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Enterobacteriaceae

Dr.Aravind

Gram Negative Enteric Rods Routinely Found In The Gastrointestinal Tract

Facultative Anaerobes
Lipopolysaccharide (LPS): Antigenic & Endotoxin Belong To Diverse Taxonomic Groups Cause Diseases In The GI Tract, Outside The GI Tract, Or In Both Locations.

Oxidase Negative
Non Spore-forming

Dr.Aravind

Enterobacteriaceae
Classification
Non Lactose Fermenters Lactose fermenters Escherichia Coli (Motile) Klebsella Pneumonia (Non motile) Motile and H2S producing Salmonella Proteus
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Non Motile and Non H2S producing Shigella Yersinia

Kingdom: Bacteria Phylum: Proteobacteria Class: Gamma Proteobacteria Order: Enterobacteriales Family: Enterobacteriaceae Genus: Escherichia Species: E. coli

Escherichia Coli (E.coli)

Dr.Aravind

Gram Negative rod Facultative anaerobic

Bacteroides species : E. coli = 20:1


O, H, and K antigens = 700 serotypes Oxidase (-), Catalase (+) Ferment glucose, Lactose, and can generate energy by reducing nitrates to nitrites MacConkey Agar- pink colonies EMB - metallic shine appearance on colonies
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Virulent Factors
P Pili (Pyelonephritis-associated Pili):
Binds To Galactose Dissaccharide Of UT Epithelium Most Imp In UTI Bind To The D-mannose Receptors On Epithelial Cell Surfaces Bind To Enterocytes

Type I Pili:

CFA Or BFA:

Non Fimbrial Adhesin (Intimin)


Siderophores
Dr.Aravind

E.Coli fimbreae

Capsule (K Antigens) :
K1 Capsule In Neonatal Meningitis Antibodies And Complement Bacterial Surface, Phagocytosis

O Antigen :
Outermembrane Endotoxin

H Antigen:
Flagella Motility And Invasive Disease

Alpha-hemolysins
Pore formation on membrane, toxic to many mammalian cells. Lyse Lymphocytes, Beta-hemolysins, Inhibit Phagocytosis And Chemotaxis Of Neutrophils
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Exotoxins:
Heat-labile Enterotoxin (LT) Similar Function To The Cholera Toxin Binds Identical Ganglioside Receptors On Enterocytes Heat Stable Toxin (ST) Binding To Guanylate Cyclase Receptors On The Apical Membranes Of Host Cells, Thereby Activating The Enzyme Diarrhea. Resistant to boiling 300C Shiga toxins (verotoxin) protein synthesis by destructing 28S ribosome HUS syndrome O157:H7 serotype
Dr.Aravind

Epidemiology
Human Bowel Is Usually Colonized Within 40 Hours Of Birth. 700 Serotypes Of E. Coli Based On O, H, And K Antigens Bacteroides Species : E. Coli = 20:1 Most Common Cause Of UTI 2rd Most Common Cause Neonatal Meningitis A Leading Cause Of Infantile Diarrhea In Developing Countries Transmission:
UTI - intestinal E. coli perineal Urethra Neonatal Meningitis Birth Canal Intestinal disease contaminated Food or water

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Pathogenic e.coli

Extra intestinal diseases


UTI Neonatal meningitis Pneumonia Septicemia

Intestinal diseases
E.coli Strains ETEC EPEC EIEC EAEC EHEC

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E.Coli UTI Pathogenesis

Rectum

Dr.Aravind

Dr.Aravind

Courtesy from Sherries Medical Microbiology

Intestinal E.coli Pathogenesis

Virulent factors CFA LT ST

Virulent factors Outer Membrane Proteins

Virulent factors BFA, Intimin ESPS


Dr.Aravind

Virulent factors Intimin Shiga like toxin

Virulent factors ST toxin hemolysin

Clinical conditions
Extra intestinal infections
Urinary Tract Infection: Uropathogenic E. Coli (UPEC) Cause 90% Of The UTI pregnancy Dysuria, Lower Abdominal Pain, Increase Discharges Cystitis, Increased Frequency Of Urination, Dyspareunia Pyelonephritis: Fever, Dysuria, Radiating Back Pain, Tenderness At The Costo Vertebral Angle, Shock.
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Neonatal meningitis: 2 nd most common Transmission - Birth canal Virulent factor K1 capsular antigen Fever, irritability, constipation, poor feeding, bulging frontanella, seizures Neonatal Pneumonia: Birth canal Respiratory symptoms Septicemia
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Intestinal Diseases
Enterotoxigenic E. Coli (ETEC): Infants And Travelers To Underdeveloped Countries Or Regions Of Poor Sanitation In U.S Outbreaks By Water, Soft Cheeses, Mexican-style Foods And Raw Vegetables Infective Dose 108 Onset In 1 2 Days Virulent Factors:
CFA, LT And ST

Watery Diarrhea Similar To Cholera Syndrome Non Inflammatory, Non Invasive Adults in endemic areas evidently develop immunity Self limiting
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Enteroinvasive E. Coli (EIEC):


Similar To Shigella Dysentery Under 5 Years Of Age Oro fecal route Lack Fimbriae Adhesins And LT And ST (has Outer Membrane Proteins) Inflammatory And Invasive dysentery-like diarrhea (mucous, blood), severe inflammation, fever

Enteroaggregative E. coli (EAEC):


persistent diarrhea in young children Non inflammatory, non invasive ST toxin and hemolysin Biofilm

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Enteropathogenic E. Coli (EPEC)


20% Of Diarrhea In Bottle-fed Infants < 1 Year Transmission:
Fomites, Drinking Water ,Meat Products Day cares and hospitals Infecting Dose For Infants Is Low

Virulent Factors:
Intimin, E. Coli Secretion Proteins (Esps), Tir (Translocated Intimin Receptor) A/E Lesions
Enteropathogenic Escherichia coli (EPEC) attachment to epithelial cells. The EPEC are attaching to and effacing the microvilli on the epithelial cell surface. The cells filamentous actin is rearranged at the attachment point

Symptoms: Watery Diarrhea


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EPEC Pathogenesis

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Courtesy by Crankshaft

Enterohemorrhagic E. Coli (EHEC):


Hemorrhagic Colitis (HC) Or Bloody Diarrhea Serotype O157:H7 Reservoir are Infected Cattle, Beef Products, Lettuce, Sprouts, Fruit, Fruit Juices, And Unpasteurized Milk. Low Infectious Dose 10 - 100 Organisms. Virulent factors:
Intimin Shiga like toxin or Vero toxin

Symptoms:

Watery Diarrhea ,Severe Cramps And Progresses To Bloody Diarrhea. Fever Is Low Grade Or Absent
Hemolytic-uremic Syndrome (HUS) Thrombotic Thrombocytopenic Purpura, Renal Failure And Microangiopathic Hemolytic Anemia HUS Ensues In Approximately 5% To 10% Antibiotics may induce Shiga toxin.

Complication:

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EHEC Pathogenesis

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Courtesy by Crankshaft

Diagnosis
Extra intestinal Infections:
Specimens - bladder or CSF Culture on MacConkey agar (pink colonies) Serological tests

Intestinal infections:
Culture on MacConkey agar ( Pink colonies) EMB agar EHEC MacConkey sorbitol agar - No growth

Oxidase Negative Leukocyte esterase positive Nitrates to nitrites


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Treatment
Extra Intestinal Infections: UTI: Ciprofloxacin, Trimethoprim, Sulfamethoxazole. Meningitis: Cefalosporins Intestinal Infections: Rehydration And Supportive Measures Trimethoprim/Sulfamethoxazole ETEC, EPEC And EIEC. EHEC: Hemodialysis Or Hemapheresis No Anti Motility Drugs
Dr.Aravind

Kingdom: Bacteria Phylum: Proteobacteria Class: Gamma Proteobacteria Order: Enterobacteriales Family: Enterobacteriaceae Genus: Klebsiella Species: K. pneumoniae

Klebsiella Pneumoniae

Dr.Aravind

Gram-negative Rod Shaped Bacterium Non-motile, Oxidase (-) Lactose Fermenting, Facultative Anaerobic Found In The Normal Flora Of The Mouth, Skin, And Intestines Thick Capsule-made Of Polysaccharides Virulent Factors: Capsule & Endotoxin Susceptible Pts:
VAP Hospitals Alcoholics & Diabetics Immuno-compromised Patients & Catheter

Causes Pneumonia, Meningitis And UTI Thickness And Bloody Sputum- B/C Of Thick Capsule Diagnosis: Culture, Serology Treatment: Cephalosporin's - Cefotaxime & Fluor quinolones
Dr.Aravind

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