CLINICAL BACTERIOLOGY Roderick D.

Balce

FAMILY ENTEROBACTERIACEAE
A. CLINICALLY IMPORTANT MEMBERS

Escherichia coli (G, R, U, B, C) Edwardsiella tarda (G, W, B) Salmonella serotypes (G, B)

Klebsiella spp. (R, U, B) Proteus spp. (U) Shigella spp. (G)
Enterobacter spp. (R, W, B) Providencia spp. (U, G) Plesiomonas shigelloides (G)
Citrobacter spp. (U, B) Morganella morganii (G) Yersinia species (G, B, R)
Serratia spp. (U, R, W, B)
*Legend:
G: GI tract, R: Respiratory, U: Urinary tract, B: Bacteremia, C: CSF (meningitis), W: Wound
Yellow = opportunistic, nosocomial Blue = primary
NOTE:
1. Lactose fermenters: E. coli, Klebsiella spp., Enterobacter spp.
2. Late lactose fermenters: Citrobacter frondii, Serratia mersescens
B. GENERAL CHARACTERISTICS AND EXCEPTIONS
 Motile, most with peritrichous flagella except: Klebsiella, Shigella, Yersinia pestis (some Yersinia spp. are
motile @ 25 deg. Celsius) | NOTE: Plesiomonas is LOPOTRICHOUS/MONOTRICHOUS
 Non-spore forming
 Short rod/coccobacilli
 Good growth at Mac Conkey Agar (MAC)
 Aerobes or facultative anaerobes
 Carbohydrate utilizers/fermenters: all ferment glucose, but not all ferment lactose
 Catalase positive except Shigella dysenteriae
 Oxidase negative except Plesiomonas shigelloides
 Nitrate reduction positive except Pantoca agglomerans, Erwingella spp.
 Klebsiella (Calymmatobacterium) granulomatis – non-Gram stainable, non-culturable on bacteriologic
media; agent of granuloma inguinale/donovanosis (STD)
 Ewingella americana – biochemically inactive/inert; currently no recommended biochem identification
scheme; not common isolate
 Yersinia pestis – only species that is NOT intestinal (NOT fecal oral route) and is transmitted from animals to man by
rat flea bites
 Serologic characteristics:
Antigen Characteristics Other comments
K, capsular Polysaccharide, heat labile Increases virulence by preventing phagocytosis
May mask O antigen (removed Present in Klebsiella, E.coli, Salmonella
by heating/boiling) K antigen of Salmonella Typhi is called Vi (Salmonella
enterica ser. Typhi)
O, somatic Lipopolysaccharide, heat Used for serogrouping of Salmonella, Shigella, E.coli
stable endotoxin O antigens of Proteus spp. (mirabilis, vulgaris) are used
Forms part of the cell wall to detect antibodies to Ricketssia spp. (WALE-FELIX
TEST)
H, flagellar Protein, heat labile Found only in motile members
Used for serotyping of Salmonella, E.coli

C. CULTURE MEDIA (to be discussed in the counterpart laboratory module)

1. Enrichment media – for recovering low numbers of Salmonella and Shigella spp. in stool
 GN broth – bile salt
 Selenite broth – Na hydrogen selenite
 Tetrathionate broth – bile salt, Na thiosulfate; turbidity = growth; may have brilliant green
2. Selective and Differential Media
Medium Inhibito Fermentable Indicator/s Lactose Non-lactose
ry carbohydrate fermenters fermenters
agents (diff.)
(sel.)
EMB Eosin Y & Lactose Eosin Y, Methylene Red / blue-black Colorless colonies
Eosin Methylene Blue Blue colonies with sheen
Methylene (against gram +) Green metallic
Blue sheen = E. coli
1
CLINICAL BACTERIOLOGY Roderick D. Balce
MAC Mac Bile salt & Lactose Neutral red (pH) Pink – red colonies Colorless colonies
Conkey Crystal Violet
SSA Bile salt, Na Lactose Neutral red (pH) Pink – red colonies Colorless colonies
Salmonella citrate, Brilliant Na thiosulfate & Ferric without black
Shigella Green ammonium citrate center
Agar (H2S) *with black center:
Shigella and
Salmonella (H2S)
HEA Bile salt Lactose, Sucrose, Bromthymol blue (pH) Yellow-orange Green/blue-green
Hektoen Salicin Na thiosulfate & Ferric colonies colonies without
Enteric ammonium citrate black center
Agar (H2S) *with black center:
H2S
XLD Bile salt Lactose, Sucrose, Phenol red (pH) Yellow colonies Red without black
Xylose “deoxycholate”, Xylose Na thiosulfate & Ferric center
Lysine but low amount ammonium citrate *with black center:
Deoxychol (H2S) Salmonella spp.
ate (less excepy S. paratyphi
inhibitory;
Shigella
most likely
to grow)
3. Other Selective Media
 SMAC – sorbitol replaces lactose in the medium; for isolation of E.coli O157H7; colorless – sorbitol negative
 BSA – contains bismuth sulfide & brilliant green ; S. Typhi colonies appear black
while those of other Salmonella serotypes are light green; used to distinguish S. ser Typhi from other
serotypes
 CIN Cefsulidin Irgasanum Novobiocin or Yersinia selective agar – contains sodium desxycholate, Cef, Irg,
Nov, CV, mannitol, and neutral red indicator; used to isolate Yersinia enterocolityca = BULLSEYE
(colorless halo around pink/red center)

2
CLINICAL BACTERIOLOGY Roderick D. Balce

3
CLINICAL BACTERIOLOGY Roderick D. Balce
D. BIOCHEMICAL TESTS AND OTHER IDENTIFICATION TECHNIQUES (to be discussed in the
counterpart laboratory module)
TEST PRINCIPLE MEDIA AND REAGENTS RESULTS
1. Motility test Growth of flagellated organisms  Semisolid 1% Triphenyl Motile: visible growth away
away from the line of inoculation Tetrazolium Chloride, SIM, from stab line, cloudy
MIO medium
Nonmotile: growth along stab
line, clear medium
2. Oxidase Detects cytochrome oxidase  1% tetramethyl-para- Positive: dark purple
phenylinediamine
dihydrochloride
(Kovac’s) Activity (to indole phenol) Negative: no color change
Note: False positive when using
IRON WIRE, hence use platinum
wire or wooden stick
3. Nitrate Ability to reduce nitrate to  Nitrate broth Positive: 1. Bubbles in
reduction nitrite or other compounds (N2,  Reagents Durham tube (N2)
NO, N2O) A= sulfanilic acid 2. Red color after adding
NO3  NO2 B= alpha-naphthylamine rgt. A and rgt. B (N02)
Zinc dust = nitrate 3. No change after
reducer
adding rgt. A and B then
zinc dust (N2O, NO)

Negative: red color after

adding rgt. A, B, then
zinc

4. Triple sugar Fermentation of glucose and  TSI agar: LF: yellow slant and butt
(A/A)
Iron ; lactose or sucrose and 1% Lactose, 1% Sucrose, NLF: red slant, yellow butt
substitute: 0.1% Glucose (10:10:1) (K/A)
Kligler Iron
Agar (has no
sucrose)
formation of H2S pH: phenol red NF: red slant and butt (K/K)
H2S: Na thiosulfate,
Ferrous sulfate
Aerogenic: cracks, bubbles,
separation of agar from
bottom of tube
H2S producers: blackening
agar
A/A w/ gas: E.coli, Klebsiella spp., Enterobacter spp.
A/A, H2S+ w/ gas: Citrobacter frondii (late lactose fermenter)
K/A, H2S+ Citrobacter frondii, most Salmonella serotypes, Proteus spp. (except P. peneri), E.
tarda
K/A TRIBE SPP: Providencia, Morganella | Shigella, Plesiomonas, Yersinia, inactive E.coli,
other Citrobacter spp., Serratia spp.
5. ONPG Detects beta-galactosidase ;  ONPG broth or Positive: yellow (LLF): C.
distinguishes LLFs from non–LFs 0.85% saline + ONPG disk frondii, S. mersescens,
Shigella sonnei, Salmonella

4
CLINICAL BACTERIOLOGY Roderick D. Balce
ser. Arizonei, Y.
enterocolytica
Negative: colorless (NLF)

6. Indole (tube) Ability to produce  Tryptophan broth, SIM, or Positive: pink-red ring
Counterpart: spot tryptophanase and hydrolyze MIO media after addition of reagent;
indole test (para- tryptophan to form the  Reagent: Kovac’s or E. coli, P. vulgaris
dimethylaminosin compound indole Negative: no color change
Ehrlich’s reagent added
emaldehyde),
after 24 hours of or yellow; P. mirabilis
where blue is
positive result incubation
7. Methyl red Detects acid production through  MRVP broth or Positive: red
(result always mixed acid fermentation Clark Lubbs CCL Broth Negative: yellow
opposite of pathway  Reagent: Methyl red
Voges-Proskauer)
8. Voges- Detects acetoin or acetylmethyl  MRVP or CL broth Positive: red
Proskauer carbinol and 2,3-butanediol  Barritt’s reagents: Negative: yellow
through butylene glycol pathway Alpha naphtol and
Potassium hydroxide _
9. Citrate Ability to use citrate as the sole  Simons Citrate Agar w/ Positive: blue (growth);
NOTE: relared carbon source and ammonium bromthymol blue Klebsiella spp., Citrobacter
tests (acetate, salts as the sole nitrogen source spp., Enterobacter spp.
malonate) *same Negative: no color change
principle
(no growth); E.coli
NOTE: THIS
PRODUCES THE
IMVIC TEST (++--)
OR (--++)
RESULTS ONLY

5
CLINICAL BACTERIOLOGY Roderick D. Balce

10. Deaminase Ability to oxidatively (slant  Phenylalanine or Positive: (only for Tribe:
portion) deaminate an amino Tryptophan agar Proteus, Providencia,
acid  Reagent: 10% Ferric Morganella)
chloride Phe agar – green
Trp agar – brown
NEGATIVE – no color
change
11. Decarboxylase Ability to anaerobically  Moeller’s decarboxylate Positive:
and dihydrolase decarboxylate or hydrolyze an broth, 3 tubes (each with Purple (alkaline)
amino acid (lysine D, ornithine diff. A. A); pH: Negative: no color change
D, or arginine H) to form an Bromcrysol purple, or yellow (acid)
amine Sterile mineral oil (to NOTE: results are
make environment CORRELATED with LYSINE
anaerobic) IRON AGAR (LIA):
Lysine positive = K/K
Lysine negative = K/A
12. Lysine iron Deamination (DA) or  LIA: lysine, glucose DA (slant): positive =
agar decarboxylation (DC) of lysine for H2S: Na thiosulfate, bordeau red/burgundy |
and formation of H2S Ferric ammonium citrate negative = purple (alkaline)
pH: bromcrysol purple
DC (butt): positive = purple
(alkaline) | negative = yellow
(acid)
K/K: E.coli, Edwardsiella tarda, Klebsiella, Enterobacter
aerogenes/gergoviae, S. marsescens, Hogmia, Salmonella (w/
H2S)
K/A: Citrobacter, Yersinia, Enterobacter cloacae/cancerogenous,
C. sakazakii, P. agglomerans, Shigella
R/A: (TRIBE) Proteus, Providencia, Morganella (deaminase test);
R= red

13. Urease Hydrolysis of urea producing  Christensen’s urea agar or Positive: pink/magenta
ammonia which alkalinizes the Stuart’s urea broth Negative: no color change
medium CHRISTENSEN’s : SLOW RAPID: Proteus, Providencia
(>24 hrs) rettgeri, Morganella
STUART’s : RAPID producer
(24 hrs)

6
CLINICAL BACTERIOLOGY Roderick D. Balce
14. MUG Methyl Detects beta-  Disk containing 4-methyl- Positive: Electric blue
Umbelliferyl diglucoronidase activity of umbelliferyl-beta- fluorescence
Glucoronide E. coli (hydrolysis of MUG) diglucoronide (MUG) Negative: no fluorescence

7
CLINICAL BACTERIOLOGY Roderick D. Balce
15. DNAse Detects production of  DNAse agar containing Positive: green  colorless
deoxyribonuclease DNA methyl green complex (S. mersescens)
which hydrolyzes DNA which dissociates after Negative: no color change
DNA hydrolysis
16. Gelatinase Detects production of  Nutrient gelatin medium Positive: partial or complete
proteolytic enzymes that liquefy liquefaction @ 4 deg. Celsius;
gelatin S. mersescens
Negative: remains solid @ 4
deg. Celsius
17. Modified Detects carbaphenimase  Mueller-Hinton agar Positive: Cloverleaf-like
Hodge test production  Antibiotic disk containing: indention of growth of E.coli
Meropenem, Ertapenem, ATCC 25922 (control strain)
Imiperem

18. Commercial systems

a. API 20E test kit (biochem)– plastic strip holding 20 mini test tubes each containing dessicated medium
inoculated with saline suspension of a pure culture
b. Automated ID systems e.g. Vitek 2 system (bioMerieux; biochem) for microbial ID and AST
c. PCR, DNA probe – genetic
d. MALDITOF-MS – physical (proteome)

Flow chart for the presumptive identification of commonly encountered Enterobacteriaceae

8
CLINICAL BACTERIOLOGY Roderick D. Balce

9
CLINICAL BACTERIOLOGY Roderick D. Balce

F. ESCHERICHIA, KLEBSIELLA, ENTEROBACTER  LACTOSE FERMENTERS

Escherichia coli Klebsiella spp. Enterobacter spp.
Key - Greenish metallic - Mucoid, glistening, wet - + ODC
characteristics sheen on EMP agar - + string test
- + MUG test (electric - + Newfeld-Quellung test =
blue fluorescence) capsular swelling test
- - Ornithin Decarboxylase Test
ODC
- Slow urease producer
Motility Motile Non-motile Motile
TSI A/A with gas A/A with gas A/A with gas
Carbohydrate Except: E. coli ser. Except: K. pneumoniae ser. Except: Enterobacter
fermentation; Alkalisensdipar aka inactive E. Rhinoscleromatis cancerogenous
correlated w/ coli
lactose
fermentation
in Mac Conkey
LIA K/K K/K K/K with gas for Enterobacter
NOTE: K/A for Except: K. pneumoniae ser. aerogenes and gergovi
non-LF Rhinoscleromatis K/A for Enterobacter cloacae
and cancerogenous
IMViC ++-- --++ for K. pneumonia ser. --++
Pneumoniae
+-++ for K. oxytoca (the only indole +
Klebsiella sp.)
1. Escherichia coli
 leading cause of Enterobacteriaceae nosocomial infections (number 1 cause of UTI and number 2 cause
of neonatal meningitis )
 Serotypes: NOTE (A-E is diarrheagenic E. coli)
Serotype Virulence factor Manifestations Other comments
a. EHEC/ Verotoxin Hemorrhagic colitis, hemolytic uremic Most common isolate: O157H7
VTEC/STEC Shiga-like toxin syndrome (renal failure) which is SMAC negative and
MUG negative
*Shows NO PMN in stool; bloody
EHEC:
stoolq
EnteroHemorrhagic
E. coli
VTEC: Verotoxic E.
coli
STEC: Shiga-like
Toxin-producing E.
coli
b. ETEC Labile and stable Cholera-like traveller’s diarrhea, Immunoassay for LT and ST
enterotoxin (LT and Montezuma’s revenge
ETEC: ST) immunoassay
EnteroToxigenic E.
coli
c. EIEC Invasin toxic Shigella or dysentery-like infection Mucoid stool has RBC, PMN,
(enterocyte mucus
EIEC: EnteroInvasive invasion) Sereny test (animal inoculation
E. coli tests)
DNA probes
d. EPEC Pili/fimbriae and Infantile diarrhea (non-invasive) Mucoid stool but NO PMN, RBC
pathogenicity DNA probes
EPEC: islands
EnteroPathogenic E. *for colonization
coli
e. EAEC Pili/fimbriae and Acute/chronic diarrhea Common in HIV patient
pathogenicity
EAEC: islands
EnteroAggregative E. *for colonization
coli
f. DAEC Adhesins Diarrhea, UTI Primary nosocomial related

DAEC: Diffusely

1
0
CLINICAL BACTERIOLOGY Roderick D. Balce
Adherent E. coli
g. UPEC Pili/fimbriae UTI Primary nosocomial related

UPEC:
UroPathogenic E.
coli

2. Klebsiella spp. (nonmotile)

 Virulence factors: capsule, Extended Spectrum Beta-lactamase (ESBL), carbapenamase
 Differentiated from Enterobacter by motility (-) and ODC (-)
 Important species:
K. pneumonia (slow urease) – Friedlander’s bacillus; causes pneumonia, UTI, septicimea, bacteremia,
HALLMARK: RED CURRANT JELLY SPUTUM ; IMVIC --++ ; normal inhabitant of respiratory tract
K. oxytoca (slow urease) – the only INDOLE POSITIVE SPECIES OF KLEBSIELLA ; IMVIC +-++
K. pneumoniae subsp. ozaenae – purulent sinus infections ; IMVIC -+- -
K. pneumoniae subsp. rhinoscleromatis – granuloma of the nose and oropharynx ; IMVIC -+- -

3. Enterobacter spp. (motile)

 commonly associated with contaminated medical devices (nosocomial), surgical wounds
 encapsulated (mucoid colonies)
 may contain plasmids that encode antibiotic resistance genes
 Important species:
E. aerogenes – Lysine decarboxylase positive, urease positive, LOA -++, ODC positive, LIA K/K
E. gergoviae – Lysine decarboxylase positive, urease positive, LOA -++, ODC positive, LIA K/K
E. cloacae – Lysine decarboxylase negative, urease positive, LOA -++, ODC positive, LIA K/A
E. Cancerogenus “TAYLORAE” – Lysine decarboxylase negative, urease positive, LOA -++, ODC positive, LIA K/A
4. Species related to Genus Enterobacter (former meribens)
Cronobacter sakazakii (old name is enterobacter)– sorbitol negative, LOA -++, colitis,
bacteremia, neonatal meningitis; YELLOW PIGMENT ENDOGENOUS
Pantoea agglomerans – indole positive, ODC negative, LOA ---, GI infection, contracted
from different sources (causes sporadic infections contracted from diverse sources including
IV fluids); YELLOW PIGMENT ENDOGENOUS
Hafnia alvei – non-lactose fermenter, delayed citrate reaction, LOA ++-

1
1
CLINICAL BACTERIOLOGY Roderick D. Balce

E. CITROBACTER, EDWARDSIELLA, SERRATIA

Citrobacter freundii (late Edwardsiella tarda ONPG Serratia marcescens (late
lactose fermenter) ONPG NEGATIVE lactose fermenter) ONPG
POSITIVE POSITIVE
Key Citrate positive, H2S positive, Citrate negative, H2S positive, Citrate positive, DNAse positive,
characteristics Indole negative Indole positive Gelatinase positive, Lipase
positive, H2S negative, Indole
negative

Bold = 3 most notable biochemical

tests for S. marcescens
MAC Colorless @ 24 hrs Colorless Colorless @ 24 hrs
Light pink @ 48 hrs Light pink @ 48 hrs
w/ endogenous red pigment (NOT
due to lactose)
TSI K/A with gas OR A/A with gas and H2S K/A with H2S K/A or A/A without H2S nor gas
+ after 48 hrs
LIA K/A K/K K/K
IMViC - + - + + + - - (like E. coli) - - + +

1. Citrobacter spp.  opportunistic UTI and bacteremia

 Most are late lactose fermenters producing colonies on MAC that resemble those of E. coli but can be
differentiated by citrate reaction in IMViC
 C. freundii – resembles Salmonella (because of H2S production) on media containing thiosulfate and
iron but differentiated by ONPG, LDC, and LIA tests where: C. freundii is ONPG +, LDC -, LIA K/A
 C. koseri – non H2S producer, indole positive, IMVIC + + - +; old name: C. diversus ; NOT LATE
LACTOSE FERMENTER
2. Edwardsiella tarda
 differentiated from most Salmonella spp. and C. freundii by IMViC of E. tarda ( + + - - ); both are H2S +
 chief reservoirs are reptiles, freshwater fishes ; infections often involve aquatic environments
3. Serratia spp.
 survive under harsh environmental conditions and is resistant to many disinfectants and antibiotics
 S. marcescens – most common clinical isolate; produces the red pigment PRODIGIOCIN (Mac Conkey)
at 25°C; causes pneumonia, septicemia, burn and wound infections in immunosuppressed or
chemotherapy patients
S. rubidaea – red pigment
S. odorifera – rancid potato-like odor

F. SALMONELLA, SHIGELLA, PLESIOMONAS

Most Salmonella serotypes* Shigella spp. Plesiomonas shigelloides
*new addition to family
Key Citrate +, Malonate +, Lysine Biochemically inert; no reaction; Most notable biochemical
characteristics decarboxylase +, aerogenic, H2S + negative characteristic: OXIDASE +
Indole +
HEA/XLD/ SSA NLF w/ black center due to H2S NLF, no black center NLF, no black center
production
Motility Motile Nonmotile Motile
TSI K/A with gas, H2S + K/A L/A
LIA K/K, H2S + K/A K/K

* Exceptions (Salmonella serotypes): Citrate neg – Paratyphi, Typhi, Gallinarum, Pullorum

LDC, H2S neg – Paratyphi
No gas – Typhi, Gallinarum Non-motile – Gallinarum, Pullorum

1. Salmonella spp.  resistant to chemicals (bile and dyes)

 2 primary species: S. enterica (human pathogen) and S. bongori (animal pathogen)
 S. enterica is subdivided into six subspecies including subsp. enterica and subsp. arizonae
 S. enterica subsp. enterica is further subdivided into >2500 serotypes based on surface antigens
 Nomenclature: When first written, serotype name must be preceded by the word “serotype” or “ser.”, first
letter CAPITALIZED, NOT italicized
Example: Salmonella enterica subsp. enterica ser. Typhi OR Salmonella Typhi or S. Typhi (the most common
and significant Salmonella serotype)
1
2
CLINICAL BACTERIOLOGY Roderick D. Balce
 Categories of infection caused by common human serotypes:
a. Gastroenteritis/enterocolitis/diarrhea – most commonly caused by S. typhimurium ser. Enteritidis and
Gallinarum
b. Bacteremia/septicemia – occur by spread from the GI tract; usually involve S. cholerasuis
c. Enteric fevers:
Typhoid fever – life-threatening infection characterized by prolonged fever and multisystem
involvement; most frequently caused by S. typhi ; chronic asymptomatic carrier is called Typhoid Mary
Diagnostic work-up: 1st week – blood , 2nd week – urine, stool , 3rd week – serum (Widal
agglutination and ELISA which is more speci and sensi) ; gold standard for diagnosis culture
Paratyphoid fever – caused by S. Paratyphi

1
3
CLINICAL BACTERIOLOGY Roderick D. Balce
2. Shigella spp.
 biochemically inert; closely related to Eschericia on molecular basis
 resist gastric acidity and require very few organisms (10-200 cells) to infect
 4 serogroups based on O antigens: MN, CT ONPG, ODC
a. Group A S. dysenteriae / shiga bacillus – most virulent; causes - - - -
bacillary dysenteris ; produces cytotoxin (Shiga toxin) which destroys
epithelial cells leading to bloody, mucoid diarrhea; best diagnostic tool – culture
of fresh stool with mucus flecks +- +-
b. Group B S. flexneri / Strong’s bacillus – causes mild diarrhea +- +-
c. Group C S. boydii – causes mild diarrhea; biochemically similar to flexneri ++ ++
d. Group D S. sonnei / Owal’s bacillus – most common cause of shigellosis

3. Plesiomonas shigelloides
 formerly a member of family Vibrionaceae ; cross-reacts with Shigella spp.
 associated with gastroenteritis following ingestion of uncooked shellfish
 motile with monotrichous or lopotrichous flagella; LOA +++ ; inositol + and DNase -

G. PROTEUS, PROVIDENCIA, MORGANELLA (TRIBE)

 General biochemical characteristics: phenylalanine/tryptophan deaminase positive, most are rapid urease
producers, and LIA = R/A
1. Proteus spp. (ordinarily harmless saprobes)
 source of antigens for Ricketssial antibodies
 growth pattern on BAP/CAP swarming phenomenon ; characteristic odor of colonies
burnt gun powder or chocolate
 Important species:
P. vulgaris – indole + ; ampicillin, cephalosporin and chloramphenicol resistant ; TSI = red slant,
yellow butt, no gas H2S + so K/A
P. mirabilis – indole - ; ampicillin, cephalosporin and chloramphenicol sensitive/susceptible
P. penneri – indole and H2S negative
2. Providencia spp.
 Citrate + ; ODC - ; cause nosocomial UTI; often resistant to antimicrobial therapy
 Important species:
P. rettgeri – urease positive
P. stuartii – urease variable
P. alkalifaciens – urease negative
3. Morganella morganii
 Citrate - ; ODC + ; causes UTI and respiratory tract infection
 Involved in similar infections with Proteus

I. YERSINIA SPECIES
 TSI = yellow slant, orange butt due to weak acid production in slant with no change in butt
 exhibits bipolar staining on Methylene blue / Wayson stain described as safety pin like
 produce V and W antigens
(primarily pesits)
 capable of growth at temperatures ranging from 4-43°C to inhibit normal flora, but optimal growth is at 25-30
deg. Celsius
 non-motile at 25-30 deg. Celsius ; motile at 25 deg. Celsius except Y. pestis
 Important species:
1. Y. pestis (not intestinal)– Plague bacillus; agent of bioterrorism; transmitted through bites of the rat flea
Xenopsylla cheopis (oriental rat flea) ; growth pattern on broth media stalactite-like ;
colonies on BAP pinpoint @ 24 hrs ; cauliflower like @ 48 hrs
Major forms of plague
1) Bubonic – characterized by high fever and painful inflammatory swelling of axilla and
groin lymph nodes (called buboles ); infection rapidly progresses to fulminant bacteremia
2) Septicemic / Bacteremic _ – characterized by black spots or patches all over the body
3) Pneumonic – characterized by malaise and pulmonary signs; airborne or consequence of
bacteremic spread; rapidly fatal
2. Y. enterocolitica – most commonly isolated species; causes enterocolitis (appendicitis-like
infection); “bull”s eye colonies” on CIN (red colonies surrounded by colorless halo); ODC, urease, and
1
4
CLINICAL BACTERIOLOGY Roderick D. Balce
ONPG + ; ferments mannitol and sucrose; delayed lactose fermenter (because of
ONPG)
3. Y. pseudotuberculosis – causes mesenteric lymphadenitis and septicemia ; ODC
; does not ferment sucrose, urease +, ONPG -

1
5