophobicity may play a role. Fimbriae undergo both phase and antigenic variation. The bacteria
attach only to microvilli of nonciliated columnar epithelial cells. Attachment to ciliated cells does not
occur.

Most of the information on bacterial invasion comes from studies with tissue culture cells and human
fallopian tube organ culture. After the bacteria attach to the nonciliated epithelial cells of the fallopian
tube, they are surrounded by the microvilli, which draw them to the surface of the mucosal cell. The
bacteria enter the epithelial cells by a process called parasite-directed endocytosis. During
endocytosis the membrane of the mucosal cell retracts and pinches off a membrane-bound vacuole that
contains the bacteria. The vacuole is transported to the base of the cell, where the bacteria are released
by exocytosis into the subepithelial tissue. The neisseriae are not destroyed within the endocytic
vacuole, but it is not clear whether they actually replicate in the vacuoles as intracellular parasites.

A major porin protein, P.I (Por), in the outer membrane of the bacterium is thought to be the invasin
that mediates penetration of a host cell. Each N. gonorrhoeae strain expresses only one type of Por;
however, there are several variations of Por that partly account for different antigenic types of the
bacterium.

Neisseria gonorrhoeae can produce one or several outer membrane proteins called Opa (P.II) proteins
. These proteins are subject to phase variation and are usually found on cells from colonies possessing a
unique opaque phenotype called O+. At any particular time, the bacterium may express zero, one, or
several different Opa proteins, and each strain has 10 or more genes for different Opas.

Rmp (P.III) is an outer membrane protein found in all strains of N. gonorrhoeae. It does not undergo
antigenic variation and is found in a complex with Por and LOS. It shares partial homology with the
OmpA protein of Escherichia coli. Antibodies to Rmp, induced either by a neisserial infection or by
colonization with E. coli, tend to block bactericidal antibodies directed against Por and LOS. In fact,
anti-Rmp antibodies may increase susceptibility to infection by N. gonorrhoeae.

During infection, bacterial lipooligosaccharide (LOS) and peptidoglycan are released by autolysis of
cells. Both bacterial polysaccharides activate the host alternative complement pathway, while LOS also
stimulates the production of tumor necrosis factor (TNF) that causes cell damage. Neutrophils are
immediately attracted to the site and feed on the bacteria. For unknown reasons, many gonococci are
able to survive inside of the phagocytes, at least until the neutrophils themselves die and release the
ingested bacteria.

Neisserial LOS has a profound effect on the virulence and pathogenesis of N. gonorrhoeae. The
bacteria can express several antigenic types of LOS and can alter the type of LOS they express by some
unknown mechanism. Gonococcal LOS produces mucosal damage in fallopian tube organ cultures and
brings about the release of enzymes, such as proteases and phospholipases, that may be important in
pathogenesis. Thus, gonococcal LOS appears to have an indirect role in mediating tissue damage.
Gonococcal LOS is also involved in the resistance of N. gonorrhoeae to the bactericidal activity of
377
normal human serum. Specific LOS oligosaccharide types are known to be associated with a serum-
resistant phenotypes of N. gonorrhoeae.

N. gonorrhoeae can utilize host-derived N-acetylneuraminic acid (sialic acid) to sialylate the
oligosaccharide component of its LOS, converting a serum-sensitive organism to a serum-resistant one.
Organisms with nonsialylated LOS are more invasive than those with sialylated LOS but organisms
with sialylated LOS are more resistant to bactericidal effects of serum. There is also antigenic
similarity between neisserial LOS and antigens present on human erthyrocytes. This similarity to "self"
may preclude an effective immune response to these LOS antigens by maintaining the
immunotolerance of the host.

N. gonorrhoeae is highly efficient at utilizing transferrin-bound iron for in vitro growth; many strains
can also utilize lactoferrin-bound iron. The bacteria bind only human transferrin and lactoferrin. This
specificity is thought to be, in part, the reason these bacteria are exclusively human pathogens.

Strains of N. gonorrhoeae produce two distinct extracellular IgA1 proteases which cleave the heavy
chain of the human immunoglobulin at different points within the hinge region. Split products of IgA1
have been found in the genital secretions of women with gonorrhea, suggesting that the bacterial IgA1
protease is present and active during genital infection. It is thought that the Fab fragments of IgA1 may
bind to the bacterial cell surface and block the Fc-mediated functions other immunoglobulins.

Occasionally, as described above, invading Neisseria gonorrhoeae enter the bloodstream causing a
Gram-negative bacteremia which may lead to a disseminated bacterial infection. Asymptomatic
infections of the urethra or cervix usually serve as focal sources for bacteremia. Strains of N.
gonorrhoeae that cause disseminated infections are usually resistant to complement and the serum
bactericidal reaction. This accounts for their ability to persist in the bacteremia. In Gram-negative
bacteremias of this sort, the effect of bacterial endotoxin can be exacerbated by the lyis of bacterial
cells which may simply liberate soluble LPS.

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 <>
Figure 3. Pathogenesis of uncomplicated gonorrhea according to Morse in Baron, Chapter 14, Neisseria,
Branhamella, Moraxella and Eikenella

Virulence Factors

Like the other pyogenic bacteria, Neisseria gonorrhoeae has a wide range of virulence determinants,
although it does not produce any exotoxins. The first stages of infection, involving adherence and
invasion, are mediated by surface components of the gonococci. The bacterium first attaches to
epithelial cells by means of its fimbriae, specifically N-methylphenylalanine (Type 4) pili, the main
subunit of which is PilE. After initial attachment, the bacteria enter a second stage of binding mediated
by the outer membrane protein P.II (also known as Opa) which is needed for tight binding and
invasion of epithelial cells. Also, P.II from one bacterium will bind to LOS of an adjacent bacterium,
which allows for the construction of a microcolony which may be functionally analogous to a biofilm.
However, the invasion of a cell involves a single bacterium, not whole microcolonies. Neisseria
gonorrhoeae also produces an IgA1 protease that probably play a role in the colonization stage.

The outer membrane porin of N. gonorrhoeae P.I (also known as Por) is equivalent to the ompC and
ompF porins of E. coli that are involved in the passage of solutes through the outer membrane.
However, P.I apparently has a role in virulence that allows the gonococci to survive inside of
phagocytes. Purified P.I has been shown to inhibit the ability of phagocytes to kill ingested bacteria.

The lipooligosaccharide (LOS) of the outer membrane is thought to be responsible for most of the
symptoms of gonorrhea. Gonococcal LOS triggers an intense inflammatory response. Subsequent
activation of complement, attraction and feeding by phagocytes, and the lysis of the phagocytes
379
themselves, contributes to the purulent discharge. The local production of TNF, elicited by LOS, is
thought to be the main cause of damage to the fallopian tubes. In addition, in strains that cause systemic
infection, LOS binds sialic acid from the serum forming a microcapsule of sialylated LOS, which
allows the gonococci to resist the host immune response and serum bactericidal reaction.

Nonsialyated LOS and P.I (Por) on the bacterial surface are known to be effective targets for
bactericidal antibodies. However, if antibodies produced against P.III (also known as Rmp) react with
their antigenic site on the gonococcal surface, the effect is to block bactericidal antibodies against LOS
and P.I and to protect the bacterium from complement-mediated lysis.

Finally, Neisseria gonorrhoeae has a well-developed iron acquisition system that permits it to extract
iron from its host during growth, which is necessary to support bacterial invasion. Basically, the
bacterium is able to form two transferrin receptors (Tbp1 and Tbp2) and one lactoferrin receptor
(Lbp) in its outer membrane, which are induced under low-iron conditions, and which are able to
directly extract iron from transferrin and lactoferrin, respectively. The proteins can also extract iron
from heme and hemoglobin.

Table 1. Surface components of N. gonorrhoeae that may play a role in virulence

Designation Location Contribution

PilE major fimbrial protein initial binding to epithelial cells
P.II (Opa) outer membrane protein contributes to invasion
may prevent phagolysosome formation in neutrophils
P.I (Por) outer membrane porin
and/or reduce oxidative burst
outer membrane
LOS elicits inflammatory response, triggers release of TNF
lipooligosaccharide
elicits formation of ineffective antibodies that block that
P.III (Rmp) outer membrane protein
block bactercidal antibodies against P.I and LOS
Tbp1 and outer membrane receptors for
iron acquisition for growth
Tbp2 transferrin
outer membrane receptor for
Lbp iron acquisition for growth
lactoferrin

Host Defenses

Infection stimulates inflammation and a local immune (IgA) response. Inflammation focuses the host
defenses but also becomes the pathology of the disease. It is not known whether the secretory immune
response is protective. Serum antibodies also appear, and IgG and complement may be components of
the inflammatory exudate. But whether the immune defenses provide much protection against
reinfection has not been clearly shown. In any case, immunity is expected to be strain specific so that
reinfection may occur.

Not everyone exposed to N. gonorrhoeae acquires the disease. This may be due to variations in the size
or virulence of the inoculum, to natural resistance, or to specific immunity. A 50% infective dose
(ID50) of about 1,000 bacteria has been determined based on experimental urethral inoculation of male
volunteers. No data is available for females.

380
Nonspecific factors have been implicated in natural resistance to gonococcal infection. In women,
changes in the genital pH and hormones may increase resistance to infection at certain times of the
menstrual cycle. Urine contains bactericidal and bacteriostatic components against N. gonorrhoeae.
Factors in urine that may be important are pH, osmolarity, and the concentration of urea. The
variability in the susceptibility of gonococcal strains to the bactericidal and bacteriostatic properties of
urine is thought to be one of the reasons some males apparently do not develop a gonorrhea infection
when exposed.

Most uninfected individuals have serum antibodies that react with gonococcal antigens. These
antibodies probably result from colonization or infection by various Gram-negative bacteria that
possess cross-reactive antigens. Such "natural antibodies" may be important in individual natural
resistance or susceptibility to infection, but this has not been clearly demonstrated.

Infection with N. gonorrhoeae stimulates both mucosal and systemic antibodies to a variety of
gonococcal antigens. Mucosal antibodies are primarily IgA and IgG. In genital secretions, antibodies
have been identified that react with Por, Opa, Rmp and LOS. Vaccine trials have suggested that
specific anti-fimbrial antibodies inhibit the fimbrial-mediated attachment of the homologous
gonococcal strain. In general, the IgA response is brief and declines rapidly after treatment; IgG levels
decline more slowly. Anti-Por antibodies apparently are bactericidal for the gonococcus. IgG that
reacts with Rmp blocks the bactericidal activity of antibodies directed against Por and LOS. Genital
infection with N. gonorrhoeae stimulates a serum antibody response against the LOS of the infecting
strain. Disseminated gonococcal infection results in much higher levels of anti-LOS antibody than do
genital infections.

Strains that cause uncomplicated genital infections usually are killed by normal human serum and are
termed serum sensitive. This bactericidal activity is mediated by IgM and IgG antibodies that
recognize sites on the LOS. Strains that cause disseminated infections are not killed by most normal
human serum and are referred to as serum resistant. Resistance is mediated, in part, by IgA that
blocks the IgG-mediated bactericidal activity of the serum. Serum from convalescent patients with
disseminating infections contains bactericidal IgG to the LOS of the infecting strain.

Individuals with inherited complement deficiencies have a markedly increased risk of acquiring
systemic neisserial infections and are subject to recurring episodes of systemic gonococcal and
meningococcal infections, indicating that the complement system is important in host defense.
Gonococci activate complement by both the classic and alternative pathways. Complement activation
by gonococci leads to the formation of the C5b-9 complex (membrane attack complex) on the outer
membrane. In normal human serum, similar numbers of C5b-9 complexes are deposited on serum-
sensitive and serum-resistant organisms, but the membrane attack complex is not functional on serum-
resistant organisms.

Treatment

The recommended treatment for uncomplicated infections is a third-generation cephalosporin or a

fluoroquinolone plus an antibiotic (e.g., doxycycline or erythromycin) effective against possible
coinfection with Chlamydia trachomatis. Sex partners should be referred and treated. The current CDC
Treatment Guidelines recommend treatment of all gonococcal infections with antibiotic regimens
effective against resistant strains. The recommended antimicrobial agents are ceftriaxone, cefixime,
ciprofloxacin, or oflaxacin.

Control
381
There is no effective vaccine to prevent gonorrhea. Candidate vaccines consisting of PilE protein or
Por are of little benefit. The development of an effective vaccine has been hampered by the lack of a
suitable animal model and the fact that an effective immune response has never been demonstrated.
Condoms are effective in preventing the transmission of gonorrhea.

The evolution of antimicrobial resistance in N. gonorrhoeae may ultimately affect the control of
gonorrhea. Strains with multiple chromosomal resistance to penicillin, tetracycline, erythromycin, and
cefoxitin have been identified in the United States and most other parts of the world. Sporadic high-
level resistance to spectinomycin and fluoroquinolones has been reported. Penicillinase-producing
strains of N. gonorrhoeae were first described in 1976. Five related -lactamase plasmids of different
sizes have been identified. Their prevalence penicillin-resistant strains has increased dramatically in the
United States since 1984.

Plasmid-mediated resistance of N. gonorrhoeae to tetracycline was first described in 1986 and has now
been reported in most parts of the world. This resistance is due to the presence of the streptococcal
tetM determinant on a gonococcal conjugative plasmid.

Tailpiece

The only natural host for N. gonorrhoeae is humans. Gonorrhea has all but disappeared in Scandinavia
and several other European countries. However, the disease is very common in the United States. CDC
estimates that more than 700,000 persons in the U.S. get new gonorrheal infections each year. Only
about half of these infections are reported to CDC. In 2002, 351,852 cases of gonorrhea were reported
to CDC. In the period from 1975 to 1997, the national gonorrhea rate declined, following the
implementation of the national gonorrhea control program in the mid-1970s. After a small increase in
1998, the gonorrhea rate has decreased slightly since 1999. In 2002, the rate of reported gonorrheal
infections was 125.0 per 100,000 persons.

Gonorrhea is transmitted almost exclusively by sexual contact. Any sexually active person can be
infected with gonorrhea. In the United States, the highest reported rates of infection are among sexually
active teenagers, young adults, and African Americans. Persons who have multiple sex partners are at
highest risk. Rates of gonorrhea are higher in males and in minority and inner-city populations.

Gonorrhea is usually contracted from a sex partner who is either asymptomatic or has only minimal
symptoms. It is estimated that the efficiency of transmission after one exposure is about 35 percent
from an infected woman to an uninfected man and 50 to 60 percent from an infected man to an
uninfected woman. More than 90 percent of men with urethral gonorrhea will develop symptoms
within 5 days; fewer than 50 percent of women with genital gonorrhea will do so. Women with
asymptomatic infections are at higher risk of developing pelvic inflammatory disease and disseminated
gonococcal infection.

Neisseria meningitidis

The bacterium Neisseria meningitidis, the meningococcus, is identical in its staining and
morphological characteristics to Neisseria gonorrhoeae. However, at the ultrastructural level, N.
meningitidis has a prominent antiphagocytic polysaccharide capsule. N. meningitidis strains are
grouped on the basis of their capsular polysaccharides, into 12 serogroups, some of which are
subdivided according to the presence of outer membrane protein and lipopolysaccharide antigens.

382
Neisseria meningitidis is usually cultivated in a peptone-blood base medium in a moist chamber
containing 5-10% CO2. All media must be warmed to 37 degrees prior to inoculation as the organism is
extremely susceptible to temperatures above or below 37 degrees. This trait is rather unique among
bacteria. Also, the organism tends to undergo rapid autolysis after death, both in vitro and in vivo. This
accounts for the dissemination of lipopolysaccharide (endotoxin) during septicemia and meningitis.

The organism tends to colonize the posterior nasopharynx of humans, and humans are the only known
host. Individuals who are colonized are carriers of the pathogen who can transmit disease to
nonimmune individuals. The bacterium also colonizes the posterior nasopharynx in the early stages of
infection prior to invasion of the meninges. Most individuals in close contact with a case of
meningococcal meningitis become carriers of the organism. This carrier rate can reach 20 percent of
the contact group before the first case is recognized, and may reach as high as 80 percent at the height
of an epidemic.

Structure and Classification

The only distinguishing structural feature between N. meningitidis and N. gonorrhoeae is the presence
of a polysaccharide capsule in the former. The capsule is antiphagocytic and is an important virulence
factor.

Meningococcal capsular polysaccharides provide the basis for grouping the organism. Twelve
serogroups have been identified (A, B, C, H, I, K, L, X, Y, Z, 29E, and W135). The most important
serogroups associated with disease in humans are A, B, C, Y, and W135. The chemical composition of
these capsular polysaccharides is known. The prominent outer membrane proteins of N. meningitidis
have been designated class 1 through class 5. The class 2 and 3 proteins function as porins and are
analogous to gonococcal Por. The class 4 and 5 proteins are analogous to gonococcal Rmp and
Opa, respectively. Serogroup B and C meningococci have been further subdivided on the basis of
serotype determinants located on the class 2 and 3 proteins. A handful of serotypes are associated with
most cases of meningococcal disease, whereas other serotypes within the same serogroup rarely cause
disease. All known group A strains have the same protein serotype antigens in the outer membrane.
Another serotyping system exists based on the antigenic diversity of meningococcal LOS.

Meningitis

The term meningitis refers to inflammation the meninges of the brain or spinaL cord. Meninges are any
of the three membranes that envelope the brain and spinal cord. The disease meningitis is caused by a
number of different bacteria and viruses. Bacterial causes include Haemophilus influenzae, Escherichia
coli, Streptococcus pneumoniae,Streptococcus pyogenes, Staphylococcus aureus, and Neisseria
meningitidis. Although a variety of cocci cause meningitis, the term meningococcus is reserved for the
Gram-negative, bean-shaped diplococcus, Neisseria meningitidis. Like its relative N. gonorrhoeae, the
organism tends to occur intracellularly in the cytoplasm of neutrophils which are attracted to the site of
inflammation in the mininges, so this type of infection is called pyogenic (pus-forming).

Marchiafava and Celli were the first to report observing Gram-negative diplococci in cerebrospinal
fluid of a fatal case of meningitis in 1884. In 1887, Weichselbaum isolated the bacterium from six
cases of meningitis and established the isolates as a distinct species and proven to be the cause of
meningitis.

Pathogenesis

383
Infection with N. meningitidis has two presentations, meningococcemia, characterized by skin lesions,
and acute bacterial meningitis. The fulminant form of disease (with or without meningitis) is
characterized by multisystem involvement and high mortality.

Infection is by aspiration of infective bacteria, which attach to epithelial cells of the nasopharyngeal
and oropharyngeal mucosa, cross the mucosal barrier, and enter the bloodstream. If not clear whether
blood-borne bacteria may enter the central nervous system and cause meningitis.

The mildest form of disease is a transient bacteremic illness characterized by a fever and malaise;
symptoms resolve spontaneously in 1 to 2 days. The most serious form is the fulminant form of disease
complicated by meningitis. The manifestations of meningococcal meningitis are similar to acute
bacterial meningitis caused by other bacteria such as Streptococcus pneumoniae, Haemophilus
influenzae, and E. coli. Chills, fever, malaise, and headache are the usual manifestations of
infection. Signs of meningeal inflammation are also present.

Clinical manifestations of N. meningitidis infection

The onset of meningococcal meningitis may be abrupt or insidious. Infants with meningococcal
meningitis rarely display signs of meningeal irritation. Irritability and refusal to take food are typical;
vomiting occurs early in the disease and may lead to dehydration. Fever is typically absent in children
younger than 2 months of age. Hypothermia is more common in neonates. As the disease progresses,
apnea, seizures, disturbances in motor tone, and coma may develop.

In older children and adults, specific symptoms and signs are usually present, with fever and altered
mental status the most consistent findings. Headache is an early, prominent complaint and is usually
very severe. Nausea, vomiting, and photophobia are also common symptoms.

Neurologic signs are common; approximately one-third of patients have convulsions or coma when
first seen by a physician. Signs of meningeal irritation such as spinal rigidity, hamstring spasms and
exaggerated reflexes are common.

Petechiae (minute hemorrhagic spots in the skin) or purpura (hemorrhages into the skin) occurs from
the first to the third day of illness in 30 to 60% of patients with meningococcal disease, with or without
meningitis. The lesions may be more prominent in areas of the skin subjected to pressure, such as the
axillary folds, the belt line, or the back.

Fulminant meningococcemia occurs in 5 to 15% of patients with meningococcal disease and has a high
mortality rate. It begins abruptly with sudden high fever, chills, myalgias, weakness, nausea, vomiting,
and headache. Apprehension, restlessness, and delirium occur within the next few hours. Widespread
purpuric and ecchymotic skin lesions appear suddenly. Typically, no signs of meningitis are present.
Pulmonary insufficiency develops within a few hours, and many patients die within 24 hours of being
hospitalized despite appropriate antibiotic therapy and intensive care.

384
Figure 4. The characteristic skin rash (purpura) of meningococcal septicemia, caused by Neisseria meningitidis

Virulence Factors

For a time, the virulence of Neisseria meningitidis was attributed to the production of an "exotoxin"
that could be recovered from culture filtrates of the organism. But when studies revealed that antitoxin
reacted equally well with washed cells as culture filtrate, it was realized that the bacteria underwent
autolysis during growth and released parts of their cell walls in a soluble form. Hence, the major toxin
of N. meningitidis is its lipooligosaccharide,LOS, and its mechanism is endotoxic. The other
important determinant of virulence of N. meningitidis is its antiphagocytic polysaccharide capsule.

The human nasopharynx is the only known reservoir of N. meningitidis. Meningococci are spread via
respiratory droplets, and transmission requires aspiration of infective particles. Meningococci attach to
the nonciliated columnar epithelial cells of the nasopharynx. Attachment is mediated by fimbriae and
possibly by other outer membrane components. Invasion of the mucosal cells occurs by a mechanism
similar to that observed with gonococci. Events involved after bloodstream invasion are unclear and
how the meningococcus enters the central nervous system is not known.

Purified meningococcal LOS is highly toxic and is as lethal for mice as the LOS from E. coli or
Salmonella typhimurium; however, meningococcal LOS is 5 to 10 times more effective than enteric
LPS in eliciting a dermal Shwartzman phenomenon (a characteristic type of inflammatory reaction) in
rabbits. Meningococcal LOS has been shown to suppress leukotriene B4 synthesis in human
polymorphonuclear leukocytes. The loss of leukotriene B4 deprives the leukocytes of a strong
chemokinetic and chemotactic factor.

Host Defenses

N. mengingitidis establishes systemic infections only in individuals who lack serum bacterial antibodies
directed against the capsular or noncapsular (cell wall) antigens of the invading strain, or in patients
deficient in the late-acting complement components.

The integrity of the pharyngeal and respiratory epithelium appears to be important in protection from
invasive disease. Chronic irritation of the mucosa due to dust or low humidity, or damage to the
mucosa resulting from a concurrent upper respiratory infection, may be predisposing factors for
invasive disease.
385
The presence of serum bactericidal IgG and IgM is probably the most important host factor in
preventing invasive disease. These antibodies are directed against both capsular and noncapsular
surface antigens. The antibodies are produced in response to colonization with carrier strains of N.
meningitidis, as well as N. lactamica, and other nonpathogenic Neisseria species that are normal
inhabitants of the upper respiratory tract. Protective antibodies are also stimulated by cross-reacting
antigens on other bacterial species such as Escherichia coli. The role of bactericidal antibodies in
prevention of invasive disease explains why high attack rates are seen in infants from 6 to 9 months
old, the time at which maternal antibodies are being lost. Individuals with complement deficiencies
(C5, C6, C7, or C8) may develop meningococcemia despite protective antibody. This emphasizes the
importance of the complement system in defense against meningococcal disease.

Epidemiology

The meningococcus usually inhabits the human nasopharynx without causing detectable disease. This
carrier state may last for a few days to months and is important because it not only provides a reservoir
for meningococcal infection but also stimulates host immunity. Between 5 and 30% of normal
individuals are carriers at any given time, yet few develop meningococcal disease. Carriage rates are
highest in older children and young adults. Attack rates highest in infants 3 months to 1 year old.
Meningococcal meningitis occurs both sporadically (mainly groups B and C meningococci) and in
epidemics (mainly group A meningococci), with the highest incidence during late winter and early
spring. Whenever group A strains become prevalent in the population, the incidence of meningitis
increases markedly.

Treatment

Penicillin is the drug of choice to treat meningococcemia and meningococcal meningitis. Although
penicillin does not penetrate the normal blood-brain barrier, it readily penetrates the blood-brain barrier
when the meninges are acutely inflamed. Either chloramphenicol or a third-generation cephalosporin
such as cefotaxime or ceftriaxone is used in persons allergic to penicillins.

Meningococcal disease is contracted through association with infected individuals, as evidenced by the
500- to 800-fold greater attack rate among household contacts than among the general population.
Because such household members are at high risk, they require chemoprophylaxis. Sulfonamides were
the chemoprophylactic agent of choice until the emergence of sulfonamide-resistant meningococci. At
present, approximately 25 percent of clinical isolates of N. meningitidis in the United States are
resistant to sulfonamides; nowadays, rifampin is the chemoprophylactic agent of choice.

Control

Groups A, C, AC, and ACYW135 capsular polysaccharide vaccines are available. However, the
polysaccharide vaccines are ineffective in young children (in children under 1 year old, antibody levels
decline rapidly after immunization) and the duration of protection is limited in children vaccinated at 1
to 4 years of age. Routine vaccination is not currently recommended because the risk of infection is
low. The group B capsular polysaccharide is a homopolymer of sialic acid and is not immunogenic in
humans. A group B meningococcal vaccine consisting of outer membrane protein antigens has recently
been developed, but is not licensed in the United States.

Tailpiece

Search for a universal vaccine for meningococcal meningitis

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There is an obvious need for a universal vaccine for meningococcal meningitis, but the development of
an effective vaccine against all forms of N. meningitidis has been hampered by the high degree of
variation in the proteins on the surface of the bacterium which leads to the occurrence of many
different antigenic types.

More than 10% of the population may be carrying the bacterium at any one time on the mucosal
surfaces of the nose and throat. The majority of these carriers will not have any symptoms of the
disease, but this continual exposure to the immune system puts pressure on the bacterium to mutate its
surface components in order to survive. Thus, natural selection is the driving force for the emergence of
new antigenic variants.

Among the class 2 and 3 outer membrane proteins of N. meningitidis, Por A has been considered a
primary target for a vaccine-induced antibody. PorA is a major component of the outer membrane of
N. meningitidis, and anti-PorA antibodies are thought to be a critical component in
immunity. Interactions between antibodies and PorA have been studied. Different strains of the
bacterium have different PorA amino acid sequences within the region of the protein that specifically
binds to antibody molecules. PorA has several large amino acid "loop" regions that protrude from the
surface, and it is these loops that are targets for antibody binding.

In the laboratory, the antigen-binding fragment (Fab) of anti-PorA antibodies can be crystallized and
reacted with the antigenic loop regions of PorA in order to determine the specificity of binding
between antigen and antibody. Slight changes in PorA amino acid sequence have been shown to cause
loss in the ability to bind to antibody molecules. In nature, the bacterium mutates to insert new amino
acid residues into the tip of the loop, which alters or eliminates many of the interactions with antibody
and allows the bacterium to bypass previous immune responses.

Figure 5. Image of the antibody (Fab) molecular surface, with the PorA antigen superimposed. The dark colored
groove on the surface of the antibody matches precisely the shape of the PorA antigen; hence any changes in the
sequence of PorA in this region can disrupt antibody binding. Jeremy Derrick, UMIST. SRS ANNUAL REPORT
1999-2000

Hence, by introducing changes into portions of the PorA protein that are exposed at the surface, the
bacterium can evade the attention of the immune system. These alterations are apparently introduced
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without compromising the biological function of PorA, as a pore-forming protein. Designing vaccines
that are able to take into account these changes is a huge challenge, but as more information of this type
becomes known, it leads to a more rational approach to design of a universal vaccine for
meningococcal meningitis.

Todar's Online Textbook of Bacteriology

Haemophilus influenzae
© 2004 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

Introduction

Haemophilus influenzae is a small, nonmotile Gram-negative bacterium in the family

Pasteurellaceae, on the level with the Vibrionaceae and the Enterobacteriaceae. The family also
includes Pasteurella and Actinobacillus, two other genera of bacteria that are parasites of
animals. Encapsulated strains of Haemophilus influenzae isolated from cerebrospinal fluid are
coccobacilli, 0.2 to 0.3 to 0.5 to 0.8 um, similar in morphology to Bordetella pertussis, the agent of
whooping cough. Non encapsulated organisms from sputum are pleomorphic and often exhibit long
threads and filaments. The organism may appear Gram-positive unless the Gram stain procedure is
very carefully carried out. Furthermore, elongated forms from sputum may exhibit bipolar staining,
leading to an erroneous diagnosis of Streptococcus pneumoniae.

Figure 1. Gram stain of Haemophilus influenzae from sputum

H. influenzae is highly adapted to its human host. It is present in the nasopharynx of approximately 75
percent of healthy children and adults. It is rarely encountered in the oral cavity and it has not been
detected in any other animal species. It is usually the non encapsulated strains that are harbored as
normal flora, but a minority of healthy individuals (3-7 percent) intermittently harbor H. influenzae
type b (Hib) encapsulated strains in the upper respiratory tract. Pharyngeal carriage of Hib is important
in the transmission of the bacterium. The success of current vaccination programs against Hib is due in
part to the effect of vaccination on decreasing carriage of the organism.

What's in a name?

Haemophilus influenzae is widespread in its distribution among the human population. It was first
isolated by Pfeiffer during the influenza pandemic of 1890. It was mistakenly thought to be the cause of
the disease influenza, and it was named accordingly. Probably, H. influenzae was an important
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secondary invader to the influenza virus in the 1890 pandemic, as it has been during many subsequent
influenza epidemics. In pigs, a synergistic association between swine influenza virus and Haemophilus.
suis is necessary for swine influenza. Similar situations between human influenza virus and H.
influenzae have been observed in chick embryos and infant rats.

Haemophilus "loves heme", more specifically it requires a precursor of heme in order to grow.
Nutritionally, H.aemophilus influenzae prefers a complex medium and requires preformed growth
factors that are present in blood, specifically X factor (i.e., hemin) and V factor (NAD or NADP). In
the laboratory it is usually grown on chocolate blood agar which is prepared by adding blood to an agar
base at 80 degrees. The heat releases X and V factors from the RBCs and turns the medium a chocolate
brown color. The bacterium grows best at 35-37 degrees and has an optimal pH of 7.6. Haemophilus
influenzaeis generally grown in the laboratory under aerobic conditions or under slight CO2 tension
(5% CO2), although it is capable of glycolytic growth and of respiratory growth using nitrate as a final
electron acceptor.

In 1995, Haemophilus influenzae was the first free-living organism to have its entire chromosome
sequenced, sneaking in just ahead of Escherichia coliin that race, mainly because its genome is smaller
in size than E. coli's. For a relatively obscure bacterium, there was already a good understanding of its
genetic processes, especially transformation.

Figure 2. A map of the circular chromosome of Haemophilus influenzae illustrating the location of known genes and
predicted coding regions

Observations of genetic transformation in Haemophilus have included drug resistance and synthesis of
specific capsular antigens. The latter is thought to be the main determinant of H. influenzae.

Transformation in Haemophilus influenzaeoccurs by several different mechanisms and is more efficient

than in enteric bacteria. When developing competence, the bacterium develops membranous "blebs" in
the outer membrane that contain a specific DNA-binding protein. This outer membrane protein
recognizes a specific 11-base pair sequence of DNA nucleotides that appears in Haemophilus DNA
with much higher frequency than in other genera of bacteria. There is some evidence that Haemophilus
is able to undergo both interspecies and intraspecies transformation in vivo (in host tissues). The

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restriction endonucleases from Haemophilus, e.g. Hind III, are widely used in biotechnology and in
the analysis and cloning of DNA.

Pathogenesis

The pathogenesis of H. influenzae infections is not completely understood, although the presence of the
type b polysaccharide capsule is known to be the major factor in virulence. Encapsulated organisms
can penetrate the epithelium of the nasopharynx and invade the blood capillaries directly. Their capsule
allows them to resist phagocytosis and complement-mediated lysis in the the nonimmune host.
Nontypable (non encapsulated) strains are less invasive, but they are apparently able to induce an
inflammatory response that causes disease. Outbreaks of H. influenzae type b infection may occur in
nurseries and child care centers, and prophylactic administration of antibiotics is warranted.
Vaccination with type b polysaccharide (in the form of Hib conjgate vaccines) is effective in
preventing infection, and several vaccines are now available for routine use.

Naturally-acquired disease caused by H. influenzae seems to occur in humans only. In infants and
young children (under 5 years of age), H. influenzae type b causes bacteremia and acute bacterial
meningitis. Occasionally, it causes epiglottitis (obstructive laryngitis), cellulitis, osteomyelitis, and
joint infections. Nontypable H. influenzae causes ear infections (otitis media) and sinusitis in
children, and is associated with respiratory tract infections (pneumonia) in infants, children and
adults.

Figure 3. Tissues infected by type b and nontypable strains of Haemophilus influenzae

Seven serotypes of the bacterium have been identified on the basis of capsular polysaccharides. Until
the implementation of widespread vaccination programs, type b H. influenzae was the most common
cause of meningitis in children between the ages of 6 months and 2 years (see Figure 4 below),
resulting in 12,000 to 20,000 cases annually in the U.S. It would be interesting to view comparative
data since the era of vaccination against H. influenzae meningitis, which began in 1985. Certainly,
there are fewer than 100 cases annually of bacterial meningitis caused by H. influenzae type b.

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Figure 4. Age-specific incidence of bacterial meningitis caused by Haemophilus influenzae, Neisseria meningitidis and
Streptococcus pneumoniae prior to 1985

Disease caused by H. influenzae usually begins in the upper respiratory tract as nasopharyngitis and
may be followed by sinusitis and otitis, possibly leading to pneumonia. In severe cases, bacteremia
may occur which frequently results in joint infections or meningitis.

Virulence

H. influenzae does not produce any demonstrable exotoxins The direct role of endotoxin in meningitis
or bacteremia is unclear, although the Gram-negative bacterium's outer membrane lipooligosaccharide
is thought to play a role in inflammation associated with otitis media. All virulent strains produce
neuraminidase and an IgA protease, but the role of these extracellular enzymes in invasion is
unproven. Fimbriae increase the adherence of bacteria to human mucosal cells in vitro, and they are
required for successful colonization of the nasopharynx. The Anton antigen, as defined in red blood
cells, appears to be the receptor.

Virulence, at least in the case of bacteremia and meningitis, is directly related to capsule formation.
Virtually all of these infections are caused by the type b serotype, and its capsular polysaccharide,
containing ribose, ribitol and phosphate, is the proven determinant of virulence. The capsule material is
antiphagocytic, and it is ineffective in inducing the alternative complement pathway, so that the
bacterium can invade the blood or cerebrospinal fluid without attracting phagocytes or provoking an
inflammatory response and complement-mediated bacteriolysis. For this reason, anticapsular antibody,
which promotes both phagocytosis and bacteriolysis, is the main factor in immune defense against H.
influenzae infections (below).

The polyribosyl ribitol phosphate (PRP) capsule is the most important virulence factor because it
renders type b H. influenzae resistant to phagocytosis by polymorphonuclear leukocytes in the absence
of specific anticapsular antibody, and it reduces the bacterum's susceptibility to the bactericidal effect
of serum. However, susceptibility to the bactericidal effect of serum depends on the presence of
antibodies to a number of other antigenic sites, including the lipooligosaccharide and outer
membrane proteins designated as P1 and P2.

Type b H. influenzae is plainly the most virulent of the Haemophilus species; 95 percent of
bloodstream and meningeal Haemophilus infections in children are due to this bacterium. In contrast, in
adults, nontypable strains of H. influenzae are the most common cause of Haemophilus infection,
presumably because most adults have naturally acquired antibody to PRP.

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Immunity

The age incidence of H. influenzae meningitis is inversely proportional to the titer of bactericidal
antibody in the blood, whether passively acquired from the mother or actively formed (see Figure 5
below). Without artificial immunization, in children aged 2 months to 3 years, antibody levels are
minimal; thereafter antibody levels increase and the disease becomes much less common. From this
curve, it is obvious that artificial active immunization should begin at 2 months of age, when nearly all
passive immunity has waned, and the child enters a vulnerable non immune period of life.

Figure 5. Relation of the age incidence of bacterial meningitis caused by Haemophilus influenzae to bactericidal
antibody titers in the blood (data pre 1985)

H. influenzae is susceptible to lysis by antibody and complement. Furthermore, anticapsular antibodies

promote phagocytosis, as well as bacteriolysis. Thus, serum antibody, complement, lysozyme and
phagocytes can work in concert during a bacteremia. During meningitis, phagocytosis is probably the
main host defense mechanism since complement rarely occurs in the cerebrospinal fluid.

For many years it was believed that bactericidal antibody directed against PRP capsule ofH. influenzae
type b was entirely responsible for host resistance to infection. However, some recent studies have
stressed a role for antibody to somatic (cell wall) antigens as well. For example, antibody to PRP can
often be detected in the sera of children on admission to the hospital with sepsis due to H. influenzae
type b. Adsorption of immune serum with PRP alone does not remove its protective capabilities,
whereas adsorption with whole organisms does. Separation of the outer membrane of type b H.
influenzae into its many protein constituents reveals several individual membrane proteins that may be
associated with immunity. Bactericidal antibodies that react with individual outer membrane proteins
or with lipooligosaccharide constituents have been identified. These findings support indicate the
potential importance of antibody to noncapsular antigens in immunity to H. influenzae type b infection.
In addition, opsonizing antibodies, which also play a role in protection, may be directed against PRP or
somatic constituents (see Figure 6 below).

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Figure 6. Phagocytic engulfment of H. influenzae bacterium opsonized by antibodies specific for the capsule and
somatic (cell wall) antigen

Recent studies of nontypable H. influenzae have shown that bactericidal antibody to outer membrane
proteins develop in infants in response to otitis media caused by the organism. Normal adults generally
have both bactericidal and opsonizing antibodies directed against nontypable H. influenzae.

Treatment and Prevention

Virtually all patients treated early in the course of H. influenzae meningitis are cured. The mortality
rate of treated infections is less than 10 percent, but nearly 30 percent of the children who recover have
residual neurologic effects. Ampicillin has been the drug of choice, but presently over 20 percent of all
strains of H. influenzae are resistant to ampicillin because of plasmid-mediated -lactamase production.

The recommended treatment for H. influenzae meningitis is ampicillin for strains of the bacterium that
do not make -lactamase, and a third-generation cephalosporin or chloramphenicol for strains that do.
Amoxicillin, together with a substance such as clavulanic acid, that blocks the activity of -lactamase,
has been unreliable in treatment of meningitis, although it is effective in treatment of sinusitis, otitis
media and respiratory infections. Chloramphenicol was long considered the drug of choice for
meningitis caused by penicillin-resistant H. influenzae, and it is still highly effective, but not without
potential toxic side effects. Third-generation cephalosporins, such as ceftriaxone or cefotaxime, are
effective against H. influenzae and penetrate the meninges well. Tetracyclines and sulfa drugs remain
effective in treating sinusitis or respiratory infection caused by nontypable H. influenzae. Amoxicillin
plus clavulanic acid (Augmentin) is effective against -lactamase producing strains. Erythromycin is
ineffective in treatment ofH. influenzae infections.

The use of polyribosyl ribitol phosphate (PRP) vaccine and, more recently, protein-conjugated PRP,
has vastly reduced the frequency of infection due to type b H. influenzae. The PRP vaccine consists of
the type b capsular polysaccharide. Like most bacterial polysaccharides, it elicits a strong primary
antibody response, but with little induction of memory. H. influenzae type b Hib conjugate vaccines,
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which couple the polysaccharide to a protein, induce memory type antibody responses in children and
are effective in younger infants who are at higher risk for the disease.

There are several types of Hib conjugate vaccines available for use. All of the vaccines are approved
for use in children 15 months of age and older and some are approved for use in children beginning at 2
months of age. All of the vaccines are considered effective. The vaccines are given by injections. More
than 90% of infants obtain long term immunity with 2-3 doses of the vaccine.

All children should have a vaccine approved for infants beginning at 2 months. Depending on the type
used, the recommended schedule for infants will vary. All unvaccinated children 15 - 59 months old
should receive a single dose of conjugate vaccine. Children 60 months of age or older and adults
normally do not need to be immunized.

Whether the vaccine provides protection against ear infections is not known. It also does not protect
against diseases caused by other types of Haemophilus. nor does it protect against meningitis caused by
other types of bacteria.

Specific characteristics of the four conjugate vaccines available for infants and children vary based on
the type of protein carrier, the size of the polysaccharide, and the chemical linkage between the
polysaccharide and carrier (see Table 1 below).

Current recommendations for vaccination of infants require parenteral administration of three different
vaccines, diphtheria-tetanus-pertussis (DTP), Hib conjugate, and hepatitis B, during two or three
different visits to a health-care provider. TETRAMUNE (see table footnote below) is the first licensed
combination vaccine that provides protection against diphtheria, tetanus, pertussis, and Hib disease.

Table 1. Hib conjugate vaccines licensed for use among children

Trade name
Vaccine Polysaccharide Linkage Protein carrier
(manufacturer)
ProHIBiT
PRP-D Medium 6-carbon Diphtheria toxoid
(Connaught)
HibTITER CRM197 mutant Corynebacterium
HbOC* Small None
(Lederle-Praxis) diphtheriae toxin protein
PedvaxHIB
PRP- Neisseria meningitidis outer membrane
(Merck Sharp and Medium Thioether
OMP protein complex
Dohme)
ActHIB
OmniHIB
PRP-T Large 6-carbon Tetanus toxoid
(Pasteur Merieux
Vaccins)

* TETRAMUNE consists of HbOC and DTP vaccine (TRI-IMMUNOL), also manufactured by

Lederle-Praxis.

Tailpiece
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Before 1985, Haemophilus influenzae type b (Hib) was the most common cause of bacterial meningitis
in children under 5 years of age (approximately 12,000 cases per year, most in children younger than
18 months). Approximately 5% of affected children died, and neurologic sequelae developed in 15% to
30% of the surviving children. An additional estimated 7,500 cases of other invasive Hib infections
also occurred annually in young children. The cumulative risk for Hib invasive disease before the age
of 5 was one in 200 children, similar to the risk for poliomyelitis during the 1950s.

In 1985, the first Hib polysaccharide vaccines were licensed for use in the United States. These
vaccines contained purified polyribosylribitol phosphate (PRP) capsular material from the type b
serovar. Antibody against PRP was shown to be the primary component of serum bactericidal activity
against the organism. PRP vaccines were ineffective in children less than 18 months of age because of
the T-cell-independent nature of the immune response to PRP polysaccharide.

Conjugation of the PRP polysaccharide with protein carriers confers T-cell-dependent characteristics to
the vaccine and substantially enhances the immunologic response to the PRP antigen. In 1989, the first
Hib conjugate vaccines were licensed for use among children 15 months of age or older. In 1990, two
new vaccines were approved for use among infants.

The incidence of Hib invasive disease among children aged 4 years or younger has declined by 98%
since the introduction of Hib conjugate vaccines. One goal of the Childhood Immunization Initiative
was to eliminate invasive Hib disease among children aged 4 years or younger by 1996. However,
approximately 300 cases of Haemophilus influenzae invasive disease per year continue to be reported
in the U.S., mainly in non immunized children. Most cases are caused by nontypable Haemophilus
influenzae. The bar graph below (Figure 7) shows the age distribution of cases in 1996 and is
comparable to Figure 5, which displays results from the pre-imuunization era.

Figure 7. Age-specific incidence of bacterial meningitis in children caused by Haemophilus influenzae in 1996

395
 Todar's Online Textbook of Bacteriology

Pseudomonas aeruginosa
© 2004 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

Gram stain of Pseudomonas aeruginosa cells

Pseudomonas aeruginosa is the epitome of an 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. The family includes other genera, which, together with certain other organisms,
constitute the bacteria informally known as pseudomonads. These bacteria are common inhabitants of
soil and water. They occur regularly on the surfaces of plants and occassionally on the surfaces of
animals. The pseudomonads are well known to plant microbiologists because they are one of the few
groups of bacteria that are true pathogens of plants. In fact, Pseudomonas aeruginosa is occasionally a
pathogen of plants. But Pseudomonas aeruginosa and two former Pseudomonas species (now
reclassified as Burkholderia) are pathogens of humans. A general treatment of the pseudomonads is
presented in The Genus Pseudomonas . This chapter deals specifically with Pseudomonas aeruginosa
as a pathogen of humans.

Pseudomonas aeruginosa is an opportunistic pathogen, meaning that it exploits some break in the
host defenses to initiate an infection. It causes urinary tract infections, respiratory system
infections, dermatitis, soft tissue infections, bacteremia, bone and joint infections, gastrointestinal
infections and a variety of systemic infections, particularly in patients with severe burns and in cancer
and AIDS patients who are immunosuppressed. Pseudomonas aeruginosa infection is a serious

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problem in patients hospitalized with cancer, cystic fibrosis, and burns. The case fatality rate in these
patients is 50 percent.

Pseudomonas aeruginosa is primarily a nosocomial pathogen. According to the CDC, the overall
incidence of P. aeruginosa infections in US hospitals averages about 0.4 percent (4 per 1000
discharges), and the bacterium is the fourth most commonly-isolated nosocomial pathogen accounting
for 10.1 percent of all hospital-acquired infections.

Characteristics

Pseudomonas aeruginosa is a Gram-negative rod measuring 0.5 to 0.8 µm by 1.5 to 3.0 µm. Almost all
strains are motile by means of a single polar flagellum.

The bacterium is ubiquitous in soil and water, and on surfaces in contact with soil or water. Its
metabolism is respiratory and never fermentative, but it will grow in the absence of O2 if NO3 is
available as a respiratory electron acceptor.

The typical Pseudomonas bacterium in nature might be found in a biofilm, attached to some surface or
substrate, or in a planktonic form, as a unicellular organism, actively swimming by means of its
flagellum. Pseudomonas is one of the most vigorous, fast-swimming bacteria seen in hay infusions and
pond water samples.

In its natural habitat Pseudomonas aeruginosa is not particularly distinctive as a pseudomonad, but it
does have a combination of physiological traits that are noteworthy and may relate to its pathogenesis.

--Pseudomonas aeruginosa has very simple nutritional requirements. It is often observed "growing in
distilled water" which is evidence of its minimal nutritional needs. In the laboratory, the simplest
medium for growth of Pseudomonas aeruginosa consists of acetate for carbon and ammonium sulfate
for nitrogen.

--P. aeruginosa possesses the metabolic versatility for which pseudomonads are so renowned. Organic
growth factors are not required, and it can use more than seventy-five organic compounds for growth.

--Its optimum temperature for growth is 37 degrees, and it is able to grow at temperatures as high as 42
degrees.

--It is tolerant to a wide variety of physical conditions, including temperature. It is resistant to high
concentrations of salts and dyes, weak antiseptics, and many commonly used antibiotics.

--Pseudomonas aeruginosa has a predilection for growth in moist environments, which is probably a
reflection of its natural existence in soil and water.

These natural properties of the bacterium undoubtedly contribute to its ecological success as an
opportunistic pathogen. They also help explain the ubiquitous nature of the organism and its
prominance as a nosocomial pathogen.

P. aeruginosa isolates may produce three colony types. Natural isolates from soil or water typically
produce a small, rough colony. Clinical samples, in general, yield one or another of two smooth colony
types. One type has a fried-egg appearance which is large, smooth, with flat edges and an elevated
appearance. Another type, frequently obtained from respiratory and urinary tract secretions, has a
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mucoid appearance, which is attributed to the production of alginate slime. The smooth and mucoid
colonies are presumed to play a role in colonization and virulence.

Pseudomonas aeruginosa colonies on agar

P. aeruginosa strains produce two types of soluble pigments, the fluorescent pigment pyoverdin and
the blue pigment pyocyanin. The latter is produced abundantly in media of low-iron content and
functions in iron metabolism in the bacterium. Pyocyanin (from "pyocyaneus") refers to "blue pus"
which is a characteristic of suppurative infections caused by Pseudomonas aeruginosa.

The soluble blue pigment pyocyanin is produced by many,

but not all, strains of Pseudomonas aeruginosa

Pseudomonas aeruginosa is notorious for its resistance to antibiotics and is, therefore, a particularly
dangerous and dreaded pathogen. The bacterium is naturally resistant to many antibiotics due to the
permeabiliity barrier afforded by its outer membrane LPS. Also, its tendency to colonize surfaces in a
biofilm form makes the cells impervious to therapeutic concentrations antibiotics. Since its natural
habitat is the soil, living in association with the bacilli, actinomycetes and molds, it has developed
resistance to a variety of their naturally-occuring antibiotics. Moreover, Pseudomonas maintains
antibiotic resistance plasmids, both R-factors and RTFs, and it is able to transfer these genes my
means of the bacterial processes of transduction and conjugation.

Only a few antibiotics are effective against Pseudomonas, including fluoroquinolones, gentamicin and
imipenem, and even these antibiotics are not effective against all strains. The futility of treating
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Pseudomonas infections with antibiotics is most dramatically illustrated in cystic fibrosis patients,
virtually all of whom eventually become infected with a strain that is so resistant that it cannot be
treated.

Diagnosis

Diagnosis of P. aeruginosa infection depends upon isolation and laboratory identification of the
bacterium . It grows well on most laboratory media and commonly is isolated on blood agar or eosin-
methylthionine blue agar. It is identified on the basis of its Gram morphology, inability to ferment
lactose, a positive oxidase reaction, its fruity odor, and its ability to grow at 42° C . Fluorescence under
ultraviolet light is helpful in early identification of P. aeruginosa colonies. Fluorescence is also used to
suggest the presence of P. aeruginosa in wounds.

Pathogenesis

For an opportunistic pathogen such as Pseudomonas aeruginosa, the disease process begins with some
alteration or circumvention of normal host defenses. The pathogenesis of Pseudomonas infections is
multifactorial, as suggested by the number and wide array of virulence determinants possessed by the
bacterium. Multiple and diverse determinants of virulence are expected in the wide range of diseases
caused, which include septicemia, urinary tract infections, pneumonia, chronic lung infections,
endocarditis, dermatitis, and osteochondritis.

Most Pseudomonas infections are both invasive and toxinogenic. The ultimate Pseudomonas infection
may be seen as composed of three distinct stages: (1) bacterial attachment and colonization; (2) local
invasion; (3) disseminated systemic disease. However, the disease process may stop at any stage.
Particular bacterial determinants of virulence mediate each of these stages and are ultimately
responsible for the characteristic syndromes that accompany the disease.

Colonization

Although colonization usually precedes infections by Pseudomonas aeruginosa, the exact source and
mode of transmission of the pathogen are often unclear because of its ubiquitous presence in the
environment. It is sometimes present as part of the normal flora of humans, although the prevalence of
colonization of healthy individuals outside the hospital is relatively low (estimates range from 0 to 24
percent depending on the anatomical locale).

The fimbriae of Pseudomonas will adhere to the epithelial cells of the upper respiratory tract and, by
inference, to other epithelial cells as well. These adhesins appear to bind to specific galactose or
mannose or sialic acid receptors on epithelial cells. Colonization of the respiratory tract by
Pseudomonas requires fimbrial adherence and may be aided by production of a protease enzyme that
degrades fibronectin in order to expose the underlying fimbrial receptors on the epithelial cell surface.
Tissue injury may also play a role in colonization of the respiratory tract since P. aeruginosa will
adhere to tracheal epithelial cells of mice infected with Influenza virus but not to normal tracheal
epithelium. This has been called opportunistic adherence, and it may be an important step in
Pseudomonas keratitis and urinary tract infections, as well as infections of the respiratory tract.

The receptor on tracheal epithelial cells for Pseudomonas pili is probably sialic acid (N-
acetylneuraminic acid). Mucoid strains, which produce an exopolysaccharide (alginate) have an
additional or alternative adhesin which attaches to the tracheobronchial mucin (N-acetylglucosamine).
Besides pili and the mucoid polysaccharide, there are possibly two other cell surface adhesins utilized
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by Pseudomonas to colonize the respiratory epithelium or mucin. Also, it is likely that surface-bound
exoenzyme S could serve as an adhesin for glycolipids on respiratory cells.

The mucoid exopolysaccharide produced by P. aeruginosa is a repeating polymer of mannuronic and

glucuronic acid referred to as alginate. Alginate slime forms the matrix of the Pseudomonas biofilm
which anchors the cells to their environment and, in medical situations, it protects the bacteria from the
host defenses such as lymphocytes, phagocytes, the ciliary action of the respiratory tract, antibodies
and complement. Biofilm mucoid strains of P. aeruginosa are also less susceptible to antibiotics than
their planktonic counterparts. Mucoid strains of P. aeruginosa are most often isolated from patients
with cystic fibrosis and they are usually found in post mortem lung tissues from such individuals.

Invasion

The ability of Pseudomonas aeruginosa to invade tissues depends upon production of extracellular
enzymes and toxins that break down physical barriers and damage host cells, as well as resistance to
phagocytosis and the host immune defenses. As mentioned above, the bacterial capsule or slime layer
effectively protects cells from opsonization by antibodies, complement deposition, and phagocyte
engulfment.

Two extracellular proteases have been associated with virulence that exert their activity at the invasive
stage: elastase and alkaline protease. Elastase has several activities that relate to virulence. The
enzyme cleaves collagen, IgG, IgA, and complement. It also lyses fibronectin to expose receptors for
bacterial attachment on the mucosa of the lung. Elastase disrupts the respiratory epithelium and
interferes with ciliary function. Alkaline protease interferes with fibrin formation and will lyse fibrin.
Together, elastase and alkaline protease destroy the ground substance of the cornea and other
supporting structures composed of fibrin and elastin. Elastase and alkaline protease together are also
reported to cause the inactivation of gamma Interferon (IFN) and Tumor Necrosis Factor (TNF).

P. aeruginosa produces three other soluble proteins involved in invasion: a cytotoxin (mw 25 kDa) and
two hemolysins. The cytotoxin is a pore-forming protein. It was originally named leukocidin because
of its effect on neutrophils, but it appears to be cytotoxic for most eukaryotic cells. Of the two
hemolysins, one is a phospholipase and the other is a lecithinase. They appear to act synergistically to
break down lipids and lecithin. The cytotoxin and hemolysins contribute to invasion through their
cytotoxic effects on eukaryotic cells.

One Pseudomonas pigment is probably a determinant of virulence for the pathogen. The blue pigment,
pyocyanin, impairs the normal function of human nasal cilia, disrupts the respiratory epithelium, and
exerts a proinflammatory effect on phagocytes. A derivative of pyocyanin, pyochelin, is a siderophore
that is produced under low-iron conditions to sequester iron from the environment for growth of the
pathogen. No role in virulence is known for the fluorescent pigments.

Dissemination

Blood stream invasion and dissemination of Pseudomonas from local sites of infection is probably
mediated by the same cell-associated and extracellular products responsible for the localized disease,
although it is not entirely clear how the bacterium produces systemic illness. P. aeruginosa is resistant
to phagocytosis and the serum bactericidal response due to its mucoid capsule and possibly LPS. The
proteases inactivate complement, cleave IgG antibodies, and inactivate IFN, TNF and probably other
cytokines . The Lipid A moiety of Pseudomonas LPS (endotoxin) mediates the usual pathologic
aspects of Gram-negative septicemia, e.g. fever, hypotension, intravascular coagulation, etc. It is also
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assumed that PseudomonasExotoxin A exerts some pathologic activity during the dissemination stage
(see below).

Toxinogenesis

P. aeruginosa produces two extracellular protein toxins, Exoenzyme S and Exotoxin A. Exoenzyme S
is probably an exotoxin. It has the characteristic subunit structure of the A-component of a bacterial
toxin, and it has ADP-ribosylating activity (for a variety of eukaryotic proteins) characteristic of
exotoxins. Exoenzyme S is produced by bacteria growing in burned tissue and may be detected in the
blood before the bacteria are. It has been suggested that exoenzyme S may act to impair the function of
phagocytic cells in the bloodstream and internal organs to prepare for invasion by P. aeruginosa.

Exotoxin A has exactly the same mechanism of action as the diphtheria toxin, it causes the ADP
ribosylation of eukaryotic elongation factor 2. It is partially-identical to diphtheria toxin, but it is
antigenically-distinct. It utilizes a different receptor on host cells, but otherwise it enters cells in the
same manner as the diphtheria toxin and it has the exact enzymatic mechanism. The production of
Exotoxin A in is regulated by exogenous iron, but the details of the regulatory process are distinctly
different in C. diphtheriae and P. aeruginosa.

Exotoxin A appears to mediate both local and systemic disease processes caused by Pseudomonas
aeruginosa. It has necrotizing activity at the site of bacterial colonization and is thereby thought to
contribute to the colonization process. Toxinogenic strains cause a more virulent form of pneumonia
than nontoxinogenic strains. In terms of its systemic role in virulence, purified Exotoxin A is highly
lethal for animals including primates. Indirect evidence involving the role of exotoxin A in disease is
seen in the increased chance of survival in patients with Pseudomonas septicemia that is correlated
with the titer of anti-exotoxin A antibodies in the serum. Also, tox- mutants show a reduced virulence
in some models.

Table 1 (below) is a summary of the virulence determinants of Pseudomonas aeruginosa. Table 2 is a

brief description of the diseases caused by Pseudomonas aeruginosa.

Table 1. Summary of the Virulence Determinants of Pathogenic Pseudomonas aeruginosa

Adhesins
fimbriae (N-methyl-phenylalanine pili)
polysaccharide capsule (glycocalyx)
alginate slime (biofilm)
Invasins
elastase
alkaline protease
hemolysins (phospholipase and lecithinase)
cytotoxin (leukocidin)
siderophores and siderophore uptake systems
pyocyanin diffusible pigment
Motility/chemotaxis
flagella
Toxins

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 Exoenzyme S
Exotoxin A
Lipopolysaccharide
Antiphagocytic surface properties
capsules, slime layers
LPS
Defense against serum bactericidal reaction
slime layers, capsules
LPS
protease enzymes
Defense against immune responses
capsules, slime layers
protease enzymes
Genetic attributes
genetic exchange by transduction and conjugation
inherent (natural) drug resistance
R factors and drug resistance plasmids
Ecologic criteria
adaptability to minimal nutritional requirements
metabolic diversity
widespread occurrence in a variety of habitats

Pseudomonas aeruginosa Scanning electron micrograph. CDC

Table 2. Diseases caused by Pseudomonas aeruginosa

Endocarditis. Pseudomonas aeruginosa infects heart valves of IV drug users and prosthetic heart
valves. The organism establishes itself on the endocardium by direct invasion from the blood stream.

Respiratory infections. Respiratory infections caused by Pseudomonas aeruginosa occur almost

exclusively in individuals with a compromised lower respiratory tract or a compromised systemic
defense mechanism. Primary pneumonia occurs in patients with chronic lung disease and congestive
heart failure. Bacteremic pneumonia commonly occurs in neutropenic cancer patients undergoing
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chemotherapy. Lower respiratory tract colonization of cystic fibrosis patients by mucoid strains of
Pseudomonas aeruginosa is common and difficult, if not impossible, to treat.

Bacteremia and Septicemia. Pseudomonas aeruginosa causes bacteremia primarily in

immunocompromised patients. Predisposing conditions include hematologic malignancies,
immunodeficiency relating to AIDS, neutropenia, diabetes mellitus, and severe burns. Most
Pseudomonas bacteremia is acquired in hospitals and nursing homes. Pseudomonas accounts for about
25 percent of all hospital acquired Gram-negative bacteremias.

Central Nervous System infections. Pseudomonas aeruginosa causes meningitis and brain abscesses.
The organism invades the CNS from a contiguous structure such as the inner ear or paranasal sinus, or
is inoculated directly by means of head trauma, surgery or invasive diagnostic procedures, or spreads
from a distant site of infection such as the urinary tract.

Ear infections including external otitis. Pseudomonas aeruginosa is the predominant bacterial
pathogen in some cases of external otitis including "swimmer's ear". The bacterium is infrequently
found in the normal ear, but often inhabits the external auditory canal in association with injury,
maceration, inflammation, or simply wet and humid conditions.

Eye infections. Pseudomonas aeruginosa can cause devastating infections in the human eye. It is one
of the most common causes of bacterial keratitis, and has been isolated as the etiologic agent of
neonatal ophthalmia. Pseudomonas can colonize the ocular epithelium by means of a fimbrial
attachment to sialic acid receptors. If the defenses of the environment are compromised in any way the
bacterium can proliferate rapidly and, through the production of enzymes such as elastase, alkaline
protease and exotoxin A, cause a rapidly destructive infection that can lead to loss of the entire eye.

Bone and joint infections. Pseudomonas infections of bones and joints result from direct inoculation
of the bacteria or the hematogenous spread of the bacteria from other primary sites of infection. Blood-
borne infections are most often seen in IV drug users, and in conjunction with urinary tract or pelvic
infections. Pseudomonas aeruginosa has a particular tropism for fibrocartilagenous joints of the axial
skeleton. Pseudomonas aeruginosa causes chronic contiguous osteomyelitis, usually resulting from
direct inoculation of bone, and is the most common pathogen implicated in osteochondritis after
puncture wounds of the foot.

Urinary tract infections. Urinary tract infections (UTI) caused by Pseudomonas aeruginosa are
usually hospital-acquired and related to urinary tract catheterization, instrumentation or surgery.
Pseudomonas aeruginosa is the third leading cause of hospital-acquired UTIs, accounting for about 12
percent of all infections of this type. The bacterium appears to be among the most adherent of common
urinary pathogens to the bladder uroepithelium. As in the case of E. coli urinary tract infection can
occur via an ascending or descending route. In addition, Pseudomonas can invade the bloodstream
from the urinary tract, and this is the source of nearly 40 percent of Pseudomonas bacteremias.

Gastrointestinal infections. Pseudomonas aeruginosa can produce disease in any part of the
gastrointestinal tract from the oropharynx to the rectum. As in other forms of Pseudomonas disease,
those involving the GI tract occur primarily in immunocompromised individuals. The organism has
been implicated in perirectal infections, pediatric diarrhea, typical gastroenteritis, and necrotizing
enterocolitis. The GI tract is also an important portal of entry in Pseudomonas septicemia.

Skin and soft tissue infections, including wound infections, pyoderma and dermatitis.
Pseudomonas aeruginosa can cause a variety of skin infections, both localized and diffuse. The
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common predisposing factors are breakdown of the integument which may result from burns, trauma or
dermatitis; high moisture conditions such as those found in the ear of swimmers and the toe webs of
athletes and combat troops, in the perineal region and under diapers of infants, and on the skin of
whirlpool and hot tub users. Individuals with AIDS are easily infected. Pseudomonas has also been
implicated in folliculitis and unmanageable forms of acne vulgaris.

Host Defenses

Most strains of P. aeruginosa are resistant to killing in serum alone, but the addition of
polymorphonuclear leukocytes results in bacterial killing. Killing is most efficient in the presence of
type-specific opsonizing antibodies, directed primarily at the antigenic determinants of LPS. This
suggests that phagocytosis is an important defense and that opsonizing antibody is the principal
functioning antibody in protecting from P. aeruginosa infections.

Once P. aeruginosa infection is established, other antibodies, such as antitoxin, may be important in
controlling disease. The observation that patients with diminished antibody responses (caused by
underlying disease or associated therapy) have more frequent and more serious P. aeruginosa
infections underscores the importance of antibody-mediated immunity in controlling infections. Cystic
fibrosis is the exception. Most cystic fibrosis patients have high levels of circulating antibodies to
bacterial antigens, but are unable to clear P. aeruginosa efficiently from their lungs. Cell-mediated
immunity does not seem to play a major role in resistance or defense against Pseudomonas infections.

Epidemiology and Control of P. aeruginosa Infections

Pseudomonas aeruginosa is a common inhabitant of soil, water, and vegetation. It is found on the skin
of some healthy persons and has been isolated from the throat (5 percent) and stool (3 percent) of
nonhospitalized patients. The gastrointestinal carriage rates increase in hospitalized patients to 20
percent within 72 hours of admission.

Within the hospital, P. aeruginosa finds numerous reservoirs: disinfectants, respiratory equipment,
food, sinks, taps, and mops. Furthermore, it is constantly reintroduced into the hospital environment on
fruits, plants, vegetables, as well by visitors and patients transferred from other facilities. Spread occurs
from patient to patient on the hands of hospital personnel, by direct patient contact with contaminated
reservoirs, and by the ingestion of contaminated foods and water.

The spread of P. aeruginosa can best be controlled by observing proper isolation procedures, aseptic
technique, and careful cleaning and monitoring of respirators, catheters, and other instruments. Topical
therapy of burn wounds with antibacterial agents such as silver sulfadiazine, coupled with surgical
debridement, dramatically reduces the incidence of P. aeruginosa sepsis in burn patients.

Pseudomonas aeruginosa is frequently resistant to many commonly used antibiotics. Although many
strains are susceptible to gentamicin, tobramycin, colistin, and amikacin, resistant forms have
developed. The combination of gentamicin and carbenicillin is frequently used to treat severe
Pseudomonas infections. Several types of vaccines are being tested, but none is currently available for
general use.

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 Todar's Online Textbook of Bacteriology

Bordetella pertussis and Whooping Cough

© 2004 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

Bordetella pertussis, the agent of pertussis or whooping cough. Gram stain. (CDC)

Bordetella pertussis

Whooping cough (pertussis) is caused by the bacterium Bordetella pertussis, B. pertussis is a very
small Gram-negative aerobic coccobacillus that appears singly or in pairs. Its metabolism is respiratory,
never fermentative, and taxonomically, Bordetella is placed among the "Gram-negative Aerobic Rods
and Cocci" in Bergey's Manual. Bordetella is not assigned to any family. The bacteria are nutritionally
fastidious and are usually cultivated on rich media supplemented with blood. They can be grown in
synthetic medium, however, which contains buffer, salts, an amino acid energy source, and growth
factors such as nicotinamide (for which there is a strict requirement). Even on blood agar the organism
grows slowly and requires 3-6 days to form pinpoint colonies.

Bordetella pertussis colonizes the cilia of the mammalian respiratory epithelium (Figure 1). Generally,
it is thought that B. pertussis does not invade the tissues, but some recent work has shown the
bacterium in alveolar macrophages. The bacterium is a pathogen for humans and possibly for higher
primates, and no other reservoir is known. Whooping cough is a relatively mild disease in adults but
has a significant mortality rate in infants. Until immunization was introduced in the 1930s, whooping
cough was one of the most frequent and severe diseases of infants in the United States.

Pathogenesis

The disease pertussis has two stages. The first stage, colonization, is an upper respiratory disease with
fever, malaise and coughing, which increases in intensity over about a 10-day period. During this stage
the organism can be recovered in large numbers from pharyngeal cultures, and the severity and
duration of the disease can be reduced by antimicrobial treatment. Adherence mechanisms of B.
pertussis involve a "filamentous hemagglutinin" (FHA), which is a fimbrial-like structure on the
bacterial surface, and cell-bound pertussis toxin (PTx). Short range effects of soluble toxins play a
role as well in invasion during the colonization stage.

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 Figure 1. Colonization of tracheal epithelial cells by Bordetella pertussis

The second or toxemic stage of pertussis follows relatively nonspecific symptoms of the colonizaton
stage. It begins gradually with prolonged and paroxysmal coughing that often ends in a characteristic
inspiratory gasp (whoop). To hear the characteristic sound of whooping cough click whoop.wav
(whoop.wav is copyright of Dr Doug Jenkinson, Nottingham, England. www.whoopingcough.net).
During the second stage, B. pertussis can rarely be recovered, and antimicrobial agents have no effect
on the progress of the disease. As described below, this stage is mediated by a variety of soluble toxins.

Colonization

Studies of B. pertussis and its adhesins have focused on cultured mammalian cells that lack most of the
features of ciliated epithelial cells. However, some generalities have been drawn. The two most
important colonization factors are the filamentous hemagglutinin (FHA) and the pertussis toxin (PTx).
Filamentous hemagglutinin is a large (220 kDa) protein that forms filamentous structures on the cell
surface. FHA binds to galactose residues on a sulfated glycolipid called sulfatide which is very
common on the surface of ciliated cells. Mutations in the FHA structural gene reduce the ability of the
organism to colonize, and antibodies against FHA provide protection against infection. However, it is
unlikely that FHA is the only adhesin involved in colonization. The structural gene for FHA has been
cloned and expressed in E. coli, raising the possibility of its production for use in a component vaccine.

One of the toxins of B. pertussis, the pertussis toxin (PTx), is also involved in adherence to the tracheal
epithelium. Pertussis toxin is a 105 kDa protein composed of six subunits: S1, S2, S3, (2)S4, and S5.
The toxin is both secreted into the extracellular fluid and cell bound. Some components of the cell-
bound toxin (S2 and S3) function as adhesins, and appear to bind the bacteria to host cells. S2 and S3
utilize different receptors on host cells. S2 binds specifically to a glycolipid called lactosylceramide,
which is found primarily on the ciliated epithelial cells. S3 binds to a glycoprotein found mainly on
phagocytic cells.

The S1 subunit of pertussis toxin is the A component with ADP ribosylating activity, and the function
of S2 and S3 is presumed to be involved in binding the intact (extracellular) toxin to its target cell
surface. Antibodies against PTx components prevent colonization of ciliated cells by the bacteria and
provide effective protection against infection. Thus, pertussis toxin is clearly an important virulence
factor in the initial colonization stage of the infection.

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Since the S3 subunit of pertussis toxin is able to bind to the surface of phagocytes, and since FHA will
attach to integrin CR3 on phagocyte surfaces (the receptor for complement C3b), it has been speculated
that the bacterium might bind preferentially to phagocytes in order to facilitate its own engulfment. The
role of such self-initiated phagocytosis is not clear. Bacteria taken up by this abnormal route may avoid
stimulating the oxidative burst that normally accompanies phagocytic uptake of bacterial cells which
are opsonized by antibodies or complement C3b. Once inside of cells the bacteria might utilize other
toxins (i.e. adenylate cyclase toxin) to compromise the bactericidal activities of phagocytes. In any
case, there is some evidence that Bordetella pertussis can use this mechanism to get into and to persist
in phagocytes as an intracellular parasite. If B. pertussis is an intracellular parasite it would explain
why immunity to pertussis correlates better with the presence of specific cytotoxic T cells than it does
with the presence of antibodies to bacterial products.

B. pertussis produces at least two other types of adhesins, two types of fimbriae and a nonfimbrial
surface protein called pertactin, but their role in adherence and pathogenesis is not well established.

Toxins Produced by B. pertussis

B. pertussis produces a variety of substances with toxic activity in the class of exotoxins and
endotoxins.

It secretes its own invasive adenylate cyclase which enters mammalian cells (Bacillus anthracis
produces a similar enzyme, EF). This toxin acts locally to reduce phagocytic activity and probably
helps the organism initiate infection. This toxin is a 45 kDa protein that may be cell-associated or
released into the environment. Mutants of B. pertussis in the adenylate cyclase gene have reduced
virulence in mouse models. The organisms can still colonize but cannot produce the lethal disease. The
adenylate cyclase toxin is a single polypeptide with an enzymatic domain (i.e., adenylate cyclase
activity) and a binding domain that will attach to host cell surfaces. The adenylate cyclase was
originally identified as a hemolysin because it will lyse red blood cells. In fact, it is responsible for
hemolytic zones around colonies of Bordetella pertussis growing on blood agar. Probably it inserts into
the erythrocyte membrane which causes hemolysis. An interesting feature of the adenylate cyclase
toxin is that it is active only in the presence of a eukaryotic regulatory molecule called calmodulin,
which up-regulates the activity of the eukaryotic adenylate cyclase. The adenylate cyclase toxin is only
active in the eukaryotic cell since no similar regulatory molecule exists in procaryotes. Thus, the
molecule seems to have evolved specifically to parasitize eukaryotic cells. Anthrax EF (edema factor)
is also a calmodulin-dependent adenylate cyclase.

It produces a highly lethal toxin (formerly called dermonecrotic toxin) which causes inflammation and
local necrosis adjacent to sites where B. pertussis is located. The lethal toxin is a 102 kDa protein
composed of four subunits, two with a mw of 24kDa and two with mw of 30 kDa. It causes necrotic
skin lesions when low doses are injected subcutaneosly in mice and is lethal in high doses. The role of
the toxin in whooping cough is not known.

It produces a substance called the tracheal cytotoxin which is toxic for ciliated respiratory epithelium
and which will stop the ciliated cells from beating. This substance is not a classic bacterial exotoxin
since it is not composed of protein. The tracheal cytotoxin is a peptidoglycan fragment, which appears
in the extracellular fluid where the bacteria are actively growing. The toxin kills ciliated cells and
causes their extrusion from the mucosa. It also stimulates release of cytokine IL-1, and so causes fever.

It produces the pertussis toxin, PTx, a protein that mediates both the colonization and toxemic stages
of the disease. PTx is a two component, A+B bacterial exotoxin. The A subunit (S1) is an ADP ribosyl
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transferase. The B component, composed of five polypeptide subunits (S2 through S5), binds to
specific carbohydrates on cell surfaces. The role of PTx in invasion has already been discussed. PTx is
transported from the site of growth of the Bordetella to various susceptible cells and tissues of the host.
Following binding of the B component to host cells, the A subunit is inserted through the membrane
and released into the cytoplasm in a mechanism of direct entry. The A subunit gains enzymatic activity
and transfers the ADP ribosyl moiety of NAD to the membrane-bound regulatory protein Gi that
normally inhibits the eukaryotic adenylate cyclase. The Gi protein is inactivated and cannot perform its
normal function to inhibit adenylate cyclase. The conversion of ATP to cyclic AMP cannot be stopped
and intracellular levels of cAMP increase. This has the effect to disrupt cellular function, and in the
case of phagocytes, to decrease their phagocytic activities such as chemotaxis, engulfment, the
oxidative burst, and bacteridcidal killing. Systemic effects of the toxin include lymphocytosis and
alteration of hormonal activities that are regulated by cAMP, such as increased insulin production
(resulting in hypoglycemia) and increased sensitivity to histamine (resulting in increased capillary
permeability, hypotension and shock). PTx also affects the immune system in experimental animals. B
cells and T cells that leave the lymphatics show an inability to return. This alters both AMI and CMI
responses and may explain the high freqency of secondary infections that accompany pertussis (the
most frequent secondary infections during whooping cough are pneumomia and otitis media).

Although the effects of the pertussis toxin are dependent on ADP ribosylation, it has been shown that
mere binding of the B oligomer can elicit a response on the cell surface such as lymphocyte
mitogenicity, platelet activation, and production of insulin effects.

The pertussis toxin gene has been cloned and sequenced and the subunits expressed in E. coli. The
toxin can be inactivated and converted to toxoid for use in component vaccines.

Figure 2. Comparison between cholera toxin and pertussis toxin (ptx) in their ability to interfere with the regulation
of the eukaryotic adenylate cyclase complex.

Normal regulation of adenylate cyclase activity in mammalian cells (Adenylate cyclase (AC) is activated normally by
a stimulatory regulatory protein (Gs) and guanosine triphosphate (GTP); however the activation is normally brief
because an inhibitory regulatory protein (Gi) hydrolyzes the GTP.

Adenylate cyclase activated by cholera toxin (The cholera toxin A1 fragment catalyzes the attachment of ADP-
Ribose (ADPR) to the regulatory protein Gs, forming Gs-ADPR from which GTP cannot be hydrolyzed. Since GTP
hydrolysis is the event that inactivates adenylate cyclase (AC), the enzyme remains continually activated.

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Adenylate cyclase activated by pertussis toxin (The pertussis A subunit transfers the ADP ribosyl moiety of NAD to
the membrane-bound regulatory protein Gi that normally inhibits the eukaryotic adenylate cyclase. The Gi protein
is inactivated and cannot perform its normal function to inhibit adenylate cyclase. The conversion of ATP to cyclic
AMP cannot be stopped.)

Lipopolysaccharide. As a Gram-negative bacterium Bordetella pertussis possesses lipopolysaccharide

(endotoxin) in its outer membrane, but its LPS is unusual. It is heterogeneous, with two major forms
differing in the phosphate content of the lipid moiety. The alternative form of Lipid A is designated
Lipid X. The unfractionated material elicits the usual effects of LPS (i.e., induction of IL-1, activation
of complement, fever, hypotension, etc.), but the distribution of those activities is different in the two
forms of LPS. For example, Lipid X, but not Lipid A, is pyrogenic, and its O-side chain is a very
powerful immune adjuvant. Furthermore, Bordetella LPS is more potent in the limulus assay than LPS
from other Gram-negative bacteria, so it is not reliable to apply knowledge of the biological activity of
LPS in the Enterobacteriaceae to the LPS of Bordetella. The role of this unusual LPS in the
pathogenesis of whooping cough has not been investigated.

Regulation of Virulence Factors in B. pertussis

The production of virulence factors in B. pertussis is regulated in several different ways. Expression of
virulence factors is regulated by the bvg operon.

First, the organisms undergo an event called phase variation resulting in the loss of most virulence
factors and some undefined outer membrane proteins. Phase variation has been shown to occur at a
genetic frequency of 10-4 - 10-6 generations and results from a specific DNA frame shift that comes
about after the insertion of a single nucleotide into the bvg (also known as vir) operon.

A similar process called phenotypic modulation, occurs in response to environmental signals such as
temperature or chemical content, and is reversible. This is an adaptive process mediated by the
products of the bvg operon, and is an example of a two-component environmental-sensing (regulatory)
system used by other bacteria. The expression of these regulatory proteins is itself regulated by
environmental signals, such that entry into a host might induce components required for survival and
production of disease.

The Whooping Cough Vaccine

The development of the whooping cough vaccine in the 1950s has made whooping cough an
uncommon disease in developed countries. In countries where the vaccine is not used whooping cough
is an important cause of mortality in children, with an estimated 51,000,000 cases and 600,000 deaths
annually.

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Historically, the whooping cough vaccine has been administered as a merthiolate-killed bacterial cell
suspension which is part of the DTP vaccine (The P in DTP stands for Pertussis cells). Unfortunately,
about 20% of the children that receive the whole cell vaccine experience mild side effects. About 0.1%
of infants experience convulsions soon after receiving the vaccine and in a very small number of cases
(1 in 150,000?) severe or irreversible brain damage may occur. In the absence of the disease in an
immune population, parents have begun to wonder if the risk of vaccinating children outweighs the risk
of the disease, and the value of the whole cell vaccine has been questioned.

Several new acellular vaccines have been developed from purified components of B. pertussis.
Demonstration of the protective effects of anti-PTx and anti-FHA antibodies in the mouse model,
focused vaccine production on combinations of inactivated pertussis toxin (toxoid) and filamentous
hemagglutinin. Multicomponent acellular vaccines containing combinations of pertussis toxoid,
filamentous hemagglutinin, pertactin, and the two types of fimbriae, are now being used in several
countries including the U.S. The new vaccine, known as acellular pertussis has fewer side effects than
the whole cell vaccine and is currently recommended for use under the conditions described below.

For decades, the pertussis vaccine has been given in combination with vaccines against diphtheria and
tetanus. The combination is known as the DTP vaccine. Recently, infants have been able to receive a
vaccine that combines the DTP vaccine with the vaccine against Haemophilus influenzae type b
meningitis (Hib). This vaccine is called DTPH. The diphtheria-tetanus-pertussis vaccine using
acellular pertussis is known as DTaP. The diphtheria-tetanus-pertussis vaccination is given in five
doses: at 2, 4, 6, 12-18 months and 4-6 years of age. Previously, DTaP had been recommended only for
the fourth and fifth doses. Following FDA licensure of DTaP for infants, the Advisory Committee on
Immunization Practices of the United States Public Health Service now recommends that DTaP be used
for the first four doses and that DTaP still be used for the fourth and fifth doses for children who
received DTP in their first three doses. The Committee is awaiting study results before making a
recommendation for the fifth dose for children who now will receive DTaP in their first four doses. The
recommendation still permits the use of DTP and DTPH--the combination that includes the vaccine
against Haemophilus influenzae type b meningitis.

Whooping Cough In Wisconsin 2004

There were more than 4,800 cases of whooping cough were reported in Wisconsin in 2004, an increase
of more than 690 percent over the previoust year, when there were 716. In the mid-1980s, when
whooping cough outbreaks were considered particularly bad, there were 400 to 500 reported cases per
year.

Dane County reported over 150 cases. The Public Health Department of the City of Madison saw over
100 cases in 2004, even though the disease is undoubtedly under-reported. The University Health
Services saw a rise in incidence on the UW campus. Last semester UHS confirmed several student
cases each week, with several additional unconfirmed occurrences.

Since the development of the pertussis vaccine, the incidence of whooping cough in the U.S. steadily
declined until the past two decades when it began to rise. According to the Center for Disease Control,
Wisconsin currently ranks second in the nation for disease incidence rate at 27.7 cases per 100,000
individuals.

It is difficult to draw conclusions by comparing the 2004 outbreak with those in past years. The
increase in whooping cough numbers can partially be explained by new testing procedures that became

410
available last year. The new test is quicker and more sensitive than previous tests, and physicians are
putting more emphasis on diagnosing the illness.

Also, whooping cough infections tend to run on a 2-5 year cycle, and 2004 could be a high point in the
cycle.

Like flu viruses, the bacterium is highly contagious and tends to pass quickly from person to person
through coughing and sneezing. If increasing numbers of individuals have the illness, then the risk of
infection increases in the general population.

Many young children are vaccinated against whooping cough with the pertussis vaccine. However, the
vaccine is only approved for children under seven years of age. Antibody-mediated immunity wanes in
approximately ten years, leaving older individuals more susceptible to the disease. Adults get infected,
often to a lesser degree, but they are still able to spread the disease to unimmunized children.

For more information on whooping cough, see the CDC listings under
Pertussis - Technical Information
vaccine: http://www.cdc.gov/nip/publications/VIS/vis-dtp.pdf.

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 Todar's Online Textbook of Bacteriology

Pathogenic E. coli
© 2002 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

Left: Escherichia coli cells. Right: E.coli colonies on EMB Agar.

Escherichia coli

The GI tract of most warm-blooded animals is colonized by E. coli within hours or a few days after
birth. The bacterium is ingested in foods or water or obtained directly from other individuals handling
the infant. The human bowel is usually colonized within 40 hours of birth. E. coli can adhere to the
mucus overlying the large intestine. Once established, an E. coli strain may persist for months or years.
Resident strains shift over a long period (weeks to months), and more rapidly after enteric infection or
antimicrobial chemotherapy that perturbs the normal flora. The basis for these shifts and the ecology of
Escherichia coli in the intestine of humans are poorly understood despite the vast amount of
information on almost every other aspect of the organism's existence. The entire DNA base sequence of
the E. coli genome has been known since 1997.

E. coli is the head of the large bacterial family, Enterobacteriaceae, the enteric bacteria, which are
faculatively anaerobic Gram-negative rods that live in the intestinal tracts of animals in health and
disease. The Enterobacteriaceae are among the most important bacteria medically. A number of genera
within the family are human intestinal pathogens (e.g. Salmonella, Shigella, Yersinia). Several others
are normal colonists of the human gastrointestinal tract (e.g. Escherichia, Enterobacter, Klebsiella), but
these bacteria, as well, may occasionally be associated with diseases of humans.

The Enterobacteriaceae are distinguished from the Pseudomonadaceae in a number of ways known
reflexively to competent microbiologists. The pseudomonads are respiratory, never fermentative,
oxidase-positive, and motile by means of polar flagella. The enterics ferment glucose producing acid
and gas, are typically oxidase-negative, and when motile, produce peritrichous flagella.

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Physiologically, E. coli is versatile and well-adapted to its characteristic habitats. It can grow in media
with glucose as the sole organic constituent. Wild-type E. coli has no growth factor requirements, and
metabolically it can transform glucose into all of the macromolecular components that make up the
cell. The bacterium can grow in the presence or absence of O2. Under anaerobic conditions it will grow
by means of fermentation, producing characteristic "mixed acids and gas" as end products. However, it
can also grow by means of anaerobic respiration, since it is able to utilize NO3, NO2 or fumarate as
final electron acceptors for respiratory electron transport processes. In part, this adapts E. coli to its
intestinal (anaerobic) and its extraintestinal (aerobic or anaerobic) habitats.

E. coli can respond to environmental signals such as chemicals, pH, temperature, osmolarity, etc., in a
number of very remarkable ways considering it is a single-celled organism. For example, it can sense
the presence or absence of chemicals and gases in its environment and swim towards or away from
them. Or it can stop swimming and grow fimbriae that will specifically attach it to a cell or surface
receptor. In response to change in temperature and osmolarity, it can vary the pore diameter of its outer
membrane porins to accommodate larger molecules (nutrients) or to exclude inhibitory substances.
With its complex mechanisms for regulation of metabolism the bacterium can survey the chemical
contents its environment in advance of synthesizing any enzymes necessary to use these compounds. It
does not wastefully produce enzymes for degradation of carbon sources unless they are available, and it
does not produce enzymes for synthesis of metabolites if they are available as nutrients in the
environment.

E. coli is a consistent inhabitant of the human intestinal tract, and it is the predominant facultative
organism in the human GI tract; however, it makes up a very small proportion of the total bacterial
content. The anaerobic Bacteroides species in the bowel outnumber E. coli by at least 20:1. however,
the regular presence of E. coli in the human intestine and feces has led to tracking the bacterium in
nature as an indicator of fecal pollution and water contamination. As such, it is taken to mean that,
wherever E. coli is found, there may be fecal contamination by intestinal parasites of humans.

Pathogenesis of E. coli

Over 700 antigenic types (serotypes) are recognized based on O, H, and K antigens. Serotyping is
still important in distinguishing the small number of strains that actually cause disease.

E. coli is responsible for three types of infections in humans: urinary tract infections (UTI), neonatal
meningitis, and intestinal diseases (gastroenteritis). These three diseases depend on a specific array
of pathogenic (virulence) determinants. The virulence determinants of various strains of pathogenic E.
coli are summarized in Table 1.

Table 1. Summary of the Virulence Determinants of Pathogenic E. coli

Adhesins
CFAI/CFAII
Type 1 fimbriae
P fimbriae
S fimbriae
Intimin (non-fimbrial adhesin)
Invasins
hemolysisn
siderophores and siderophore uptake systems
Shigella-like "invasins" for intracellular invasion and spread
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Motility/chemotaxis
flagella
Toxins
LT toxin
ST toxin
Shiga-like toxin
cytotoxins
endotoxin LPS)
Antiphagocytic surface properties
capsules
K antigens
LPS
Defense against serum bactericidal reactions
LPS
K antigens
Defense against immune responses
capsules
K antigens
LPS
antigenic variation
Genetic attributes
genetic exchange by transduction and conjugation
transmissible plasmids
R factors and drug resistance plasmids
toxin and other virulence plasmids

Urinary tract infections

Uropathogenic E. coli cause 90% of the urinary tract infections (UTI) in anatomically-normal,
unobstructed urinary tracts. The bacteria colonize from the feces or perineal region and ascend the
urinary tract to the bladder. Bladder infections are 14-times more common in females than males by
virtue of the shortened urethra. The typical patient with uncomplicated cystitis is a sexually-active
female who was first colonized in the intestine with a uropathogenic E. coli strain. 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). The letter designation is derived from the ability of P
fimbriae to bind specifically to the P blood group antigen which contains a D-galactose-D-galactose
residue. The fimbriae bind not only to red cells but to a specific galactose dissaccharide that is found on
the surfaces uroepithelial cells in approximately 99% of the population.

The frequency of the distribution of this host cell receptor plays a role in susceptibility and explains
why certain individuals have repeated UTI caused by E. coli. Uncomplicated E. coli UTI virtually
never occurs in individuals lacking the receptors.

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Uropathogenic strains of E. coli possess other determinants of virulence in addition to P fimbriae. E.
coli with P fimbriae also possess the gene for Type 1 fimbriae, and there is evidence that P fimbriae are
derived from Type 1 fimbriae by insertion of a new fimbrial tip protein to replace the mannose-binding
domain of Type 1 fimbria. In any case, Type 1 fimbriae could provide a supplementary mechanism of
adherence or play a role in aggregating the bacteria to a specific manosyl-glycoprotein that occurs in
urine.

Uropathogenic strains of E. coli usually produce siderophores that probably play an essential role in
iron acquisition for the bacteria during or after colonization. They also produce hemolysins which are
cytotoxic due to formation of transmembranous pores in host cells. One strategy for obtaining iron and
other nutrients for bacterial growth may involve the lysis of host cells to release these substances. The
activity of hemolysins is not limited to red cells since the alpha-hemolysins of E. coli also lyse
lymphocytes, and the beta-hemolysins inhibit phagocytosis and chemotaxis of neutrophils.

Another factor thought to be involved in the pathogenicity of the uropathogenic strains of E. coli is
their resistance to the complement-dependent bactericidal effect of serum. The presence of K antigens
is associated with upper urinary tract infections, and antibody to the K antigen has been shown to
afford some degree of protection in experimental infections. The K antigens of E. coli are "capsular"
antigens that may be composed of proteinaceous organelles associated with colonization (e.g., CFA
antigens), or made of polysaccharides. Regardless of their chemistry, these capsules may be able to
promote bacterial virulence by decreasing the ability of antibodies and/or complement to bind to the
bacterial surface, and the ability of phagocytes to recognize and engulf the bacterial cells. The best
studied K antigen, K-1, is composed of a polymer of N-acetyl neuraminic acid (sialic acid), which
besides being antiphagocytic, has the additional property of being an antigenic disguise.

Neonatal Meningitis

Neonatal meningitis affects1/2,000-4,000 infants. Eighty percent of E. coli strains involved synthesize
K-1 capsular antigens (K-1 is only present 20-40% of the time in intestinal isolates).

E. coli strains invade the blood stream of infants from the nasopharynx or GI tract and are carried to the
meninges.

The K-1 antigen is considered the major determinant of virulence among strains of E. coli that cause
neonatal meningitis. K-1 is a homopolymer of sialic acid. It inhibits phagocytosis, complement, and
responses from the host's immunological mechanisms. K-1 may not be the only determinant of
virulence, however, as siderophore production and endotoxin are also likely to be involved.

Epidemiologic studies have shown that pregnancy is associated with increased rates of colonization by
K-1 strains and that these strains become involved in the subsequent cases of meningitis in the
newborn. Probably, the infant GI tract is the portal of entry into the bloodstream. Fortunately, although
colonization is fairly common, invasion and the catastrophic sequelae are rare.

Neonatal meningitis requires antibiotic therapy that usually includes ampicillin and a third-generation
cephalosporin.

Intestinal Diseases Caused by E. coli

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As a pathogen, E. coli, of course, is best known for its ability to cause intestinal diseases. Five classes
(virotypes) of E. coli that cause diarrheal diseases are now recognized: enterotoxigenic E. coli
(ETEC), enteroinvasive E. coli (EIEC), enterohemorrhagic E. coli (EHEC), enteropathogenic E.
coli (EPEC), and enteroaggregative E. coli (EAggEC). Each class falls within a serological subgroup
and manifests distinct features in pathogenesis.

Enterotoxigenic E. coli (ETEC)

ETEC are an important cause of diarrhea in infants and travelers in underdeveloped countries or
regions of poor sanitation. The diseases vary from minor discomfort to a severe cholera-like syndrome.
ETEC are acquired by ingestion of contaminated food and water, and adults in endemic areas evidently
develop immunity. The disease requires colonization and elaboration of one or more enterotoxins. Both
traits are plasmid-encoded.

ETEC adhesins are fimbriae which are species-specific. For example, the K-88 fimbrial Ag is found
on strains from piglets; K-99 Ag is found on strains from calves and lambs; CFA I, and CFA II, are
found on strains from humans. These fimbrial adhesins adhere to specific receptors on enterocytes of
the proximal small intestine.

Enterotoxins produced by ETEC include the LT(heat-labile) toxin and/or the ST (heat-stable) toxin,
the genes for which may occur on the same or separate plasmids. The LT enterotoxin is very similar to
cholera toxin in both structure and mode of action. It is an 86kDa protein composed of an
enzymatically active (A) subunit surrounded by 5 identical binding (B) subunits. It binds to the same
identical ganglioside receptors that are recognized by the cholera toxin (i.e., GM1), and its enzymatic
activity is identical to that of the cholera toxin.

The ST enterotoxin is actually a family of toxins which are peptides of molecular weight about 2,000
daltons. Their small size explains why they are not inactivated by heat. ST causes an increase in cyclic
GMP in host cell cytoplasm leading to the same effects as an increase in cAMP. STa is known to act
by binding to a guanylate cyclase that is located on the apical membranes of host cells, thereby
activating the enzyme. This leads to secretion of fluid and electrolytes resulting in diarrhea.

Symptoms ETEC infections include diarrhea without fever. The bacteria colonize the GI tract by means
of a fimbrial adhesin, e.g. CFA I and CFA II, and are noninvasive, but produce either the LT or ST
toxin.

Enteroinvasive E. coli (EIEC)

EIEC closely resemble Shigella in their pathogenic mechanisms and the kind of clinical illness they
produce. EIEC penetrate and multiply within epithelial cells of the colon causing widespread cell
destruction. The clinical syndrome is identical to Shigella dysentery and includes a dysentery-like
diarrhea with fever. EIEC apparently lack fimbrial adhesins but do possess a specific adhesin that, as in
Shigella, is thought to be an outer membrane protein. Also, likeShigella, EIEC are invasive
organisms. They do not produce LT or ST toxin and, unlike Shigella, they do not produce the shiga
toxin.

Enteropathogenic E. coli (EPEC)

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EPEC induce a watery diarrhea similar to ETEC, but they do not possess the same colonization factors
and do not produce ST or LT toxins. They produce a non fimbrial adhesin designated intimin, an
outer membrane protein, that mediates the final stages of adherence. Although they do not produce LT
or ST toxins, there are reports that they produce an enterotoxin similar to that of Shigella. Other
virulence factors may be related to those in Shigella.

Adherence of EPEC strains to the intestinal mucosa is a very complicated process and produces
dramatic effects in the ultrastructure of the cells resulting in rearrangements of actin in the vicinity of
adherent bacteria. The phenomenon is sometimes called "attaching and effacing" of cells. EPEC
strains are said to be "moderately-invasive" meaning they are not as invasive as Shigella, and unlike
ETEC or EAggEC, they cause an inflammatory response. The diarrhea and other symptoms of EPEC
infections probably are caused by bacterial invasion of host cells and interference with normal cellular
signal transduction, rather than by production of toxins.

Some types of EPEC are referred to as Enteroadherent E. coli (EAEC), based on specific patterns of
adherence. They are an important cause of traveler's diarrhea in Mexico and in North Africa.

Enteroaggregative E. coli (EAggEC)

The distinguishing feature of EAggEC strains is their ability to attach to tissue culture cells in an
aggregative manner. These strains are associated with persistent diarrhea in young children. They
resemble ETEC strains in that the bacteria adhere to the intestinal mucosa and cause non-bloody
diarrhea without invading or causing inflammation. This suggests that the organisms produce a toxin of
some sort. Recently, a distinctive heat-labile plasmid-encoded toxin has been isolated from these
strains, called the EAST (EnteroAggregative ST) toxin. They also produce a hemolysin related to the
hemolysin produced by E. coli strains involved in urinary tract infections. The role of the toxin and the
hemolysin in virulence has not been proven. The significance of EAggEC strains in human disease is
controversial.

Enterohemorrhagic E. coli (EHEC)

EHEC are represented by a single strain (serotype O157:H7), which causes a diarrheal syndrome
distinct from EIEC (and Shigella) in that there is copious bloody discharge and no fever. A frequent
life-threatening situation is its toxic effects on the kidneys (hemolytic uremia).

EHEC has recently been recognized as a cause of serious disease often associated with ingestion of
inadequately cooked hamburger meat. Pediatric diarrhea caused by this strain can be fatal due to
acute kidney failure (hemolytic uremic syndrome [HUS]). EHEC are also considered to be
"moderately invasive". Nothing is known about the colonization antigens of EHEC but fimbriae are
presumed to be involved. The bacteria do not invade mucosal cells as readily as Shigella, but EHEC
strains produce a toxin that is virtually identical to the Shiga toxin. The toxin plays a role in the intense
inflammatory response produced by EHEC strains and may explain the ability of EHEC strains to
cause HUS. The toxin is phage encoded and its production is enhanced by iron deficiency.

Table 2. Pathogenic E. coli: Summary of Virulence Characteristics of Intestinal Pathogens

ETEC
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 fimbrial adhesins e.g. CFA I, CFAII, K88. K99
non invasive
produce LT and/or ST toxin
watery diarrhea in infants and travelers; no inflammation, no fever
EIEC
nonfimbrial adhesins, possibly outer membrane protein
invasive (penetrate and multiply within epithelial cells)
does not produce shiga toxin
dysentery-like diarrhea (mucous, blood), severe inflammation, fever
EPEC
non fimbrial adhesin (intimin)
moderately invasive (not as invasive as Shigella or EIEC)
does not produce LT or ST; some reports of shiga-like toxin
usually infantile diarrhea; watery diarrhea similar to ETEC, some inflammation, no fever;
symptoms probably result mainly from invasion rather than toxigenesis
EAggEC
adhesins not characterized
non invasive
produce ST-like toxin (EAST) and a hemolysin
persistent diarrhea in young children without inflammation, no fever
EHEC

adhesins not characterized, probably fimbriae

moderately invasive
does not produce LT or ST but does produce shiga toxin
pediatric diarrhea, copious bloody discharge (hemorrhagic colitis), intense inflammatory response, may
be complicated by hemolytic uremia

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 Todar's Online Textbook of Bacteriology

Vibrio cholerae and Asiatic Cholera

© 2005 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

Introduction

The genus Vibrio consists of Gram-negative straight or curved rods, motile by means of a single polar
flagellum. Vibrios are capable of both respiratory and fermentative metabolism. O2 is a universal
electron acceptor; they do not denitrify. Most species are oxidase-positive. In most ways vibrios are
related to enteric bacteria, but they share some properties with pseudomonads a well. The Family
Vibrionaceae is found in the "Facultatively Anaerobic Gram-negative Rods" in Bergey's Manual
(1986), on the level with the Family Enterobacteriaceae. In the revisionist taxonomy of 2001
(Bergey's Manual), based on phylogenetic analysis, Vibrionaceae, Pseudomonadaceae and
Enterobacteriaceae are all landed in the Gammaproteobacteria. Vibrios are distinguished from
enterics by being oxidase-positive and motile by means of polar flagella. Vibrios are distinguished
from pseudomonads by being fermentative as well as oxidative in their metabolism. Of the vibrios that
are clinically significant to humans, Vibrio cholerae,the agent of cholera, is the most important.

Most vibrios have relatively simple growth factor requirements and will grow in synthetic media with
glucose as a sole source of carbon and energy. However, since vibrios are typically marine organisms,
most species require 2-3% NaCl or a sea water base for optimal growth. Vibrios vary in their
nutritional versatility, but some species will grow on more than 150 different organic compounds as
carbon and energy sources, occupying the same level of metabolic versatility as Pseudomonas. In
liquid media vibrios are motile by polar flagella that are enclosed in a sheath continuous with the outer
membrane of the cell wall. On solid media they may synthesize numerous lateral flagella which are not
sheathed.

Vibrios are one of the most common organisms in surface waters of the world. They occur in both
marine and freshwater habitats and in associations with aquatic animals. Some species are
bioluminescent and live in mutualistic associations with fish and other marine life. Other species are
pathogenic for fish, eels, and frogs, as well as other vertebrates and invertebrates.

V. cholerae and V. parahaemolyticus are pathogens of humans. Both produce diarrhea, but in ways that
are entirely different. V. parahaemolyticus is an invasive organism affecting primarily the colon; V.
cholerae is noninvasive, affecting the small intestine through secretion of an enterotoxin. Vibrio
vulnificus is an emerging pathogen of humans. This organism causes wound infections, gastroenteritis,
or a syndrome known as "primary septicemia."

Campylobacter jejuni (formerly Vibrio fetus), is now moved to the class Epsilonproteobacteria in the
the family Campylobacteraceae. Campylobacter jejuni has been associated with dysentery-like
gastroenteritis, as well as with other types of infection, including bacteremic and central nervous
system infections in humans. Another vibrio-like organism, Helicobacter pylori causes duodenal and
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gastric ulcers and gastric cancer. It is also reclassified into the class Epsilonproteobacteria family
Helicobacteraceae.

Cholera

Vibrio cholerae

Cholera (frequently called Asiatic cholera or epidemic cholera) is a severe diarrheal disease caused
by the bacterium Vibrio cholerae. Transmission to humans is by water or food. The natural reservoir of
the organism is not known. It was long assumed to be humans, but some evidence suggests that it is the
aquatic environment.

V. cholerae produces cholera toxin, the model for enterotoxins, whose action on the mucosal
epithelium is responsible for the characteristic diarrhea of the disease cholera. In its extreme
manifestation, cholera is one of the most rapidly fatal illnesses known. A healthy person may become
hypotensive within an hour of the onset of symptoms and may die within 2-3 hours if no treatment is
provided. More commonly, the disease progresses from the first liquid stool to shock in 4-12 hours,
with death following in 18 hours to several days.

The clinical description of cholera begins with sudden onset of massive diarrhea. The patient may lose
gallons of protein-free fluid and associated electrolytes, bicarbonates and ions within a day or two. This
results from the activity of the cholera enterotoxin which activates the adenylate cyclase enzyme in the
intestinal cells, converting them into pumps which extract water and electrolytes from blood and tissues
and pump it into the lumen of the intestine. This loss of fluid leads to dehydration, anuria, acidosis and
shock. The watery diarrhea is speckled with flakes of mucus and epithelial cells ("rice-water stool")
and contains enormous numbers of vibrios. The loss of potassium ions may result in cardiac
complications and circulatory failure. Untreated cholera frequently results in high (50-60%) mortality
rates.

Treatment of cholera involves the rapid intravenous replacement of the lost fluid and ions. Following
this replacement, administration of isotonic maintenance solution should continue until the diarrhea
ceases. If glucose is added to the maintenance solution it may be administered orally, thereby
eliminating the need for sterility and iv. administration. By this simple treatment regimen, patients on
the brink of death seem to be miraculously cured and the mortality rate of cholera can be reduced more
than ten-fold. Most antibiotics and chemotherapeutic agents have no value in cholera therapy, although
a few (e.g. tetracyclines) may shorten the duration of diarrhea and reduce fluid loss.

History and spread of epidemic cholera

Cholera has smoldered in an endemic fashion on the Indian subcontinent for centuries. There are
references to deaths due to dehydrating diarrhea dating back to Hippocrates and Sanskrit writings.
Epidemic cholera was described in 1563 by Garcia del Huerto, a Portuguese physician at Goa, India.
The mode of transmission of cholera by water was proven in 1849 by John Snow, a London physician.
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In 1883, Robert Koch successfully isolated the cholera vibrio from the intestinal discharges of cholera
patients and proved conclusively that it was the agent of the disease.

The first long-distance spread of cholera to Europe and the Americas began in 1817, such that by the
early 20th century, six waves of cholera had spread across the world in devastating epidemic fashion.
Since then, until the 1960s, the disease contracted, remaining present only in southern Asia. In 1961,
the "El Tor" biotype (distinguished from classic biotypes by the production of hemolysins) reemerged
and produced a major epidemic in the Philippines to initiate a seventh global pandemic (See map
below). Since then, this biotype has spread across Asia, the Middle East, Africa, and parts of Europe.

There are several characteristics of the El Tor strain that confer upon it a high degree of "epidemic
virulence" allowing it to spread across the world as previous strains have done. First, the ratio of cases
to carriers is much less than in cholera due to classic biotypes (1: 30-100 for El Tor vs. 1: 2 - 4 for
"classic" biotypes). Second, the duration of carriage after infection is longer for the El Tor strain than
the classic strains. Third, the El Tor strain survives for longer periods in the extraintestinal
environment. Between 1969 and 1974, El Tor replaced the classic strains in the heartland of endemic
cholera, the Ganges River Delta of India.

The global spread of cholera during the seventh pandemic, 1961-1971. (CDC)

El Tor broke out explosively in Peru in 1991 (after an absence of cholera there for 100 years), and
spread rapidly in Central and South America, with recurrent epidemics in 1992 and 1993. From the
onset of the epidemic in January 1991 through September 1, 1994, a total of 1,041,422 cases and 9,642
deaths (overall case-fatality rate: 0.9%) were reported from countries in the Western Hemisphere to the
Pan American Health Organization. In 1993, the numbers of reported cases and deaths were 204,543
and 2362, respectively.

In 1982, in Bangladesh, a classic biotype resurfaced with a new capacity to produce more severe
illness, and it rapidly replaced the El Tor strain which was thought to be well-entrenched. This classic
strain has not yet produced a major outbreak in any other country.

In December, 1992, a large epidemic of cholera began in Bangladesh, and large numbers of people
have been involved. The organism has been characterized as V. cholerae O139 "Bengal". It is derived
genetically from the El Tor pandemic strain but it has changed its antigenic structure such that there is
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no existing immunity and all ages, even in endemic areas, are susceptible. The epidemic has continued
to spread. and V. choleraeO139 has affected at least 11 countries in southern Asia. Specific totals for
numbers of V. cholerae O139 cases are unknown because affected countries do not report infections
caused by O1 and O139 separately.

In April 1997, a cholera outbreak occurred among 90,000 Rwandan refugees residing in temporary
camps in the Democratic Republic of Congo. During the first 22 days of the outbreak, 1521 deaths
were recorded, most of which occurred outside of health-care facilities.

In the United States, cholera was prevalent in the 1800s but has been virtually eliminated by modern
sewage and water treatment systems. However, as a result of improved transportation, more persons
from the United States travel to parts of Latin America, Africa, or Asia where epidemic cholera is
occurring. U.S. travelers to areas with epidemic cholera may be exposed to the bacterium. In addition,
travelers may bring contaminated seafood back to the United States. A few foodborne outbreaks have
been caused by contaminated seafood brought into this country by travelers. Greater than 90 percent of
the cases of cholera in the U.S. have been associated with foreign travel.

V. choleraemay also live in the environment in brackish rivers and coastal waters. Shellfish eaten raw
have been a source of cholera, and a few persons in the United States have contracted cholera after
eating raw or undercooked shellfish from the Gulf of Mexico.

Antigenic Variation and LPS Structure in Vibrio cholerae

Antigenic variation plays an important role in the epidemiology and virulence of cholera. The
emergence of the Bengal strain, mentioned above, is an example. The flagellar antigens of V. cholerae
are shared with many water vibrios and therefore are of no use in distinguishing strains causing
epidemic cholera. O antigens, however, do distinguish strains of V. cholerae into 139 known serotypes.
Almost all of these strains of V. cholerae are nonvirulent. Until the emergence of the Bengal strain
(which is "non-O1") a single serotype, designated O1, has been responsible for epidemic cholera.
However, there are three distinct O1 biotypes, named Ogawa, Inaba and Hikojima, and each biotype
may display the "classical" or El Tor phenotype. The Bengal strain (O139) is a new serological strain
with a unique O-antigen which partly explains the lack of residual immunity.

Antigenic Determinants of Vibrio cholerae

Serotype O Antigens
Ogawa A, B
Inaba A, C
Hikojima A, B, C

Endotoxin is present in Vibrio cholerae as in other Gram-negative bacteria. Fewer details of the
chemical structure of Vibrio cholerae LPS are known than in the case of E. coli and Salmonella, but
some unique properties have been described. Most importantly, variations in LPS occur in vivo and in
vitro, which may be correlated with reversion in nature of nonepidemic strains to classic epidemic
strains and vice versa.

Cholera Toxin

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Cholera toxin activates the adenylate cyclase enzyme in cells of the intestinal mucosa leading to
increased levels of intracellular cAMP, and the secretion of H20, Na+, K+, Cl-, and HCO3- into the
lumen of the small intestine. The effect is dependent on a specific receptor, monosialosyl ganglioside
(GM1 ganglioside) present on the surface of intestinal mucosal cells. The bacterium produces an
invasin, neuraminidase, during the colonization stage which has the interesting property of degrading
gangliosides to the monosialosyl form, which is the specific receptor for the toxin.

The toxin has been characterized and contains 5 binding (B) subunits of 11,500 daltons, an active
(A1) subunit of 23,500 daltons, and a bridging piece (A2) of 5,500 daltons that links A1 to the 5B
subunits. Once it has entered the cell, the A1 subunit enzymatically transfers ADP ribose from NAD to
a protein (called Gs or Ns), that regulates the adenylate cyclase system which is located on the inside of
the plasma membrane of mammalian cells.

Enzymatically, fragment A1 catalyzes the transfer of the ADP-ribosyl moiety of NAD to a component
of the adenylate cyclase system. The process is complex. Adenylate cyclase (AC) is activated normally
by a regulatory protein (GS) and GTP; however activation is normally brief because another regulatory
protein (Gi), hydrolyzes GTP. The normal situation is described as follows.

The A1 fragment catalyzes the attachment of ADP-Ribose (ADPR) to the regulatory protein forming
Gs-ADPR from which GTP cannot be hydrolyzed. Since GTP hydrolysis is the event that inactivates
the adenylate cyclase, the enzyme remains continually activated. This situation can be illustrated as
follows.

Thus, the net effect of the toxin is to cause cAMP to be produced at an abnormally high rate which
stimulates mucosal cells to pump large amounts of Cl- into the intestinal contents. H2O, Na+ and other
electrolytes follow due to the osmotic and electrical gradients caused by the loss of Cl-. The lost H2O
and electrolytes in mucosal cells are replaced from the blood. Thus, the toxin-damaged cells become

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pumps for water and electrolytes causing the diarrhea, loss of electrolytes, and dehydration that are
characteristic of cholera.

Mechanism of action of cholera enterotoxin according to Finkelstein in Baron, Chapter 24. Cholera toxin
approaches target cell surface. B subunits bind to oligosaccharide of GM1 ganglioside. Conformational alteration of
holotoxin occurs, allowing the presentation of the A subunit to cell surface. The A subunit enters the cell. The
disulfide bond of the A subunit is reduced by intracellular glutathione, freeing A1 and A2. NAD is hydrolyzed by A1,
yielding ADP-ribose and nicotinamide. One of the G proteins of adenylate cyclase is ADP-ribosylated, inhibiting the
action of GTPase and locking adenylate cyclase in the "on" mode.

Colonization of the Small Intestine

There are several characteristics of pathogenic V. cholerae that are important determinants of the
colonization process. These include adhesins, neuraminidase, motility, chemotaxis and toxin

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production. If the bacteria are able to survive the gastric secretions and low pH of the stomach, they are
well adapted to survival in the small intestine. V. cholerae is resistant to bile salts and can penetrate the
mucus layer of the small intestine, possibly aided by secretion of neuraminidase and proteases
(mucinases). They withstand propulsive gut motility by their own swimming ability and chemotaxis
directed against the gut mucosa.

Specific adherence of V. cholerae to the intestinal mucosa is probably mediated by long filamentous
fimbriae that form bundles at the poles of the cells. These fimbriae have been termed Tcp pili (for
toxin coregulated pili), because expression of these pili genes is coregulated with expression of the
cholera toxin genes. Not much is known about the interaction of Tcp pili with host cells, and the host
cell receptor for these fimbriae has not been identified. Tcp pili share amino acid sequence similarity
with N-methylphenylalanine pili of Pseudomonas and Neisseria.

Two other possible adhesins in V. cholerae are a surface protein that agglutinates red blood cells
(hemagglutinin) and a group of outer membrane proteins which are products of the acf (accessory
colonization factor) genes. acf mutants have been shown to have reduced ability to colonize the
intestinal tract. It has been suggested that V. cholerae might use these nonfimbrial adhesins to mediate
a tighter binding to host cells than is attainable with fimbriae alone.

V. cholerae produces a protease originally called mucinase that degrades different types of protein
including fibronectin, lactoferrin and cholera toxin itself. Its role in virulence is not known but it
probably is not involved in colonization since mutations in the mucinase gene (designated hap for
hemagglutinin protease) do not exhibit reduced virulence. It has been suggested that the mucinase
might contribute to detachment rather than attachment. Possibly the vibrios would need to detach from
cells that are being sloughed off of the mucosa in order to reattach to newly formed mucosal cells.

Genetic Organization and Regulation of Virulence Factors in Vibrio cholerae

In Vibrio cholerae, the production of virulence factors is regulated at several levels. Regulation of
genes at the transcriptional level, especially the genes for toxin production and fimbrial synthesis, has
been studied in the greatest detail.

V. cholerae enterotoxin is a product of ctx genes. ctxA encodes the A subunit of the toxin, and ctxB
encodes the B subunit. The genes are part of the same operon. The transcript (mRNA) of the ctx operon
has two ribosome binding sites (rbs), one upstream of the A coding region and another upstream of the
B coding region. The rbs upstream of the B coding region is at least seven-times stronger than the rbs
of the A coding region. In this way the organism is able to translate more B proteins than A proteins,
which is required to assemble the toxin in the appropriate 1A: 5B proportion. The components are
assembled in the periplasm after translation. Any extra B subunits can be excreted by the cell, but A
must be attached to 5B in order to exit the cell. Intact A subunit is not enzymatically active, but must be
nicked to produce fragments A1 and A2 which are linked by a disulfide bond. Once the cholera toxin
has bound to the GM1 receptor on host cells, the A1 subunit is released from the toxin by reduction of
the disulfide bond that links it to A2, and enters the cell by an unknown translocation mechanism. One
hypothesis is that the 5 B subunits form a pore in the host cell membrane through which the A1 unit
passes.

Transcription of the ctxAB operon is regulated by a number of environmental signals, including

temperature, pH, osmolarity, and certain amino acids. Several other V. cholerae genes are coregulated
in the same manner including the tcp operon, which is concerned with fimbrial synthesis and assembly.

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Thus the ctx operon and the tcp operon are part of a regulon, the expression of which is controlled by
the same environmental signals.

The proteins involved in control of this regulon expression have been identified as ToxR, ToxS and
ToxT. ToxR is a transmembranous protein with about two-thirds of its amino terminal part exposed to
the cytoplasm. ToxR dimers, but not ToxR monomers, will bind to the operator region of ctxAB operon
and activate its transcription. ToxS is a periplasmic protein. It is thought that ToxS can respond to
environmental signals, change conformation, and somehow influence dimerization of ToxR which
activities transcription of the operon. ToxR and ToxS appear to form a standard two-component
regulatory system with ToxS functioning as a sensor protein that phosphorylates and thus converts
ToxR to its active DNA binding form. ToxT is a cytoplasmic protein that is a transcriptional activator
of the tcp operon. Expression of ToxT is activated by ToxR, while ToxT, in turn, activates transcription
of tcp genes for synthesis of tcp pili.

Thus, the ToxR protein is a regulatory protein which functions as an inducer in a system of positive
control. Tox R is thought to interact with ToxS in order to sense some change in the environment and
transmit a molecular signal to the chromosome which induces the transcription of genes for attachment
(pili formation) and toxin production. It is reasonable to expect that the environmental conditions that
exist in the GI tract (i.e., 37o temperature, low pH, high osmolarity, etc.), as opposed to conditions in
the extraintestinal (aquatic) environment of the vibrios, are those that are necessary to induce formation
of the virulence factors necessary to infect. However, there is conflicting experimental evidence in this
regard, which leads to speculation of the ecological function of the toxin during human infection.

Immunity to Cholera

Infection with V. cholerae results in a spectrum of responses ranging from life-threatening secretory
diarrhea to mild or unapparent infections of no manifestation except a serologic response. The reasons
for these differences are not known. One idea is that individuals differ in the availability of intestinal
receptors for cholera vibrios or for their toxin, but this has not been proven. Prior immunologic
experience is certainly a major factor. For example, in heavily endemic regions such as Bangladesh, the
attack rate is relatively low among adults in comparison with children.

After natural infection by V. cholerae, circulating antibodies can be detected against several cholera
antigens including the toxin, somatic (O) antigens, and flagellar (H) antigens. These antibodies are also
raised by parenteral injection of antigens as vaccine components. Antibodies directed against Vibrio O
antigens are considered "vibriocidal" antibodies because they will lyse V. cholerae cells in the presence
of complement and serum components. Vibriocidal antibodies reach a peak 8-10 days after the onset of
clinical illness, and then decrease, returning to the baseline 2 - 7 months later. Their presence correlates
with resistance to infection, but they may not be the mediators of this protection, and the role of
circulating antibodies in natural infection is unclear.

After natural infection, people also develop toxin-neutralizing antibodies butthere is no correlation
between antitoxic antibody levels and the incidence of disease in cholera zones.

Since cholera is essentially a topical disease of the small intestine, it would seem that topical defense
might be a main determinant of protection against infection by V. cholerae. Recurrent infections of
cholera are in fact, rare, and this is probably due to local immune defense mediated by antibodies
secreted onto the surfaces of the intestinal mucosa. Moreover, in children who are nursing cholera is
less likely to occur, presumably due to protection afforded by secretory antibody in mother's milk.

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Secretory IgA, as well as IgG and IgM in serum exudate, can be detected in the intestinal mucosa of
immune individuals. Although these antibodies presumably have to function in the absence of
complement they still bring about protective immunity. Motility is important in pathogenesis, and
antibodies against flagella could immobilize the vibrios. Antibodies against flagella or somatic O
antigens could cause clumping and arrested motion of cells. Antitoxic antibodies could react with toxin
at the epithelial cell surface and block binding or activity of the the toxin. Since the process by which
the vibrios attach to the intestinal epithelium is highly specific, antibodies against Vibrio fimbriae or
other surface components (LPS?) could block attachment.

The observation that natural infection confers effective and long-lasting immunity against cholera has
led to efforts to develop a vaccine which will elicit protective immunity. The first attempts at a vaccine
in 1960s were directed at whole cell preparations injected parenterally. At best, 90% protection was
achieved and this immunity waned rapidly to the baseline within one year. Purified LPS fractions from
different biotypes have also been given as vaccines with variable success. The cholera toxin can be
converted to toxoid in the presence of formalin and glutaraldehyde. The toxoid is a poor antigen,
however, and it elicits a very low level of protection.

At the present time, the manufacture and sale of the only licensed cholera vaccine in the United States
has been discontinued. Two recently developed oral vaccines for cholera are licensed and available in
other countries (Dukoral®, Biotec AB and Mutacol®, Berna). Both vaccines appear to
provide somewhat better immunity and fewer side-effects than the previously available vaccine.
However, neither of these two vaccines is recommended for travelers nor are they available in the
United States. Nor are the vaccines recommended for inhabitants of regions where cholera is
entrenched, since their use may render complacency with regard to individual susceptibility to disease.
One of the vaccines also advertises protection against enterotoxigenic E. coli (ETEC) which produces a
toxin (LT) identical to cholera toxin, and which is an important cause of traveller's diarrhea.

The oral vaccines are made from a live attenuated strains of V. cholerae.The ideal properties of such a
"vaccine strain" of the bacterium would be to possess all the pathogenicity factors required for
colonization of the small intestine (e.g. motility, fimbriae, neuraminidase, etc.) but not to produce a
complete toxin molecule. Ideally it should produce only the B subunit of the toxin which would
stimulate formation of antibodies that could neutralize the binding of the native toxin molecule to
epithelial cells.

A new vaccine has been developed to combat the Vibrio cholerae Bengal strain that has started
spreading in epidemic fashion in the Indian subcontinent and Southeast Asia. The Bengal strain differs
from previously isolated epidemic strains in that it is serogroup 0139 rather than 01, and it expresses a
distinct polysaccharide capsule. Since previous exposure to 01 Vibrio cholerae does not provide
protective immunity against 0139, there is no residual immunity in the indigenous population to the
Bengal form of cholera.

The noncellular vaccine is relatively nontoxic and contains little or no LPS and other impurities. The
vaccine will be used for active immunization against Vibrio cholerae O139 and other bacterial species
expressing similar surface polysaccharides. In addition, human or other antibodies induced by this
vaccine could be used to identify Vibrio cholerae Bengal for the diagnosis of the infection and for
environmental monitoring of the bacterium.

Cholera References and Links

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Baron Medical Microbiology Textbook
Cholera, Vibrio cholerae O1 and O139, and Other Pathogenic Vibrios by Richard A. Finkelstein

World Health Organization

Cholera

CDC
Cholera
Travelers' Health Information on Cholera

FDA Bad Bug Book

Vibrio cholerae Serogroup O1

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 Todar's Online Textbook of Bacteriology

Salmonella and salmonellosis

© 2005 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

Salmonella enterica

Salmonella is a Gram-negative facultative rod-shaped bacterium in the same proteobacterial family as

Escherichia coli, the family Enterobacteriaceae, trivially known as "enteric" bacteria. Salmonella is
nearly as well-studied as E. coli from a structural, biochemical and molecular point of view, and as
poorly understood as E. coli from an ecological point of view. Salmonellae live in the intestinal tracts
of warm and cold blooded animals. Some species are ubiquitous. Other species are specifically adapted
to a particular host. In humans, Salmonella are the cause of two diseases called salmonellosis: enteric
fever (typhoid), resulting from bacterial invasion of the bloodstream, and acute gastroenteritis,
resulting from a foodborne infection/intoxication.

Discovery of the Typhoid Bacillus

At the beginning of the 19th century, typhoid was defined on the basis of clinical signs and symptoms
and pathological (anatomical) changes. However, at this time, all sorts of enteric fevers were
characterized as "typhoid".

In 1880s, the typhoid bacillus was first observed by Eberth in spleen sections and mesenteric lymph
nodes from a patient who died from typhoid. Robert Koch confirmed a related finding by Gaffky and
succeeded in cultivating the bacterium in 1881. But due to the lack of differential characters, separation
of the typhoid bacillus from other enteric bacteria was uncertain.

In 1896, it was demonstrated that the serum from an animal immunized with the typhoid bacillus
agglutinated (clumped) the typhoid bacterial cells, and it was shown that the serum of patients afflicted
with typhoid likewise agglutinated the typhoid bacillus. Serodiagnosis of typhoid was thus made
possible by 1896.

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Figure 1. Salmonella typhi, the agent of typhoid. Gram stain. (CDC)

Salmonella Nomenclature

The genus Salmonella is a member of the family Enterobacteriaceae, It is composed of bacteria

related to each other both phenotypically and genotypically. Salmonella DNA base composition is 50-
52 mol% G+C, similar to that of Escherichia, Shigella, and Citrobacter. The bacteria of the genus
Salmonella are also related to each other by DNA sequence. The genera with DNA most closely related
to Salmonella are Escherichia, Shigella, and Citrobacter. Similar relationships were found by
numerical taxonomy and 16S ssRNA analysis.

Salmonella nomenclature has been controversial since the original taxonomy of the genus was not
based on DNA relatedness, rather names were given according to clinical considerations, e.g.,
Salmonella typhi, Salmonella cholerae-suis, Salmonella abortus-ovis, and so on. When serological
analysis was adopted into the Kauffmann-White scheme in 1946, a Salmonella species was defined as
"a group of related fermentation phage-type" with the result that each Salmonella serovar was
considered as a species. Since the host-specificity suggested by some of these earlier names does not
exist (e.g., S. typhi-murium, S. cholerae-suis are in fact ubiquitous), names derived from the
geographical origin of the first isolated strain of the newly discovered serovars were next chosen, e.g.,
S. london, S. panama, S. stanleyville.

Susequently it was found that all Salmonella serovars form a single DNA hybridization group, i.e., a
single species composed of seven subspecies, and thenomenclature had to be adapted. To avoid
confusion with the familiar names of serovars, the species name Salmonella enterica was proposed
with the following names for the subspecies:
enterica I
salamae II
arizonae IIIa
diarizonae IIIb
houtenae IV
bongori V
indica VI
Each subspecies contains various serovars defined by a characteristic antigenic formula.

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Since this formal Latin nomenclature may not be clearly understood by physicians and epidemiologists,
who are the most familiar with the names given to the most common serovars, the common serovars
names are kept for subspecies I strains, which represent more than 99.5% of the Salmonella strains
isolated from humans and other warm-blooded animals. The vernacular terminology seems preferred in
medical practice, e.g., Salmonella ser. Typhimurium (not italicized) or shorter Salmonella (or S.)
Typhimurium.

Antigenic Structure

As with all Enterobacteriaceae, the genus Salmonella has three kinds of major antigens with diagnostic
or identifying applications: somatic, surface, and flagellar.

Somatic (O) or Cell Wall Antigens

Somatic antigens are heat stable and alcohol resistant. Cross-absorption studies individualize a large
number of antigenic factors, 67 of which are used for serological identification. O factors labeled with
the same number are closely related, although not always antigenically identical.

Surface (Envelope) Antigens

Surface antigens, commonly observed in other genera of enteric bacteria (e.g., Escherichia coli and
Klebsiella), may be found in some Salmonella serovars. Surface antigens in Salmonella may mask O
antigens, and the bacteria will not be agglutinated with O antisera. One specific surface antigen is well
known: the Vi antigen. The Vi antigen occurs in only three Salmonella serovars (out of about 2,200):
Typhi, Paratyphi C, and Dublin. Strains of these three serovars may or may not have the Vi antigen.

Flagellar (H) Antigens

Flagellar antigens are heat-labile proteins. Mixing salmonella cells with flagella-specific antisera gives
a characteristic pattern of agglutination (bacteria are loosely attached to each other by their flagella and
can be dissociated by shaking). Also, antiflagellar antibodies can immobilize bacteria with
corresponding H antigens.

A few Salmonella entericaserovars (e.g., Enteritidis, Typhi) produce flagella which always have the
same antigenic specificity. Such an H antigen is then called monophasic. Most Salmonella serovars,
however, can alternatively produce flagella with two different H antigenic specificities. The H antigen
is then called diphasic. For example, Typhimurium cells can produce flagella with either antigen i or
antigen 1,2. If a clone is derived from a bacterial cell with H antigen i, it will consist of bacteria with i
flagellar antigen. However, at a frequency of 10-3- 10-5, bacterial cells with 1,2 flagellar antigen pattern
will appear in this clone.

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Figure 2. Flagellar stain of a Salmonella Typhi. Like E. coli, Salmonella are motile by means of peritrichous flagella.
A close relative that causes enteric infections is the bacterium Shigella. Shigella is not motile, and therefore it can be
differentiated from Salmonella on the bais of a motility test or a flagellar stain. (CDC)

Habitats

The principal habitat of the salmonellae is the intestinal tract of humans and animals. Salmonella
serovars can be found predominantly in one particular host, can be ubiquitous, or can have an unknown
habitat. Typhi and Paratyphi A are strictly human serovars that may cause grave diseases often
associated with invasion of the bloodstream. Salmonellosis in these cases is transmitted through fecal
contamination of water or food. Gallinarum, Abortusovis, and Typhisuis are, respectively, avian,
ovine, and porcine Salmonella serovars. Such host-adapted serovars cannot grow on minimal medium
without growth factors (contrary to the ubiquitous Salmonella serovars).

Ubiquitous (non-host-adapted) Salmonella serovars (e.g., Typhimurium) cause very diverse clinical
symptoms, from asymptomatic infection to serious typhoid-like syndromes in infants or certain highly
susceptible animals (mice). In human adults, ubiquitous Salmonella organisms are mostly responsible
for foodborne toxic infections.

The pathogenic role of a number of Salmonella serovars is unknown. This is especially the case with
serovars from subspecies II to VI. A number of these serovars have been isolated rarely (some only
once) during a systematic search in cold-blooded animals.

Salmonella in the Natural Environment

Salmonellae are disseminated in the natural environment (water, soil, sometimes plants used as food)
through human or animal excretion. Humans and animals (either wild or domesticated) can excrete
Salmonella either when clinically diseased or after having had salmonellosis, if they remain carriers.
Salmonella organisms do not seem to multiply significantly in the natural environment (out of digestive
tracts), but they can survive several weeks in water and several years in soil if conditions of
temperature, humidity, and pH are favorable.

Isolation and Identification of Salmonella

A number of plating media have been devised for the isolation of Salmonella. Some media are
differential and nonselective, i.e., they contain lactose with a pH indicator, but do not contain any
inhibitor for non salmonellae (e.g., bromocresol purple lactose agar). Other media are differential and
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slightly selective, i.e., in addition to lactose and a pH indicator, they contain an inhibitor for
nonenterics (e.g., MacConkey agar and eosin-methylene blue agar).

The most commonly used media selective for Salmonella are SS agar, bismuth sulfite agar, Hektoen
enteric (HE) medium, brilliant green agar and xylose-lisine-deoxycholate (XLD) agar. All these media
contain both selective and differential ingredients and they are commercially available.

Figure 3. Salmonella sp. after 24 hours growth on XLD agar. Xylose Lysine (XL) agar is used when trying to culture
and isolate Gram-negative enteric bacilli. When XL agar is supplemented with sodium thiosulfate, ferric ammonium
citrate, and sodium deoxycholate, it is then termed XLD agar, and is then an even more selective medium than XL
alone. The presence of any black colored area indicates the deposition of hydrogen sulfide, (H2S) under alkaline
conditions. (CDC)

Media used for Salmonella identification are those used for identification of all Enterobacteriaceae.
Most Salmonella strains are motile with peritrichous flagella, however, nonmotile variants may occur
occasionally. Most strains grow on nutrient agar as smooth colonies, 2-4 mm in diameter. Most strains

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are prototrophs, not requiring any growth factors. However, auxotrophic strains do occur, especially in
host-adapted serovars such as Typhi and Paratyphi A.

Figure 4. Colonial growth Salmonella choleraesuis subsp. arizonae bacteria grown on a blood agar culture plate.
Also known as Salmonella Arizonae, it is a zoonotic bacterium that can infect humans, birds, reptiles, and other
animals. (CDC)

Table 1. Characteristics shared by most Salmonella strains belonging to subspecies I

Motile, Gram-negative bacteria

Lactose negative; acid and gas from glucose, mannitol, maltose, and sorbitol; no Acid from
adonitol, sucrose, salicin, lactose
ONPG test negative (lactose negative)
Indole test negative
Methyl red test positive
Voges-Proskauer test negative
Citrate positive (growth on Simmon's citrate agar)
Lysine decarboxylase positive
Urease negative
Ornithine decarboxylase positive
H2S produced from thiosulfate
Do not grow with KCN
Phenylalanine and tryptophan deaminase negative
Gelatin hydrolysis negative
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 Figure 5. Colonial growth pattern displayed by Salmonella Typhimurium cultured on a Hektoen enteric (HE) agar.
S. Typhimurium colonies grown on HE agar are blue-green in color indcating that the bacterium does not ferment
lactose However it does produce hydrogen sulfide, (H2S), as indicated by black deposits in the centers of the colonies.
(CDC)
HE agar is the medium designed for the isolation and recovery of fecal bacteria belonging to the family,
Enterbacteriaceae. S.Typhimurium causes 25% of the 1.4 million salmonellosis infections a year in the United States.
Most persons infected with Salmonella sp. develop diarrhea, fever, and abdominal cramps 12 - 72 hours after
infection. The illness usually lasts 4 - 7 days, and most people recover without treatment. However, in some cases, the
diarrhea may be so severe that the patient needs to be hospitalized.

Genetics of Salmonella

The genetic map of the Salmonella Typhimurium strain LT2 is not very different from that of
Escherichia coli K-12. The F plasmid can be transferred to Typhimurium, and an Hfr strain of
Typhimurium may subsequently be selected. Conjugative chromosomal transfer may occur from
Typhimurium Hfr to E. coli or from E. coli Hfr to Typhimurium. Chromosomal genes responsible for
O, Vi, and H antigens can be transferred from Salmonella to Escherichia.

Also, Salmonella may harbor temperate phages and plasmids. Plasmids in Salmonella may code for
antibiotic resistance (resistance plasmids are frequent due to the selective pressure of extensive
antibiotic therapy), bacteriocins, metabolic characteristics such as lactose or sucrose fermentation, or
antigenic changes of O antigen.

Pathogenesis of Salmomella Infections in Humans

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Salmonella infections in humans vary with the serovar, the strain, the infectious dose, the nature of the
contaminated food, and the host status. Certain serovars are highly pathogenic for humans; the
virulence of more rare serovars is unknown. Strains of the same serovar are also known to differ in
their pathogenicity. An oral dose of at least 105Salmonella Typhi cells are needed to cause typhoid in
50% of human volunteers, whereas at least 109 S. Typhimurium cells (oral dose) are needed to cause
symptoms of a toxic infection. Infants, immunosuppressed patients, and those affected with blood
disease are more susceptible to Salmonella infection than healthy adults.

In the pathogenesis of typhoid the bacteria enter the human digestive tract, penetrate the intestinal
mucosa (causing no lesion), and are stopped in the mesenteric lymph nodes. There, bacterial
multiplication occurs, and part of the bacterial population lyses. From the mesenteric lymph nodes,
viable bacteria and LPS (endotoxin) may be released into the bloodstream resulting in
septicemia Release of endotoxin is responsible for cardiovascular collapsus and tuphos (a stuporous
state origin of the name typhoid) due to action on the ventriculus neurovegetative centers.

Salmonella excretion by human patients may continue long after clinical cure. Asymptomatic carriers
are potentially dangerous when unnoticed. About 5% of patients clinically cured from typhoid remain
carriers for months or even years. Antibiotics are usually ineffective on Salmonella carriage (even if
salmonellae are susceptible to them) because the site of carriage may not allow penetration by the
antibiotic.

Salmonellae survive sewage treatments if suitable germicides are not used in sewage processing. In a
typical cycle of typhoid, sewage from a community is directed to a sewage plant. Effluent from the
sewage plant passes into a coastal river where edible shellfish (mussels, oysters) live. Shellfish
concentrate bacteria as they filter several liters of water per hour. Ingestion by humans of these
seafoods (uncooked or superficially cooked) may cause typhoid or other salmonellosis. Salmonellae do
not colonize or multiply in contaminated shellfish.

Typhoid is strictly a human disease.The incidence of human disease decreases when the level of
development of a country increases (i.e., controlled water sewage systems, pasteurization of milk and
dairy products). Where these hygienic conditions are missing, the probability of fecal contamination of
water and food remains high and so is the incidence of typhoid.

Foodborne Salmonella toxic infections are caused by ubiquitous Salmonella serovars (e.g.,
Typhimurium). About 12-24 hours following ingestion of contaminated food (containing a sufficient
number of Salmonella), symptoms appear (diarrhea, vomiting, fever) and last 2-5 days. Spontaneous
cure usually occurs.

Salmonella may be associated with all kinds of food. Contamination of meat (cattle, pigs, goats,
chicken, etc.) may originate from animal salmonellosis, but most often it results from contamination of
muscles with the intestinal contents during evisceration of animals, washing, and transportation of
carcasses. Surface contamination of meat is usually of little consequence, as proper cooking will
sterilize it (although handling of contaminated meat may result in contamination of hands, tables,
kitchenware, towels, other foods, etc.). However, when contaminated meat is ground, multiplication of
Salmonella may occur within the ground meat and if cooking is superficial, ingestion of this highly
contaminated food may produce a Salmonellainfection. Infection may follow ingestion of any food that
supports multiplication of Salmonella such as eggs, cream, mayonnaise, creamed foods, etc.), as a large
number of ingested salmonellae are needed to give symptoms. Prevention of Salmonella toxic infection
relies on avoiding contamination (improvement of hygiene), preventing multiplication of Salmonella in
food (constant storage of food at 4°C), and use of pasteurized and sterilized milk and milk products.
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Vegetables and fruits may carry Salmonella when contaminated with fertilizers of fecal origin, or when
washed with polluted water.

The incidence of foodborne Salmonella infection/toxication remains reletavely high in developed

countries because of commercially prepared food or ingredients for food. Any contamination of
commercially prepared food will result in a large-scale infection. In underdeveloped countries,
foodborne Salmonella intoxications are less spectacular because of the smaller number of individuals
simultaneously infected, but also because the bacteriological diagnosis of Salmonella toxic infection
may not be available. However, the incidence of Salmonella carriage in underdeveloped countries is
known to be high.

Salmonella epidemics may occur among infants in pediatric wards. The frequency and gravity of these
epidemics are affected by hygienic conditions, malnutrition, and the excessive use of antibiotics that
select for multiresistant strains.

Salmonella Enteritidis Infection

Egg-associated salmonellosis is an important public health problem in the United States and several
European countries. Salmonella Enteritidis, can be inside perfectly normal-appearing eggs, and if the
eggs are eaten raw or undercooked, the bacterium can cause illness. During the 1980s, illness related to
contaminated eggs occurred mosy frequently in the northeastern United States, but now illness caused
by S. Enteritidis is increasing in other parts of the country as well.

Unlike eggborne salmonellosis of past decades, the current epidemic is due to intact and disinfected
grade A eggs. Salmonella Enteritidis silently infects the ovaries of healthy appearing hens and
contaminates the eggs before the shells are formed. Most types of Salmonella live in the intestinal
tracts of animals and birds and are transmitted to humans by contaminated foods of animal origin.
Stringent procedures for cleaning and inspecting eggs were implemented in the 1970s and have made
salmonellosis caused by external fecal contamination of egg shells extremely rare. However, unlike
eggborne salmonellosis of past decades, the current epidemic is due to intact and disinfected grade A
eggs. The reason for this is that Salmonella Enteritidis silently infects the ovaries of hens and
contaminates the eggs before the shells are formed.

Although most infected hens have been found in the northeastern United States, the infection also
occurs in hens in other areas of the country. In the Northeast, approximately one in 10,000 eggs may be
internally contaminated. In other parts of the United States, contaminated eggs appear less common.
Only a small number of hens seem to be infected at any given time, and an infected hen can lay many
normal eggs while only occasionally laying an egg contaminated with Salmonella Enteritidis.

A person infected with the Salmonella Enteritidis usually has fever, abdominal cramps, and diarrhea
beginning 12 to 72 hours after consuming a contaminated food or beverage. The illness usually lasts 4
to 7 days, and most persons recover without antibiotic treatment. However, the diarrhea can be severe,
and the person may be ill enough to require hospitalization. The elderly, infants, and those with
impaired immune systems (including HIV) may have a more severe illness. In these patients, the
infection may spread from the intestines to the bloodstream, and then to other body sites and can cause
death unless the person is treated promptly with antibiotics.

Exotoxins

Salmonella strains may produce a thermolabile enterotoxin that bears a limited relatedness to cholera
toxin both structurally and antigenically. This enterotoxin causes water secretion in rat ileal loop and is
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recognized by antibodies against both cholera toxin and the thermolabile enterotoxin (LT) of
enterotoxinogenic E. coli, but it does not bind in vitro to ganglioside GM1 (the receptor for E. coli LT
and cholera ctx). Additionally, a cytotoxin that inhibits protein synthesis and is immunologically
distinct from Shiga toxin has been demonstrated. Both of these toxins are presumed to play a role in the
diarrheal symptoms of salmonellosis.

Antibiotic Susceptibility

During the last decade, antibiotic resistance and multiresistance of Salmonella spp. have increased a
great deal. The cause appears to be the increased and indiscriminate use of antibiotics in the treatment
of humans and animals and the addition of growth-promoting antibiotics to the food of breeding
animals. Plasmid-borne antibiotic resistance is very frequent among Salmonella strains involved in
pediatric epidemics (e.g., Typhimurium, Panama, Wien, Infantis). Resistance to ampicillin,
streptomycin, kanamycin, chloramphenicol, tetracycline, and sulfonamides is commonly observed.
Colistin resistance has not yet been observed.

Until 1972, Typhi strains had remained susceptible to antibiotics, including chloramphenicol (the
antibiotic most commonly used against typhoid) but in 1972, a widespread epidemic in Mexico was
caused by a chloramphenicol-resistant strain of S. Typhi. Other chloramphenicol-resistant strains have
since been isolated in India, Thailand, and Vietnam. Possible importation or appearance of
chloramphenicol-resistance strains in the United States is a real threat. Salmonella strains should be
systematically checked for antibiotic resistance to aid in the choice of an efficient drug when needed
and to detect any change in antibiotic susceptibility of strains (either from animal or human source).
Indiscriminate distribution and use of antibiotics should be discouraged.

Vaccination Against Typhoid Fever

Three types of typhoid vaccines are currently available for use in the United States: (1) an oral live-
attenuated vaccine; (2) a parenteral heat-phenol-inactivated vaccine; (3) a newly licensed capsular
polysaccharide vaccine for parenteral use. A fourth vaccine, an acetone-inactivated parenteral vaccine,
is currently available only to the armed forces.

1. Live oral vaccines. Although oral killed vaccines are without efficacy, vaccines using living
avirulent bacteria have shown promise. A galactose-epimeraseless mutant of Typhi has given very
good results in a field trials. Mutants of Typhimurium that have given a good protection in animals
include mutants lacking adenylate-cyclase and AMP receptor protein, and mutants auxotrophic for p-
aminobenzoate and adenine.Typhi with the same mutations does not cause adverse reactions and is
immunogenic in human.

The Live Oral Typhoid Vaccine should not be given to children younger than 6 years of age. It is given
in four doses, 2 days apart, as needed for protection. The last dose should be given at least 1 week
before travel to allow the vaccine time to work. A booster dose is needed every 5 years for people who
remain at risk.

2. The parenteral heat-phenol-inactivated vaccine has been widely used for many years. In field trials
involving a primary series of two doses of heat-phenol- inactivated typhoid vaccine, efficacy over the
2- to 3-year follow-up periods ranged from 51% to 77% . Efficacy for the acetone- inactivated
parenteral vaccine, available only to the armed forces, ranges from 75% to 94%.

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Since the inactivated vaccines contain the O antigen (endotoxin), local and general reactions occur. Vi
antigen extracted following the methodology used for the meningococcal vaccine seems to avoid
reactions to endotoxin.

The inactivated Typhoid Vaccine should not be given to children younger than 2 years of age. One
dose provides protection. It should be given at least 2 weeks before travel to allow the vaccine time to
work. A booster dose is needed every 2 years for people who remain at risk.

3. The newly licensed parenteral vaccine [Vi capsular polysaccharide (ViCPS)] is composed of
purified Vi ("virulence") antigen, the capsular polysaccharide elaborated by S.Typhi isolated from
blood cultures. In recent studies, one 25-ug injection of purified ViCPS produced seroconversion (i.e.,
at least a fourfold rise in antibody titers) in 93% of healthy U.S. adults. Two field trials in disease-
endemic areas have demonstrated the efficacy of ViCPS in preventing typhoid fever. In one trial in
Nepal, in which vaccine recipients were observed for 20 months, one dose of ViCPS among persons 5-
44 years of age resulted in 74% fewer cases of typhoid fever. ViCPS has not been tested among
children less than 1 year of age.

NOTE: No typhoid vaccine is 100% effective and is not a substitute for being careful about what you
eat or drink.

Routine typhoid vaccination is not recommended in the United States, but typhoid vaccine is
recommended for travellers to parts of the world where typhoid is common, people in close contact
with a typhoid carriers, and laboratory workers who work with Salmonella Typhi bacteria.

Figure 6. Salmonella that has been cultured in a tetrathionate-enrichment broth, and stained using the direct
fluorescent-antibody (FA) technique. Tetrathionate-enrichment broth contains bile salts, thereby inhibiting the
439
growth of Gram-positive organisms, while the Gram-negative Salmonella sp., being an organism that possess the
enzyme tetrathionate reductase, is able to break down tetrathionate, and grow uninhibited. (CDC)

For more information on salmonella infections please see

CDC Salmonellosis
CDC Salmonella enteritidis
CDC Salmonella Infection (salmonellosis) and Animals
CDC Typhoid General information
CDC Typhoid traveller's information
CDC Typhoid vaccine: What You Need to Know
FDA/CFSAN Bad Bug Book - Salmonella spp
MedlinePlus Enteric fever
NOVA | The Most Dangerous Woman in America (Typhoid Mary)
Typhoid and paratyphoid fever (UK)
Typhoid Fever Utah Health Dept
Typhoid fever NY Communicable Disease Fact Sheet
WHO Salmonella
WHO Typhoid fever

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 Todar's Online Textbook of Bacteriology

Shigella and Shigellosis

© 2005 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

Shigella is a genus of the bacterial family Enterobacteriaceae. Shigellae are Gram-negative,

nonmotile, non-spore forming, rod-shaped bacteria, very closely related to Escherichia coli.

Shigellosis is an infectious disease caused by various species of Shigella. People infected with Shigella
develop diarrhea, fever, and stomach cramps starting a day or two after they are exposed to the
bacterium. The diarrhea is often bloody. Shigellosis usually resolves in 5 to 7 days, but in some
persons, especially young children and the elderly, the diarrhea can be so severe that the patient needs
to be hospitalized. A severe infection with high fever may also be associated with seizures in children
less than 2 years old. Some persons who are infected may have no symptoms at all, but may still
teansmit the Shigella bacteria to others.

Shigella were discovered over 100 years ago by a Japanese microbiologist named Shiga, for whom the
genus are named. There are four species of Shigella: boydii, dysenteriae, flexneri, and sonnei.
Shigella sonnei, also known as "Group D" Shigella, accounts for over two-thirds of the shigellosis in
the United States. Shigella flexneri, or "group B" Shigella, accounts for almost all of the rest. Other
types of Shigella are rare in this country, although they are important causes of disease in the
developing world. One type, Shigella dysenteriae type 1, causes deadly epidemics in many developing
regions and nations.

Diagnosis
Determining that Shigella is the cause of the illness depends on laboratory tests that identify the
bacteria in the stool of an infected person. Some of the tests may not be performed routinely, so the
bacteriology laboratory should be instructed to look for the organism. The laboratory can also do tests
to determine which type of Shigella is involved, and which antibiotics, if any, would be best for
treatment.

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Figure 1. Several media have been designed to selectively grow enteric bacteria and allow differentiation of
Salmonella and Shigella from E. coli. The primary plating media shown here are eosin methylene blue (EMB) agar,
MacConkey agar, ENDO agar, Hektoen enteric (HE) agar and Salmonella-Shigella (SS) agar.

Treatment
Shigellosis can usually be treated with antibiotics. The antibiotics commonly used are ampicillin,
trimethoprim/sulfamethoxazole (also known as Bactrim or Septra), nalidixic acid and the
fluoroquinolone, ciprofloxacin. Appropriate treatment kills the bacteria present in the gastrointestinal
tract and shortens the course of the illness.
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Some Shigella have become resistant to antibiotics and inappropriate use of antibiotics to treat
shigellosis can actually make the organisms more resistant in the future. Persons with mild infections
will usually recover quickly without antibiotic treatment. Therefore, when many persons in a
community are affected by shigellosis, antibiotics are sometimes used selectively to treat only the more
severe cases. Antidiarrheal agents such as loperamide (Imodium) or diphenoxylate with atropine
(Lomotil) are likely to make the illness worse and should be avoided.

Reiter's syndrome
Persons with diarrhea usually recover completely, although it may be several months before their
bowel habits are entirely normal. About 3% of persons who are infected with Shigella flexneri may
subsequently develop pains in their joints, irritation of the eyes, and painful urination. This condition is
called Reiter's syndrome. It can last for months or years, and can lead to chronic arthritis which is
difficult to treat. Reiter's syndrome is a late complication of S. flexneri infection, especially in persons
with a certain genetic predisposition, namely HLA-B27.

Hemolytic Uremic Syndrome (HUS)

Hemolytic-uremic syndrome (HUS) can occur after S. dysenteriae type 1 infection. Convulsions may
occur in children; the mechanism may be related to a rapid rate of temperature elevation or metabolic
alterations, and is associated with the production of the Shiga toxin, which is discussed below.

Transmission

Shigella are transmitted from an infected person to another who become infected. Shigella are present
in the diarrheal stools of infected persons while they are sick and for a week or two afterwards. Most
Shigella infections are the result of the bacterium passing from stools or soiled fingers of one person to
the mouth of another person. This happens when basic hygiene and handwashing habits are inadequate.
It is particularly likely to occur among toddlers who are not fully toilet-trained. Family members and
playmates of such children are at high risk of becoming infected. The spread of Shigella from an
infected person to other persons can be stopped by frequent and careful handwashing with soap, a
practice that is important among all age groups.

Part of the reason for the efficiency of transmission is because a very small inoculum (10 to 200
organisms) is sufficient to cause infection. As a result, spread can easily occur by the fecal-oral route
and occurs in areas where hygiene is poor. Epidemics may be foodborne or waterborne. Shigella can
also be transmitted by flies.

Shigella infections may be acquired from eating food that has become contaminated by infected food
handlers. Vegetables can become contaminated if they are harvested from a field with contaminated
sewage or wherein infected field workers defecate. Flies can breed in infected feces and then
contaminate food. Shigella infections can also be acquired by drinking or swimming in contaminated
water. Water may become contaminated if sewage runs into it, or even if someone with shigellosis
swims or bathes or, much less, defecates, in it.

Immunity and Vaccines

Once someone has had shigellosis, they are not likely to get infected with that specific type again for at
least several years. However, they can still get infected with other types of Shigella. Presumably, this
immunity is due to secretory IgA, although CMI may not be ruled out. Circulating antiboies can also be
detected in immune individuals.

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Currently, there is no vaccine to prevent shigellosis. However, since the virulence of Shigella is well-
understood, and considering the present art of vaccine development, it seems that vaccination should be
feasable.

OFF THE WALL

On the topic of vaccines, the following information is from the Walter Reed Army Institute of Research, Walter
Reed Army Institute of Research, Vaccines: The Best Revenge

"So far, the institute has four vaccines in the works. 'Ideally, the goal would be to have one vaccine that will protect
against multiple pathogens that can easily be given to deploying soldiers,' said Maj. David Katz, a senior clinical
investigator at WRAIR. 'So soldiers can take it before they deploy to an area, and they'll be protected.'

A vaccine to combat Shigella flexneri, called SC602, was developed along with The Institut Pasteur. Since 1992 it has
undergone clinical trials in the States and Bangladesh. 'The wonderful thing about the shigella vaccines is... the
bacteria (used in them) are alive but weakened to diminish the amount of symptoms,' Katz said. 'The body thinks it's
infected and gives an immune response, but you don't get infected like a natural infection because the bacteria don't
spread from cell to cell.'

Receiving the oral vaccine before deploying is key, Katz said. 'Most of the soldiers will get hit right when they arrive
in a new area, either because they're eating on the economy or they're in a new area and their system has not been
primed.'

'Another reason to give the vaccine ahead of time is because of potential side effects,' said Dr. Thomas Hale, Chief of
the Department of Enteric Infections at WRAIR. 'The vaccine can cause some short-term fevers and mild diarrhea
in 20 percent of the people who receive it, so soldiers need to take it well before they get on a plane.'

A vaccine for Shigella sonnei, which often attacks travelers and stateside daycare centers, is a possible stand alone
product, Hale said. 'This one vaccine could make a significant difference in the health of soldiers deployed to the
Middle East (where 90 percent of outbreaks occur) and the developing world.'

Drs. Malabi Venkatesan and Antoinette Hartman from WRAIR developed the oral vaccine, called WRSS1, that is
currently in clinical trials in conjunction with the University of Maryland Medical School and the National Institute
of Allergy and Infectious Diseases.

The Department of Enteric Infections at WRAIR has teamed up with the Israel Defense Force for a vaccine trial
evaluating WRSS1 this winter. 'Israel has cities that are very Westernized, but almost everyone has a compulsory
military obligation, so they go from cities to field posts and the incidence of diarrheal disease is significant,' Katz
said.

To combat the deadly form of diarrhea, dysentery--also called bloody diarrhea--WRAIR researchers are working
with the Bloomberg School of Public Health at Johns Hopkins University to test the oral Walter Reed Shigella-
Dysentery-1 vaccine, WRSD1.

The other diarrhea-causing bacteria WRAIR and the Navy Medical Research Unit researchers are trying to disable
is E. coli. Whereas shigella bacteria invades a cell's wall and moves from cell to cell to spread the disease, E. coli
prefers to stick to the intestine's lining, homestead and crank out toxins that cause diarrhea. To outsmart the
unwanted tenant, researchers are trying to make antibodies that will prevent squatters from colonizing because they
can't stick to the intestine. The vaccine's been tested in a time-release capsule form as well as a transdermal patch,

'It should be easy for the soldier to use: Just pop the patch on and that's it,' Katz said. Though having one vaccine to
combat all major forms of infectious diarrhea is a ways off, the quest to prevent soldiers from needing to run, trot
and quick step will be WRAIR researchers' best revenge on Montezuma."

Incidence and Risk of Infection

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Meanwhile, back in the USA, there are approximately 14,000 laboratory-confirmed cases of shigellosis
and an estimated 448,240 total cases (85% due to S. sonnei) that occur each year, according to CDC.
In the developing world, S.flexneri predominates. Epidemics of S. dysenteriae type 1 have occurred in
Africa and Central America with case fatality rates of 5-15%.

In the United States, groups at increased risk of shigellosis include children in child-care centers and
persons in custodial institutions, where personal hygiene is difficult to maintain; Native Americans;
orthodox Jews; international travelers; men who have sex with men; and those in homes with
inadequate water for handwashing.

Pathogenesis of Shigella flexneri

Shigella flexneri causes bacillary dysentery, the symptoms of which include abdominal pain, diarrhea,
fever, vomiting and blood or mucus in the stool. The bacteria are transmitted by the fecal-oral route,
and through contaminated food and water. Once ingested, the bacteria survive the gastric environment
of the stomach and move on to the large intestine. There, they attach to and penetrate the epithelial cells
of the intestinal mucosa. After invasion, they multiply intracellularly and spread to neighboring
epithelial cells, resulting in tissue destruction and characteristic pathology of shigellosis.

Entry of Shigella flexneri into Epithelial Cells

In order for S. flexneri to enter an epithelial cell, the bacterium must first adhere to its target cell. It is
then internalized by a process which is similar to the mechanism of phagocytosis. Generally, the
bacterium adheres to the membrane of the cell and is internalized via an endosome, which it
subsequently lyses to gain access to the cytoplasm where multiplication occurs.

To aid its entry into the epithelial cell, the bacterial DNA encodes a number of plasmid and
chromosomal proteins. These proteins are the invasion plasmid antigens (Ipa), surface presentation
antigens (Spa), membrane excretion proteins (Mxi), and virulence proteins (Vir).

When the bacterium grows at 37oC, the virulence protein VirF induces the expression of the VirB
protein. The VirB protein then activates the ipa, mxi, and spa promoters leading to expression of the
spa and mxi operons. This results in the synthesis and assembly of a protein complex called the Mxi-
Spa translocon. When the bacterium makes contact with the epithelial cell membrane, the translocon
becomes activated and secretes the pre-synthesized Ipa proteins. IpaB, IpaC and IpaA associate to form
a complex which interacts with the host epithelial cell membrane to induce a cascade of cellular signals
which will lead to the internalization of the bacterium via an endosome. The Ipa proteins are also
required for escape from the endosome.

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Figure 2 Electron Micrograph of Shigellain a membrane-enclosed endosome of an epithelial cell

Intracellular and Intercellular Spread

Extracellular S. flexneri cells are nonmotile, but intracellular bacteria move to occupy the entire
cytoplasm of the infected cell, and they are able to spread between cells. The genes necessary for
intracellular and intercellular spreading are virG (icsA) and icsB.

After entry into the cell, intracellular movement occurs if the bacterium expresses both an "organelle-
like movement" (Olm) phenotype, and an alternative Ics phenotype. The expression the Olm
phenotype allows the bacteria to "slide" along actin stress cables inside the host cell, while the
expression of the Ics phenotype allows the bacteria to "spread" or infect adjacent cells.

Specifically, movement of S. flexneri between adjacent cells is mediated via the product of the virG
(icsA) gene. The icsA gene ellicits actin polymerization at the poles of the bacteria and induces the
formation of protrusions. In some instances, these tightly packed actin filaments appear to form a
cylinder. The bacteria in the protrusions can move through the host cell and penetrate into an adjacent
cell without coming in contact with the extracellular medium where they would be rendered nonmotile.

The mxiG gene is required for Ipa protein secretion, and is also essential for entry. This gene and others
in the Mxi-Spa translocon are also required for intercellular dissemination.

Pathological Effects
Following host epithelial cell invasion and penetration of the colonic mucosa, Shigella infection is
characterized by degeneration of the epithelium and inflammation of the lamina propria. This results in
desquamation and ulceration of the mucosa, and subsequent leakage of blood, inflammatory elements
and mucus into the intestinal lumen. Patients suffering from Shigella infection will therefore pass
frequent, scanty, dysenteric stool mixed with blood and mucus since under these conditions, the
absorption of water by the colon is inhibited. This is in opposition to the diarrheal symptoms seen in
patients suffering from extensive Shigella colitis, and the pathologic basis for this is unknown. It is
possible that prostaglandin interactions induced by the inflammatory response to bacterial invasion
contributes to diarrhea in patients with Shigella colitis.

The Large Virulence Plasmid of Shigella flexneri

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All virulent strains of Shigella flexneri possess a large 230kb plasmid that mediates its virulence
properties. This so-called the invasion plasmid has been shown to encode the genes for several aspects
of Shigella virulence, including

- Ligands that are involved in the adherence of bacteria onto the surface of target epithelial cells

- The production of invasion plasmid antigens (Ipa) that have a direct role in the Shigella invasion
process

- Transport or processing functions that ensure the correct surface expression of the Ipa proteins

- The induction of endocytic uptake of bacteria and disruption of endocytic vacuoles

- The intra- and intercellular spreading phenotypes

- The regulation of plasmid-encoded vir genes

The presence of this plasmid was discovered in the 1980s after the observation that essentially the
entire chromosome of S. flexneri could be transferred to E. coli without reconstituting the virulence
phenotype of the donor. However, the ability to invade tissue culture cells was transferred to E. coli by
the conjugal mobilization of this plasmid from S. flexneri.The 230kb plasmid has been subjected to SalI
endonuclease digestion and 23 fragments labeled A through F have been identified and mapped.

Figure 3.The Circular SalI restriction map of Shigella flexneri 2a plasmid pMYSH6000. Adapted from Hale (1991).
The large Shigella plasmid encodes many of the virulence-associated genes which are summarized in the table below.

Table 1.Virulence-associated Genes and Functions Encoded by the Large Shigella Virulence
Plasmid
Protein Product
Gene Regulatory or effector function
MW
virF 30 kDa Positive regulation of virB(invE, ipaR) and virG(icsA)

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 Necessary for invasion (orients ipa gene products in outer
invA(mxiB) 38 kDa
membrane)
mxiA 76 kDA Same as above
invJ Unknown Same as above
invH Unknown Necessary for invasion (role unknown)
invF Unknown Same as above
invG 24 kDa Not necessary for invasion (role unknown)
ippI 18 kDa Same as above
Necessary for invasion (may mediate endocytic uptake of
ipaB 62 kDa
shigellae)
ipaC 43 kDa Same as above
Same as above (may mediate adherence of shigellae to host cell
ipaD 38 kDa
membrane)
ipaA 78 kDa Not necessary for invasion (role unknown)
virB(invE,ipaR) 33 kDa Positive regulation of ipaABCD and invAKJHFG
virG(icsA) 120 kDa Associated with intra- and intercellular bacterial spread
ipaH 60 kDa Unknown (may inhibit coagulation)
Adapted from Hale, T. L. (1991) Genetic Basis of Virulence in Shigella Species, Microbiological
Reviews,55: 206-224.

The Shiga Toxin

The Shiga toxin, also called the verotoxin, is produced by the bacteria Shigella dysenteriae and
enterohemorrhagic Escherichia coli (EHEC), of which the strain O157:H7 has become the best known.

The syndromes associated with shiga toxin include dysentery, hemorrhagic colitis, and hemolytic
uremic syndrome. The name is dependent upon the causative organism and the symptoms, which may
include severe diarrhea, abdominal pain, vomiting, and bloody urine (in the case of hemolytic uremic
syndrome).

The onset of symptoms is generally within a few hours, with higher doses leading to more rapid onset.
There is no antidote for the toxin. Supportive care requires maintenance of fluid and electrolyte levels,
and monitoring and support of kidney function.

Immunoassays are available for rapid diagnosis of the toxin.

Inactivation of the toxin is achieved by steam treatment, oxidizing agents such as bleach, and chemical
sterilizing agents such as glutaraldehyde.

The toxicity of Shiga Toxin for the mouse (LD50) is <20 micrograms/kg by intravenous or
intraperitoneal administration. There is no published data on the inhalation toxicity of Shiga toxin.
However, there are often indirect effects on the lungs when the toxin is taken in as a food contaminant.

Table 2. The toxin has been given several trivial names depending on the bacterium that produces it and the gene
that encodes it.

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 Source Gene Toxin Older
Organism Designation Name Names
Shigella Shiga toxin
stx Shiga toxin
dysenteriae, type I (Stx)
Escherichia Shiga toxin 1 Shiga-like toxin I,
stx1
coli (Stx1) Verotoxin 1
Shiga toxin 2 Shiga-like toxin II,
stx2
(Stx2) Verotoxin 2

Structure of the Toxin

The toxin has a molecular weight of 68,000 da. It is a multisubunit protein made up one molecule of an
A subunit (32,000 molecular weight) responsible for the toxic action of the protein, and five molecules
of the B subunit (7,700 molecular weight) responsible for binding to a specific cell type.

Mechanism of Action
The toxin acts on the lining of the blood vessels, the vascular endothelium. The B subunits of the toxin
bind to a component of the cell membrane known as Gb3 and the complex enters the cell. When the
protein is inside the cell, the A subunit interacts with the ribosomes to inactivate them. The A subunit
of Shiga toxin is an N-glycosidase that modifies the RNA component of the ribosome to inactivate it
and so bring a halt to protein synthesis leading to the death of the cell. The vascular endothelium has to
continually renew itself, so this killing of cells leads to a breakdown of the lining and to hemorrhage.
The first response is commonly a bloody diarrhea. This is because Shiga toxin is usually taken in with
contaminated food or water.

The toxin is effective against small blood vessels, such as found in the digestive tract, the kidney, and
lungs, but not against large vessels such as the arteries or major veins. A specific target for the toxin
appears to the vascular endothelium of the glomerulus. This is the filtering structure that is a key to the
function of the kidney. Destroying these structures leads to kidney failure and the development of the
often deadly and frequently debilitating hemolytic uremic syndrome. Food poisoning with Shiga toxin
often also has effects on the lungs and the nervous system.

Shiga Toxin-Producing Escherichia coli (STEC)

Shiga toxin-producing Escherichia coli is a type of enterohemorrhagic E. coli (EHEC) bacteria that
can cause illness ranging from mild intestinal disease to severe kidney
complications. Enterohemorrhagic E. coli include the relatively important serotype E. coli O157:H7,
but other non-O157 strains, such as O111 and O26, have been associated with shiga toxin production.

The incubation period for STEC ranges from 1 to 8 days, though typically it is 3 to 5 days.Typical
symptoms include severe abdominal cramping, sudden onset of watery diarrhea, frequently bloody, and
sometimes vomiting and a low-grade fever. Most often the illness is mild and self-limited generally
lasting 1-3 days. However, serious complications such as hemorrhagic colitis, Hemolytic Uremic
Syndrome (HUS), or postdiarrheal thrombotic thrombocytopenic purpura (TTP) can occur in up to 10%
of cases.

Cases and outbreaks of Shiga toxin-producing Escherichia coli have been associated with the
consumption of undercooked beef (especially ground beef), raw milk, unpasteurized apple juice,
contaminated water, red leaf lettuce, alfalfa sprouts, and venison jerky. The bacteria have also been

449
isolated from poultry, pork and lamb. Person-to- person spread, via fecal-oral transmission, may occur
in high-risk settings like day care centers and nursing homes.

Although anyone can get infected, the highest infection rates are in children under age 5. Elderly
patients also account for a large number of cases. Outbreaks have occurred in child-care facilities and
nursing homes.

For mild illness, antibiotics have not been shown to shorten the duration of symptoms and may make
the illness more severe in some people. Severe complications, such as Hemolytic Uremic Syndrome,
require hospitalization.

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 Todar's Online Textbook of Bacteriology

The Pathogenic Clostridia

© 2005 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

Clostridium botulinum

The Genus Clostridium

The clostridia are relatively large, Gram-positive, rod-shaped bacteria. All species form endospores
and have a strictly fermentative mode of metabolism. Most clostridia will not grow under aerobic
conditions and vegetative cells are killed by exposure to O2, but their spores are able to survive long
periods of exposure to air.

The clostridia are ancient organisms that live in virtually all of the anaerobic habitats of nature where
organic compounds are present, including soils, aquatic sediments and the intestinal tracts of animals.

Clostridia are able to ferment a wide variety of organic compounds. They produce end products such as
butyric acid, acetic acid, butanol and acetone, and large amounts of gas (CO2 and H2) during
fermentation of sugars. A variety of foul smelling compounds are formed during the fermentation of
amino acids and fatty acids. The clostridia also produce a wide variety of extracellular enzymes to
degrade large biological molecules in the environment into fermentable components. Hence, the
clostridia play an important role in nature in biodegradation and the carbon cycle. In anaerobic
clostridial infections, these enzymes play a role in invasion and pathology.

Most of the clostridia are saprophytes but a few are pathogenic for humans. Those that are pathogens
have primarily a saprophytic existence in nature and, in a sense, are opportunistic pathogens.
Clostridium tetani and Clostridium botulinum produce the most potent biological toxins known to
affect humans. As pathogens of tetanus and food-borne botulism, they owe their virulence almost
entirely to their toxigenicity. Other clostridia, however, are highly invasive under certain
circumstances.

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Stained pus from a mixed anaerobic infection. At least three different clostridia are apparent.

Clostridium perfringens

C. perfringens

Clostridium perfringens, which produces a huge array of invasins and exotoxins, causes wound and
surgical infections that lead to gas gangrene, in addition to severe uterine infections. Clostridial
hemolysins and extracellular enzymes such as proteases, lipases, collagenase and hyaluronidase,
contribute to the invasive process. Clostridium perfringens also produces an enterotoxin and is an
important cause of food poisoning. Usually the organism is encountered in improperly sterilized
(canned) foods in which endospores have germinated.

OFF THE WALL

Case Report of C. perfringens Food Poisoning

Clostridium perfringens is a common cause of outbreaks of foodborne illness in the United States, especially
outbreaks in which cooked beef is the implicated source. This is a condensed version of an MMWR report that
describes an outbreak of C. perfringens gastroenteritis following St.Patrick's Day meals of corned beef. The report
typifies outbreaks of C. perfringens food poisoning.

Report
On March 18, 1993, the Cleveland City Health Department received telephone calls from 15 persons who became ill
after eating corned beef purchased from one delicatessen. After a local newspaper article publicized this problem,
156 persons contacted the health department to report onset of diarrheal illness within 48 hours of eating food from
the delicatessen on March 16 or March 17. Symptoms included abdominal cramps (88%) and vomiting (13%); no
persons were hospitalized. The median incubation period was 12 hours (range: 2-48 hours). Of the 156 persons
reporting illness, 144 (92%) reported having eaten corned beef; 20 (13%), pickles; 12 (8%), potato salad; and 11
(7%), roast beef.

In anticipation of a large demand for corned beef on St. Patrick's Day (March 17), the delicatessen had purchased
1400 pounds of raw, salt-cured product. Beginning March 12, portions of the corned beef were boiled for 3 hours at
the delicatessen, allowed to cool at room temperature, and refrigerated. On March 16 and 17, the portions were
removed from the refrigerator, held in a warmer at 120 F (48.8 C), and sliced and served. Corned beef sandwiches
also were made for catering to several groups on March 17; these sandwiches were held at room temperature from
11 a.m. until they were eaten throughout the afternoon.

Cultures
5
of two of three samples of leftover corned beef obtained from the delicatessen yielded greater than or equal
to 10 colonies of C. perfringens per gram.

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Following the outbreak, public health officials recommended to the delicatessen that meat not served immediately
after cooking be divided into small pieces, placed in shallow pans, and chilled rapidly on ice before refrigerating and
that cooked meat be reheated immediately before serving to an internal temperature of greater than or equal to 165
F (74 C).

Analysis
C, perfringens is a ubiquitous, anaerobic, Gram-positive, spore-forming bacillus and a frequent contaminant of meat
and poultry. C. perfringens food poisoning is characterized by onset of abdominal cramps and diarrhea 8-16 hours
after eating contaminated meat or poultry. By sporulating, this organism can survive high temperatures during
initial cooking; the spores germinate during cooling of the food, and vegetative forms of the organism multiply if the
food is subsequently held at temperatures of 60 F-125 F (16 C-52 C). If served without adequate reheating, live
vegetative forms of C. perfringens may be ingested. The bacteria then elaborate the enterotoxin that causes the
characteristic symptoms of diarrhea and abdominal cramping.

Laboratory confirmation of C. perfringens foodborne outbreaks requires quantitative cultures of implicated food or
5
stool from ill persons. This outbreak was confirmed by the recovery of greater than orequal to 10 organisms per
gram of epidemiologically implicated food. An alternate criterion is that cultures of stool samples from persons
affected yield greater than or equal to 10 6 colonies per gram. Stool cultures were not done in this
outbreak. Serotyping is not useful for confirming C. perfringens outbreaks and, in general, is not available.

Corned beef is a popular ethnic dish that is commonly served to celebrate St. Patrick's Day. The errors in
preparation of the corned beef in this outbreak were typical of those associated with previously reported foodborne
outbreaks of C. perfringens.Improper holding temperatures were a contributing factor in most (97%) C. perfringens
outbreaks reported to CDC from 1973 through 1987. To avoid illness caused by this organism, food should be eaten
while still hot or reheated to an internal temperature of greater than or equal to 165 F (74 C) before serving.

Clostridium perfringens, Gram Stain. Most clostridia are reknowned for staining "Gram-variable".

Clostridium difficile

C. difficile

Clostridium difficile causes antibiotic asociated diarrhea (AAD) and more serious intestinal
conditions such as colitis and pseudomembranous colitis in humans. These conditions generally
result from overgrowth of Clostridium difficile in the colon, usually after the normal flora has been
disturbed by antimicrobial chemotherapy.

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People in good health usually do not get C. difficile disease. Individuals who have other conditions that
require prolonged use of antibiotics and the elderly are at greater risk of the disease. Also, individuals
who have recently undergone gastrointestinal surgery, or have a serious underlying illness, or who are
immunocompromised, are at risk.

C. difficile produces two toxins: Toxin A is referred to as an enterotoxin because it causes fluid
accumulation in the bowel. Toxin B is an extremely lethal (cytopathic) toxin.

Stool cultures for diagnosis of the bacterium may be complicated by the occurrence and finding of non
toxigenic strains of the bacterium, so the most reliable tests involve testing for the presence of the
Toxin A and/or Toxin B in the stool. The toxins are very unstable. They degrade at room temperature
and may be undetectable within two hours after collection of a stool specimen leading to false negative
results of the diagnosis.

In the hospital and nursing home setting, C. difficile infections can be minimized by judicious use of
antibiotics, use of contact precautions with patients with known or suspected cases of disease, and by
implementation of an effective environmental and disinfection strategy.

Clostridium difficile infections can usually be treated successfully with a 10 day course of antibiotics
including metronidiazole or vancomycin (administered orally).

C. difficile colonies on blood agar

C. difficile endospores.

Clostridium tetani

C. tetani

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Clostridium tetani is the causative agent of tetanus. The organism is found in soil, especially heavily-
manured soils, and in the intestinal tracts and feces of various animals. Carrier rates in humans vary
from 0 to 25%, and the organism is thought to be a transient member of the flora whose presence
depends upon ingestion. The organism produces terminal spores within a swollen sporangium giving it
a distinctive drumstick appearance. Although the bacterium has a typical Gram-positive cell wall, it
may stain Gram-negative or Gram-variable, especially in older cells.

Clostridium tetani characteristic terminal endospores in a swollen sporangium.

Tetanus is a highly fatal disease of humans. Mortality rates reported vary from 40% to 78%. The
disease stems not from invasive infection but from a potent neurotoxin (tetanus toxin or
tetanospasmin) produced when spores germinate and vegetative cells grow after gaining access to
wounds. The organism multiplies locally and symptoms appear remote from the infection site.

Because of the widespread use of the tetanus toxoid for prophylactic immunization, fewer than 150
cases occur annually in the U.S., but the disease is a significant problem world-wide where there are >
more than 300,000 cases annually. Most cases in the U.S occur in individuals over age 60, which is
taken to mean that waning immunity is a significant risk factor.

Pathogenesis

Most cases of tetanus result from small puncture wounds or lacerations which become contaminated
with C. tetani spores that germinate and produce toxin. The infection remains localized often with only
minimal inflammatory damage. The toxin is produced during cell growth, sporulation and lysis. It
migrates along neural paths from a local wound to sites of action in the central nervous system. The
clinical pattern of generalized tetanus consists of severe painful spasms and rigidity of the voluntary
muscles. The characteristic symptom of "lockjaw" involves spasms of the masseter muscle. It is an
early symptom which is followed by progressive rigidity and violent spasms of the trunk and limb
muscles. Spasms of the pharyngeal muscles cause difficulty in swallowing. Death usually results from
interference with the mechanics of respiration.

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Sir Charles Bell's portrait of a soldier dying of tetanus. The characteristic rigidity of the body is referred to as
opisthotonos and risus sardonicus. Original in the Royal College of Surgeons of Edinburgh, Scotland.

Neonatal tetanus accounts for about half of the tetanus deaths in developing countries. In a study of
neonatal mortality in Bangladesh, 112 of 330 infant deaths were due to tetanus. Neonatal tetanus
follows infection of the umbilical stump in infants born to nonimmune mothers (therefore, the infant
has not acquired passive immunity). It usually results from a failure of aseptic technique during the
birthing, but certain cultural practices may contribute to infection.

Tetanus Toxin

There have been 11 strains of C. tetani distinguished primarily on the basis of flagellar antigens. They
differ in their ability to produce tetanus toxin (tetanospasmin), but all strains produce a toxin which is
identical in its immunological and pharmacological properties. Tetanospasmin is encoded on a
plasmid which is present in all toxigenic strains.

Tetanus toxin is one of the three most poisonous substances known, the other two being the toxins of
botulism and diphtheria. The toxin is produced by growing cells and released only on cell lysis. Cells
lyse naturally during germination the outgrowth of spores, as well as during vegetative growth. After
inoculation of a wound with C. tetani spores, only a minimal amount of spore germination and
vegetative cell growth are required until the toxin is produced.

The bacterium synthesizes the tetanus toxin as a single 150kDa polypeptide chain (called the progenitor
toxin), that is cleaved extracellularly by a bacterial protease into a 100 kDa heavy chain (fragment B)
and a 50kDa light chain (fragment A) which remain connected by a disulfide bridge. The specific
protease that cleaves the progenitor toxin can be found in culture filtrates of C. tetani. Cleavage of the
progenitor toxin into A and B fragments can also be induced artificially with trypsin.

Tetanus toxin is produced in vitro in amounts up to 5 to 10% of the bacterial weight. Because the toxin
has a specific affinity for nervous tissue, it is referred to as a neurotoxin. The toxin has no known
useful function to C. tetani. Why the toxin has a specific action on nervous tissue, to which the
organism naturally has no access, may be an anomaly of nature. The toxin is heat labile, being
destroyed at 56 degrees C in 5 minutes, and is O2 labile. The purified toxin rapidly converts to toxoid
at 0 degrees C in the presence of formalin.
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Toxin Action

Tetanospasmin initially binds to peripheral nerve terminals. It is transported within the axon and
across synaptic junctions until it reaches the central nervous system. There it becomes rapidly fixed to
gangliosides at the presynaptic inhibitory motor nerve endings, and is taken up into the axon by
endocytosis. The effect of the toxin is to block the release of inhibitory neurotransmitters (glycine
and gamma-amino butyric acid) across the synaptic cleft, which is required to check the nervous
impulse. If nervous impulses cannot be checked by normal inhibitory mechanisms, it produces the
generalized muscular spasms characteristic of tetanus. Tetanospasmin appears to act by selective
cleavage of a protein component of synaptic vesicles, synaptobrevin II, and this prevents the release
of neurotransmitters by the cells.

The receptor to which tetanospasmin binds has been reported as ganglioside GT and/or GD1b, but its
exact identity is still in question. Binding appears to depend on the number and position of sialic acid
residues on the ganglioside. Isolated B fragments, but not A fragments will bind to the ganglioside. The
A fragment has toxic (enzymatic) activity after the B fragment secures its entry. Binding appears to be
an irreversible event. Recovery depends on sprouting a new axon terminal.

Immunity

Unlike other diseases, such as diphtheria, recovery from the natural disease usually does not confer
immunity, since even a lethal dose of tetanospasmin is insufficient to provoke an immune response.

Prophylactic immunization is accomplished with tetanus toxoid, as part of the DPT (DTP) vaccine or
the DT (TD) vaccine. Three injections are given in the first year of life, and a booster is given about a
year later, and again on the entrance into elementary school.

Whenever a previously-immunized individual sustains a potentially dangerous wound, a booster of

toxoid should be injected. Wherever employed, intensive programs of immunization with toxoid have
led to a striking reduction in the incidence of the disease.

Clostridium botulinum

C. botulinum

C. botulinum is a large anaerobic bacillus that forms subterminal endospores. It is widely distributed in
soil, sediments of lakes and ponds, and decaying vegetation. Hence, the intestinal tracts of birds,
mammals and fish may occasionally contain the organism as a transient. Seven toxigenic types of the
organism exist, each producing an immunologically distinct form of botulinum toxin. The toxins are
designated A, B, C1, D, E, F, and G). In the U.S. type A is the most significant cause of botulism,
involved in 62% of the cases. Not all strains of C. botulinum produce the botulinum toxin. Lysogenic
phages encode toxin serotypes C and D, and non lysogenized bacteria (which exist in nature) do not
produce the toxin. Type G toxin is thought to be plasmid encoded.

Pathogenesis of Botulism
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Food-borne Botulism

In food-borne botulism the botulinum toxin is ingested with food in which spores have germinated and
the organism has grown. The toxin is absorbed by the upper part of the GI tract in the duodenum and
jejunum, and passes into the blood stream by which it reaches the peripheral neuromuscular synapses.
The toxin binds to the presynaptic stimulatory terminals and blocks the release of the neurotransmitter
acetylcholine which is required for a nerve to simulate the muscle.

Food-borne botulism is not an infection but an intoxication since it results from the ingestion of foods
that contain the preformed clostridial toxin. In this respect it resembles staphylococcal food poisoning.
Botulism results from eating uncooked foods in which contaminating spores have germinated and
produced the toxin. C. botulinum spores are relatively heat resistant and may survive the sterilizing
process of improper canning procedures. The anaerobic environment produced by the canning process
may further encourage the outgrowth of spores. The organisms grow best in neutral or "low acid"
vegetables (>pH4.5).

Clinical symptoms of botulism begin 18-36 hours after toxin ingestion with weakness, dizziness and
dryness of the mouth. Nausea and vomiting may occur. Neurologic features soon develop: blurred
vision, inability to swallow, difficulty in speech, descending weakness of skeletal muscles and
respiratory paralysis.

Botulinum toxin may be transported within nerves in a manner analogous to tetanospasmin, and can
thereby gain access to the CNS. However, symptomatic CNS involvement is rare.

Clostridium botulinum

Infant Botulism

Infant botulism is due to infection caused by C. botulinum. The disease occurs in infants 5 - 20 weeks
of age that have been exposed to solid foods, presumably the source of infection (spores). It is
characterized by constipation and weak sucking ability and generalized weakness. C. botulinum can
apparently establish itself in the bowel of infants at a critical age before the establishment of competing
intestinal bacteria (normal flora). Production of toxin by bacteria in the GI tract induces symptoms.
This "infection-intoxication" is restricted to infants. C. botulinum organisms, as well as toxin can be

458
found in the feces of infected infants. Almost all known cases of the disease have recovered. The
possible role of infant botulism in "sudden infant death syndrome-SIDS" has been suggested and is
under investigation. C. botulinum, its toxin, or both have been found in the bowel contents of several
infants who have died suddenly and unexpectedly.

The Botulinum Toxins

The botulinum toxins are very similar in structure and function to the tetanus toxin, but differ
dramatically in their clinical effects because they target different cells in the nervous system.
Botulinum neurotoxins predominantly affect the peripheral nervous system reflecting a preference of
the toxin for stimulatory motor neurons at a neuromuscular junction. The primary symptom is
weakness or flaccid paralysis. Tetanus toxin can affect the same system, but the tetanospasmin shows
a tropism for inhibitory motor neurons of the central nervous system, and its effects are primarily
rigidity and spastic paralysis.

Botulinum toxin is synthesized as a single polypeptide chain with a molecular weight around 150 kDa.
In this form the toxin has a relatively low potency. The toxin is nicked by a bacterial protease (or
possibly by gastric proteases) to produce two chains: a light chain (the A fragment) with a molecular
weight of 50 kDa; and a heavy chain (the B fragment), with a mw of 100kDa. As with tetanospasmin,
the chains remain connected by a disulfide bond. The A fragment of the nicked toxin, on a molecular
weight basis, becomes the most potent toxin found in nature.

Structure of the botulinum toxins

Toxin Action

The botulinum toxin is specific for peripheral nerve endings at the point where a motor neuron
stimulates a muscle. The toxin binds to the neuron and prevents the release of acetylcholine across
the synaptic cleft.

The heavy chain of the toxin mediates binding to presynaptic receptors. The nature of these receptors is
uncertain; different toxin types seem to utilize slightly different receptors. The binding region of the
toxin molecule is located near the carboxy terminus of the heavy chain. The amino terminus of the
heavy chain is thought to form a channel through the membrane of the neuron allowing the light chain
to enter. The toxin (A fragment) enters the cell by receptor mediated endocytosis. Once inside a
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neuron, the toxin types probably differ in mechanisms by which they inhibit acetylcholine release, but a
mechanism similar to or identical to tetanospasmin has been reported (i.e., proteolytic cleavage of
synaptobrevin II). The affected cells fail to release a neurotransmitter, thus producing paralysis of the
motor system. Once damaged, the synapse is rendered permanently useless. The recovery of function
requires sprouting of a new presynaptic axon and the subsequent formation of a new synapse.

As stated above, the mechanism by which acetylcholine release is prevented is not known. However,
recent evidence suggests that both botulinum toxin as well as tetanus toxin are zinc-dependent
endopeptidases that cleave specific proteins that are involved in excretion of neurotransmitters. Both
toxins cleave a set of proteins called synaptobrevins. Synaptobrevins are a set of proteins found in
synaptic vesicle of neurons, the vesicles responsible for release of neurotransmitters. Presumably,
proteolytic cleavage of synaptobrevin II would interfere with vesicle function and release of
neurotransmitters.

Immunity

On the average there are about 25 cases of botulism annually in the U.S. Prior to the advent of critical
care, the case fatality rate exceeded 60%, but currently it is about 20%. The first (or only) patient in an
outbreak has a 25% chance of death, whereas subsequent cases which are diagnosed and treated more
quickly, carry only a 4% risk.

The toxins that cause botulism are each specifically neutralized by its antitoxin. Botulinum toxins can
be toxoided and make good antigens for inducing protective antibody. As with tetanus, immunity to
botulism does not develop, even with severe disease, because the amount of toxin necessary to induce
an immune response is toxic. Repeated occurrence of botulism has been reported.

Once the botulinum toxin has bound to nerve endings, its activity is unaffected by antitoxin. Any
circulating ("unfixed") toxin can be neutralized by intravenous injection of antitoxin. Individuals
known to have ingested food with botulism should be treated immediately with antiserum.

A multivalent toxoid evokes good protective antibiody response but its use is unjustified due to the
infrequency of the disease. An experimental vaccine exists for laboratory workers.

Prevention

The most important aspect of botulism prevention is proper food handling and preparation. The spores
of C. botulinum can survive boiling (100 degrees at 1 atm) for more than one hour although they are
killed by autoclaving. Because the toxin is heat-labile boiling or intense heating (cooking) of
contaminated food will inactivate the toxin. Food containers that bulge may contain gas produced by C.
botulinum and should not be opened or tasted. Other foods that appear to be spoiled should not be
tasted.

OFF THE WALL

Botulinum Toxin in Biowarfare......of course, it has been thought of .......botulinum toxin is the
most potent poison known for humans; 10 grams is a lethal dose for the human population of Los
Angeles. Below is an interesting anecdote that appeared in JAMA Vol. 285, No. 21, June 6, 2001

To the Editor:
A historical incident illustrates a number of features of botulinum toxin not discussed in the review of bioweaponry
by Dr Arnon and colleagues.

460
During World War II, the US Office of Strategic Services (OSS) developed a plan for Chinese prostitutes to
assassinate high-ranking Japanese officers with whom they sometimes consorted in occupied Chinese cities.
Concealing traditional weapons on the women at the appropriate time would obviously be difficult. Therefore, under
the direction of Stanley Lovell, the OSS prepared gelatin capsules "less than the size of the head of a common pin"
containing a lethal dose of botulinum toxin. Wetted, a capsule could be stuck behind the ear or in scalp hair, later to
be detached and slipped into the officer's food or drink. The OSS recognized that the normal background of
botulism cases would deflect suspicion from the women.

The capsules were shipped to Chunking, China. The Navy detachment there, taking nothing for granted, tested the
capsules on stray donkeys. The donkeys lived. Lovell was informed that the capsules were faulty, and the project was
abandoned. Much later, Lovell learned of the donkey test with, one imagines, some consternation, since "donkeys
are one of the few living creatures immune to botulism."

This incident has been retold in other publications. No source for the donkey-resistance information is ever given.
More recent experience shows that botulism can occur in mules and donkeys (R. H. Whitlock, DVM, PhD, written
communication, April 27, 2001).

Nevertheless, this incident raises 2 points: (1) botulism need not occur in epidemics when it is being used as a
bioweapon, and (2) botulism in animals may be a sign of biowarfare.

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 Todar's Online Textbook of Bacteriology

Bacillus cereus
© 2005 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

Bacillus cereus food poisoning

Bacillus cereus Spore Stain

Bacillus cereus has been recognized as an agent of food poisoning since 1955. Between 1972 and 1986,
52 outbreaks of food-borne disease associated with B. cereus were reported to the CDC, but this is
thought to represent only 2% of the total cases which have occurred in that time. B. cereus causes two
types of food-borne intoxications (as opposed to infections). One type is characterized by nausea and
vomiting and abdominal cramps and has an incubation period of 1 to 6 hours. It resembles
Staphylococcus aureus food poisoning in its symptoms and incubation period. This is the "short-
incubation" or emetic form of the disease. The second type is manifested primarily by abdominal
cramps and diarrhea with an incubation period of 8 to 16 hours. Diarrhea may be a small volume or
profuse and watery. This type is referred to as the "long-incubation" or diarrheal form of the disease,
and it resembles more food poisoning caused by Clostridium perfringens. In either type, the illness
usually lasts less than 24 hours after onset. In a few patients symptoms may last longer.

The short-incubation form is caused by a preformed heat-stable enterotoxin of molecular weight less
than 5,000 daltons. The mechanism and site of action of this toxin are unknown. The long-incubation
form of illness is mediated by a heat-labile enterotoxin (molecular weight of approximately 50,000
daltons) which activates intestinal adenylate cyclase and causes intestinal fluid secretion.

B. cereus food poisoning occurs year-round and is without any particular geographic distribution. The
short-incubation form is most often associated with fried rice that has been cooked and then held at
warm temperatures for several hours. The disease is often associated with Chinese restaurants. In one
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reported outbreak, macaroni and cheese made from powdered milk turned out to be the source of the
bacterium.

Long-incubation B. cereus food poisoning is frequently associated with meat or vegetable-containing

foods after cooking. The bacterium has been isolated from 50% of dried beans and cereals and from
25% of dried foods such as spices, seasoning mixes and potatoes. One outbreak of the long-incubation
form was traced to a "meals-on-wheels" program in which food was held above room temperature for a
prolonged period.

The short-incubation or emetic form of the disease is diagnosed by the isolation of B. cereus from the
incriminated food. The long-incubation or diarrheal form is diagnosed by isolation of the organism
from stool and food. Isolation from stools alone is not sufficient because 14% of healthy adults have
been reported to have transient gastrointestinal colonization with B. cereus. Because B. cereus
gastroenteritis is generally a benign, self-limited illness, antimicrobial agents are of no value in
management. Since bacteria grow best at temperatures ranging from 40 to 140°F, infection may be
prevented if cold food is refrigerated and if hot food is held at greater than 140°F before serving.

Nonanthrax Bacillus species, especially B. cereus, are occasionally implicated in local infections
especially involving the eye. They can cause conjunctivitis, keratitis, iridocyclitis, dacryocystitis,
orbital abscess, and panophthalmitis. The usual setting is that of previous occurrence of penetrating
nonsurgical trauma. An intra-ocular foreign body such as a metal projectile is often present, or the
injury occurs in a rural or farm location where there is a greater risk of eye contamination with dust or
soil. B. cereus is one of the most destructive organisms to infect the eye. Bacillus thuringiensis has also
been known to infect the eye. A case of human infection with B. thuringiensis was reported in 1983 in
a healthy farmer who splashed the BT insecticide into his eye. The organism was recovered from a
corneal ulcer. The clinical course was much less fulminant than with B. cereus infection.

OFF THE WALL

Summary and Analysis of a Report of Bacillus cereus Food Poisoning Associated with Fried Rice at Two Child Day
Care Centers -- Virginia, 1993 (from CDC)

Summary
On July 21, 1993, a regional public health facility received reports of acute gastrointestinal illness that
occurred among children and staff at two jointly owned child day care centers following a catered
lunch.

The catered lunch was served on July 21 to 82 children aged less than or equal to 6 years, and to nine
staff; dietary histories were obtained for 80 persons. 67 ate the catered lunch. A case was defined as
vomiting by a person who was present at either day care center on July 21. Fourteen (21%) persons
who ate the lunch became ill, compared with none of 13 who did not. Symptoms included nausea
(71%), abdominal cramps or pain (36%), and diarrhea (14%). Twelve of the 14 cases occurred among
children aged 2.5-5 years, and two occurred among staff. The median incubation period was 2 hours
(range: 1.5-3.5 hours). Symptoms resolved a median of 4 hours after onset (range: 1.5-22 hours).

Chicken fried rice prepared at a local restaurant was the only food significantly associated with illness;
illness occurred in 14 (29%) of 48 persons who ate chicken fried rice, compared with none of 16 who
did not.

The rice had been cooked the night of July 20 and cooled at room temperature before refrigeration. On
the morning of the lunch, the rice was pan-fried in oil with pieces of cooked chicken, delivered to the

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day care centers at approximately 10:30 a.m., held without refrigeration, and served at noon without
reheating.

Following the outbreak, health officials recommended to day care staff and restaurant food handlers
that the practice of cooling rice or any food at room temperature be discontinued, food be maintained at
proper temperatures (i.e., below 41 F {5 C} or above 140 F {60 C}), and a thermometer be used to
verify food temperatures.

Analysis
The emetic ("short incubation") form of the disease,which occurred in this outbreak, is mediated by a
highly stable toxin that survives high temperatures and exposure to trypsin, pepsin, and pH extremes;
the diarrheal syndrome is mediated by a heat- and acid-labile enterotoxin that is sensitive to proteolytic
enzymes.

The diagnosis of B. cereus food poisoning can be confirmed by the isolation of greater than or equal to
105 B. cereus organisms per gram from epidemiologically implicated food. Underreporting of such
outbreaks is likely because illness associated with B. cereus is usually self-limiting and not severe. In
addition, findings of a recent survey about culture practices for outbreaks of apparent foodborne illness
indicate that 20% of state public health laboratories do not make B. cereus testing routinely available.

Fried rice is a leading cause of B. cereus emetic-type food poisoning in the United States. B. cereus is
frequently present in uncooked rice, and heat-resistant spores may survive cooking. If cooked rice is
subsequently held at room temperature, vegetative forms multiply, and heat-stable toxin is produced
that can survive brief heating, such as stir frying. In the outbreak described in this report, vegetative
forms of the organism probably multiplied at the restaurant and the day care centers while the rice was
held at room temperature.

The day care staff and restaurant food handlers in this report were unaware that cooked rice was a
potentially hazardous food. This report underscores the ongoing need to educate food handlers about
basic practices for safe food handling.

Bacillus cereus Colonies on Blood Agar

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 Todar's Online Textbook of Bacteriology

Bacillus anthracis and anthrax

© 2005 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

Introduction

The anthrax bacillus, Bacillus anthracis, was the first bacterium shown to be the cause of a disease. In
1877, Robert Koch grew the organism in pure culture, demonstrated its ability to form endospores, and
produced experimental anthrax by injecting it into animals.

Figure 1. Robert Koch's original photomicrographs of Bacillus anthracis, the agent of anthrax. Compare the cell
morphology and spore position with the Gram stain below (Figure 2). This is Bacillus anthracis. Beware of phony
and mislabled images of B. anthracis on the internet, including some that are posted by otherwise credible websites.
Look for large cells with square ends and centrally-located ellipsoid spores when identifying Bacillus anthracis.

Bacillus anthracis is very large, Gram-positive, sporeforming rod, 1 - 1.2µm in width x 3 - 5µm in
length. The bacterium can be cultivated in ordinary nutrient medium under aerobic or anaerobic
conditions. Genotypically and phenotypically it is very similar to Bacillus cereus, which is found in
soil habitats around the world, and to Bacillus thuringiensis, the pathogen for larvae of Lepidoptera.
The three species have the same cellular size and morphology and form oval spores located centrally in
a nonswollen sporangium.

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Figure 2. Bacillus anthracis. Gram stain. 1500X. The cells have characteristic squared ends. The endospores are
ellipsoidal shaped and located centrally in the sporangium. The spores are highly refractile to light and resistant to
staining.

Bacillus thuringiensis is distinguished from B. cereus or B. anthracis by its pathogenicity for

Lepidopteran insects (moths and caterpillars) and by production of an intracellular parasporal crystal
in association with spore formation. The bacteria and protein crystals are sold as "Bt" insecticide,
which is used for the biological control of certain garden and crop pests.

Figure 3. Bacillus thuringiensis. Phase Photomicrograph of vegetative cells, intracellular spores (light) and
parasporal crystals (dark). 1000X.

Bacillus cereus is a normal inhabitant of the soil, but it can be regularly isolated from foods such as
grains and spices. B. cereuscauses two types of food-borne intoxications (as opposed to infections).
One type is characterized by nausea and vomiting and abdominal cramps and has an incubation period
of 1 to 6 hours. It resembles Staphylococcus aureus food poisoning in its symptoms and incubation
period. This is the "short-incubation" or emetic form of the disease. The second type is manifested
primarily by abdominal cramps and diarrhea with an incubation period of 8 to 16 hours. Diarrhea may
be a small volume or profuse and watery. This type is referred to as the "long-incubation" or diarrheal
form of the disease, and it resembles food poisoning caused by Clostridium perfringens. In either type,
the illness usually lasts less than 24 hours after onset.

The short-incubation form is caused by a preformed heat-stable enterotoxin of molecular weight less
than 5,000 daltons. The mechanism and site of action of this toxin are unknown. The long-incubation
form of illness is mediated by a heat-labile enterotoxin (molecular weight of approximately 50,000
daltons) which activates intestinal adenylate cyclase and causes intestinal fluid secretion.

466
Figure 4. Bacillus cereus. Gram stain. 450X. Bacilli are large bacteria, so that they are readily observed with the
microscope's "high dry objective" ........but you can't detect anything about their spores.This could be a
Lactobacillus.

Cultivation

Several nonselective and selective media for the detection and isolation of Bacillus anthracis have been
described, as well as a rapid screening test for the bacterium based on the morphology of
microcolonies. Table 1 provides the differential characteristics that are used to distinguish Bacillus
anthracis from most strains of Bacillus cereus and Bacillus thuringiensis but not necessarily from other
saprophytic species of Bacillus. Otherwise, it is not the intent of this article to provide information on
the growth of the bacterium in the laboratory.

Table 1. Differential Characteristics of B. anthracis B. cereus and B. thuringiensis

B. cereus and
Characteristic B. anthracis
B. thuringiensis
growth requirement for thiamin + -
hemolysis on sheep blood agar - +
glutamyl-polypeptide capsule + -
lysis by gamma phage + -
motility - +
growth on chloralhydrate agar - +
string-of-pearls test + -

The following figures (5, 6, and 7) from the CDC are reliable images of Bacillus anthracis grown as described in the
figure legends.

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Figure 5. Colonies of Bacillus cereus on the left; colonies of Bacillus anthracis on the right. B. cereus colonies are
larger, more mucoid, and this strain exhibits a slight zone of hemolysis on blood agar.

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Figure 6. Lysis of Bacillus anthracis by the lytic phage gamma. The plaque (clear area) in the region of confluent
growth is where the gamma phage was applied. The plaque results from the phage's abliity to lyse the bacterial cells.
Since the gamma phage is specific for B. anthracis, and will not lyse B. thuringiensis or B. cereus, we know that this is
Bacillus anthracis. The colony type of is similar to Figure 5.

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 Figure 7. Mucoid colonies of Bacillus anthracis. This culture was probaby incubated at an increased CO2 tension
(5% CO 2) which greatly enhances production of the poly-D-glutamyl capsule and accounts for the mucoid colony
type.

Anthrax

Anthrax is primarily a disease of domesticated and wild animals, particularly herbivorous animals, such
as cattle, sheep, horses, mules, and goats. Humans become infected incidentally when brought into
contact with diseased animals, which includes their flesh, bones, hides, hair and excrement.

The natural history of Bacillus anthracis is obscure. Although the spores have been found naturally in
soil samples from around the world, the organisms cannot be regularly cultivated from soils where
there is an absence of endemic anthrax. In the United States there are recognized areas of infection in
South Dakota, Nebraska, Arkansas, Texas, Louisiana, Mississippi and California; small areas exist in
other states. Even in endemic areas, anthrax occurs irregularly, often with many years between
occurrences.

In the United States, the incidence of naturally-acquired anthrax is extremely rare (1-2 cases of
cutaneous disease per year). Worldwide, the incidence is unknown, although B. anthracis is present in
most of the world. Unreliable reporting makes it difficult to estimate the true incidence of human
anthrax worldwide. However, in fall 2001, 22 cases of anthrax (11 inhalation, 11 cutaneous) were
identified in the United States following intentional contamination of the mail.

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The most common form of the disease in humans is cutaneous anthrax, which is usually acquired via
injured skin or mucous membranes. A minor scratch or abrasion, usually on an exposed area of the face
or neck or arms, is inoculated by spores from the soil or a contaminated animal or carcass. The spores
germinate, vegetative cells multiply, and a characteristic gelatinous edema develops at the site. This
develops into papule within 12-36 hours after infection. The papule changes rapidly to a vesicle, then a
pustule (malignant pustule), and finally into a necrotic ulcer from which infection may disseminate,
giving rise to septicemia. Lymphatic swelling also occurs within seven days. In severe cases, where the
blood stream is eventually invaded, the disease is frequently fatal.

Another form of the disease, inhalation anthrax (woolsorters' disease), results most commonly from
inhalation of spore-containing dust where animal hair or hides are being handled. The disease begins
abruptly with high fever and chest pain. It progresses rapidly to a systemic hemorrhagic pathology and
is often fatal if treatment cannot stop the invasive aspect of the infection.

Gastrointestinal anthrax is analogous to cutaneous anthrax but occurs on the intestinal mucosa. As in
cutaneous anthrax, the organisms probably invade the mucosa through a preexisting lesion. The
bacteria spread from the mucosal lesion to the lymphatic system. Intestinal anthrax results from the
ingestion of poorly cooked meat from infected animals. Gastrointestinal anthrax is rare, but may occur
as explosive outbreaks associated with ingestion of infected animals. Intestinal anthrax has an
extremely high mortality rate.

Meningitis due to B. anthracis is a very rare complication that may result from a primary infection
elsewhere.

Pathogenicity of Bacillus anthracis

Bacillus anthracis clearly owes its pathogenicity to two major determinants of virulence: the formation
of a poly-D-glutamyly capsule, which mediates the invasive stage of the infection, and the production
of the multicomponent anthrax toxin which mediates the toxigenic stage.

Poly-D-glutamyl capsule

Bacillus anthracis forms a single antigenic type of capsule consisting of a poly-D-glutamate

polypeptide. All virulent strains of B. anthracis form this capsule. Production of capsular material is
associated with the formation of a characteristic mucoid or "smooth" colony type. "Smooth" (S) to
"rough" (R) colonial variants occur, which is correlated with ability to produce the capsule. R variants
are relatively avirulent. Capsule production depends on a 60 megadalton plasmid, pX02; its transfer to
nonencapsulated B. anthracis via transduction produces the encapsulated phenotype.

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Figure 8. Two microscopic techniques to demonstrate the presence of the poly-D-glutamyl capsule of Bacillus
anthracis. Left. India ink capsule outline 1000X. Right a fluorescent-labeled antibody is reacted specifically with the
capsular material which renders the capsule fluorescent - FA stain 1000X.

The poly-D-glutamyl capsule is itself nontoxic, but functions to protect the organism against the
bactericidal components of serum and phagocytes, and against phagocytic engulfment. The capsule
plays its most important role during the establishment of the infection, and a less significant role in the
terminal phases of the disease, which are mediated by the anthrax toxin.

The poly-D-glutamyl capsule is formed in vivo or in the laboratory when the bacterium is grown on
serum plates in a 5% CO2 atmosphere. The capsular material can be detected by the McFadyean
reaction which involves staining with polychrome methylene blue. Blue rods in a background of
purple/pink-stained capsular material is a positive test (Figure 9). Neither B. cereus nor B.
thuringiensis synthesizes this capsular polymer, so the detection of capsular material can be used to
distinguish B. anthracis from its closest relatives.

Figure 9. McFadyean's reaction showing short chains of Bacillus anthracis cells lying among amorphous,
disintegrated capsular material. White blood cells can also be seen.

Anthrax Toxin

The toxigenic properties of Bacillus anthracis were not recognized until 1954. Prior to that time,
because of the tremendous number of anthrax bacilli observed in the blood of animals dying of the
disease (109 bacteria/ml), it was assumed that death was due to blockage of the capillaries, popularly
known as the "log-jam" theory. But experimentally it was shown that only about 3 x 106 cells/ml are
necessary to cause death of the animal. Furthermore, the cell-free plasma of animals dying of anthrax
infection contained a toxin which causes symptoms of anthrax when injected into normal guinea pigs.

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These observations left little doubt that a diffusible exotoxin plays a major role in the pathogenesis of
anthrax.

One component of the anthrax toxin has a lethal mode of the action that is not understood at this time.
Death is apparently due to oxygen depletion, secondary shock, increased vascular permeability,
respiratory failure and cardiac failure. Death from anthrax in humans or animals frequently occurs
suddenly and unexpectedly. The level of the lethal toxin in the circulation increases rapidly quite late in
the disease, and it closely parallels the concentration of organisms in the blood.

Production of the anthrax toxin is mediated by a temperature-sensitive plasmid, pX01, of 110

megadaltons. The toxin consists of three distinct antigenic components. Each component of the toxin is
a thermolabile protein with a mw of approximately 80kDa.

Factor I is the edema factor (EF) which is necessary for the edema producing activity of the toxin. EF
is known to be an inherent adenylate cyclase, similar to the Bordetella pertussis adenylate cyclase
toxin.

Factor II is the protective antigen (PA), because it induces protective antitoxic antibodies in guinea
pigs. PA is the binding (B) domain of the anthrax toxin which has two active (A) domains, EF (above)
and LF (below).

Factor III is known as the lethal factor (LF) because it is essential for the lethal effects of the anthrax
toxin. Apart from their antigenicity, each of the three factors exhibits no significant biological activity
in an animal. However, combinations of two or three of the toxin components yield the following
results in experimental animals.

PA+LF combine to produce lethal activity

EF+PA produce edema
EF+LF is inactive
PA+LF+EF produces edema and necrosis and is lethal

These experiments suggest that the anthrax toxin has the familiar A-B enzymatic-binding structure of
bacterial exotoxins with PA acting as the B fragment and either EF or LF acting as the active A
fragment.

EF+PA has been shown to elevate cyclic AMP to extraordinary levels in susceptible cells. Changes in
intracellular cAMP are known to affect changes in membrane permeability and may account for edema.
In macrophages and neutrophils an additional effect is the depletion of ATP reserves which are needed
for the engulfment process. Hence, one effect of the toxin may be to impair the activity of regional
phagocytes during the infectious process.

The effects of EF and LF on neutrophils have been studied in some detail. Phagocytosis by opsonized
or heat-killed Bacillus anthracis cells is not inhibited by either EF or LF, but a combination of EF + LF
inhibits engulfment of the bacteria and the oxidative burst in the pmns. The two toxin components also
increased levels of cAMP in the neutrophils. These studies suggest that the two active components of
the toxin, EF + LF, together increase host susceptibility to infection by suppressing neutrophil function
and impairing host resistance.

LF+PA have combined lethal activity as stated above. The lethal factor is a Zn++ dependent protease
that induces cytokine production in macrophages and lymphocytes, and its mechanism of action is
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slowly becoming understood. The crystal structure of lethal factor, the crucial pathogenic enzyme of
anthrax toxin, is known to to be a member of the mitogen-activated protein kinase (MAPKK) family of
enzymes that disrupts cellular signalling. Furthermore, the identity of the human receptor for anthrax
PA, named anthrax toxin receptor, has been demonstrated to be a type I membrane protein that binds
directly to PA.

In summary, the virulence of Bacillus anthracis is attributable to three bacterial components:

1. Capsular material composed of poly-D-glutamate polypeptide
2. EF component of exotoxin
3. LF component of exotoxin

Both the capsule and the anthrax toxin may play a role in the early stages of infection, through their
direct effects on phagocytes. Virulent anthrax bacilli multiply at the site of the lesion. Phagocytes
migrate to the area but the encapsulated organisms can resist phagocytic engulfment, or if engulfed, can
resist killing and digestion. A short range effect of the toxin is its further impairment of phagocytic
activity and its lethal effect on leukocytes, including phagocytes, at the site. After the organisms and
their toxin enter the circulation, the systemic pathology, which may be lethal, will result.

Bacillus anthracis coordinates the expression of its virulence factors in response to a specific
environmental signal. Anthrax toxin proteins and the antiphagocytic capsule are produced in response
to growth in increased atmospheric CO2. This CO2 signal is thought to be of physiological significance
for a pathogen which invades mammalian host tissues.

Immunity to Anthrax

Considerable variation in genetic susceptibility to anthrax exists among animal species. Resistant
animals fall into two groups: (1) resistant to establishment of anthrax but sensitive to the toxin and (2)
resistant to the toxin but susceptible to establishment of disease. This is illustrated in the table below.
Neither the source of the inoculum (spores or vegetative cells or a mixture) nor the route of inoculation
(subcutaneous, gastrointestinal, or inhalational) is stated. The infectious dose of anthrax is expected to
vary widely based on these parameters, as well.

Table 2. The infectious dose of B. anthracis and the lethal dose of toxin varies greatly within animal species. The
data do not specify the route of infection or whether spores or vegetative cells were used in the inoculum.

Animal model Infectious dose Toxic dose causing death Bacteria per ml blood at time death
Mouse 5 cells 1000 units/kg 107
Monkey 3000 cells 2500 unit/kg 107
Rat 106 cells 15 units/kg 105

Animals surviving naturally-acquired anthrax are immune to reinfection. Second attacks are extremely
rare. Permanent immunity to anthrax seems to require antibodies to both the toxin and the capsular
polypeptide, but the relative importance of the two kinds of antibodies appears to vary widely in
different animals.

Vaccines composed of killed bacilli and/or capsular antigens produce no significant immunity. A
nonencapsulated toxigenic strain has been used effectively in livestock. The Sterne Strain of Bacillus
anthracis produces sublethal amounts of the toxin that induces formation of protective antibody.

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The anthrax vaccine for humans, which is used in the U.S., is a preparation of the protective antigen
recovered from the culture filtrate of an avirulent, nonencapsulated strain of Bacillus anthracis that
produces PA during active growth. Anthrax immunization consists of three subcutaneous injections
given two weeks apart followed by three additional subcutaneous injections given at 6, 12, and 18
months. Annual booster injections of the vaccine are required to maintain a protective level of
immunity.

The vaccine is indicated for individuals who come in contact in the workplace with imported animal
hides, furs, bone, meat, wool, animal hair (especially goat hair) and bristles; and for individuals
engaged in diagnostic or investigational activities which may bring them into contact with anthrax
spores. Otherwise, of course, it has been indicated for the military during the curerent era of biological
warfare.

The vaccine should only be administered to healthy individuals from 18 to 65 years of age, since
investigations to date have been conducted exclusively in that population. It is not known whether the
anthrax vaccine can cause fetal harm, and pregnant women should not be vaccinated.

A new type of passive vaccine to anthrax is currently on the horizon. This was recently announced by
R.G. Crystal and colleagues from the Medical College of Cornell University, in the February, 2005
issue of the journal, Molecular Therapy. They demonstrated that mice vaccinated with a human
adenovirus expressing a single-chain antibody directed against protective antigen (PA) became immune
to anthrax within 24 hours of vaccination. This is much quicker than is possible with existing anthrax
vaccines, which are a relatively crude preparation of PA.

Currently available anthrax vaccines have limited use in a bioterrorism attack because they are active
vaccines in which multiple doses are required over several months to elicit protective immunity against
anthrax. Passive vaccines, on the other hand, shuttle fully formed antibodies directly to the body and
immunity is achieved much sooner.

In mice receiving the adenovirus-based anti-PA vaccine, PA-specific serum antibodies were detectable
within 24 hours. These antibodies had neutralizing activity that protected mice from an intravenous
lethal toxin challenge administered 1-14 days post vaccination.

Crystal, et al envision a possible scenario wherein both the passive and active vaccine might be given.
Passive vaccines lose their effectiveness fairly rapidly over time, whereas active vaccines do not. The
passive vaccine could provide protection that would last a couple of weeks, but that would provide a
safety margin for development of more active, long-term immunity stimulated by the active vaccine.

Passive immunotherapy with such adenovirus-based vectors expressing anti-PA antibody, either alone
or in combination with antibiotics, may be a rapid, convenient, and highly effective strategy to protect
against or treat anthrax in a bioterrorism attack.

Also, in cases of anthrax, coadministration of the passive vaccine with antibiotics may maximize the
utility of antibiotic therapy. Coadministration would counter the effects of lethal toxin, and likely
prolong the time frame for effective antibiotic treatment and/or reduce the amount of antibiotic therapy
required.

Treatment of Anthrax

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Antibiotics should be given to unvaccinated individuals exposed to inhalation anthrax. Penicillin,
tetracyclines and fluoroquinolones are effective if administered before the onset of lymphatic spread or
septicemia, estimated to be about 24 hours. Antibiotic treatment is also known to lessen the severity of
disease in individuals who acquire anthrax through the skin. Inhalation anthrax was formerly thought to
be nearly 100% fatal despite antibiotic treatment, particularly if treatment is started after symptoms
appear. A recent Army study resulted in successful treatment of monkeys with antibiotic therapy after
being exposed to anthrax spores. The antibiotic therapy was begun one day after exposure.

Anthrax and Biological Warfare

The inhalation of anthrax spores can lead to infection and disease. The possibility of creating aerosols
containing anthrax spores has made B. anthracis a chosen weapon of bioterrorism. Several powers may
have the ability to load spores of B.anthracis into weapons. Domestic terrorists may develop means to
distribute spores via mass attacks or small-scale attacks at a local level.

As an agent of biological warfare it is expected that a cloud of anthrax spores would be released at a
strategic location to be inhaled by the individuals under attack. Spores of B. anthracis can be produced
and stored in a dry form and remain viable for decades in storage or after release.

There is no evidence of person-to-person transmission of anthrax. Quarantine of affected individuals is

not recommended. Anthrax spores may survive in the soil, water and on surfaces for many years.
Spores can only be destroyed by steam sterilization or burning. Chemical disinfection of buildings is
problematic. The U.S. Navy Manual on Operational Medicine and Fleet Support, entitled Biological
Warfare Defense Information Sheet states "Disinfection of contaminated articles may be accomplished
using a 0.05% hypochlorite solution (1 tbsp. bleach per gallon of water). Spore destruction requires
steam sterilization."

Anthrax spores are killed by boiling (100C or 212F) for 30 minutes (the actual reported time is
considerably less). If boiling as a means of disinfection, the spores must be in liquid suspension (to
ensure killing) and in a sealed container (to avoid aerosolization or vaporization of droplet nuclei
containing spores).

An infection of local animal populations such as sheep and cattle could follow a biological attack with
spores. Infected animals could then transmit the disease to humans through the cutaneous, intestinal or
inhalation route by spores from a contaminated animal, carcass or hide.

A segment of the U.S. military population has been vaccinated against anthrax. Anthrax vaccine
consists of a series of six doses with yearly boosters. The first vaccine of the series must be given at
least four weeks before exposure to the disease. This vaccine protects against anthrax that is acquired
through the skin and it is believed that it would also be effective against inhaled spores in a biowarfare
situation. Of course, a vaccinated military population would be needed to respond to a terrorist attack
with anthrax spores.

OFF THE WALL

One strategy for the development of new vaccines is to expose T-cells to bacterial or viral antigens in
order to directly stimulate the mechanisms of cell-mediated immunity (CMI). Such types of vaccines
are known as intracellular vaccines, and they theoretically have the potential to stimulate protective
CMI, which is rarely accomplished with most present vaccines. Recently, the toxin of Bacillus
anthracis, specifically its cell-binding domain (PA), has been exploited to transport molecules into T-
cells in the search for new vaccines aimed against intracellular parasites. In this case, bacterial or viral
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antigens were fused to PA creating what is called a model pathogen molecule which is able to
recognize and be taken up by T-cells, but which does not produce disease. Though still in early stages
of testing, the vaccines show promise, and this work may lead to an entirely new class of human
vaccines against most viruses, certain bacteria, and parasites.

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 Todar's Online Textbook of Bacteriology

Diphtheria
© 2002 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

Diphtheria

Corynebacteria are Gram-positive, aerobic, nonmotile, rod-shaped bacteria related to the

Actinomycetes. They do not form spores or branch as do the actinomycetes, but they have the
characteristic of forming irregular shaped, club-shaped or V-shaped arrangements in normal growth.
They undergo snapping movements just after cell division which brings them into characteristic
arrangements resembling Chinese letters.

Figure 1. Stained Corynebacterium cells. The "barred" appearance is due to the presence of polyphosphate
inclusions called metachromatic granules. Note also the characteristic "Chinese-letter" arrangement of cells.

The genus Corynebacterium consists of a diverse group of bacteria including animal and plant
pathogens, as well as saprophytes. Some corynebacteria are part of the normal flora of humans, finding
a suitable niche in virtually every anatomic site. The best known and most widely studied species is
Corynebacterium diphtheriae, the causal agent of the disease diphtheria.

History and Background

No bacterial disease of humans has been as successfully studied as diphtheria. The etiology, mode of
transmission, pathogenic mechanism and molecular basis of exotoxin structure, function, and action
have been clearly established. Consequently, highly effective methods of treatment and prevention of
diphtheria have been developed.

The study of Corynebacterium diphtheriae traces closely the development of medical microbiology,
immunology and molecular biology. Many contributions to these fields, as well as to our understanding
of host-bacterial interactions, have been made studying diphtheria and the diphtheria toxin.

Hippocrates provided the first clinical description of diphtheria in the 4th century B.C. There are also
references to the disease in ancient Syria and Egypt.

In the 17th century, murderous epidemics of diphtheria swept Europe; in Spain the disease became
known as "El garatillo" (the strangler"), in Italy and Sicily as "the gullet disease".
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In the 18th century, the disease reached the American colonies where it reached epidemic proportions
about1735. Often, whole families died of the disease in a few weeks.

The bacterium that caused diphtheria was first described by Klebs in 1883, and was cultivated by
Loeffler in 1884, who applied Koch's postulates and properly identified Corynebacterium diphtheriae
as the agent of the disease.

In 1884, Loeffler concluded that C. diphtheriae produced a soluble toxin, and thereby provided the first
description of a bacterial exotoxin.

In 1888, Roux and Yersin demonstrated the presence of the toxin in the cell-free culture fluid of C.
diphtheriae which, when injected into suitable lab animals, caused the systemic manifestation of
diphtheria.

Two years later, von Behring and Kitasato succeeded in immunizing guinea pigs with a heat-attenuated
form of the toxin and demonstrated that the sera of immunized animals contained an antitoxin capable
of protecting other susceptible animals against the disease. This modified toxin was suitable for
immunizing animals to obtain antitoxin, but it was found to cause severe local reactions in humans and
could not be used as a vaccine.

In 1909, Theobald Smith, in the U.S., demonstrated that diphtheria toxin neutralized by antitoxin
(forming a Toxin-Anti-Toxin complex, TAT) remained immunogenic and eliminated local reactions
seen in the modified toxin. For some years, beginning about 1910, TAT was used for active
immunization against diphtheria. TAT had two undesirable characteristics as a vaccine. First, the toxin
used was highly toxic, and the quantity injected could result in a fatal toxemia unless the toxin was
fully neutralized by antitoxin. Second, the antitoxin mixture was horse serum, the components of which
tended to be allergenic and to sensitize individuals to the serum.

In 1913, Schick designed a skin test as a means of determining susceptibility or immunity to diphtheria
in humans. Diphtheria toxin will cause an inflammatory reaction when very small amounts are injected
intracutaneously. The Schick Test involves injecting a very small dose of the toxin under the skin of the
forearm and evaluating the injection site after 48 hours. A positive test (inflammatory reaction)
indicates susceptibility (nonimmunity). A negative test (no reaction) indicates immunity (antibody
neutralizes toxin).

In 1929, Ramon demonstrated the conversion of diphtheria toxin to its nontoxic, but antigenic,
equivalent (toxoid) by using formaldehyde. He provided humanity with one of the safest and surest
vaccines of all time-the diphtheria toxoid.

In 1951, Freeman made the remarkable discovery that pathogenic (toxigenic) strains of C. diphtheriae
are lysogenic, (i.e., are infected by a temperate B phage), while non lysogenized strains are avirulent.
Subsequently, it was shown that the gene for toxin production is located on the DNA of the B phage.

In the early 1960s, Pappenheimer and his group at Harvard conducted experiments on the mechanism
of a action of the diphtheria toxin. They studied the effects of the toxin in HeLa cell cultures and in
cell-free systems, and concluded that the toxin inhibited protein synthesis by blocking the transfer of
amino acids from tRNA to the growing polypeptide chain on the ribosome. They found that this action
of the toxin could be neutralized by prior treatment with diphtheria antitoxin.

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Subsequently, the exact mechanism of action of the toxin was shown, and the toxin has become a
classic model of a bacterial exotoxin.

At the turn of the century, in the United States, diphtheria was common, occurring primarily in
children, and was one of the leading causes of death in infants and children. In the l920's, when data
were first gathered, in the United States there were approximately 150,000 cases and 13,000 deaths
reported annually. After diphtheria immunization was introduced, the number of cases gradually fell to
about 19,000 in 1945. When diphtheria immunization became widespread in the late 1940's, a more
rapid decrease in the number of cases and deaths occurred.

From 1970 to 1979, an average of 196 cases per year were reported. Seventeen outbreaks of 15 or more
cases occurred in the United States between 1959 and 1980, but there have been none since 1980. From
1980-1989, the number of cases in the United States dropped to 24; two cases were fatal and 18
occurred in persons 20 years of age or older. Most cases have occurred nonimmunized (or inadequately
immunized) individuals.

Human Disease

CDC describes diphtheria as "an upper respiratory tract illness characterized by sore throat, low-grade
fever, and an adherent membrane of the tonsil(s), pharynx, and/or nose". Diphtheria is a rapidly
developing, acute, febrile infection which involves both local and systemic pathology. A local lesion
develops in the upper respiratory tract and involves necrotic injury to epithelial cells. As a result of this
injury, blood plasma leaks into the area and a fibrin network forms which is interlaced with with
rapidly-growing C. diphtheriae cells. This membranous network covers over the site of the local lesion
and is referred to as the pseudomembrane.

The diphtheria bacilli do not tend to invade tissues below or away from the surface epithelial cells at
the site of the local lesion. At this site they produce the toxin that is absorbed and disseminated through
lymph channels and blood to the susceptible tissues of the body. Degenerative changes in these tissues,
which include heart, muscle, peripheral nerves, adrenals, kidneys, liver and spleen, result in the
systemic pathology of the disease.

In parts of the world where diphtheria still occurs, it is primarily a disease of children, and most
individuals who survive infancy and childhood have acquired immunity to diphtheria. In earlier times,
when nonimmune populations (i.e., Native Americans) were exposed to the disease, people of all ages
were infected and many were killed.

About one person in 10 who gets diphtheria dies of it. Diphtheria is more severe for those under 5 and
over 40 years of age.

Pathogenicity

The pathogenicity of Corynebacterium diphtheriae includes two distinct phenomena:

1. Invasion of the local tissues of the throat, which requires colonization and subsequent bacterial
proliferation. Nothing is known about the adherence mechanisms of C. diphtheriae

2. Toxigenesis: bacterial production of the toxin. The diphtheria toxin causes the death eukaryotic cells
and tissues by inhibition protein synthesis in the cells. Although the toxin is responsible for the lethal
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symptoms of the disease, the virulence of C. diphtheriae cannot be attributed to toxigenicity alone,
since a distinct invasive phase apparently precedes toxigenesis. However, it has not been ruled out that
the diphtheria toxin plays an essential role in the colonization process due to short-range effects at the
colonization site.

Three strains of Corynebacterium diphtheriae are recognized, gravis, intermedius and mitis. They
are listed here by falling order of the severity of the disease that they produce in humans. All strains
produce the identical toxin and are capable of colonizing the throat. The differences in virulence
between the three strains can be explained by their differing abilities to produce the toxin in rate and
quantity, and by their differing growth rates.

The gravis strain has a generation time (in vitro) of 60 minutes; the intermedius strain has a generation
time of about 100 minutes; and the mitis stain has a generation time of about 180 minutes. The faster
growing strains typically produce a larger colony on most growth media. In the throat (in vivo), a faster
growth rate may allow the organism to deplete the local iron supply more rapidly in the invaded tissues,
thereby allowing earlier or greater production of the diphtheria toxin. Also, if the kinetics of toxin
production follow the kinetics of bacterial growth, the faster growing variety would achieve an
effective level of toxin before the slow growing varieties.

Toxigenicity

Two factors have great influence on the ability of Corynebacterium diphtheriae to produce the
diphtheria toxin: (1) low extracellular concentrations of iron and (2) the presence of a lysogenic
prophage in the bacterial chromosome. The gene for toxin production occurs on the chromosome of
the prophage, but a bacterial repressor protein controls the expression of this gene. The repressor is
activated by iron, and it is in this way that iron influences toxin production. High yields of toxin are
synthesized only by lysogenic bacteria under conditions of iron deficiency.

The role of iron. In artificial culture the most important factor controlling yield of the toxin is the
concentration of inorganic iron (Fe++ or Fe+++) present in the culture medium. Toxin is synthesized in
high yield only after the exogenous supply of iron has become exhausted (This has practical
importance for the industrial production of toxin to make toxoid. Under the appropriate conditions of
iron starvation, C. diphtheriae will synthesize diphtheria toxin as 5% of its total protein!). Presumably,
this phenomenon takes place in vivo as well. The bacterium may not produce maximal amounts of
toxin until the iron supply in tissues of the upper respiratory tract has become depleted. It is the
regulation of toxin production in the bacterium that is partially controlled by iron. The tox gene is
regulated by a mechanism of negative control wherein a repressor molecule, product of the DtxR gene,
is activated by iron. The active repressor binds to the tox gene operator and prevents transcription.
When iron is removed from the repressor (under growth conditions of iron limitation), derepression
occurs, the repressor is inactivated and transcription of the tox genes can occur. Iron is referred to as a
corepressor since it is required for repression of the toxin gene.

The role of B-phage. Only those strains of Corynebacterium diphtheriae that that are lysogenized by a
specific Beta-phage produce diphtheria toxin. A phage lytic cycle is not necessary for toxin production
or release. The phage contains the structural gene for the toxin molecule. The original proof rested
in the demonstration that lysogeny of C. diphtheriae by various mutated Beta phages leads to
production of nontoxic but antigenically-related material (called CRM for "cross-reacting material").
CRMs have shorter chain length than the diphtheria toxin molecule but cross react with diphtheria
antitoxins due to their antigenic similarities to the toxin. The properties of CRMs established beyond a
doubt that the tox genes resided on the phage chromosome rather than the bacterial chromosome.
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Even though the tox gene is not part of the bacterial chromosome the regulation of toxin production is
under bacterial control since the DtxR (regulatory) gene is on bacterial chromosome and toxin
production depends upon bacterial iron metabolism.

It is of some interest to speculate on the role of the diphtheria toxin in the natural history of the
bacterium. Of what value should it be to an organism to synthesize up to 5% of its total protein as a
toxin that specifically inhibits protein synthesis in eukaryotes (and archaebacteria)? Possibly the toxin
assists colonization of the throat (or skin) by killing epithelial cells or neutrophils. There is no evidence
to suggest a key role of the toxin in the life cycle of the organism. Since mass immunization against
diphtheria has been practiced, the disease has virtually disappeared, and C. diphtheriae is no longer a
component of the normal flora of the human throat and pharynx. It may be that the toxin played a key
role in the colonization of the throat in nonimmune individuals and, as a consequence of exhaustive
immunization, toxigenic strains have become virtually extinct.

Figure 2a. The Diphtheria Toxin (DT) Monomer

A (red) is the catalytic domain; B (yellow) is the binding domain which displays the receptor for cell attachment; T
(blue) is the hydrophobic domain responsible for insertion into the endosome membrane to secure the release of A.
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The protein is illustrated in its "closed" configuration.

Fig 2b. Mode of Action of the Diphtheria Toxin

The diphtheria toxin is a two component bacterial exotoxin synthesized as a single polypeptide chain
containing an A (active) domain and a B (binding) domain. Proteolytic nicking of the secreted form of
the toxin separates the A chain from the B chain.

The toxin binds to a specific receptor (now known as the HB-EGF receptor) on susceptible cells and
enters by receptor-mediated endocytosis. Acidification of the endosome vesicle results in unfolding of
the protein and insertion of a segment into the endosomal membrane. Apparently as a result of activity
on the endosome membrane, the A subunit is cleaved and released from the B subunit as it inserts and
passes through the membrane. Once in the cytoplasm, the A fragment regains its conformation and its
enzymatic activity. Fragment A catalyzes the transfer of ADP-ribose from NAD to the eukaryotic
Elongation Factor 2 which inhibits the function of the latter in protein synthesis. Ultimately,
inactivation of all of the host cell EF-2 molecules causes death of the cell. Attachment of the ADP
ribosyl group occurs at an unusual derivative of histadine called diphthamide.

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 Figure 3. Uptake and activity of the diphtheria toxin in Eukaryotic cells

The figure above was redrawn from the Diphtheria Toxin Homepage at UCLA. A represents the A/B toxin's A
(catalytic) domain; B is the B (receptor) domain: T is the hydrophobic domain that inserts into the cell membrane.

In vitro, the native diphtheria toxin is inactive and can be activated by trypsin in the presence of thiol.
The enzymatic activity of fragment A is masked in the intact toxin. Fragment B is required to bind the
native toxin to its cognate receptor and to permit the escape of fragment A from the endosome. The C
terminal end of Fragment B contains the peptide region that attaches to the HB-EGF receptor on the
sensitive cell membrane, and the N-terminal end is a strongly hydrophobic region which will insert into
a membrane lipid bilayer.

The specific membrane receptor, heparin-binding epidermal growth factor (HB-EGF) precursor is a
protein on the surface of many types of cells. The occurrence and distribution of the HB-EGF receptor
on cells determines the susceptibility of an animal species, and certain cells of an animal species, to the
diphtheria toxin. Normally, the HB-EGF precursor releases a peptide hormone that influences normal
cell growth and differentiation. One hypothesis is that the HB-EGF receptor itself is the protease that
nicks the A fragment and reduces the disulfide bridge between it and the B fragment when the A
fragment makes its way through the endosomal membrane into the cytoplasm.
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Immunity to Diphtheria

Acquired immunity to diphtheria is due primarily to toxin-neutralizing antibody (antitoxin). Passive

immunity in utero is acquired transplacentally and can last at most 1 or 2 years after birth. In areas
where diphtheria is endemic and mass immunization is not practiced, most young children are highly
susceptible to infection. Probably active immunity can be produced by a mild or inapparent infection in
infants who retain some maternal immunity, and in adults infected with strains of low virulence
(inapparent infections).

Individuals that have fully recovered from diphtheria may continue to harbor the organisms in the
throat or nose for weeks or even months. In the past, it was mainly through such healthy carriers that
the disease was spread, and toxigenic bacteria were maintained in the population. Before mass
immunization of children, carrier rates of C. diphtheriae of 5% or higher were observed.

Because of the high degree of susceptibility of children, artificial immunization at an early age is
universally advocated. Toxoid is given in 2 or 3 doses (1 month apart) for primary immunization at an
age of 3 - 4 months. A booster injection should be given about a year later, and it is advisable to
administer several booster injections during childhood. Usually, infants in the United States are
immunized with a trivalent vaccine containing diphtheria toxoid, pertussis vaccine, and tetanus toxoid
(DPT or DTP vaccine).

The relative absence of diphtheria in the United States is due primarily to the high level of appropriate
immunization in children, and to an apparent reduction in toxin-producing strains of the bacterium.
However, the increasing percentage of diphtheria cases in adults suggests that many adults may not be
protected against diphtheria, because they have not receive booster immunizations within the past ten
years. A similar situation exists with tetanus.

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 Todar's Online Textbook of Bacteriology

Tuberculosis
© 2005 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

Tuberculosis (TB) is the leading cause of death in the world from a bacterial infectious disease. The
disease affects 1.7 billion people/year which is equal to one-third of the entire world population.

In the United States TB is on the decline. There was a resurgence of TB from 1986 to 1992, but since
1993, the numbers of cases have been going down and are now at the lowest they have ever been. Also,
since 1993, there has been a gradual decline in the number of TB patients with coinfection with HIV,
and the number of cases of multiple drug-resistant (MDR) TB dropped during this period of time. In
many states, especially in the West, the upper Midwest, and the Northeast, most new cases of TB now
occur in individuals who are foreign born. This is evident in the following statistics provided by the
CDC Division of Tuberculosis Elimination.

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Mycobacterium tuberculosis

Mycobacterium tuberculosis is the etiologic agent of tuberculosis in humans. Humans are the only
reservoir for the bacterium.

Mycobacterium bovisis the etiologic agent of TB in cows and rarely in humans. Both cows and humans
can serve as reservoirs. Humans can also be infected by the consumption of unpasteurized milk. This
route of transmission can lead to the development of extrapulmonary TB, exemplified in history by
bone infections that led to hunched backs.

Other human pathogens belonging to the Mycobacterium genus include Mycobacterium avium which
causes a TB-like disease especially prevalent in AIDS patients, and Mycobacterium leprae, the
causative agent of leprosy.

History and Present Day Importance

Mycobacterium tuberculosis (M.TB.) was the cause of the "White Plague" of the 17th and 18th
centuries in Europe. During this period nearly 100 percent of the European population was infected
with M.TB., and 25 percent of all adult deaths were caused by M.TB. (Note: The White Plague is not to
be confused with the "Black Plague", which was caused by Yersinia pestisand occurred about 3
centuries earlier).

General Characteristics

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Mycobacterium tuberculosis is a fairly large nonmotile rod-shaped bacterium distantly related to the
Actinomycetes. Many non pathogenic mycobacteria are components of the normal flora of humans,
found most often in dry and oily locales. The rods are 2-4 um in length and 0.2-0.5 um in width.

Mycobacterium tuberculosis is an obligate aerobe. For this reason, in the classic case of tuberculosis,
the M.TB. complexes are always found in the well-aerated upper lobes of the lungs. The bacterium is a
facultative intracellular parasite, usually of macrophages, and has a slow generation time, 15-20
hours, a physiological characteristic that may contribute to its virulence.

Two media are used to grow M.TB. Middlebrook's medium which is an agar based medium and
Lowenstein-Jensen medium which is an egg based medium. M.TB. colonies are small and buff
colored when grown on either medium. Both types of media contain inhibitors to keep contaminants
from out-growing M.TB. It takes 4-6 weeks to get visual colonies on either type of media.

Colonies of Mycobacterium tuberculosis on Lowenstein-Jensen medium. CDC.

Chains of cells in smears made from in vitro-grown colonies often form distinctive serpentine cords.
This observation was first made by Robert Koch who associated cord factor with virulent strains of the
bacterium.

M.TB. is not classified as either Gram-positive or Gram-negative because it does not have the
chemical characteristics of either, although the bacteria do contain peptidoglycan (murein) in their cell
wall. If a Gram stain is performed on M.TB., it stains very weakly Gram-positive or not at all (referred
to as "ghosts").

Mycobacterium species, along with members of a related genus Nocardia, are classified as acid-fast
bacteria due to their impermeability by certain dyes and stains. Despite this, once stained, acid-fast
bacteria will retain dyes when heated and treated with acidified organic compounds. One acid-fast
staining method for Mycobacterium tuberculosis is the Ziehl-Neelsen stain. When this method is used,
the M.TB. smear is fixed, stained with carbol-fuchsin (a pink dye), and decolorized with acid-alcohol.
The smear is counterstained with methylene-blue or certain other dyes. Acid-fast bacilli appear pink in
a contrasting background.

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In order to detect Mycobacterium tuberculosis in a sputum sample, in excess of 10,000 organisms per
ml of sputum are needed to visualize the bacilli with a 100X microscope objective. One acid-fast
bacillus/slide is regarded as "suspicious" of an M.TB. infection.

Mycobacterium tuberculosis. Acid-fast stain. CDC.

Cell Wall Structure

The cell wall structure of Mycobacterium tuberculosis deserves special attention because it is unique
among procaryotes and it is a major determinant of virulence for the bacterium. The cell wall complex
contains peptidoglycan, but otherwise it is composed of complex lipids. Over 60% of the
mycobacterial cell wall is lipid. The lipid fraction of M.TB's cell wall consists of three major
components.

Mycolic acids are unique alpha-branched lipids found in cell walls of Mycobacterium and
Corynebacterium. They make up 50% of the dry weight of the mycobacterial cell envelope. Mycolic
acids are strong hydrophobic molecules that form a lipid shell around the organism and affect
permeability properties at the cell surface. Mycolic Acids are are thought to be a significant
determinant of virulence in M.TB. Probably, they prevent attack of the mycobacteria by cationic
proteins, lysozyme and oxygen radicals in the phagocytic granule. They also protect extracellular
mycobacteria from complement deposition in serum.

Cord Factor is responsible for the serpentine cording mentioned above. Cord factor is toxic to
mammalian cells and is also an inhibitor of PMN migration. Cord factor is most abundantly produced
in virulent strains of M.TB.

Wax-D in the cell envelope is the major component of Freund's complete adjuvant (CFA).

In summary, the high concentration of lipids in the cell wall of Mycobacterium tuberculosis has been
associated with these properties of the bacterium:

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 Impermeability to stains and dyes
Resistance to many antibiotics
Resistance to killing by acidic and alkaline compounds
Resistance to osmotic lysis via complement deposition
Resistance to lethal oxidations and survival inside of macrophages

The Disease Tuberculosis

TB infection means that M.TB. is in the body but the immune system is keeping the bacteria under
control. The immune system does this by producing macrophages that surround the tubercle bacilli.
The cells form a hard shell that keeps the bacilli contained and under control. Most people with TB
infection have a positive reaction to the tuberculin skin test. People who have TB infection but not
TB disease are NOT infectious, i.e., they cannot spread the infection to other people. These people
usually have a normal chest x-ray. TB infection is not considered a case of TB. Major similarities and
differences between TB infection and TB disease are shown below.

Tuberculosis: Infection vs Disease

TB Infection TB disease in lungs

M.TB. present M.TB. present
Tuberculin skin test positive Tuberculin skin test positive
Chest X-ray normal Chest X-ray usually reveals lesion
Sputum smears and cultures negative Sputum smears and cultures positive
No symptoms Symptoms such as cough, fever, weight loss
Not infectious Often infectious before treatment
Not defined as a case of TB Defined as a case of TB

Predisposing factors for TB infection include:

Close contact with large populations of people, i.e., schools, nursing homes, dormitories, prisons, etc.
Poor nutrition
iv drug use
Alcoholism
HIV infection is the #1 predisposing factor for M.TB. infection. 10 percent of all HIV-positive
individuals harbor M.TB. This is 400-times the rate associated with the general public

Only 3-4% of infected individuals will develop active disease upon initial infection, 5-10% within one
year. These percentages are much higher if the individual is HIV+.

Stages of the Disease

The following stages that will be explained are for a M.TB. sensitive host. It should be realized that, as
stated previously, only a small percent of M.TB. infections progress to disease and even a smaller
percent progress all the way to stage 5. Usually the host will control the infection at some point.

Disease progression depends on:

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 Strain of M.TB.
Prior exposure
Vaccination
Infectious dose
Immune status of the host

Stage 1

Droplet nuclei are inhaled. One droplet nuclei contains no more than 3 bacilli. Droplet nuclei are so
small that they can remain air-borne for extended periods of time. The most effective (infective) droplet
nuclei tend to have a diameter of 5 um. Droplet nuclei are generated by during talking coughing and
sneezing. Coughing generates about 3000 droplet nuclei. Talking for 5 minutes generates 3000 droplet
nuclei but singing generates 3000 droplet nuclei in one minute. Sneezing generates the most droplet
nuclei by far, which can spread to individuals up to 10 feet away.

Spread of droplet nuclei from one individual to another. CDC. After droplet nuclei are inhaled,
the bacteria are nonspecifically taken up by alveolar macrophages. However, the macrophages
are not activated and are unable to destroy the intracellular organisms.

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Tuberculosis begins when droplet nuclei reach the alveoli. When a person inhales air that
contains droplets most of the larger droplets become lodged in the upper respiratory tract (the
nose and throat), where infection is unlikely to develop. However, the smaller droplet nuclei may
reach the small air sacs of the lung (the alveoli), where infection begins.

Stage 2

Begins 7-21 days after initial infection. M.TB. multiplies virtually unrestricted within unactivated
macrophages until the macrophages burst. Other macrophages begin to extravasate from peripheral
blood. These macrophages also phagocytose M.TB., but they are also unactivated and hence can not
destroy M.TB.

Stage 3

At this stage lymphocytes begin to infiltrate. The lymphocytes, specifically T-cells, recognize
processed and presented M.TB. antigen in context of MHC molecules. This results in T-cell activation
and the liberation of cytokines including gamma interferon (IFN). The liberation of IFN causes in the
activation of macrophages. These activated macrophages are now capable of destroying M.TB.

It is at this stage that the individual becomes tuberculin-positive. This positive tuberculin reaction is
the result of the host developing a vigorous cell mediated immune (CMI) response. A CMI response
must be mounted to control an M.TB. infection. An antibody mediated immune (AMI) will not aid in
the control of a M.TB. infection because M.TB. is intracellular and if extracellular, it is resistant to
complement killing due to the high lipid concentration in its cell wall.

Although a CMI response is necessary to control an M.TB. infection, it is also responsible for much of
the pathology associated with tuberculosis. Activated macrophages may release lytic enzymes and
reactive intermediates that facilitate the development of immune pathology. Activated macrophages
and T-cells also secrete cytokines that may also play a role in the development of immune pathology,
including Interleukin 1 ( IL-l), tumor necrosis factor (TNF), and gamma IFN.

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It is also at this stage that tubercle formation begins. The center of the tubercle is characterized by
"caseation necrosis" meaning semi-solid or "cheesy" consistency. M.TB. cannot multiply within these
tubercles because of the low pH and anoxic environment. M.TB. can, however, persist within these
tubercles for extended periods.

Stage 4

Although many activated macrophages can be found surrounding the tubercles, many other
macrophages present remain unactivated or poorly activated. M.TB. uses these macrophages to
replicate and hence the tubercle grows.

The growing tubercle may invade a bronchus. If this happens, M.TB. infection can spread to other parts
of the lung. Similarly the tubercle may invade an artery or other blood supply line. The hematogenous
spread of M.TB. may result in extrapulmonary tuberculosis otherwise known as milliary tuberculosis.
The name "milliary" is derived from the fact that metastasizing tubercles are about the same size as a
millet seed, a grain commonly grown in Africa.

The secondary lesions caused by milliary TB can occur at almost any anatomical location, but usually
involve the genitourinary system, bones, joints, lymph nodes, and peritoneum. These lesions are of two
types:

1. Exudative lesions result from the accumulation of PMN's around M.TB. Here the bacteria replicate
with virtually no resistance. This situation gives rise to the formation of a "soft tubercle".

2. Productive or granulomatous lesions occur when the host becomes hypersensitive to

tuberculoproteins. This situation gives rise to the formation of a "hard tubercle".

Stage 5

For unknown reasons, the caseous centers of the tubercles liquify. This liquid is very conducive to
M.TB. growth and hence the organism begins to rapidly multiply extracellularly. After time, the large
antigen load causes the walls of nearby bronchi to become necrotic and rupture. This results in cavity
formation. This also allows M.TB. to spill into other airways and rapidly spread to other parts of the
lung.

As stated previously, only a very small percent of M.TB. infections result in disease, and even a
smaller percentage of M.TB. infections progress to an advanced stage. Usually the host will begin to
control the infection at some point. When the primary lesion heals, it becomes fibrous and calcifies.
When this happens the lesion is referred to as the Ghon complex. Depending on the size and severity,
the Ghon complex may never subside. Typically the Ghon complex is readily visible upon chest X-ray.

Small metastatic foci containing low numbers of M.TB. may also calcify. However, in many cases
these foci will contain viable organisms. These foci are referred to Simon foci. The Simon foci are also
visible upon chest X-ray and are often the site of disease reactivation.

Virulence Mechanisms and Virulence Factors

Mycobacterium tuberculosis does not possess the classic bacterial virulence factors such as toxins,
capsules and fimbriae. However, a number of structural and physiological properties of the bacterium

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are beginning to be recognized for their contribution to bacterial virulence and the pathology of
tuberculosis.

M.TB. has special mechanisms for cell entry. The tubercle bacillus can bind directly to mannose
receptors on macrophages via the cell wall- associated mannosylated glycolipid, LAM, or indirectly
via certain complement receptors or Fc receptors.

M.TB. can grow intracellularly. This is an effective means of evading the immune system. In
particular, antibodies and complement are ineffective. Once M.TB. is phagocytosed, it can inhibit
phagosome-lysosome fusion. The exact mechanism used by M.TB. to accomplish this is not known but
it is thought to be the result of a protein secreted by bacterium trhat modifies the phagosome
membrane. The bacterium may remain in the phagosome or escape from the phagosome, in either case
finding a protected environment for growth in the macrophage.

M.TB. interferes with the toxic effects of reactive oxygen intermediates produced in the process of
phagocytosis by two mechanisms:

1. Compounds including glycolipids, sulfatides and LAM down regulate the oxidative cytotoxic
mechanism.

2. Macrophage uptake via complement receptors may bypass the activation of a respiratory burst.

Antigen 85 complex. This complex is composed of a group of proteins secreted by M.TB. that are
known to bind fibronectin. These proteins may aid in walling off the bacteria from the immune system
and may facilitate tubercle formation although evidence of this is lacking.

Slow generation time. Because of M.TB's slow generation time, the immune system may not readily
recognize the bacteria or may not be triggered sufficiently to eliminate them. Many other chronic
disease are caused by bacteria with slow generation times, for example, slow-growing M. leprae
causes leprosy, Treponema pallidum causes syphilis, and Borrelia burgdorferi causes Lyme disease.

High lipid concentration in cell wall, as mentioned previously, accounts for impermeability and
resistance to antimicrobial agents, resistance to killing by acidic and alkaline compounds in both the
intracellular and extracellular environment, and resistance to osmotic lysis via complement deposition
and attack by lysozyme.

Cord factor. The cord factor is primarily associated with virulent strains of M.TB. It is known to be
toxic to mammalian cells and to be an inhibitor of PMN migration. However, its exact role in M.TB.
virulence is unclear.

Clinical Identification and Diagnosis of Tuberculosis

The diganosis of tuberculosis requires detection of acid-fast bacilli in sputum via the Ziehl-Neelsen
method as previously described.

The organisms must then be cultured from sputum. First, the sputum sample is treated with NaOH.
This kills other contaminating bacteria but does not kill the M.TB. present because M.TB. is resistant
to alkaline compounds by virtue of its lipid layer.

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The media used for growth and the the resulting colony morphology have been described previously.
However, methods of culturing can take 4-6 weeks to yield visible colonies. As a result, another
method is commonly used call the BACTEC System. The media used in the BACTEC system
contains radio-labeled palmitate as the sole carbon source. As M.TB. multiplies, it breaks down the
palmitate and liberates radio-labeled CO2. Using the BACTEC system, M.TB. growth can be detected
in 9-16 days vs 4-6 weeks using conventional media.

Skin Testing is performed as the tuberulin or Mantoux test. PPD (purified protein derivative) is
employed as the test antigen in the Mantoux test. PPD is generated by boiling a culture of M.TB.,
specifically Old Tuberculin (OT). 5 TU (tuberculin units), which equals 0.000lmg of PPD, in a O.1 ml
volume is intracutaneously injected in the forearm. The test is read within 48-72 hours.

Administering the Mantoux test. CDC.

The test is considered positive if the diameter of the resulting lesion is 10 mm or greater. The lesion is
characterized by erythema (redness) and swelling and induration (raised and hard). 90% of people that
have a lesion of 10 mm or greater are currently infected with M.TB. or have been previously exposed
to M.TB. 100% of people that have a lesion of 15 mm or greater are currently infected with M.TB. or
have been previously exposed to M.TB.

False positive tests usually manifest themselves as lesser reactions. These lesser reactions could
indicate prior exposure or infection with other Mycobacteria or vaccination with BCG. However, in
places were the vaccine is not used, lesser reactions should be regarded as highly suspicious.

False negatives are more rare than false positives but are especially common in AIDS patients as they
have an impaired CMI response. Other conditions such as malnutrition, steroids, etc., can rarely result
in a false negative reaction.

Tuberculosis Treatment

Because administration of a single drug often leads to the development of a bacterial population
resistant to that drug, effective regimens for the treatment of TB must contain multiple drugs to

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which the organisms are susceptible. When two or more drugs are used simultaneously, each helps
prevent the emergence of tubercle bacilli resistant to the others. However, when the in vitro
susceptibility of a patient's isolate is not known, which is generally the case at the beginning of therapy,
selecting two agents to which the patient's isolate is likely to be susceptible can be difficult, and
improper selection of drugs may subsequently result in the development of additional drug-resistant
organisms.

Hence, tuberculosis is usually treated with four different antimicrobial agents The course of drug
therapy usually lasts from 6-9 months. The most commonly used drugs are rifampin (RIF) isoniazid
(INH), pyrazinamide (PZA ) and ethambutol (EMB) or streptomycin (SM). When adherence with the
regimen is assured, this four-drug regimen is highly effective . Based on the prevalence and
characteristics of drug-resistant organisms, at least 95% of patients will receive an adequate regimen
(at least two drugs to which their organisms are susceptible) if this four-drug regimen is used at the
beginning of therapy (CDC, unpublished data). Furthermore, a patient who is treated with the four-drug
regimen, but who defaults therapy, is more likely to be cured and not relapse when compared with a
patient treated for the same length of time with a three-drug regimen.

Drugs used to treat TB disease. From left to right isoniazid, rifampin, pyrazinamide, and
ethambutol. Streptomycin (not shown) is given by injection. CDC.

Prevention

A vaccine against M.TB. is available. It is called BCG (Bacillus of Calmette and Guerin, after the two
Frenchmen that developed it). BCG consists of a live attenuated strain derived from Mycobacterium
bovis. This strain of Mycobacterium has remained avirulent for over 60 years.

The vaccine is not 100% effective. Studies suggest a 60-80% effective rate in children.

The vaccine is not administered in the U.S. for several reasons:

The vaccine cannot circumvent disease reactivation in previously exposed individuals.

The vaccine does not prevent infection, only disease. Therefore, the entire population would have to
be vaccinated if the vaccine was to be considered efficacious.
Vaccination may complicate the way the tuberculin skin test is read in this country. In places that do
not vaccinate, the skin test may be used to monitor the effectiveness of antibiotic therapy.

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 Todar's Online Textbook of Bacteriology

Lyme Disease
© 2005 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

Borrelia burgdorferi the spirochete that causes Lyme Disease. FA stain (CDC)

Introduction

Lyme disease was first recognized in the United States in 1975 by Dr. Allen Steere, following a
mysterious outbreak of juvenile rheumatoid arthritis near the community of Lyme, Connecticut. The
rural location of the Lyme outbreak and the onset of illness during summer and early fall suggested that
the transmission of the disease was by an arthropod vector.

In 1982, the etiologic agent of Lyme disease was discovered by Willy Burgdorfer who isolated
spirochetes belonging to the genus Borrelia from the mid-guts of Ixodes ticks. He showed that these
spirochetes reacted with immune serum from patients that had been diagnosed with Lyme disease.
Subsequently, the etiologic agent was given the name Borrelia burgdorferi.

Since then, reports of Lyme disease have increased dramatically to the point that the disease has
become an important public health problem in some areas of the United States. Today Lyme disease is
the most prevalent tick-borne illness in the US. Lyme disease has been reported in 49 states and on four
different continents. In 2002, there were 23,763 new cases reported in the U.S. Between 1996 and 2001
the number was level at about 17,000 new cases per year, but increased by nearly 7,000 cases in 2002.
See Figure 1 below from the CDC.

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Biology of Borrelia burgdorferi

Borrelia burgdorferi, like the human pathogen Treponema pallidum, is a spirochete. Spirochetes are a
group of phylogenetically-distinct bacteria that have a unique mode of motility by means of axial
filaments (endoflagella). Spirochetes are widespread in viscous environments and they are found in the
intestinal tracts of animals and the oral cavity of humans. The spirochetes have a unique cell surface
which accompanies their unique type of motility. The endoflagella are contained within the periplasmic
space between a semi rigid peptidoglycan helix and a multi-layer, flexible outer membrane sheath.
When the filaments rotate within this space, the spirochetes move in cork-screw fashion. This type of
movement may be an adaptation to viscous environments such as aquatic sediments, biofilms, mucosal
tissues and the intestinal tracts of animals. For pathogens, this allows the spirochetes to hide their
flagella, which are normally antigenic, from the host immune defenses.

Spirochetes are usually much longer than they are wide, and often their width is below the resolving
power of the light microscope. For example, Borrelia may have a length of 20-30um but a width of
only .2-.3um. Hence, most spirochetes cannot be viewed using conventional light microscopy. Dark-
field microscopy must be used to view spirochetes. Dark field microscopy utilizes a special condenser
which directs light toward an object at a angle, rather than from the bottom. As a result, particles or
cells are seen as light objects against a dark background.

B. burgdorferi dark field illumination (CDC)

The spirochetes are not classified as either Gram-positive or Gram-negative. When Borrelia
burgdorferi is Gram-stained, the cells stain a weak Gram-negative by default, as safranin is the last dye
used. Borrelia, like most spirochetes, does have an outer membrane that contains an LPS-like
substance, an inner membrane, and a periplasmic space which contains a layer of peptidoglycan.
Therefore, it has a Gram-negative bacterial type cell wall, despite its staining characteristics.

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Cultivation

Unlike Treponema pallidum, Borrelia burgdorferi can be cultivated in vitro. However, the bacterium is
fastidious and requires a very complex growth medium. The medium used to grow Borrelia
burgdorferi is called Barbour-Stoenner-Kelly (BSK) medium. It contains over thirteen ingredients in a
rabbit serum base. Borrelia burgdorferi has an optimal temperature for growth of 32 C, in a
microaerobic environment. Even under optimal conditions, the generation time is slow, about 12-24
hours.

Borrelia from ticks and from the blood, skin, and cerebrospinalfluid of Lyme disease patients have
been successfully cultivated in BSK medium. BSK solidified with 1.3% agarose allows the production
of colonies from single organisms.

Strains of Borrelia

Recently, the Borrelia causing Lyme disease were divided into several "genospecies", three of which
have been firmly established and are well accepted:

I. Borrelia burgdorferi sensu stricto

II. Borrelia garinii

III. Borrelia afzelii

The term used to collectively describe all three genospecies is Borrelia burgdorferi sensu lato. The
differences in genospecies are revealed by restriction fragment length polymorphism, (RFLP), multi-
locus enzyme electrophoresis (MLEE) and ssuRNA sequences. All US isolates fall into genospecies I.
Examples of all three genospecies have been found in Europe and Asia, although II and III predominate
there.

Outer Surface Proteins

The outer membrane of Borrelia burgdorferi is composed of various unique outer surface proteins
(Osp) that have been characterized (Osp A through OspF). They are presumed to play a role in
virulence. Osp A and Osp B are by far the most abundant outer surface proteins. The genes encoding
these proteins are transcribed from a common promoter, and are located on a 49 kb linear plasmid. The
chromosome of Borrelia burgdorferi is also linear and is almost 1100 kb in size.

Pathogenicity
Borrelia burgdorferi invades the blood and tissues of various infected mammals and birds. The natural
reservoir for Borrelia burgdorferi is thought to be the white-footed mouse. Ticks transfer the
spirochetes to the white-tailed deer, humans, and other warm-blooded animals after a blood meal on an
infected animal. In humans, dogs, and many other animals, infection with Borrelia burgdorferi results
in the pathology of Lyme Disease.

Incidence and Distribution of Lyme Disease in the United States

Lyme disease has a wide distribution in northern temperate regions of the world. In the United States,
the highest incidence occurs in the Northeast, from Massachusetts to Maryland and the North-central
states, especially Wisconsin and Minnesota.
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In 2002, more than 23,000 cases of Lyme disease were reported in the U.S., the highest number ever
reported. This increase could be caused by an increase in human contact with infected ticks and
enhanced reporting of cases.

Twelve states reported an incidence of Lyme Disease that was higher than the national average in both
2001 and 2002: Connecticut, Delaware, Maine, Maryland, Massachusetts, Minnesota, New Hampshire,
New Jersey, New York, Pennsylvania, Rhode Island, and Wisconsin. These 12 states account for 95%
of cases reported nationally. See Figure 2 below from CDC.

Transmission of Lyme Disease

Lyme disease is spread by the bite of ticks of the genus Ixodes that are infected with Borrelia
burgdorferi. Ixodes, commonly known as the deer tick (or bear tick), normally feeds on the white-
footed mouse, the white-tailed deer, and certain other mammals. It is responsible for transmitting the
spirochetes to humans in the northeastern and north-central United States. On the Pacific Coast, the
bacteria are transmitted to humans by the western black-legged tick, and in the southeastern states by
the related black-legged tick.

Distribution of Ixodes ticks that transmit Lyme disease in the U.S. (CDC)
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Ixodes ticks are much smaller than common dog and cattle ticks. In their larval and nymphal stages,
they are no bigger than a pinhead. Adult ticks are slightly larger. The tick nymphs, which are most
likely to feed on a person and are rarely noticed because of their small size (less than 2 mm), are
usually involved in the transmission of the disease.

Ixodes ticks (CDC)

Spirochete prevalence in adult Ixodes ticks has been shown to be approximately 35% (for example, in
the Baraboo Hills, northwest of Madison, Wisconsin), but varies greatly among geographic locations
(e.g. California = 2%, New York =50%).

For Lyme disease to exist in an area, at least three closely interrelated elements must be present in
nature: the Lyme disease bacteria, ticks that can transmit them, and mammals (such as mice and deer)
to provide food for the ticks in their various life stages. The tick life cycle consists of three distinctive
stages: larvae, nymphs, and adults. A blood meal is required for ticks to molt from the larvae stage to
the nymph stage and from the nymph stage to the adult stage. The tick larvae and nymphs typically
become infected with Lyme disease bacteria when they feed on infected small animals, particularly the
white-footed mouse. The bacteria remain in the tick as it changes from larva to nymph or from nymph
to adult. Infected nymphs and adult ticks then bite and transmit Lyme disease bacteria to other small
rodents, other animals, and humans, all in the course of their normal feeding behavior. Adult ticks
preferentially feed on the white-tailed deer, which thereby becomes an important reservoir in regions of
infestation. The tick life cycle takes two years to complete (See diagram below).

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Lyme disease occurs in domestic animals, as well. In dogs, the disease usually presents as arthritis.
Domestic animals can carry infected ticks into areas where humans live, but whether pet owners are
more likely than others to get Lyme disease is not known.

Symptoms of Lyme disease

The symptoms of Lyme disease in humans occur in three stages.

Stage one (early infection). The early stage of Lyme disease is often characterized by a distinctive,
expanding red rash that usually develops at the site of the tick bite. This rash, known as erythema
migrans, is seen in 60-80% of infected individuals (it is important to remember that the converse is
true: no rash is ever observed in 20-40 % of the cases!). Spirochetes can be isolated from the leading
edge of the rash. Erythema migrans is a red circular patch that appears usually 3 days to 1 month
following the bite of the tick. The patch then expands, often to a large size and develops a characteristic
"bull's eye"appearance. However, not all rashes that occur at the site of a tick bite are due to Lyme
disease. An allergic reaction to tick saliva often occurs at the site of a tick bite. This rash can be
confused with the rash of Lyme disease. Allergic reactions to tick saliva usually occur within hours to a
few days after the tick bite, usually do not expand, and disappear within a few days. Erythema migrans
persists longer, but usually subsides within 3-4 weeks.

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The presentation of erythema migrans in Stage 1

Stage two (dissemination stage): occurs days to weeks following infection. At this stage the
spirochetes spread hematogenously to additional body tissues. One or more of the following symptoms
and signs may be noted:
fatigue
chills and fever
headache
muscle and joint pain
swollen lymph nodes
secondary annular skin lesions

Stage three (persistent infection). Some symptoms and signs of Lyme disease may not appear until
weeks, months, or years after a tick bite. Stage three typically involves intermittent episodes of joint
pain. Common clinical manifestations at this stage may include meningitis, Bell's palsy, cardiac
involvement, and migratory pain to joints, tendons, muscle and bone:

Arthritis is most likely to appear as brief bouts of pain and swelling, usually in one or more large joints,
especially the knees.

Nervous system abnormalities can include numbness, pain, Bell's palsy (paralysis of the facial muscles,
usually on one side), and meningitis (fever, stiff neck, and severe headache).

Less frequently, irregularities of the heart rhythm occur.

In a minority of individuals (11%) the development of chronic Lyme arthritis may lead to erosion of
cartilage and/or bone. Other clinical manifestations associated with stage three Lyme disease include
neurologic complications such as disturbances in memory, mood, or sleep patterns, and sensations of
numbness and tingling in the hands or feet.

Lyme disease mimics other diseases and pathologies and is highly variable in its presentation. In some
persons the rash never forms; in some, the first and only sign of Lyme disease is arthritis, and in others,
nervous system problems are the only evidence of Lyme disease. There is an increasing and alarming
number of reports of neuropsychiatric effects associated with Lyme Disease.

Diagnosis of Lyme disease

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Lyme disease is often difficult to diagnose because its symptoms and signs mimic those of so many
other diseases. The fever, muscle aches, and fatigue of Lyme disease can easily be mistaken for viral
infections, such as influenza or infectious mononucleosis. Joint pain can be mistaken for other types of
arthritis, such as rheumatoid arthritis, and neurologic signs can mimic those caused by other conditions,
such as multiple sclerosis. At the same time, other types of arthritis or neurologic diseases can be
misdiagnosed as Lyme disease.

The clinical diagnosis of Lyme disease is usually based on history of possible exposure to ticks,
especially in areas where Lyme disease is known to occur and a combination of symptoms and signs of
infection. Serodiagnosis to detect anti-borrelia antibodies is not useful until in later stages of illness.
Serologic testing may, however, provide valuable supportive diagnostic information in patients with
endemic exposure and/or clinical findings that suggest late stage or disseminated Lyme disease.

When serologic testing is indicated, CDC recommends testing first with an enzyme-linked
immunosorbent assay (ELISA) or an indirect fluorescent antibody (IFA) test, followed by a more
specific Western immunoblot (WB) test to corroborate equivocal or positive results obtained with the
first test. None of these tests is useful in the diagnosis of early stages of Lyme disease since a primary
serum immune rsponse is just beginning. Furthermore, these tests are associated with a high degree of
cross-reactivity, since sera from patients with Rocky Mountain spotted fever, relapsing fever,
mononucleosis, syphilis, and rheumatoid arthritis often test positive for Lyme disease.

Patients with early disseminated or late-stage disease usually have strong serological reactivity.
Antibodies may persist for months or years following successfully treated or untreated infection. Thus,
seroreactivity alone cannot be used as a marker of active disease.

Neither a positive serologic activity nor a history of previous Lyme disease assures that an individual
has protective immunity. Repeated infection with B. burgdorferi has been documented.

B. burgdorferi can be cultured from 80% or more of biopsy specimens taken from early erythema
migrans lesions. However, the diagnostic value of this procedure is limited because of the need for
special bacteriologic media (BSK medium) and protracted observation of cultures.

Polymerase chain reaction (PCR) has been used to amplify genomic DNA of B. burgdorferi in skin,
blood, cerobro-spinal fluid, and synovial fluid, but PCR has not been standardized for routine diagnosis
of Lyme disease.

Treatment of Lyme disease

Since the diagnosis of Lyme disease is based primarily on clinical findings, it is often appropriate to
treat patients with early disease solely on the basis of objective signs and a known exposure.

Several antibiotics are effective in the treatment of Lyme disease. The present drug of choice is
doxycycline, a semisynthetic derivative of tetracycline. Even patients who are treated in later stages of
the disease respond well to antibiotics. In a few patients who are treated for Lyme disease, symptoms
of persisting infection may continue or recur, making additional antibiotic treatment necessary. Varying
degrees of permanent damage to joints or the nervous system can develop in patients with late chronic
Lyme disease. Typically these are patients in whom Lyme disease was unrecognized in the early stages
or for whom the initial treatment was unsuccessful.

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Prevention

Removing leaves and clearing brush and tall grass around houses and at the edges of gardens may
reduce the numbers of ticks that transmit Lyme disease. A relationship has been observed between the
abundance of deer and the abundance of deer ticks in some parts United States. Reducing and
managing deer populations in geographic areas where Lyme disease occurs may reduce tick abundance.

CDC recommends the following for personal protection from tick bites and Lyme disease:

Avoid tick-infested areas, especially in May, June, and July.

Wear light-colored clothing so that ticks can be spotted more easily. Tuck pant legs into socks or boots
and shirt into pants or ape the area where pants and socks meet so that ticks cannot crawl under
clothing.

Spray insect repellent containing DEET on clothes and on exposed skin other than the face, or treat
clothes (especially pants, socks, and shoes) with permethrin, which kills ticks on contact.

Wear a hat and a long-sleeved shirt for added protection.

Walk in the center of trails to avoid overhanging grass and brush.

After being outdoors, remove clothing and wash and dry it at a high temperature; inspect body
carefully and remove attached ticks with tweezers, grasping the tick as close to the skin surface as
possible and pulling straight back with a slow steady force; avoid crushing the tick's body. In some
areas, ticks (saved in a sealed container) can be submitted to the local health department for
identification.

Preventive antibiotic treatment with erythromycin or doxycycline to prevent Lyme disease after a
known tick bite may be warranted.

Personal protective measures, such as repellent use and routine tick checks, are key components of
primary prevention. Removing infected ticks within 48 hours of attachment can reduce the likelihood
of transmission, and prompt antimicrobial prophylaxis of tick bites, although controversial, might be
beneficial under certain circumstances. Exposure to ticks in yards and recreational areas can be reduced
50-90% through simple landscaping practices, such as removingbrush and leaf litter or creating a buffer
zone of wood chips or gravel between forest and lawn or recreational areas. Correctly timed
applications of pesticides to yards once or twice a year can decrease the number of nymphal ticks 68%-
-100%.

In addition to these interventions, several novel approaches to Lyme disease prevention are under
investigation or will soon be available. These include bait boxes and "four-poster" devices that deliver
acaricides to rodents and deer without harming them, and the use of biologic agents, such as fungi that
kill Ixodes ticks.

Vaccines for Lyme disease

In 1998, the Food and Drug Administration licensed the LYMErixTM vaccine against Lyme disease for
human use . LYMErixTM contains lipidated recombinant outer surface protein A (OspA) of Borrelia
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burgdorferi sensu stricto, the causative agent of Lyme disease in North America, adsorbed onto
aluminum adjuvant. It was indicated for use in persons aged 15-70 years. Three doses of the vaccine
are administered by intramuscular injection. The initial dose is followed by a second dose 1 month later
and a third dose 12 months after the first. Vaccine administration should be timed so the second dose
and the third dose are given several weeks before the beginning of the B. burgdorferi transmission
season which usually begins in April.

The vaccine is targeted at persons at risk for exposure to infected vector ticks. This risk should be
assessed by considering the regional distribution of the disease and the extent to which a person's
activities place them in contact with ticks. A Lyme disease risk map (below) is available from CDC.
Vaccination of persons with frequent or prolonged exposure to ticks in areas endemic for Lyme disease
is expected to be an important preventive strategy. Recommendations for use of the LYMErixTM
vaccine have been developed by the Advisory Committee for Immunization Practices of the CDC and
are available at CDC Lyme Disease Vaccine Recommendations.In February, 2002, the manufacturer
of the FDA-approved LYMErixô Lyme disease vaccine withdrew it from the market, reportedly
because of poor sales. However, several other effective preventive measures remain available to
persons living in areas where the disease is endemic.

Lyme Disease Websites

CDC Lyme Disease Home Page

Lyme Disease: Questions and Answers - CDC

Lyme Disease: Diagnosis - CDC

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Lyme Disease: Prevention and Control - CDC

PBS Documentary on Lyme Disease - CDC

Lyme Disease: Vaccine Recommendations - CDC

Lyme Disease, NIH Division of Microbiology and Infectious Diseases

Lyme Disease: Scientific Literature

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 Todar's Online Textbook of Bacteriology

The Rickettsiae
© 2005 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

Introduction to the Rickettsiae

The rickettsiae are small (0.3-0.5 x 0.8-2.0 um), Gram-negative, aerobic, coccobacilli that are obligate
intracellular parasites of eukaryotic cells. They may reside in the cytoplasm or within the nucleus of the
cell that they invade. They divide by binary fission and they metabolize host-derived glutamate
via aerobic respiration and the citric acid (TCA) cycle. They have typical Gram-negative cell walls,
amd they lack flagella. The rickettsiae frequently have a close relationship with arthropod vectors that
may transmit the organism to mammalian hosts. The rickettsiae have very small genomes of about 1.0-
1.5 million bases.

Rickettsiae must be grown in the laboratory by co-cultivation with eukaryotic cells, and they have not
been grown by in axenic culture. The basis of their obligate relationship with eukaryotic cells has been
explained by rickettsial possesion of "leaky membranes" that require the osmolarity and nutritional
environment supplied by an intracellular habitat.

The rickettsiae, in spite of their small size and obligate intracellular habitat, are a group of
alphaproteobacteria, which inlcude many well-known organisms such as Acetobacter, Rhodobacter,
Rhizobium and Agrobacterium. Very few of the alphaproteobacteria are pathogens of humans.
Brucella, Bartonella, Rickettsia, and a related intracellular parasite, Ehrlichia, are the main exceptions.

Taxonomy
The genus Rickettsia is included in the bacterial tribe Rickettsieae, family Rickettsiaceae, and order
Rickettsiales. This genus includes many other species of bacteria associated with human disease,
including those in the spotted fever group and the typhus group (figure1).

Figure 1. Taxonomic classification of the order Rickettsiales

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The rickettsiae can be subdivided into two or three major groups, depending on your taxonomic point
of view (1. spotted fever; 2. typhus; and 3. scrub typhus groups) based on clinical characteristics of
disease and phylogenetic relationships.

Spotted Fever Group (SFG)

Rickettsia rickettsii is the cause of Rocky Mountain spotted fever (RMSF) and is the prototype
bacterium in the spotted fever group of rickettsiae. Rickettsia rickettsii is found in the Americas and is
transmitted to humans through the bite of infected ticks. The bacterium infects human vascular
endothelial cells, producing an inflammatory response. The pathogenesis of RMSF is discussed in
some detail below.

Other spotted fever group rickettsiae that produce human rickettsioses include R. conorii, R.
mongolotimonae and R. slovaca (bouteonneuse fever and similar illnesses), R. akari (rickettsial pox),
R. japonica (Japanese spotted fever), R.sibirica (North Asian tick typhus), R. africae (African tick bite
fever), R. helvetica (perimyocarditis), R. australis(Queensland tick typhus) and R. honei (Flinders
Island spotted fever). The spotted fever rickettsiae have been found on every continent except
Antarctica.

Typhus Group (TG)

Rickettsia prowazekii is the cause of epidemic or louse-borne typhus and is the prototypical bacterium
from the typhus group of rickettsiae. R. prowazekii infects human vascular endothelial cells, producing
widespread vasculitis. In contrast to RMSF, louse-borne typhus tends to occur in the winter. Infection
usually is transmitted from person to person by the body louse and, therefore, tends to manifest under
conditions of crowding and poor hygiene. The southern flying squirrel is apparently the reservoir in the
United States, but the vector involved in transmission from the flying squirrel to humans is unknown.
The disease has a worldwide distribution.

Other rickettsiae in the typhus group include R. typhi and R. felis. Murine typhus is caused by
transmission of R. typhi from rats, cats and opossums to humans via a flea vector. Murine typhus is
found worldwide and is endemic to areas of Texas and southern California in the United States.
Although R. felis is phylogenetically more closely related to the spotted fever group of rickettsiae than
the typhus group, it shares antigens with R. typhi and produces a murine typhus-like illness. Rickettsia
felis has been detected in cat fleas and opossums.

Scrub Typhus Group (STG)

Orientia (Rickettsia) tsutsugamushi is the cause of scrub typhus. Originally called Rickettsia
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tsutsugamushi, this organism was given its own genus designation because it is phylogenetically
distinct from the other rickettsiae, though closely related. Orientia tsutsugamushi is transmitted to
humans by the bite of trombiculid mites (chiggers), which are the vector and host. Scrub typhus occurs
throughout much of Asia and Australia.

Virulence of Rickettsiae

Adherence to the Host Cell

Rickettsiae are inoculated into the dermis of the skin by a tick bite or through damaged skin from the
feces of lice or fleas. The bacteria spread through the bloodstream and infect the endothelium.
Adherence to the host cell is the first step of rickettsial pathogenesis. The adhesins are presumed to be
outer membrane proteins. The outer membrane protein OmpA has been implicated in adherence of R.
rickettsii because antibodies to OmpA habe been shown to block adherence.

The host cell receptor for any Rickettsia has yet to be identified. Although the main target cells of
Rickettsia in vivo are endothelial cells, rickettsiae can infect virtually every cell line in vitro. Thus,
either the receptor for Rickettsia is ubiquitous among cells, or rickettsiae can bind to different
receptors.

Invasion of Host Cells

Upon attaching to the host cell membrane, rickettsiae are phagocytosed by the host cell. The
rickettsiae are believed to induce host cell phagocytosis because they can enter cells that normally do
not phagocytose particles. Once phagocytosed by the host cell, rickettsiae are observed to quickly
escape from the phagosome membrane and enter the cyoplasm. The mechanism of escape from the
phagosome membrane is not well understood, but it is thought to be mediated by a rickettsial enzyme,
phospholipase A2.

Movement within and Release from the Host Cell

Observations in cell culture systems suggest that the mechanisms of intracellular movement and
destruction of the host cells differ among the spotted fever group and typhus group rickettsiae.

Typhus group rickettsiae are released from host cells by lysis of the cells. After infection with R.
prowazekii or R. typhi, the rickettsiae continue to multiply until the cell is packed with organisms and
then bursts. Phospholipase A2 may be involved in cell llysis. Typhus group rickettsia-infected host
cells have a normal ultrastructural appearance.

Spotted fever group rickettsiae seldom accumulate in large numbers and do not lyse the host cells.
They escape from the cell by stimulating polymerization of host cell-derived actin tails, which propel
them through the cytoplasm and into tips of membranous extrusions, from which they emerge. Infected
cells exhibit signs of membrane damage associated with an influx of water, but the means by which
rickettsiae damage host cell membranes is uncertain. There is evidence to suggest a role for free
radicals of oxygen, phospholipase, and a protease. The protein responsible for the actin-based
movement in spotted fever group rickettsiae has yet to be identified, but it is apparently different than
the proteins responsible for actin polymerization by Listeria monocytogenes and Shigella flexneri.

Diseases

Rickettsial diseases vary in clinical severity according to the virulence of the Rickettsia and host
factors, such as age, male gender, alcoholism, and other underlying diseases. The most virulent
rickettsiae are R. rickettsii and R. prowazekii, which kill a significant portion of infected persons,
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unless the diseases are treated sufficiently early in the course of infection with an effective
antimicrobial agent, usually doxycycline.

All rickettsial infections begin with introduction of the organisms into the skin, either through a tick
bite or cutaneous abrasions contaminated by flea or louse feces. Rickettsiae enter dermal cells
including endothelium and proliferate locally intracellularly with endothelial cell-to-cell spread for
most SFG rickettsioses resulting in an eschar or tache noire, a zone of dermal and epidermal necrosis
approximately 1 cm in diameter with a surrounding zone of erythema. Eschars do not occur in
epidemic and murine typhus and are rarely observed in Rocky Mountain spotted fever.

SFG rickettsioses often manifest regional lymphadenopathy in the drainage of the eschar, suggesting
that rickettsiae may spread via lymphatic vessels from the tick bite inoculation site early in the
infection. Rickettsiae spread throughout the body and infect mainly endothelial cells, establishing many
foci of contiguous infected blood vessel-lining cells. Injury in these local sites causes vascular damage
manifesting as rash, interstitial pneumonia, encephalitis, interstitial nephritis, and interstitial
myocarditis, as well as lesions in the liver, gastrointestinal wall, pancreas, and potemtially any
vascularized tissue of the body.

The most important pathophysiologic effect is increased vascular permeability with consequent edema,
loss of blood volume, hypoalbuminemia, decreased osmotic pressure, and hypotension. These effects
can be life threatening resulting in pulmonary edema and adult respiratory distress syndrome, shock, or
acute tubular necrosis.

Rocky Mountain Spotted Fever

Rocky Mountain spotted fever is the most severe and most frequently reported rickettsial disease in
the United States. In the pre-antibiotic era, 20-25% of previously healthy, infected persons died of the
illness. Today, even with antimicrobial agents that are highly effective, 3-5% of persons die mainly
because of late or mis-diagnosed infection and delayed or ineffective antimicrobialtreatment.

The disease is caused by Rickettsia rickettsii, a species of bacteria that are spread to humans by Ixodes
ticks. The onset of disease follows an infective bite by a week (range 2-14 days), beginning with fever,
severe headache, and muscle pain, followed by development of rash. The disease can be difficult to
diagnose in the early stages, and without prompt and appropriate treatment it can be fatal.

The reasons are that up to 40% of patients are unaware of a tick bite, which is painless and may go
unnoticed or be forgotten, and that the rash does not usually appear until 3-5 days after onset of illness.
To further confound the diagnosis, symptoms such as nausea, vomiting, diarrhea, abdominal pain, and
cough may suggest other diagnoses such as enterocolitis, acute surgical abdomen, or pneumonia. The
rash typically appears on the ankles and wrists as faint pink 1-5 mm macules that represent a focus of
vascular infection and surrounding vasodilation. These lesions may progress to become maculopapular,
owing to the leakage of edema fluid from the affected blood vessels, with the development of a
hemorrhage (petechia) in the center of the lesions.

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Figure 2. Characteristic spotted rash of late-stage Rocky Mountain spotted fever on legs of a patient. (CDC)

Rocky Mountain spotted fever was first recognized in 1896 in the Snake River Valley of Idaho and was
originally called "black measles" because of the characteristic rash. It was a dreaded and frequently
fatal disease that affected hundreds of people in this area. By the early 1900s, the geographic
distribution of the disease in United States was recgnized as far north as Washington and Montana and
as far south as California, Arizona, and New Mexico.

Howard Ricketts was the first to establish the identity of the infectious organism that causes Rocky
Mountain spotted fever in . He and others characterized the basic epidemiologic features of the
disease, including the role of tick vectors. Their studies found that Rocky Mountain spotted fever is
caused by Rickettsia rickettsii, and invo alves a complex cycle between ticks and mammals. Humans
are accidental hosts, but are not involved in the natural transmission cycle of the pathogen.

The name Rocky Mountain spotted fever is somewhat of a misnomer. Beginning in the 1930s, it
became clear that this disease occurred in many areas of the United States other than the Rocky
Mountain region. It is now recognized that this disease is broadly distributed throughout the continental
United States, as well as southern Canada, Central America, Mexico, and parts of South
America. Between 1981 and 1996, this disease was reported from every U.S. state except Hawaii,
Vermont, Maine, and Alaska.

Rocky Mountain spotted fever remains a serious and potentially life-threatening infectious disease
today. Despite the availability of effective treatment and advances in medical care, approximately 3-
5% of individuals who become ill with Rocky Mountain spotted fever die from the infection. However,
effective antibiotic therapy has dramatically reduced the number of deaths caused by Rocky Mountain
spotted fever. Hefore the discovery of tetracycline and chloramphenicol in the late 1940s, as many as
30% of indyviduals infected with R. rickettsii died.

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Figure 3. Discovery of chloramphenicol and tetracycline antibiotics in the 1940s led to a sharp decline in RMSF-
related mortality. Today, doxycycline is the drug of choice for treatment of RMSF. (CDC)

Rickettsia rickettsii, is a very small bacterium that must live inside the cells of its hosts. Consequently,
they are difficult to see in tissues by using routine histologic stains and generally require the use of
special staining methods (Figure 4).

Figure 4. Gimenez stain of tick hemolymph cells infected with R. rickettsii. (CDC)

In humans, Rickettsia rickettsii live and multiply primarily within cells that line small- to medium-sized
blood vessels. Spotted fever group rickettsiae can grow in the nucleus or in the cytoplasm of the host
cell. Once inside the host the rickettsiae multiply, resulting in damage and death of these cells. This
causes blood to leak through tiny holes in vessel walls into adjacent tissues. This process causes the
rash that is traditionally associated with Rocky Mountain spotted fever and causes damage to organs
and tissues.

Natural History
Rocky Mountain spotted fever, like all rickettsial infections, is classified as a zoonosis. Zoonoses are
diseases of animals that can be transmitted to humans. Many zoonotic diseases require a vector (e.g., a
mosquito, tick, or mite) in order to be transmitted from the animal host to the human host. In the case
of Rocky Mountain spotted fever, ticks are the natural hosts, serving as both reservoirs and vectors of
R. rickettsii. Ticks transmit the organism to vertebrates primarily by their bite. Less commonly,
infections may occur following exposure to crushed tick tissues, fluids, or feces.

Only members of the tick family Ixodidae (hard ticks) are naturally infected with Rickettsia rickettsii.
These ticks have four stages in their life cycle: egg, larva, nymph, and adult. After the eggs hatch, each
stage must feed once to develop into the next stage. Both male and female ticks will bite.

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A female tick can transmit R. rickettsii to her eggs in a process called transovarial transmission. Ticks
can also become infected with R. rickettsii while feeding on blood from the host in either the larval or
nymphal stage. After the tick develops into the next stage, R. rickettsii may be transmitted to the second
host during the feeding process. Furthermore, male ticks may transfer R. rickettsii to female ticks
through body fluids or spermatazoa during mating.. In this manner generations or each life stage of
infected ticks are maintained. Once infected, the tick can carry the rickettsie for life.

Rickettsiae are transmitted to a vertebrate host through saliva while a tick is feeding. It usually takes
several hours of attachment and feeding before the rickettsiae are transmitted to the host. The risk of
exposure to a tick carrying R. rickettsii is low. Generally, about 1 -3% of the tick population carries R.
rickettsii, even in areas where the majority of human cases are reported.

Major Tick Vectors in the United States

There are two major vectors of R. rickettsii in the United States, the American dog tick and the Rocky
Mountain wood tick.

The American dog tick (Dermacentor variabilis) is widely distributed east of the Rocky Mountains and
also occurs in limited areas along the Pacific Coast. Dogs and medium-sized mammals are the
preferred hosts of adult D. variabilis, although it feeds on other large mammals, including humans.
This tick is the most commonly identified species responsible for transmitting R. rickettsii to humans.

Figure 5. American dog tick (Dermacentorvariabilis). (CDC)

Figure 6. Approximate distribution of the American dog tick. (CDC)

The Rocky Mountain wood tick (Dermacentor andersoni) is found in the Rocky Mountain states and in
southwestern Canada. The life cycle of this tick may require up to 2 to 3 years for completion. Adult
ticks feed primarily on large mammals. Larvae and nymphs feed on small rodents.

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Figure 7. Rocky Mountain wood tick (Dermacentor andersoni). (CDC)

Figure 8. Approximate distribution of the Rocky Mountain wood tick. (CDC)

Other tick species have been shown to be naturally infected with R. rickettsii but these species are
likely to play only a minor role in the ecology of R. rickettsii.

Epidemiology
Rocky Mountain spotted fever has been a reportable disease in the United States since the 1920s. In the
last 50 years, approximately 250-1200 cases of Rocky Mountain spotted fever have been reported
annually, although it is likely that many more cases go unreported.

Figure 9. Reported cases of Rocky Mountain spotted fever in the United States,1942-1996. CDC compiles the
number of cases reported by the state health departments. (CDC)

Over 90% of patients with Rocky Mountain spotted fever are infected during April through
September. This period is the season for increased numbers of adult and nymphal Dermacentor ticks.
A history of tick bite or exposure to tick-infested habitats is reported in approximately 60% of all cases
of Rocky Mountain spotted fever.

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Figure 10. Seasonal distribution of reported cases of Rocky Mountain spotted fever, 1993-1996. (CDC)

Over half of Rocky Mountain spotted fever infections are reported from the south-Atlantic region of
the United States (Delaware, Maryland, Washington D.C., Virginia, West Virginia, North Carolina,
South Carolina, Georgia, and Florida). Infection also occurs in other parts of the United States, namely
the Pacific region (Washington, Oregon, and California) and west south-central (Arkansas, Louisiana,
Oklahoma, and Texas) region.

The states with the highest incidences of Rocky Mountain spotted fever are North Carolina
and Oklahoma. These two states combined accounted for 35% of the total number of U.S. cases
reported to CDC during 1993 through 1996. Although Rocky Mountain spotted fever was first
identified in the Rocky Mountain states, actually less than 3% of the U.S. cases were reported from that
area during the same interval (1993-1996).

Figure 11. Number of reported cases of Rocky Mountain spotted fever by state and region, 1994-1998. (CDC)

Certain induvudyuals are at higher risk of disease. The frequency of reported cases of Rocky Mountain
spotted fever is highest among males, Caucasians, and children. Two-thirds of the Rocky Mountain
spotted fever cases occur in children under the age of 15 years, with the peak age being 5 to 9 years old
(see Figure 12). Individuals with frequent exposure to dogs and who reside near wooded areas or areas

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with high grass may also be at increased risk of infection.

Figure 12. Average annual incidence of Rocky Mountain spotted fever by age group, 1993-1996. (CDC)

Signs and Symptoms

Rocky Mountain spotted fever can be very difficult to diagnose in its early stages, even among
experienced physicians who are familiar with the disease. Patients infected with R. rickettsii generally
visit a physician in the first week of their illness, following an incubation period of about 5-10 days
after a tick bite. The early clinical presentation of Rocky Mountain spotted fever is nonspecific and
may resemble a variety of other infectious and non-infectious diseases.

Initial symptoms may include fever, nausea, vomiting, severe headache, muscle pain, and lack of
appetite. Later signs and symptoms include rash, abdominal pain, joint pain and diarrhea.

The classic triad of findings for this disease are fever, rash, and history of tick bite. However, this
combination is often not identified when the patient initially presents for care. The rash first appears 2-
5 days after the onset of fever and is often not present or may be very subtle when the patient is initially
seen by a physician. Younger patients usually develop the rash earlier than older patients. Most often it
begins as small, flat, pink, non-itchy spots (macules) on the wrists, forearms, and ankles (Figure
13). These spots turn pale when pressure is applied and eventually become raised on the skin. The
characteristic red, spotted (petechial) rash of Rocky Mountain spotted fever is usually not seen until the
sixth day or later after onset of symptoms, and this type of rash occurs in only 35% to 60% of patients
with Rocky Mountain spotted fever (Figure 14). The rash involves the palms or soles in as many as
50% to 80% of patients; however, this distribution may not occur until later in the course of the
disease. As many as 10% to 15% of patients may never develop a rash.

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Figure 13. Early (macular) rash on sole of foot. (CDC)

Figure 14. Late (petechial) rash on palm and forearm. (CDC)

Rocky Mountain spotted fever can be a very severe illness and patients often require hospitalization.
Because R. rickettsii infects the cells lining blood vessels throughout the body, severe manifestations
of this disease may involve the respiratory system, central nervous system, gastrointestinal system, or
renal system. Host factors associated with severe or fatal Rocky Mountain spotted fever include
advanced age, male sex, African-American race, chronic alcohol abuse, and glucose-6-phosphate
dehydrogenase (G6PD) deficiency. Deficiency of G6PD is a sex-linked genetic condition affecting
approximately 12% of the U.S. African-American male population; deficiency of this enzyme is
associated with a high proportion of severe cases of Rocky Mountain spotted fever. This is a rare
clinical course that is often fatal within 5 days of onset of illness.

Long-term health problems following acute Rocky Mountain spotted fever infection include partial
paralysis of the lower extremities, gangrene requiring amputation of fingers, toes, or arms or legs,
hearing loss, loss of bowel or bladder control, movement disorders, and language disorders. These
complications are most frequent in persons recovering from severe, life-threatening disease, often
following lengthy hospitalizations.

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Laboratory Diagnosis
There is no widely available laboratory assay that provides rapid confirmation of early Rocky
Mountain spotted fever. Treatment decisions must be based on epidemiologic and clinical clues, and
should never be delayed while waiting for confirmation by laboratory results.

Serologic assays are the most widely available and frequently used methods for confirming cases of
Rocky Mountain spotted fever. The indirect immunofluorescence assay (IFA) is generally considered
the reference standard in Rocky Mountain spotted fever serology and is the test currently used by CDC
and most state public health laboratories (Figure 15).

Figure 15. IFA reaction of a positive human serum on Rickettsia rickettsii grown in chicken yolk sacs, 400X. (CDC)

IFA can be used to detect either IgG or IgM antibodies. Blood samples taken early (acute) and late
(convalescent) in the disease are the preferred specimens for evaluation. Most patients demonstrate
increased IgM titers by the end of the first week of illness. Diagnostic levels of IgG antibody generally
do not appear until 7-10 days after the onset of illness. It is important to consider the amount of time it
takes for antibodies to appear when ordering laboratory tests, especially because most patients visit
their physician relatively early in the course of the illness, before diagnostic antibody levels may be
present. The value of testing two sequential serum or plasma samples together to show a rising
antibody level is considerably more important in confirming acute infection with rickettsial agents
because antibody titers may persist in some patients for years after the original exposure.

Another approach to Rocky Mountain spotted fever diagnostics is immunostaining. This method is
used by taking a skin biopsy of the rash from an infected patient prior to therapy or within the first 48
hours after antibiotic therapy has been started. Because rickettsiae are focally distributed in lesions of
Rocky Mountain spotted fever, this test may not always detect the agent. Even in laboratories with
expertise in performing this test, the sensitivity is only about 70% on biopsied tissues. This assay may
also be used to test tissues obtained at autopsy and has been used to confirm Rocky Mountain spotted
fever in otherwise unexplained deaths (Figure 16). Immunostaining for spotted fever group rickettsiae
519
is offered by the CDC, a few state health departments, and some university-based hospitals and
commercial laboratories in the United States.

Figure 16. Red structures indicate immunohistological staining of Rickettsia rickettsii in endothelial cells of a blood
vessel from a patient with fatal RMSF. (CDC)

Treatment
Appropriate antibiotic treatment should be initiated immediately when there is a suspicion of Rocky
Mountain spotted fever on the basis of clinical and epidemiologic findings. Treatment should not be
delayed until laboratory confirmation is obtained.

If the patient is treated within the first 4-5 days of the disease, fever generally subsides within 24-72
hours after treatment with an appropriate antibiotic (usually a tetracycline). In fact, failure to respond
to a tetracycline antibiotic argues against a diagnosis of RMSF. Severely ill patients may require longer
periods before their fever resolves, especially if they have experienced damage to multiple organ
systems. Prophylactic therapy in non-ill patients who have had recent tick bites is not recommended
and may, in fact, only delay the onset of disease.

Doxycycline (100 mg every 12 hours for adults or 4 mg/kg body weight per day in two divided doses
for children under 45 kg [100 lbs]) is the drug of choice for patients with Rocky Mountain spotted
fever. Therapy is continued for at least 3 days after fever subsides and until there is unnequivocal
evidence of clinical improvement, generally for a minimum total course of 5 to 10 days. Severe or
complicated disease may require longer treatment courses. Doxycycline is also the preferred drug for
patients with ehrlichiosis, another tick-transmitted infection with signs and symptoms that may
resemble Rocky Mountain spotted fever.

Tetracyclines are usually not the preferred drug for use in pregnant women because of risks associated
with malformation of teeth and bones in unborn children. Chloramphenicol is an alternative drug that
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can be used to treat Rocky Mountain spotted fever; however, this drug may be associated with a wide
range of side effects including aplastic anemia, and may require careful monitoring of blood levels.

Prevention and Control

Limiting exposure to ticks is the most effective way to reduce the likelihood of Rocky Mountain
spotted fever infection. In persons exposed to tick-infested habitats, prompt careful inspection and
removal of crawling or attached ticks is an important method of preventing disease. It may take several
hours of attachment before organisms are transmitted from the tick to the host.

Currently, no licensed vaccine is available for Rocky Mountain spotted fever.

It is unreasonable to assume that a person can completely eliminate activities that may result in tick
exposure. Therefore, prevention measures should be aimed at personal protection. CDC recommends
the following prevention measures:

-Wear light-colored clothing to allow you to see ticks that are crawling on your clothing.

-Tuck your pants legs into your socks so that ticks cannot crawl up the inside of your pants legs.

-Apply repellants to discourage tick attachment. Repellents containing permethrin can be sprayed on
boots and clothing, and will last for several days. Repellents containing DEET(diethyltoluamide) can
be applied to the skin, but will last only a few hours before reapplication is necessary. Use DEET with
caution on children. Application of large amounts of DEET on children has been associated with
adverse reactions.

-Conduct a body check upon return from potentially tick-infested areas by searching yourentire body
for ticks. Use a hand-held or full-length mirror to view all parts of your body.

-Remove any tick you find on your body. Parents should check their children for ticks, especially in the
hair, when returning from potentially tick-infested areas. Additionally, ticks may be carried into the
household on clothing and pets. Both should be examined carefully.

Tick Control
Strategies to reduce populations of vector ticks through area-wide application of acaricides (chemicals
that will kill ticks and mites) and control of tick habitats (e.g., leaf litter and brush) have been effective
in small-scale trials. New methods being developed include applying acaricides to rodents by using
baited tubes, boxes, and feeding stations in areas where these pathogens are endemic. Biological
control with fungi, parasitic nematodes, and parasitic wasps may play alternate roles in integrated tick
control efforts. Community-based, integrated, tick-management strategies may prove to be an effective
public health response to reduce the incidence of tick-borne infections. However, limiting exposure to
ticks is currently the most effective method of prevention.

Boutonneuse Fever and African Tick-bite Fever

Boutonneuse fever and its agent were first described in North Africa in 1910, and variants of R. conorii
have been identified in South Africa, Kenya, Somalia, Israel, Morocco, Ethiopia, Russia, India and
Pakistan. In parts of Africa, tick-transmitted diseases caused by R. conorii and R. africae overlap
geographically. Although their clinical manifestations also overlap, their are differences sufficient to
distinguish two different disease agents. Generally milder than boutonneuse fever, African tick bite
fever has a lower incidence of rash, which is more often vesicular and sparse, a higher incidence of
521
eschars that are frequently multiple, and more prominent regional lymphadenopathy. Each of these
diseases has been diagnosed in the United States after patients return from vacation abroad, particularly
from African safaris.

Rickettsialpox

R. akari has been recognized mainly in the urban United States as an agent maintained in a mite-mouse
cycle with humans as an accidental host. The organism may, however, have a broader host range and
geographic distribution.

A papule appears at the site of mite feeding in the skin during the incubation period, and over 2-7 days,
evolves into an eschar. Later fever, chills, malaise, headache, and myalgia develop, followed after 2-6
days by a macular rash that becomes maculopapular and then vesicular before crusting and healing.
Fatalities have not been reported.

Cat Flea Typhus

Despite the widespread geographic distribution and prevalence of R. felisin cat fleas, there have been
only a handful of clinical investigations of undertaken to diagnose cat flea typhus.

Among eight reported cases of human infection with R. felis (five diagnosed by polymerase chain
reaction [PCR] and three by differential antibody titers), all had fever and constitutional
symptoms. The majority manifested rash, headache, and central nervous system (CNS) involvement,
and variable proportions suffered nausea, vomiting, diarrhea, abdominal pain, myalgia and
conjunctivitis. The actual spectrum of illness of this infection requires further clinical studies.

Typhus Fever

Rickettsia prowazekii infections occur in three situations: louse-transmitted epidemics, reactivation of a

longstanding latent infection, and zoonotic infection transmitted from flying squirrels by their
ectoparasites. Onset of disease is characterized by fever, chills, headache, and myalgia. Macules of 2-6
mm usually appear first on the trunk on day 5 and later spread to the extremities. Rales, conjunctival
injection, and delirium are frequent manifestations. Reactivated typhus is a milder version wih the same
signs and symptoms. Flying squirrel-associated typhus has also been described as less severe; whether
this is due to antimicrobial treatment or less virulent strains of rickettsiae is unclear.

Murine Typhus

Flea-borne R. typhi infections cause extreme discomfort but are seldom fatal healthy young individuals.
The difficulty in detecting a rash in darkly pigmented skin was evident in a study finding only 20% of
experimentally infected African-American volunteers had rashes, compared to 80% of Caucasian
volunteers. The infection can follow a mild course in children with as many as half suffering only fever
at night, but necessitates intensive care unit support in 10% of hospitalized adult patients. Pneumonitis
or meningoencephalitis can be the major manifestation in some patients.

Treatment of Rickettsioses

Doxycycline is the drug of choice for the treatment of infections caused by Rickettsia except in cases of
pregnancy and tetracycline hypersensitivity. some studies have shown that doxycycline is superior to
chloramphenicol for the treatment of Rocky Mountain spotted fever as it is associated with a lower case
522
fatality rate and a lower hospitalization rate. Several fluoroquinolones, azithromycin, and
clarithromycin, have been used successfully to treat boutonneuse fever but are not recommended for
more pathogenic rickettsioses. It should be emphasized that rickettsiae are highly resistant to most
antibiotics. Most fatal cases of Rocky Mountain spotted fever have received substantial courses of
antimicrobial treatment, including beta lactams, aminoglycosides, and erythromycin. Sulfonamide
antimicrobials actually appear to exacerbate the severity of rickettsial infections.

Immunity

Rickettsial infection stimulates an early innate immune response with activation of natural killer cells
and production of gamma interferon (gammaIFN), which act in concert to dampen rickettsial growth.
Acquired immunity develops with clonal expansion of CD4 and CD8 T lymphocytes as well as
antibody-producing B cells. Clearance of intraendothelial rickettsiae is achieved by rickettsicidal
effects due to cytokine activation of the infected endothelial cells themselves. Cell mefiated immunuty
(CMI) plays an important role as expected in infection by an intracellular parasite, but antibodies
(including those directed at epitopes of OmpA and OmpB) also play a role in protective immunity.

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 Todar's Online Textbook of Bacteriology

Vibrio vulnificus
© 2005 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

Vibrio vulnificus is scarcely recognized by many microbiologists, much less by the public. Yet, in this
country, the bacterium causes a disease with over a 50 percent mortality rate, and it causes 95 percent
of all seafood-related deaths.

Vibrio vulnificus is a Gram-negative, motile curved bacterium found in marine and estuarine
environments. It has been isolated from seawater, sediments, plankton and shellfish (oysters, clams and
crabs) located in the Gulf of Mexico, the Atlantic Coast as far north as Cape Cod, and the entire U.S.
West Coast. The bacterium thrives in warm seawater and is part of a group of vibrios that are
"moderate halophiles", meaning they require salt for growth. The vibrios are frequently isolated from
oysters and other shellfish in warm coastal waters during the summer months. This correlates with the
peak incidence of disease caused by the bacterium.

Vibrio vulnificus is in the Bacterial family Vibrionaceae, the same as Vibrio cholerae, the agent of
epidemic cholera in humans. Vibrios are one of the most common organisms in surface waters of the
world. They occur in both marine and freshwater habitats and in associations with aquatic animals.
Some species are bioluminescent and live in mutualistic associations with fish and other marine life.
Other species are pathogenic for fish, eels, and frogs, as well as other vertebrates and invertebrates.

V. cholerae and V. parahaemolyticus are pathogens of humans. Both produce diarrhea, but in ways that
are entirely different. V. parahaemolyticus is an invasive organism affecting primarily the colon; V.
cholerae is noninvasive, affecting the small intestine through secretion of an enterotoxin.

Vibrio vulnificus is an emerging pathogen of humans. It causes wound infections, gastroenteritis, or a

syndrome known as primary septicemia. It was first recognized as an agent of disease in 1976. The
first documented case of disease caused by the bacterium was in 1979.

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Figure 1. Vibrio vulnificus is a typical marine vibrio - a slightly curved bacterium, motile by means of a single polar
flagellum.

Disease

V. vulnificus causes disease in individuals who eat contaminated seafood (usually raw or undercooked
oysters) or have an open wound that is exposed to seawater. Among healthy people, ingestion of V.
vulnificus can cause vomiting, diarrhea, and abdominal pain. Most V. vulnificus infections are acute
and have no long-term consequences.

In immunocompromised persons, particularly those with chronic liver disease, V. vulnificus can invade
the bloodstream from either a wound or from the GI tract, causing a severe and life-threatening
illness called primary septicemia, characterized by fever, chills, septic shock and death. Blistering skin
lesions accompany the disease in about 70% of the cases. V. vulnificus bloodstream infections are fatal
about 50% of the time.

Although V. vulnificus is a rare cause of disease, it is likely that it is unrecognized and underreported
(one estimate of the total number of cases annually in the U.S. is as high as 45,000). Between 1988 and
1995, CDC received reports of over 300 V. vulnificus infections from the Gulf Coast states, where the
majority of cases occur.

Persons who are immunocompromised, especially those with chronic liver disease, are at risk for V.
vulnificus when they eat raw seafood, particularly oysters. These individuals are 80-200 times more
likely to develop V. vulnificus primary septicemia than are healthy people. For this particular risk
group, the infection carries one of the highest mortality rates of all bacterial infections.

Health conditions that place a person at risk for serious illness or death from V. vulnificus infection
include liver disease, hemochromatosis, diabetes, stomach problems, kidney disease, cancer, immune
disorders (including HIV) and long-term steroid use. In these individuals, the bacterium enters the
blood stream, resulting in septic shock, rapidly followed by death in many cases. These individuals are
strongly advised not to consume raw or inadequately cooked seafood. Many of these health conditions
may exist but be unrecognized in a person, so that they do not realize they are at risk of V. vulnificus
disease.
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Pathogenesis

Wound infections result from contaminating an existing open wound with seawater harboring the
organism, or by cutting part of the body on coral, fish, fishhooks, etc., followed by contamination with
the organism.

Also, people who consume foods contaminated with this organism are susceptible to gastroenteritis,
which usually develops within 16 hours of eating the contaminated food. They experience vomiting,
diarrhea, and abdominal pain. Many patients develop distinctive bullous skin lesions.

The bacterium invades directly from the GI tract or broken skin to produce bacteremia and septicemia.
Invasion is characterized by the occurrence of blister-like skin lesions or bullae, and rapidly-spreading
necrosis resembling necrotizing fasciitis.

Figure 2. A.Characteristic skin lesions associated with Vibrio vulnificus infection on the leg in a 75-year-old patient
with liver cirrhosis in whom septic shock and bacteremia developed. B V. vulnificus bacteremia developed one day
after a fish bone injury on the fourth finger of the left hand (arrow) in a 45-year-old patient with uremia. C. Gram-
negative curved bacilli isolated from a blood sample of the 45-year-old patient with uremia.(Photos from Hsueh, et
al. Vibrio vulnificus in Taiwan..CDC Emerging Infectious Diseases Volume 10, Number 8, August 2004)

Determinants of Virulence

Attempts to associate phenotypic or genotypic characteristics of Vibrio vulnificus with strain virulence
have been largely unsuccessful. V. vulnificus exhibits considerable strain-to-strain variation in
virulence. More than 100 strains of the bacterium have been identified, and it is possible that many
thousands more exist. The bacterium also exhibits a large number of potential determinants of

526
virulence, on the order of V. cholerae and Pseudomonas aeruginosa combined, but thier role in
disease has not been elucidated.

There are at least three ways that Vibrio vulnificus strains have been divided into two "biotypes", one of
which is pathogenic for humans, and the other of which is found in shellfish or fish, or is free-
living. One way is based on the difference in a 17-bp nucleotide sequence of the 16S rRNA gene. By
this criterion two major groups of V. vulnificus have been identified, designated types A and B. The
majority of nonclinical isolates are type A, and there is a positive correlation between the type B
genotype and the cause of human disease. Similarly, a homogeneous LPS type is found in vibrios that
live in associations with eels (biotype 2), and disinct heterogenous LPS types are observed in clinical
isolates (Biotype 1). And while the presence of a capsule occurs in virulent strains, noncapsulated
strains are nonvirulent. The significance of these observations is not known and they do not explain
how the bacteria are able to switch from free-swimming and colonizimg oysters to colonizing human
tissues.

Generalized Stress Response

Many of the heat shock proteins produced by V. vulnificus, such as the chaperonins DnaK and GroEL,
and the proteases, Clp and Lon, are induced by environmental changes other than increased
temperature, such as ethanol, heavy metals or oxidizing agents, high osmolarity, pollutants, starvation,
exposure to low temperature, or interaction with eukaryotic hosts. This is thought to be a generalized
stress response in the bacterium. Through a process termed cross protection, this response improves
the bacterium's thermotolerance, salt tolerance, tolerance to heavy metals and UV exposure, and
starvation survival. The generalized stress response may be critical for bacterial adaptation to changes
in the environment, and is a major link between bacterial ecology and bacterial pathogenesis.

Stress is also thought to cause genomic differences observed among strains of V. vulnificus. Genomic
differences may be the result of gene rearrangements in the bacterium. Since the bacterium may exist in
a rapidly changing ecosystem where major alterations in temperature, salt concentration, UV
irradiation, and nutrient availability are routinely encountered, it is possible that such gene
rearrangements may increase the chances of survival of the bacterium when it moves from water to
oyster to human.

Capsule
Expression of a polysaccharide capsule is necessary for virulence of Vibrio vulnificus. The
noncapsulated form is nonvirulent. Under laboratory conditions, acapsular variants arise at a fairly high
frequency (~1/100), with certain environmental stresses dramatically increasing this switch rate. Once
such noncapsulated (translucent) colonies arise, they do not appear able to revert back to the capsule-
expressing (opaque) morphology. The mechanism of this capsule switching has not been explained.

Fimbriae
Type IV pili (fimbriae) are required for virulence. Type IV pili are N-methylphenylalanine pili,
characteristic of vibrios, that allow the bacteria to adhere to epithelial cells. The receptor has not yet
been identified. The N-methylphenylalanine pili of Vibrio cholerae utilize N-acetylneuraminic acid
(sialic acid) as a receptor.

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 Figure 3. Electron micrograph of Vibrio vulnificus. The arrows mark fimbriae (pili) of the bacterium. The laboratory
of Dr. Mark Strom at the NOAA Northwest Fisheries Science Center is studying how the adhesins of the
bacterium, which include fimbriae and other cell surface components, influence the course of mammalian
colonization and infection, as well as the organism's ability to colonize and persist in shellfish.

LPS
As a Gram negative bacterium, V. vulnificus lipopolysaccharide (endotoxin) is expected to play a role
in fever and septic shock brought on by infection. On the basis of lipopolysaccharide (LPS) antigens,
the species can be organized into three biotypes. Biotype 1 is the predominant human pathogen;
biotype 2 is associated with eels; and biotype 3 was recently isolated from fish handlers in Israel.
Biotype 2 consists of a homogeneous type of LPS, and although Biotype 1 was originally divided into
5 antigenic subgroups, other subgroups are known to exist. Biotype 1 is almost invariably associated
with human disease, and one particular LPS type (1/5) is significantly more prevalent among clinical
strains. This suggests that either the presence of this LPS type itself causes increased virulence, or that
the LPS type is a marker of more virulent strains.

Besides attachment ability, capsule switching, LPS, and the ability to undergo the stress response, other
properties of V. vulnificus that have been considered as determinants of virulence include production of
alternate (stress) sigma factors, SSR repeats, motility, quorum sensing, production of a siderophore and
a hemolysin (cytolysin), and numerous extracellular enzymes, including proteases, collagenase,
mucinase, esterase, chondroitinase, hyaluronidase, DNAase and sulfatase.

A recently identified determinant of virulence in Vibrio vulnificus is the member of the RTX family of
toxins produced by a limited group of Gram-negative pathogens. RTX toxins cause pore formation in
red blood cells, necrotic death of Hep2 cells, and depolymerization of actin in HeLa cells.

For an excellent review of the virulence of Vibrio vulnificus see Gulig. et al. Molecular Pathogenesis of
Vibrio vulnificus (2005).

Treatment

Antibiotics are necessary for treatmeent of V. vulnificus infections. Effective antibiotics include
tetracycline, third-generation cephalosporins (e.g., ceftazidime), and imipenem. In case of wound
infection, aggressive debridement is necessary to remove necrotic tissue.

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For more information on Vibrio vulnificus

CDC - General Information

CDC - Technical Information
FDA/CFSAN Bad Bug Book
FDA/CFSAN Prime Connection
Clemson University
Florida State University - Vibrio vulnificus
Florida State Ubiversity - Toward Safer Oysters
NOAA Northwest Fisheries Science Center
Southern Medical Association Vibrio vulnificus Infection: case study
UNC Charlotte - Oliver Research Lab
Molecular Pathogenesis of Vibrio vulnificus

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 Todar's Online Textbook of Bacteriology

The Genus Bacillus

© 2005 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

Introduction

In 1872, Ferdinand Cohn, a student of Robert Koch, recognized and named the bacterium Bacillus
subtilis. The organism was made to represent a large and diverse genus of Bacteria, Bacillus, and was
placed in the family Bacillaceae. The family's distinguishing feature is the production of endospores,
which are highly refractile resting structures formed within the bacterial cells. Since this time, members
of the genus Bacillus are characterized as Gram-positive, rod-shaped, aerobic or facultative, endospore-
forming bacteria.

The ubiquity of Bacillus species in nature, the unusual resistance of their endospores to chemical and
physical agents, the developmental cycle of endospore formation, the production of antibiotics, the
toxicity of their spores and protein crystals for many insects, and the pathogen Bacillus anthracis, have
attracted ongoing interest in the genus since Koch's time.

There is great diversity in physiology among members of the genus, whose collective features include
degradation of most all substrates derived from plant and animal sources, including cellulose, starch,
pectin, proteins, agar, hydrocarbons, and others; antibiotic production; nitrification; denitrification;
nitrogen fixation; facultative lithotrophy; autotrophy; acidophily; alkaliphily; psychrophily;
thermophily; and parasitism. Spore formation, universally found in the genus, is thought to be a
strategy for survival in the soil environment, wherein the bacteria predominate. Aerial distribution of
the dormant spores probably explains the occurrence of Bacillus species in most habitats examined.

530
Bacillus coagulans. Gram stain. CDC.Gram-positive or Gram-negative? The cell wall structure of the bacilli is
consistent with that of Gram-positive bacteria, and young cultures stain as expected. However, many sporeformers
rapidly become Gram-negative when entering the stationary phase of growth.

Classification and Phylogeny

Early attempts at classification of Bacillus species were based on two characteristics: aerobic growth
and endospore formation. This resulted in tethering together many bacteria possessing different kinds
of physiology and occupying a variety of habitats. Hence, the heterogeneity in physiology, ecology,
and genetics, made it difficult to categorize the genus Bacillus or to make generalizations about it.

In Bergey's Manual of Systematic Bacteriology (1st ed. 1986), the G+C content of known species of
Bacillus ranges from 32 to 69%. This observation, as well as DNA hybridization tests, revealed the
genetic heterogeneity of the genus. Not only is there variation from species to species, but there are
sometimes profound differences in G+C content within strains of a species. For example, the G+C
content of the B. megaterium group ranges from 36 to 45%.

In Bergey's Manual of Systematic Bacteriology (2nd ed. 2001), phylogenetic classification schemes
landed the two most prominant types of endospore-forming bacteria, clostridia and bacilli, in two
different "classes" of Gram-positives, "clostridia" and "bacilli". "Clostridia" includes the Order
Clostridiales and Family Clostridiaceae with 11 genera including, Clostridium. "Bacilli" includes the
Order Bacillales and the Family Bacillaceae. In this family there are several new genera on the level
with Bacillus. This explains heterogeneity in G+C content observed in the 1986 "genus" Bacillus.

The phylogenetic approach to Bacillus taxonomy has been accomplished largely by analysis of 16S
rRNA molecules by oligonucleotide sequencing. This technique, of course, also reveals phylogenetic
relationships. Surprisingly, Bacillus species showed a kinship with certain nonsporeforming species,
including Planococcus, Lactobacillus and Staphylococcus.

In one study, 16S rRNA cataloging showed that B. subtilis and other ellipsoidal-sporeforming species,
B. cereus, B. megaterium, and B. pumilus, formed a coherent cluster, but the round-sporeforming
species, B. sphaericus, B. globisporus, and B. aminovorans, did not cluster.

In another 16S rRNA sequencing study, three major Bacillus taxonomic cluster groups were
defined by determining complete or partial sequences of 16S RNA (exceeding 1,100 nucleotides) on
35 recognized reference strains. These cluster groups were quite different from those previously
noted.

531
For the purposes of differentiation and and identification of Bacillus species, this article follows the
nomenclature in Bergey's Manual of Systematic Bacteriology (1st ed. 1986), which is intended for
this purpose.

In Bergey's Manual of Systematic Bacteriology (1986) there are six genera of endospore-forming
bacteria featured. Bacillus is distinguished from the other endospore-forming bacteria on the basis of
being a strict or facultative aerobe, rod-shaped, and (usually) catalase-positive. Other endospore-
forming genera in the are Sporolactobacillus, which is microaerophilic and catalase-negative;
Clostridium, which is anaerobic and does not reduce sulfate; Desulfotomaculum, which is anaerobic
but does reduce sulfate; Sporosarcina, which has a coccal morphology; and Thermoactinomycetes,
which while forming endospores, displays typical actinomycete characteristics. These genera are
related phenotypically as Gram-positive bacteria that form endospores; they are not related
phylogenetically.

In the 1986 edition of Bergey's, there are 40 recognized species in the genus Bacillus The table at the
end of this chapter lists the 34 type species and some of their characteristics. Several valid species of
Bacillus have been designated since 1986. Some of these are among the more than 200 species of
Bacillus in the 1986 Bergey's that are in the category "Species Incertae Sedis"; other species are
newly-discovered; still others have been moved to new or existing genera of endospore-forming
bacteria based on phylogenetic comparison with true Bacillus species.

For the most current information on taxonomic flux within the genus Bacillus go to this link: Bacterial
Nomenclature up-to-date: the Genus Bacillus.

Nutrition and Growth

Most Bacillus species are versatile chemoheterotrophs capable of respiration using a variety of simple
organic compounds (sugars, amino acids, organic acids). In some cases, they also ferment
carbohydrates in a mixed reaction that typically produces glycerol and butanediol. A few species, such
as Bacillus megaterium, require no organic growth factors; others may require amino acids, B-vitamins,
or both. The majority are mesophiles, with temperature optima between 30 and 45 degrees, but the
genus also contains a number of thermophilic species with optima as high as 65 degrees. In the
laboratory, under optimal conditions of growth, Bacillus species exhibit generation times of about 25
minutes.

Bacillus species are easily isolated and readily grown in the bacteriology laboratory. The simplest
technique that enriches for aerobic spore formers is to pasteurize a diluted soil sample at 80 degrees for
15 minutes, then plate onto nutrient agar and incubate at 37 degrees for 24 hours up to several days.
The plates are examined after 24 hours for typical Bacillus colonies identified as catalase-positive,
Gram-positive, endospore-forming rods. Although many species contain sporangia and free spores
within 24 hours, some cultures must be incubated 5-7 days before mature sporangia, and the size and
shape of the endospore contained therein, can be observed. The insect pathogens, B. larvae, B.
popilliae and B. lentimorbis, are more fastidious and must be isolated on J-agar (below). Furthermore,
they are typically catalase-negative, and they require special media or inoculation into insect hosts for
sporulation.

532
Mucoid-type colonies of an encapsulated Bacillus species. CDC.

Most Bacillus species, except the insect pathogens, B. larvae, B. popilliae and B. lentimorbis, can be
grown in defined or relatively-simple complex media. For a few bacilli (e.g. B. subtilis, B. megaterium)
, minimal media have been established. Primary isolations can be performed on either nutrient agar
(peptone 5g/l, beef extract 3g/l, agar15g/l, pH6.8) or plates of J-agar (tryptone 5g/l, yeast extract 15g/l,
K2HPO4 3g/l, glucose 2g/l, agar20g/l, pH7.4). Stock cultures can be maintained in the laboratory on
soil extract agar or on special sporulation media.

Table 1. Minimal medium for the growth of Bacillus megaterium.

Component Amount
sucrose 10.0 g
K2HPO4 2.5 g
KH2PO4 2.5 g
(NH4)2HPO4 1.0 g
MgSO4 7H2O 0.20 g
FeSO4 7H2O 0.01 g
MnSO4 7H2O 0.007 g
water 985 ml
pH 7.0

Surface Structure of Bacillus

Like most Gram-positive bacteria the surface of the Bacillus is complex and is associated with their
properties of adherence, resistance and tactical responses. The vegetative cell surface is a laminated

533
structure that consists of a capsule, a proteinaceous surface layer (S-layer), several layers of
peptidoglycan sheeting, and the proteins on the outer surface of the plasma membrane.

Surface of a Bacillus. Transmission E.M. C=Capsule; S=S-layer; P=Peptidoglycan. Pasteur Institute.

S-layers
Crystalline surface layers of protein or glycoprotein subunits, called S-layers, are found in members of
the genus Bacillus. As with S-layers of other bacteria, their function in Bacillus is unknown. However,
it has been demonstrated that the S-layer can physically mask the negatively charged peptidoglycan
sheet in B. stearothermophilus and prevent autoagglutination, and it has been proposed that the layer
may play some role in bacteria-metal interactions.

Capsules
The capsules of many bacilli, including B. anthracis, B. subtilis, B. megaterium, and B. licheniformis,
contain poly-D- or L-glutamic acid. Other Bacillus species, e.g., B. circulans, B. megaterium, B.
mycoides, and B. pumilus, produce carbohydrate capsules. Dextran and levan are common, but more
complex polysaccharides are produced, as well.

Some of the Bacillus polysaccharides cross react with antisera from other genera of bacteria including
human pathogens. For example, B. mycoides with Streptococcus pneumoniae type III; B. pumilus with
Neisseria meningitidis group A; B.alveli with Haemophilus influenzae type B.

When examined by transmission electron microscopy some polypeptide and complex polysaccharide
capsules appear fibrillar in their arrangement on the cell surface. The capsules are easily observed by
light microscopy, especially if the bacteria are prepared ahead of time by growth on media that enhance
capsule production. Heavily encapsulated strains may form a mucoid or slimy colony on agar.

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FA stain of the capsule of Bacillus anthracis.CDC

Negative stain (India Ink outline) of the capsule of Bacillus anthracis.CDC

Bacillus megaterium synthesizes a capsule composed of both polypeptide and polysaccharide. The
polypeptide is located laterally along the axis of the cell and the polysaccharide is located at the poles
and at the equator of the cell.

The capsule of B. anthracis is composed of a poly-D-glutamic acid. The capsule is a major

determinant of virulence in anthrax. The capsule is not synthesized by the closest relatives of B.
anthracis, i.e., B. cereus and B. thuringiensis, and this criterion can be used to distinguish the species.

Cell Walls
The variability of cell wall structure that is common in most Gram-positive bacteria does not occur in
the genus Bacillus. The vegetative cell wall of almost all Bacillus species is made up of a
peptidoglycan containing meso-diaminopimelic acid (DAP). The exceptions are B. sphaericus and the
related species, B. pasteurii and B. globisporus, that contain lysine, instead. This is the same type of
cell wall polymer that is nearly universal in Gram-negative bacteria, i.e., containing DAP as the
diamino acid. In some cases, DAP is directly cross-linked to D-alanine, same as in the
Enterobacteriaceae; in other cases, two tetrapeptide side chains of peptidoglycan are spanned by an
interpeptide bridge between DAP and D-alanine, which is characteristic of most Gram-positive
bacteria.

In addition to peptidoglycan in the cell wall, all Bacillus species contain large amounts of teichoic acids
which are bonded to muramic acid residues. The types of glycerol teichoic acids vary greatly between

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Bacillus species and within species. As in many other Gram-positive bacteria, lipoteichoic acids are
found associated with the cell membranes of Bacillus species. These compounds are thought to be
involved in the synthesis of wall teichoic acids, as regulators of autolytic activity, and as scavengers of
bivalent ions for the bacterium.

Structure of the muropeptide subunit of the peptidoglycan of Bacillus megaterium. In most Bacillus species, an
interpeptide bridge that connects D-alanine to meso-diaminopimelic acid (DAP) is absent. The peptidoglycan of B.
sphaericus and B. pasteurii contains L-lysine in place of DAP, but all Bacillus spores contain this type of muramic
acid subunit in the spore cortex.

Flagella
Most Bacillus species are motile by means of peritrichous flagella. Chemotaxis has been studied
extensively in B. subtilis. The flagellar filament of B. firmus, an alkaliphile, has a remarkably low
content of basic amino acids, thought to render it more stable in environmental pH values up to 11.

Flagellar stains (Leifson's Method) of various species of Bacillus from CDC

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Individual cells of motile Bacillus species photographed on nutrient agar. About 15,000X magnification. U.S. Dept. of
Agriculture. A. B. subtilis; B. B. polymyxa; C. B. laterosporis; D. B. alveli.

Endospores

Endospores were first described by Cohn in Bacillus subtilis and later by Koch in the pathogen,
Bacillus anthracis. Cohn demonstrated the heat resistance of endospores in B. subtilis, and Koch
described the developmental cycle of spore formation in B. anthracis. Endospores are so named
because they are formed intacellularly, although they are eventually released from this mother cell or
sporangium as free spores. Endospores have proven to be the most durable type of cell found in Nature,
and in their cryptobiotic state of dormancy, they can remain viable for extremely long periods of time,
perhaps millions of years.

When viewed unstained, endospores of living bacilli appear edged in black and are very bright and
refractile. Endospores strongly resist application of simple stains or dyes and hence appear as
nonstaining entities in Gram-stain preparations. However, once stained, endospores are quite resistant
to decolorization. This is the basis of several spore stains such as the Schaeffer-Fulton staining method
which also differentiates the spores from sporangia and vegetative cells.

Left.Bacillus thuringiensis phase micrograph. Endospores can be readily recognized microscopically by their
intracellular site of formation and their extreme refractility. Right.Bacillus anthracis Crystal violet stain viewed by
light microscopy. Endospores are highly resistant to application of basic analine dyes that readily stain vegetative
cells. Below. Spore stain of a Bacillus species. CDC. The staining technique employed is the Schaeffer-Fulton
method. A fixed smear is flooded with a solution of malachite green and placed over boiling water for 5 minutes.
After rinsing, the smear is counterstained with safranine. Mature spores stain green, whether free or still in the

537
vegetative sporangium; vegetative cells and sporangia stain red.

Endospores do not form normally during active growth and cell division. Rather, their differentiation
begins when a population of vegetative cells passes out of the exponential phase of growth, usually as a
result of nutrient depletion. Typically one endospore is formed per vegetative cell. The mature spore is
liberated by lysis of the mother cell (sporangium) in which it was formed.

The formation of endospores is a complex and highly-regulated form of development in a relatively simple
(procaryotic) cell. In all Bacillus species studied, the process of spore formation is similar, and can be divided into
seven defined stages (0-VI).The vegetative cell (a) begins spore development when the DNA coils along the central
axis of the cell as an "axial filament" (b). The DNA then separates and one chromosome becomes enclosed in plasma
membrane to form a protoplast (c). The protoplast is then engulfed by the mother cell membrane to form a
intermediate structure called a forespore (d) . Between the two membranes, The core (cell) wall, cortex and spore
coats are synthesized (e). As water is removed from the spore and as it matures, it becomes increasingly heat
resistant and more refractile (f). The mature spore is eventually liberated by lysis of the mother cell. The entire
process takes place over a period of 6-7 hours and requires the temporal regulation of more than 50 unique genes.
Pasteur Institute.

Mature spores have no detectable metabolism, a state that is described as cryptobiotic. They are highly
resistant to environmental stresses such as high temperature (some endospores can be boiled for several
hours and retain their viability), irradiation, strong acids, disinfectants, etc. Although cryptobiotic, they
retain viability indefinitely such that under appropriate environmental conditions, they germinate into
vegetative cells. Endospores are formed by vegetative cells in response to environmental signals that
indicate a limiting factor for vegetative growth, such as exhaustion of an essential nutrient. They
germinate and become vegetative cells when the environmental stress is relieved. Hence, endospore-
formation is a mechanism of survival rather than a mechanism of reproduction.

Below. Drawing of a cross-section of a Bacillus endospore by Viake Haas, University of Wisconsin. In cross section,
Bacillus spores show a more complex ultrastructure than that seen in vegetative cells. The spore protoplast (core) is
surrounded by the core (cell) wall, the cortex, and then the spore coat. Depending on the species, an exosporium may
be present. The core wall is composed of the same type of peptidoglycan as the vegetative cell wall. The cortex is
composed of a unique peptidoglycan that bears three repeat subunits, always contains DAP, and has very little cross-
linking between tetrapeptide chains. The outer spore coat represents 30-60 percent of the dry weight of the spore.
The spore coat proteins have an unusually high content of cysteine and of hydrophobic amino acids, and are highly

538
resistant to treatments that solubilize most proteins.

Table 2.Differences between endospores and vegetative cells in Bacillus species

Property Vegetative cells Endospores

Typical Gram-positive murein cell wall Thick spore coat, cortex, and unique
Surface coats
polymer; crystalline S-layer peptidoglycan core wall; no S-layer
Microscopic appearance Nonrefractile Refractile
Calcium dipicolinic acid Absent Present in core
Cytoplasmic water activity High Very low
Enzymatic activity Present Absent
Macromolecular synthesis Present Absent
Heat resistance Low High
Resistance to chemicals
Low High
and acids
Radiation resistance Low High
Sensitivity to lysozyme Some sensitive; some resistant Resistant
Sensitivity to dyes and
Sensitive Resistant
staining

Genetics of Bacillus

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The discovery of transformation in a strain of Bacillus subtilis in 1958 focused attention on the
genetics of the bacterium. This is one of relatively few bacteria in which competence for DNA uptake
has been found to occur as a natural part of the bacterium's life cycle. Subsequently, generalized and
specialized transduction was observed in B. subtilis, and knowledge of the genetics and chromosomal
organization of the bacterium quickly mounted to become second only to that of the enteric bacteria.
Furthermore, the identification of numerous genes affecting sporulation in B. subtilis has provided a
means for analyzing the complex developmental program of sporulation.

Bacteriophages capable of mediating generalized transduction have also been reported in other species
of Bacillus, including B. cereus, B. megaterium, B. thuringiensis, B. anthracis, and B.
stearothermophilus.

Conjugative plasmids (fertility plasmids capable of bringing about their own transfer from one
bacterium to another) have been described in several species of Bacillus. The capacity to produce the
insecticidal delta toxin crystal protein in B. thuringiensis is encoded in large plasmids. These plasmids
can be transferred to plasmid-deficient strains of B. thuringiensis, as well as to B. cereus, to yield
recipients that produce crystal protein. B. thuringiensis transfers the pXO11 and pXO12 plasmids to B.
anthracis and to B. cereus. The recipients, in turn, become effective donors, and in the case of those
inheriting pXO12, also acquire the ability to produce parasporal crystals. Strains of B. anthracis that
acquire plasmid pXO12 can subsequently mobilize and transfer nonconjugative plasmids present in the
same cell. The B. anthracis toxin plasmid pXO1, and the capsule plasmid pXO2 can be transmitted to
B. anthracis and B. cereus recipients lacking these plasmids.

The large B. anthracis plasmids are apparently transferred by a process called conduction. This
involves formation of cointegrative molecules in the donor, and resolution of the cointegrates into
pXO12 and the respective B. anthracis plasmid in the recipient. Cell-to-cell contact is necessary for
plasmid transfer and is resistant to DNase, but little is known about the mechanisms or conjugative
structures that may be involved. None of the conjugative plasmids have been found to mobilize and
transfer chromosomal markers as is observed with the F plasmid of E. coli.

In addition to the naturally occurring transmissible plasmids of Bacillus, a conjugative transposon

(Tn925) has been identified, which transfers from Enterococcus faecalis to B. subtilis.

Our understanding of the Bacillus genome, and their means of DNA transfer, has led to its
manipulation. So far, this has resulted in numerous medical, agricultural and industrial achievements,
involving the use of the organism or its products.

This e.m. image of a spore-forming Bacillus (also at the top of this page) is that of B. megaterium which has been
cloned with the Bt gene and is expressing Bt in the form of the bipyramidal "parasporal" crystal adjacent to the
spore (from faculty.washington.edu/jclara/ 410/Micro410Exams.html). Bt is an insecticidal protein produced by
Bacillus thuringiensis.

Ecology

540
Due to the resistance of their endospores to environmental stress, as well as their long-term survival
under adverse conditions, most aerobic sporeformers are ubiquitous and can be isolated from a wide
variety of sources. Hence, the occurrence of sporeforming bacteria in a certain environment is not
necessarily an indication of habitat. However, it is generally accepted that the primary habitat of the
aerobic endospore-forming bacilli is the soil. The great Russian microbiologist Winogradsky
considered them as "normal flora" of the soil.

In the soil environment the bacteria become metabolically-active when suitable substrates for their
growth are available, and presumably they form spores when their nutrients become exhausted. This is
a strategy used by other microbes in the soil habitat, including the filamentous fungi and the
actinomycetes, which also predominate in the aerobic soil habitat. It is probably not a coincidence,
rather an example of convergent evolution, that these three dissimilar groups of microbes live in the
soil, form resting structures (spores), and produce antibiotics in association with their sporulation
process.

Since most Bacillus species can effectively degrade a series of biopolymers (proteins, starch, pectin,
etc.), they are assumed to play a significant role in the biological cycles of carbon and nitrogen.

From soil, by direct contact or air-borne dust, Bacillus spores can contaminate just about anything that
is not maintained in a sterile environment. They may play a biodegradative role in whatever they
contaminate, and thereby they may be agents of unwanted decomposition and decay. Several Bacillus
species are especially important as food spoilage organisms.

Ecophysiological groups

Generally, neither morphologic nor phylogenetic criteria adequately distinguish the members of the
genus Bacillus for discussion or positive identification. An artificial, but convenient, way to organize
the members of the genus for this purpose is to place them into ecophysiological groups, such as
nitrogen-fixers, denitrifiers, insect pathogens, animal pathogens, thermophiles, antibiotic producers,
and so on. Such an approach also allows some speculation concerning the natural history and ecology
of this important group of bacteria.

Acidophiles: include B. acidocaldarius, B. coagulans, and B. polymyxa.

Alkaliphiles: B. alkalophilus and B. pasteurii. The optimum pH is 8 and some strains grow at pH 11.

Halophiles: B. pantothenticus, B. pasteurii. Some strains grow in 10 % NaCl.

Psychrophiles or psychrotrophs: B. globisporus, B. insolitus, B. marinus, B. macquariensis, B.

megaterium, B. polymyxa. Two species will grow and form spores at 0o C.

Thermophiles: include B. acidocaldarius, B. schlegelii, and B. stearothermophilus. Acidophiles and

Lithoautotrophs are found in this group, too. The upper temperature limit is 65o C.

Denitrifiers: include B. azotoformans, B. cereus, B. laterosporus, B. licheniformis, B. pasteurii, B.

stearothermophilus (over half the type species reduce NO3 to NO2). Although Bacillus species are
common in agricultural soils, and they are attributed to participate in wasteful denitrification
(conversion of the farmer's paid-for NO3 fertilizers to volatile NH3, N20 or N2) their exact role in the
economy of this process has not been clarified.

541
Nitrogen-fixers: B. macerans and B. polymyxa. B. macerans is a fairly prominent bacterium in soil and
in decaying vegetable material. The bacteria only fix nitrogen under anaerobic conditions because they
do not have a mechanism for protection of their nitrogenase enzyme from the damaging effects of
O2. In the same way as the role of the bacilli in denitrification and nitrification, their overall
contribution to non symbiotic global nitrogen fixation is not known.

Antibiotic Producers: B. brevis (e.g. gramicidin, tyrothricin), B. cereus (e.g. cerexin, zwittermicin), B.
circulans (e.g. circulin), B. laterosporus (e.g. laterosporin), B. licheniformis (e.g. bacitracin), B.
polymyxa (e.g. polymyxin, colistin), B. pumilus (e.g. pumulin) B. subtilis (e.g. polymyxin, difficidin,
subtilin, mycobacillin).

Bacillus antibiotics share a full range of antimicrobial activity: bacitracin, pumulin, laterosporin,
gramicidin and tyrocidin are effective against Gram-positive bacteria; colistin and polymyxin are anti-
Gram-negative; difficidin is broad spectrum; and mycobacillin and zwittermicin are anti-fungal.

As in the case of the actinomycetes, antibiotic production in the bacilli is accompanied by cessation of
vegetative growth and spore formation. This has led to the idea that the ecological role of antibiotics
may not rest with competition between species, but with the regulation of sporulation and/or the
maintenance of dormancy.

Pathogens of Insects: B. larvae, B. lentimorbis, and B. popilliae are invasive pathogens. B.

thuringiensis forms a parasporal crystal that is toxic to Lepidoptera.

B. larvae, B. lentimorbis and B. popilliae are a related cluster of Bacillus species, being insect
pathogens, with swollen sporangia, and typically catalase-negative. They also are unable to grow in
nutrient broth, probably because it is insufficient in thiamin, which they need as a growth factor. Yeast
extract (15g/l) must be added to their media for growth. Also, B. lentimorbis and B. popilliae are quite
similar in their biochemical properties , virulence and host range. They sometimes occur in
coinfections.

B. larvae is the causative agent of American foulbrood of honeybees, which is the most widespread
and persistent of the honeybee brood diseases. The organism can be isolated repeatedly from infected
brood and honeycomb, usually in a pure culture. It has been noted on many occasions that the natural
habitat of the bacterium is remarkably free of contaminants. Presumably, the bacterium can be isolated
from soil around the hives of infected bees, but it has not been isolated from other sources. This is
indicative of a very close and specific type of host-parasite interaction between the bacterium and the
honeybee.

B. popilliae is the cause of the most widespread of two milky diseases of the Japanese beetle, Popillia
japonica. Their spores, in a swollen sporangium, are frequently accompanied by a parasporal crystal.
Interestingly, the bacterium sporulates with ease in the hemolymph of the infected insect, but will not
form mature spores in most artificial media. Special media have been designed that induce B. popilliae
and B. lentimorbus to form mature spores. The prospect that B. popilliae, together with B. lentimorbus,
might be used to control or eliminate the Japanese beetle and the European chafer (Amphimallon
majalis) has drawn attention to these bacteria. B. popilliae is encountered in naturally-infected grubs far
more frequently than B. lentimorbus, which also causes milky disease.

B. lentimorbus is similar in most ways to B. popilliae. The most obvious difference is that B.
lentimorbus does not form a parasporal body. The bacteria also differ morphologically and culturally.
B. lentimorbus likewise causes one of two milky diseases in the Japanese beetle. The bacterium can
542
only be isolated from the hemolymph of scarabaeid beetles, although it most certainly exists in soil
inhabited with infected larvae.

The principal interest in B. lentimorbus arises from its ability to cause disease of Japanese beetle and
European chafer larvae, which together cause millions of dollars in damage each year to a variety of
plants. B. lentimorbus is more widespread than B. popilliae, which also causes milky disease in the
same hosts. The reason the infections are called "milky disease" is that as the disease develops, the
larvae become milky in appearance. This is caused by the prolific production of spores in the
hemolymph.

Spores of the the insect pathogens seen by phase microscopy. U.S. Dept. of Agriculture. A. B. larvae spores from a
comb infected with American foulbrood; B. B. lentimorbus spores from hemolymph of infected Japanese beetle
larvae; C. Spores of B. popilliae from hemolymph of infected Japanese beetle larvae.

Bacillus thuringiensis is a variety of B. cereus and is therefore considered in the B. cereus-B. anthracis-
B. thuringiensis group. B thuringiensis is distinguished from B. cereus or B. anthracis by its
pathogenicity for lepidopteran insects and by production of an intracellular parasporal crystal in
association with spore formation. The bacteria and protein crystals are sold as "Bt" insecticide, which is
used for the biological control of certain garden and crop pests.

Pathogens of Animals: B. anthracis, and B. cereus. B. alvei, B. megaterium, B. coagulans, B.

laterosporus, B. subtilis, B. sphaericus, B. circulans, B. brevis, B. licheniformis, B. macerans, B.
pumilus, and B. thuringiensis have been isolated from human infections.

The Genus Bacillus includes two bacteria of significant medical importance, B. anthracis, the causative
agent of anthrax, and B. cereus, which causes food poisoning. Nonanthrax Bacillus species can also
cause a wide variety of other infections, and they are being recognized with increasing frequency as
pathogens in humans.

Anthrax
Anthrax is primarily a disease of domesticated and wild animals, particularly herbivorous animals, such
as cattle, sheep, horses, mules, and goats. Humans become infected incidentally when brought into
contact with diseased animals, which includes their flesh, bones, hides, hair and excrement. In the
United States, the incidence of naturally-acquired anthrax is extremely rare (1-2 cases of cutaneous
disease per year). Worldwide, the incidence is unknown, although B. anthracis is present in most of the
world's soils.

The most common form of the disease in humans is cutaneous anthrax, which is usually acquired via
injured skin or mucous membranes. A minor scratch or abrasion, usually on an exposed area of the face
or neck or arms, is inoculated by spores from the soil or a contaminated animal or carcass. The spores

543
germinate, vegetative cells multiply, and a characteristic gelatinous edema develops at the site. This
develops into papule within 12-36 hours after infection. The papule changes rapidly to a vesicle, then a
pustule (malignant pustule), and finally into a necrotic ulcer from which infection may disseminate,
giving rise to septicemia. Lymphatic swelling also occurs within seven days. In severe cases, where the
blood stream is eventually invaded, the disease is frequently fatal.

Another form of the disease, inhalation anthrax (woolsorters' disease), results most commonly from
inhalation of spore-containing dust where animal hair or hides are being handled. The disease begins
abruptly with high fever and chest pain. It progresses rapidly to a systemic hemorrhagic pathology and
is often fatal if treatment cannot stop the invasive aspect of the infection.

Gastrointestinal anthrax is analogous to cutaneous anthrax but occurs on the intestinal mucosa. As in
cutaneous anthrax, the organisms probably invade the mucosa through a preexisting lesion. The
bacteria spread from the mucosal lesion to the lymphatic system. Intestinal anthrax results from the
ingestion of poorly cooked meat from infected animals. Gastrointestinal anthrax is rare, but may occur
as explosive outbreaks associated with ingestion of infected animals.

The pathology of anthrax is mediated by two primary determinants of bacterial virulence: presence of
an antiphagoytic capsule, which promotes bacterial invasion, and production of a powerful lethal toxin,
the anthrax toxin.

For more information on anthrax, including use and detection of Bacillus anthracis as an agent of
bioterrorism, please see the chapter on Bacillus anthracis and Anthrax.

Bacillus anthracis Gram stain. CDC.

Bacillus cereus food poisoning

Bacillus cereus causes two types of food-borne intoxications. One type is characterized by nausea and
vomiting and abdominal cramps and has an incubation period of 1 to 6 hours. It resembles
Staphylococcus aureus food poisoning in its symptoms and incubation period. This is the "short-
incubation" or emetic form of the disease. The second type is manifested primarily by abdominal
cramps and diarrhea with an incubation period of 8 to 16 hours. Diarrhea may be a small volume or
544
profuse and watery. This type is referred to as the "long-incubation" or diarrheal form of the disease,
and it resembles more food poisoning caused by Clostridium perfringens. In either type, the illness
usually lasts less than 24 hours after onset.

The short-incubation form of disease is caused by a preformed heat-stable enterotoxin. The mechanism
and site of action of this toxin are unknown. The long-incubation form of illness is mediated by a heat-
labile enterotoxin which activates intestinal adenylate cyclase and causes intestinal fluid secretion.

This bacterium is dealt with separately in the medical section of the text at Bacillus cereus and Food
Poisoning.

Colonies of Bacillus anthracis (right) and Bacillus cereus (left) on a plate of blood agar. CDC.

Characteristics of Type Species of the Genus Bacillus

B. acidocaldarius Thermoacidophile. Limits of temperature for growth are 45o and 65o C degrees.
Limits of pH for growth are 2 and 6. Found in hot acidic environments. Spores have surprisingly weak
thermal resistance.

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B. alkalophilus Alkaliphile. Tolerant to alkaline conditions and does not grow at pH 7. Capable of
growth at pH >10.

B. alvei Isolated from soil and from honeybee larvae suffering from European foulbrood disease. Not
classified as an insect pathogen.

B. anthracis The causative agent of anthrax in humans and in animals. Spores persist for long periods
on contaminated materials.

B. azotoformans. Has a negative Gram reaction. Can respire anaerobically using NO3, NO2, SO4 or
fumarate as a final electron acceptor. A vigorous denitrifying bacterium in soils, it converts NO3, NO2
and N2O to large amounts of N2.

B. badius Forms a distinct colony with rhizoid outgrowths. Has been isolated from feces, dust, marine
sources, foods and antacids.

B. brevis Has been isolated chiefly from soils and foods. Requires a mixture of amino acids without
vitamins for growth.

B. cereus A close relative of B. anthracis, B. mycoides and B. thuringiensis. Spores are widespread in
soil and air. Usually observed multiplying in foods such as cooked rice and may lead to food poisoning.
Produces antibiotics.

B. circulans Some strains are cellulolytic. Has a distinct rhizoid colony.

B. coagulans Includes acidophilic strains. Spores are relatively sparse in soils. May multiply in acid
foods such as canned tomato juice and silage. Found in medicated creams and antacids

B. fastidiosis Uses only uric acid, allantoic acid or allantoin as an energy source. Isolated from soil and
from poultry litter.

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B. firmus Isolated chiefly from soil. Pigmented strains occur in salt marshes.

B. globisporus Forms spherical spores and is related to B. sphaericus. Found in soil and river water.

B. insolitus Growth and sporulation occur at 0 degrees. Vegetative cells are short and stout. Found in
Arctic soils.

B. larvae Causes American foulbrood in honeybees.

B. laterosporus Produces a canoe-like body attached to the side of spore forcing the spore into a lateral
position in the sporangium. Rarely isolated, but has been found in dead honeybee larvae, soil, water
and antacids.

B. lentimorbus More fastidious nutritionally and more widespread than B. popilliae, it also infects the
Japanese beetle and the European chafer. Isolated from diseased larvae or infected honeycombs.

B. lentus Similar to B. firmus, but more nutritionally-versatile. Isolated from soil, food and spices.

B. licheniformis Produces same type of poly-D-glutamate capsule as B. anthracis. Red pigment

produced by many strains. Spores occur in soil. Growth in foods, especially if held between 30 and 50
degrees. Industrial source of bacitracin, a medically useful antibiotic.

B. macerans Most strains fix N2 under anaerobic conditions. Degrades pectin and plant
polysaccharides. Some strains moderately thermophilic. Also has been found in canned fruit at pH 3.8.

B. macquariensis Grows and sporulates at 0 degrees. Otherwise similar to B. circulans.

547
B. marinus Grows at 5-30 degrees but not at 37 degrees. Has an obligate requirement for Na+. Isolated
routinely from marine sediments.

B. megaterium "megaterium" means "big beast". The largest cell diameter of any aerobic spore former
(1.2 -1.5 micrometers). Grows in minimal medium without any added growth factors. Spores are
common in soil. Subject of many basic studies of Gram-positive bacteria in the laboratory.

B. mycoides Similar to B. cereus but non motile, and forms distinctive rhizoid colonies. High degree of
relatedness with B. anthracis, B. cereus and B. thuringiensis.

B. pantothenticus Has a growth factor requirement for pantothentic acid, apparently unique to the
genus Bacillus. Has been isolated from soils and antacids.

B. pasteurii Converts urea to ammonium carbonate more actively than any known bacterium. Requires
alkaline medium (pH 9) for growth. Isolated from soil, water, sewage and encrustations on urinals.

B. polymyxa Colonies are mucoid, slimy and tend to spread. Synthesizes profuse levan capsule from
sucrose. Spores have longitudinal surface ridges so are star-shaped in cross-section. Degrades pectin
and plant polysaccharides. Nitrogen fixed under anaerobic conditions. Spores are widespread.
Multiplication occurs chiefly in decaying vegetation. Often isolated from foods. Found in medicated
creams and antacids. Source of the antibiotic polymyxin. A very versatile and widespread Bacillus.

B. popilliae Pathogen of scarabeid beetles that causes (one variety of) milky disease in the Japanese
beetle. Together with B. lentimorbis, it is a biological agent for the Japanese beetle and the European
chafer. The larvae become milky white because of the prolific production of spores in the insect
hemolymph. Forms a distinctive parasporal crystal that distinguishes it from B. lentimorbis. Isolated
from hemolymph of Japanese beetle grubs.

B. pumilus Spores are ubiquitous; occurs in soil more frequently than those of B. subtilis.

B. schlegelii Thermophile, similar to B. acidocaldarius and B. sphaericus in its high G+C content, but
differentiated from the latter because it is a facultative lithoautotroph The bacterium can derive energy

548
from the oxidation of H2 or CO while obtaining carbon from either CO2 or CO. Isolated from lake
sediments and sugar factory sludge.

B. sphaericus Isolated from soil, marine and fresh water sediments, milk and foods.

B. stearothermophilus Grows at 65o C and has tolerance to acid. Occurs in soil, hot springs, desert
sand, Arctic waters, ocean sediments, food and compost.

B. subtilis Grows as a unicellular rod, seldom as chains. Degrades pectin and polysaccharides in plant
tissues, and some strains cause rots in live potato tubers. Grows in a minimal defined medium with no
added growth factors. Endospores are widespread. Vegetative organisms take part in various stages in
the early breakdown of materials of plant and animal origin. Grows in non acid food under aerobic
conditions. Causative agent of ropy (slimy) bread. This bacterium is the "E. coli" of Gram-positive
bacteria. Much of the information we have on the biology, biochemistry and genetics of the Gram-
positive cell, indeed, of bacteria in general, has been derived from the study of B. subtilis.

B. thuringiensis Distinguished from B. cereus by pathogenicity for lepidopteran insects, and

production of a parasporal crystal in association with spore formation. In the larval gut, the protein
(crystal) is toxic. The spores and crystals are marketed in garden centers as BT, for biogical control of
lepidopterans that attack garden and crop plants.

Bt is encoded on a plasmid which can be spontaneously transferred to B. cereus, endowing it with

the ability to produce the toxic crystal. Some taxonomists have argued that this is evidence of such a
close genetic relationship between the two bacteria that B. thuringiensis should be considered a variant
subspecies of B. cereus. The same argument has been made for the relationship between B. anthracis,
the plasmid-encoded anthrax toxin, and B. cereus.

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 Todar's Online Textbook of Bacteriology

Pseudomonas and Related Bacteria

© 2004 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

Pseudomonas and Pseudomonas-like Bacteria

The biological identity of the genus Pseudomonas has changed dramatically in recent years during the
transition between artificial classification based on phenotypic properties (e.g. Bergey's Manual of
Systematic Bacteriology,1st ed., 1986) and revisionist classification based on genotypic (phylogenetic)
properties (e.g. Bergey's Manual of Systematic Bacteriology, 2nd ed., 2001). However, in either
scheme, the genus comprises a relatively large and important group of Gram-negative bacteria.
Members of the genus are found abundantly as free-living organisms in soils, fresh water and marine
environments, and in many other natural habitats. They may also be found in associations with plants
and animals as normal flora or as agents of disease. For the purposes of this article, the term
"pseudomonad" refers to a bacterium with ecophysiological properties similar to members of the
genus Pseudomonas. Some of these bacteria were formerly in the genus Pseudomonas but have been
moved to other genera, families, or orders among the alpha Proteobacteria because of their
phylogenetic distance from Pseudomonas. This article will use both old and new taxonomy to identify
the pseudomonads, until this period of confusion has passed.

Morphologically, members of the genus Pseudomonas (as well as most other pseudomonads) may be
described as Gram-negative, non-spore forming, straight or slightly curved rods. They are typically
motile by means of one or more polar flagella. These basic morphological characteristics, however, are
common to many families of bacteria and so are of little value in the positive identification or diagnosis
of a member of the genus Pseudomonas.

Generally, common to all constituent species of the genus Pseudomonas are certain physiological
properties such as chemoorganotrophic nutrition, aerobic metabolism, absence of fermentation, absence
of photosynthesis, inability to fix nitrogen, and capacity for growth at the expense of a large variety of
organic substrates.

There are, of course, a few exceptions to these standardized criteria of definition or identification:
-The traditional description of a short rod-shape body does not always fit the cell morphology of all Pseudomonas
species. In some of them, the cells can be extremely short, while in others (e.g. certain strains of Pseudomonas putida,

550
and P. syringae) they may be very long. Occasionally, particularly in old cultures, the cells can be of such unusual
shapes and sizes that a casual microscopic observation may cast doubt on the purity of the population.

-Some defining physiological characteristics have not been critically tested in all members of the family, and as a
consequence, occasional reports of exceptional strains have been noted. Thus, nitrogen fixation has been shown to
occur in Pseudomonas stutzeri, and Pseudomonas aeruginosa is capable of anaerobic respiration utilizing NO3 as a
final electron acceptor (denitrification), and it can grow anaerobically, albeit slowly, with arginine and small
amounts of yeast extract.

Pseudomonads are important in the balance of nature and also in the economy of human affairs.
Pseudomonads are globally active in aerobic decomposition and biodegradation, and hence, they play a
key role in the carbon cycle. Pseudomonas species are renowned for their abilities to degrade
compounds which are highly refractory to other organisms, including aliphatic and aromatic
hydrocarbons, fatty acids, insecticides and other environmental pollutants. Apparently, the only organic
compounds that these pseudomonads can't attack are teflon, styrofoam and one-carbon organic
compounds (methane, methanol, formaldehyde, etc.). Pseudomonads are also a regular component of
microbial food spoilage in the field, in the market place, and in the home.

Pseudomonas and certain other pseudomonads include species pathogenic for humans, domestic
animals, and cultivated plants. Pseudomonas species, as well as species included in the newly-created
genera Burkholderia and Ralstonia (ex-Pseudomonas) are among the most important bacteria that are
pathogens of plants. They cause economically significant crop disease and crop loss world-
wide. Pseudomonas aeruginosa infects both plants and animals and has evolved into one of the most
common and refractory nosocomial pathogens of the post-antibiotic era.

A close relative of Pseudomonas is Xanthomonas. Xanthomonas includes both phytopathogenic species

and saprophytic strains. Another pseudomonad, Zoogloea is ecologically more restricted, but it has an
extremely active oxidative metabolism in its natural habitat and is an important participant in the
carbon cycle as a component of the microflora of activated sludge. Differentiation of the three is
possible (though often not clear cut) by certain structural, physiological or ecological characteristics,
some of which are summarized in the table below.

Table 1. Selected characteristics of diagnostic value for the differentiation of three genera of bacteria considered
pseudomonads. This scheme of internal subdivision is reasonably consistent with separation of the genera on the
basis of phylogenetic criteria.

Genus Characteristic

Usually motile and oxidase-positive. Capable of growth in simple minimal media at the
Pseudomonas
expense of a large variety of low-molecular-weight organic compounds. Organic growth
factors are not required.

Water-insoluble yellow pigments (xanthomonadins) produced by the plant pathogenic

Xanthomonas
species. Growth on nutrient agar inhibited by 0.1% triphenyltetrazolium chloride. Weak
or negative oxidase reaction. Organic growth factors required.

Zoogloea Cells actively motile when young. Production of dendritic masses of growth attaching to
solid detritus in natural waters and sewage.

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The Genus Pseudomonas

The bacteriological criteria that distinguish the members of the genus Pseudomonas are given below in
Table 2.

Table 2. General characteristics of the genus Pseudomonas

Gram-negative
Rod-shaped, 0.5-0.8 um x 1-3 um
Strictly aerobic; the only anaerobic activities may be denitrification and arginine degradation to
ornithine
Motile by polar flagella; some strains also produce lateral flagella
Oxidative, chemoorganotrophic metabolism
Catalase-positive
Usually oxidase-positive
No organic growth factors are required
Diffusible and/or insoluble pigments may be produced
GC content of the DNA: 58-68 mol%

Classification and Taxonomy

Note: The classification and taxonomy of Pseudomonas has been in flux since the advance of techniques for
comparative alignment of small subunit rRNA sequences, and also in between editions of Bergey's Manualand The
Prokaryotes. This article, "The genus Pseudomonas ", is mainly about bacterial species that have existed historically
as members of the genus Pseudomonas. These bacterial species exemplify the notion of a "pseudomonad" even
though they are not related on phylogenetic grounds.

Previously, according to Palleroni and his colleagues at the University of California, Pseudomonas
species were classified into one of five natural clusters based on ribosomal RNA homology, called
RNA similarity groups (Table 3). There were about forty species, not counting biovars among
fluorescent pseudomonads and serovars among phytopathogenic species. In more recent times,
beginning in 1990, the members of group I were held in the genus Pseudomonas, but the members of
groups II, III, IV and V are (to be) moved into new or previously-existing genera. Their new generic
assignments are shown in ( ) where appropriate for all bacterial names used below Table 3.

Table 3. Species of Pseudomonas and Xanthomonas assigned to the various rRNA similarity groups, according to
Palleroni, et al. 1973. Groups II, III, and IV are currently placed in new genera among the alpha proteobacteria
based on 16SRNA nucleotide sequencing. This might have been predicted based on Palleroni's "RNA homology
groups", and in a sense, he was the first to use RNA homology as a tool to classify bacteria.

RNA
similarity Constituent Species
group
P. aeruginosa, P. fluorescens (several biovars), P. putida, P. chlororaphis, P. syringae
(many pathovars), P. cichorii, P. stutzeri, P. mendocina, P. alcaligenes, P.
I
pseudoalcaligenes, P. agarici, P. angulata, P. fragi, P. synxantha, P. taetrolens, P.
mucidolens, P. oleovorans, P. resinovorans
P. cepacia, P. gladioli, P. caryophylli, P. pseudomallei, P. mallei, P. solanacearum, P.
II
pickettii, P. pyrrocinia, P. andropogonis
III P. (Comamonas) acidovorans, P. (Comamonas) testosteroni, P. saccharophila, P.

552
 facilis, P. delafieldii, P. alboprecipitans, P. palleronii
IV P. diminuta, P. vesicularis
V Xanthomonas spp. including X. (Pseudomonas) maltophilia, P. geniculata, P. gardneri

Group I is the largest of the groups. It includes fluorescent species such as P. aeruginosa, P.
fluorescens and the plant pathogens, P. syringae and P. cichorii. It also includes several important
nonfluorescent species, such as P. stutzeri and P. mendocina. The current taxonomic genus
Pseudomonas has contracted into this group.

P. aeruginosa is the type species of the genus. It is one of the most sharply defined and the easiest to
identify of the members of the genus. It is also the species of the genus best known from a genetic
standpoint, and of course, its genome has now been sequenced. Among the species of
Pseudomonas, P. aeruginosa is the most important as an opportunistic pathogen of humans. As such,
Pseudomonas aeruginosa is presented in another section of the textbook ( Opportunistic Infections
caused by Pseudomonas aeruginosa).

In contrast to P. aeruginosa, P. fluorescens is a remarkably heterogeneous species that can be

subdivided by various taxonomic criteria into subspecies referred to as biotypes or biovars. On purely
phylogenetic grounds, some of these subspecies may warrant a new Pseudomonas species designation.

In the laboratory, the plant-pathogenic pseudomonads, P. cichorii and P. syringae, are distinguished by
an inability to utilize arginine through possession of an arginine dihydrolase system. They also
represent a branch phylogenetically separated from the other fluorescent bacteria of group I. The
oxidase reaction differentiates the two species, P. cichorii (oxidase positive) and P. syringae (oxidase
negative). Like P. aeruginosa, Pseudomonas syringae is actually represented by many different strains
presently classified as pathovars. These strains were originally described as separate species, based on
their host (plant) specificity. What these strains have in common, that is uncommon in Pseudomonas, is
a lack of a specific cytochrome c oxidase in their respiratory electron transport chain which renders a
negative oxidase reaction. Consequently, the Pseudomonas syringae taxon became the dumping ground
for oxidase-negative phytopathogenic Pseudomonas species.

The second rRNA similarity group, group II, is mainly composed of pathogens. One of the most
important species of the group is Pseudomonas (Burkholderia) cepacia, which is a plant pathogen as
well as an animal pathogen, and which includes the most versatile strains of the genus with regard to
nutritional properties. Two other group II species, Pseudomonas (Burkholderia) pseudomallei and
Pseudomonas (Burkholderia) mallei, the agents of the animal diseases melioidosis and glanders,
respectively, are also very versatile organisms.

The third RNA similarity group, group III, is represented by five species. Two of the species, P.
(Comamonas) acidovorans and P. (Comamonas) testosteroni, have been shown to be so distantly
related to other Pseudomonas species that a new genus, Comamonas, has been proposed.

The two genera in Group IV, P. diminuta and P. vesicularis, have also been challenged as bonafide
taxonomic members of the genus. In their properties, these bacteria more closely resemble strains of
Gluconobacter.

Group V, the fifth RNA similarity group, consists of P. (Xanthomonas) maltophilia and species of
Xanthomonas. While the strains of the latter are considered to be universally plant pathogenic, P.

553
(Xanthomonas) maltophilia can be found in many natural habitats living as a saprophyte, and it is also
occasionally isolated from clinical specimens.

Nutrition and Growth

Pseudomonas species have very simple nutritional requirements. In the laboratory they grow well in
media with some organic matter in solution, at neutral pH, and at temperatures in the mesophilic range.
One of the handiest media for culturing Pseudomonas in the laboratory is King's B medium, the
formulation of which is given below (Table 4). Most Pseudomonas species grow in chemically-
defined media without added growth factors.

Pseudomonas species are respiratory and never fermentative. All species respire aerobically, and some
respire anaerobically with NO3 as a final electron acceptor. Pseudomonas species dissimilate sugars
through the Entner-Doudoroff pathway. Some Pseudomonas species can utilize more than 150 different
organic compounds as a sole source of carbon and energy and are remarkable for their catabolic
diversity.

Saprophytic species of Pseudomonas can be directly isolated by streaking source materials on plates of
common bacteriological media such as nutrient agar. A simple enrichment procedure involves plating
the organisms onto media with special carbon sources (e.g. nicotine, toluene, octane, etc.) that can be
used by the desired organism. Fluorescent species of the genus Pseudomonas can be isolated from soils
by the use of selective media that contain antibiotics and/or metals which enhance pigment formation.

Denitrifying pseudomonads can be isolated by specific enrichment procedures, essentially in medium

containing NO3 under anaerobic conditions. Denitrification enrichments with various carbon sources
carried out at 37 - 40°C can yield P. aeruginosa, P. stutzeri, and P. mendocina. Lower incubation
temperatures (around 30°C) enriches for the denitrifying biotypes of P. fluorescens.

Pigments

A common characteristic of the fluorescent pseudomonads is the production of pigments that fluoresce
under short wave length (254 nm) ultraviolet light, particularly after growth under conditions of iron
limitation. Some of these pigments and/or their derivatives are known to play a role as siderophores in
the iron uptake systems of the bacteria., and hence, their production is markedly enhanced under
conditions of iron deficiency. The production of pigments is readily demonstrated by culturing the
bacteria in media such as King's Medium B, which contains no added iron. The medium is also
recommended to demonstrate the production of the nonfluorescent blue pigment, pyocyanin,
characteristically produced by most strains of P. aeruginosa.

Table 4. Composition of King's Medium B. The mineral salts of this medium, as well as the exclusion of iron,
enhance the production of pigments.In many laboratories, King's B Medium is used as a general medium for routine
cultivation of Pseudomonas.

Proteose Peptone no. 3 2g

Glycerol 1g
K2HPO4 0.15 g
MgSO4·7H2O 0.15 g
Agar 1.5 g
Distilled water 100 ml
Adjust to pH 7.2

554
Temperature of Incubation

In clinical laboratories it is usual to maintain the temperature of incubators at 37°C. This is optimal for
the growth of P. aeruginosa, the most likely species to be encountered in medical specimens, but all the
known species of Pseudomonas grow quite well at 28-30°C. Indeed, this temperature is more
appropriate for some of the species of group I. By lowering the temperature of incubation to within this
range, strains which only grow marginally at body temperature may not be missed in isolations from
clinical materials.

Motility and Flagella

Most Pseudomonas species are motile by means of one or more polar flagella. In wet mounts of pond
water or hay infusions they are likely to be the rapidly motile rod-shaped bacteria that dart across the
microscope field. Chemotaxis and aerotaxis have been observed, and motility is clearly a selectively
useful trait for existence in the aquatic environment.

In the laboratory, both the composition of the medium and the temperature of incubation affect
motility. Young cultures in the active stages of growth are best for observation of motility. In dense cell
suspensions in wet mounts, motility rapidly ceases except in cells that are close to a bubble or the edges
of the coverslip, suggesting that the cells must find O2 as a respiratory electron acceptor in order to
maintain flagellar rotation. Arginine can prolong motility under anaerobic conditions in strains that
possess the arginine dihydrolase system.

Plasmids

Most importantly, Pseudomonas plasmids confer resistance to many antibiotics and antibacterial
agents. However, in comparison with clinical strains of other species, the proportion of strains of P.
aeruginosa carrying transmissible extrachromosomal determinants of resistance is fairly low. The
species is also naturally resistant to deleterious agents, including many antibiotics. Such natural
resistance results from its inherent Gram-negative cell wall structure, and its propensity to construct
protective biofilms in medical settings.

Thirteen compatibility groups of plasmids have been identified in Pseudomonas. One group, P-2,
contains over half the transmissible plasmids identified in the species. In addition to a variety of
markers determining resistance to various antibiotics and simple chemicals (e.g. mercury, borate), all
P-2 plasmids carry determinants of resistance to tellurite and tellurate, which makes these agents useful
for selective isolation. The largest Pseudomonas plasmids (some exceeding 300 kbp) are in this group.

The plasmids of group P-9 are typically catabolic plasmids, and they contribute significantly to the
nutritional diversity of some Pseudomonas species. For example, plasmids NAH, SAL, and TOL, carry
genes involved in the degradation of naphthalene, salicylate, and toluene, respectively.

In addition to resistance to toxic agents, some plasmids of Pseudomonas determine various other
important properties, such as fertility and resistance to physical agents, bacteriophages and
bacteriocins. Some Pseudomonas plasmids are capable of mobilizing the bacterial chromosome and
have been used extensively in the study of Pseudomonas genetics.

Group P-1 contains "wide host-range plasmids" which are capable of transfer to strains of practically
any Gram-negative species. Derivatives of these plasmids can be isolated from various Gram-negative
species by means of complementation of auxotrophic markers in Pseudomonas species. The transfer in
555
nature of Pseudomonas resistance markers to other Gram-negative species of medical importance is a
matter of some concern.

Ecology

Pseudomonads are truly ubiquitous organisms, even though some pathogenic species are ecological
specialists found in specific types of environments. The ubiquity of the pseudomonads would seem to
be a consequence of their meager nutritional requirements, the range of carbon compounds they can
utilize, and the diversity of their metabolism which reaches into autotrophy, lithotrophy and anaerobic
modes of respiration. Having said this, Pseudomonas species predominate in soils and water under
aerobic, mesophilic and neutral conditions. They do not ferment, they are not abundant in anaerobic
environments, and they do not occur in thermophilic or acidophilic habitats.

Pseudomonas and its relatives occupy a prominent position in nature for their active participation in the
carbon cycle. Pseudomonas metabolism has been the subject of intensive biochemical research, and
many of the unique catabolic pathways found in pseudomonads have been described. Studies on the
degradation of natural and artificially synthesized compounds by pseudomonads has been exploited in
approaches to solution of environmental pollution problems.

The conditions under which pseudomonads flourish in soil are also favorable for growth of aerobic
actinomycetes of the genus Streptomyces, among many other types of bacteria. It has been suggested
that soil dwelling pseudomonads may preferentially grow in association with the streptomycetes. The
streptomycetes, which are masters of aerobic decomposition of organic compounds the soil could
provide pseudomonads with monomeric carbon sources which they require. Also, associations between
Pseudomonas and Streptomyces in Nature may explain the notorious resistance of Pseudomonas to
streptomycete antibiotics in a medical setting.

Strains of Pseudomonas are often carriers of plasmids containing genes that confer the capacity for
antibiotic resistance, and if the notion that R factors originated in antibiotic producing organisms is
correct, it is possible that Pseudomonas strains were among the first groups of organisms to have
received these factors from streptomycetes as a consequence of their association in the same ecological
niches.

In nature, Pseudomonas species exist as saprophytes and as parasites. Those that are parasites, with one
exception, apparently have a saprophytic mode of existence as well. After all, the ultimate distinction
between a parasite and a saprophyte is whether or not the organism is growing at the expense of
"living" or "dead" organic matter.

Many phytopathogenic pseudomonads, which also includes members of the genus Xanthomonas, can
only be found on diseased plants. In these special ecological niches they appear as practically
homogeneous populations when the pathological lesions are young, which makes their isolation in pure
culture a relatively straightforward process. The distribution of many of these pathogens outside their
host plants is poorly known at present, although many of them seem to be able to exist as saprophytes.

Animal pathogens are far less host specific than the phytopathogens, and most are considered to be
opportunistic pathogens. One species, P. (Burkholderia) mallei, is an exception to this rule. This
bacterium is the agent of glanders in horses, mules, and donkeys. P. (Burkholderia) mallei is not found
living saprophytically, and it is considered to be the only pseudomonad with a specialized parasitic
animal niche.

556
Pathogens of Humans and Animals

Pseudomonas species are widespread saprophytes in Nature, particularly in soil and water, but some
are also pathogens of plants and animals. Consequently, some species are medically important and
frequently can be isolated from a variety of clinical specimens. Most species, however, are classified as
opportunistic pathogens. Only Pseudomonas (Burkholderia) mallei and P. (Burkholderia) pseudomallei
are regarded as primary pathogens. Even so, P. (Burkholderia) pseudomallei can be found in nature as
a free-living organism.

P. aeruginosa is by far the dominating human and animal pathogen. Interestingly, it is also a pathogen
of plants, which illustrates the fuzzy boundary between between phytopathogenic and medical
pseudomonads.

In a disease context, the Pseudomonas pathogens of humans and animals are characterized as having a
"low virulence", i.e., they are opportunistic and do not produce disease unless the animal's constitutive
or immune defenses are compromised. This is certainly not to say that they lack any determinants of
virulence. Considering the number of structural, biochemical, and genetic properties of P. aeruginosa
that contribute to its virulence, it ranks with leading pathogens such as Staphylococcus or
Streptococcus.

Pathogen Habitats

Pathogenic Pseudomonas may be isolated from infections at almost any body site, most commonly of
the urinary tract, respiratory tract, wounds, and the blood.

Strains of Pseudomonas can be extremely versatile from a nutritional standpoint, and they can grow in
very simple nutritional environments without any organic growth factors. They can remain viable for
long periods of time in many different habitats. Many different materials used in medical practice may
be contaminated with pseudomonads. This even includes solutions of antiseptics and disinfectants, but
more commonly, water, saline solutions, utensils, and medical instruments. The bacteria have been
found in pharmaceuticals, cosmetics, and preparations involving plant materials.

In hospitals, P. aeruginosa can be spread through fecal material. Also Pseudomonas has been isolated
from many natural and manufactured foods, and therefore, foods have been implicated as sources of
infection in hospitals. In addition, visitors can transport the bacteria to the hospital as contaminants in
foods, plants, flowers and presents. Health personnel may also be involved.

The widespread habitat of P. aeruginosa in nature, which includes soil, water, food, and the surfaces of
plants and animals, makes it very difficult to control the organism in a hospital setting. Prevention of
contamination is practically impossible. The main danger is the infection of patients who are
immunologically compromised, or in burn units, neonatal units and cancer wards. When conditions are
favorable, P. aeruginosa and other pseudomonads can infect wounds, burnt areas, and the urinary and
respiratory tracts, and may also be involved in pneumonia, endocarditis, meningitis, and various other
pathological conditions.

Pseudomonas aeruginosa

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Among pseudomonads, P. aeruginosa has attracted the most attention from general and clinical
microbiologists, geneticists, and biochemists. The list of materials from which this species can be
isolated is almost endless, so that from a practical point of view, one can assume that the bacterium is
present everywhere. Most strains of the species can be easily identified by a number of phenotypic
characteristics never found in the same combination in other species. Most important among these are
production of pigments, including pyacyanin, the ability to denitrify, and the ability to grow at 41°C.

Gram stain of Pseudomonas aeruginosa cells

The colonies of P. aeruginosa are flat, grayish, with irregular edges, and with time they tend to spread
on the surface of the agar. Mucoid colonies frequently appear among isolates from the respiratory tract
of patients with cystic fibrosis. The mucoid extracellular substance is alginate.

P. aeruginosa is capable of producing several pigments, of which the most characteristic is pyocyanin.
As far as is known, this blue pigment is an absolute diagnostic character, since no other species has
been found to produce it. Pyoverdin is the fluorescent pigment most often produced, but the bacteria
may be able to produce several additional pigments, including a reddish pigment, pyorubrin, and a
brown pigment, pyomelanin. This pigment, in common with other melanins, is produced from
aromatic amino acids such as tyrosine or phenylalanine, while pyorubrin production is enhanced by the
addition of glutamate to the medium. Besides pyoverdin, which acts as a siderophore, the function of
these pigments is obscure.

Pseudomonas aeruginosa colonies on agar

558
P. aeruginosa has long been known as an opportunistic pathogen, especially dreaded in the hospital
environment. Early reports pointing to infection with this organism described a blue pus associated
with wound infections. P. aeruginosa has been isolated from wounds in almost all locations in the
human or animal body, as well from purulent infections of the urinary and respiratory tracts. P.
aeruginosa associated with pneumonia, enteritis, vaginitis, mastitis, and endometritis in animals is
abundantly recorded in the literature.

Since the tissue invasiveness of the organism is very limited, P. aeruginosa usually uses accidental
ports of entry (burns, wounds, intravenous and urinary catheterization, surgical procedures, etc.) to gain
access to its compromised host.

Several extracellular products (proteases, elastase, etc.) help the invasion and dissemination of P.
aeruginosa. Most isolates of the species produce exotoxin A, which is induced under the conditions of
iron limitation that characterize many animal tissues. The target of this toxin is one of the elongation
factors in translation during protein synthesis. Strains incapable of producing exotoxin A have reduced
virulence. A general discussion of virulence and disease caused by P. aeruginosa is presented in
another section of the text ( Opportunistic Infections caused by Pseudomonas aeruginosa).

For epidemiological investigations the strains of P. aeruginosa can be divided into types, which are
taxonomic categories below the species level. Various typing methods can be used: biotyping,
antibiograms, serotyping, bacteriocin typing, and phage typing. As far as serotyping is concerned, there
has been subdivision into 12 somatic groups.

P. fluorescens and P. putida

These species were described a few years after the description of P. aeruginosa. In human and
veterinary medicine, while P. aeruginosa has historically been the most significant pathogenic species,
it is now becoming evident that other species of the genus may be serious opportunistic pathogens.
This includes the fluorescent pseudomonads, herein described, and certain nonfluorescent species
which will be discussed below. Both P. fluorescens and its close relative, P. putida, have a natural
history similar to P. aeruginosa. Two phenotypic characteristics of P. fluorescens that distinguish it
from P. putida are its ability to grow at 4°C, and its ability to hydrolyze gelatin. These characteristics
help explain its frequent involvement in spoilage of refrigerated food, in particular chicken and
processed meats. If it's fluorescent, get rid of it!

Bacteria in the P.fluorescens-P. putida complex have been isolated from lizards, insects and mammals.
Clinical sources from which strains of these species have been isolated include respiratory tract
specimens, pleural fluid, urine, cerebrospinal fluid, feces, blood, and a variety of other materials.
However, from a medical point of view, the clinical importance of P. fluorescens and P. putida is
debatable. The main property that conspires against their becoming important opportunistic pathogens
is their inability to grow at body temperature. Indeed, they are rarely pathogenic for humans, even
though they have been found associated with empyema, urinary tract infections, septicemia, and
various other episodes. In any event, although their virulence may be low, P. fluorescens and P. putida
should be considered as potentially pathogenic.

Nonfluorescent Pseudomonas pathogens

Note: Among the nonfluorescent members of the genus, only those assigned to Palleroni's group I are designated to
remain in the genus. Groups II, III, IV and V are slated for new genus names, and hence, are formally moved out of
the genus Pseudomonas. Group I survivors are considered here.

559
Among the the nonfluorescent Pseudomonas species, those which have been encountered in clinical
laboratories include P. stutzeri, P. mendocina, and P. alcaligenes.

P. stutzeri is a strong denitrifier that usually can be identified by the appearance of the colonies, which
are wrinkled, coherent, hard, and of a dark brown color due to their high cytochrome c content. P.
stutzeri is a common soil inhabitant and can also be found in plant materials and in water. Therefore,
reports of its isolation from various clinical materials are not surprising. Moreover, the organism can
grow at body temperature. However, its pathogenic properties have not been clearly demonstrated.

P. mendocina is related to P. stutzeri, and it can be isolated similarly from denitrification enrichments.
The colonies are flat and smooth, and have a yellowish color due to the presence of carotenoid
pigments. P. mendocina has rarely been isolated from materials of clinical origin, but it has not been
incriminated as a cause of infection in humans. However, strains of P. mendocina have been found to
produce alginate, same as Pseudomonas aeruginosa. In the latter species, alginate-producing strains
can be isolated from cystic fibrosis patients, where they become selected through the protecting action
of the exopolysaccharide against phagocytosis by alveolar macrophages.

P. alcaligenes is only found occasionally associated with infection in humans, and it can, at best, be
considered as a rare opportunistic pathogen.

Other Pathogenic Pseudomonads

The genus Pseudomonas has become restricted to members of of Palleroni's group I, based on nucleic
acid sequence similarity studies. This puts aside many species of bacteria formerly assigned to the
genus that are pathogenic for humans or other animals. Some of these are briefly discussed here as
"pseudomonads" or bacteria with a phenotypic and ecophysiological similarity to members of the
genus Pseudomonas.

Most of the species of Pseudomonas of Palleroni's group II (Table 3) are pathogenic for plants, animals
or humans. These species have now been placed in the genus Burkholderia. B. mallei is the agent of
glanders, a zoonosis in equines; B. pseudomallei causes a similar condition, melioidosis. B. cepacia
and B. gladioli, in addition to B. multivorans, and B. vietnamiensis, have been found associated with
lung infection, bacteremia, endocarditis, septic arthritis, and cystitis. Their role in cystic fibrosis
patients is unclear. Burkholderia species are resistant to aminoglycosides.

A species that has attracted some attention is B. cepacia, originally a poorly known plant pathogen,
Pseudomonas cepacia. Of all the species originally assigned to the genus Pseudomonas, this is by far
the most versatile from the point of view of its nutrition. Many different compounds can serve
individually as sole sources of carbon and energy when added to minimal media, including penicillin
G, which can be used both as a carbon and a nitrogen source.

B. cepacia has been isolated from a large number of different sources, including habitats that normally
are unfavorable for most other procaryotes. These include antiseptic solutions and crystal violet
solutions. A penicillinase has been characterized, in addition to which natural resistance to various
antibiotics, including chloramphenicol, aminoglycosides, beta-lactams and polymyxin, has been
reported.

B. cepacia has been found associated with many different infections of nosocomial origin. In recent
years, B. cepacia has been found associated with cases of cystic fibrosis. Adherence of cells to

560
respiratory epithelial cells was found to be enhanced by the presence of Pseudomonas aeruginosa,
another opportunistic pathogen found in infections of the respiratory tract.

B. mallei is the etiologic agent of glanders, a serious disease of equines, and B. pseudomallei causes a
related disease. Glanders can be transmitted from equines to animals of other groups and also to
humans. The disease can start in the respiratory tract or as an ulcerative process, rapidly spreading to
the lymph nodes with fatal consequences. The organism is not found living freely in Nature, and
normally passes from animal to animal.

In contrast to B. mallei, B. pseudomallei can be found in soil and water. But its occurrence is mostly
restricted to tropical regions. Animals and humans are highly susceptible. The organism usually enters
the host through wounds. B. pseudomallei, and to a lesser degree, B. mallei, are also nutritionally-
versatile organisms, analogous to many other pseudomonads.

Pseudomonas pickettii was described as an organism resembling the plant-pathogenic species, P.

(Ralstonia) solanacearum. P. pickettii has been found in hospital samples, including urine, abscesses,
wounds, and various other clinical sources. Although the pathogenicity of the bacterium is not clear, it
was once incriminated in an epidemic bacteremia in Australia. P. pickettii also might be moved into the
genus Ralstonia.

Phytopathogenic and Plant-Associated Pseudomonads

The phytopathogenic pseudomonads are a very diverse group of bacteria with respect to their genetics,
ecology, and the kinds of diseases they cause. Currently, they are grouped into approximately 25
species in three distinct genera. One species, Pseudomonas syringae, contains over 50 pathovars, most
of which attack different hosts. There also are multiple pathovars in other species.

Phytopathogenic pseudomonads are worldwide in distribution and cause diseases of most major groups
of higher plants. Some of the world's most serious plant diseases are caused by pseudomonads, such as
Pseudomonas (Ralstonia) solanacearum. Disease symptoms in plants range from necrotic lesions,
spots, cankers and blights, to hyperplasias (galls, scabs), tissue maceration (rots), and vascular
infections (wilts). As mentioned earlier, some pseudomonads, for example, P. aeruginosa and P.
(Burkholderia) cepacia, appear to infect both plants and animals.

Besides parasitic associations with plants, some pseudomonads exist in various other associations with
plants. For example, some pseudomonads affect plant growth through their interactions with fungal
plant pathogens or by their direct effect on the roots, possibly because of hormone production. These
bacteria may colonize plant parts, and in some cases, they appear to damage the plant. Here, again,
there is no clear demarcation between parasitism and saprophytism.

Pseudomonas, Ralstonia, Burkholderia and Acidovorax

The evidence suggesting that the Pseudomonas phytopathogens belong to at least three different genera
is derived primarily from studies of rRNA-DNA homologies. The three groups containing plant
pathogens are the P. fluorescens group (called the fluorescents ), the P. (Ralstonia) solanacearum
P. (Burkholderia) cepacia group, and the P. (Acidovorax) avenae group. The latter two groups are
usually lumped together as the nonfluorescents.

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 Bacterial fruit blotch of watermelon caused by Acidovorax avenae biovar citrulli. Photograph by Tom Kucharek, UF-
IFAS. DOACS-Plant Pathology Section-Acidovorax avenae subsp. citrulli. The bacterium can be introduced into
watermelon fields by infested seed, infected transplants, natural spread from alternate hosts or from volunteer
watermelon. The bacterium can be a surface contaminant of seed harvested from infected watermelon. Bacterial
fruit blotch disease development is favored by warm wet weather. The naturally occurring waxy layer that develops
on maturing watermelon hinders bacterial invasion and infection unless the fruit rind becomes injured and the
protective wax layer is compromised.

Xanthomonas

This pseudomonad is differentiated from members of the genus Pseudomonas (here, to include
Ralstonia, Burkholderia and Acidovorax) by production of water-insoluble yellow pigments
(xanthomonadins), and a requirement of certain organic growth factors. Xanthomonas is a legitimate
genus in the family Pseudomonadaceae (see Table 1) and it, along with Pseudomonas (Xanthomonas)
maltophilia, is the primary constituent member of Palleroni's RNA homology group V (see Table 3).

As a phytopathogen, only one species of Xanthomonas is important, X. campestris. However, X.

campestris represents at least 100 pathovars based on characteristics of their pathogenicity, i.e. the
species of plant which is their host. Hence the pathovars are named for the specific plant that becomes
infected. Thus, X. campestris pv. cannabis infects Cannabis sativa; X. campestris pv. eucalyptae
infects Eucalyptus citrodora; and so on. The original isolates of Xanthomonas campestris caused a
vascular disease of Brassica campestris, its host plant. But now the species includes and is subdivided
into a large number of pathovars that cause diseases in many plants.

Common Blight of beans caused by Xanthomonas campestris pv. phaseoli. Bacterial Blights Fact sheet, Cornell
University, Department of Plant Pathology. Characteristic leaf symptoms of common blight consist of irregular
areas of brown dry tissues surrounded by a narrow lemon yellow border. These lesions frequently occur at the leaf
562
margins. Pods have sunken circular spots with a reddish brown narrow border. The bacteria invade the seeds and
remain dormant until germination begins. Even a trace of infected seed when planted can initiate severe infection of
entire fields. The bacteria exude in the leaf and pod spots and are spread mainly by splashing and blowing rain.
Warm, humid conditions favor development of the disease.

Toxins

Several pathovars of P. syringae produce phytotoxins. Chemical structures have been established for
four of these toxins, as well as rhizobitoxin which is produced by Pseudomonas andropogonis. Sites of
action of bacterial phytotoxins include amino acid biosynthetic pathway enzymes (e.g. glutamine
synthetase and ornithine carbamoyltransferase for the active moieties of tabtoxin and phaseolotoxin,
respectively), chloroplast RNA polymerase for tagetitoxin, cystathionase for rhizobitoxin, and certain
protein kinases of plant and other eukaryotic cells for syringomycin. Several of these toxins are
capable, in purified form, of reproducing one or more aspects of disease symptomology attributed to
them, usually chlorosis or necrosis. The causal relationships between the effect of the toxin on the
target site and expression of disease symptoms are less clear.

In contrast to the phytotoxins produced by fungal pathogens, which are host specific, the Pseudomonas
phytotoxins are active against plants on which their producers do not cause disease. Some of these
toxins are also active against other microorganisms.

Whether these phytotoxins constitute pathogenicity or virulence factors is actively debated among
plant pathologists because much of the experimental information is equivocal. For example, mutants
of P. s. pv. phaseolicola that do not produce phaseolotoxin show identical growth kinetics in the plant
as do wild type strains. Other Pseudomonas toxins that have been examined in this respect (e.g.
coronatine, syringotoxin) appear to play a role in pathogen multiplication in the plant, since tox-
mutants of P. s. pv. tomato and P. s. pv. syringae (citrus strain) show reduced in virulence.

Two Pseudomonas toxins, syringomycin and syringotoxin, are cyclic peptides containing one or more
nonprotein amino acids. They are presumed to be synthesized by enzyme systems analogous to those
involved in the synthesis of cyclic peptide antibiotics by Bacillus species. Two other toxins, tabtoxin
and phaseolotoxin, are synthesized and secreted from the cells as linear peptides but are hydrolyzed in
the plant to nonpeptide forms. Cleavage by plant peptidases potentiates the action of these toxins.

Halo Blight caused by Pseudomonas phaseolicola.Bacterial Blights Fact sheet, Cornell University, Department of
Plant Pathology. Halo blight is one of the most important bacterial diseases of beans. The most characteristic
symptoms occur on the bean leaves. Small, water-soaked spots, resembling pinpricks, develop on the undersides of
the leaves. These spots soon turn reddish brown, and the tissues surrounding the spots gradually become yellow
green. Severe infections resulting from seed contamination may give internal systemic infection, exhibited by
yellowing and stunting. These plants defoliate, wilt, and die early, but serve as important reservoirs of bacteria to be
spread to neighboring plants.

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Phytohormones

In addition to phytotoxins, phytohormones represent another group of low-molecular-weight

substances which play a role in pathogenesis by Pseudomonas. A useful conceptual distinction between
a phytotoxin and a phytohormone is that the latter are also produced by the host. A role for
phytohormones is usually suspected when pathogens induce growth abnormalities in the host, examples
being the crown gall, hairy root and olive knot diseases. However, other pathogens that do not cause
hypertrophic symptoms on their hosts also produce these substances.

Nine different plant pathogenic pseudomonads produce indole acetic acid (IAA) and additional indole
compounds in media that have been supplemented with tryptophan. P. (Ralstonia) solanacearum and
P. s. pv. syringae also synthesize exceptionally high amounts of IAA both in the presence and absence
of exogenous tryptophan. A role of hormones in either vascular wilt or in the brown spot disease has
not been established. IAA has numerous other effects on plant cells which may favor bacterial
multiplication in the absence of hypertrophy.

There is definitive evidence for the involvement of IAA in the interaction between P. s. pv. savastanoi
and two of its hosts. The pathogen synthesizes the hormone (from tryptophan in two steps catalyzed by
tryptophan monooxygenase and indoleacetamide hydrolase), which incites hyperplasias on oleander
and olive.

Bacterial galls on oleander stem and leaves caused by Pseudomonas savastanoi (Pseudomonas syringae pv. savastanoi)
Photo by Jack Kelly Clark. UC Management Guidelines for Olive Knot on Olive. Olive knot appears as rough galls
or swellings about 0.5 to 2 inches in diameter on twigs, branches, trunks, roots, leaves, or fruit stems. Galls also form
at trunk or limb wounds. Olive knot does not kill trees, but it does reduce productivity by destroying twigs and
branches, and the flavor of fruit from infected trees may be affected. Bacteria survive in the knots and are readily
spread by water at all times of the year. Infection occurs at low temperatures, usually in fall or spring. Openings are
necessary for penetration of bacteria, and these are provided by leaf scars, pruning wounds, or bark cracks made by
freezing. Damage can be severe when weather favors disease.

P. s. pv. savastanoi and P.(Ralstonia) solanacearum have been shown to produce cytokinins. There is
diversity in both the types of cytokinins and the amounts produced by different strains. The role of
these substances in symptom expression and the basis of variations has not been established.
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Ice Nucleation

Three Pseudomonas species are efficient ice nucleators at temperatures above -10°C: P. syringae
(various pathovars), P. fluorescens (biotype G), and P. viridiflava (several strains). The study of
bacterial ice nucleation has received attention in recent years because of the role of ice-nucleating
bacteria, particularly P. syringae, as agents of frost injury to plants.

It is now firmly established that a family of large and unusual proteins (ice nucleation proteins, mw 118
kDa, or larger) are a key component of bacterial ice nuclei. Predicted amino acid sequences of two such
proteins from P. syringae and P. fluorescens, respectively, have revealed a consensus octapeptide with
alternative periodicities of 16 and 48 amino acids. Although not unique among proteins, the repeat
structure suggests itself as being central to the ice nucleation function. Several repeat domains may
collectively form a catalytic surface of some critical size which effectively orders water molecules in
an ice-like lattice.

Site-directed deletion of the ice nucleation gene from competent nonpathogenic strains of P. syringae
and P. fluorescens ( ice-minus mutants) have been generated as biological control agents of frost
injury to plants, representing the first genetically-engineered bacteria to be released outside the
laboratory under Environmental Protection Agency (EPA) permit in the USA.

Todar's Online Textbook of Bacteriology

The Enteric Bacteria

© 2004 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology

Introduction to the Family Enterobacteriaceae

Enterobacteriaceae are Gram-negative, oxidase-negative, rod-shaped bacteria, 0.3-1.0 x 1.0-6.0 um.

Typically, they are motile by peritrichous flagella. They are facultative anaerobes,
being chemoorganotrophs that exhibit both respiratory and fermentative metabolism. Most grow well
between 22 and 35°C on media containing peptone or beef extract. They also grow on MacConkey's
agar which may be used for their selective isolation. Most grow on glucose as a sole carbon source,
although some require vitamins and/or amino acids for growth. Thet produce mixed acids and often gas
from fermentation of sugars. With very few exceptions they are catalase-positive, and most strains
reduce nitrate to nitrite.

Escherichia coli is the type species. E. coli is considered the most thoroughly studied of all species of
bacteria, and the family Enterobacteriaceae, as a whole, is the best studied group of microorganisms.
Among the reasons for their popularity are their medical and economic importance, ease of isolation
and cultivation, rapid generation time, and their ability to be genetically manipulated.

Enterobacteriaceae are distributed worldwide. They are found in water and soil and as normal
intestinal flora in humans and many animals. They live as .saprophytically, as symbionts, epiphytes,

565
and parasites. Their host range includes animals ranging from insects to humans, as well as fruits,
vegetables, grains, flowering plants, and trees.

Economic and Medical Importance

As stated above, one of the reasons that the enterobacteriaceae have ben so widely studied is due to
their obvious impact on human and animal health and on agricultural practice. The enterobacteriaceae
include agents of food poisoning and gastroenteritis, hospital-acquired infections, enteric fevers (e.g.
typhoid fever) and plague. They also cause infections in domestic, farm and zoo animals and include an
important group of plant pathogens. Some of these bacteria are discussed below.

Plant Pathogens
Many species of Enterobacteriaceae are responsible for significant economic losses in
agriculture. Erwinia species cause blight, wilt, or soft-rot in numerous trees, flowers, and crops, often
destroying substantial amounts of crops. Among the plants affected are walnut and oak trees, rose,
orchid and chrysanthemum flowers, and crops such as corn, wheat, potato, carrot, sugar beet, sugar
cane and pineapple.

Animal Pathogens
Enterobacteriaceae cause disease in all sorts of animals, ranging from nematodes and insects through
primates. Salmonella alone has been associated with disease in more than 125 species. Infections
frequently cause problems in zoos, often in snakes and lizards. In regional primate centers in the United
States, the most frequently diagnosed diarrheal diseases were caused by Enterobacteriaceae, most
often by Shigella, E. coli and Salmonella. Klebsiella pneumoniae is a frequent cause of respiratory
disease in primates, and Yersinia pseudotuberculosis is associated with enterocolitis and peritonitis.

Pets and farm animals are affected by a variety of enterobacterial diseases. Cats and dogs are
susceptible to cystitis and other urogenital infections caused by E. coli. Proteus species cause other
diseases in cats and dogs, and these animals can be carriers of Salmonella. Salmonellae, especially S.
typhimurium, S. newport, and S. anatum, cause enteritis with high fatality and septic abortion in horses,
and K. pneumoniae causes metritis in mares and pneumonia in foals.

Septicemia caused by E. coli is an important cause of death in chickens. Serotypes of Salmonella

enterica are pathogenic and highly fatal for turkeys and other poultry, causing a characteristic diarrheal
syndrome. Pullorum disease, caused by Salmonella pullorum, is highly fatal to eggs and chicks. Fowl
typhoid, a septicemic disease of poultry, especially chickens, is caused by Salmonella gallinarum. Both
pullorum disease and fowl typhoid can be largely eradicated if infected adult birds are
slaughtered. Nearly 200 Salmonella serotypes had been isolated from fowl in the United States. The
distribution of salmonellosis in poultry is worldwide. As in human disease, certain serotypes are
prevalent in some regions and absent in others. A mortality rate of 10-20% is normal in young birds,
mostly in the first two weeks after hatching.

Sheep suffer from a variety of illnesses caused by Enterobacteriaceae. Infant diarrhea in lambs, is
usually caused by strains of E. coli producing a heat-stable enterotoxin. Most of these strains also
contain the K-99 fimbrial adhesin. Salmonella abortion is usually caused by Salmonella abortusovis, S.
typhimurium, or S. dublin, which also cause stillbirths and wool damage.

Calves are susceptible to both systemic colibacillosis and neonatal diarrhea (calf scours), which are
usually fatal if not promptly treated. Specific heat-stable enterotoxigenic E. coli serotypes containing
566
K99 fimbrial adhesin are the causative agents. Bovine mastitis has become a very prevalent disease
since the advent of antibiotics. The most prevalent causative agents are E. coli and Serratia species,
and less often, Klebsiella species and Citrobacter freundii. Salmonellosis is frequent in cattle. Most
cases are due to Salmonella dublin and S. typhimurium, although more than 100 serotypes have been
isolated. As with other animal infections, Salmonella is frequently introduced through contaminated
feed.

Swine are subject to infection with several species of Enterobacteriaceae. E. coli infection may present
as diarrhea in piglets, or as edema preceded by mild diarrhea. Both forms are acute and highly fatal. As
in sheep and cows, the causative strains produce a heat-stable enterotoxin, but they may also produce a
heat-labile enterotoxin. Swine strains usually possess a K88 fimbrial adhesin, which is antigenically
distict from K99. Sows are susceptible to mastitis and metritis caused by K. pneumoniae, and to
enteritis and lymphadenitis caused by Yersinia enterocolitica. More than 100 Salmonella serotypes
have been isolated from pigs. However, only two serotypes, S. choleraesuis and S. typhisuis, have pigs
as their primary host. S. choleraesuis has a wide host range, including humans, but S. typhisuis is rarely
pathogenic to animals other than pigs. Salmonella typhimurium and S. derby are also frequently
isolated from porcine salmonellosis.

Substantial losses in fishing industries are caused by enterobacterial diseases. Yersinia ruckeri is the
cause of outbreaks of redmouth disease in salmon and trout hatcheries. Edwardsiella tarda is
pathogenic for eels, catfish, and goldfish, and Edwardsiella ictaluri is pathogenic for catfish.

The host range for species of Enterobacteriaceae varies greatly. For example Proteus myxofaciens has
been isolated only from larvae of gypsy moths and Escherichia blattae has been isolated only from the
hindgut of cockroaches. Shigellae are seen only in primates. Others, including E. coli, many
salmonellae, and yersiniae, infect or are carried by hosts ranging from insects to humans.

Human Pathogens
Enterobacteriaceae as a group were originally divided into pathogens and nonpathogens based on their
ability to cause diarrheal disease of humans. The pathogenic genera were Salmonella and Shigella.
However, it is now known that E. coli causes at least five types of gastrointestinal disease in humans.
Pathogenicity in E. coli strains is due to the presence of one or more virulence factors, including
invasiveness factors (invasins), heat-labile and heat-stable enterotoxins, verotoxins, and colonization
factors or adhesins. Pathogenic strains are usually identified by detection of a specific virulence factor
or of a serotype associated with a virulence factor. The most recently identified E. coli disease is
hemorrhagic colitis caused by strains of serotype 0157:H7. The disease, characterized by painful
abdominal cramping and bloody diarrhea, is caused by strains that produce verotoxin, and the same
strains are associated with hemolytic uremic syndrome (HUS).

Yersinia enterocolitica causes diarrhea, probably by a combination of invasiveness and the presence of
a heat-stable enterotoxin. Strains of Klebsiella pneumoniae and Enterobacter cloacae isolated from
patients with tropical sprue contained a heat-stable enterotoxin. Edwardsiella tarda and Citrobacter
strains are occasionally associated with diarrhea and have been shown to produce heat-stable or heat-
labile enterotoxin.

Foodborne and waterborne disease outbreaks in the U.S. are frequently associated with
Enterobacteriaceae. According to the Centers for Disease Control (CDC), 40-45% of such outbreaks
are caused by Enterobacteriaceae, the overwhelming majority by Salmonella. Meats, milk and milk
products, and eggs are the most common vehicles of transmission. Such figures represent only a small
fraction of total foodborne disease, since the etiologic agent is identified in only about one-third of the
567
outbreaks, and many outbreaks are undetected or are not reported to the Centers for Disease Control.
For Salmonella, it is estimated that each reported case represents about 100 total cases. The largest
outbreak of salmonellosis in the United States occurred in 1985 in Illinois and Wisconsin, where an
estimated 170,000 to almost 200,000 persons were infected with Salmonella typhimurium transmitted
in pasteurized milk from a single dairy plant.

The incidence and recognition of rheumatoid disease occurring secondary to foodborne and waterborne
diarrheal disease have also increased. These diseases include reactive arthritis, Reiter's syndrome,
ankylosing spondylitis, septic and aseptic arthritis, ulcerative colitis, Crohn's disease, and Whipple's
disease. Y. enterocolitica, Y. pseudotuberculosis, Shigella flexneri, Shigella dysenteriae, various
salmonellae, E. coli, and K. pneumoniae have been associated with these chronic conditions.

Waterborne disease outbreaks due to Enterobacteriaceae are usually due to contaminated wells. Cases
of shigellosis due to a contaminated wells have been reported; even typhoid fever has occurred fairly
recently in community water systems contaminated with human sewage.

Enterobacteriaceae not normally associated with the GI tract or diarrheal disease may still be
pathogens of humans. Most notably, Yersinia pestis, which does not have an intestinal habitat, is the
etiologic agent of plague a highly fatal disease that has dessimated whole populations of individuals at
several times in the history of civilization. Furthermore, most, if not all, Enterobacteriaceae are
opportunistic pathogens. Once established, they can cause a variety of infections, including urinary
tract disease, pneumonia, septicemia, meningitis, and wound infection.

According to the CDC, Enterobacteriaceae are responsible for 40-50% of nosocomial infections
occurring in the United States. E. coli is the worst offender, followed by Klebsiella, Proteus-
Providencia-Morganella, Serratia, and Citrobacter. The compromised host is particularly susceptible
to nosocomial infections. Catheterized patients, patients on immunosuppressants, burn patients, cancer
patients, and elderly patients are all especially vulnerable to opportunistic pathogens. To make matters
worse, many of these organisms acquired in the hospital setting are multiply drug resistant.

Taxonmy and Classification of Enteric Bacteria

In artificial classification schemes (e.g. Bergey's Manual of Systematic Bacteriology, 1st edition,
1986) Enterobacteriaceae is a family of bacteria in Section 8 - Gram-negative facultatively
anaerobic rods. Because of the large number and broad range of phenotypic properties that solidifiy
the group, these traits being a reflection of their genetic relatedness, these bacteria have remained
unified in modern phylogenetic schemes based on 16S ribosomal RNA comparison. Thus, Citrobacter,
Edwardsiella, Enterobacter, Erwinia, Escherichia, Klebsiella, Proteus, Providencia, Salmonella,
Serratia, Shigella, and Yersinia (along with several other genera, including Hafnia, Morganella,
Photorhabdus,and Xenorhabdus) are presently classified in the subclass Gammaproteobacteria,
order Enterobacteriales, family Enterobacteriaceae in Bergey's Manual of Systematic Bacteriology,
2nd Edition, 2001.

The classic definition of an enteric bacterium is one that is found in the intestinal tract of warm-
blooded animals in health and disease, but bacteriologists reserve the term for reference to E. coli and
its relatives, even though some of the relatives of E. coli rarely or never are found growing in the GI
tract. But in the end, this is one of the most close-related and cohesive groups of bacteria that can be
brought together for discussion.

The Genus Escherichia

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Theodor Escherich first described E. coli in 1885, as Bacterium coli commune, which he isolated from
the feces of neonates. It was later renamed Escherichia coli, and for many years the bacterium was
simply considered to be a commensal organism of the large intestine. It was not until 1935 that a strain
of E. coli was shown to be the cause of an outbreak of diarrhea among neonates.

Most investigations of enteric organisms at the turn of the 20th century were concerned with the
problems of being able to distinguish the "typhoid bacillus" and other types of Salmonella from non-
Salmonella organisms. Early workers also demonstrated that there were a number of types and
subtypes of these organisms, which could easily be distinguished from the typhoid bacillus and E. coli.
Thus, the biochemical techniques that have become the basis for most taxonomic studies came into
being during the early 1900s. These studies led to the modern taxonomy of the group, which in
principle is still valid today.

Initially, the family Enterobacteriaceae was created by Rahn in 1937, for the genus Enterobacter, and
despite some debate about nomenclature among bacteriologists, the family name was maintained with
the type genus becoming Escherichia. The family currently comprises Gram-negative,
nonsporeforming, rod-shaped bacteria that are often motile by means of peritrichous flagella. The
majority of strains grow well on the usual laboratory media in both the presence and absence of
oxygen, and metabolism can be either respiratory or fermentative. The fermentation products of
glucose and other carbohydrate substrates include mixed acids and (usually) detectable gas. Most
strains are oxidase-negative and are able to reduce nitrate to nitrite.

The taxonomic distinctiveness of Escherichia has been confirmed by rRNA-DNA heteroduplex studies.
On the basis of DNA-DNA relatedness studies, the genera of enteric bacteria are placed into a series of
groupings, with Escherichia and Shigella forming a close group distinct from their nearest group,
which includes the genera Citrobacter, Enterobacter, Klebsiella, and Salmonella.

Although most investigations of the genus Escherichia have centered on various aspects of the E. coli
species, it should not be forgotten that a number of other species have been described, including E.
blattae, E. fergusonii, E. hermanii, and E. vulneris. These species can be differentiated on the basis of a
large battery of biochemical tests.

For many years it has been realized that there exists a close relationship between two genera of
enterics, Escherichia and Shigella. This is true for their biochemical characteristics as well as various
other phenotypic traits. Also, studies of certain E. coli antigens have shown a close relationship ("cross
reactivity") with Shigella antigens. The "O" antigens of virtually all serotypes of Shigella are either
identical with or closely related to those of E. coli. The discovery that the characteristic invasiveness
of Shigella strains is also possessed by certain types of E. coli, which have become known as
enteroinvasive E. coli (EIEC), also suggests a close relationship. EIEC can cause dysentery-like
symptoms clinically indistinguishable from those caused by strains of Shigella. Furthermore, antigens
of E. coli strain O124 are shown to have a very close relationship to Shigella dysenteriae type 3
antigens, and a serological relationship between E. coli strain O129 and S. flexneri type 5 is also
known. Finally, enterohemorrhagic strains of E. coli (EHEC), specifically E. coli O157:H7 produce
the shiga (vero) toxin which is identical to the toxin produced by Shigella dysenteriae.The point being
that it has become apparent that the line dividing these two genera of enteric bacteria is exceedingly
thin, and it should be remembered that on the basis of DNA relatedness alone, Shigella and E. coli
have been considered one genus.

569
Detection and Isolation of Escherichia coli

E. coli as an Indicator of Fecal Pollution

For most of the 20th century, E. coli has been used as the principal indicator of fecal pollution in both
tropical and temperate countries. E. coli comprises about 1% of the total fecal bacterial flora of humans
and most warm-blooded animals. Sewage is always likely to contain E. coli in relatively large numbers.
In addition, E. coli, being a typical member of the Enterobacteriaceae, is presumed to have survival
characteristics very similar to those of the well-known pathogenic members of the family, Salmonella
and Shigella. Thus, E. coli has been used world-wide as an indicator of fecal microbiological
contamination. As such an indicator organism, its value is significantly enhanced by the ease with
which it can be detected. and cultured.

Tests to identify isolates as E. coli have, of necessity, been simple tests designed predominantly to
differentiate them from organisms normally associated with uncontaminated water. Since full
biochemical analyses are not generally performed, the term "coliform" has been coined to describe E.
coli-like organisms that satisfy these limited tests. As a result, regulations are promulgated throughout
the world defining standards for water based on the so-called "coliform count." For example, in the
U.S., according to a regulation published in the Federal Register (1986), there is a requirement that
there be 0 coliforms/100 ml drinking water, as determined by any method for any sampling frequency.
Since not all organisms which meet the criteria of a coliform are associated with the intestinal tract
(some may be saprophytic), a further distinction must be made between "fecal coliforms" (E coli) and
"nonfecal coliforms" (e.g. Klebsiella and Enterobacter).

Early attempts to distinguish strains of E. coli from other related Enterobacteriaceae centered on being
able to distinguish them from the various pathogenic groups, since E. coli was initially not considered
to be a pathogen. When E. coli was recognized to be a useful marker for fecal pollution, it similarly
became important to distinguish it from related species likely to be found naturally in the environment.
The realization that strains of E. coli generally ferment lactose, while those of Salmonella and Shigella
do not, led to an early method of preliminary differentiation. The IMViC tests were developed in order
to distinguish strains of E. coli from related species that also produced acid and gas from the
fermentation of lactose. IMViC is an acronym in which the capital letters stand for Indole, Methyl red,
Voges-Proskauer, and Citrate.) The IMViC set of tests examines: the ability of an organism to (1)
produce Indole; (2) produce sufficient acid to change the color of Methyl red indicator; (3) produce
acetoin, an intermediate in ther butanediol fermentation pathway (a positive result of the Voges-
Proskauer test); and (4) the ability to grow on Citrate as the sole source of carbon. Lactose fermenters
are considered E. coli if they are positive in the first two tests and negative in the second two.

Detection of E. coli in Food

The International Commission on Microbiological Specifications for Foods (ICMSF, 1978) has
adopted a set of standard techniques for the enumeration of E. coli in food products, accepted by the
International Standards Organization (ISO, 1984). This method employs the use of lauryl sulfate
tryptose broth at 35 or 37°C as a mildly selective-enrichment medium. This is followed by growth in
EC broth containing 0.15% bile salts at 45°C as a second selective step. The ability to produce indole
from tryptophan (in tryptone broth) at 45°C defines the strains as E. coli. These tests miss some types
of E. coli, such as those most closely related to the Shigella group, but it is the detection of possible
fecal contamination that is important in these tests rather than the presence of specific types.

Detection of E. coli in Water

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There is no method for the detection of E. coli in water that is accepted throughout the world. In the
US, a standard method using membrane filter enumeration for both total and thermotolerant coliforms
has been established (American Public Health Association (1986). Further IMViC tests on selected
isolates can then be performed.

In the UK, the definition of E. coli in water microbiology is also based on the ability to produce gas
from lactose and produce indole from tryptophan at 44°C. A method for enumeration employs a
standard multiple tube test with a modified glutamate synthetic medium at 37°C as a first selective step,
followed by further cultivation in standard media at 44°C.

Detection of E. coli in Clinical Specimens

While large numbers of E. coli will be found in fecal specimens or specimens contaminated with feces
or intestinal contents, most other clinical specimens are usually not contaminated with E. coli. The
major exception is urine, which requires special attention in the clinical situation. From those
specimens in which E. coli is likely to be present in large numbers, direct plating on media such as
MacConkey agar or Eosin Methylene Blue (EMB) agar is sufficient. If the number of E. coli is likely to
be very low or the amount of specimen is limited, enrichment in a rich nutrient medium such as brain
heart infusion broth may be used. A number of different commercially available kits are generally used
to identify the isolates as E. coli.

From specimens likely to contain only a few viable E. coli cells, such as blood from patients suspected
of having E. coli bacteremia, various enrichment procedures are used. Identification follows standard
bacteriological techniques.

Left: Escherichia coli microcolony. Right: E.coli colonies on EMB Agar.

Rapid Methods for Detecting E. coli

A fluorogenic detection method has been developed based on the cleavage of methylumbelliferyl-D-
glucuronide (MUG) to the free methylumbelliferyl moiety, which fluoresces a blue color after
irradiation with long-wave ultraviolet radiation. Although strains of E. coli are generally positive in this
test, some strains of Salmonella, Shigella, and Yersinia are also capable of splitting MUG; the latter
two genera are usually not present in food. A disadvantage is that enterohemorhagic E. coli (EHEC)
strains are generally negative in this test. MUG can be added to various selective media, so there is a
great potential in its use for detecting E. coli.

Automated or semi-automated systems are also being used for the detection of E. coli as part of the
detection methods for Enterobacteriaceae. Techniques involving impedance measurements have
shown promise. Other techniques such as immunoassays and nucleic acid hybridization studies can

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also be used to enumerate E. coli, and DNA probes directed at a number of genes have also been
developed.

Physiology of E. coli

Physiologically, E. coli is versatile and well-adapted to its characteristic habitats. In the laboratory it
can grow in media with glucose as the sole organic constituent. Wild-type E. coli has no growth factor
requirements, and metabolically it can transform glucose into all of the macromolecular components
that make up the cell. The bacterium can grow in the presence or absence of O2. Under anaerobic
conditions it will grow by means of fermentation, producing characteristic "mixed acids and gas" as
end products. However, it can also grow by means of anaerobic respiration, since it is able to utilize
NO3 or fumarate as final electron acceptors for respiratory electron transport processes. In part, this
adapts E. coli to its intestinal (anaerobic) and its extraintestinal (aerobic or anaerobic) habitats.

In the ecological niches that E. coli occupies, its abilities to grow both aerobically and anaerobically are
important. E. coli is well adapted to its intestinal environment as it is able to survive on a relatively
limited number of low-molecular weight substances, which may only be available transiently and at
relatively low concentrations. The generation time for E. coli in the intestine is thought to be about 12
hours. The type of nutrients available there to E. coli consist of mucus, desquamated cells, intestinal
enzyme secretions, and incompletely digested food. Given the absorption capacity and efficiency of
the intestine, there are probably only small amounts free carbohydrates or other easily absorbable forms
of nutrients, and there is competition from hundreds of other types pf bacteria. A similar situation
probably also applies to sources of nitrogen.

In its natural environment, as well as the laboratory, E. coli can respond to environmental signals such
as chemicals, pH, temperature, osmolarity, etc., in a number of very remarkable ways considering it is a
single-celled organism. For example, it can sense the presence or absence of chemicals and gases in its
environment and swim towards or away from them. Or it can stop swimming and grow fimbriae that
will specifically attach it to a cell or surface receptor. In response to changes in temperature and
osmolarity, it can vary the pore diameter of its outer membrane porins to accommodate larger
molecules (nutrients) or to exclude inhibitory substances (e.g. bile salts). With its complex mechanisms
for regulation of metabolism the bacterium can survey the chemical content its environment in advance
of synthesizing any enzymes necessary to use these compounds. It does not wastefully produce
enzymes for degradation of carbon sources unless they are available, and it does not produce enzymes
for synthesis of metabolites if they are available as nutrients or growth factors in the environment.

Escherichia coli in the Gastrointestinal Tract

The commensal E. coli strains that inhabit the large intestine of all humans and warm-blooded animals
comprise about 1% of the total bacterial biomass. This E. coli flora is in constant flux. One study on
the distribution of different E. coli strains colonizing the large intestine of women during a one year
period (in a hospital setting) showed that 52.1% yielded one serogroup, 34.9% yielded two, 4.4%
yielded three, and 0.6% yielded four. The most likely source of new serotypes of E. coli is acquisition
by the oral route. To study oral acquisition, the carriage rate of E. coli carrying antibiotic-resistance (R)
plasmids was examined among vegetarians, babies, and nonvegetarians. It was assumed that
nonvegetarians might carry more E. coli with R factors due to their presumed high incidence in animals
treated with growth-promoting antimicrobial agents. However, omnivores had no higher an incidence
of R-factor-containing E. coli than vegetarians, and babies had more resistant E. coli in their feces than
nonvegetarians. No suitable explanation could be offered for these findings. Besides, investigation of

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the microbial flora of the uninhabited Krakatoa archipelago has shown the presence of antibiotic-
resistant E. coli associated with plants.

Infections Caused by Pathogenic E. coli

E. coli is responsible primarily for three types of infections in humans: urinary tract infections,
neonatal meningitis, and intestinal diseases. These condituions depend on a specific array of
pathogenic (virulence) determinants possessed by the organism. Pathogenic E. coli are discussed
elsewhere in the text in more detail at Pathogenic E. coli: Gastroenteritis, Urinary tract Infections and
Neonatal Meningitis.

Urinary Tract Infections

Uropathogenic E. coli cause 90% of the urinary tract infections (UTI) in anatomically-normal,
unobstructed urinary tracts. The bacteria colonize from the feces or perineal region and ascend the
urinary tract to the bladder. Bladder infections are 14-times more common in females than males by
virtue of the shortened urethra. The typical patient with uncomplicated cystitis is a sexually-active
female who was first colonized in the intestine with a uropathogenic E. coli strain. 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). The letter designation is derived from the ability of P
fimbriae to bind specifically to the P blood group antigen which contains a D-galactose-D-galactose
residue. The fimbriae bind not only to red cells but to a specific galactose dissaccharide that is found on
the surfaces uroepithelial cells in approximately 99% of the population.

The frequency of the distribution of this host cell receptor plays a role in susceptibility and explains
why certain individuals have repeated UTI caused by E. coli. Uncomplicated E. coli UTI virtually
never occurs in individuals lacking the receptors.

Uropathogenic strains of E. coli possess other determinants of virulence in addition to P fimbriae. E.

coli with P fimbriae also possess the gene for Type 1 fimbriae, and there is evidence that P fimbriae are
derived from Type 1 fimbriae by insertion of a new fimbrial tip protein to replace the mannose-binding
domain of Type 1 fimbria. In any case, Type 1 fimbriae could provide a supplementary mechanism of
adherence or play a role in aggregating the bacteria to a specific manosyl-glycoprotein that occurs in
urine.

Uropathogenic strains of E. coli usually produce siderophores that probably play an essential role in
iron acquisition for the bacteria during or after colonization. They also produce hemolysins which are
cytotoxic due to formation of transmembranous pores in host cells. One strategy for obtaining iron and
other nutrients for bacterial growth may involve the lysis of host cells to release these substances. The
activity of hemolysins is not limited to red cells since the alpha-hemolysins of E. coli also lyse
lymphocytes, and the beta-hemolysins inhibit phagocytosis and chemotaxis of neutrophils.

Another factor thought to be involved in the pathogenicity of the uropathogenic strains of E. coli is
their resistance to the complement-dependent bactericidal effect of serum. The presence of K antigens
is associated with upper urinary tract infections, and antibody to the K antigen has been shown to
afford some degree of protection in experimental infections. The K antigens of E. coli are "capsular"
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antigens that may be composed of proteinaceous organelles associated with colonization (e.g., CFA
antigens), or made of polysaccharides. Regardless of their chemistry, these capsules may be able to
promote bacterial virulence by decreasing the ability of antibodies and/or complement to bind to the
bacterial surface, and the ability of phagocytes to recognize and engulf the bacterial cells. The best
studied K antigen, K-1, is composed of a polymer of N-acetyl neuraminic acid (sialic acid), which
besides being antiphagocytic, has the additional property of being an antigenic disguise.

Neonatal meningitis

Neonatal meningitis affects1/2,000-4,000 infants. Eighty percent of E. coli strains involved synthesize
K-1 capsular antigens (K-1 is only present 20-40% of the time in intestinal isolates).

E. coli strains invade the blood stream of infants from the nasopharynx or GI tract and are carried to the
meninges.

The K-1 antigen is considered the major determinant of virulence among strains of E. coli that cause
neonatal meningitis. K-1 is a homopolymer of sialic acid. It inhibits phagocytosis, complement, and
responses from the host's immunological mechanisms. K-1 may not be the only determinant of
virulence, however, as siderophore production and endotoxin are also likely to be involved.

Epidemiologic studies have shown that pregnancy is associated with increased rates of colonization by
K-1 strains and that these strains become involved in the subsequent cases of meningitis in the
newborn. Probably, the infant GI tract is the portal of entry into the bloodstream. Fortunately, although
colonization is fairly common, invasion and the catastrophic sequelae are rare.

Neonatal meningitis requires antibiotic therapy that usually includes ampicillin and a third-generation
cephalosporin.

Intestinal Diseases

As a pathogen, E. coli, of course, is best known for its ability to cause intestinal diseases. Five classes
(virotypes) of E. coli that cause diarrheal diseases are now recognized: enterotoxigenic E. coli (ETEC),
enteroinvasive E. coli (EIEC), enterohemorrhagic E. coli (EHEC), enteropathogenic E. coli (EPEC),
and enteroaggregative E. coli (EAggEC). Each class falls within a serological subgroup and manifests
distinct features in pathogenesis.

Enterotoxigenic E. coli (ETEC)

ETEC are an important cause of diarrhea in infants and travelers in underdeveloped countries or
regions of poor sanitation. The diseases vary from minor discomfort to a severe cholera-like syndrome.
ETEC are acquired by ingestion of contaminated food and water, and adults in endemic areas evidently
develop immunity. The disease requires colonization and elaboration of one or more enterotoxins. Both
traits are plasmid-encoded.

ETEC adhesins are fimbriae which are species-specific. For example, the K-88 fimbrial Ag is found on
strains from piglets; K-99 Ag is found on strains from calves and lambs; CFA I, and CFA II, are found
on strains from humans. These fimbrial adhesins adhere to specific receptors on enterocytes of the
proximal small intestine.

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Enterotoxins produced by ETEC include the LT (heat-labile) toxin and/or the ST (heat-stable) toxin,
the genes for which may occur on the same or separate plasmids. The LT enterotoxin is very similar to
cholera toxin in both structure and mode of action. It is an 86kDa protein composed of an
enzymatically active (A) subunit surrounded by 5 identical binding (B) subunits. It binds to the same
identical ganglioside receptors that are recognized by the cholera toxin (i.e., GM1), and its enzymatic
activity is identical to that of the cholera toxin.

The ST enterotoxin is actually a family of toxins which are peptides of molecular weight about 2,000
daltons. Their small size explains why they are not inactivated by heat. ST causes an increase in cyclic
GMP in host cell cytoplasm leading to the same effects as an increase in cAMP. STa is known to act by
binding to a guanylate cyclase that is located on the apical membranes of host cells, thereby activating
the enzyme. This leads to secretion of fluid and electrolytes resulting in diarrhea.

Symptoms ETEC infections include diarrhea without fever. The bacteria colonize the GI tract by means
of a fimbrial adhesin, e.g. CFA I and CFA II, and are noninvasive, but produce either the LT or ST
toxin.

Enteroivasive E. coli (EIEC)

EIEC closely resemble Shigella in their pathogenic mechanisms and the kind of clinical illness they
produce. EIEC penetrate and multiply within epithelial cells of the colon causing widespread cell
destruction. The clinical syndrome is identical to Shigella dysentery and includes a dysentery-like
diarrhea with fever. EIEC apparently lack fimbrial adhesins but do possess a specific adhesin that, as in
Shigella, is thought to be an outer membrane protein. Also, likeShigella, EIEC are invasive organisms.
They do not produce LT or ST toxin and, unlike Shigella, they do not produce the shiga toxin.

Enteropathogenic E. coli (EPEC)

EPEC induce a watery diarrhea similar to ETEC, but they do not possess the same colonization factors
and do not produce ST or LT toxins. They produce a non fimbrial adhesin designated intimin, an outer
membrane protein, that mediates the final stages of adherence. Although they do not produce LT or ST
toxins, there are reports that they produce an enterotoxin similar to that of Shigella. Other virulence
factors may be related to those in Shigella.

Adherence of EPEC strains to the intestinal mucosa is a very complicated process and produces
dramatic effects in the ultrastructure of the cells resulting in rearrangements of actin in the vicinity of
adherent bacteria. The phenomenon is sometimes called "attaching and effacing" of cells. EPEC strains
are said to be "moderately-invasive" meaning they are not as invasive as Shigella, and unlike ETEC or
EAggEC, they cause an inflammatory response. The diarrhea and other symptoms of EPEC infections
probably are caused by bacterial invasion of host cells and interference with normal cellular signal
transduction, rather than by production of toxins.

Some types of EPEC are referred to as Enteroadherent E. coli (EAEC), based on specific patterns of
adherence. They are an important cause of traveler's diarrhea in Mexico and in North Africa.

Enteroaggregative E. coli (EAggEC)

The distinguishing feature of EAggEC strains is their ability to attach to tissue culture cells in an
aggregative manner. These strains are associated with persistent diarrhea in young children. They
resemble ETEC strains in that the bacteria adhere to the intestinal mucosa and cause non-bloody
diarrhea without invading or causing inflammation. This suggests that the organisms produce a toxin of
some sort. Recently, a distinctive heat-labile plasmid-encoded toxin has been isolated from these
strains, called the EAST (EnteroAggregative ST) toxin. They also produce a hemolysin related to the
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hemolysin produced by E. coli strains involved in urinary tract infections. The role of the toxin and the
hemolysin in virulence has not been proven. The significance of EAggEC strains in human disease is
controversial.

Enterohemorrhagic E. coli (EHEC)

EHEC are represented by a single strain (serotype O157:H7), which causes a diarrheal syndrome
distinct from EIEC (and Shigella) in that there is copious bloody discharge and no fever. A frequent
life-threatening situation is its toxic effects on the kidneys (hemolytic uremia).

EHEC has recently been recognized as a cause of serious disease often associated with ingestion of
inadequately cooked hamburger meat. Pediatric diarrhea caused by this strain can be fatal due to acute
kidney failure (hemolytic uremic syndrome [HUS]). EHEC are also considered to be "moderately
invasive". Nothing is known about the colonization antigens of EHEC but fimbriae are presumed to be
involved. The bacteria do not invade mucosal cells as readily as Shigella, but EHEC strains produce a
toxin that is virtually identical to the Shiga toxin. The toxin plays a role in the intense inflammatory
response produced by EHEC strains and may explain the ability of EHEC strains to cause HUS. The
toxin is phage encoded and its production is enhanced by iron deficiency.

E. coli O157:H7 Transmission EM. American Society for Microbiology

Biotechnological Applications of E. coli

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The advances in molecular biology, genetics and biochemistry during the past four decades have led to
an enormous development in the field of biotechnology. Studies with E. coli have played a major role
in these developments, and the bacterium has been in the forefront of many technological advances.

In the early days of biotechnology (1960s), emphasis was placed on improvements of established
procedures of bioprocessing, such as the production of yeasts, vaccines, and antibiotics. These
investigations stimulated genetic research of microbes to increase their potential to produce a wide
variety of products in the service of humanity. Although much was being learned about E. coli and its
genetics, the direct use of the bacterium in the industry was limited. The industrial production of the
amino acid threonine by E. coli mutants, begun in 1961, is an exception.
At this time, organisms were generally subjected to mutagenic agents, which produced a series of
random mutations, from which the specifically required mutants were selected.

In the last two decades, procedures have evolved which permit the preparation of strains that have very
specific productive capabilities. As the genetic structure of E. coli was well known, and it is an
organism which can grow on simple media (mineral salts and glucose) under aerobic and anaerobic
conditions, the bacterium became the basis for most developments in genetic manipulations leading to
genetic engineering.

The basic principle of these genetic manipulations is gene cloning, which enables the isolation and
replication of individual DNA fragments. This consists of a series of linked steps, involving the
isolation of the desired gene as double-stranded DNA (dsDNA), insertion of the gene into a suitable
vector, and using the vector to introduce the DNA into a cell which will express the desired genetic
information. In the case of cloning a gene in E. coli,first the DNA of suitable character is isolated, then
it is joined to the DNA of a suitable vector producing a series of recombinant molecules. Then the
recombinant molecules are introduced into the bacterium in which the target gene becomes established.
Recombinants are selected in various ways with the purpose of expressing the desired genetic
information.

The source for DNA cloning can be genomic DNA fragments, cDNA fragments produced by the action
of reverse transcriptase on mRNA molecules, chemically synthesized oligonucleotides, or amplified
DNA from the products of the polymerase chain reaction (PCR). Plasmids, phages, and cosmids have
all been successfully used as vectors, and transformation, transfection, and transduction have all been
used to introduce the foreign DNA into the E. coli cell. Plasmids are among the most widely used
vectors for the insertion of foreign DNA into an E. coli. Plasmids lend themselves very well as vectors
since they are independent replicons which are stabily inherited in an extrachromosomal state and can
be made to carry easily identifiable phenotypic markers such as antibiotic resistance or sugar
fermentation.

An example of the use of plasmids to introduce a foreign gene into E. coli in order to produce a useful
product is illustrated by the use of the E. coli plasmid pBR322 to clone the gene for production of the
human growth hormone, somatostatin. In this case, the gene for the small polypeptide hormone was
produced by synthetic means. The double-stranded DNA coding for the 15 amino acids of somatostatin
was synthesized with the addition of a translation a stop signal at the end. The synthetic gene was then
recombined with the plasmid within the beta-galactosidase structural gene and introduced into E. coli.
In this way, the production of the somatostatin peptide could be controlled by the lac operon. In a
similar manner, the genes for human insulin production were inserted into E. coli which was then able
to synthesize the human hormone.

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Such general techniques of molecular biology and bacterial genetics are now being applied within
research laboratories and industry to produce a wide variety of strains of genetically engineered E. coli
from which a number of useful products can be produced. Likewise, the problems associated with the
expression of eukaryotic DNA by a procaryotic promoter in E. coli were solved by construction of a
fusion gene. In this system, the control region and the N-terminal coding sequence of an E. coli gene
are ligated to a eukaryotic sequence sothat translation of the chimeric protein can occur. The only
condition is that the eukaryotic sequence must be in the correct reading frame. The desired protein is
then enzymatically or chemically cleaved from the E. coli product.

E. coli strains ave been genetically engineered to produce a variety of mammalian proteins, especially
products of medical or veterinary interest including enzymes and vaccine components. E. coli has also
been used to manufacture other substances including enzymes that are useful in the degradation of
cellulose and aromatic compounds and enzymes for ethanol production. There may be no limit to what
E. coli can produce through recombinant DNA technology as long as the substance is a natural product
for which a genetic sequence can be found.

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