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Enteric Bacteria
Enteric Bacteria
Enterobacteriaceae
The Enterobacteriaceae are a large, heterogeneous group of gram-
negative rods whose natural habitat is the intestinal tract of humans
and animals. The family includes many genera ( Escherichia, Shigella,
Salmonella,Enterobacter, Klebsiella, Serratia, Proteus, and others).
PATHOGENS BOTH WITHIN & OUTSIDE THE ENTERIC TRACT
Escherichia
Salmonella
1) Mucosal interaction:
Mucosal adherence with pili(colonization factor).
Ability to invade intestinal epithelial cells.
2) Exotoxin production:
pore-forming cytotoxin
cytotoxic necrotizing factor (CNF)
Heat-labile and stable toxin (LT and ST).
Shiga-like toxin.
3) Endotoxin: Lipid A portion of lipopolysaccharide (LPS).
4) Iron-binding siderophore: obtains iron from Human transferrin or
lactoferrin.
Classification
Shiga toxin-producing E. coli (STEC)- Shiga toxin-producing
Escherichia coli (STEC) are food-borne pathogens whose source
is most often the digestive tract of ruminants. Ingestion of
ruminant-derived raw products, such as uncooked meat or raw
milk dairy products, contaminated with STEC may result in a
human infection. STEC infections are most often diagnosed
through laboratory testing of stool (poop) specimens.
Enterotoxigenic E. coli (ETEC)- Enterotoxigenic Escherichia coli
(E. coli), or ETEC, is an important cause of bacterial diarrheal
illness. Infection with ETEC is the leading cause of travelers'
diarrhea. ETEC is transmitted by food or water contaminated
with animal or human feces. Infection can be prevented by
avoiding or safely preparing foods and beverages that could be
contaminated with the bacteria, as well as washing hands with
soap frequently.
Diagnosis
Physical examination
Stool analysis
Toxin detection -PCR
Blood test (CBC)
Creatinine- for kidney function
Salmonella
There are more than 2500 serotypes of salmonellae. There are three
types of Salmonella infections: enterocolitis, enteric fevers,and
bacteremia with focal lesions.
Four serotypes of salmonellae that cause enteric fever can
beidentified in the clinical laboratory by biochemical and serologic
tests. They are as follows:
Salmonella Paratyphi A (serogroup A)
Salmonella Paratyphi B (serogroup B)
Salmonella Choleraesuis (serogroup C1)
S Typhi (serogroup D).
Salmonella serotypes Enteritidis and Typhimurium are the two most
common serotypes.
Sources of Infection
The sources of infection are food and drink that have been
contaminated with salmonellae. The following sources are
important:
Water—Contamination with feces often results in explosive
epidemics
Milk and other dairy products
Shellfish—From contaminated water
Dried or frozen eggs—From infected fowl or contaminated
during processing
Meats and meat products
“Recreational” drugs—Marijuana and other drugs
Animal dyes—Dyes (eg, carmine) used in drugs, foods, and
cosmetics
Household pets—Turtles, dogs, cats…
Diagnosis
Blood test for culture
WIDAL test- (demonstration of Salmonella antibodies against
antigens O and H)
Stool and Urine test for culture
Differential medium culture
Nucleic acid amplification test
Shigella
Shigella is a genus of bacteria that is Gram-negative, facultative
anaerobic, non-spore-forming, nonmotile, rod-shaped, and
genetically closely related to E. coli. Shigella does not ferment lactose
and does not produce H2S.These properties can be used to
distinguish Shigella from Escherichia coli (lactose fermenter) and
Salmonella (non-lactose fermenter, produces H2S).
Shigella species are classified by three serogroups and one serotype:
Serogroup A: S. dysenteriae (15 serotypes)
Serogroup B: S. flexneri (9 serotypes)
Serogroup C: S. boydii (19 serotypes)
Serogroup D: S. sonnei (one serotype)
Shigellosis
Shigellosis is an infectious disease caused by various species of
Shigella. People infected with Shigella develop diarrhea, fever and
stomach cramps starting a day or two after they are exposed to the
bacterium. The diarrhea is often bloody. Shigellosis usually resolves
in 5 to 7 days, but in some persons, especially young children and the
elderly, the diarrhea can be so severe that the patient needs to be
hospitalized.
Treatment
Shigellosis can usually be treated with antibiotics. The antibiotics
commonly used are ampicillin, trimethoprim/sulfamethoxazole
(also known as Bactrim or Septra), nalidixic acid and the
fluoroquinolone, ciprofloxacin.
Reiter's syndrome
Persons with diarrhea usually recover completely, although it may be
several months before their bowel habits are entirely normal. About
3% of persons who are infected with Shigella flexneri may
subsequently develop pains in their joints, irritation of the eyes, and
painful urination. This condition is called Reiter's syndrome. It can
last for months or years, and can lead to chronic arthritis which is
difficult to treat.
VIBRIO
curved, comma-shaped, gram-negative rods
V. cholerae, the major pathogen in this genus, is the cause of cholera
V. cholerae is transmitted by fecal contamination of water and
food, primarily from human sources.
The main animal reservoirs are marine shellfish, such as shrimp
and oysters.
The pathogenesis of cholera is dependent on colonization of the
small intestine by the organism and secretion of enterotoxin-
cholera toxin.
Treatment - consists of prompt, adequate
replacement of water and electrolytes,
either orally or intravenously. Antibiotics
such as tetracycline are not necessary,
but they do shorten the duration of symptoms
and reduce the time of excretion of the
organisms.
CAMPYLOBACTER
Campylobacters are curved, gram-negative rods that appear
either comma- or S -shaped.
Domestic animals such as cattle, chickens, and dogs serve as a
source of the organisms for humans. Transmission is usually
fecal–oral. Food and water,contaminated with animal feces are
the major sources of human infection
Treatment
Erythromycin or ciprofloxacin is used successfully in C. jejuni
enterocolitis.
HELICOBACTER
urease-positive curved gram-negative rods, microaerophilic, spiral
(helical) bacterium usually found in the stomach.
H.pylori infection is one of the most common worldwide human
infections.
Is associated with a number of important upper GI conditions:
Chronic gastritis
Peptic ulcer disease
Gastric malignancy
Symptoms
Abdominal pain
Mild nausea
Irritable bowel syndrome
Anemia
Gastric reflux
Treatment
In gastritis we use clarithromycin,amoxicillin
In peptic ulcer we use metronidazole
PATHOGENS OUTSIDE THE ENTERIC TRACT
Klebsiella
Proteus
Klebsiella
Klebsiellae are nonmotile, rod-shaped, gram-negative bacteria with
a prominent polysaccharide capsule. Members of the Klebsiella
genus typically express 2 types of antigens on their cell surface.
lipopolysaccharide (O antigen);
capsular polysaccharide (K antigen).
Both of these antigens contribute to pathogenicity.
Three species in the genus Klebsiella are associated with illness in
humans:
Klebsiella pneumoniae
Klebsiella oxytoca
Klebsiella granulomatis.
Klebsiella organisms can lead to a wide range of disease states,
notably pneumonia, urinary tract infections, sepsis, meningitis,
diarrhea, peritonitis and soft tissue infections,wound infection,uti
infection.
Treatment – we use carbapenems
Proteus
Proteus species are part of the Enterobacteriaceae family of gram-
negative “swarming” bacilli. Proteus species are most commonly
found in the human intestinal tract as part of normal human
intestinal flora. Three species are important pathogens:
Proteus mirabilis
Proteus vulgaris
Proteus panneri
It causes uti infections,kidney stones
Treatment
We use ampicillin and cephalosporins