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ENTEROBACTERIACEAE ● Plesiomonas shigelloids- Oxidase positive (+)

● 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

RAPID UREASE LATE UREASE


PRODUCERS PRODUCERS
4 HOURS 18-24 HOURS
Proteus Citrobacter
P. rettgeri Klebsiella
Morganella morganii Enterobacter
Serratia
Yersinia (except Y. pestis)

CAYABYAB | DE GUZMAN | DUBLIN | EBOL | ESPELETA | MACALMA | NOCUM | PAULINO | RECIO | TOLENTINO 1
ESCHERICHIA COLI

● Also known as colon bacillus because this is a


normal flora
● Prodominant facultative in large intestine (normal
flora siya sa bituka)
● cross-reactivity with Shigella
- Pwede mo mapagkamalan si E. coli na
Shigella except that pag nakita mo sa
MacConkey Agar Shigella is non-lactose
fermenter while E. coli is lactose fermenter
● Beta-hemolytic on BAP
● normal flora of GIT
● Mostly motile and possess
● Adhesive fimbriae/sex pili (primary virulence
factor)
● O, H and K antigens
● #1 cause of community-acquired UTI
● #2 neonatal meningitis(E.coli K1- strained),
nosocomial (normal flora) wound, bacteremia
● Biochemical Characteristics:
- IMViC = + + - -; H2S (-);

CLASSIFICATION BASED ON LACTOSE MUG TEST


FERMENTATION ● 4-methylumbelliferyl-β-D-glucuronide Escherichia
coli broth medium (EC-MUG)
Lactose Fermenters- Escheria Coli, Klebsiella, Enterobacter ● Standard Analysis of Water includes the Most
Non Lactose Fermenters- PMP Edwaesiella all Salmonella Probable Number (MPN) for the presumptive and
except S. arizona. All Yersinia except Y. enterocolitica. All quantitative detection of coliform and fecal coliform
Shigella bacteria in water samples.
- Ginagamit sa maynilad, industrial-like manila
water
- This a effective and rapid for the detection of
E. Coli hindi lang sa water pwede din sa food
and other environmental samples
● (+) electric blue fluorescence under long
wavelength UV light
- If nakita yan yung tubig mo ay fecally
contaminated
- Bakit fecally contaminated? Kase normal
MEMBERS OF FAMILY ENTEROBACTERIACEAE flora siya sa bituka so ibigsabihin yung mga
LACTOSE FERMENTERS pipe lines ay merong butas so baka nalagay
ng dumi kaya nakacontaminate.
LACTOSE ● Escherichia coli ● E. coli is the number 1 index of food water pollution
FERMENTERS ● Klebsiella
(ALL ● Enterobacter
NON-PATHOGENIC)

NON-LACTOSE ● Proteus
FERMENTERS ● Morganella
(ALL PATHOGENIC) ● Providencia
● Edwardsiella/All
Salmonella except
Arzona/Hafnia
● All Yersinia except Y.
enterocolitica/ All Shigella

LATE LACTOSE ● Citrobacter


FERMENTER ● Serratia
● S. Sonnei
● Y. enterocolitica
● A. hinshawii (S. arizona)

CAYABYAB | DE GUZMAN | DUBLIN | EBOL | ESPELETA | MACALMA | NOCUM | PAULINO | RECIO | TOLENTINO 2
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

CAYABYAB | DE GUZMAN | DUBLIN | EBOL | ESPELETA | MACALMA | NOCUM | PAULINO | RECIO | TOLENTINO 3
MODE OF TRANSMISSION Anaerogenic E. coli or Inactive E. coli

● Processed meals H2S (-) ; NLF ; NM; PG (-) ; Vi (-)


● Unpasteurized dairies
● Apple cider ● Before it is called : Alkalescens dispar
● Sprouts/Spinach

Associated with: Infectious Diseases associated with E. coli


● Hemorrhagic Diarrhea
● Hemorrhagic colitis
● Hemolytic Uremic Syndrome (HUS) ● Intestinal infections (diarrhea, gastroenteritis)
● Also called: HAMBURGER DISEASE ● UTI (asymptomatic bacteriuria, cystitis, pyelonephritis,
prostatitis)
Diffuse aggregative E. coli (DAEC)
● Bacteremia, sepsis
● Diffuse Adherent E. coli
● Constitutes the 6th group of diarrheagenic E. ● Endotoxin induced shock
coli ● Neonatal meningitis

Other members of Escherichia


Extraintestinal E. coli STRAINS
● Uropathogenic E. coli (UPEC)
Escherichia Escherichia Escherichia
○ Cystitis and acute pyelonephritis
hermannii vulneris albertii
○ Dominant resident of colon
● Meningitis/sepsis-associated E. coli (MNEC)
○ Causes neonatal meningitis Isolated from Isolated from Associated with
CSF, wounds, infected wounds diarrheal disease
blood in children

TYPE Virulence Relevant Serotypes


factors DIsease Can also be
isolated from raw
milk, beef
UPEC P pilus UTIs -
Type 1
fimbriae Can be same Can also produce
source of yellow colonies or
O157: H7 yellow pigmented
DAEC Adhesions UTIs -
colonies
EPEC Pathogenecity Infantile O55:NM 055:H6
islands diarrhea O111:NM O111:H2
O114:NM O114:H2
KESH
(Klebsiella-Enterobacter-Serratia-Hafnia)
EHEC Shiga toxin Hemorrhagic O157:H7 O157:NM
Verotoxin diarrhea, O26:H11 O104:H21 Klebsiella
colitis, HUS O111:H2 O111:H8
O113:H21 O118:H2 General characteristics

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

CAYABYAB | DE GUZMAN | DUBLIN | EBOL | ESPELETA | MACALMA | NOCUM | PAULINO | RECIO | TOLENTINO 4
Species:
Klebsiella quasipneumoniae subsp. similipneumoniae

○ Also called sometimes K.


pneumoniae K6 strains
○ Known to produce ESBL
○ Commonly in elderly (80 yrs old K. pneumoniae is a lactose fermenter: pink
above) Klebsiella pneumoniae subsp. ozaenae
Klebsiella variicola
- Associated with malignancy ● cause atrophic rhinitis
○ Ozena; causes purulent sinus infection
● K. pneumoniae subsp. pneumoniae
○ (pinakasikat sa lahat) ● Biochemically inactive;Voges Proskauer VP (-)
○ It is also classified as ● Highly associated with the presence of
○ Klebsiella quasipneumoniae subsp. plasmid-mediated ESBLs
similipneumoniae
○ Usually they are recovered in the nose
● K. oxytoca
● K. pneumoniae subsp. ozaenae
● Isolated from nasal secretions and cerebral
● K. pneumoniae subsp. Rhinoscleromatis abscesses
● K. ornithinolytica (Raoultella ornithinolytica)
● K. planticola (Raoultella planticola) Klebsiella granulomatis (Calymmatobacterium
● K. terrigena (Raoultella terrigena) granulomatis)

Klebsiella pneumoniae ● Require additional nutrients for growth


- Friedlander’s bacillus ● Intracellular organism
- (formerly known) Bacillus mucosus capsulatus ○ Live inside the cytoplasm of the
macrophages
● Disease: pneumonia, septicemia, bacteremia, ○ They cannot grow on artificial media
neonatal meningitis, UTI , wound infection ● Associated with Granuloma inguinale or
● ESBL (Extended Spectrum Beta-Lactamases); sa mga
Donovanosis (a sexually transmitted disease)
cephalosporins ○ Safety pin appearance
● Klebsiella’s pathogenicity - heat-stable enterotoxin; ● Diagnostic. Feature: Donovan body- stains as
resistant to ampicillin blue rod with prominent granules
● Distinctive feature of K. pneumoniae: Large ○ Can use Wright’s or Giemsa stain
polysaccharide capsule ● Beefy red ulcers in the genitalia (like sugat sugat
● Secondary pneumonia/Classic pneumonia nila)
(characterized in the emission of bloody sputum) and UTI in ○ Painless papules on the genital area
catheterized patients. ● Diagnosis: biopsy from the genital area or tissue
● K. pneumoniae is second only to E. coli specimen
○ #1 cause of UTI is E. coli
○ #2 cause of UTI is K. pneumoniae Klebsiella oxytoca
● Causative agent of community acquired pneumonia -
produce a currant jelly like sputum ● This is ONLY the indole POSITIVE
● All of the Klebsiella members are negative
● K. pneumoniae and K. oxytoca - inhabits nasopharynx ● Linked to antimicrobial-associated hemorrhagic
and GIT colitis (GI tract/colon) _ usually in colon
● Biochemically identical to K. pneumoniae ;
❖ (serotypes) Carbapenemase-producing K. IMViC + - + +
pneumoniae is an important cause of ● Heat labile cytotoxin
ventilator-associated pneumonia ● Disease is similar to Klebsiella pneumoniae
➢ KPC - Klebsiella pneumoniae
carbapenemase-producing strain
Klebsiella pneumoniae subsp. Rhinoscleromatis
o Biochemical Characteristics:
IMViC = - - + +; ● Causes granulomatous
Urease (+) ; ○ Granuloma in nose and nasopharynx
OD (-) ● Isolated from patients with rhinoscleroma
o Neufeld-Quellung Reaction: capsule ○ Rhinoscleroma - intense swelling and
malformation of entire face and neck
○ Pharyngeal or nasal infection

CAYABYAB | DE GUZMAN | DUBLIN | EBOL | ESPELETA | MACALMA | NOCUM | PAULINO | RECIO | TOLENTINO 5
● 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

CAYABYAB | DE GUZMAN | DUBLIN | EBOL | ESPELETA | MACALMA | NOCUM | PAULINO | RECIO | TOLENTINO 6
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

● Motile, LLF or non lactose fermenter in books


● Some are chromogenic (prodigiosin- color
red). Production of this pigment is enhanced by
incubation at room temperature;
● Prodigiosin is a non water soluble pigment; color
red

● Opportunistic pathogens; clear colonies on
MacConkey
● Dnase, Lipase & gelatinase (+) Serratia marcescens
○ Can use to differentiate serratia from ● Contamination of antiseptic solution used for
other members of joint injections has resulted in an epidemic of
ENTEROBACTERIACEAE septic arthritis
● Indole (neg); MR (V); VP (+); Citrate (+)
● Resistant to wide range of antibiotics - *V is VARIABLE
● Ranked 12th - most common organism isolated ● LDC and ADH (+); DNase (+)
in pediatric patients in North and Latin America, ● Seen among patients who are undergoing
Europe chemotherapy
Virulence factor: pigment - prodigiosin
SALMONELLA

● Non- lactose fermentose


● MOT: Ingestion of contaminated water or food
(poultry, dairy products), containing animal
feces; transmitted human to human which is the
carrier state
- When you say carrier state, it is the VI
antigen yung nakikita
● Pathogenicity: Salmonellosis

CAYABYAB | DE GUZMAN | DUBLIN | EBOL | ESPELETA | MACALMA | NOCUM | PAULINO | RECIO | TOLENTINO 7
● 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

CAYABYAB | DE GUZMAN | DUBLIN | EBOL | ESPELETA | MACALMA | NOCUM | PAULINO | RECIO | TOLENTINO 8
Salmonella typhi or S. enterica subsp. enterica
serotype typhi
Common name: Eberth’s bacillus

Causes typhoid fever


- Inhabit phagocytosis by inactivating the adenyl
cyclase system
● (+) Rose spots on the skin, abdomen,
and chest
S. S. S.
- Site of long-term carriage is in the gallbladder S. typhi
paratyphi A paratyphi B paratyphi C
Diseases: Typhoid fever, Osteomyelitis, Meningitis
Serogroup S. S. Serogroup
Complication: Psychosis scottmuelleri hirschfeldii
A D
● EMB and Mac- colorless colonies Serogroup B Formerly
● SSA (Salmonella Shigella Agar)- colorless with Serogroup C
black center colonies
● XLD (Xylose Lysine Deoxycholate agar)- pink to
red colonies with black center
SHIGELLA
● HEA (Hektoen Enteric Agar)- green colonies with
black center
● BSA (Bismuth Sulphite Agar)- green with black ● NLF except S. sonneii slender, NE
center (non-encapsulated), NM (non-motile)
● BGA (Brilliant Green Agar)- pink-white opaque ● LD (lysine decarboxylase), Citrate, Malonate,
surrounded by brilliant red; except for S. typhi xylose, H2S (-)
Salmonella colonies ● Anaerogenic (do not produce gas); intestinal
● Selenite F broth- enrichment medium for pathogen - dysentery
Salmonella ● resembles E. coli but lactose (-)
● E. coli: Acetate (+); Shigella: Acetate (-)
MOT: Ingestion of uncooked meat and egg ● possess O antigen
● Biochemically inert
Chickens are a major reservoir of Salmonella ● S. sonnei is unique bec. Its ability to
decarboxylate ornithine
Laboratory diagnosis
➢ Transmitted by flies, fingers, food and feces and
1. Culture (is the gold standard) water
Blood culture- 1st week; most reliable - MOT: Fecal-oral
Stool & Urine culture- 2nd week; usually carrier ➢ Highly communicable because of the low
2. Biochemical infective dose required (<200 bacilli)
TSI= K/A no gas little H2S for S. typhi multiply within the cells of the colon
K/A with gas and H2S for other Salmonella ➢ Natural habitat: intestinal tract of humans and
spp. other primates
- H2S is the mustache sulfide, parang ➢ Virulence factor: Shiga toxin
bigote ● ONPG (+)Pink colonies on MAC after 48
3. Widal’s test- 3rd week or subsequent weeks hours
(serological testing) ➢ Incubation period:1-7 days
- Serological test- tinetest is antibodies sa
blood against S. typhi Virulence factors:
➢ Titer O- active infection: >=1:160 ● Shiga toxin- associated with diarrhea and
➢ Titer H- post vaccination/past inf dysentery
>=1:160 ● Endotoxin- associated with inflammation
● Neurotoxin
Resistance: ● Invasive property
Killed at 60 degrees for 15-20 minutes ● Antigens
○ All possess O antigens, some have K
(capsular) antigen

CAYABYAB | DE GUZMAN | DUBLIN | EBOL | ESPELETA | MACALMA | NOCUM | PAULINO | RECIO | TOLENTINO 9
○ K antigen- interfere with the detection
of O antigen during serologic testing
○ H and K antigen are heat labile

In developing countries, S. dysenteriae type 1 and S.


boydii
- S. dysenteriae type 1 is the most virulent spp. Of
shigella)
Salmonella arizona (Arizona hinshawii)

● 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 (-)

E. hoshinae– snakes, birds, water

E. ictaluri– enteric septicemia in fish

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CITROBACTER

● formerly classified as the Bethesda-Ballerup


group
● Resembles Salmonella but ONPG (+) and
LDC(-)
- ONPG is a test for late lactose
fermenters and Citrobacter is a late
lactose fermenter
Proteus-Providencia-Morganella
C. freundii
PROTEUS
● Morphologically similar to E. coli and
biochemically resembling Salmonella ● Proteus and Providencia are normal inhabitants
● slow LF & Citrate (+) of gastrointestinal tract
● normal gut flora ● Actively motile at 37C, pleomorphic, NLF, urease
● On plated media has strong resemblance to E. (+), PAD (+)
coli colonies ● Rapidly hydrolyzes urease in 2-4 hrs.; swarming
● Cause diarrhea and possibly extraintestinal motility on BAP
infections ● Surface growth that gives off burnt gun
powder/burnt chocolate odor/ “chocolate
C. koseri (diversus) cake”
● Formerly named as diversus ● Thought to play a role in the ascending nature of
● Associated with cases of neonatal meningitis in Proteus-associated UTIs
newborns, nursery outbreak - Proteus mirabilis- associated with
● H2S (-) meaning no blackening of agar; indole renal stone formation
(+) ➢ Dienes phenomenon may dalawang proteus:
● Malonate test (+) - Proteus mirabilis
- Proteus vulgaris
C. braaki - In Dienes phenomenon, hinahati (one side is proteus
- A rare human pathogen associated with mirabilis then the other side is vulgaris)
community-acquired infections including
septicemia in a patient with cervical cancer - nagkakaroon ng demarcation line if both proteus pero if
one side is a proteus and the other side is not (ex. E.
Differences: coli), later on matatakpan na yung E. coli
● LDC (lysine decarboxylase):
○ Citrobacter (-) Indication of both proteus- may demarcation line
○ Salmonella (+) (Dienes phenomenon)
● Lactose:
○ Citrobacter (LLF)
○ Salmonella (NLF)

Key biochemical tests:


● Utilize Citrate (+)
● ONPG (+)
● Methyl Red (+)

Pathogenecity: Can cause wound and urinary tract


infections, UTI, bacteremia, pneumonia, nosocomial
infection

CAYABYAB | DE GUZMAN | DUBLIN | EBOL | ESPELETA | MACALMA | NOCUM | PAULINO | RECIO | TOLENTINO 11
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 +/-

• Urease activity can lead • Urease (+) except P.


to alcalifaciens Providencia rettgeri Providencia stuartii
struvite kidney stones
(calculi). • Very strong urease activity • Variable urease result
P. penneri Causes UTI and skin Causes UTI in dwelling
• Cause pneumonia and infections catheters
Indole, ODC, H2S (-)
septicemia
• Implicated in diarrheal • Outbreaks in burn units
disease among travelers (nosocomial)
• Susceptible to AP,
cephalosporin and C • Isolated from urine culture

• Indole (-) ; ODC (+)


• IMVIC:- + v v YERSINIA
• LOA: - - - ; ONPG (+)
● NLF; microaerophilic, short coccobacilli
● exhibit bipolar granules; ferments glucose
● Exhibit safety pin appearance when stained with
Morganella morganii Wayson with small pinpoint colonies at 24C on
Mac Conkey; weak acid production
● Only important species of this genus; do not ● Indole (-); MR (+); Urease (+) except Y. pestis
swarm ● NM at 37C
● Can cause urinary tract and wound infections, ○ Y. enterocotica and Y.
as well as diarrhea and neonatal sepsis pseudotuberculosis -motile at 25C
● Lactose, citrate, H2S and LDC (-); urease and ○ Y. pestis –NM at 25 or 37C
deaminase (+)
● Biochemically similar to Proteus ● Virulence factors: endotoxin, coagulase,
fibrinolysin
Key tests: lac, LDC, citrate ● Ability to survive and multiply inside
phagocytes–yersinial plasmid-encoded outer
PROVIDENCIA membrane proteins (YOPS)
● In old broth cultures, organism forms surface
● Normal intestinal flora; difficult to treat growth pellicle with stalactite pattern.
● Do not swarm on BAP; NLF
● Associated with nosocomial UTI Deoxycholate agar– reddish pink colony, doesn’t ferment
● Gram (-), pleomorphic lactose
● Motile at 25 degrees, weak & non-motile at 31

CAYABYAB | DE GUZMAN | DUBLIN | EBOL | ESPELETA | MACALMA | NOCUM | PAULINO | RECIO | TOLENTINO 12
● Virulence factor- enterotoxin

MOT: Ingestion of improperly cooked food and dairy


products
Yersiniosis- cause a severe intestinal inflammation
Yersinia pseudotuberculosis
● Mesenteric Lymphadenitis, septicaemia; motile
at room temp
● LOA - - - ; Urease (+); ODC (-)
Yersinia pestis- Plague Bacillus
Yersiniosis
Plague ● Y. enterocolitica and Y. pseudotuberculosis (sila
● NM at room temperature lang meron)
● Facultative intracellular parasite
● Not an enteric pathogen Laboratory Diagnosis
● Urease (-); Ornithine (-) ● Cultivation: Cefsulodin-irgasan-novobiocin (CIN)
● On BAP– “hammered copper” colonies; ● Stained smears– Wayson and Giemsa stain
cauliflower appearance; pinpoint ● Culture
● Presence of V and W antigens ○ Mac (colorless to peach)
● MOT: bite of rat fleas (Xenopsylla cheopis) ○ EMB (colorless to purple)
● Also considered as bioterrorism agent ○ HEA (salmon); XLD (yellow)
○ SSA (colorless)
3 Types of Human Plague:
● Bubonic plague- buboes Biochemical Reaction:
● Pneumonic plague- airborne transmission - Should be suspected if TSI is yellow over
● Septicemic plague- “Black Death” due to orange due to weak acid production in slant with
Schwartzmann phenomenon, black purpuric no change in butt– K/A no gas
lesion in body; second pandemic plague in 14th
century which infected 25 million people in Transport medium- Cary-Blair
Europe, almost ¼ of the entire population - Transporting and maintaining tissues infected
with Yersinia pestis
Virulence factors:
● Fraction 1- antiphagocytic
● V protein
● W lipoprotein

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

CAYABYAB | DE GUZMAN | DUBLIN | EBOL | ESPELETA | MACALMA | NOCUM | PAULINO | RECIO | TOLENTINO 13
● 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 -

At least three major clinical types of gastroenteritis are


caused by Plesiomonas:

● common is watery diarrhea


● A subacute or chronic disease that lasts from 14
days to 2 to 3months
● A more invasive, dysenteric form

CAYABYAB | DE GUZMAN | DUBLIN | EBOL | ESPELETA | MACALMA | NOCUM | PAULINO | RECIO | TOLENTINO 14

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