Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
147 Cards in this Set
- Front
- Back
Hektoen enteric (HE) agar
|
differential, selective for Salmonella and Shigella
Green in color, contains: lactose,sucrose, and salicin h2s system present |
|
Salmonella and Shigella colonies on Hektoen enteric agar
|
Salmonella--blue-green with black centers
Shigella--green, same color as media |
|
What is Hektoen enteric agar used to ID what bacteria
|
Salmonella and Shigella,
Proteus can be distunguished from Salmonella |
|
Salmonella-Shigella (SS) agar
|
differential selective media, neutral red--pH indicator,
h2s detection system used to isolate Salmonella and Shigella. Not recommended for primary isolation of Shigella |
|
Salmonella-Shigell(SS) agar
colonies-- Lactose Fermenters |
Red or pink
E.coli, Kelebsiella and enterobacter spp. |
|
Salmonella-Shegella (SS) agar
colonies-- Lactose non-fermenters |
clear--Shigella
Clear w/black centers--Salmonella and Proteus |
|
General characteristics for Enterobacteriacae
|
GNR, non-spore forming, facultative anaerobes, Cocobacilli or straight rods,all ferment glucose, oxidase neg, reduce nitrate, NF of GI tract(except Salmonella, Shigella, Yersinia), motile(except Yersinia, Shigella, Klebsiella), all colonies look same on SBA and Choc
|
|
2 Catagories of Pathogens
(Based on infection they produce) |
1)Opportunistic - NF in GI;commensal
Casue serious infection else where in body. EX: UTI, Septicemia, wound infection 2)Primary(true path)- Not NF in GI--Shigella, Salmonella, Yersinia--ingested in food and water |
|
Classification of Entero bacteria
|
Edwards and Ewing's Identification (1963)
Tribes Genus Species-grouped by biochemical similarties |
|
Virulence factor of Entero bacteria
|
1)Ablility to colonize in yoiur body
2)Adherence(especially in mucos membranes 3)Tosin producers-endo and exotoxins 4)Ability to invade tissue 5)Use plasmids for antibotic resistance |
|
Antigens for Id of entero bacteria
(Salmonella, Shigella, E coli 0157) |
1) o ag- somatic- heat-stable, in cell wall(sub wall)
2)H ag- flagellar- heat labile- in flagellum 3) K ag - capsular - heat labile- polysaccrides in some encapsulated species |
|
Media used to ID Entero bacteria
|
MacConkey
Hektoen enteric (HE) Xylose-lysine desoycholate (XLD) Fermentation: ID by color change |
|
Primary, Intestinal (True) Pathogens do not ferment what sugars
|
lactose, xylose, sucrose
|
|
True Pathogens (entero) appearance on media
|
MAC- clear or color of media(pink
HE- clear or green(color of media) XLD- Clear or red(color of media H2S production- Salmonella will have colonies with black centers |
|
Opportuntistic Pathogen
E. Coli |
Most significant: most common
Primary marker- fecal contamination of water sources UTI-most common inf., septicemia, wound, meningitis in neonates |
|
E.coli appearance on media
|
MAC- lactose pos, pink colony(smells fruity)
EMB- green, metallic sheen (smells metalic) |
|
E.coli Virulence factors
|
adhesive fimbriae
sex pili- adhesive factor Ag: H,K, and O Motile: most |
|
Biochemical Characteristics of E.coli
|
Fermentation: glucose, lactose
Neg for H2S TSI: A/A, H2S neg; Citrate:neg; Indole:pos; Lysine:pos(decarboxylate); DNase:neg; urease:neg; PAD(PDA):neg IMVC= ++-- |
|
Diseases caused by E.coli
|
1)Uropathogenic- UTI, #1 cause
2)Gasrointestinal- 5 catagories 3) Extraintestinal- a) neonatal septicemia and meningitis; colized vaginal canal or contaminated amniotic fluid, (E.Coli K1) b) Adult septicemia (from UTI or bowel infection) |
|
5 catagories of Gastrointestinal Pathoges of E.coli
|
1) ETEC- Enterotoxigenic--traveler's diarrhea
2)EIEC- Enteroinvasive--dysentry 3)EPEC- Enteropathogenic--infantile diarrhea 4)EHEC (E.coli 0157:H7)- Enterohemorrhagic 5)Enteroadherent E.coli--UTI and diarrhea |
|
ETEC Enterotoxigenic
E.coli |
Diarrhea- infants/adults-tropical areas
most common cause-Traveler's diarrhea; Infective dose-10 6-10 8;toxins-fimbriae--small intestine microvilli--release LT & ST causes hyperscertion of electrolytes--1-5 days |
|
EIEC-Enteroinvasive E.coli
|
Dysentery with direct penetration, invasion,destructin of intestinal mucosa; person to person transmission;stools-scanty,watery, pus mucus, blood--misID as Shigella-higer infective dose needed *lysine-neg(80% E.coli pos)
|
|
EPEC-enteropathogenic E.coli
|
infantile diarrhea--daycare--suspect in cases in >lyr old. stool-a lot of mucus, no blood
|
|
EHEC-Enterohemorrhagic
E.coli 0157:H7 |
Discovered in 1982;Sx. HUS-hemolytic-uremic syndrom--low platelet ct, anemia, kidney failure; can be fatal young children and elderly; Stool-watery, progressing to bloody, NO PUS; cause processed meats,apple cider, bean sprouts, unpas. dairy;
2 cytotoxins--verotoxin I & II |
|
EHEC Identification
|
1)MAC containing sorbitol(not lactose)-E.coli 0157:H7--colorless (other E.coli pink)
2)MUG assay--B-glucuronidase--produce fluorescent product--neg (other coli pos) 3) Sorbitol neg colonies sub culture for SEROTYPING (O ag) |
|
Enteroadherent EC
|
adhere to mucose of intestine
UTI and diarrhea Two Strains--EaaggEc-enteroaggregative; DAEC-diffusely adherent; mostly children; can last 2 weeks, dehydration Sx; Stool--watery, no blood |
|
E. hermannii
|
yellow pigment
found in csf, wounds, blood lysine-neg |
|
E. vulneris
|
newest species
yellow pigment infected wounds indole-neg |
|
Klebsielleae tribe
5 genus |
Klebsiella
Enterobacter Hafnia Serratia Pantoea |
|
Klebsiella ID
|
non motile
UTI,pneumonia(noscomial),wounds,sepsis MAC-large pink,drippy colonies TSI: A/A, H2S neg MR-neg, VP-pos, indole-neg motile variable |
|
K. pneumoniae
IMVC and other biochemical tests |
IMVC= --++
Urea-pos Lysine-pos resist phago and antimicrobial absorption |
|
K. oxytoca
IMVC and other biochemical tests |
IMVC= +-++
urea-pos lysine-pos indole-POS |
|
K. pneumoniae sub. OZAENAE
IMVC and other biochemical tests |
IMVC= -+--
lysine-neg orn-neg arg-neg Sx- nasal secrection & cerebral abscesses |
|
K. pneuomonia sub RHINOSCLEROMATIS
IMVC and other biochemical tests |
IMVC= -+--
lys-neg orn-neg arg-neg Sx--rhinoscleroma, inf. nasal cavity; swelling and maform neck and face (africa and s. america) |
|
Enterobacter (12 spp) & Pantoea ID
|
MAC- looks like Kleb but motlity
TSI: A/A, H2s neg Inf. E. cloacae, E. aerogenes: 2 most common isolates, wounds, UTI, blood, CSF |
|
E. colacae
IMVC and biochemical tests |
IMVC= --++
arg-pos orn-pos urea-pos |
|
E. aerogenes
IMVC and biochemical tests |
IMVC= --++
lys-pos orn-pos |
|
P. agglomerans
IMVC and biochemical tests |
IMVC= -v+v
arg-neg orn-neg lys-neg *triple decarboxylase negative *get from IV fluids- famous for septicemia yellow pigment |
|
Serratia ID
|
Opportunistic pathogen-nosocomial inf.
MAC- clear, delayed lactose fermentor ONPG-pos-slow lactose ferm. Lys-pos Orn-pos resistant to wide range antibiotics: test all isolates |
|
S. marcescens
IMVC and biochemical tests |
IMVC= --++
red pigment colonies nosocomial inf of resp & UTI |
|
S. odorifera
IMVC and biochemical tests |
IMVC= v+v+
dirty, musty oror, like rotten potatoes |
|
S. liquefaciens
IMVC |
IMVC= -+++
|
|
Hafnia ID
2 subspecies H. alvei & H. alvei biotype 1 |
Biotype 1- in breweries; not clinically sig
stool culture: MAC-clear;delayed lactose fer. TSI: K/A,H2S neg-like Shigella ONPG-pos VP-pos, like Shigella *delayed pos for citrate test |
|
Citrate agar
|
blue color is pos
citrate is the only carbon in agar growth will cause an alkaline pH |
|
phenylalanine-deaminase
(PAD) test |
phenylalanine---(PAD)
--->phenylpyruvic acid + FeCl3 (ferric chloride)---> green color = pos *read w/i 10 minutes |
|
Why use the PAD test?
|
Differentiates Proteus, Morganella, and Providencia (all pos),
from other Enterobac (rest neg) |
|
Motility Test
|
detects motility of MOs by ablility to spread in tube.
pos=hazy appearance throught medium= flagella on MO 2 tubes one at RT and 35 deg C Medium: conc. 0.4% or less or wet prep with broth |
|
Decarboxylase test
(Moeller decarboxylase base medium) |
detects decarboxylase, which produces amines/diamine, CO2
pH-acid anaerobic rxn, overlay w/oil amino acids: lysine, ornithine (sometimes arginine) |
|
Decarboxylase reaction
2 steps |
1)glucose ferm.-
acid pH (yellow color) 2)enzyme production and aa decarboxylation- alk pH (purple color) incubate for up to 4 days pos=purple; neg=yellow control tube=yellow or invalid |
|
lysine decarboxylation produces what?
|
cadaverine + CO2
|
|
Ornithine decarboxylation produces what?
|
putrescine
|
|
Lysine Iron Agar (LIA) media and
3 reactions determined |
media=purple; lysine, glucose, soldium thiosulfate, ferric ammonium citrate,
pH id= bromcresol purple 1) decarboxylation of lysine 2) deamination of lysine 3)H2S production *read after 18 hours |
|
LIA rxn
Decarboxylation |
anaerobic
anaerobic pos= yellow back to dark purple butt, K/K (neg=yellow butt,K/A) +/- H2S(black butt)-may hide decarboxylation |
|
LIA rxn
Deamination |
aerorbic
pos= purple SLANT changes to reddish purple R/A neg-K/A |
|
Why is LIA test used?
|
Screen stools for enteric pathogens--
Salmonella= K/K,H2S Citrobacter= K/A, H2S & Differentiating Proteus, Morganella and Providencia sp. from other Entero bact. |
|
LIA result of K/K would indicate what Entero bact.?
K/K,H2S pos? |
E. coli
Kelebsiella Serratia H2S pos=Salmonella |
|
LIA result of R/A would indicate what Entero bact.?
|
Proteus
Providencia Morganella |
|
LIA result of K/A would indcate what Entero bact.?
K/A, H2S pos |
Shigella
E. cloacae H2S pos+ som Citrobacter spp. |
|
H2S postive Entero bacteria?
|
Salmonella
Cirtobacter Edwardsiella Proteus |
|
Gas producing Entero bacteria?
|
Morganella
Y. enterocolitica Citrobacter (some spp) Proteus (some spp) Klebsiella (some spp) |
|
Nitrate Reduction test
reagents? |
Media--Nutrient broth w/ KNO3
Nitrite sulfanilic acid NNDN (N,N-Dimethyl- 1napthyllamine zinc dust durham tube |
|
Determining results for Nitrate test
|
1)red color after acid + NNDN
= pos for nitrites 2)clear after acid + NNDN = unknown, pos neg: add zinc dust 3)red color w/ zinc dust = true neg for nitrite *no color change = pos for nitrate= pos for nitrate reduction |
|
Oxidase Fermentation Media
(two tube system, aerobic and anaerobic) |
Media-O/F basal media(OFBM)
Hugh-Leifson media-green color pH ID-bromthyinol blue 1% carbohydrates;0.2% peptones Acid=yellow; alkaline=blue-purple |
|
Oxidase Fermentation Media results
|
*2 yellow tubes= oxidizer,fermenter
*yellow in closed tube only = ferm. only *yellow in open tube only =oxidative only *neither tube changes color =asaccharolytic |
|
Why use Fermentation (Hugh-Leifson) media?
|
To seperate enterobacteria from non fermentors
|
|
Oxidase test reagents?
|
Kovac's (reagent
(tetramethyl-p-phenylenediamine dihydrochloride) |
|
Why use the oxidase test?
|
to differentiate enterobacteriaceae-oxidase-neg
from pseudomonads-oxidase pos ID of Neisseria-oxidase pos *inoculating loop can give false pos,use non-nichromed Pos= lavender color in 10-15 seconds 10-15 secon |
|
Indole test reagents
|
trytophanase
PDAB (1% paradimethylaminobenzaldehyde)Ehrlich's or Kovac's reagent |
|
What does the oxidase test detect?
|
cytochrome oxidase system
|
|
What reagent is used in the Ehrlich's indole test to extract the indole?
|
xylene
add PDAB and red color= pos |
|
When would use the Ehrlich's test over Kovac's indole test?
|
When testing nonfermentative bacteria.
Ehrlich's is more sensitive |
|
Enterobacteriacae
General ID |
MAC-pos
Oxidase-neg nitrite-pos glucose ferm.-pos GNR BAP-wet,gray,round colonies, maybe b-hemolytic and spready Choc-all gray MAC flat-raised, wet-dry, round-irregular |
|
ID of lactose fermentation by Entero bacteria.
3 tests |
1)MAC media
2)TSI or KIA 3)ONPG |
|
What do slow lactose fermenters lack?
|
B-glactoside permease
|
|
What are the two enzyme used in lactose fermentation
|
b-glactosidase
b-glactoside permease |
|
TSI- Triple Sugar Iron Agar used to determine?
|
organisms ablility to:
ferment glucose ferment lactose or sucrose produce H2S produce gas read in 18-24 hours |
|
What are the ingredients in TSI agar?
|
1 part glucose
10 parts lactose 10 parts sucrose peptone ph ID- phenol red |
|
TSI results
|
all yellow tube A/A = Glucose and lactose fermenters
red and yellow, K/A = Glucose ferm. lactose non ferm. all red tube K/K = non glucose and lactose ferm black in tube = H2S pos Cracks in media = gas |
|
ONPG test used to determine?
|
Id true non-fermenters for late/slow lactose fermenters, which have B-galactosidase, but no permease
|
|
What are the ingredients in ONPG test?
|
O-Nitrophenyl-BlD-Glactopyranoside (colorless)
and saline in tube incubate 4 hours at 36 deg C |
|
What is the end product if ONPG test is positive?
|
orthonitrophenol
which is yellow |
|
Glucose Fermentation
what are the two pathways? |
Mixed Acid Fermentation Pathway--acidic
Butylene Glycol Pathway--neutral pH |
|
What are the two test use to id glucose fermentation pathway?
|
Methyl Red test (MR)
Voges-Proskauer (VP) |
|
What is the Embden-Meyerfoh pathway
|
fermentation of lactose to glactose + glucose, then to pyruvic acid intermediate
*all MOs use this pathway to this point |
|
Metyl Red test (MR) uses what pathway, end product and what is a positive result
|
Mixed acid Fermentation Pathway
Pyruvic acid + methyl red red color = pos, yellow = neg |
|
Voges-Proskauer test(VP) uses what pathway, end product and what is the positive result.
|
Butylene Glycol Pathway
acetoin-->2,3 butanediol reagent add change end product to diacetyl red color = pos, yellow = neg |
|
What are the ingredients used in a VP test?
|
a-Naphthol
KOH or NaOH allow ten minutes for rxn |
|
What are the ingredients for MR test?
|
Clark and Lub medium
methyl red results are immediate for pos =red color |
|
What ingredients in Citrate Utilization test?
|
Na Citrate
(simmon's media-green color) NH4 bromthymol blue (indicator) |
|
What is a positive result for citrate test?
|
blue color = pos, cause by release of NH3 (which is alk)
neg = no color change- green (color of media) false positive can happen if to heavy innoculum read for up to 7 days |
|
What is a positive Urease test?
|
bright pink color = pos
neg = yellow color read test after 24 hours |
|
What is the end product of Urease rxn?
|
ammonia(NH3)+H2O=CO2
alkaline |
|
What ingredients are need to run a Urease test?
|
Christensen's urea agar
phenol red (indicator) |
|
Proteus, Morganella and Providencia are the same for what tests?
|
PDA(PAD,PD)-pos
lactose-neg |
|
Proteus, Morganella and Providencia are the only Enterobacter postive for what test?
|
PAD
|
|
What MOs are in the Proteeae tribe?
|
Opportuntistic pathogens:
Proteus Morganella Providencia |
|
General ID of Proteus
|
swarming colonies
burned chocolate odor MAC-clear colonies ONPG-neg True non-fermenter (doesn't count glucose) H2S positive Urea-pos |
|
Proteus
2 pathogens? |
P. mirabilis
P. vulgaris |
|
P.mirabilis IMVC
and other biochemical tests |
IMVC= -+vv
indole-neg orn-pos TSI: K/A, H2S pos,same for KIA |
|
P.vulgaris IMVC
and other biochemical tests |
IMVC= ++--
indole-pos orn-neg TSI: A/A, H2S pos *special because ferments SUCROSE KIA: K/A, H2S pos |
|
Morganella morganii (only sp)
IMVC and other IDing factors. |
IMVC= ++--
no swarming colonies inf.= UTI, wounds MAC-clear colonies urea-pos ODC-pos ONPG-neg TSI:K/A |
|
Providencia (4 species)
IMVC and other IDing factors. |
IMVC= ++-+
urea-pos ONPG-neg MAC- clear colonies TSI: K/A inf. UTI, nosocomial |
|
P.stuartii and P. rettgeri
|
p.stuartii-nosocomial in burn units
p. rettgeri- urinary pathogen *both resistant |
|
Edwardsielleae Tribe
Edwardsiella |
E.trada-only human pathogen
opportuntist Erwinia and Pectobacterium-plant pathogens, not clinically significant |
|
Citrobacteriaceae Tribe
Citrobacter General ID |
Inf.- nosocomial; in stool
MAC-clear or pink *easily confused with Salmonella 50% are lactose-neg (like Salmonella) Most H2S-pos most urease-pos most lysine-neg (salmonella urease-neg,lys-pos) TSI: K/A & A/A, H2S pos |
|
C. freundii IMVC and biochemical tests.
|
IMVC= -+-+
H2S-po arg-pos MAC-clear colonies nosocomial UTI, pneumonia, intra-abdominal abscesses |
|
C. diversus (koseri) IMVC and biochemical tests.
|
IMVC= ++-+
arg-pos orn-pos MaC-clear colonies neonatal meningitis |
|
Primary Intestinal Pathogens
|
Salmonella and Shigella
|
|
Salmonella Identification factors.
|
IMVC= -+-+
GNR MAC-clear colonies HE-clear, green, H2S pos XLD-clear,red, H2S pos TSI: K/A, H2S pos lysine-pos urea-neg PAD-neg mortile-pos lactose, sucrose & xylose-neg NF in animal GI tract- pet turtles, snakes, fish, rodents and birds. Human can be carriers for 3 months after syptoms |
|
What are the positive test for Salmonella?
|
H2S-pos
lysine-pos motility-pos |
|
Disease caused by Salmonella.
S. enterica, with subspecies |
Typhi, Parathphi, Cholerasuis
Biochemically inert |
|
Virulence factors of Salmonella.
|
O somatic-heat stable
Lps, outer cell wall may be multiple, id with #s H flageller- heat labile Occur in small # serotype Determines immuno.IDserotype Vi-capsular, heat labile Impt. in ID of S.Thphi, Cholerasuis Prevents phagocytosis Blocks typing of O antigen |
|
Acute Gastroenteritis by Salmonella.
|
food poisoning
most common cause,vomiting & diarrhea Cause-cont.food, handling pets, direct transmission infective dose: 10 6 bacteria |
|
Symptoms of acute gastroenteritis-food poisoning
|
vomiting, diarrhea, chills, fever, abdominal pain, watery diarrhea
tx: non, self-limiting-- antimicrobials may cause carriers |
|
Typhoid Fever caused by?
|
S.serotype Typhi
Febrile disease fecal oral route, contam.food, food handlers carriers--typhoid mary(carried in gall bladder). tropical traveler disease RARE in US |
|
Symptoms of Typhoid fever?
|
prolonged fever 9-14 days
bacteremia,lethargy, headache involvement w/ spleen, liver penetrates mucosa-get constipation penetrates lymph nodes, to blood (febrile condition) Peyer's patches-in bowel Rose spots-red bumps around belly button. carrier-harbor in gallbladder tx: antibotics, remove gallbladder |
|
Bacteremia cause by what Salmonella species?
|
S.serotypes Typhi, Parathphi, Cholerasuis
Sx: prolonged fever, pos B.C. yound children, adults with underlying diseases |
|
Shigella ID
|
NEVER NF
IMVC=v+-- (like e.coli) GNR MAC-clear HE-clear, green XLD-clear, red TSI- K/A lysine-neg arg-neg orn-neg urea-neg non-motile *exception-S.sonnei,ONPG-pos,orn-pos |
|
Shigella caused disease.
|
Bacillary dysentery
no animal transmittion caused by contaminated h2o, oral/anal sex, croweded living, young children |
|
Shigella positive biochemical tests.
|
glucose
MR some pos for indole all other tests are negative |
|
If all biochemical tests were negative except MR what MO would you expect?
|
Shigella
|
|
S.sonnei is positive for what tests?
|
ONPG-pos
orn-pos MR-pos |
|
Virulence factors of Shigella.
|
K- mask O, heat labile
-boil to remove O ag groups; A,B.C,D NO H antigen- non-motile Inf. dose <200microorganisms |
|
How do you acquire Shigella?
|
the 5 "F's"
fingers flies food feces fomite |
|
Shigella that cause disease.
|
S.sonnei-most common in US
short lived, self-limiting S.flexneri-gay bowel syndrome" S.dysenteriae type 1 and S. boydii--found in developing countries- most virulent: high mortality |
|
Bacillary dysentery
|
24-48 hours post ingestion
penetrates mucosa and attaches- inflammmation, shedding of mucosa formation of ulcers Sx:high fever,chills, abd cramps, pain, rectal prolapse Isolate MO 1-3 days post ingestion complications-obstructionof intestinal-can be life-threatening Tx; self-limiting Stool: blood,mucus,pus plate stool immediately, acid ph sensitive |
|
Yersinia General ID and
diseases. |
GNR w/bipolar staining
GI disease mediastinal lymphadenitis septicemia pneumonia |
|
K/A, H2S+ bacteria
|
P. mirabilis
Salmonella spp. C. freundii E. tarda |
|
A/A, H2S- bacteria
|
P. vulgaris
C. freundii |
|
K/A, H2S- bacteria
|
P.rettgeri
M. morganii P. stuartii Citrobacter spp. Shigella spp. E.coli Y. pestis Serratoa spp. |
|
A/A, H2S- bacteria
|
E.coli
Klebsiella spp. Enterobacter spp. Serratia sp. |
|
K/K bacteria
|
No Enterobacteriaceae,
ID of NLF |
|
PAD positive bacteria
|
All Proteus spp.
M.morganii |
|
Lysine positive bacteria
|
Salmonella spp.
(except Paraptyphi) E.tarda |
|
Indole positive bacteria
|
E.tarda
P.vulgaris Providencia spp. M.morganii K.oxytoca Edwardsielleae |
|
Citrate positive bacteria
|
Providencia spp.
|
|
Motility (37 deg) bacteria
|
E.coli
Citrobacer spp. Serratia spp. Enterobacter spp. Y.pseudotuberculosis |
|
Motility (25 deg) bacteria
|
Y. enterocolitica
Y.pseudotuberculosis |
|
Motility (37 deg) bacteria
|
e.coli
Citrobacter spp. Serratia spp. Enterobacter spp. |
|
Dnase positive bacteria
|
Serratiea sp.
|
|
IMVC ++-- bacteria
|
E.coli
M.Morganii P.vulgaris Y.enterocolitica(variable) Shigella(variable) |
|
IMVC --++ bacteria
|
Enterobactersp.
Klebsiella sp. Serratia sp. S. marcescens P.agglomerans(variable) E.cloacae E.aerogenes |
|
IMVC -+-+ bacteria
|
Salmonella
C.freundii P.mirabilis(variable) S.odorifera(variable) |
|
IMVC ++-+
|
Providencia
C.diversus K.oxytoca s.odorifera(variable)` |
|
IMVC --+-
|
K.pneumoniae sub. ozaenae
K.pneumoniae sub. rhinoscleromatis P. agglomerans (variable) |
|
IMVC -+--
|
Y.pestis
Y.pseudotuberculosis Y.enterocolitica(variable) Shigella(variable) P.mirabilis(variable) |
|
Shigella O ag groups
|
A: S.deysenteriae
B: S.flexneri C: S.boydii D: S. sonnei |