GRAM NEGATIVE BACILLI

ENTEROBACTERICEAE
 TRIBES OF
ENTEROBACTERICEAE
 ESCHERIACEAE
 Escherichia
 Edwardshiella
 Citrobacter
 Salmonella
 Shigella
 klebsiellae
 Klebshiella
 Enterobacter
 Hafnia
 serratia
 Proteae
 Proteus
 providencia
 Yersiniae
 Yersinia
 Erwiniae
 Erwinia
 Rapid fermenters
 Escherichia
 Enterobacter
 klebsiella
 Slow fermenter
 Edwardsiella
 Citrobacter
 Hafnia
 Serratia
 Providencia
 erwinia
 Non lactose fermenter
 Salmonella
 Shigella
 proteus
 General characteristics
 Bacteria that occurs singly or in pairs
(Klebsiella)
 Motile (except for Shigella and Klebsiella)
with peritrichous flagella
 Unencapsulated
 Glucose fermenters
 Produce endotoxin and may invade the
bloodstream causing bacteremia and
septicemia
 Escherichia coli: The Most Prevalent
12
Enteric Bacillus
 Most common aerobic and non-fastidious
bacterium in gut
 150 strains
 Some have developed virulence through
plasmid transfer, others are opportunists.
Pathogenic Strains of E.coli
 ESCHERICHIA AND GI
DISEASE
E coli O157 serotype
 ISTHE MOST IMPORTANT EHE C Infection
 Causes outbreaks and sporadic cases
worldwide
 Food and unpasteurized milk important in
spread
 Prevented by refraining from eating raw or
undercooked beef or drinking raw milk
 ESCHERICHIA AND GI
DISEASE
 E coli O157
serotype
 Causes:
 Hemorrhagic colitis
 Hemolytic Uremic
Syndrome
 Thrombotic,
thrombocytopenic
purpura
 Also known as
“hamburger
syndrome”
 Dairy and beef cattle
as reservoirs
 Escherichia coli
 Opportunistic normal flora of the large
intestines
 Synthesize vitamin K
 With 3 antigenic types:
 Ag H: flagellar antigen, used for specie
identification
 Ag O: cell wall or somatic antigen
 Ag K: capsular antigen

11/02/21 16
 Strains of e. coli
 E. coli var. communior
 E. coli var communis
 E. aurescens
 Cultivation
 EMB- greenish metallic sheen
 MacConkey- pinkish colonies

 Biochemical
 TSI- A/A w/gas
 IMViC- ++--
Escherichia coli
With 4 pathogenic strains:
 ETEC (Enterotoxigenic E. coli)
( Produce toxin that result in diarrhea syndrome )
 Voluminous
 Watery
 Non-blood streaked
 Non-mucoid
 Borborygmy
 Managed primarily by fluid replacement
 Antibiotics are not indicated
 Causes summer outbreaks of diarrhea, traveler's
diarrhea
 EIEC (Enteroinvasive E. coli)

Causes invasion of tissues outside of the

intestinal tract
 Most common cause of UTI in women
 May also cause otitis media and meningitis in
children
 Managed with appropriate antibiotics:
 Co-trimoxazole
 Quinolones
 EPEC (Enteropathogenic E. coli)

 Invasive to the GI tract in

immunocompromised individuals
 Causes dysentery symptoms in infantile
diarrhea
 Antimicrobial management includes:
 Ampicillin
 Cephalosporin (2nd or 3rd generation)
 Chloramphenicol
 Aminoglycosides
 EHEC ( VTEC )-
enterohemorrhagic e. coli
 Shigella like toxin
 Destroy intestinal mucosa
 Bloddy diarrhea
 Klebshiella pneumoniae
 Friedlander’s bacilli
 Capsulated rod
 Enteritis
 Pneumonia
 Septicemia
 meningitis
 Biochemical
 TSI- A/A w/ gas
 IMViC- --++
 Other species
 K. oxytoca
 K. ozaenae- atrophic rhinitis
 K. rhinoscleromatis- granulomatous
destruction of the nose
 Paratyphoid fever
 Caused by Salmonella paratyphosa
 Produces a milder form of typhoid infection

Non-typhoidal gastroenteritis
 Caused by Salmonella enteritidis
 Nausea, vomiting, watery diarrhea

11/02/21 30
 Other salmonella
 Enteric fever
 S. typhi- Eberth’s bacilli
 S. paratyphi A

 Septicemia
 S. paratyphi B ( s. scotmuelleri )
 S. paratyphi C ( s. hirschfeldi )
 S. typhimurium
 S. cholerasuis
 Gastroenteritidis
 s. gastroenteriditis- ( Gartner’s bacilli )
 S. typhimurium
 S. paratyphi A and B
 Salmonella
 Cause typhoid fever
 Source: contaminated food and drink
 Transmitted by fecal-oral route, direct contact
 Enteric fever with dysentery symptoms:
 Tenesmus
 Blood-streaked stools
 Mucoid stools
 Crampy abdominal pain
 Fever
 Bacteria invades Peyer’s patches w/c
causes internal bleeding
 Person is communicable throughout the
duration of fecal excretion of bacteria
 Infection confers life long immunity
 Typhoid Fever/ Salmonella
36
typhi
 Bacillus enters with ingestion of fecally
contaminated food or water; occasionally spread
by close personal contact; ID 1,000-10,000 cells
 Asymptomatic carriers; some chronic carriers
shed bacilli from gallbladder
 Bacilli adhere to small intestine, cause invasive
diarrhea that leads to septicemia
 Treat chronic infections with chloramphenicol or
sulfa-trimethoprim
 2 vaccines for temporary protection
37
SALMONELLA
CLINICAL MANIFESTATIONS
 Salmonella  Hemorrhagic E.
 Nausea Coli
 Vomiting  Bloody diarrhea
 Abdominal cramps  Severe abdominal
 Diarrhea cramps
 Fever  Urinary tract infection
 Headache  can lead to death
 TYPHOID FEVER:
Presence of rose
spots – rashes on the
upper abdomen
 Dx: typhidot, blood culture (1st week), urine culture
(1st 2 weeks), stool culture ( throughout the
illness), BM aspirate culture
 Treatment: Chloramphenicol, Co-trimoxazole
 Vaccine is preventive (active immunity)
 With O- somatic,H- flagellar, V1 antigen- capsular
 test
 TSI-Alk/A
 IMViC- -+-+
 Shigella
 S. dysenteriae- Shiga bacilli
 S. flexneri- Strong bacilli
 S. boydii- Boyd’s bacilli

 S. sonnei- Sonneduval bacilli (most

common)
Shigella and Bacillary Dysentery
 Infection confers short term immunity
 Most common cause of bloody diarrhea
among infants and children in the
Philippines
 Transmitted by contaminated food and
water
 Person is communicable as long as he
excretes the bacteria
 Shigella and Bacillary
46
Dysentery
 Shigellosis – incapacitating dysentery
 S. dysenteriae, S. sonnei, S. flexneri and S. boydii
 Human parasites
 Invades villus of large intestine, can perforate
intestine or invade blood
 Enters Peyer’s patches instigate inflammatory
response; endotoxin and exotoxins
 Treatment – fluid replacement and ciprofloxacin and
sulfa-trimethoprim,Co-trimoxazole
 Presents with:
 Watery diarrhea
 Tenesmus
 Abdominal cramps
 fever
 test
 TSI- alk/a
 IMViC- V+--
SHIGELLA
SHIGELLA
 Vibrio
 Gram (-) coma shaped or S shaped rods
 Aerobic, motile with monotrichous flagella
 Glucose fermenting, oxidase positive
 Halophilic bacteria
 Family Vibrionaceae
 Curved or straight
rods capable of
aerobic and
anaerobic growth
 Non-spore formers
 Primarily found in
water
 Family includes 3
genera, the most well-
known being Vibrio
 Vibrio cholerae
 Pathology  clinical Findings
 Only pathogenic to
humans under normal
conditions
 Infection occurs with
ingestion of 108 – 1010
 Non-invasive
 Virulent organisms are
attached to the
microvilli of the brush
borders
 Multiply and liberate
cholera toxin, and
endotoxins
 Incubation period of 1-4
days, sudden onset of
nausea and vomiting,
profuse diarrhea with
abdominal cramps
 “rice water stools”
contain epithelial cells
and the microbe
 Rapid loss of fluids and
electrolytes, circulatory
collapse, anuria
 Mortality is 25-50% if
without treatment
MANIFESTATIONS
VIRULENCE FACTORS
 v. cholerae
 aka Asiatic cholera or El Tor
 Produce a very potent exotoxin resulting
in explosive diarrhea w/ a characteristic
“rice watery” stool
 May result in hypovolemia, shock and
metabolic acidosis
 TREATMENT
 Adequate fluid and electrolyte replacement
 Correction of sodium, glucose and chloride
to physiologic levels
 Antimicrobial therapy shortens the
duration of the diarrhea and magnitude of
the fluid loss
 Erythromycin, Tetracycline
 Other vibrio
 Vibrio parahemolyticus – causes summer
outbreaks of self-limiting diarrhea
associated with ingestion of seafoods
 Vibrio fetus
 Campylobacter jejuni Enteritis
62
 Important cause of bacterial gastroenteritis
 Transmitted by beverages and food
 Reach mucosa at the last segment of small intestine
near colon; adhere, burrow through mucus and
multiply
 Heat-labile enterotoxin CJT stimulates a secretory
diarrhea like that of cholera.
 Symptoms of headache, fever, abdominal pain,
bloody or watery diarrhea
 Treatment with rehydration and electrolyte balance
therapy
63

 Campylobacter fetus – opportunistic

pathogen that infects debilitated
persons or women late in pregnancy
 Meningitis, pneumonia, arthritis, fatal
septicemia in the newborn
 Helicobacter pylori: Gastric
64
Pathogen
 Curved cells discovered in 1979 in stomach
biopsied specimens
 Causes 90% of stomach and duodenal ulcers;
apparent cofactor in stomach cancer
 People with type O blood have a 1.5-2X higher
rate of ulcers.
 Produces urease which converts ammonium and
bicarbonate into alkaline products that neutralize
stomach acid
Other enterobactericeae
 Proteus
 P. vulgaris
 P. mirabilis
 Proteus vulgaris
ordinarily harmless saprobes in soil, manure,
sewage, polluted water, commensals of
humans and animals
 Proteus sp. - swarm on surface of moist agar in a
concentric pattern
 involved in UTI, wound infections, pneumonia,
septicemia, and infant diarrhea
 Edwardshiella
 E. tarda- wound infection, gastroenteritis
 Citrobacter
 C. freudii
 Arizona
 A. hinshawii- birds and reptiles
 Serratia
 S. marcescens, liquifaciens, rubidasa
 Nosocomial infection

 Morganella
 M. morganii
 Providencia
 P. rettgeri
 Yersinia pestis

 Zoonotic infection, rodents are reservoirs

 Transmitted to humans by rat fleas
(Xenopsylla cheopsis)
 Obligate intracellular parasite
 Causes bubonic plague (black death)
 Treatment: Streptomycin, Tetracycline
 Strict quarantine of patients, rodent and
vector control as well as vaccines are
preventive
 Yersinia pestis
71

 Humans develop plague through contact with

wild animals (sylvatic plague) or domestic or
semidomestic animals (urban plague) or infected
humans.
 Found in 200 species of mammals – rodents,
without causing disease
 Flea vectors – bacteria replicates in gut,
coagulase causes blood clotting that blocks the
esophagus; flea becomes ravenous
72
 Pathology of Plague
73
 ID 3-50 bacilli
 Bubonic – bacillus multiplies in flea bite, enters lymph,
causes necrosis and swelling called a bubo in groin or
axilla
 Septicemic – progression to massive bacterial growth;
virulence factors cause intravascular coagulation
subcutaneous hemorrhage and purpura – black plague
 Pneumonic – infection localized to lungs, highly
contagious; fatal without treatment
 TSI- alk/a
 IMViC- -+--

 Y. psudotuberculosis
 Y. enterocolitica
Non fermentative group
 Pseudomonas
77  Small Gram-negative rods with a single polar
flagellum
 Free living
 primarily in soil, sea water, and fresh water;
also colonize plants and animals
 Important decomposers and bioremediators
 Frequent contaminants in homes and clinical
settings
 Water bug organism
 Oxidase +
 Polar flagella
 Use aerobic respiration; do not ferment
carbohydrates
 Produce oxidase and catalase
 Many produce water soluble pigments.
79
 Pseudomonas aeruginosa
80

 Common inhabitant of soil and water

 Intestinal resident in 10% normal people
 Resistant to soaps, dyes, quaternary
ammonium disinfectants, drugs, drying
 Frequent contaminant of ventilators, IV
solutions, anesthesia equipment
 Opportunistic pathogen
 Pseudomonas aeruginosa
81
 Common cause of nosocomial infections in
hosts with burns, neoplastic disease, cystic
fibrosis
 Complications include pneumonia, UTI,
abscesses, otitis, and corneal disease
 Endocarditis, meningitis, bronchopneumonia
 Grapelike odor
 Pseudomonas
 Greenish-blue pigment (pyocyanin)
 Multidrug resistant
 Cephalosporins, aminoglycosides,
carbenicillin, polymixin, quinolones, and
monobactams
 P. aeroginosa
 Wound infection
 Otitis media
 Cystic fibrosis
 Meningitis
 UTI
 Pneumonia
 Secondary burn infection
 Nosocomial infection
 Other pseudomonas
 P. mallei- Glander’s bacillus
 P. pseudomallei
 P. maltophilia- URTI
 Alcaligenes faecalis
 Acinetobacter group
 Herella vaginicola
 Bacterium anitratum
 Achromobacterium anitratum
 Acinetobacter anitratum
 Acinetobacter calcoaceticus
 Moraxella group
 M. lacunata- blepharo-conjunctivitis
 M. osloensis

 Flavobacterium group
 F. meningosepticum
Small gram negative
 Haemophilus group
 Aerobic
 Non spore former
 Respiratory tract
 Meninges
 Conjunctiva
 Genito-urinary tract
 Species
 H. influenzae
 Pfeiffer’s bacilli
 Meningitis, otitis media
 Secondary invadeer of influenza
 ACUTE EPIGLOTTITIS
 Due to Haemophilus
influenzae Type B (HIB)
 Most often seen in
young children
 Severe inflammation
and edema of the
epiglottis
 Is AN EMERGENCY
◦ Necessitates intubation
◦ Treated with
cefotaxime,
chloramphenicol
 H. aegyptius
 Koch-Week’s bacilli
 Conjunctivitis ( pink-eye )

 H. haemolyticus
 H. parahaemolyticus
 H. parainfluenzae
 H. ducreyi
 Chancroid or ulcus molle
 Erythromycin
 Trimethropim
 Ciprofloxacin
 azithromycin
Hemophilus ducreyii
 Bordatella pertussis

 grown in Bordet-Gengou agar forming

mercury drop colonies
 Causes pertussis or whooping cough in
unimmunized children below 8 yrs. old,
natural immunity develops in children
above 8 y/o
 DPT vaccine is preventive
 Bordetella pertussis
96

 Minute, encapsulated coccobacillus

 Causes pertussis or whooping cough, a
communicable childhood affliction
 Acute respiratory syndrome
 Often severe, life-threatening complications in
babies
 Reservoir – apparently healthy carriers
 Transmission by direct contact or inhalation of
aerosols
 Bordetella pertussis
97
 Virulence factors
 receptors that recognize and bind to
ciliated respiratory epithelial cells
 toxins that destroy and dislodge ciliated
cells
 Loss of ciliary mechanism leads to buildup
of mucus and blockage of the airways.
 Vaccine – DTaP- acellular vaccine contains
toxoid and other Ags
Bordatella pertussis
 species
 B. parapertusis
 B. broncoseptica

 DOC: Erythromycin,azithromycin
 Francisella tularensis

 Zoonotic infection transmitted from rodents and

rabbits or their infected ticks (Dermacentor ticks)
 Causes tularemia, rabbit fever, deerfly fever:
 Skinulcer
 Swollen painful regional lymph nodes
 Fever
 No spread from person to person
 Treatment: Streptomycin, vaccine
 Brucella

 Primarily an animal pathogen infecting

cows, goats, pigs
 Causes Human brucellosis, Malta fever,
Undulent fever
 Bacteria enters through:
 abrasions in the skin
 Ingestion of contaminated milk and dairy
products
 Respiratory route (most common)
 Manifests w/ flu-like symptoms (on and off
fever)
 Treatment: Tetracycline, Streptomycin,
Co-trimoxazole
 Species
 B. abortus
 B. melitensis
 B. suis
 B. neotamae
 B. ovis
 B. canis
 Miscellaneous Gram negative
 Bacteroides fragilis
 Fusobacterium nucleatum
 Oral infection, lung abscess
 Bartonella bacilliformis
 Oroya fever
 Verruca peruana
 Eikenella corrodens
 URTI
 gastrointestinal
 Chromobacterium violaceum
 Septicemia, lung, liver, subcutaneous
abscess
 Gardnerella vaginitis
 Clue cells
 Legionella pneumophillia
 Erthyromycin
 Legionnaire’s disease
 with diarrhea, mental confusion, and/or hepatorenal
dysfunction
 Discovered after epidemic of pneumonia of unknown
cause among American Legion members in a
convention
 From air conditioners
 Legionnaire’s Disease
 Legionella pneumophila