Enteric BacteriaEnteric BacteriaProf. Dr. Asem ShehabiProf. Dr. Asem Shehabi

Faculty of MedicineFaculty of Medicine University of JordanUniversity of Jordan

Enteric BacteriaEnteric Bacteria• General CharacteristicsGeneral Characteristics: Gram-ve Bacilli, Facultative : Gram-ve Bacilli, Facultative

Anaerobes, Oxidase-negative.. Part Intestinal Normal Anaerobes, Oxidase-negative.. Part Intestinal Normal Flora.. Humans, Animals, Birds.. Common Waste water, Flora.. Humans, Animals, Birds.. Common Waste water, Natural Water, Soil, Vegetation.Natural Water, Soil, Vegetation.

• OpportunisticOpportunistic Pathogens/ObligatePathogens/Obligate Pathogens.. Pathogens.. Enterotoxins, Endotoxins, Capsules, Flagella, Pili Enterotoxins, Endotoxins, Capsules, Flagella, Pili

• Coliform GroupColiform Group: : 1. 1. Escherichia coliEscherichia coli: Urinary Tract Infect (40-70%)..Single : Urinary Tract Infect (40-70%)..Single

Organism, Septicemia, Neonatal Meningitis, Wounds. Organism, Septicemia, Neonatal Meningitis, Wounds. Diarrheagenic E coli strainsDiarrheagenic E coli strains: : - - Enteropathogenic:InfantsEnteropathogenic:Infants.. mild-chronic diarrhea, .. mild-chronic diarrhea,

EnterotoxigenicEnterotoxigenic.. Heat-Labile/Stable Enterotoxin, Watery .. Heat-Labile/Stable Enterotoxin, Watery diarrhea.. More Children than Adults.. Travelers diarrhea.. More Children than Adults.. Travelers diarrhea..Contamination Water/Vegetables / Fresh fooddiarrhea..Contamination Water/Vegetables / Fresh food

Coli-form group-2Coli-form group-2 dairy products ..Mostly Self-limited.. No need for Antibiotics dairy products ..Mostly Self-limited.. No need for Antibiotics

treatment.treatment.- - EnterohaemorrhagicEnterohaemorrhagic .. .. Common in intestinal Cattels, Common in intestinal Cattels,

verotoxins.. Contamination Ground verotoxins.. Contamination Ground meat/Hamburger,Dairy products..Bloody diarrhea.. meat/Hamburger,Dairy products..Bloody diarrhea.. Haemolytic-ureamic syndrome, pertonitis, Kidney Haemolytic-ureamic syndrome, pertonitis, Kidney failure..Outbreaks of infections.failure..Outbreaks of infections.

• E. coli E. coli is used as indicator for detection of water & is used as indicator for detection of water & Food fecal contamination. Food fecal contamination.

2. 2. Klebsiella-Enterobacter –Serratia speciesKlebsiella-Enterobacter –Serratia species: UTI, : UTI, Septicemia, Wounds.. Rare Meningitis.. Common Septicemia, Wounds.. Rare Meningitis.. Common Hospitalized patients. Hospitalized patients.

• K. pneumoniaeK. pneumoniae.. Large polysaccharide.. capsule.. .. Large polysaccharide.. capsule.. Nosocomial Pneumonia.Nosocomial Pneumonia.

E. coli E. coli Culture Culture –– Red color Red color on MaConkey agaron MaConkey agar indicates Lactose-positive & indicates Lactose-positive & Gram-stain Gram-stain

E.coli-Flagella-Fimbriae-PiliE.coli-Flagella-Fimbriae-Pili Klebsiella pneumonia- Klebsiella pneumonia-CapsuleCapsule

Coliform group-3Coliform group-3• E.coli, E.coli, Klebsiella-Enterobacter –Serratia spp.. Klebsiella-Enterobacter –Serratia spp..

Lactose+ve , urease-ve & oxidase-negative..Lactose+ve , urease-ve & oxidase-negative..• Klebsilla spp. Klebsilla spp. often encapsulated.. Non-motileoften encapsulated.. Non-motile• 3. 3. Proteus-Providencia-Morganella speciesProteus-Providencia-Morganella species::

Lactose-ve & urease positive.. cause UTILactose-ve & urease positive.. cause UTI, , Septicemia, Wounds.. Commonly in Septicemia, Wounds.. Commonly in Hospitalized patients.Hospitalized patients.

• Lab Lab Diagnosis:Diagnosis: All Enteric bacteria grow on All Enteric bacteria grow on MacCokeny-, Blood-, CLED-agar. Full MacCokeny-, Blood-, CLED-agar. Full identification done using Biochemical Tests.. identification done using Biochemical Tests.. Antibiotic Susceptibility must be done.Antibiotic Susceptibility must be done.

44 . .Pseudomonas groupPseudomonas group• Gram-ve bacilli, Oxidase-positive, Single polar Gram-ve bacilli, Oxidase-positive, Single polar

flagellum,Fimbriae, obligate aerobe, widely distributed flagellum,Fimbriae, obligate aerobe, widely distributed in human intestine, animal, plants, environment & in human intestine, animal, plants, environment & water. Survive in disinfection solutions.. 70% water. Survive in disinfection solutions.. 70% Alcohol..contaminate Hospital sinks & equipments. Alcohol..contaminate Hospital sinks & equipments.

• P. P. aeruginosa: aeruginosa: Most common causes of human & Most common causes of human & animal infections.. Produce several hemolytic-animal infections.. Produce several hemolytic-protolytic enzymes, toxins, fluorescent pigments-protolytic enzymes, toxins, fluorescent pigments-pyocyanin / Burn-Blue Green Pus.. can overcome host pyocyanin / Burn-Blue Green Pus.. can overcome host defenses.. Wounds,, External Otitis Media, Septicemia, defenses.. Wounds,, External Otitis Media, Septicemia, Pneumonia, UTI, Nosocomial Infection, Mutlidrug Pneumonia, UTI, Nosocomial Infection, Mutlidrug Resistance.. Intrinsic-R to many antibiotics..Common Resistance.. Intrinsic-R to many antibiotics..Common Nosocomial/ opportunistic Pathogen. Nosocomial/ opportunistic Pathogen.

55--Salmonella groupSalmonella group • Gram-ve bacilli.. Lactose-ve, urease-ve, Motile, Gram-ve bacilli.. Lactose-ve, urease-ve, Motile,

Facultative Anaerobes.. Endotoxin/LPS, Cytotoxin.. Facultative Anaerobes.. Endotoxin/LPS, Cytotoxin.. common in Nature.. Humans, most domestic & common in Nature.. Humans, most domestic & wild Animals, Birds, Reptiles ..Develop of specific wild Animals, Birds, Reptiles ..Develop of specific antibodies during invasive infection against their antibodies during invasive infection against their O/H- Antigens.. O/H- Antigens..

• Salmonellosis:Salmonellosis:• 1-Gastroenteritis/ Food-poisoning Salmonella:1-Gastroenteritis/ Food-poisoning Salmonella: S. S.

enterica/ enteritidis.. Numerous Serotypes.. enterica/ enteritidis.. Numerous Serotypes.. Common Farm Chickens, Pets.. Contamination Common Farm Chickens, Pets.. Contamination Chicken Meat-Eggs, Water.. Fecal-Oral Infection.. Chicken Meat-Eggs, Water.. Fecal-Oral Infection.. Incub. 8-24 h.. Mild-Severe Diarrhea, Vomiting, Incub. 8-24 h.. Mild-Severe Diarrhea, Vomiting, Fever.. Mostly Self-Limited in Adults. More severe Fever.. Mostly Self-Limited in Adults. More severe infection in children.. Septicemia-Meningitis in infection in children.. Septicemia-Meningitis in Immuno-compromised Pat. Immuno-compromised Pat.

V. cholerae V. cholerae –– Salmonella/ Salmonella/ FlagellaFlagella

HektonHekton––Enteric agar for Isolation Enteric agar for Isolation of Salmonella (E.coli-Salmonella of Salmonella (E.coli-Salmonella growth)growth)

Typhoidal SalmonellaTyphoidal Salmonella 2- 2- Typhoidal Salmonella:Typhoidal Salmonella: Human Enteric Fever.. Human Enteric Fever..

Salmonella enterica /subtype Typhi & Paratyhi A, B, Salmonella enterica /subtype Typhi & Paratyhi A, B, C., Fecal-Oral route, Fecal water contamination or C., Fecal-Oral route, Fecal water contamination or drinks/ Fresh Food.. Intestine..Blood, drinks/ Fresh Food.. Intestine..Blood, Meningis,Urinary tract.. Meningis,Urinary tract.. Incubation Period 1-3 Incubation Period 1-3 WeeksWeeks, high Fever up to 42, Diarrhea, constipation, , high Fever up to 42, Diarrhea, constipation, Septicemia, Meningitis, Hepatospenomegaly, Septicemia, Meningitis, Hepatospenomegaly, Intestinal Perforation.. Healthy Carriers.. Mostly Intestinal Perforation.. Healthy Carriers.. Mostly females in Gallbladder.. Less Intestine.. Repeat females in Gallbladder.. Less Intestine.. Repeat chronic infection.. Stool Excretion..single cases and chronic infection.. Stool Excretion..single cases and community water outbreaks. community water outbreaks.

• Lab Diagnosis:Lab Diagnosis: Culture Feces, blood, Urine, CSF, Selective Culture Feces, blood, Urine, CSF, Selective Media.. Serological Media.. Serological Widel Test Widel Test for detection of specific for detection of specific antibodies against O & H antigens ( Titer > 160 ).. Antibiotic, antibodies against O & H antigens ( Titer > 160 ).. Antibiotic, Human vaccine available. Human vaccine available.

6-Shigella group 6-Shigella group • Shigella species.. Shigella species.. Gram-ve bacilli, cause Only human Gram-ve bacilli, cause Only human

disease.. Endo/Enterotoxins.. Susceptible to Dryness, disease.. Endo/Enterotoxins.. Susceptible to Dryness, Acid, Low-High Tempt.Acid, Low-High Tempt. Fecal-Oral infectionFecal-Oral infection.. .. Water, Water, fresh Vegetations,fresh Vegetations, Common serotypes, Common serotypes, S. S. SonneiSonnei, , Sh.boydii Sh. flexneriSh.boydii Sh. flexneri Purulent-Bloody-Purulent-Bloody-Diarrhea..Fever abdominal pain..Recovery 2-4 days Diarrhea..Fever abdominal pain..Recovery 2-4 days with treatment.. No chronic healthy Carriers.with treatment.. No chronic healthy Carriers.

• S.dysenteriaeS.dysenteriae... . Enterotoxin (Neurocytotoxin), Severe Enterotoxin (Neurocytotoxin), Severe Necrosis, high Fever, Severe Necrosis, high Fever, Severe Purulent-Bloody-DiarrheaPurulent-Bloody-Diarrhea

& Abdominal Cramps, CNS affection.. Rare & Abdominal Cramps, CNS affection.. Rare Septicemia. Septicemia.

• Lab Diagnosis:Lab Diagnosis: Feces Culture.. S-S Agar, Hecton Feces Culture.. S-S Agar, Hecton ––Enteric Agar.. Recommended Antibiotic Treatment, Enteric Agar.. Recommended Antibiotic Treatment, Control Sanitation & hygiene.. water, fresh Food.Control Sanitation & hygiene.. water, fresh Food.

77--Vibrio choleraeVibrio cholerae • Gram-ve VibriosGram-ve Vibrios.. .. Oxidase-positive & Motile, Aerobic Oxidase-positive & Motile, Aerobic

Alkaline Medium (pH >8-9)..Killed in low acidity.. Alkaline Medium (pH >8-9)..Killed in low acidity.. Survive in saline water for long time.. Survive in saline water for long time.. Endemic In Endemic In India/Bangladish.. Highly infectious.. Epidemic India/Bangladish.. Highly infectious.. Epidemic Human Outbreaks.. Water, Fresh Green leaves & Human Outbreaks.. Water, Fresh Green leaves & Food Food

• V. cholera-01V. cholera-01: : Type Type V. cholera El-TorV. cholera El-Tor.. Only Human.. .. Only Human.. Fecal-Oral Infection, multiply small intestine..release Fecal-Oral Infection, multiply small intestine..release Cholera-toxin.. Heat-labile enterotoxin, Incub. 8-48 Cholera-toxin.. Heat-labile enterotoxin, Incub. 8-48 h.. Severe Watery Diarrhea, Dehydration, Shock.. h.. Severe Watery Diarrhea, Dehydration, Shock.. Death. Within 24 hrs..No invasive infection.Death. Within 24 hrs..No invasive infection.

• Lab DiagnosisLab Diagnosis: : Feces Culture.. Selective TCBS agar.Feces Culture.. Selective TCBS agar.• Treatment:Treatment: Replacement Fluids & Electrolytes.. Replacement Fluids & Electrolytes..

Antibiotic.. Public Heath Measurements.. Human Antibiotic.. Public Heath Measurements.. Human Vaccine recommended for Refuges & Army. Vaccine recommended for Refuges & Army.

CholeraCholera

TCBS agar for isolation of V.cholerae/TCBS agar for isolation of V.cholerae/SalmonellaSalmonella––Shigella agar (Lactose-Shigella agar (Lactose-negative)negative)

88--Brucella speciesBrucella species• Brucellosis/Malta FeverBrucellosis/Malta Fever.... Gram-ve Gram-ve

coccobacilli..Non-motile,coccobacilli..Non-motile, Intracellular, Intracellular, Endotoxins..Endotoxins.. Primarily a Pathogens of Animals Primarily a Pathogens of Animals (Zoonosis), Localized Infection in reproductive (Zoonosis), Localized Infection in reproductive Organs.. Sepsis, Abortions. Organs.. Sepsis, Abortions.

• Br. abortus Br. abortus (Cattel), (Cattel), Br. melitensis Br. melitensis (Goats/Sheep).(Goats/Sheep).• Human Brucellosis/Malt Fever : Human Brucellosis/Malt Fever : Mostly Br. Mostly Br.

melitensis.. Rare Other species in Jordan.melitensis.. Rare Other species in Jordan.• Transmitted to Humans.. Unpasteurized Milk/Milk Transmitted to Humans.. Unpasteurized Milk/Milk

Products.. Cheese, Direct Animal Contact.. Few Products.. Cheese, Direct Animal Contact.. Few Cells Enter Through GI, Skin Abrasions, Eye, Cells Enter Through GI, Skin Abrasions, Eye, Inhalation/Droplets.. Intracellular ..Lymphatic Inhalation/Droplets.. Intracellular ..Lymphatic System.. Septicemia, Meningitis, Chronic diseaseSystem.. Septicemia, Meningitis, Chronic disease

Brucella-2Brucella-2

• Clinical Features:Clinical Features: Incub. 1-6 Weeks.. Incub. 1-6 Weeks.. Intermittent fever, headaches, fatigue, joint and Intermittent fever, headaches, fatigue, joint and bone pain, GI Symptoms, Sweats, Back Pains, bone pain, GI Symptoms, Sweats, Back Pains, Acute- Subacute-Chronic Infections. Acute- Subacute-Chronic Infections.

• Common ComplicationsCommon Complications: : Arthritis, Meningitis-Arthritis, Meningitis-CNS, Osteomylitis, Localized Lesions in any body CNS, Osteomylitis, Localized Lesions in any body part.part.

• Lab DiagnosisLab Diagnosis:: Culture Blood, CSF, Bone Culture Blood, CSF, Bone marrow (Chronic Infection).. Brucella marrow (Chronic Infection).. Brucella agglutination Test.. Specific Antibodiesagglutination Test.. Specific Antibodies

• Treatment:Treatment: 6-8 Weeks with Antimicrobial drugs 6-8 Weeks with Antimicrobial drugs• Prevention:Prevention: Control Brucella in Animals by Control Brucella in Animals by

slaughtering infected animals .. Animal slaughtering infected animals .. Animal Vaccination, Pasteurization Milk/ Milk ProductsVaccination, Pasteurization Milk/ Milk Products

99--Campylobacter Campylobacter SpeciesSpecies• Campylobacter jejuniCampylobacter jejuni , , is Gram-negative is Gram-negative

slender, curved, motile by one/ two polar slender, curved, motile by one/ two polar Flagellium, Spiral form, Grow Microaerophilic at 37-Flagellium, Spiral form, Grow Microaerophilic at 37-42..Normal Intestines flora all Birds, Animal..dogs, 42..Normal Intestines flora all Birds, Animal..dogs, cats.. contaminated often Chicken Meat, Milk, food, cats.. contaminated often Chicken Meat, Milk, food, water.water.

• It is primarily an animal pathogen causing It is primarily an animal pathogen causing abortion abortion and enteritis in sheep and cattleand enteritis in sheep and cattle..

• Common cause of food-poisoning, important enteric Common cause of food-poisoning, important enteric pathogen since 1976.. In Western Countries.pathogen since 1976.. In Western Countries.

• C. jejuniC. jejuni .. Incubation 2-5 days..release Cytotoxins.. .. Incubation 2-5 days..release Cytotoxins.. Intestinal inflammation..causes mild-moderate Intestinal inflammation..causes mild-moderate bloody-water diarrhea, Children.. , Other symptoms bloody-water diarrhea, Children.. , Other symptoms often present are fever, abdominal pain, nausea, often present are fever, abdominal pain, nausea, headache and muscle pain..Rare Sepsis & headache and muscle pain..Rare Sepsis & complication Arthritis, complication Arthritis,

• Diagnosis:Diagnosis: Stool culture .. Selective culture Media Stool culture .. Selective culture Media

Cambylobacter Cell Cambylobacter Cell morphologymorphology

1010--Helicobacter SpeciesHelicobacter Species

• Helicobacter pyloriHelicobacter pylori is a spiral shaped is a spiral shaped bacterium..One polar flagella.. Colonize only bacterium..One polar flagella.. Colonize only mucus mucus lining lining cover mucosa of cover mucosa of Gastric AntrimGastric Antrim.. and .. and duodenum.. Produce extensive duodenum.. Produce extensive Urease.Urease..Split urea to .Split urea to Ammonia..release Ammonia..release CytotoxinCytotoxin.. Mild-sever ulceration .. Mild-sever ulceration

• The stomach is protected from its own gastric juice The stomach is protected from its own gastric juice by a thick layer of mucus that covers the stomach by a thick layer of mucus that covers the stomach lining. lining.

• Helicobacter colonize and infect only humans Helicobacter colonize and infect only humans worldwide, where up to 10% of children & 80% of worldwide, where up to 10% of children & 80% of adults can have evidence of an adults can have evidence of an H. pyloriH. pylori infection - infection - usually without having any clinical signs or usually without having any clinical signs or symptoms.symptoms.

HelicobacterHelicobacter

Helicobacter Species-2Helicobacter Species-2• Common symptomsCommon symptoms: gastritis or : gastritis or peptic ulcerpeptic ulcer

/Stomach.. /Stomach.. duodenal ulcersduodenal ulcers ..burning, Abdomen ..burning, Abdomen Pain, Nausea, Vomiting.Pain, Nausea, Vomiting.

• Persistence of ulcers .. Development of Persistence of ulcers .. Development of Stomach Cancer and Lymphoma..1-3%Stomach Cancer and Lymphoma..1-3%

• H. pyloriH. pylori can be successfully eradicated using can be successfully eradicated using a combination of certain antibiotics and a combination of certain antibiotics and medicines that suppress stomach acid medicines that suppress stomach acid production. Common Re-occurrence of infection production. Common Re-occurrence of infection & disease& disease

• Diagnosis:Diagnosis: Urea Breath Test, Culture Stomach Urea Breath Test, Culture Stomach Biopsy.. Culture on Selective Medium.. 42C..Biopsy.. Culture on Selective Medium.. 42C..

• Serological test for Serological test for specific antibodies is not specific antibodies is not significantsignificant