GRAM NEGATIVE RODS

Family Enterobacteriaceae
Found in
Soil
H2O
Decaying matter
Large intestines
ALL RODS are gram (-) except
1. Haemophillus
2. Neisseria
3. Burdotella
4. Brucella
ALL COCCI are gram (+) except
1. Clostridium/Cornybacterium
2. Listeria
3. Bacillus
All NON lactose fermenter are oxidase (-) except
Pseudomonas

CULTURE MEDIUM
1.
2.

ANTIGENIC STRUCTURE
-

GENERAL MORPHOLOGY
-

Small
Gram negative
Non-sporeforming
MOTILE except
Shigella
Klebsiella
NON-CAPSULATED except
Klebsiella (Swarming)
Oxidase (-)
Catalase (+)

LACTOSE FERMENTERS

DIFFERENTIAL
EMB (Eosin Methylene Blue)
Mc Conkey
Highly Selective

Plays important role in epidemiological

classification
1. O (Somatic)
Outermost Ag
A polysaccharide endotoxin in the cell
wall (LPS)
2. H (Flagellar)
3. K (Capsular)

DETERMINANTS of PATHOGENICITY
-

ALL gram (+) produce exotoxins

ALL gram (-) produce ENDOTOXINS

1.
2.
3.

Endotoxin (LPS)
Enterotoxin
Colonization factor

ESCHERICHIAE (E.coli)

KLEBSIELLA
Citrate (+)
Non-motile

Motile
Lactose fermenter (Rapid)
Encapsulated
Urease (-)
Non-fastidious
Most common cause of MENINGITIS in
the YOUNG
Most common cause of UTI (most
common)

Lactose fermenter
Encapsulated
Urease (+)

ENTEROBAC
TER
Citrate (+)
Motile
Lactose
fermenter
(Rapid)
Non-capsulated
Urease (-)

YERSENIA

CITROBAC
TER
Use CITRATE
as a carbon
source

Motile
Lactose
fermenter
(Slow)

Lactose
Fermenter

Urease (+)
Accumulate
URANIUM

ANTIGENIC
STRUCTURE
- posses O and K Ag
CULTURE MEDIA:
CULTURE MEDIA:
1. EMB
Smooth, circular, convex
colonies with GREENISH
BLACK METALIC SHEEN
DETERMINANTS of PATHOGENICITY
1. Surface Antigens
- (K/capsular Ag)
2.
Enterotoxins
3.
Verotoxins
STRAINS OF E. coli (Diarrhea)

1. McConkey
(String Test)
- Red, large,
mucoid gelatinous
colonies

CULTURE:
Blood/Nutrient
Agar

DETERMINANTS of
PATHOGENICITY
1. Capsule
2. Endotoxin

1. ETEC
Enterotoxigeneic E. coli
Traveler and infantile
diarrhea in developing
countries
2. EIEC
-

Enteroinvasiveness E.coli
Shigella like dysentery
Fever, abdominal cramp,
blood and pus in stool

3. EPEC
Enteropathogenic E.coli
2nd most common cause
infantile diarrhea next to
ROTAVIRUS
4. EHEC
Enterohemorrhagic E.coli
Hemorrhagic colitis with
bloody stool
Also HUS syndrome
Hemolytic Uremic
Syndrome
Microhemolytic anemia,
thrombocytopenia, renal
failure

PREDISPOSING
FACTORS - BEFORE:
Most common
nosocomial
organism
1. Alcoholism
2. Chronic
bronchopulmonary
disease
3. Diabetes Mellitus
TREATMENT:
Cephalosporin

DISEASE:
GASTROENTE
RITIS
Self
limiting
MOT:
Ingestion of
contaminat
ed
food/H2O
Fever,
abdominal
pain,
bloody
diarrhea
mimics
CHRON'S
DISEASE/A
PPENDICITI
S
YOUNG
child
TREATMENT:
Ampicillin
Tetracyclin
e

TREATMENT:
Aminoglycosid
e,
Tetracycline,

Supportive
(maintenan
ce of fluid
and
electrolyte)

Chlorampheni
col

NON-LACTOSE FERMENTERS
SHIGELLA

SALMONELLA (Saw
tooth)

Non-motile

Non-sporeforming
Motile

Non-lactose fermenter

Non-lactose fermenter

Non-capsulated

Non-encapsulated

SERRATIA
Motile
Non-lactose
fermenter
Noncapsulated

PROTEUS
Majority isolated
from URINE
Motile (swarming)
Non-lactose
fermenter

Urease (+)
Antigenic Structure
- All have O antigen
- Only few have K
antigen which can
easily be remove by
BOILING

DISEASE: BACILLARY
DYSENTERY/SHIGELLOSIS
MOT: Fecal-oral route
(toddlers)
Painful (tenesmus)
passage of low volume
stools containing blood
and mucus
Bloody mucopurulent
diarrhea
4Fs: Finger, Flies, Flood,
Feces

DETERMINANTS of
PATHOGENICITY
1. O antigen (LPS Ag)
2. Invasiveness
- invade and proliferate within
EPITHELIAL cells of INTESTINAL
MUCOSA

Antigenic structure
1. O & H Ag
2. H Ag
3. Vi Ag (Capsular antigen)
- plays IMPORTANT
role in detecting
typhoid fever
- Unique to Salmonella
CLINICAL
MANIFESTATION:
- MOT: Fecal-oral route
- INGESTION > organism
penetrate the INTESTINAL
WALL > infect regional
lymphatic system >
BLOODSTREAM > RES >
Multiplication
1. FIRST WEEK
- non-specific (lethargy,
fever, malaise, myalgia and
constipation)
2. SECOND WEEK
- organism REENTER to
bloodstream - temperature
104F and delirious -Rose
spots
3. THIRD WEEK
- exhausted d/t
dehydration
CULTURE: Blood is best
specimen to detect during
1st week
DETERMINANTS of
PATHOGENICITY
1. Surface Ag
2. Invasiveness
3. Endotoxin
4. Enterotoxin

MORGANE
LLA

PROVIDEN
CIA

Similar to
PROTEUS
Non-lactose
fermenter

Urease (+)

Urease (-)
*
differentiate
Providencia
from Proteus

3. Shiga toxin
a. NEUROTOXIC (convulsion)
b. CYTOTOXIC (bloody diarrhea
with mucus and pus)
c. ENTEROTOXIC (watery
diarrhea)
TREATMENT:
1. Fluid and electrolyte
replacement
2. Ampicillin (DOC)

TREATMENT:
1. Chloramphenicol (DOC)
2. Ampicillin +
Cholecystectony (Chronic
carrier)
3. Ciprofloxacin (Resistant
case)

TREATMENT:
Amikacin,
Chloramphenic
ol,
Ciprofloxacin
Gentamycin,

TREATMENT
- ALL proteus
RESISTANT to
TETRACYCLINE
- Ampicillin and
Cephalosporin

TREATMENT:
Ampicillin
and
Cephalospori
n