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Chapter 16 - : Enterobacteriaceae
Chapter 16 - : Enterobacteriaceae
Enterobacteriaceae
Characteristics
Dry, pink (lactose positive) colony
with surrounding pink area on
MacConkey
Escherichia coli (cont’d)
Ferments glucose, lactose,
trehalose, & xylose
Positive indole and methyl red tests
Does NOT produce H2S or
phenylalanine deaminase
Simmons citrate negative
Usually motile
Voges-Proskauer test negative
Escherichia coli (cont’d)
Infections
Wide range including meningitis,
gastrointestinal, urinary tract,
wound, and bacteremia
Gastrointestinal Infections
• Enteropathogenic (EPEC) – primarily in
infants and children; outbreaks in
hospital nurseries and day care
centers; stool has mucous but not
blood; identified by serotyping
Escherichia coli (cont’d)
• Enterotoxigenic (ETEC) – “traveler’s
diarrhea”; watery diarrhea without
blood; self-limiting; usually not
identified, other than patient history
and lactose-positive organisms cultured
on differential media
• Enteroinvasive (EIEC) – produce
dysentery with bowel penetration,
invasion and destruction of intestinal
mucosa; watery diarrhea with blood; do
NOT ferment lactose; identified via
DNA probes
Escherichia coli (cont’d)
• Enterohemorrhagic (EHEC serotype
0157:H7) – associated with
hemorrhagic diarrhea and hemolytic-
uremic syndrome (HUS), which includes
low platelet count, hemolytic anemia,
and kidney failure; potentially fatal,
especially in young children;
undercooked hamburger, unpasteurized
milk and apple cider have spread the
infection; does NOT ferment sucrose;
identified by serotyping
Escherichia coli (cont’d)
• Enteroaggregative (EaggEC) – cause
diarrhea by adhering to the mucosal
surface of the intestine; watery
diarrhea; symptoms may persist for
over two weeks
Urinary Tract Infections
• E. coli is most common cause of UTI
and kidney infection in humans
• Usually originate in the large instestine
• Able to adhere to epithelial cells in the
urinary tract
Escherichia coli (cont’d)
Septicemia & Meningitis
• E. coli is one of the most common causes of
septicemia and meningitis among neonates;
acquired in the birth canal before or during
delivery
• E. coli also causes bacteremia in adults,
primarily from a genitourinary tract infection
or a gastrointestinal source
Escherichia hermannii – yellow pigmented;
isolated from CSF, wounds and blood
Escherichia vulneris - wounds
Klebsiella, Enterobacter,
Serratia & Hafnia sp.
Usually found in intestinal tract
Wide variety of infections, primarily
pneumonia, wound, and UTI
General characteristics:
Some species are non-motile
Simmons citrate positive
H2S negative
Phenylalanine deaminase negative
Some weakly urease positive
MR negative; VP positive
Klebsiella species
Usually found in GI tract
Four major species
K. pneumoniae is mostly commonly isolated
species
Possesses a polysaccharide capsule, which
protects against phagocytosis and
antibiotics AND makes the colonies moist
and mucoid
Has a distinctive “yeasty” odor
Frequent cause of nosocomial pneumonia
Klebsiella species (cont’d)
Significant biochemical reactions
• Lactose positive
• Most are urease positive
• Non-motile
Enterobacter species
Comprised of 12 species; E. cloacae
and E. aerogenes are most common
Isolated from wounds, urine, blood
and CSF
Major characteristics
Colonies resemble Klebsiella
Motile
MR negative; VP positive
Enterobacter species
(cont’d)
Serratia species
Seven species, but S. marcescens is
the only one clinically important
Frequently found in nosocomial
infections of urinary or respiratory
tracts
Implicated in bacteremic outbreaks
in nurseries, cardiac surgery, and
burn units
Fairly resistant to antibiotics
Serratia species (cont’d)
Major characteristics
Ferments lactose slowly
Produce characteristic pink pigment,
especially when cultures are left at
room temperature
S. marscens on
nutrient agar →
Hafnia species
Hafnia alvei is only species
Has been isolated from many
anatomical sites in humans and the
environment
Occasionally isolated from stools
Deaminate phenylalanine
S. flexneri (Group B)
S. boydii (Group C)
S. sonnei (Group D)
Shigella (cont’d)
Characteristics
Non-motile
Do not produce gas from glucose
Do not hydrolyze urea
Do not produce H2S on TSI
Lysine decarboxylase negative
ONPG positive (delayed lactose +)
Fragile organisms
Possess O and some have K antigens
Shigella (cont’d)
Clinical Infections
Cause dysentery (bloody stools, mucous,
and numerous WBC)
S. sonnei is most common, followed by S.
flexneri (“gay bowel syndrome”)
Humans are only known reservoir
Oral-fecal transmission
Fewer than 200 bacilli are needed for
infection in health individuals
Shigella (cont’d)
Yersinia species
Consists of 11 named species
Yersinia pestis
Causes plague, which is a disease primarily
of rodents; transmitted by fleas
Two forms of plague, bubonic and
pneumonic
Gram-negative, short, plump bacillus,
exhibiting “safety-pin” or “bipolar”
staining
Yersinia species
Yersinia enterocolitica
Most common form of Yersinia
Found worldwide
Found in pigs, cats and dogs
Human also infected by ingestion of contaminated
food or water
Some infections result from eating contaminated
market meat and vacuum-packed beef
Is able to survive refrigerator temperatures (can
use “cold enrichment” to isolate)
Mainly causes acute gastroenteritis with fever
Yersinia species
Yersinia pseudotuberculosis
Pathogen of rodents, particularly
guinea pigs
Septicemia with mesenteric
lymphadenitis, similar to
appendicitis
Motile at 18 to 22 degrees C
Laboratory Diagnosis of
Enterics
Collection and Handling
If not processed quickly, should be
collected and transported in Cary-
Blair, Amies, or Stuart media
Isolation and Identification
Site of origin must be considered
Enterics from sterile body sites are
highly significant
Routinely cultured from stool
Laboratory Diagnosis of
Enterics (cont’d)
Media for Isolation and
Identification of Enterics
Most labs use BAP, CA and a
selective/differential medium such
as MacConkey
On MacConkey, lactose positive are
pink; lactose negative are clear and
colorless
Laboratory Diagnosis of
Enterics (cont’d)
For stools, highly selective media,
such as Hektoen Enteric (HE), XLD,
or SS is used along with MacConkey
agar
Identification
Most labs use a miniaturized or
automated commercial identification
system, rather than multiple tubes
inoculated manually
Laboratory Diagnosis of
Enterics (cont’d)
Identification (cont’d)
All enterics are
• Oxidase negative
• Ferment glucose
• Reduce nitrates to nitrites
Laboratory Diagnosis of
Enterics (cont’d)
Common Biochemical Tests
Lactose fermentation and utilization
of carbohydrates
Triple Sugar Iron (TSI)
ONPG
Glucose metabolism
• Methyl red
• Voges-Proskauer
Laboratory Diagnosis of
Enterics (cont’d)
Common Biochemical Tests (cont’d)
Miscellaneous Reactions
• Indole
• Citrate utilization
• Urease production
• Motility
• Phenylalanine deaminase
• Decarboxylase tests
Screening Stools for
Pathogens
Because stools have numerous
microbial flora, efficient screening
methods must be used to recover
any pathogens
Enteric pathogens include
Salmonella, Shigella, Aeromonas,
Campylobacter, Yersinia, Vibrio, and
E. coli 0157:H7
Screening Stools for
Pathogens (cont’d)
Most labs screen for Salmonella,
Shigella, and Campylobacter; many
screen for E. coli 0157:H7
Fecal pathogens are generally
lactose-negative (although Proteus,
Providencia, Serratia, Citrobacter
and Pseudomonas are also lactose-
negative)