The Enterics Antigenic Classification

 Gram negative bacteria that are part of The enteric form many groups based on cell
the normal intestinal flora or cause surface structures that bind specific antibodies
gastrointestinal disease
The enteric have 3 major surface antigens:
 The main groups are
Enterobacteriaceae, Vibrionaceae, 1. O antigen - most external component of
Bacteroidaceae and the lipopolysaccharide of gram negative
Pseudomonadaceae bacteria
 These organisms are also divided into 2. K antigen - capsule that covers the O
groups based upon antigen
 Biochemical and antigenic properties 3. H antigen - antigenic determinant that
makes up the subunits of the bacterial
Biochemical Classification
flagella
Some of the important biochemical properties
Family Enterobacteriaceae
of the organisms which can be measured in the
lab are: Normal flora of the colon

1. The ability to Ferment lactose and E. coli acquire virulence by the following:
convert it to gas and acid
2. The production of H2S, ability to  DNA swapping among Enterics by
hydrolyze urea, liquefy gelatin and conjugation with plasmid exchange
decarboxylate specific amino acids  Lysogenic conversion by temperate
bacteriophages
Some growth media do 2 things at once:  Direct transposons mediated DNA
insertion
1. They contain chemicals that inhibit the
growth of gram-positive bacteria that Virulence Factors include the following:
may be containing the sample
2. They have indicators that change the 1. Mucosal Interaction:
color in the presence of lactose
a) Mucosal Adherence with pili
fermentation
b) Ability to invade intestinal epithelial
EMB agar (Eosine Methylene Blue) - Methylene cells
blue inhibits gram positive bacteria and colonies
2. Exotoxin production: Heat labile and stable
of lactose fermenters become deep purple to
toxin (LT and ST) Shiga like toxin
black in this medium. E. Coli colonies take on a
metallic green sheen in the medium 3. Endotoxin: Lipid A portion of
lipopolysaccharide (LPS)
MacConkey Agar: Bile salts in the medium
inhibit gram positive bacteria and lactose 4. Iron Binding siderophore : obtains iron from
fermenters develop a pink-purple coloration human transferrin or lactoferrin
Diarrhea producing E. coli  EIEC produces small amount of Shiga-
like toxins which results to an immune
ENTEROTOXIGENIC E. coli (ETEC)
mediated inflammatory reaction with
 Causes Traveller's Diarrhea fever
 It has Pili that helps it to bind to Escherichia coli Urinary tract infections
intestinal epithelial cells where it
releases exotoxins (Heat Labile Toxins)  Most common cause of urinary tract
 These toxins inhibits the reabsorption infections
of Na and Cl and stimulate the Cl and  Symptoms include dysuria, urinary
HCO3 into the intestinal lumen frequency and feeling of fullness in the
bladder
ENTEROHEMORRHAGIC Escherichia coli (EHEC)
Escherichia coli Meningitis
 Hemorrhagic colitis
 Pili present like the colonization factor  Common cause of neonatal meningitis
of ETEC but differ with the secretion of during the first month of life
Shiga-like toxin (verotoxin)
Escherichia coli sepsis
 Inhibits protein synthesis by inhibiting
the 60s ribosomes which results in  Most common cause of gram negative
intestinal epithelial cell death sepsis occurring in debilitated
 The diarrhea is bloody accompanied hospitalized patients
with severe abdominal cramps  Septic shock is due to lipid A
component of the LPS is usually the
Hemolytic Uremic Syndrome (HUS)
cause of death
 Caused by EHEC ( E. Coli 0157:H7)
Escherichia coli Pneumonia
 Symptoms of anemia,
thrombocytopenia and renal failure  Common cause of hospital acquired
 Numerous outbreak have occurred pneumonia
secondary to infected hamburger meat
served at fast food chains suggesting
that cattle may be a reservoir for EHEC

ENTEROINVASIVE Escherichia coli (EIEC)

 This disease is the same as that caused

by Shigella
 Main virulence factor is encoded in a
plasmid shared by Shigella and
Escherichia coli
 The plasmid gives the bacteria the
ability to actually invade the epithelial
cells
Proteus mirabilis resistance to ampicillin and early
generation cephalosporins
 Most common Proteus species which  Mutant strains maybe induced to
causes disease in humans produce even more B-lactamase making
 Very motile organism them resistant to third generation
 Breaks down urea and often referred as cephalosporins
the urea-splitting Proteus
 There are 3 strains of Proteus that have Serratia
cross-reacting antigens with some
 Notable for its production of bright red
Rickettsia ( OX-19, OX-2 and OX-K)
pigment
 It is another common cause of urinary
 Can cause urinary tract infections,
tract infection and hospital acquired
wound infections or pneumonia
infection
 Examination of urine will reveal an Shigella
alkaline pH which is due to Proteus
ability to split urea into NH3 and CO2  Four species of Shigella (dysenteriae,
flexneri, boydii and sonnei)
Klebsiella pneumoniae  Non motile
 Does not ferment lactose and does not
 Encapsulated (o antigen)
produce H2S
 Non motile
 Humans are the only host of Shigella
 Second most common cause of sepsis
 Fecal to oral route transmissions
 Causes urinary tract infections in
 Shigella is never considered a part of
hospitalized patients and alcoholics
the normal intestinal flora
 Cause of pneumonia characterized by
 It is similar to EIEC that invades
bloody sputum in about 50% of cases
intestinal epithelial cells and release
 Symptoms are violent and destroys lung
Shiga toxin which causes cell
tissue produces cavities
destruction
 Sputum coughed out classically looks
 Colon via colonoscopy has shallow
like red currant jelly which is the color
ulcers where cells are sloughed off
of the O antigen capsule
 Illness begins with fever, abdominal
 Mortality rate is high despite antibiotic
pain and diarrhea
therapy
 Diarrhea may contain flecks of bright
Enterobacter red blood and inflamed colon

 Highly motile gram negative rod

 Part of the normal flora of the gut
 Occasionally responsible for hospital
acquired infections
 Most strains carry a chromosomal B-
lactamase called ampC which leads to
Salmonella

 Non lactose fermenter

 Motile
 Produces H2S  Salmonellosis starts 1-3 weeks after
 Has Vi antigen - polysaccharide capsule exposure and includes fever,
that surrounds the O antigen protecting headache and abdominal pain that
the bacteria from antibody attack on is either diffused or localized to the
the O antigen right lower quadrant often
 Salmonella infections are divided into mimicking appendicitis
two groups typhoidal salmonella and  As inflammation of the involved
non typhoidal salmonella organ occurs, spleen may enlarge
 Salmonella differs from the other and patient may develop diarrhea
enteric because it lives in the and rose spots in the abdomen
gastrointestinal tracts of animals and  Diagnosis by culturing blood, urine and
infects humans when there is stool
contamination of food or water with  Antibiotics of choice: Ciprofloxacin or
animal feces Ceftriaxone
 Salmonella is commonly acquired from
eating chicken and uncooked eggs Carrier State
 Salmonella typhi is not zoonotic (carried
 Salmonella typhi harbored in the
only by humans)
gallbladders and excreting bacteria
 Always pathogenic and cause 4 disease constantly
states in humans
 These people are not actively infected
1. typhoid fever
and do not have symptoms
2. carrier state
 Some carriers require surgical removal
3. sepsis
of their gallbladders to cure
4. gastroenteritis
Sepsis
Typhoid Fever
 Salmonella in the blood stream can
 The illness caused by Salmonella typhi is
infect lungs, brain or bone
also called enteric fever
 Salmonella is encapsulated with the Vi
 After invading the intestinal epithelial
Capsule
cells, it invades the regional lymph
 Our immune system clears
nodes and finally seeding multiple
encapsulated bacteria by opsonizing
organ systems
them with antibodies then phagocytose
 During the invasion, bacteria are
with the macrophages and neutrophils
phagocytose by monocytes and can
in the spleen
survive intracellularly
 Patients with sickle-cell anemia are
 Facultatively intracellular parasite
particularly prone to Salmonella
osteomyelitis
Diarrhea (Gastroenteritis)  Fecally contaminated water is usually
the culprit
 Salmonella diarrhea is the most
 The bacteria multiply in the intestine
common type of Salmonella infection
and causes the same disease as ETEC
 Presentation includes nausea, but more severe
abdominal pain, and diarrhea that’s
 The bacteria attach to the epithelial
either watery or less commonly
cells and release the cholera toxin
contains mucous and trace of blood
which is called choleragen
 Fever occurs in half of the patients
 Disease presents with the about onset
 Treatment usually involves fluid and of watery diarrhea with the loss of up to
electrolyte replacement 1 liter of fluid per hour in severe cases
 Antibiotics do not shorten the course of  Cholera causes death by dehydration
the disease but prolong bacterial
 Physical findings such as diminished
shedding in the stool
pulses, sunken eyeball and poor skin
Yersinia enterocolica turgor can be seen on severe
dehydration
 Motile gram negative rod
 Another common cause of acute Choleragen
gastroenteritis  This toxin has the same mechanism of
 Not really an enteric bacterium but is action as Escherichia coli’s LT toxin
included here because it causes  There is one A subunit attached to five
diarrhea B subunits
 Closely related to Yersinia pestis that  The B subunit binds to the GM1
causes the bubonic plague ganglioside on the intestinal epithelial
 Fecal oral route cell surface allowing entry of the A
 Following ingestion of contaminated subunit
materials there would be fever,  In the cell, A subunit activates G
diarrhea and abdominal pain protein, which in turn stimulates the
 Abdominal pain is most severe in the activity of a membranebound adenylate
right lower quadrant mimicking acute cyclase resulting in cAMP
appendicitis  Intracellular cAMP results in active
 Examination of the terminal ileum will secretion of Na and Cl as well as
reveal mucosal ulceration inhibition of Na and Cl reabsorption
Family Vibrionaceae  Fluid, bicarbonate and potassium are
lost with the osmotic pull of the NaCl as
 Vibrio cholera is a curved gram negative it travels down the intestine
rod that stains red with a single polar  Microscopic exam of the stools should
flagellum not reveal leucocytes but may reveal
 Cholera is a diarrheal disease caused by numerous curved rods with fast darting
Vibrio cholera movements
 Transmitted by the fecal-oral route
  Treatment with fluid and electrolytes  Leading cause of gastric ulcers
and doxycycline will shorten the  Evidences the this organism produces
duration of illness ulcers
 Helicobacter pylori can be cultured
Vibrio parahaemolyticus
from ulcer craters
 Marine bacterium that causes  Feeding human volunteers Helicobacter
gastroenteritis after ingestion of pylori causes ulcer formation
uncooked seafood  Pepto-bismol used for years for gastritis
 Leading cause of diarrhea in Japan has bismuth salts which inhibit the
growth of Helicobacter pylori
Campylobacter jejuni  Antibiotics help treat duodenal and
gastric ulcer disease
 Gram negative rod
 Campylobacter jejuni, ETEC and the Family Bacteroidaceae
Rotavirus are the three most common
causes of diarrhea  99% of the flora of our intestinal tract is
 Zoonic disease made up of obligate anaerobic gram
 Fecal oral route via contaminated water negative rods comprising of family
is often the mode of transmission Bacteroidaceae
 Acquired by drinking unpasteurized milk Bacteroides fragilis
 Children are the most commonly
affected worldwide  Gram negative
 Illness begins with a prodrome of fever  Does not contain Lipid A in the outer
and headache followed by abdominal membrane
cramps and a bloody loose diarrhea  Has capsule
 Invades the lining of the small intestines
Bacteroides melaninogenicus
and spreads systemically as do
Salmonella typhi and Yersinia  Produces black pigment when grown in
enterocolitica blood agar
 Secretes an LT toxin similar to that of E.  Lives in the mouth, vagina and
coli and an unknown cytotoxin that intestines and usually involved in
destroys mucosal cells necrotizing anaerobic pneumonia s
 The exact role of these toxins in the caused by aspiration of sputum from
pathogenesis of Campylobacter mouth
diarrhea is still unknown  Causes periodontal disease
Helicobacter pylori Fusobacterium
 Formerly known as Campylobacter  Causes periodontal disease and
pylori aspiration pneumonia
 Most common cause of duodenal ulcers  Causes abdominal and pelvic abscesses
and chronic gastritis and otitis media
Anaerobic Gram-positive Cocci

 Peptostreptococcus and Peptococcus

are gram positive anaerobes
 Part of the normal flora of the mouth,
vagina and intestines
 Streptococcus viridian gram positive,
microaerophilic and are frequently
isolated from abscesses