 Gram negative rods

 Can be found in soil, water, and vegetation

 Infection can originated from an animal
reservoir, human carrier, or through
endogenous spread of organism
 Facultative anaerob and have simple nutritional
requirement
 Catalase positive, oxidase negative
 Lactose fermenting strain :
Escherichia, Klebsiella, Enterobacter, Citrobacter, Serratia
 Doesnt-ferment-lactose strain
Proteus, Salmonela, Shigella, Yersinia
 LPS is the major cell wall antigen, consist of 3
component
◦ O polysaccharide  determine the classification of the
strain
◦ Core polysaccharide (enterobacterial common antigen)
◦ Lipid A  endotoxin activitiy
 Epidemic classification based on
◦ Somatic O polysaccharide
◦ K antigen
◦ H protein
 Motile, except Klebsiella, Shigella, Yersinia
 Beside flagella, enterobacteriaceae also
possess fimbriae which have been divided to
2 class : common fimbriae and conjugative
pilli
 Endotoxin
◦ Virulence factor among aerobic and anaerobic organism
◦ Depends on Lipid A
◦ Activation of complement, release of cytokines,
leukocytosis, thrombocytopenia, DIC, fever, shock, death
 Capsule
◦ Protect bacteria from phagocytosis by the hydrophilic
capsular antigen, which repel the hydrophobic
membrane of phagocytic cell
◦ Poor immunogen
 Antigenic Phase Variation
◦ Variation of 3 major antigen evade bacteria from
antibody mediated cell death
 Type III Secretion System
◦ Yersinia, Salmonella, Shigella, EPEC, Pseudomonas,
Chlamydia have this system
◦ This system help organism to transfer bacterial virulence
factor to the cell target
 Sequestration of Growth Factor
◦ Bacteria need iron as its growth factor. Because of that,
bacteria produce siderophores or enterobactin, aerobactin
to bind the iron
 Resistance of Serum Killing
◦ Bacterial capsule can protect organism from serum killing
 Antimicrobial Resistance
◦ The antibiotic resistance can be encoded on transfable
plasmid and exchanged among species, genera, and even
families of bacteria
 Pathogenesis and Immunity
◦ It has 2 more virulence factor : adhesins and
exotoxin
 Epidemiology
◦ ETEC : CFA LT; ST
◦ EPEC : BFP
◦ EAEC : AAF ST
◦ EHEC : BFP shiga toxin
◦ EIEC : Invasive plasmid antigen hemolysin
◦ Uropathogen : P pili
 Clinical disease
◦ Gastroentertitis
 ETEC, EPEC, EAEC  secretory diarrhea in small int
 EHEC, EIEC  secretory diarrhea in large int
 ETEC
 Traveler’s diarrhea
 Fecal oral
 The symptoms similir to cholera, but are usually milder
 LT = similir to cholera toxin, bind to GM1  increase cAMP 
enhanced secretion of chloride and stop absorption of sodium and
chloride
 ST = bind to guanylate cyclase  increase CGMP  hypersecretion
 CFA is fimbriae that recognize host glycoprotein receptor
 EPEC
 Major cause of infant diarrhea
 Watery diarrhea, fever, vomit
 Attach to int. Tenue epithelial cell  destruction of villi
 Formation of colonies on epithelial cell mediated by BFP
 Tir is inserted to cell host and the has function as a receptor for an
outer membrane bacterial adhesin, intimin  cell death
 EAEC
 Persisten watery diarrhea
 Chronic diarrhea and growth retardation
 Autoaggutination in a stacked brick arrangement, mediated
by AAF I
 Adhere to surface of the intestine  formation of thick biofim
 protect bacteria from antibiotic and phagocytic cell
 EHEC
 Developed countries, young children
 Diarrhea – hemorrhagic colitis, no high fever
 Complication = HUS
 Shiga toxin bind to intestinal villi and renal endothelial cell
because they have Gb3
 EIEC
 Watery diarrhea, fever, abdominal cramps
 pInv genesmediate bacterial invasion into the colonic
epithelium  replicate in the cell cytoplasm  cell
destruction
◦ UTI
 E coli is particulary virulent to urinary tract because it
has adhesin and hemolysin
◦ Neonatal Meningitis
 E coli and Streptococcus group B are the major cause
of CNS infection in infants
◦ Septicemia
 Originate from UT or GI
 Mortality is high
 Salmonella enterica
 It has various serotype, commonly listed as
individual species (Salmonella Typhii, Salmonella
Choleraesuis, Salmonella Typhimurium,
Salmonella Enteridis)
 Pathogenesis and Immunity
◦ Salmonella attach to the mucosa of the small intestine
and invade to M cells  stay in endocytic vacuole,
replicate  released into blood and lymphatic circulation
◦ Regulation is controlled by pathogenicity island I and II
◦ Pathogenicity island I  Ssps and type III secretion
system
◦ Pathogenicity island II  allow bacteria to evade the
host’s immune response
 Epidemiology
◦ Most infectious results from the ingestion of
contaminated food
◦ Common source of human infection are poultry, eggs,
dairy products
 Clinical dease
◦ Gastroenteritis
 Nausea vomit non bloody diarrhea
◦ Septicemia
 Can occur localized suppurative infections
◦ Enteric fever
 Thypoid fever or parathypoid fever
 Fever headache malaise myalgia
 Pathogenesis and immunity
◦ Invading and replicating in the colon
◦ Attach to M cells  secretion of IpaA IpaB IpaC and IpaD
into epithelial cells
◦ Replicate in cytoplasma
◦ Shigella survive phagocytosis by inducing apoptosis,
also lead to release of IL 1  bacteria can reach deeper
tissue
◦ Produce shiga toxin
 Clinical disease
◦ Abdominal cramps diarrhea fever bloody stools
◦ First sign is watery diarrhea
◦ Tenesmus ani and lower abdminal cramps, pus and
blood in stool
 Pathogenesis and immunity
◦ Has ability to resist phagocytic killing
◦ Has 2 plasmid : f1 gene and plasminogen activator
protease gene which degrade C3b and C5a
 Clinical disease
◦ Bubonic plague
 Bitten by infected flea
 High fever and painful bubo in groin and axilla
◦ Pneumonic plague
 Fever and malaise
 Spread by aerosol
◦ enterocolitis
 Diarrhea fever and abdominal pain
 Can mimic acute appendicitis
 Culture
◦ MacConkey agar, EMB agar
◦ S MAC for E coli O157
◦ Cold enrichment permits the growth of yersinia but
inhibit or kill other organism
 Serologic
◦ Useful for EHEC and Y. enterocolitica
 EHEC and Salmonella gastroenteritis =
symptomatic relief, antibiotic can make this
organism cause secondary complication
 Carbapenem
 There is vaccine for Typhi, administered in
multiple doses and require booster
immunization