Enterobacteriaceae

Aman Ullah

Common characteristics

Gram-negative
Short rods
Facultative anaerobe
Ferments glucose and a wide range
of carbohydrates
Oxidase negative

Escherichia coli

Pathogenesis/Clinical
Significance
E. coli is part of the normal flora in the colon of
humans and other animals,
Pathogenic both within and outside the
gastrointestinal tract.
E.coli species possess three types of antigens: O, K,
and H.
Pili facilitate the attachment of the bacterium to
human epithelial surfaces
Pathogenic E. coli virotypes differ from the normal
flora E. coli by the acquisition of genes that encode
new virulence factors allowing for toxin production
and attachment to or invasion of host cells.

Pathogenesis/Clinical
Significance
Urinary tract infections (UTI)
E. coli is the most common cause of UTIs, especially
in women
Symptoms include dysuria, urinary frequency,
hematuria, and pyuria

Meningitis in infants
E. coli and group B streptococci are the leading
causes of neonatal meningitis
E. coli strains that cause meningitis express the
K1 capsule, which is chemically identical to the
capsule produced by serogroup B meningococci

Pathogenesis/Clinical
Significance
Diarrhea
Several categories
of diarrhea are
caused by different
strains of E. coli
Lab diagnosis
Specimens:
depend on the site
of infection
Diagnose on the
base of culture and
sensitivity

Salmonella
Salmonella enterica serovar Typhi
Salmonella enterica serovar
Typhimurium

Salmonella enterica serovar

Typhi
Pathogenesis/Clinical Significance
S. enterica serovar Typhi is transmitted between humans, without
animal or fowl reservoirs
Infection is via the oralfecal route, generally through food or
water contaminated by human feces
Young children and older adults are particularly susceptible to
Salmonella infections, as are individuals in crowded institutions or
living conditions
S. enterica serovar Typhi causes disease by attaching to and
invading macrophages of the intestinal lymphoid tissue (Peyer's
patches)
The bacteria replicate rapidly within these cells, and eventually
spread to the reticuloendothelial system (including both liver and
spleen, which become enlarged) and potentially to the gallbladder.

Pathogenesis/Clinical Significance
Enteric (typhoid) fever
This is a severe, life-threatening systemic illness,
characterized by fever and, frequently, by
abdominal symptoms
About 30 percent of patients have a faint,
maculopapular rash on the trunk (termed "rose
spots")
After 1 to 3 weeks of incubation, S. serovar Typhi
can enter the blood, with the resulting bacteremia
causing fever, headache, malaise, and bloody
diarrhea
Perforations of the intestine can lead to
hemorrhage

Salmonella enterica serovar

Typhimurium
Pathogenesis/Clinical Significance
S. enterica serovar Typhimurium (and other Salmonella species that
cause enterocolitis) reside in the gastrointestinal tracts of humans,
other animals, and fowl
They are transmitted through contaminated food products, or via
the oral/fecal route
Enterocolitis (gastroenteritis, foodborne infection)
Contaminated poultry products including eggs are the primary
vehicles for infection of humans by serovar Typhimurium, although
raw milk and pets such as turtles also transmit the disease
Salmonella adhere to and invade enterocytes of both the small and
large intestine, causing a profound inflammatory response. Within
10 to 48 hours after ingestion, nausea, vomiting, abdominal
cramps, and diarrhea ensue
Diarrhea usually ends spontaneously within a week.

Lab diagnosis
Blood, urine and blood for culture
and sensitivity
Serologic tests for antibodies against
O antigen in patient's serum also aid
in the diagnosis

Shigella
Med. Imp. Species: Shigella sonnei and dysenteriae
Pathogenesis/Clinical Significance
Shigella species are spread from person to person, with
contaminated stools serving as a major source of
organisms
Flies and contaminated food and water can also transmit
the disease
S. sonnei invades and destroys the mucosa of the large
intestine but rarely penetrates to the deeper intestinal
layers
S. dysenteriae also invades the colonic mucosa but, in
addition, produces an exotoxin (Shiga toxin) with
enterotoxic and cytotoxic properties

Shigella
Bacillary dysentery (shigellosis)
This disease is characterized by diarrhea with
blood, mucus, and painful abdominal cramping
The disease is generally most severe in the
young and in older adults, and among
malnourished individuals, in whom shigellosis
may lead to severe dehydration and even
death
Lab diagnosis
Stool for C/S

Yersinia pestis
Pathogenesis/Clinical Significance
Y. pestis is endemic in a variety of mammals, both urban and sylvatic, and is
distributed worldwide.
Infection is transmitted by fleas, which serve to maintain the infection within the
animal reservoir
The organism can also be transmitted by ingestion of contaminated animal
tissues and via the respiratory route.
Organisms are carried by the lymphatic system from the site of inoculation to
regional lymph nodes, where they are ingested by phagocytes
Y. pestis multiplies in these cells. Hematogenous spread of bacteria to other
organs and tissues may occur, resulting in hemorrhagic lesions at these sites
Bubonic (septicemic) plague
The incubation period (from flea bite to development of symptoms) is generally 2
to 8 days. Onset of nonspecific symptoms, such as high fever, chills, headache,
myalgia, and weakness that proceeds to prostration, is characteristically sudden.
Within a short time, the characteristic, painful buboes develop, typically in the
groin, but they may also occur in axillae or on the neck
Blood pressure drops, potentially leading to septic shock and death.
Pneumonic plague
If plague bacilli reach the lungs, they cause a purulent pneumonia that is highly
contagious, and, if untreated, is rapidly fatal.

Lab diagnosis
Laboratory identification can be
made by a gram stained smear, and
culture of an aspirate from a bubo (or
sputum in the case of pneumonic
plague)

OTHER ENTEROBACTERIACEAE
Other genera of Enterobacteriaceae, such
as Klebsiella, Enterobacter, Proteus, and
Serratia, which can be found as normal
inhabitants of the large intestine, include
organisms that are primarily opportunistic
and often nosocomial pathogens
Widespread antibiotic resistance among
these organisms necessitates sensitivity
testing to determine the appropriate
antibiotic treatment

Enterobacter
They rarely cause primary disease in
humans but frequently colonize
hospitalized patients, especially in
association with antibiotic treatment,
indwelling catheters, and invasive
procedures
These organisms may infect burns,
wounds, and the respiratory (causing
pneumonia) and urinary tracts

Klebsiella
Klebsiellae are large, nonmotile bacilli that
possess a luxurious capsule
Klebsiella pneumoniae and Klebsiella
oxytoca cause necrotizing lobar pneumonia
in individuals compromised by alcoholism,
diabetes, or chronic obstructive pulmonary
disease.
K. pneumoniae also causes UTI and
bacteremia, particularly in hospitalized
patients

Serratia
The species of Serratia that most
frequently causes human infection is
Serratia marcescens
Serratia can cause extraintestinal
infections such as those of the lower
respiratory and urinary tracts,
especially among hospitalized
patients

Proteus, Providencia, and

Morganella
Members of these genera are agents of urinary tract
and other extraintestinal infections
Proteus species are relatively common causes of
uncomplicated as well as nosocomial UTI
Other extraintestinal infections, such as wound
infections, pneumonias, and septicemias, are
associated with compromised patients
Proteus organisms produce urease, which catalyzes
the hydrolysis of urea to ammonia. The resulting
alkaline environment promotes the precipitation of
struvite stones containing insoluble phosphates of
magnesium and phosphate.