Enterobacteriaceae
By: Charles Sy 😊
General Characteristics:
 Gram-negative bacilli and
coccobacilli
 Does not produce cytochrome
oxidase (except Plesiomonas)
 Ferment glucose
 Reduce nitrate to nitrite (except
Photorhabdus and Xenorhabdus)
 Motile at body temp (except
Klebsiella, Shigella, Yersinia)
Microscopic and Colony Morphology:
 Gram-negative
 Non-spore forming
 Facultatively anaerobic
 Differential and Selective Media
o Eosin-Methylene Blue
o MacConkey Agar
o Hektoen Enteric agar
o Xylose-Lysine-
Desoxycholate (XLD)
Virulence and Antigenic Factors:
 Many members of the
Enterobacteriaceae possess
antigens that can be used in the
identification of diff. serologic
groups:
o O antigen (Somatic
antigen)
 Heat stable
 Cell wall located
o H antigen (Flagellar)
 Heat-labile
 Surface of Flagella
o K antigen (Capsular)
 Heat-labile
 Polysaccharide
 Examples
 K1 Antigen of
E. coli
 Vi antigen of
S. Typhi
Clinical Significance
 Can be classified as:
o Opportunistic Pathogens
 Escherichia coli
 Citrobacter spp.
 Enterobacter spp.
 And the like
o Primary Pathogens
 S. enterica
 Shigella spp.
 Yersinia spp.
Escherichia coli
 Primary marker for fecal
contamination in water quality
testing
 Most strains are:
o Motile
o Possess adhesive fimbriae
o Sex pili
o O, H, and K antigen
 O antigen cross-
reacts with Shigella
spp.
Characteristics:
 Ferments glucose, lactose,
trehalose, and xylose
 Indole from tryptophan
 Methyl Red positive, Voges-
Proskauer negative
 Do not produce H2S, DNase,
Urease, Phe deaminase
 Cannot use citrate as sole C source
Uropathogenic E. coli:
 Most common cause of UTIs in
humans
 Produce factors that allow
adhesion to urinary epithelium:
o Pili
o Cytolysins
 Kill immune effector  Shigella
cells dysenteriae
o Aerobactin type I.
 Allows bacterial cell  Neutralized by Stx
to chelate Fe antibody
o Verotoxin II
Gastrointestinal Pathogens  Immunologically
 Can be divided into five major different from Stx
categories of diarrheogenic E. coli: o Shiga toxin-producing E.
coli
A. Enterotoxigenic E. coli (ETEC)  Produce Stx1 and
 Most common cause of a diarrheal Stx2, which are
disease sometimes referred to as typically produced
traveler’s diarrhea by Shigella
 Produces a heat-labile toxin, dysenteriae
similar to V. cholerae o Cultured in MAC agar
o Causes accumulation of containing sorbitol (SMAC)
cAMP instead of lactose.
 EHEC appear
B. Enteropathogenic E. coli (EPEC) colorless on SMAC
 Children’s diarrhea  EHEC does not
 Characterized by low-grade fever, ferment sorbitol in
malaise, vomiting, and diarrhea 48 hours.

C. Enteroinvasive E. coli (EIEC) E. Enteroadherent E. coli

 Produce dysentery by direct  Two types:
penetration of intestinal mucosa o DAEC
 Similar to Shigella spp.  Associated with
 Nonmotile and do not ferment UTIs and diarrheal
lactose disease
 Do not decarboxylate lysine  Uropathogenic
 Infective does is 106 DAEC is associated
with cystitis in
D. Enterohemorrhagic E. coli (EHEC) children and
 E. coli O157:H7 pylenophritis in
pregnant women
 Associated with hemorrhagic
o EAEC
diarrhea, colitis, and hemolytic
 Causes diarrhea
uremic syndrome (HUS)
 Adheres to the
 Toxins produced:
surface of the
o Verotoxin I
intestinal mucosa
 Phage-encoded
 HEp2 cells
cytotoxin
 Identical to Shiga
toxin (Stx)
Extraintestinal Infections:
 Most common cause of septicemia
and meningitis among neonates
o 40% of the cases of Gm –
meningitis
 Strains associated with diarrheal
disease
o Associated with neonatal
sepsis or meningitis
Klebsiella and Raoutella
 Normal flora of intestinal tract
 Characteristics:
o Growth on Simmon’s citrate
and Potassium cyanide
broth
o None produce H2S
o Urea hydrolysis is slow
(few)
o MR negative
o VP positive
o No indole from tryptophan
o Variable motility
Klebsiella pneumoniae subsp.
pneumoniae:
 Possesses a large polysaccharide
capsule
o Protection against
phagocytosis
o Antimicrobial absorption
o Responsible for moist,
mucoid colonies
 Colonizes respiratory tracts of
hospitalized patients
 Other infections include: (immune
compromised hosts)
o Wound infections
o UTIs
o Liver abscesses
o Bacteremia
 Antimicrobial resistant
Klebsiella oxytoca:
 Similar to K. pneumoniae infections
 Linked to antibiotic-associated
hemorrhagic colitis
 Biochemically similar to K.
pneumoniae except for production
of indole.
Klebsiella pneumoniae subsp. ozaenae:
 Isolated from nasal secretions and
cerebral abscesses
 Causes atrophic rhinitis
o Tissue-destructive disease
restricted to the nose.
Klebsiella pneumoniae subsp.
rhinoscleromatis:
 Isolated from patients with
rhinoscleroma
o Intense swelling and
malformation of entire face
and neck
Enterobacter, Cronobacter, and
Pantoea
 Significant species:
o Enterobacter cloacae
o Enterobacter aerogenes
o Enterobacter gergoviae
o Enterobacter hormaechei
 Characteristics:
o Growth in Simmon’s Citrate
and Potassium Cyanide
broth
o MR negative
o VP positive
o Ornithine positive
E. cloacae and E. aerogenes:
 Common isolates from the group
 Isolated from wounds, urine,
blood, and CSF
Pantoea agglomerans: Hafnia spp.
 Septicemia from contaminated IV  Composed of one specie, H. alvei
fluids  Has been linked to gastroenteritis
 Lysine-, Arginine-, Ornithine-  Delayed positive citrate reaction
negative
o Triple decarboxylase
negative Proteus spp.
 Normal intestinal microbiota
Cronobacter sakazakii:  Opportunistic pathogens
 Pathogen in neonates  Most common isolate:
o Meningitis o Proteus mirabilis
o Bacteremia  Able to deaminate phenylalanine
 Comes from powdered infant  Does not ferment lactose
formula  Ascend urinary tract, causing
infection in both lower and upper
urinary tract
Serratia spp.
 Opportunistic pathogens Proteus mirabilis:
 Ferment lactose slowly  Can produce “swarming” colonies
 O-nitrophenyl-B-D- on nonselective media
galactopyranoside (ONPG) test  Indole negative
positive  Ornithine positive
 Produce extracellular DNase
 Resistant to a wide range of Proteus vulgaris:
antimicrobials  Indole positive
 Most significant:  Ornithine negative
o S. marcescens  Ferments sucrose
 Nosocomial o A/A in TSI
infections
 UTIs
 RTIs Providencia spp.
 Bacteremic  P. stuartii
outbreaks o Isolated from urine cultures
 Two biogroups of S. odorifera o Outbreaks in burn units
o Biogroup 1
 Predominantly from  P. alcalifaciens
resp. tract o Commonly found in the
 Sucrose, Raffinose, feces of children w/
Ornithine positive diarrhea
o Biogroup 2
 Blood and CSF  P. rettgeri
 Sucrose, Raffinose, o Documented pathogen of
Ornithine negative urinary tract
Citrobacter spp.
 Characteristics:
o Urea hydrolysis slow
o Lactose fermenting
o Growth on Simmons citrate
o MR positive
Citrobacter freundii:
 Isolated in diarrheal stool cultures
 Extraintestinal pathogen
 Nosocomial infection:
o UTIs
o Pneumonias
o Intraabdominal abscesses
 Endocarditis in intravenous drug
abusers
 Characteristics:
o Hydrolyzes urea
o Fail to decarboxylate lysine
Citrobacter koseri:
 Cause of nursery outbreaks of:
o Neonatal meningitis
o Brain abscesses
Salmonella
 Gram-negative
 Facultative anaerobes
 Non-lactose fermenter
 Characteristics:
o Do not ferment lactose
o Indole, VP, Phe deaminase,
Urease negative
o Produce H2S (except
Salmonella Paratyphi)
o Do not grow in potassium
cyanide broth
Classification:
 Only two species are designated:
o S. enterica
o S. bongori
 S. enterica is divided into six
subspecies:
o S. enterica subsp. enterica
(subsp. I)
o S. enterica subsp. salamae
(subspecies II)
o S. enterica subsp. arizonae
(subspecies III)
o S. enterica subsp. diarzonae
(subspecies IV)
o S. enterica subsp. houtenae
(subspecies V)
o S. enterica subsp. indica
(subspecies VI)
 S. enterica subsp. enterica is
composed of 3 serotypes:
o Salmonella serotype Typhi
o Salmonella serotype
Paratyphi
o Salmonella serotype
Choleraesuis
Virulence Factors:
 Fimbriae
 Ability to transverse intestinal
mucosa
 Enterotoxins
Antigenic Structures:
 Similar to antigens of other
enterobacteria
 Few strains possess capsular K
antigen, designated as Vi antigen
o Salmonella Typhi
Clinical Infections:
 Gastroenteritis
o One of the most common
forms of food poisoning
o Infective dose is 106
o Symptoms appear 8-36
hours after ingestion
 Nausea
 Vomiting
  Fever and Chills  Meningitis
 Watery diarrhea and  Osteomyelitis
abdominal pain  Endocarditis
o Usually self-limiting  Abscesses
o Antimicrobial choice
 Chloramphenicol  Bacteremia
 Ampicillin o Caused by nontyphoidal
 Trimethoprim- Salmonella
sulfamethoxazole  Typhimirium
 Paratyphi
 Enteric Fever  Choleraesuis
o Salmonella Typhi o Observed among two
o Also known as Typhoid different groups:
fever  Young children
o Develops approximately 9-  Adults
14 days after ingestion
o Signs and symptoms:  Carrier State
 Malaise o Individuals who recover
 Fever from infection
 Anorexia o Harbor organisms in the
 Lethargy gallbladder
 Myalgia o May be terminated by
 Dull Frontal antimicrobial therapy
Headache
o Pathogenicity:
 First Week Shigella
 Experience  Characteristics:
constipation o Nonmotile
rather than o Do not produce gas from
diarrhea glucose (S. flexneri)
 Second and 3rd week o Do not hydrolyze urea
 Sustained o Do not produce H2S
fever o Do not decarboxylate lysine
 Prolonged
bacteremia Antigenic Structure:
 Invasion of  All Shigella possess O antigens
gallbladder  Certain strains possess K antigens
and Peyer’s
patches Clinical Infections:
 Rose spots  S. sonnei
(umbilical o Usually a short, self limiting
spots) disease
o Complications: o Characterized by:
 Pneumonia  Fever
 Thrombophlebitis  Watery diarrhea
  S. dysenteriae type 1  Most common
o Most virulent species  S/Sx appear 2-5
o Significant morbidity and days after infection
high mortality  Symptoms:
o Low infective dose (<100  High Fever
bacilli)  Buboes
 Bacillary dysentery (swollen
o Penetration of intestinal lymph nodes)
epithelial cells o Septicemic plague
o Local inflammation  Occurs when
o Shedding of intestinal lining bacteria spread to
o Formation of ulcers the bloodstream
o Epithelial penetration o Pneumonic plague
 Shigellosis  Occurs secondary to
o Initial symptoms bubonic or
 High fever septicemic
 Chills  Organisms
 Abdominal cramps proliferate in
 Pain accompanied bloodstream and
by tenesmus resp. tract
 24-48 hours  Primary infection
 Dysentery caused by S. dysenteriae site if inhaled.
Type 1  Characteristics:
o Bloody diarrhea that o Gram-negative, short,
progresses to dysentery plump bacillus
o Extremely painful bowel o Stains with methylene blue
movements or Wayson stain
o Serious complications:  Intense staining in
 Ileus each end of bacillus
 Obstruction  Bipolar
of intestines staining
 Marked  Safety pin
abdominal appearance
dilation  Culture Method:
 Toxic o Preferred temperature is
megacolon 25-30C

Yersinia Yersinia enterocolitica:

 Can be acquired from contact with
Yersinia pestis: household pets
 Causative agent of ancient plague  Infection manifests as:
 Transmitted by flea bites o Acute enteritis
 Can occur in 3 forms o Arthritis
o Bubonic plague o Erythema nodosum
  Acute Enteritis
o Most common form of
infection
o Characterized by
 Fever
 Headache
 Abdominal pain
 Nausea
 Diarrhea
 Arthritis
o A common extraintestinal
form of infection
 Erythema nodosum
o Inflammatory reaction
o Characterized by tender,
red nodules that may be
accompanied by itching and
burning
 Anterior portion of
legs
 Culture Methods:
o Morphologically resembles
other Yersinia spp.
o Grows on routine isolation
media, SBA and MAC
o Optimal temp is 25-30C

Yersinia pseudotuberculosis:
 Causes a disease characterized by
caseous swellings called
pseudotubercles
 Differentiated from Y. pestis by:
o Motility at 18-22C
o Urease production
o Rhamnose fermentation