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• Only few serotypes actually cause disease & each pathogenic serotype has
specific virulence factors (plasmid or bacteriophage encoded)
• Family: Enterobacteriaceae
• IMViC test (+ + - -)
Diarrhea causing E.coli
• Diarrhea-causing E coli are conveniently classified according to their
virulence properties
Each group causes disease by a different mechanism, and the resulting syndromes usually
differ clinically and epidemiologically.
Virulence Factors
Virulence factors: Surface Antigens & Toxins
• Surface Antigens
Lipopolysaccharide (LPS) :
– Lipid A – endotoxic shock (septic shock)
– O polysaccharide - antigenic
Pili / Fimbriae : colonization factors ( specific types in different strains)
Capsule (in some strains) : protects against phagocytosis and
antibacterial factors in serum & capsular antigen is called “K” antigen
• Toxins
LT (heat labile) & ST (heat stable) toxins ( ETEC)
VT (verocytotoxin or shiga- like toxin) – EHEC
Enteroaggregative heat stable (EAST) – EAEC
Enterotoxigenic E.coli (ETEC)
Common cause of “Traveller's diarrhea” in people visiting developing
countries & diarrhea in children residing in developing countries
• Heat labile toxin causes activation of adenyl cyclase and increased production cAMP
• Heat stable (ST) toxin causes activation of guanyl cyclase and increased production of cGMP
Pathogenesis of ETEC diarrhea
Enters through Fecal-oral route transmission
• Pathogenesis:
• Combination of attachment/effacement (A/E) lesion + cytolytic action of toxin
(shiga like toxin (Stx1& Stx2)
Pathogenesis of EHEC
Complications of EHEC
• Complications (esp. in young children and elderly)
• Hemorrhagic colitis
• Thrombocytopenia
• Receptors for Stx are found on Renal micro vascular endothelial cells
• Results in decrease in renal perfusion, oliguria, hematuria ( hemolysis) and renal failure
Enteroaggregative E.coli
• Persistent mucus diarrhea in children in
developing countries
Pathogenesis:
• Adherence to intestinal mucosa
• Release of toxin
– Other tests: Serotyping , Sereny’s test for EIEC, Rabbit ileal loop test for ETEC
Summary of Diarrheogenic E. Coli
group Site Disease Virulence factors Pathogenesis identification
• Colonization factor antigens
Travelers’ (CFAs) encoded on plasmid. • LT ligated
diarrhea, Hypersecretion of fluids rabbit ileal loop,
Enterotoxigenic E. Coli Small
diarrhea in • two toxins: and electrolytes into gut
(ETEC) intestine LT (heat labile) • DNA probe
malnourished lumen watery diarrhea.
infant ST (heat stable) • ELISA
Destruction of microvilli
Infant diarrhea
Enteropathogenic E. Coli Small Bundle forming pili malabsorption, watery Serotyping with
in developing
(EPEC) intestine localized adherence diarrhea (mucoid, no specific antisera.
countries
blood).
• Cytopathic effect
Intracellular multiplication. on HEP-2 cell
Diarrhea in cultures
Extension to adjacent
Enteroinvasive E. Coli Large children (like Invasion of epithelial cell of
epithelial cells diarrhea • Detection of
(EIEC) intestine bacillary colon
(blood, mucus, pus in virulence marker
dysentery)
stool). antigen (VMA) by
ELISA
• Vaccines:
– Whole cell killed vaccine + recombinant B subunit (WC/rBS)
– Live attenuated vaccine
– Efficacy is 50-70% & protection is only for a short period of 3-6 months
• Prevention:
– Good hygiene, Clean & Safe drinking water, and food supply
– Proper sewage treatment
Vibrio parahemolyticus
• Halophilic vibrios (high requirement of salt )
• Natural habitat : Sea water, marine life
• Food poisoning from improperly cooked sea foods( Shell fish, Raw
oysters, Crabs etc)
• Pathogenesis:
Little is known about its pathogenesis, except that an enterotoxin similar to cholera
toxin is secreted and limited invasion sometimes occurs.
Self limiting watery diarrhea, fecal leucocytes often present
Disease can be prevented by proper refrigeration and cooking of seafood.