6£

, t of r,niph} lo<e /q mcnc:url•~ . 6) ~urvci flo ncc nvc, ,

cmp orn len •Ot1 ~lld l1
a· ric mcornrc~ th ere; 7) 1renl111c111 wrlh n r,haue 11 f PP1•<-11,
• of prt.lp II)' l . -: · " nll >r.
Per1<in
• llACI wilh /he qfck ir11.J1 v1duofq, H) nh~crvn111.c of qa 1 ~Ii,
were 111 i.:lll
. . h .
"''itry a11d
hy11,•.
,
• 1 child-cnrc 111s1ltu11ons. nl omc and 01 plac.e~ r ~ i..
regimens II r, Work
111
. d (liililishrnenrs. at cntcrintt cqt11b lishm enls, In food ~lore~
,n U~l r) C~
" ~.-i

6.5. Kleh.flel/ae

The fa mily Enreroboctcrieccae. genus Klebsiella. include bact

ena fA,h
are capab
l'e of producing ~apsules when present
n1 ed",a.
in the host's body
or on nut,

~lorphology.
ic~
, i-
f;/ebsiel/a organ isms
are !hick
short bacilli 0.6-6.0 µm in lcn"'~
ou, and
0.3-1. 5 µm in width. Kiebsiella
are
rounder and thicker than other
members of Enterobacteriaceae
family. They have rounded ends. are
non-motile and devoid of spore~. They
occur mainly in pairs but may be seen frequently as single organisms, and are
normally surrounded by a capsule. They stain readily with all an iline dyes and
are Gram-negative. IC pneumoniae and K ozaenae have funbriae.
Cultivation. Klebsie/lae are facultati ve anaerobes, which grow readily on
common nutrient media at pH 7.2 and at the temperature of 35-37°( . No growth

-
is shown belo"'' 12°(: or above 37°C. The organisms are capable of synthesizing _
all amino acids essential for their growth. They form turbid mucilaginous
colonies on agar and produce intense turbidity in broth. After 2 or 4 hours the
capsulated bacteria show a characteristic arrangement in the young colonies.
The young colonies are studied with a dry Jens in pieces of agar taken from Petri
dishes. The agar-microscopy method is used for differentiation of capsula,itd
bacteria.
170
 A. /,•/!•1d/1n mn, ll,'iC' th , •Ill<'" hv 111l11nnccl ,11!x11 lllrl' on SO pc,
cent h1k hwth. nnd 11c41111 c Ihem nt1a111 In rA~~AJlt' 'l hrnuah wh11e mice: The
Mgnrn1sm'- Lllss<'c1n1r intci ~- r111LI R-form q when thcy nr c c,rosed 10 the ~•l'Yn 1,f
km ll"mpemturc-~. h11~·1crmplu1gc, chcmKal sub•nnnccs. h1le, nnd antrqcrum or
when the) arc frcqucntl~ subcuhureJ.
Entymalic properlie~. Kleh.,utlla organism,. d o not liquefy gelatin and
prodl!lce neither indolc nor hydrogen ,;ulfide. They redruce nitrates to n1crlte:s and
decompose urea. Milk is not always curdled. The organisms fcrmernt
carbohydrates. producing both acid and gas or. sometimes, only acid. Glucose
and urea fermentation is usuall y a constant property.
Toxin production. K. pneumoniae produce thermostable cxotoxin. their
toxicity being associated with an endotoxin.
Antigenic structure. Capsulated bacteria contain three types of antigens:
capsuJar (K-ant.igen), smoot'h somatic (O-antigen), and rough somatic (R-
antigen). The K- and O-antigens are carbohydrates, and the R-anLigen is a
protein. The O-antigen is subdivided into three groups: O-group 1, 0-group 2.
and O-group 3. The O-group I and the coli bacilli possess common antigens.
Bacterioci.nes and phages have been discovered in K/ehsiella organisms.
The organjsms are differentiated by the presence of 0- and K-antigens.
An agglutination reaction with non-capsulated strain containing O-antigens and

the complement-fixation reaction with the capsular antigen are performed for
antibody detection.
Table 6.
Difrerentialion or Klebsiell11e organisms
I
Microscopical Growth in Fermentation of carbohydrates
strucrure of bile or m
colonies on agar 50 % bile I V -- I
~
Q.) 0

hroth -
r11
0
Ill
0
t.) ·-u ,_
~
::I
I ~ 7n :J,
i K.pn·eumoniae Form loops + A AG A +

171
 \ I\ I I
t
T C , ,,, 1 r t1f11 l t1 l h

c, 1 11rrnf
j t''t,f1< rntr I\" I
. .• , ,,, J
11 I d •\ Ci nut I nllt I c.!A ~. '" " 1 t ~ fl;T,,.., rh In h1ie
.\ ,ncirLII<' " Ill I
' ,,,, d IC'" t,ccnCl' o f fcrm cntal 1<1n ancl /ilf'>Wl h
. • ,n 1cn 11
11111Pn ,,I urea
JL•mH'f1 . // raam~m c; .. u rv, , e at room lcwpera tur'" fr•r Wtck ,
r A/r /tnr ,1 o ~ ·
Aed1111n r the 1t• rnrcni 111re n l <,'i ( they are de,r,r
-~
h \\ 'hen h c.>.t I t"U 10 'Yed tn
,wd cHn '""" ' ~ n c. are ,;uscepl lb l e 10 lrentm ent w11h so lur,o
r•nt The organ1c;1
h ('ltJT . r ns ri f
• 1 nnd o ther d1sin,ec rnnts
L hlMamine. phen,1I. u 1ra .
. ,, animal~ . Among the experim ental animals wh,re rn,c,
P1rhoJE 'nl<'lh'. ,or
'bl n1ev die witl1in 24-48 hourc. fo llowing inocu lar101"1.
art' mn~t suscepll e. •
of septicae mia. Severe inflamm atio n and enlargemeni of
dlspla~ in~ symp1om s
lrver are found at autopsy . Caps ulated bacteria are found in
tht sp Ittn an d
abundanC'C' io smears made from organs and blood . The pathogc nicity of
capsularcd bactena is associol!!d witJ1 the capsule. and bacteria which have lost
their abiliiy 10 produce capsules become non-pa thogeni c and are rapidly exposed

10 the action of phage when injecred into the ani maJ body.
Pathogenesis aod disease s in man. Three species o f caps ullated bacteria
play the most important role in human patholo gy : rhe causati ve agents of
pneumo nia, ozaena. and rhinosc leroma.

Klehlit!llae p11eumoniu
Klehsie/la pneumoniae grow readily o n solid media, produc ing opaque
mucilaginous colonie s. In yo ung colonie s grown on agar they occur in loops and
are serologically heterog eneous . lnfected guinea pigs and white mice exhibit
anil hm• •htcc~~ I he lt2th nit h It 1lc htRll In t:ime catc, the e1•,vm•m"
J!'\II \ ht ri"<rim, ,hlr Im mm,nsr,trt • M'f'.T'CI 111~ f\ •cmla "11!'1' , lt!Jt •!'ki
0 ,;11t1i. I ht, "'"' 111~1, t1111tc inf'amnutmn m a tc1 of nthttl 1nrt ,, l'!<t

1'H'MH'll1r n·ontn
Alil ,1tlla 11: 1, ttlt • the '™-"J1lmloi!1.:al 1.:h..ml.:1<ri-tt<~ are 11ven ab,,vr In
~ Ntntt rr lon,r~ 1hr i'rgl!OJ(ffl~ an C'f!rkcntn1..all) (1,.11t1crtd It 1,; 1u<iumed that
the, lln.' 11.'9)0('1,tblr !('tr rhinlll ~ chl\ractCTlZCd h) an o rrcn11\( na.'1.11 di~c:harvc ,.
,coeno alll!\.~ the mucou~ mtmbnuie~ or the n~c na~I ~mu,;e<, and r.:onchat
Th,s mui~ an produc11on or a , 1sc1d discharge wh,c:h dri~ up lllld (orm5 th1\'. ~
~b'i with an nffcnsh r odour. Th~c scab~ make breathing difficult
0 1,aena 1s m1ldl) contagious disease and is transmtncJ by the air-droplet
mutr. h ,~ possible that other factors (trophic and endocrine disturbances. etc 1
also contn'butc to ,ts development The disease is prevalent in Spam. Indra.
China. and Japan and occurs sporadica I ly in Ukraine.

Kkbtiielltll rltinosdt'romaro
Klcbs1el/ae rlunoscleromatis arc differentiated b) their growth on agar
and other properties. In ~-oung colonies they are arranged concentrically.
The rhinoscleroma bacteria occur in tissue nodes (infocLious granu-
lomas) in the form of short capsu I ated microbes. They are localized intra- and
extracellularly
The organisms are responsible for chronic granulomatosis of the skin 1:1nd
mucous membranes of the nose, pharynx, larynx, trachea, and bronchi, with the
formati on of granulomas. Rhinoscleroma is a mildly contagious disease. It
prevails in Austria and Poland and occurs sometimes in Belorussia, Ukraine,
Siberia, and Central Asia. Treatment is a matter of great difficulty and involves
complex therapeutic measures which must b..: carried out over a long period of
time.

173
r ,, . 1r
lrn f" ""l11
,n mttn· 1
1 '
p ,,r ,.• t• ,
,, 1 1u 11n 1
" '
n11<t'< 1
,in ti
t, ,

t ,-,,,r
r11r•11 Int ,I p11th1111t'n1 c
ln t t crt a lt:a1, ,
It nu:n l fh in ll "" h t
" o1 ,r, a,,
pr"
ni•<l tc ro rn ll 11 11 ,, en l' hu t ''' "" Jll 1tl t c 11v ,
, .,,._
•
ti-it 'l'I
'-I ,,.l ,,, •'" ' tf \ll ar,1 ,h t
It, ( r "
,t f 111•u • 111 1f lll lll l t1, ,, rr ol ,11 •1) lh t: rc:H r,n ,ro te 11
1n ll
1he 111\<tfl ' t ' H,r ,~..
nn?h11•"'" .
,11tn: ,,t tht (t di (r •H •<
','-r
, " '' " h t foll owing meth
di •· ,nduJc~
,no''' od ,
I t,111-9 !0 1 \ II
t
I ' r, 11mHlAIIOll ( n ,t ~
matlc fro m ,putum
t) f rrom Pitt
1 , 1',l"l,cd'P'"
,;

,cu~ d,cc hnrflC Cfrom pa11entc "" 1th 07aena t an •tn11

th rnt'um •'"'' l· naqa I "" d ,.•
"• lcrcim h
o) Pa t oh 1sto Iog, caI •\ue
t~ w ith rhlnusc
Cftl'<-uncn' ifr<'m pa11rn t'<amtnat,«>n
·,·-· f ·u
- t num~e r u pe\; lia r giant Vl it uhcz'c; ce lls r,f
rtV
infi ltBfl'~ eA I" -.R, ..11 0 w h rch conia
cteno '" a gelattn· ' e n , su bs tance T ,c maten a I
J 1n
-2p~u1a1rd ba ,,. co IIectcd w,th
, ..,,., swab . having pre vi ously sc ari fied the mucos a
I,,op or ronC1n·\' '" ' a su rface
d its identific at io n b
ISCl laOOO Cl f rh c pure culture an y cu Itura I, b1ochem
-· ical
11,c and st"rologkal .
phagOC' 1 <' ' • pro perties.
• · -tio
~ Complcment- fi xa
tton rca1. n with patients' sera and capsular antig
. .
en . Tbis
reactio n most frequent I), vi e Ids positive resu Its. .
; Sera d!luted m ran os
r the o lutinat
from I.5
to 1.400 ar t used ,o ion reac tion with a non-
r 3o-2
cap sulated strain .
4 The allerg ic skin
test is made as an addi
tional test. but is Ies
ag!!lutination reaction or s specific than the
the co mplem ent- fixa
n reaction.tio
Trtitment. Patients ar
e treated with stre
ptomyc in, ch lo ramph
tctrae)cJine. an d antim
ony preparations (sol enicol.
us urmin ). Vaccine
employed . The vaccine therapy is also
is prepared from ca ps
u lated bacteria stra in
been killed by heat trea s \\ hich have
tment.
Prophylaxis is ensure
d by recognit io n o f
the early stages of
rhinoscleroma, acti ve an ozaena and
tibiotic therapy, and
prevention o f health
from being infected by y indi viduals
th e sick .

6.6 . Proteus
Proteus was discov
ered in
· 188
5 by G. Hauser. It is a
(the 0-fonn is non -mot polymorph ous , motl·1
ile) . . e
' pentnchous Gram
-negative rod . The
organism docs
174
 , , cilh u o;p1i1 c~ 111 ,nr• uh: ,. Ill <'" , 111 1un pu11111rr
111 111 1111 " ht:l\l.CCn 2'\ nnd , .. (
_,11,fll', gel111m nml uio1t11ll\tC~ ~l.'111111 p11ll l111;c
1111 :, h )1h
111tt n •11lph1dc. nmm onia
,md ,mlolt. m.l11~roi nitrate• In nil11 lt41 nnd ferm
ent, lt\11 l11,c , 14lt1l1t~c. l(lllac1o<1c
~c-chl\n,1.e. nmyttdnhn l\ml mnho,;e . w11h neu
t 11nd ga• format ,rm r wd1tarH
al~,, test~ po~111vc for the meth) I red (mi xed ec1d
fc rmcntatmnJ 1c,1 l'rr,1t 11, 1• a
faculteltVC anaer,,he nnJ grow~ rcud 1ly nn common
med10, / 1ro1e 11., v11IK"'" c.in
n\(n be 11 rcnse ncgn1ive in solid med ia, b111 ,.,,i
ll be urease pos1t1vc 10 liquid
medin. n,c l l-fom1 i~ characterized by cree ping
growtl1 Proteus plays an
impnrtan1 role III putrefactive proccsse!- owi
ng lo il5 abi lily lo prod uce
prolt'OI) 1ic enzym es.
Genus Prote11s incl udes the follo~ ing
five species : P. vulgaris. P.m ,rabilis. P
morgani (66 serovars). P. rerrgeri (45
serovars), and P. inco nstans ( I56 serovars ).
The species are differentiated by studying
their fermenta tive properties.
Num erous investigators consider the
bacterium to be an opportunistic organism.
although this is as yet not definjtely proved.
Proteus m,rabilis causes close to 90°/o of Proteus
infections. It is possible that
not all the bacterial strains but only the pathoge nic
variations are responsible for
diseases. Proteus occurs in humans in association
with other bacteria in cystitis
and pyelitis, and is disc harged from wound pus.
Such urinary tract infectio n
because of ureasc prod ucti on leads to precipitatio
n of organic ad non-or~anic
com pounds and formatio n of stones. lt is also beli
eved to be the cause of food
poisoning. Apparently, Proteus is of epidemi ological
importance in diarrhoea in
children. Also Proteus can lecd to sepsis and bactere
mia.
Treatment is carr ied out with anti biotics (chl oram
phenico l, streptomyc in,
ciprofloxacin. ceftazidime, sulbactam, mer ope
nem, piperacillin etc.).

175
Proph~ l,\\IS con'li~ts 111 protecting wntcr ond foodsturr11 fto
m con1an11.11at1r ,
fccc~nnd purulent cJi~chnrgc 11
-~111

176
 I\ ~ II• •
h !illbcitrn le '
'!JI • I \.• • - •

, .. .. ,,, 1 r,ritllrtirt ,
,1 ,,., ,,
.,11111
, 1

,,.. •"'111' r1tcf1'I"~,

J11l t,ic
111lll •
. tifi c centers
ful For lcHd1ng sc 1e
·
n
ess
of
.
I' ,.,,, succc ~s of the effectiv e n
tr ''t " o)'~ ,
..1 ff•
,.., I• ',; -' , c1I al
, 1c 11
od indicator
IJ(f'
1h t 111P ool is 8 go
,,,.... b<'''<' R o
,, ti-·•'"'n
t ,,. H r'~,lfl " . the foll owi ng
n•,ii
,,t f recent stud ,es.
~~~ .. results 0 . .
O " th~
f H p yl o ri bacteria.
•
,~ • . Based nsrni ss 1on o . with food
~, 1,t•S· I
rror a~· heir to rcJuce tra peci al y
d hand wasbing. es
111
~ oad hygiene an
pr,t:0CC g th at mavJ be
• ..reparation. . . testinal syrnptoms d
r- 'th chronic gastrom hould be tested and treate to
. .
.\II patients w, H p,1.1,Jon. infection s
• 'th
ociatcd W I . J
ass . to family members.
rerent e>.'J'osure ..
p ping
''. . tain proper nutr1t1on
.
• • conditions in develo
• ,'Vlain ·es to improve li v111g
• Support po Cl
li

countries.

2. 7. Pseudomonas
ic , rod-shap ed ba cteria with
Pstudomonads are Gra
m-negative, aerob
lly in dam p biotopes . The most
natw'e, especia
ir1despitad occurrence in iew is of v
ri be d spec ies for a m edical point
impMant species from 19
1 desc
a terminal electron acceptor to
i q u ired as
Pmuiomonas oe rMginosa. Free D is re

grow the organism in cultu

res.
is co m plex . T h e org anism can
as infections
. Pathogenesis of Pseudomon
attachm ent .li Th e relev an t viru len t factors are :
US( llS
pi to adhere to host cells.
tx .
ym c S · ·
p rotea se s, an d tw o types o f
C !lz al
'cytotoxin, vanous met
~XIII A, QO
n
 , l \ lt tht' lipuflolysncc hniide 111 thu nute,
rhl,~1,h" I'Jl"~~
Ctllll SC,
ni
emh,11
,~ ,mpoi 18111 n,le Ill 1H1lh o11cnc~i , Ile II
111 110 "i
p l'scmJon1<'nn s mfoctmn, occur only in rnti cntg with
weakened 'l'Tlni
,.. dofc n~e syq1cm,. notab ly pncumon 11
' ~- • "-
f' ' "' • '"'
, ..
, fibrosis. · I i
co on zat,.on of burn
in
cy,t,,
.,_ t • 1 t
WQun.1
~ .. ' ' ' cndocnrditis In drug add icts, l>Osto e
t~ ~ ..
41, ' '

. ""''

~ -.. , ,-' .. _ , \
- , , ' ' .
•' . : wound infect, on. urmary tract infe ctio p T'lllJ~,
,, l ~ '- I~. n. scp~,s
... 1 ,,, , f' a11r11 gi111 Ma frequently
' . • ,- coni r·
,b•·t
... e, lo
-
1..... ~'' • " :,
,...,
; nosocomial infe ctions. Diagnosis
requuc,
( \
, , iden tific atio n of the pathogen in
.,_ 4 -' cull\Jrcs
... t \ , , -. \ .., Mu lup ' Ie res1·sta nee I ..
o anu -rnfective a
.,. • , 1 "- ,
· -.. ' ") \....,, , presents a therape utic prob &ents
lem.
\_ ' 1 ~ .., N
. -~~~~ ~\: . umerous other Pseudomonas species
~- t~ , ..~ 4.. and the species of the genera Burkholderia and
Stenotrophomonas arc occasionally found m patnogenk roles 10
immunos uppressed patients. B. mallei causes
malleus (glanders) and
B. pseudomallei causes melioidosis.

Pseudomonas aeruginosa
Pseudomonads comprise members of the family
Pseudomonadaceae.
Many species of pseudomonads are free-living and harm
less , whe reas other can
produce disease in plants and animals. The genus Pse
udo monas contains species
with remarkably diverse biochemical capabilities.
Occurrence, significance. AU pseudomonads are
widespread in nature.
They arc regularly found in soils , surface water, incl
uding oceans, on plants and,
in small numbers, in human and animal intestines.
They can proliferate in a
moist milieu containing only traces of nutr ient substan
ces. The most impon.ant
species in this group from a medical point of view
is P. aeruginosa. which
causes infections in person with immune diso rders.

78
 , t~
n,,1r1t-n ~
by n,cmbcr11 of this genus Include unusual
sugnr'l.
nd' ns ds
. ,,1ro" t11r 1110,~- coniplex cornpoun . "Ille,, Bl! those co0111 , nlng.
, l

<"
,cid•· 1111t.l • I I
Ps111domo11as spco1es p ay an mportnn1 role In the
,,11" ThUS,
I' ,.: rlnJ5 nthetlc nnd natural compounds that resist brcokdown hy
~ f 011111>1 sy
...d•110 n o , s The ability to carry out some of these degradation'!
~ p- • roorg1111sm ·
het' n,1c
~"' 1asn1ids.
-.ded bYP d ulture. P. aen,ginosa are plump, 2-4 µm long rods
1,1 d1""'- 11ofolY Ill C
r.tof'P olar flagella. Some stTains can produce 8 viscous
,th one ltl
"I
5
severtl I P
1101e layer.
These mucoid strains are frequently isolated in the ,
I

~ 118cet111tar from cystic fibrosis patients. P. aen,ginosa possesses an outer

. I isolated h' f .
,na1en• f its cell wall. The arc 1tecture o this membrane is
a part o
n,e111b ranc as atural resistance of th'as bactenum
· to many ant,'b'1otics.
·
'ble for the n
resJJ0°51 • can only be grown in culture media containing free o~as a
P. ocrug1nosa •
cccptor. In nutrient broth, the organism therefore grows at the
inal electron a . .
,enn 8
so-called pellicle. Colonies on nutnent agar often have a
surface to form . . ..
. (P aeruginosa; Latin: aes = metal ore). Given suitable cond1t1ons ,
metalhc sheen ·
. can produce two pigments, i.e., both yellow-green tluorescein and
P. oerug,nosa
blue-green pyocyanin.
Patllogenesis and clinical manifestation. The pathomechanisms involved
art highly complex. P. aeruginosa usually enters the body tissues through
injuries. It attaches to tissue ceUs using specific attachment funbriae. The most
important virulent factor is exotoxin A (ADP ribosyl transferase), which blocks
translation in protein synthesis by inactivating the elongation factor eEF2. The
c~ocnzyme S (a]so an ADP ribosyl transferase:) inactivates cytoskclctal proteins
and GIP-binding proteins in eukaryotic cells. The so-called cytotoxin damages

cells by creating transmembrane pores. Various different metalloproteases

hydrolyze elastin, collagen, or laminin. Two type C phospholipases show
membrane
. activny.
· Despite · these facts, pathogenic determinants are rare in
inununoeolllpete t . 111 ,,a;. .:duals
n tn n . Defective nonspecific and specific immwie
defenses arc P ,.a: •
reconwtions for clinically manifested infections. Patients suffering
79
t!'('ln, II( uln~prn111. llrt 11 htW\ 11 ~k Ihe mn111 l111tc1lu11s 111c J\llcun,
11
in " ' hi
fitln.,ct~. on rt ,p,rt 1tOt)' c411 1pmc111 , 111lcc1t uns of burn wound• l~tt ,l
· J){"lnper
wl,und ,n,C\:,1m0 ~• chronic pycloncplmtls. cndocardll l, In dru u lldd
r
., a1i~,
1c1,. ~tJi,i,
nnd maltgnanl <'lilts c'(1cma
Bumeu.1 "'.. ~ca·~ with the ir demngcd skin 11rc ideal sites for in' .
. •tction h)
. r
~nctcna rom c th. en,•iro nm ent or normal noru /\ lmosl nny opp
OT1u n,111c
pa:thogcn 1: ·an inlc ct hum s but one of the mosl common and difficult
•
10 trea
the Gram-n cgati\tt rod r .fe 11domm1u.~ aer 111
uginosa, whi ch can actually color lht
bum~ ussucs grten from the formatio n
of its pigments, pyocyanin &nd
Ouorescein. It is especially dreaded becaus
e ii resists a wide variety oi
Mtibiolics. ln fact. f seudom onas infec1ions
have bee n a major cause of death
10
bum patient s.
Pseudomonas aer11ginosa is a common
cause of hos pital acquired
(nosocomial) infectio ns. ft is motile by means
of a single nagellum at the end of
the cells. Rod 1.5-3 µm in length and 0,5-0.8
µm in breadth. non•sporefonning,
mostly has a capsule (lipopolysaccharide).
The organis ms grow readily and readily on
many media at 37'C. Som~
strains of this organism can also grow in a var
iety of aqueous solutions, even in
distilled water and some disinfectant solution
s. Most P. aeruginosaare strict
aerobes. generally utilizes oxygen as the
final electron acceptor in the
breakdown of nutrients. However, it can also
grow well anaerobical.ly on man y
media containing nitrate, which can substitu
te for oxygen as a tioal electron
acceptor. As mentioned above, most strains of
P. ueruginosa produce a greenish
discolorati on of growth media resulting from
the formation of two pigments.
Several toxins, including one especially
powerful exotoxin, arc
manufactured by some strains. Surprisingly,
cxotoxin of P.ae111ginosa has the
same mode of action as diphtheria toxin, alth
ough P. aeruginosa docs not cause
dipntheria. The reason for this discrepancy is
that P. aeruginosa toxin penetrates
different host cells that docs C. diphtheriae
toxing. P. aeruginosa 's exotoxin

80
 ein th
. . nnd 501ru: enz yme : a) cxu toxl n A - prot at effe cts
otoion
,..c 0( tfl
)Lb C" hcniornglc rosh . blookq pro tcn qc!I. l11hlbit,
pha .
&0CylO'IJ5.
rd""- ntacltCS,
•' is of JICP _ delltroys red blood cell s;
,, ernolysln . •
I!) II• tein whi ch inhibits sam e oom pon cnlq o f com plcm cnl!s.
sc - pro
c) c111slfl
rcase:
d) pro c. break.,; dow n col lage n, tissue fibe r:
~111,gcnas . .
. . _ kills leuk ocytes by evo kin g intrace llular release of
c) c
0 1cukoc1d1n
...nnes:
'c Cn'-1' ..
h~ lyti brea ks dow n fat:
g) lipase - . . .
. f p aeruginoso 1s m bac terial cell wal l.
Endoto"1n o . . .
is com monly present lD hospita ls. growing on plants in
.
0 . . ,
P. ae111gmos .
f water in certain med ical equipment,
and even in dilute
.
def1S8non o ary ammonium
,.on tions such as hex achlorophenc and quatern
I th b . . h . . .
disinfectal1' so u mt mte stm al tracts.
About 10 % of humans carry e actenum
e1r
. . . . . .
compounds. killed by most phenolic dtsrnfectants
p aer uginosa 1s readily
Generally, ·
tiss ue it can suivive
. g However in pus and in fragments of burned
and by drym · '
both disinfectants and long periods of dry ing. Exp
erimentally . active and passiv~

imm uniz.ation against P. aeruginosa gives

some protection against the
erally useful in burn cases.
organisms. but these immunizing agents are not gen
Fortunately, high concentrations of certain sul
fonamide compounds control
rease the chance of blood
growth of the organisms on the burn surface and dec
stream invasion.
treated effectively by
Invasion of the blood stream or deep tissues can be
venous adm inistration of am inoglycos ide and ~-lactam antibiotic (for
intra
tly in higher doses than
example, amikacin and imipenem) given concurren
nonnal.
of the pathogen from
Diagnosis. Laboratory diagnosis includes isolation
. metabo\.1c
relevant materiaJ s and .
. its I .den tification based on a specific pat tern of

Confirm atio n tests includ e production of the water-soluble blue-

Pl'Opertics.
green pigment (pyocyanin) on cctrimide agar and gro
wth at 42°C.
 Therap). The antibiotics that can be used to treat p
infections arc aminoglycosides, acylureidopenicillins, carhoxyJp .· . ae,-14gino30
en1c1llins
3b cephalosporins. and carbapenems. The combination of amin ' &roup
. . 1
og Ycoside .
betalactam is indicated in severe mfectmns. Susceptibility tests . w,tb
. are nee ~~~
due to frequent resistance. -1
Epidemiology and prevention. Except cystic fibrosis, P. ae .
. . . . . rugmosa is
mainly a hospilal problem. Smee tbts ub1quttous organism can prorr,
I crate und
the sparest of conditions in a moist medium, a number of sources f' . er
0 tnfecr
arc possible: sinks, toilets. cosmetics, vaporizers. inhalers r . ion
' esp1rators
anesthesiology equipment, dialysis equipment, etc. Infected palh:nts d '
. . ~ s~
carrying the organism are also potential primary sources of infection.
Neutropenic patients are particularly susceptible. Preventive m
easures
and above all disinfection and clinical hygic:ne, concentrate on av 'd• '
01 Ing
exposure.