Enterobacteriaceae

Dr. Noura AL-Sweih

Enterobacteriaceae

Definition of the family

Gram- negative bacilli

Grow on simple media/ Mac

Oxidase negative
Enterobacteriaceae

The common Enterobacteriaceae of

importance in human infections
Escherichia coli/ E.coli  LF
Klebsiella species  LF
Salmonella species  NLF
Shigella species  NLF
Proteus  NLF
Serratia  NLF
 Enterobacteriacea

Lactose fermenter Non-lactose fermenter

Proteus sp
E.Coli Serratia sp
Klebsiella sp Salmonella sp
Shigella sp
 Lactose fermenter

E.Coli Klebsiella
Non-mucoid Mucoid

Biochemical
tests
E.coli

Lactose –fermenter/ LF

Predominant flora in the gut of man &

animals

E.coli  indicate fecal contamination if

detected in drinking water or food
E.Coli Clinical Infections

A- Urinary tract infection/ UTI

The Most common causative organism of

UTI in community & hospital

B- Neonatal Infections

Meningitis & Septicemia

Q1
Name other
organisms causing
neonatal meningitis
or septicemia?
What is the source
of this organism?
E.coli

C- Wound infections

Especially after abdominal surgery

D- Diarrhoea

Strains that cause diarrhoea fall into

four groups:
E.coli/ Diarrhoea

Enteropathogenic E.coli / EPEC

Cause infantile diarrhoea or enteritis/ children

less than 2 year ( pediatric)

Pathogenic mechanism: adherence to

microvilli
E.coli/ Diarrhoea
Enterotoxigenic E.coli / ETEC

Common cause of travellers diarrhoea

Developing countries  common cause of

diarrhoea in children less than 5 years

Infection may resemble cholera

Pathogenic mechanism: enterotoxin
E.coli/ Diarrhoea

Entero-invasive E.coli / EIEC

Affect all ages / food borne

infection
Cause illness like shigella
dysentery
Pathogenic mechanism: Invasion
of epithelial cell & tissue
destruction
E.coli/ Diarrhoea

Vero Cytotoxin-producing E.coli/

VTEC
Other name Entero-haemorrhagic
E.coli/ EHEC
O157 is the commonest serogroup
Pathogenic mechanism: Cytotoxin
Cause a range of illnesses:
a-   Mild watery diarrhoea
b-   Sever bloody diarrhoea
c-   Haemorrhagic colitis
d- Haemolytic Uraemic Syndrome/ HUS
Pathogenic Mechanism/ Diarrhoea

E.coli / Strain Mechanism

EPEC Adherence to
microvilli
ETEC Adherence &
Enterotoxins
EIEC Invasion &
destruction
EHEC/VTEC Verocytotoxins
E.coli

Treatment
A- Extraintestinal E.coli Infections

UTI = Cephalosporin, Trimethoprim, Quinolones

Meningitis = Cefotaxime

B- E.coli enteritis
Correction of fluid & electrolyte (Oral Rehydration)
ORT i.e. Symptomatic treatment
Klebsiella species

Lactose-fermenter / LF

Capsulated / large capsule  mucoid

colonies

Common member is K. pneumoniae

Klebsiella species

Clinical Infections

UTI (community & hospital)

Sever bronchopneumonia (CAP)

rare & high mortality

Hospital Acquired infections

UTI
Wound infection
Septicemia & pneumonia
Klebsiella spp

Treatment
Always naturally resistant to
ampicillin
Treatment depend on infection:
UTI = trimethoprim
Pneumonia = Cefotaxime
Nosocomial Infections =
gentamicin & cefotaxime
 Non-lactose fermenter

Proteus, swarming, urease +

Serratia, red pigment colony

Salmonella, Black colonies

in SS & TSI agar, serotyping

Shigella, no black colonies in SS & TSI

serotyping
Proteus
Swarming
Non-lactose
flagella
fermenter / NLF
Clinical infections
UTI/ community &
hospital
Wound infections
Treatment
Ampicillin
Swarming
Urease +
Serratia
Red pigment

Hospital acquired
infections
Salmonella
Major cause of
food-borne
infection world-
wide.
NLF
Widely distributed
in nature; gut of all
vertebrates & a
wide range of
arthropods
Salmonella
Salmonella

Antigenic structure

Antigens found in all salmonella

species
O antigen ( Somatic/ part of cell wall
LPS/ eg. O1,9,12)
H antigen ( Flagellar/ H)
Vi antigen (S. typhi surface antigen)
Salmonella

What is the importance of the

antigenic structure?

a-   To give salmonella species

name
b-   > 2000 serotypes described

c-   Epidemiology
Salmonella

Pathogenesis
Infective dose
Infection initiated by ingestion of
large number of salmonella
species
Salmonella must overcome gastric
acidity & colonize small intestine
Salmonella
Pathogenesis
Multiplication ↑ no.of bacteria
Attachment to microvilli of ileum
Degeneration of microvilli
Penetration of salmonella (Intracellular)
Multiplication intracellular 
macrophages of Peyer,s patches &
penetrate into local mesenteric lymph
nodes  some may invade blood
Different Clinical Manifestation depend
on level of pathogenesis
Salmonella

Clinical Infections
Enteric fever (Typhoid)
Caused by Salmonella typhi or
S.Paratyphi A, B & C
Primarily human pathogens
Long incubation period 10-14 days
Salmonella

Enteric fever
Organism invade blood stream 
Bacteraemia
Fever, headache & abdominal pain
Diarrhoea is not common feature
Mortality ~ 20% if untreated
Salmonella
Laboratory diagnosis of
Enteric fever

Blood culture / first week of

illness

Stool culture / second week of

illness

Urine culture / third week of

illness
Salmonella
Enteric fever
Epidemiology

Reservoir host & Source is usually

human
Incidence , decline Why?
Improve sanitation & chlorination of
water supply
Salmonella
Enteric fever
Treatment
Cefotaxime or Ciprofloxacin
Control measures
Public health problem
Good water supply & proper disposal of
human excreta
Prophylactic immunization for travelers to
endemic area:
1-   Killed vaccine 3-7 years protection
2-   Live attenuated vaccine
Salmonella

Gastro-enteritis and food

poisoning
Common organisms
S. Enteritidis
S. Typhimurium
Clinical features:
Vomiting
Diarrhoea
Abdominal pain
Fever
Salmonella
Gastro-enteritis and food poisoning

Food poisoning
(Bacteria multiply in food & reach infective dose)
Incubation period: 8-48 hours

Epidemiology

Zoonotic salmonellosis

Source; eggs, meat, milk, poultry

Salmonella
Gastro-enteritis and food poisoning
Prevention:
Never mix raw food with cooked food

Cooked food should be eaten immediately or cooled

rapidly
Treatment
Oral Rehydration
In case of septicemia give cefotaxime or
ciprofloxacin
Salmonella

Bacteraemia and metastatic

disease
A Common feature of enteric fever
Rare complication of other salmonella
infections
May lead to focal infections eg bone &
joint  Osteomyelitis & arthritis
especially in Sickle cell disease
Treatment  Cefotaxime or
Ciprofloxacin
Salmonella

Prolonged carrier state

After recovery ,Most patients will excrete
salmonella for days Or weeks 
Clearance
Few continue to excrete salmonella for
year or > Chronic carrier
Common site is gall bladder
Chronic carrier  Follow symptomatic
& asymptomatic infections (5% with
S. typhi)
Salmonella

Treatment of Chronic carriers

Gall bladder surgery

Long course of ampicillin  80%

cure rate

Hand Hygiene – Hygiene & Hygiene

Shigella

Description  NLF
Divided into 4 species
1-   Shigella dysenteriae
2- Shigella flexneri
3- Shigella bodyii
4- Shigella sonnei
Shigella

Dysentery ( blood-stained
mucopurulent stool)

Two categories
A- Amoebic (Parasite)
B- Bacillary (Shigella)
Shigella
Shigella

Pathogenesis
Infecting dose is small
Invasive to large intestine epithelial cells

Clinical features

Abdominal pain, diarrhoea +/- fever

Incubation period = 2-3 days
Few cases may progress to dysentery
Shigella

Severity of clinical illness depend on type of

species
  S. dysenteriae associated with sever
illness / young children  produce potent
exotoxin [neurotoxin]

S. dysenteriae type I associated with HUS

 S. flexneri & S. bodyii  sever illness
S. sonnei  mild illness
Shigella

Treatment
S. sonnei , mild , no antibiotic
rehydration only

Others, antibiotic & rehydration

eg. Ciprofloxacin

Co-trimoxazole
Shigella

Epidemiology
S.dysenteriae, now rare
S. sonnei , most common
Source & spread
Case or Carrier
Faeco –oral route
Mainly school age children
Control
Hygiene, hand washing
Salmonella enteritidis
Brucella spp
Bacillus anthrax

What is common to these organisms?

Common causes of Food poisoning

S.aureus
E.coli
Salmonella spp
Bacillus cereus

What is the source?

Quiz (T/F)

E.coli
Is a normal gut flora
Is always sensitive to ampicillin
Is a common etiological agent of UTI
Is an important cause of neonatal
meningitis
Produce pink/red colonies on
MacConkey
Is oxidase positive