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MICROBIOLOGY LECTURE 11 – Escherichia Coli, Klebsiella- • Pyelonephritis – characterized by fever, chills and flank

Enterobacter Serratia Group pains

Notes from Lecture Laboratory Diagnosis
USTMED ’07 Sec C AsM • lactose fermenters
forming pink colonies in
• greenish sheen on EMB
Important Properties
• most abundant facultative anaerobe in the colon
• produces indole from
• ferments lactose tryptophan
• has 3 antigens decarboxylates lysine
1. 0 – 150 • uses acetate as its only
2. H – 50 result in more than 1000 source of carbon
3. K – 90 antigenic types
• motile
Virulence Factors • ferments sorbitol (except E. coli 0.157:H7)
• Pili
• Capsule Treatment:
• Endotoxin • Uncomplicated UTI – oral cotrimoxazole
• exotoxin (enterotoxin) • Complicated UTI and sepsis – parenteral antibiotics (3rd
generation cephalosphorin with or without
- high molecular weight (heat labile) aminoglycosides)
- low molecular weight (heat stable) • Toxigenic/traveller’s diarrhea
o self-limited (no antibiotic, only fluid and
Pathogenesis of Diseases electrolyte replacement)
A. Intestinal Tract Infection
• adherence of bacteria to the epithelial cells of jejunum KLEBSIELLA-ENTEROBACTER SERRATIA GROUP
and ileum by means of pili
o bacteria synthesize enterotoxin Important Properties
o (no inflammation nor invasion) • Frequently found in the large intestine but are also
o watery, non-bloody diarrhea (cells of the colon present in soil and water
are not susceptible probably because they lack • Group has very similar properties and are usually
receptor for the toxin disintiguished on the basis of biochemical reactions and
• Enterotoxigenic E. coli is the most common cause of motility
traveler’s diarrhea • Klebsiella pneumoniae has a very large capsule (giving
• Enteropathogenic (enteroinvasive) strains cause disease the colonies striking mucoid appearance)
not by enterotoxin formation but by invasion of the • Serratia marcescens produces red pigmented colonies
epithelium of the large intestine causing bloody diarrhea
(dysentery) accompanied by inflammatory cells Pathogenesis and Epidemiology
(nuetrophils) in the stools A. Klebsiella pneumoniae
• Enterohemorrhagic strains (O157:H7) produces verotoxin • Most likely to be a primary non-opportunistic pathogen
or Shiga-like toxin causing bloody diarrhea but does not (related to its antiphagocytic capsule)
cause inflammation, so neutrophils are not found in the • Predisposing factors
stool o advanced age
• Associated with outbreaks of diarrhea following o chronic respiratory disease
ingestion of undercooked hamburgers at fast food o diabetes
restaurants and direct contact with animals (visit to o alcoholism
farms and petting zoos)
• 10% of healthy people are carriers
• Some strain cause hemolytic-uremic syndrome (non-
immune hemolytic anemia, thrombocytopenia, and
B. Enterobacter /Serratia
acute renal failure
• associated with hospital acquired infections sec to
B. Systemic Infections invasive procedures
o intravenous catheterization
• Structures responsible for systemic disease are the
o respiratory intubation
capsule and endotoxin
o Capsule – prevents phagocytosis, enhancing o urinary tract manipulation
the organism ability to cause infection in • outbreaks of Serratia pnuemonia have been associated
various organs (neonatal meningitis) with contamination of the water in respiratory therapy
o Endotoxin – a lipopolysaccharide which cause devices
features of gram negative sepsis (fever,
hypotension, disseminated intravascular Clinical Findings/Disease
coagulation) • UTI
• Bacteremiaà sepsis
C. Urinary Tract Infections • Meningitis
• Factors favoring uropathic strains of E. coli to produce • Pneumonia
o pili with adhesion protein or adhesin that - if due to Klebsiella, patient produces thick, bloody
binds to specific receptors (dimers of sputum (current-jelly) and can progress to necrosis and
galactose) in the urinary tract epithelium abscess formation
o motility aids in the ability to ascend the
urethra into the bladder à urether à kidney Laboratory Diagnosis
• E. coli is the leading cause of community acquired UTI • Lactose fermenting colonies on differential agar
(occurs primarily in women) (MacConkey’s or EMB
• Reasons why it is more common in women: • Serratia – late lactose fermenter and can produce a
o short urethra negative reaction
o proximity of the urethra to the anus • Differentiated by the use of biochemical test
o colonization of the vagina by members of the
fecal flora Treatment
• also the most frequent cause of nosocomial (hospital – • Frequently resistant to multiple antibiotics especially if
acquired) UTI hospital acquired
• occurs equally in both men and women • Empicic treatment with cephalosporin plus an
• associated with indwelling catheters aminoglycosides pending result of sensitivity testing

Clinical Presentation Prevention

• Cystitis – if only the bladder is involved (present with • Changing site of intravenous catheters
dysuria and frequency) • Removing urinary catheters when they are no longer
needed • strict aerobes
• Proper care of respiratory therapy devices • non-fermenters (do not ferment glucose)
• oxidase-positive
• able to grow in water containing only traces of nutrients
e.g. tap water
Important Properties • Some species (aeruginosa and cepacia) have a
• Produce the enzymes phenylalanine deaminase remarkable ability to withstand disinfectants (grows in
exachlorophene- containing soap solution, in antiseptics,
(distinguish them from other members of
and in detergents.
• Produce the enzyme urease Pseudomonas Aeruginosa
• Certain species are motile and produce swarming effect • Produces 2 pigments
on blood agar
• Cell wall O antigens (Ox-2, Ox-19, Ox-K) cross react with
1. Pyocyanin – color the pus in a wound blue
antigen of several species of rickettsiae in patient’s 2. Pyoverdin – a yellow-green pigment that fluoresces
serum (Weil- Felix reaction) under ultraviolet light (can be used to detect early
• Species of clinical importance- P. vulgaris, P. mirabilis, P. infection in burn patient)
morganii (Morganella morganii) and P. rettgeri • strains of Pseudomonas with prominent shrine layer
(Providencia rettgeri) (glycocalyx) give colonies a very mucoid appearance
• slime layer mediates adherence of the organism to
Pathogenesis and Epidemiology mucous membrane of the respiratory tract and prevents
• Organism present in human colon, soil and water antibody from binding to the organism
• their tendency to cause urinary tract infection is
Epidemiology of P. Aeruginosa
probably due to their presence in the colon and to • found chiefly in soil and water
colonization of the urethra, especially in women
• approximately 10% of people carry
• the vigorous motility of the organism may contribute to • it in the normal flora of the colon
their ability to invade the urinary tract • found in the skin of moist areas
• produces urease which hydrolysis urea in urine to form • can colonize the upper respiratory tract of hospitalized
ammonia, which changes the pH and encourage stone patients
formation (struvite calculi) which obstruct urine flow,
• grow in simple aqueous solutions (results in
damage urinary epithelium, and serve as nidus for
contamination of respiratory therapy and anesthesia
recurrent infection by trapping bacteria within the stone
equipment, intravenous fluids, and even distilled water)

Primarily an opportunistic pathogen that causes infections in

hospitalized patients
• those with extensive burns
• those with chronic respiratory disease
• those who are immunocompromised (neutrophil count
less than 500/uL)
• those with indwelling catheters
• 10-20% of hospital-acquired infection are due to
• most common cause of gram negative nosocomial
Clinical Infection pneumonia
• Pneumonia Pathogenesis of P. Aeruginosa
• Wound infection • based on multiple virulence factors
• Septicemia 1. Endotoxin – similar to those of other gram-negative
bacteria causing symptom of sepsis and septic
 Proteus mirabilis is the species of Proteus that causes shock
most community and hospital acquired infection. 2. Exotoxin A – causes tissue necrosis (inhibits
eukaryotic protein synthesis)
Laboratory Diagnosis
3. Enzymes (elastase and proteases) – histotoxic and
• Non-lactose
facilitates invasion of the organism into the
fermenting colonies in bloodstream
MacConkeys or EMB
agar 4. Pyocyanin – damages cilia and mucosal cells of the
• “Swarming” on blood respiratory tract
• Some strains with type III secretion system are
• P. vulgaris and P.
significantly more virulent than those without this
mirabilis produce H2S
secretion system
(blackers the butt of
TSI agar) • This secretion system transfer the exotoxin from the
• All proteus are indole bacterium directly into the adjacent human cell, which
allow the toxin to avoid neutralizing antibody
positive except P. mirabilis
• This system is mediated by transport pumps in the
Treatment bacterial cell membrane
• For indole positive – cephalosporin (Cefotaxime)
Clinical Findings
• Most strains are sensitive to Aminoglycoside and
• can cause infection virtually anywhere in the body but
urinary tract infections, pneumonia, and wound
• P. mirabilis is frequently sensitive to Ampicillin
infections (burns) predominate
• P. rettgeri is frequently resistant to multiple antibiotics • can enter the blood causing sepsis causes endocarditis in
IV drug users, severe external otitis (malignant otitis
externa), skin lesion (folliculitis) from inadequately
chlorinated swimming pools and hot tubs,
osteochondritis of the foot in those who sustain
• gram negative rods related to Salmonella and Arizona
punctured wound through the soles of gym shoes, and
• Occur in the environment and in human colon corneal infection in contact lens users
• Causes sepsis in immuno-compromised host • When bacteria spread to the skin, they cause black
necrotic lesions called ecthyma gangrenum

Important Properties
• gram-negative rods
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Laboratory Diagnosis

A. Presumptive
• non- lactose fermenting
(colorless) on MacConkey
or EMB agar
• typical metallic sheen of
the growth on TSI agar
• blue-green pigment on
ordinary nutrient agar
• fruity aroma

B. Confirmatory
• biochemical reactions

• resistant to many antibiotics
• treatment of choice – combination of anti-pseudomonal
penicillin (ticarcillin or piperacillin) plus an
aminoglycoside (gentamicin or amikacin)


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