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
 Associated with hemorrhagic pregnant women
diarrhea, colitis, and hemolytic o EAEC
uremic syndrome (HUS)  Causes diarrhea
 Toxins produced:  Adheres to the
o Verotoxin I surface of the
 Phage-encoded intestinal mucosa
cytotoxin  HEp2 cells
 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,  Sucrose, Raffinose,
blood, and CSF Ornithine negative

Pantoea agglomerans:
 Septicemia from contaminated IV Hafnia spp.
fluids  Composed of one specie, H. alvei
 Lysine-, Arginine-, Ornithine-  Has been linked to gastroenteritis
negative  Delayed positive citrate reaction
o Triple decarboxylase
negative
Proteus spp.
Cronobacter sakazakii:  Normal intestinal microbiota
 Pathogen in neonates  Opportunistic pathogens
o Meningitis  Most common isolate:
o Bacteremia o Proteus mirabilis
 Comes from powdered infant  Able to deaminate phenylalanine
formula  Does not ferment lactose
 Ascend urinary tract, causing
infection in both lower and upper
Serratia spp. urinary tract
 Opportunistic pathogens
 Ferment lactose slowly Proteus mirabilis:
 O-nitrophenyl-B-D-  Can produce “swarming” colonies
galactopyranoside (ONPG) test on nonselective media
positive  Indole negative
 Produce extracellular DNase  Ornithine positive
 Resistant to a wide range of
antimicrobials Proteus vulgaris:
 Most significant:  Indole positive
o S. marcescens  Ornithine negative
 Nosocomial  Ferments sucrose
infections o A/A in TSI
 UTIs
 RTIs
 Bacteremic Providencia spp.
outbreaks  P. stuartii
 Two biogroups of S. odorifera o Isolated from urine cultures
o Biogroup 1 o Outbreaks in burn units
 Predominantly from
resp. tract  P. alcalifaciens
 Sucrose, Raffinose, o Commonly found in the
Ornithine positive feces of children w/
o Biogroup 2 diarrhea
 Blood and CSF
  P. rettgeri
o Documented pathogen of
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 and Peyer’s
forms of food poisoning patches
o Infective dose is 106  Rose spots
o Symptoms appear 8-36 (umbilical
hours after ingestion spots)
 Nausea o Complications:
 Vomiting  Pneumonia
 Fever and Chills  Thrombophlebitis
 Watery diarrhea and  Meningitis
abdominal pain  Osteomyelitis
o Usually self-limiting  Endocarditis
o Antimicrobial choice  Abscesses
 Chloramphenicol
 Ampicillin  Bacteremia
 Trimethoprim- o Caused by nontyphoidal
sulfamethoxazole Salmonella
 Typhimirium
 Enteric Fever  Paratyphi
o Salmonella Typhi  Choleraesuis
o Also known as Typhoid o Observed among two
fever different groups:
o Develops approximately 9-  Young children
14 days after ingestion  Adults
o Signs and symptoms:
 Malaise  Carrier State
 Fever o Individuals who recover
 Anorexia from infection
 Lethargy o Harbor organisms in the
 Myalgia gallbladder
 Dull Frontal o May be terminated by
Headache antimicrobial therapy
o Pathogenicity:
 First Week
 Experience Shigella
constipation  Characteristics:
rather than o Nonmotile
diarrhea o Do not produce gas from
 Second and 3rd week glucose (S. flexneri)
 Sustained o Do not hydrolyze urea
fever o Do not produce H2S
 Prolonged o Do not decarboxylate lysine
bacteremia
 Invasion of Antigenic Structure:
gallbladder  All Shigella possess O antigens
 Certain strains possess K antigens
Clinical Infections:
 S. sonnei Yersinia
o Usually a short, self limiting
disease Yersinia pestis:
o Characterized by:  Causative agent of ancient plague
 Fever  Transmitted by flea bites
 Watery diarrhea  Can occur in 3 forms
 S. dysenteriae type 1 o Bubonic plague
o Most virulent species  Most common
o Significant morbidity and  S/Sx appear 2-5
high mortality days after infection
o Low infective dose (<100  Symptoms:
bacilli)  High Fever
 Bacillary dysentery  Buboes
o Penetration of intestinal (swollen
epithelial cells lymph nodes)
o Local inflammation o Septicemic plague
o Shedding of intestinal lining  Occurs when
o Formation of ulcers bacteria spread to
o Epithelial penetration the bloodstream
o Pneumonic plague
 Shigellosis
o Initial symptoms  Occurs secondary to
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
 o Rhamnose fermentation

Yersinia enterocolitica:
 Can be acquired from contact with
household pets
 Infection manifests as:
o Acute enteritis
o Arthritis
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