Enteric BacteriaEnteric Bacteria

Prof. 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, Intestinal Normal Flora.. Humans, Animals, Anaerobes, Intestinal Normal Flora.. Humans, Animals, Birds.. Common Waste water, Natural Water, Soil, Birds.. Common Waste water, Natural Water, Soil, Vegetation.Vegetation.

• OpportunisticOpportunistic Pathogens/Obligate Pathogens/Obligate Pathogens Pathogens.. .. Enterotoxins, Endotoxins, Capsule, Flagella. Enterotoxins, Endotoxins, Capsule, Flagella.

• Coliform GroupColiform Group: : 11. . Escherichia coliEscherichia coli: Urinary Tract Infect (40-70%)..Single : Urinary Tract Infect (40-70%)..Single

Organism, Septicemia, Meningitis, Wounds. Organism, Septicemia, Meningitis, Wounds. Diarrheagenic E coli Diarrheagenic E coli StrainsStrains:: Enteropathogenic (Infants), Enteropathogenic (Infants),

Enterotoxigenic ( Heat-Labile/Stable Enterotoxin).. Watery Enterotoxigenic ( Heat-Labile/Stable Enterotoxin).. Watery diarrhea Children/Adults.. Travelers.. Contamination diarrhea Children/Adults.. Travelers.. Contamination Water/Vegetables / Fresh Food ..Self-limitedWater/Vegetables / Fresh Food ..Self-limited

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

Coli-form BacteriaColi-form Bacteria 2. 2. Klebsiella-Enterobacter speciesKlebsiella-Enterobacter species: UTI, : UTI,

Septicemia, Wounds.. Rare Meningitis.. Common Septicemia, Wounds.. Rare Meningitis.. Common Hospitalized patients. Hospitalized patients. K. pneumoniaeK. pneumoniae.. Nosocomial .. Nosocomial infections..Pneumoniainfections..Pneumonia

3. 3. Proteus-Providencia speciesProteus-Providencia species:: UTIUTI, , Septicemia, Septicemia, Wounds.. Common Hospitalized patients.Wounds.. Common Hospitalized patients.

4. 4. Pseudomonas aeruginosaPseudomonas aeruginosa & & Pseudomonas groupPseudomonas group. . Several Enzymes & Toxins.. Common Water Several Enzymes & Toxins.. Common Water Environment, Vegetations, Disinfection Solutions, Environment, Vegetations, Disinfection Solutions, Wounds, Burn.. Blue Green Pus, External Otitis Wounds, Burn.. Blue Green Pus, External Otitis Media, Septicemia, Pneumonia, UTI, Nosocomial Media, Septicemia, Pneumonia, UTI, Nosocomial Infect, Mutlidrug Resistance..Infect, Mutlidrug Resistance..

Diagnosis:Diagnosis: MacCokeny -Blood Agar.. CLED, Biochemical MacCokeny -Blood Agar.. CLED, Biochemical Tests. Tests.

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

Salmonella groupSalmonella group •

Gram-ve bacilli.. Facultative Anaerobes.. Gram-ve bacilli.. Facultative Anaerobes.. Lactose-negative, Endotoxin/LPS.. common in Lactose-negative, Endotoxin/LPS.. common in Nature.. Humans, Animals, Birds.. O/H- Nature.. Humans, Animals, Birds.. O/H- Antigens..Specific antibodies Antigens..Specific antibodies

• Salmonellosis:Salmonellosis:• 1-Gastroenteritis 1-Gastroenteritis /Food-poisoning /Food-poisoning

SalmonellaSalmonella:: S. entericaS. enterica/ enteritidis/ enteritidis.. 2000 .. 2000 Serotypes.. Common Birds, Farm Chickens, Serotypes.. Common Birds, Farm Chickens, Pets.. Contamination.. Food-poisoning.. Pets.. Contamination.. Food-poisoning.. Chicken Meat-Eggs, Water.. Fecal-Oral Chicken Meat-Eggs, Water.. Fecal-Oral Infection.. Incub. 8-24 h.. Mild-Severe Infection.. Incub. 8-24 h.. Mild-Severe Diarrhea, Vomiting, Fever.. Self-Limiting.. Diarrhea, Vomiting, Fever.. Self-Limiting.. Adults Rarely Septicemia-Meningitis Adults Rarely Septicemia-Meningitis Infant/young Children.. Immun-difficiant Infant/young Children.. Immun-difficiant PatientsPatients

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

• Lab Diagnosis:Lab Diagnosis: Culture Feces, Food.. S-S AgarCulture Feces, Food.. S-S Agar, , Hekton-Hekton-enteric agar. Prevention.. Control Sanitation & hygieneenteric agar. Prevention.. Control Sanitation & hygiene....

2- 2- Typhoidal Salmonella:Typhoidal Salmonella: Human Enteric Fever.. Human Enteric Fever.. Salmonella enterica /typhi & paratyhi A, B, C.. Invasive, Salmonella enterica /typhi & paratyhi A, B, C.. Invasive, only human,Fecal-Oral, Human Healthy Carriers.. Water-only human,Fecal-Oral, Human Healthy Carriers.. Water-Food.. Incub. 1-3 Weeks.. high Fever, Diarrhea, Septicemia, Food.. Incub. 1-3 Weeks.. high Fever, Diarrhea, Septicemia, Meningitis, hepatospenomegaly, Intestinal Perforation.. Meningitis, hepatospenomegaly, Intestinal Perforation.. Healthy Carriers.. Gallbladder.. Intestine.. Short/Life LongHealthy Carriers.. Gallbladder.. Intestine.. Short/Life Long

• 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)antibodies against O & H antigens ( Titer > 160)

Antibiotic, Human vaccine available. Antibiotic, Human vaccine available.

Shigella groupShigella group

• 4- Shigella species4- Shigella species.. Endo/Enterotoxins.. .. Endo/Enterotoxins.. Lactose-negative, Susceptible to Dryness, Acid, Lactose-negative, Susceptible to Dryness, Acid, Low-High Tempt.Low-High Tempt. Fecal-Oral infectionFecal-Oral infection.. .. Water, Water, fresh Vegetations,fresh Vegetations, Few serotypes.. Incub. 1-2 Few serotypes.. Incub. 1-2 Days.. Common Days.. Common S. S. SonneiSonnei, , Sh.boydiiSh.boydii .. .. Purulent-Purulent-Bloody-Diarrhea..not invasiveBloody-Diarrhea..not invasive

• S.dysenteriaeS.dysenteriae.. Enterotoxin /Neurocytotoxin...., .. Enterotoxin /Neurocytotoxin...., Necrosis, Fever, Severe Necrosis, Fever, Severe Purulent-Bloody-Purulent-Bloody-DiarrheaDiarrhea

Abdominal Cramps, CNS.. Rare Septicemia. Abdominal Cramps, CNS.. Rare Septicemia. • Lab Diagnosis:Lab Diagnosis: Feces Culture.. S-S Agar, Hecton Feces Culture.. S-S Agar, Hecton

––Enteric Agar.. Recommended Antimicrobials Enteric Agar.. Recommended Antimicrobials Treatment .. Treatment .. Control Sanitation & hygiene.Control Sanitation & hygiene.

Vibrio choleraeVibrio cholerae • Gram-ve VibriosGram-ve Vibrios.. .. Aerobic Growth..Aerobic Growth.. Alkaline Alkaline

Medium (pH >8-9).. Water.. Fresh Food..Medium (pH >8-9).. Water.. Fresh Food..Reservoir Reservoir human & waterhuman & water. . Endemic In India/Bangladish.. Endemic In India/Bangladish.. Epidemic Disease, Causeing Epidemic Disease, Causeing human Outbreaks.human Outbreaks.

• V. cholerae-01V. cholerae-01: Type : Type V. cholerae El-TorV. cholerae El-Tor.. Only .. Only Human.. Fecal-Oral Infection.. Raw Sea/ Fresh Human.. Fecal-Oral Infection.. Raw Sea/ Fresh Foods, Small Intestine Infect. Cholera-Foods, Small Intestine Infect. Cholera-enterotoxin, Incub. 8-48 h.. Severe Water enterotoxin, Incub. 8-48 h.. Severe Water Diarrhea-Dehydration.. Shock.. Death..Diarrhea-Dehydration.. Shock.. Death..

• Lab DiagnosisLab Diagnosis: Feces Culture.. Selective TCBS : Feces Culture.. Selective TCBS agar.agar.

• Treatment:Treatment: Replacement Fluids & Electrolytes.. Replacement Fluids & Electrolytes.. Antibiotic.. Public Heath Measurements.. Human Antibiotic.. Public Heath Measurements.. Human Vaccine. Vaccine.

CholeraCholera

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

Brucella speciesBrucella species

• Brucellosis/Malta FeverBrucellosis/Malta Fever.... Gram-ve coccobacilli..Gram-ve coccobacilli.. Intracellular, Intracellular, Endotoxins..Endotoxins.. Primarily pathogens Primarily pathogens of Animals (causing Zoonosis), Localized of Animals (causing Zoonosis), Localized Infection in animal reproductive Organs,Sepsis, Infection in animal reproductive Organs,Sepsis, Abortions. Abortions.

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

melitensis.. Rare Other species in Jordan.melitensis.. Rare Other species in Jordan.• Transmitted to HumansTransmitted to Humans:Unpasteurized Milk/Milk :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 System.. Septicemia, Meningitis, Chronic disease..long lifedisease..long life

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 CNS, Osteomylitis, Localized Lesions in any body part.body part.

• Lab DiagnosisLab Diagnosis:: Culture Blood, CSF, Bone marrow Culture Blood, CSF, Bone marrow (Chronic Infection).. Brucella agglutination Test.. (Chronic Infection).. Brucella agglutination Test.. Specific AntibodiesSpecific 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, Vaccination, slaughtering infected animals, Vaccination, Pasteurization Milk/ Milk ProductsPasteurization Milk/ Milk Products

Campylobacter SpeciesCampylobacter Species• C. jejuniC. jejuni is Gram-negative slender, curved, motile is Gram-negative slender, curved, motile

rod, Grow Microaerophilic.. Optimal growth 42 C.rod, Grow Microaerophilic.. Optimal growth 42 C.• This bacterium became important enteric pathogen This bacterium became important enteric pathogen

since 1976..widely spread in small animals.. Birdssince 1976..widely spread in small animals.. Birds• 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..• C. jejuniC. jejuni infection causes mild-moderate diarrhea, infection causes mild-moderate diarrhea,

Children.. watery or sticky, contain blood , fecal Children.. watery or sticky, contain blood , fecal leukocytes Other symptoms often present are fever, Other symptoms often present are fever, abdominal pain, nausea, headache and muscle pain. abdominal pain, nausea, headache and muscle pain.

• The illness usually occurs 2-5 days after ingestion of The illness usually occurs 2-5 days after ingestion of the contaminated Chicken Meat, Milk, food water.the contaminated Chicken Meat, Milk, food water.

• Diagnosis:Diagnosis: Stool culture .. Selective Capylobacter Stool culture .. Selective Capylobacter Media including 3 antibiotics.Media including 3 antibiotics.

Helicobacter SpeciesHelicobacter Species • Helicobacter pyloriHelicobacter pylori is a spiral shaped bacterium is a spiral shaped bacterium

that lives in the that lives in the mucus lining mucus lining Pyloric interimPyloric interim--stomach and duodenumstomach and duodenum..Cytotoxin, Only ..Cytotoxin, Only pathogenic in humanpathogenic in human

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

• The bacteria are found worldwide, where up to The bacteria are found worldwide, where up to 10% of children - 80% of adults can have 10% of children - 80% of adults can have evidence of an evidence of an H. pyloriH. pylori infection - usually infection - usually without having any clinical signs or symptoms.without having any clinical signs or symptoms.

• Transmission route.. Close personal contact, less Transmission route.. Close personal contact, less other sources.other sources.

HelicobacterHelicobacter

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

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

• Persistence of ulcers .. development of Persistence of ulcers .. development of Stomach Stomach Cancer and Lymphoma.Cancer and Lymphoma.

• H. pyloriH. pylori can be successfully eradicated (95%) can be successfully eradicated (95%) using a combination of certain antibiotics and using a combination of certain antibiotics and medicines that suppress stomach acid medicines that suppress stomach acid production. Common Re-occurrence within few production. Common Re-occurrence within few weeks-months.weeks-months.

• Diagnosis:Diagnosis: Urea BreathTest, Culture Stomach Urea BreathTest, Culture Stomach Biopsy.. Selective Medium.. 42C, Specific Biopsy.. Selective Medium.. 42C, Specific H. H. pyloripylori antibodies antibodies not significant alone.not significant alone.