4C: Gram Negative Rods - 1St Half Of Pp (1-21)

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About Gram negative bacilli group

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Large, diverse group of non-spore forming bacteria

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Many of the members of the gram negative bacilli group are

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Not medically important but are prevalent in the environment

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Kinds of pathogens of Gram negative bacilli group (2)

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1) Some are true pathogens

2) Some are opportunistic pathogens

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Habitats of Gram negative bacilli (5)

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Wide range of habitats:

1) large intestines (enteric)

2) Zoonotic

3) Respiratory tract

4) Soil

5) Water

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All gram negative bacilli have this characteristic

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Outer lipopolysaccharide membrane of cell wall = endotoxin / endotoxic layer

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Nonenteric Aerobes- 4 species and what they cause

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1) Pseudomonas aeruginosa - Swimmers ear, misc.

2) Francisella tularensis - tularemia

3) Bordetella pertussis - whooping cough

4) Legionella pneumophila - pneumonia

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Pseudomonas aeruginosa habitat (5)

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1) Primarily water

2) Soil

3) Sewage

4) Air

5) Few in human intestine (10% carried as NF)

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Unique trait of Pseudomonas aeruginosa

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Produces a blue-green soluble pigment called pyocyanin which causes blue-green pus

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Pseudomonas aeruginosa causes infection where? (2)

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-In wounds and burns

-In people with cystic fibrosis

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Pseudomonas aeruginosa is resistant to (6)

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1) Soaps

2) Dyes

3) Quaternary ammonium

4) Disinfectants

5) Drying

6) Drugs

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Pseudomonas aeruginosa is a frequent contaminant of (3)

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1) Ventilators

2) IV solutions

3) Anesthesia equipment

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Pseudomonas aeruginosa is what kind of pathogen?

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Opportunistic pathogen

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Diseases of Pseudomonas aeruginosa (4)

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1) Wound infections

2) Meningitis

3) Respiratory tract infections

4) Eye infections (from contact lenses)

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Pseudomonas aeruginosa infects which type of people?

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Individuals with lowered resistance

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Pseudomonas aeruginosa is associated with what situation?

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Hot tub outbreaks

1) Skin rashes

2) UTI's

3) External ear infections

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Francisella tularensis causes

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Tularemia

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Tularemia

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Zoonotic dz. of mammals endemic to the northern hemisphere (particular to rabbits)

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Francisella tularensis is transmitted by (3)

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Contact with

1) Infected animal

2) Contaminated water and dust

3) Bites by vectors

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Symptoms of tularemia (6)

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1) Headache

2) Backache

3) Fever

4) Chills

5) malaise

6) Weakness

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Death rate of systemic and pulmonic tularemia

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10% death rate

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Francisella tularensis is what kind of organism?

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Intracellular

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Treatment against Francisella tularensis

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Gentamicin or tetracycline

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What kind of protection is available for tularemia?

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Attenuated vaccine

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Important fact of Francisella tularensis

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Potential bioterrorism agent (because it is so infectious)

-On terrorism watch list

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Bordetella pertussis causes

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Pertussis / whooping cough

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Whooping cough is...

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Very contagious childhood dz.

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Pertussis is primarily spread by

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Adults who's immunity from vaccine wanes

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Pertussis is a dz. that affects what area of body?

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Upper respiratory tract

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Prevention available for pertussis

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Vaccine - DTaP

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Diagnosis of pertussis (3)

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1) Nasopharyngeal swab

2) Direct antigen test

3) Serology

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Incubation period for pertussis lasts

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2 weeks

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2 Stages of pertussis

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1) Catarrhal stage

2) Paroxysmal stage

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Catarrhal stage (2)

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-Mild cough and sneezing

-Infectious stage even though person is not very sick

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Pertussis is spread through

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Respiratory droplets

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Paroxysmal stage

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An abrupt, hacking cough develops followed by a deep inhalation (=whoop)

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Paroxysmal stage leads to (Complications of pertussis)

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Vomiting, cyanosis and convulsions

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What Bordetella pertussis does to body

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Destroys ciliated cells of respiratory tract...leads to buildup of mucus in airways

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Main danger of destruction of ciliated cells

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Bronchopneumonia

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Legionella pneumophila causes

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Legionellosis

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Legionella pneumophila is distributed through

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Water (aqueous habitats)

-Showers

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Legionella pneumophila is transmitted through

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Aerosols

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Legionella pneumophila lives in close association with

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Amoebas (which helps its survival in these habitats)

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Epidemic of Legionellosis (Legionnaire's dz.)

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1976 epidemic of pneumonia afflicted 200 American Legion members attending a convention in Philadelphia and killed 29 ppl

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2 clinical forms of Legionellosis

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1) Legionnaires disease - high mortality rate

2) Pontiac fever - like a pneumonia fever

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Legionellosis is prevalent in which groups of people (2)

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-Males over 50

-Nosocomial disease in elderly patients with certain dz.'s

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Symptoms of Legionellosis (5)

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1) Fever

2) Cough

3) Diarrhea

4) Abdominal pain

5) Pneumonia with fatality rate of 3-30% (only in Legionnaire's dz.)

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Treatment for Legionellosis

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Azithromycin

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Enterobacteriaceae family - habitat

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Intestines of humans - Enterics

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About the Enterobacteriaceae family (3)

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1) Large family

2) Small, non-spore forming

3) Gram negative rods

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Other habitats of Enterobacteriaceae family (4)

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1) Soil

2) Water

3) Decaying matter

4) Common occupants of large bowel of animals (including humans)

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Main dz. caused by Enterobacteriaceae

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Diarrhea through enterotoxins

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50% of nosocomial infections are caused by

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Enterobacteriaceae and Pseudomonas sp.

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O2 requirements for Enterobacteriaceae family

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Facultative anaerobes but grow best in air

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Enterobacteriaceae family and their common traits (4)

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All:

1) Ferment glucose

2) Reduce nitrates to nitrites

3) Oxidase negative

4) Catalase positive

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There are 2 groups of Enterobacteriaceae in bowel

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1) Coliforms = lactose fermenters

2) Non-coliforms = Non-lactose fermenters

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When screening fecal samples for pathogenic organisms...

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Selective and differential medias are used to separate lactose fermenters and non-lactose fermenters (coliforms and non-coliforms)

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Antigenic structures and virulence factors of Enterobacteriaceae

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Have complex surface antigens that contribute to pathogenicity and trigger immune responses

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These surface antigens help to...

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Type the many different organism

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Different surface antigens of Enterobacteriaceae (3)

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1) H - flagellar ag.

2) K - capsule and / or fimbrial ag.

3) O - lipopolysaccharide ag. (all have)

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Virulence factors of Enterobacteriaceae (2)

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1) Endotoxin

2) Exotoxins

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Medically important Enterobacteriaceae and their dz.'s (5)

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1) Salmonella - gastroenteritis

2) Shigella - bacillary dysentery

3) Escherichia coli - diarrhea

4) Yersinia pestis - plague

5) Opportunistic coliforms - dz. in immunocompromised people

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The most prevalent enteric bacillus is

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Escherichia coli

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Escherichia coli is the most common

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Aerobic and non-fastidious bacterium in gut

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# of E. coli strains

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150

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Most strains are ... but some have ...

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1) Most strains are not highly infections

2) But some have developed virulence through plasmid transfer - and yet others are opportunists

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Pathogenic strains of E. coli (4)

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1) Enterotoxigenic E. coli

2) Enteroinvasive E. coli

3) Enteropathogenic E. coli

4) Enterohemorrhagic E. coli

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Enterotoxigenic E. coli (3)

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-Causes severe diarrhea due to both heat-labile toxin and heat-stable toxin

-Toxins stimulate secretion and fluid loss

-Has fimbriae

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Enteroinvasive E. coli

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-Causes inflammatory dz. of large intestine by invasion

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Enteropathogenic E. coli

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Linked to wasting form infantile diarrhea (still not well understood)

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Enterohemorrhagic E. coli

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-E. coli O157:H7 strain

-Causes hemorrhagic colitis syndrome and can lead to kidney damage

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One of the greatest causes of infant mortality

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Diarrhea (caused by E. coli)

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Species of opportunistic coliforms (4)

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1) Klebsiella pneumoniae

2) Enterobacter sp.

3) Citrobacter sp.

4) Serratia marcescens

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Klebsiella pneumoniae habitat

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Normal inhabitant of respiratory tract (that has traveled from gut to throat by stomach acid reducers)

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Virulence trait of K. pneumoniae

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Large capsule

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K. pneumoniae diseases (5)

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1) Nosocomial pneumonia

2) Meningitis

3) Bacteremia

4) Wound infections

5) UTI's

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Nosocomial pneumonia and K. pneumoniae

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Within 3 days, 100% of critical care pts. are colonized with gut flora in resp. tract

-->If they aspirate, they get pneumonias with fecal organisms such as K. pneumoniae

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Enterobacter sp. diseases (2)

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1) UTI's

2) Surgical wounds

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Citrobacter sp. diseases (2)

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1) Opportunistic UTI's

2) Bacteremia

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Serratia marcescens diseases (4)

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1) Pneumonia

2) Burn and wound infections

3) Septicemmia

4) Meningitis

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Unique characteristic of S. marcescens

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Produces a red pigment

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Other opportunists (3)

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1) Proteus and its relatives:

2) Morganella morganii

3) Providencia sp.

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Proteus and its relatives habitat

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Normally they are harmless saprobes in:

1) Soil

2) Manure

3) Polluted water

4) Sewage

And are also:

5) Commensals of humans/animals

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Saprobes

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Organisms that live in decaying organisms

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Commensals

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Organisms that live on / with another organism without causing harm

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Unique trait of Proteus sp.

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Swarm on surface of moist agar in concentric pattern

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Proteus sp. diseases (5)

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1) UTI's

2) Wound infections

3) pneumonia

4) Septicemia

5) Infant diarrhea

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Morganella morganii and Providencia sp. diseases (2)

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1) Involved in similar infections as Proteus sp.

2) Big in UTI's in long term care facilities

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Salmonella and Shigella are what kind of pathogens?

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True (primary) pathogens - not normal human flora

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Characteristics of Salmonella and Shigella

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Well developed virulence factors

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Salmonella and Shigella diseases (2)

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1) Show some gastrointestinal involvement and diarrhea

2) Often affect other systems

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Salmonella typhi (about)

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Most serious pathogen of the genus

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Salmonella typhi disease

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Typoid fever

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Host of Salmonella typhi

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Human host

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Salmonella enteritidis and variation of organism

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Includes 1,700 different serotypes based on variation on O, H, and V(i) antigens

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Characteristic of S. enteritidis (3)

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1) Flagellated

2) Survive outside the host

3) Resistant to chemicals (biles and dyes)

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Infection with typhoid fever (2 steps)

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1) Bacillus enters with ingestion of fecally contaminated food or water

-Occassionally spread by close personal contact

2) Bacilli adhere to SMALL intestine and cause invasive diarrhea that leads to septicemia

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Typhoid fever carriers

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There can be asymptomatic carriers and chronic carriers that shed the bacilli from their gallbladder (to intestines and exit through feces)

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Treatment for typhoid fever

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Chloramphenicol or sulfatrimethoprim

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Prevention available for typhoid fever

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2 vaccines for temporary protection (travelers and military personnel)

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Nontyphoidal Salmonelloses / Animal Salmonelloses

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Animal Salmonelloses - Salmonelloses other than typhoid fever are called enteric fevers

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Examples of enteric fevers (2)

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1) Salmonella food poisoning

2) Gastroenteritis

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Animal Salmonelloses compared to typhoid fever

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Animal Salmonelloses are less severe than typhoid fever but more prevalent

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Animal Salmonelloses are caused by

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One of many serotypes of Salmonella enteritidis

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Animal Salmonelloses origin

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Zoonotic in origin but humans can become carriers

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Animals of origin of Animal Salmonelloses (4)

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1) Cattle

2) Poultry

3) Rodents

4) Reptiles

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Spread of Animal Salmonelloses

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1) Contaminated animal and dairy products

2) Fomites contaminated with animal intestinal flora

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Shigellosis

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Incapacitating dysentery

-Crippling abdominal cramps; frequent defecation of watery/bloody stools

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Shigellosis causing organisms

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1) S. dysenteriae

2) S. sonnei

3) S. flexneri

4) S. boydii

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Infection with Shigella (3 steps)

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1) Invades villus of LARGE intestine (does not perforate intestine or invade blood)

2) Enters intestinal mucosa through Peyer's patches

3) Instigates inflammatory response by means of endotoxin and exotoxins once inside the mucosa

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Treatment for Shigellosis (2)

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1) Fluid replacement

2) Ciprofloxacin and Sulfatrimethoprim

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Transmission of Shigella (4)

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Via feces transferred to:

1) Food

2) Flies

3) Fingers

4) Fomites

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Yersinia pestis disease

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The plague

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How humans contract the plague (3)

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Through contact with

1) wild animals

2) domestic / semidomestic animals

3) Infected humans (rare)

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The plague is found in ...

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200 species of mammals (especially rodents) which don't develop the disease

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Pathway of transmission (3 steps)

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1) primary host

2) Other mammals

3) Human

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Primary agent of transmission of the plague

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Flea vectors

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How the plague affects fleas (3 steps)

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1) Bacteria replicates in gut

2) Coagulase causes blood clotting that blocks the esophagus

3) Flea becomes ravenous and jumps from animal to animal biting them - regurgitates infectious bacteria into bite wound

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2 types of the plague

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1) Bubonic plague - affects lymph nodes

2) Pneumonic plague - affects lungs

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Transmission of Bubonic plague

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Animal to human via a vector

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Transmission of pneumonic plague

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Person to person transmission

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Infectious dose of Yersinia pestis

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3-50 bacilli

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Infection with Bubonic plague (3 steps)

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1) Bacillus multiplies in flea bite

2) Enters lymph

3) Causes necrosis and swelling of node called bubo in groin or axilla

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Infection wiith septicemic plague

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Progression to massive bacterial growth in blood

2) Virulence factors cause intravascular coagulation, subcutaneous hemorrhage and purpura

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Purpura

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Purple or brownish - red spots on skin from diffusion of blood (in skin)

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Septicemic plague is known as

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Black plague because of the visible necrosis and darkening of skin

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Infection with pneumonic plague (3-About)

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1) Infection is localized to lungs

2) It is highly contagious

3) Fatal without treatment

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Non-enteric pathogens and diseases they cause (3)

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1) Haemophilus influenzae - epiglottitis / meningitis

2) Haemophilus aegyptius - pink eye

3) Gardnerella vaginalis - vaginitis

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Haemophilus requirements

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Fastidious organism

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Specific requirements of Haemophilus

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X (hemin) and V (NAD) = Components inside RBC's

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2 pathogenic species of Haemophilus

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1) Haemophilus influenzae

2) Haemophilus aegyptius

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Haemophilus influenzae habitat

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Found in throat of 1/3 of normal people

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H. influenzae is seen in what disease?

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Pneumonia - person aspirates their own normal flora

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Virulence factor of H. influenzae

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Capsule - of some forms such as Type B

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Prevention for Type B H. influenzae

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HIB vaccine

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Haemophilus influenzae diseases (3)

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1) Meningitis

2) Epiglottitis

3) Otitis media

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Haemophilus aegyptius disease

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Pink eye / conjunctivitis

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Treatment of conjunctivitis

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Antibiotics (if bacterial)

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Infectiousness of H. aegyptius

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Secretions are highly infectious

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Gardnerella vaginalis disease

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Causes (bacterial) vaginitis

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Transmission of Gardnerella vaginalis

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Sexually transmitted

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Signs of bacterial vaginitis (2)

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1) Can see clue cells ( squamous epithelial cell with many adherent gram variable bacteria)

2) Fishy odor of secretions

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Curved gram negatives (4)

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1) Vibrio cholerae - cholera

2) Vibrio parahemolyticus - diarrhea

3) Campylobacter jejuni - diarrhea

4) Helicobacter pylori - stomach ulcers

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Vibrio cholerae is a problem in this situation

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Natural disasters with no clean water

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Spread of V. cholerae

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Fecal-oral route (fecally contaminated water)

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Signs of cholera (3)

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1) Severe diarrhea - person may lose 10-15 liters of water / day

2) Severe dehydration and electrolyte loss

3) Feces has flecks of tissue debris (rice-water stool)

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Source of contraction of V. cholerae

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1) Undercooked shellfish

2) Fecally contaminated water

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Treatment for cholera

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Fluid replacement

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Control / prevention of cholera (2)

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1) Proper sewage disposal

2) Adequate water sanitation

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Other Vibrio pathogens (2)

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1) Vibrio parahaemolyticus

2) Vibrio vulnificus

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Habitat of V. parahaemolyticus and vulnificus

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Salt-tolerant inhabitants of coastal waters - associated with marine invertebrates

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Treatment of V. parahaemolyticus and vulnificus (2)

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1) Fluid and electrolyte replacement

2) Occasionally antibiotics (antimicrobials)

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Campylobacter jejuni disease

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Important cause of bacterial gastroenteritis

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Transmission of Campylobacter jejuni

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Beverages and food (Raw / unpasteurized milk / juice)

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Main group of people of people Campylobacter jejuni affects

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Children

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Infection with Campylobacter jejuni (2 steps)

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1) Reaches mucosa at the last segment of small intestine near colon

2) Adhere and burrow through mucus and multiply

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Virulence factor and its affects of C. jejuni

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Heat-labile enterotoxin CJT stimulates a secretory diarrhea like that of cholera

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Symptoms of infection with C. jejuni (4)

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1) Headache

2) Fever

3) Abdominal pain

4) Bloody / watery diarrhea

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Treatment of infection with C. jejuni

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Rehydration and electrolyte balance therapy

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Complication of infection with C. jejuni

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Gillain Barre syndrome - rapid, paralytic syndrome

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Helicobacter pylori habitat

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Gastric pathogen

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Discovery of Helicobacter pylori

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Curved cells discoered in 1979 in stomach ulcer patients

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Helicobacter pylori diseases (2)

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1) Causes 90% of stomach and duodenal ulcers

2) Apparent cofacter in stomach cancer

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Virulence factor of Helicobacter pylori

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Produces urease which converts urea into ammonium and bicarbonate - alkaline compounds that neutralize stomach acid