BACTE-LEC ENTEROBACTERIACEAE - Docx 1
BACTE-LEC ENTEROBACTERIACEAE - Docx 1
BACTE-LEC ENTEROBACTERIACEAE - Docx 1
● All Enterobacteriaceae share this characteristic: pH indicator used in media for enterics: CHO
● “Eae” family of Enterobacteriaceae fermentation
● Family of “Enteric” means found in the intestinal tract ● Some of ph indicator is phenol red and
neutral red
● All of Enterobacteriaceae is “aerogenic” means they
can produce significant amount of gas in culture Deaminase positive (+) PMP = Proteus, Morganella,
media Providencia
● Most member of Enterobacteriaceae is commensal or H2S (hydrogen sulfide) SPaCEd = Salmonella,
normal flora of the intestinal tract. positive (+) Proteus, Citrobacter,
GENERALIZATION EXCEPTIONS Edwardsiella
“Premise” Vp positive (+) PSHEK= Pantoea, Serratia,
Except Plesiomonas - Vp means Voges Hafnia, Enterobacter,
- Plesiomonas is a Proskuer is a Klebsiella
new member of biochemical test
Enterobacteriaceae that we need to
family memorize
- Oxidase positive (+)
Cytochrome oxidase - Kasama siya before Lactose fermenters possess 2 enzymes:
negative (-) sa member nila 1. Beta-galactosidase - major enzyme
Vibrio, Aeromonas 2. Lactose permease - it allows the lactose to penetrate
sila sila yung the cell wall
magkakasama - Lactose is a disaccharide
Bakit nalipat si Plesiomonas - Glucose is a monosaccharide
sa Enterobacteriaceae Late lactose fermenters: beta-galactosidase
family? - after 24 hours of incubation the color is colorless so it
- This organism grown means non-lactose fermenter but if you incubate
in enteric media another 24 hours it becomes lactose fermenter which
Catalase positive (+) Except Shigella dysenteriae is color pink (48 hours)
All ferments glucose, -
reduce nitrates to nitrite ANTIGENS:
Xylose fermenters Except Shigella Note: MacConkey Agar is important in Enterobacteriaceae
Nonsucrose fermenters Except Yersinia - Bakit MacConkey Agar is pink so doon makikita kung lactose
enterocolitica fermenter or non-lactose fermenter.
Fermentative, gram - - Dry, Mucoid, Watery pink means Lactose fermenter
negative (-) enteric bacilli - Colorless means Non-lactose fermenter
Facultative anaerobes, NS
Motile at 37C Except Klebsiella Shigella ● K antigen- envelope ag, capsular, heat-labile (usually
(peritrichous) )type of Yersinia found in E.coli, Salmonella and Klebsiella) Vi (usually
flagella Salmonella typhi)
● O antigen- somatic; serotype 0157:H7 (responsible
Non- encapsulated Except for Klebsiella and
for infant diarrhea), serotype 0111
Enterobacter
● H antigen- Flagellar, heat labile; protein in nature
Non- hemolytic Except Escherichia coli
- Some strange of E.
Enterobacteriaceae are capable of producing Beta-lactamases
coli are
that hydrolyze penicillins and cephalosporins, including the
beta-hemolysis
extended-spectrum cephalosporins (cefoxime, ceffriazone,
True pathogens: Shigella, - ceffizoxime, and ceftazidime) ESBLs (extended spectrum
Salmonella, Yersinia cepahlosporins) are inhibted by culvanic acid.
Aerogenic Except Salmonella typhi,
Yersinia, Shigella,
Providencia
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ESCHERICHIA COLI
NON-LACTOSE ● Proteus
FERMENTERS ● Morganella
(ALL PATHOGENIC) ● Providencia
● Edwardsiella/All
Salmonella except
Arzona/Hafnia
● All Yersinia except Y.
enterocolitica/ All Shigella
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E. Coli SEROTYPES: ENTEROVIRULENT E.coli ● Produces heat-labile (LT) and or heat stable – which
ENTEROPATHOGENIC E. coli (EPEC) causes hypersecretion (ST) enterotoxins: stimulates
● relapsing watery diarrhea adenylcyclase
- Means infantile diarrhea non bloody ● For adhesion: colonization factor antigen
(walang dugo kapag dumumi) ● Cause hemorrhagic colitis and watery diarrhea
- Most common in hospital nursery, daycare ● Serotypes: E. coli 06; E. coli 08; E. coli 025
center (sa mga bata) HIGH INFECTIVE DOSE (106 TO 1010 ORGANISMS)
● Non-invasive, non-toxigenic, nosocomial - Protective mechanisms are: Stomach acidity/
( hospital-acquired) Achlorhydria (deficiency of hydrochloric acid in the
● capable of producing lesions called “attaching and stomach, medyo high risk)
effacing lesions”
- Found in younger in 6 months and newborns
● Virulence factor: Pili (pathogenicity island) / bundle Enterohemorrhagic E. coli (EHEC)
forming pilus (BFP) ● Also called: VTEC Verocytotoxin E. coli
● Serotypes: E. coli 0111; E. coli 0114 ● Also called: HAMBURGER DISEASE
ENTEROINVASIVE E. coli (EIEC) ● Produces verotoxin HUS (hemorrhagic uremic
● Produces a Shigella like disease (dysentery like syndrome)
diarrhea) ○ HUS - most severe manifestation of EHEC
● Stool with red blood cells, neutrophils and mucus ● Verocytotoxin or Shigella-like toxin (Life
- Painful if nagpopoop ka threatening )
- If watery diarrhea yan ○ Shigella-like toxin will enter the blood and
- Found in mahihirap na bansa then be carried to the kidneys.
● EIEC isolates may be mistaken for nonpathogenic E. ○ Kids- madamage yung vascular cells; and
coli will cause HUS
● Bloody diarrhea seen in poor countries and in children ● Sorbitol replaces lactose in MAC
● Invade and kill epithelial cells of the large intestines ○ Hindi siya tutubo in normally MAC ;cannot
● Serotypes: E. coli 0124; E. coli 143; E. coli 164 identify or isolate the E.coli 0157:H7
● Sereny test – virulence test ○ SMAC - sorbitol MacConkey Agar (to identify
- Pwede din siya kay Shigella at Listeria the E.coli 0157:H7
monocytogenes ● Most important strain: Verotoxin 1 and Verotoxin 2
● Virulence factor: invasin
ENTEROADHERENT E. coli (EAEC) Verotoxin 1 Verotoxin 2
● associated with two kinds of human disease: diarrhea
and UTI stx 1 - Shigella stx 2 -Shigella-like toxin
● Two types of ENTEROADHERENT E. COLI – DAEC dysenteriae Type 1 E.coli
& EAEC Also called (STEC)
DIFFUSELY ADHERENT E.coli (DAEC) - verocytotoxin 1 E.coli strains;
- associated with UTIs and diarrheal
disease
ENTEROAGGREGATIVE E. coli ● Associated with the consumption of undercooked
- Associated in diarrhea only infected hamburger from a fast food chain such as
- Seen among children and even in AIDS E. coli 0157:H7
patients (prolong in aids patients) ○ In US, this case is rampant especially in the Kids;
- “Stacked-brick” (fimbrae) pattern on the hamburger duon ay makapal; hindi naluluto yung
gitna
cells
- cause of persistent diarrhea in developing ● Produce a shiga-like toxin that kills epithelial cells of
countries the large intestines causing hemorrhagic colitis
● Pinaka malala sa lahat: Grossly bloody diarrhea;
- (AggR gene) Aggregative regulator gene pwedeng may fever, pwedeng wala.
(virulence)
- Watery diarrhea (without blood and no
pus cells)
● ST hemolysin-like toxins.
ENTEROTOXIGENIC E. coli (ETEC)
● Toxin produce enterotoxin is similar to Vibrio
cholerae
● Traveller’s diarrhea, Turista Belly Delhi diarrhea
● profuse watery stool “Montezuma’s revenge”
- No mucus, no pus cells, non bloody,
noninvasive
● It is also cause childhood diarrhea
● High infective dose for the disease to occur Colorless - kapag ito ay si E.coli 0157:H7
Ordinary E.coli (ETEC, EPEC, EIEC) is color pink in SMAC
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MODE OF TRANSMISSION Anaerogenic E. coli or Inactive E. coli
EIEC Invasin Dysentery O124: H30 ● Encapsulated (they have capsule); NM ; mucoid
O143:NM O164:NM colonies
● Inhabits nasopharynx and GIT
ETEC LT, ST Traveler’s O6:NM O6:H16 ● Associated with various opportunistic and
diarrhea O8:H9 O25:NM hospital-acquired infections (particularly the
O27:NM O63:H12 ventilator-associated pneumonia)
○ Septicemia
EAEC AAF Fimbriae Persistent O44:H18 ○ Liver abscess
Afa/Dr ○ Wound infections
adhesions, A Pediatric ○ UTI
IDA-1,
pathogenicity diarrhea Virulence factor: polysaccharide capsule
islands
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Species:
Klebsiella quasipneumoniae subsp. similipneumoniae
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● Biochemically inert; VP (-) Species:
● E. aerogenes - (formerly known) Klebsiella
Raoultella (Klebsiella) planticola aerogenes
● Before it is called Klebsiella planticola ○ Isolated from wounds, urine, blood,
● Environmental organisms CSF
○ Opportunistic pathogen; nosocomial
● Isolated from urine, respiratory tracts and blood, infections
wound infections ● E. cloacae - most predominant isolate
● Hard to differentiate to K. pneumoniae ● Pantoea agglomerans - (formerly known) E.
agglomerans
○ Caused septicemia from
contaminated IV fluids or medical
REMEMBER:
supplies used in parenteral nutrition
LACTOSE FERMENTER
○ Can cause nosocomial infection
E.coli
Klebsiella Key test: YELLOW PIGMENT
Enterobacter
● “Triple decarboxylase negative” - ODC /
Magkapatid is Klebsiella and Enterobacter - mucoid and ADH / LDC
pink in MAC ○ ODC -ornithine decarboxylase
○ ADH - arginine dihydrolase
Differentiate by the use of Biochemical test; Klebsiella is ○ LDC -lysine decarboxylase
NON MOTILE ● Caused a nationwide outbreak of
Enterobacter is MOTILE septicemia resulting from contaminated
intravenous fluids
Enterobacter ● E. gergoviae
○ Recovered from respiratory
● Formerly Aerobacter samples
● Resembles K. pneumoniae ; highly motile ; fish ○ Rarely isolated from blood cultures
eye appearance ○ Has STRONG urease reaction
● Urease (-) except E. gergoviae
● Biochemically they are similar Klebsiella except that Cronobacter sakazakii
for Lysine
● They are ALL positive except for E. cloacae (which is ● (formerly known as Enterobacter sakazakii)
lysine negative [-] ) ● Yellow pigmented Enterobacter cloacae
● Normal flora of GIT but may be opportunistic ● Intensifies at 25 °C
pathogens ● DNASE + , sorbitol -
● May cause necrotizing fasciitis (due to powdered ● VP (-), OD (+), arginine dihydrolase (-)
infant milk formula) ● Causes meningitis and bacteremia
● Associated with contaminated medical devices among neonates
(like respiratory) ● May cause necrotizing fasciitis (due to
powdered infant milk formula)
● Distinct feature is yellow colonies
NOTE:
Biochemical test similar to Klebsiella except for E. cancerogenus (E. taylorae)
Lysine all are (+) except E. cloacae
● Nosocomial infection; usually affected yung
bone
Differentiating Points between Klebsiella and ● Cause osteomyelitis after traumatic
Enterobacter wounds
● Key test: Lactose (-), ONPH, ADH,
K. pneumoniae Enterobacter ODH (+) ; LDC (-)
● MAC - colonies with purple centers
Ornithine decarboxylase Ornithine decarboxylase
after extended incubation
OD (-) OD (+)
Motility ( - ) Motility (+)
E. asburiae
● Isolated from blood, urine, feces,
All Enterobacter are OD (+) except E. agglomerans
wounds, and sputum
● Biochemically they are similar to E.
cloacae
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S. S. S. rubidaea S.
E. hormaechei
marcescens liquefaciens odorifera
● Isolated from blood, wounds and sputum
-pinakasikat sa Non- -Produces -Rotten/
lahat pathogenic red pigment rancid
Hafnia alvei - Produced red potato like
pigment when -Malonate odor
● Isa lang siya; only Hafnia alvei incubated at test:
● Link to hemolytic uremic syndrome; graft vs. host room temp Biogroup 1 -
disease S. rubidaea respiratory
● Organ transplant ; blood transfusion or sepsis -Resistant to (+) tract
● Commensal of human GIT, not normally many
pathogenic but it may cause disease in antibiotics S. marcescens (+)
immunocompromised patients in patients with (-) sucrose,
underlying disease (malignancy) or after trauma -Outbreaks in raffinose
nurseries and and
or surgery ornithine
cardiac surgery
● LLF or sometimes in other books ay non lactose fermenters and burn units
; Motile (-v++); positive delayed Citrate activity Biogroup
(MAJOR CHARACTERISTICS OF HAFNIA) -Known to 2 - isolated
● Rarely consider as pathogenic cause from blood
● Dnase, gelatinase and Lipase (-) and CSF
● TSI = K/A with gas no H2S; lac and suc (-) Harmful
● Strong scent of feces pathogens: can (-) sucrose,
● Also linked to hemolytic uremic syndrome, graft cause UTI, raffinose
versus host disease and sepsis wound and
infections and ornithine
pneumonia and
bacteremia.
Serratia
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● Serve as naturals hosts- birds, rodents, cold ➢ S. enterica subsp. enterica serotype
blooded animals Enteritidis
● Associated with individuals who handle reptiles - Associated with gastroenteritis
and amphibians or enteric fever
➢ Facultative anaerobe ● S. enterica subsp. salamae
➢ NLF (Non-lactose fermenter) , NE, ● S. enterica subsp. arizonae
produce H2S ● S. enterica subsp. diarizonae
➢ Indole, VP, PAD (Phenylalanine ● S. enterica subsp. houtenae
deaminase) , Urease (-) ● S. enterica subsp. Indica
➢ Most species produces H2S (Hydrogen
sulfide) except for Salmonella paratyphi A Vi antigen - Salmonella serotype Typhi and a few
➢ They do not grow in medium with strains Salmonella serotype Choleraesuis
potassium cyanide - Kay S. typhi; nakikita pag carrier ang isang
➢ Motile except S. pullorum, S, patient meaning there is NO SYMPTOMS
gallinarum (gallinarum is sa birds) pero nakakahawa
➢ Most are citrate (+) except for S. typhi O antigen- located in the outer membrane of the cell
➢ Most are LDC (+) for S. paratyphi wall
● Antigenic structures: O, H, and K (Vi Ag) antigen - Somatic antigen
serotyping (based on Kauffman-White) H antigen- proteins are heat labile
- Flagella antigen
● Virulence factor: fimbriae
Bacteremia- often caused by S. Choleraesuis
● Incubation period: 1-4 weeks
Serotypes most commonly associated with bacteremia
Diseases associated with Salmonella:
are:
● Gastroenteritis
● Typhimurium- food poisoning
● Bacteremia or septicemia without Gi symptoms
● Paratyphi- parathyroid fever
● Enteric fever
● Choleraesuis- non typhoidal fever
● Carrier state
● Focal infections
NOTE: Pag sinabing serotype, lalagyan ng Salmonella
➢ Osteomyelitis
lahat. ex. Salmonella enterica subsp. Enterica
➢ Meningitis
serotype typhimurium
➢ Brain abscess
➢ Endocarditis
Common sequelae: Salmonella osteomyelitis
Carrier state
Classification
● “Typhoid Mary”
Previously, there are 3 biochemically species: - Isang syang cook or chef na nagtatrabaho.
○ S. enteritidis Due to improper hygiene nakakainfect ito sa
○ S. choleraesuis mga tao, maraming namatay that’s why it’s
○ S. typhi called Typhoid Mary
- Usually narerecover yung infection.
These organisms are now considered as serotypes or Nagkaroon ng infection pero nakarecover
subspecies pero naharbor yung organism sa gallbladder
➢ Salmonella comprises only two species (currently na in which becomes the site of chronic carriage
nirerecognize) (don nagtatago).
● S. enterica is the type species of the -
People have also died due to Typhoid
genus (associated with humans) Mary
■ Medically important spp. affecting S. serotype Choleraesuis
humans - Non typhoidal fever with or without gastroenteritis
S. serotype Typhi
● S. bongori is a rarely isolated species - Typhoid fever
■ Primarily affect reptiles - Humans are the only reservoir
S. serotype Paratyphi
Within the species S. enterica are six subspecies: - Paratyphoid fever
S. serotype Typhimurium
● S. enterica subsp. enterica - Food poisoning usually dairy products
➢ S. enterica subsp. enterica serotype
Typhi
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Salmonella typhi or S. enterica subsp. enterica
serotype typhi
Common name: Eberth’s bacillus
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○ K antigen- interfere with the detection
of O antigen during serologic testing
○ H and K antigen are heat labile
● Motile
● Can be distinguished from Salmonella by their
LLF (late lactose fermenters)
● Growth on sodium malonate
● (+) result– blue color
● Normally present in the intestinal content of
reptiles
● Reported as serotype of the genus Salmonella
● Can cause gastroenteritis or sepsis
● Biochemical tests:
- TSI: A/Ag with H2S
- IMViC: - + - +
- LIA: K/K
Edwardsiella tarda
Laboratory Diagnosis
● Only species implicated in human
1.Culture (best) - fresh stool with mucous flecks ● Motile, NLF
2. Rectal swab of ulcer ● Biochemically similar to E. coli but E. tarda
S.sonnei- may produce only watery diarrhea produces abundant H2S
● Usually found in aquatic animals and reptiles
Pathogenecity: all Shigella spp. cause Bacillary (cold & warm blood animals)
dysentery which is a painful diarrhea characterized by ● Can cause gastroenteritis, wound infections,
watery, blood streaks, and plenty of pus cells whereas bacteremia
for Amoebic dysentery- small amount of pus cells ● Source of GI infection
● Citrate (-)
Ewing’s Classification of Shigella ● Biochemical tests:
- TSI: K/Ag with H2S
- IMViC: + + - -
- LD, H2S, indole (+)
- Urea (-)
CAYABYAB | DE GUZMAN | DUBLIN | EBOL | ESPELETA | MACALMA | NOCUM | PAULINO | RECIO | TOLENTINO 10
CITROBACTER
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Providencia alcalifaciens
P. mirabilis P. vulgaris
● associated with some cases of diarrhea in
• Nosocomial UTI
children. Infection is rare
• Most important member
● Do not swarm on BAP
of this genus
• Has OX-2 and OX-19 ● Biochemically similar to Proteus
• Has OX-K antigen antigens
Biochemical reaction
•Targets immunosuppressed ● TSI –K/A without H2S
• Rapid urease producer individuals ● IMViC = ++-+; PAD (+); Lysine (-)
● Lactose (-); Citrate (+)
• Cause human infection • Can be used to diagnose
only when they leave the some diseases “Weil- Felix
GIT; Most common Test”
clinical isolate.
• AP, Cephalosporin, C–
• Clear colonies on Mac
• Indole (+); ODC (-)
Conkey with burnt gun • IMVIC: + + - V
powder odor • PAD (+) ; LIA +/-
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● Virulence factor- enterotoxin
Safety pin
appearance Plesiomonas shigelloides
Oxidase (+)
● Biochemically imitates Shigella; motile, do not
Yersinia enterocolitica produce gas
● LLF ● glucose fermenters
● Causes enterocolitis, mesenteric lymphadenitis ● Specimen: stool and rectal swab
in children ● Mistaken for Vibrio and Aeromonas because of
● Motile at room temp. “bull’s eye colonies” glucose fermentation and (+) oxidase result
● Invasive pathogen which can penetrate the gut ● exposure to cold blooded animals
lining ● May cause gastritis
● Appendicitis- like infection/ pseudoappendicular ● Causes secretory diarrhea in HIV positive
syndrome individuals with inflammatory bowel disease
● Urease (+); Ornithine (+)
● ONPG (+); Oxidase (-) Triple Decarboxylase Positive: LDC / ODC / ADH
● Main reservoir
● Reservoir- dogs, cats, rabbits, pigs, cattle Laboratory Diagnosis
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● Culture media
○ Cary Blair, TCBS, APW
● String test- 0.5% sodium desoxycholate
● biochemical test
○ TSI- A/A w/o fas no H2S
○ LIA- K/K; (+) indole -
CAYABYAB | DE GUZMAN | DUBLIN | EBOL | ESPELETA | MACALMA | NOCUM | PAULINO | RECIO | TOLENTINO 14